Generated Narrative: Questionnaire DeafnessR67AskAtOrderEntry

Profile: Questionnaire

Structure
LinkIDTextCardinalityTypeDescription & Constraintsdoco
.. **For analysis purposes only - not an active or planned project.** **Ask At Order Entry Questions** for the **Deafness Testing Proforma (R67 Non-Syndromic Hearing Loss)**, used alongside the [common core order form](Questionnaire-GenomicTestOrder.html) - see [Order Entry Questions](Questionnaire-GenomicTestOrder.html#order-entry-questions). The test code (R67) is fixed by the choice of form rather than entered - the proforma instead exists to capture the clinical detail (audiogram, syndromic features, risk factors) that supports the R67 eligibility criteria.Questionnairehttps://fhir.nwgenomics.nhs.uk/Questionnaire/DeafnessR67AskAtOrderEntry#2.2.0
... PatientPatient Details0..1groupDefinition: Patient
.... NOS/PatientNameName0..1stringDefinition: Patient.name
..... NOS/PatientName-designNoteSingle free-text Name field on this form, unlike the Surname/Forename split most other paper forms use.0..1display
.... LN/21112-8Date of birth0..1dateDefinition: Patient.birthDate
.... LN/46098-0Gender0..1choiceDefinition: Patient.gender
Value Set: AdministrativeGender
.... LN/56799-0Address0..1stringDefinition: Patient.address.line
.... LN/45401-7Postcode0..1stringDefinition: Patient.address.postalCode
.... LN/76435-7Hospital Number0..1stringDefinition: Patient.identifier:MedicalRecordNumber
.... LN/89061-6NHS no0..1stringDefinition: Patient.identifier:nhsNumber
... HealthcareProfessionalReferring Clinician0..1groupDefinition: PractitionerRole
.... LN/18705-4Referring clinician0..1stringDefinition: PractitionerRole.practitioner.display
.... NOS/DepartmentAddressAddress0..1stringDefinition: PractitionerRole.organization.display
.... LN/89058-2Email0..1stringDefinition: PractitionerRole.telecom.value
... AskAtOrderEntryAsk At Order Entry Questions0..1group
.... NOS/FamilyHistoryPedigreeFamily history/pedigree: other affected individuals, parental consanguinity, ethnicity0..1stringDefinition: ServiceRequest.note
.... AudiogramAudiogram0..1group
..... NOS/AudiogramFindingsAudiogram findings (serial if relevant)0..1stringDefinition: Observation.valueString
..... NOS/AudiogramSeverityRightSeverity - right ear0..1integerDefinition: Observation.valueQuantity
..... NOS/AudiogramSeverityLeftSeverity - left ear0..1integerDefinition: Observation.valueQuantity
..... NOS/AudiogramProgressionProgression0..1stringDefinition: Observation.valueString
.... NOS/SuspectedSyndromicDiagnosisClinically suspected syndromic diagnosis0..*choiceDefinition: ServiceRequest.reasonCode
Options: 6 options
.... NOS/DeafnessRiskFactorsRisk factors0..*choiceDefinition: Observation.valueCodeableConcept
Options: 4 options
.... SNM/113091000-mriMRI performed?0..1booleanDefinition: Observation.valueBoolean
.... NOS/MRIFindingsMRI findings0..1stringDefinition: Observation.valueString
Enable When: SNM/113091000-mri = true

doco Documentation for this format

Options Sets

Answer options for NOS/SuspectedSyndromicDiagnosis

  • https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#DeafnessSyndromePendred
  • https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#DeafnessSyndromeUsher
  • https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#DeafnessSyndromeJervellLangeNielsen
  • https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#DeafnessSyndromeWaardenburg
  • https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#DeafnessSyndromeBranchioOtoRenal
  • https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#DeafnessSyndromeWolfram

