<derivedFrom value="https://fhir.nwgenomics.nhs.uk/Questionnaire/GenomicTestOrder"> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-derivationType"> <valueCoding> <system value="http://hl7.org/fhir/questionnaire-derivationType"/> <code value="extends"/> </valueCoding> </extension> </derivedFrom> <status value="draft"/> <date value="2026-09-20T05:53:36+00:00"/> <publisher value="NHS North West Genomics"/> <contact> <telecom> <system value="url"/> <value value="https://www.nwgenomics.nhs.uk/contact-us"/> </telecom> </contact> <description value="**Test Specific Additional Ask At Order Entry Questions** used alongside the [common core order form](Questionnaire-GenomicTestOrder.html) for the "Chimerism Testing Blood (PB)" order screen within Histocompatibility and Immunogenetics orders (SNOMED CT `909871000000100`) - the same "Test Specific" tier pattern [WGS Test Additional Ask At Order Entry Questions](Questionnaire-WGSTestAdditionalAskAtOrderQuestions.html) follows for WGS orders - see [Order Entry Questions](Questionnaire-GenomicTestOrder.html#order-entry-questions) and [Histocompatibility and Immunogenetics](HistocompatibilityAndImmunogenetics.html#ask-at-order-entry-questions). For the sibling HLA testing order screen, see [HLA Tests - Transplant Ask At Order Entry](Questionnaire-HLATestsTransplantAskAtOrderEntry.html). Extracted from the `NTE` segments of a live Histotrac `ORM^O01` order for a Chimerism Testing (Performable) test - see the worked [example](HistocompatibilityAndImmunogenetics.html#chimerism-testing-ask-at-order-entry) for the full message. Unlike HLA Tests - Transplant, this order carries only two `NTE` segments, and in the reverse order (Specimen Source before Patient Test(s)). See also [Chimerism Testing Result Panel](Questionnaire-ChimerismResultPanel.html) for the (separate) structured *result* payload this order eventually produces. **Research summary**: as with [HLA Tests - Transplant](Questionnaire-HLATestsTransplantAskAtOrderEntry.html), no NHS England or NHSBT-published order-comms/interoperability standard was found specifically for Chimerism testing order entry. NHSBT's INF136 "User Guide for Histocompatibility and Immunogenetics Diagnostics Services" defines `FRM1010` "H&I Haematopoietic Stem Cell Transplantation (Recipients & Donors)" as the relevant national request form for post-transplant chimerism monitoring, but does not publish a FHIR/LOINC/SNOMED binding for the specific test-panel or specimen-source values Hive uses. See each item below for candidate LOINC/SNOMED codes."/> <jurisdiction> <coding> <system value="urn:iso:std:iso:3166"/> <code value="GB"/> <display value="United Kingdom of Great Britain and Northern Ireland"/> </coding> </jurisdiction> <item> <linkId value="AskAtOrderEntry"/> <text value="Ask At Order Entry Questions"/> <type value="group"/> <item> <linkId value="ChimIG/specimen_source"/> <definition value="http://hl7.org/fhir/StructureDefinition/Specimen#Specimen.type.coding.code"/> <code> <system value="http://loinc.org"/> <code value="66746-9"/> <display value="Specimen Type"/> </code> <code> <system value="http://snomed.info/sct"/> <code value="123038009"/> <display value="Specimen"/> </code> <text value="Specimen Source"/> <type value="choice"/> <answerOption> <valueCoding> <system value="https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA"/> <code value="ChimerismBloodPB"/> <display value="Blood (PB)"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA"/> <code value="ChimerismBoneMarrowBM"/> <display value="Bone Marrow (BM)"/> </valueCoding> </answerOption> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="help"/> </coding> </valueCodeableConcept> </extension> <linkId value="ChimIG/specimen_source-designNote"/> <text value="Confirmed as this 2-value list (Blood (PB), Bone Marrow (BM)) from the Hive/Histotrac order-entry UI's Chimerism panel - a different list from the Blood/Buccal/Other list [HLA Tests - Transplant](Questionnaire-HLATestsTransplantAskAtOrderEntry.html) uses for the same underlying `code` (LOINC `66746-9`), since the two order screens offer different specimen-source options in Hive. Coded locally against the `NWGMSA` CodeSystem rather than the EU/UK/NW-compatible [Specimen Type](ValueSet-specimen-type.html) value set, to match what Hive actually offers for this exchange. Deliberately given its own `ChimIG/specimen_source` linkId rather than reusing the base [Genomic Test Order](Questionnaire-GenomicTestOrder.html)'s own `LN/66746-9` Specimen Type item - the IG Publisher's Questionnaire derivation validator does not support a `derivedFrom`/`extends` item reusing a base item's linkId while also declaring more than one `answerOption`. Ordered first (before Patient Test(s)) to match `NTE|1` in the live Histotrac order - the reverse of HLA Tests - Transplant, where Patient Test(s) comes first."/> <type value="display"/> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="help"/> </coding> </valueCodeableConcept> </extension> <linkId value="ChimIG/specimen_source-reference"/> <text value="Post-transplant chimerism monitoring conventionally uses peripheral blood, with bone marrow used for deeper/marrow-level engraftment assessment - consistent with this 2-value list. If a coded alternative to the local `NWGMSA` codes is wanted, the [Specimen Type](ValueSet-specimen-type.html) value set remains a candidate binding (e.g. whole blood specimen for Blood (PB); bone marrow specimen for Bone Marrow (BM)). No dedicated NHS-published specimen-type binding specific to H&I chimerism testing was found."/> <type value="display"/> </item> </item> <item> <linkId value="ChimIG/patient_test"/> <definition value="http://hl7.org/fhir/StructureDefinition/ServiceRequest#ServiceRequest.orderDetail"/> <text value="Patient Test(s)"/> <type value="choice"/> <repeats value="true"/> <answerOption> <valueCoding> <system value="https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA"/> <code value="ChimerismPeripheralBlood"/> <display value="Chimerism Peripheral Blood"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA"/> <code value="ChimerismCD3"/> <display value="Chimerism CD3"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA"/> <code value="ChimerismCD15"/> <display value="Chimerism CD15"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA"/> <code value="ChimerismCD19"/> <display value="Chimerism CD19"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA"/> <code value="ChimerismLineageOther"/> <display value="Chimerism Lineage Other"/> </valueCoding> </answerOption> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="help"/> </coding> </valueCodeableConcept> </extension> <linkId value="ChimIG/patient_test-designNote"/> <text value="Which chimerism panel/lineage is being tested - the same Ask At Order Entry pattern as `HistoIG/patient_test` on [HLA Tests - Transplant](Questionnaire-HLATestsTransplantAskAtOrderEntry.html) (`repeats = true`, since the Hive UI presents them as checkboxes - more than one may be selected per order). Confirmed as this fixed 5-value checklist from the Hive/Histotrac order-entry UI - coded locally against the `NWGMSA` CodeSystem, as no NHSBT/NHS England-published FHIR/LOINC/SNOMED binding exists. Ordered second (after Specimen Source) to match `NTE|2` in the live Histotrac order, whose NTE-3 value carries a `(PB)` suffix ("Chimerism Peripheral Blood (PB)") the Hive checkbox label itself doesn't show - the same OBR-4-restatement behaviour as HLA Tests - Transplant's Patient Test(s) item. Mapped to `ServiceRequest.orderDetail` rather than `ServiceRequest.code` - the same reasoning as that item: `ServiceRequest.code` is single-cardinality and already targeted by the base [Genomic Test Order](Questionnaire-GenomicTestOrder.html)'s own Test Code item, with no `enableWhen` to say which wins, while `orderDetail` is repeating and intended for exactly this kind of further order qualifier."/> <type value="display"/> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="help"/> </coding> </valueCodeableConcept> </extension> <linkId value="ChimIG/patient_test-reference"/> <text value="No MFT/NHS England code set was found for these five specific test names. LOINC has short tandem repeat (STR)/chimerism-adjacent panels (e.g. `48018-6` Gene studied, engraftment-monitoring local codes used elsewhere in genetics laboratories) but no exact match for a CD3/CD15/CD19 lineage-specific chimerism checklist was confirmed - a candidate future binding if a coded alternative to the local `NWGMSA` codes is wanted. See also this IG's existing [Chimerism](CodeSystem-Chimerism.html) CodeSystem, which covers the *result* payload's OBX-3 sub-identifiers (STR/IM/RANGE/CV/EXT/PURE/POST/DTP/DID) rather than these order-entry test-selection values."/> <type value="display"/> </item> </item> </item> </Questionnaire>

Generated Narrative: Questionnaire ChimerismTestAdditionalAskAtOrderQuestions

Structure

Options Sets

Answer options for ChimIG/specimen_source

Answer options for ChimIG/patient_test