Answer options for NOS/DeafnessRiskFactors

  • https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#DeafnessRiskFactorPrematurity
  • https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#DeafnessRiskFactorHyperbilirubinemia
  • https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#DeafnessRiskFactorProlongedNNUStay
  • https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#DeafnessRiskFactorOtotoxicMedication
 <status value="unknown"/> <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="**For analysis purposes only - not an active or planned project.** **Ask At Order Entry Questions** for the **Deafness Testing Proforma (R67 Non-Syndromic Hearing Loss)**, used alongside the [common core order form](Questionnaire-GenomicTestOrder.html) - see [Order Entry Questions](Questionnaire-GenomicTestOrder.html#order-entry-questions). The test code (R67) is fixed by the choice of form rather than entered - the proforma instead exists to capture the clinical detail (audiogram, syndromic features, risk factors) that supports the R67 eligibility criteria."/> <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="Patient"/> <definition value="http://hl7.org/fhir/StructureDefinition/Patient#Patient"/> <text value="Patient Details"/> <type value="group"/> <item> <linkId value="NOS/PatientName"/> <definition value="http://hl7.org/fhir/StructureDefinition/Patient#Patient.name"/> <text value="Name"/> <type value="string"/> <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="NOS/PatientName-designNote"/> <text value="Single free-text Name field on this form, unlike the Surname/Forename split most other paper forms use."/> <type value="display"/> </item> </item> <item> <linkId value="LN/21112-8"/> <definition value="http://hl7.org/fhir/StructureDefinition/Patient#Patient.birthDate"/> <code> <system value="http://loinc.org"/> <code value="21112-8"/> </code> <text value="Date of birth"/> <type value="date"/> </item> <item> <linkId value="LN/46098-0"/> <definition value="http://hl7.org/fhir/StructureDefinition/Patient#Patient.gender"/> <code> <system value="http://loinc.org"/> <code value="46098-0"/> </code> <text value="Gender"/> <type value="choice"/> <answerValueSet value="http://hl7.org/fhir/ValueSet/administrative-gender"/> </item> <item> <linkId value="LN/56799-0"/> <definition value="http://hl7.org/fhir/StructureDefinition/Patient#Patient.address.line"/> <code> <system value="http://loinc.org"/> <code value="56799-0"/> </code> <text value="Address"/> <type value="string"/> </item> <item> <linkId value="LN/45401-7"/> <definition value="http://hl7.org/fhir/StructureDefinition/Patient#Patient.address.postalCode"/> <code> <system value="http://loinc.org"/> <code value="45401-7"/> </code> <text value="Postcode"/> <type value="string"/> </item> <item> <linkId value="LN/76435-7"/> <definition value="http://hl7.org/fhir/StructureDefinition/Patient#Patient.identifier:MedicalRecordNumber"/> <code> <system value="http://loinc.org"/> <code value="76435-7"/> </code> <text value="Hospital Number"/> <type value="string"/> </item> <item> <linkId value="LN/89061-6"/> <definition value="http://hl7.org/fhir/StructureDefinition/Patient#Patient.identifier:nhsNumber"/> <code> <system value="http://loinc.org"/> <code value="89061-6"/> </code> <text value="NHS no"/> <type value="string"/> </item> </item> <item> <linkId value="HealthcareProfessional"/> <definition value="http://hl7.org/fhir/StructureDefinition/PractitionerRole#PractitionerRole"/> <text value="Referring Clinician"/> <type value="group"/> <item> <linkId value="LN/18705-4"/> <definition value="http://hl7.org/fhir/StructureDefinition/PractitionerRole#PractitionerRole.practitioner.display"/> <code> <system value="http://loinc.org"/> <code value="18705-4"/> </code> <text value="Referring clinician"/> <type value="string"/> </item> <item> <linkId value="NOS/DepartmentAddress"/> <definition value="http://hl7.org/fhir/StructureDefinition/PractitionerRole#PractitionerRole.organization.display"/> <text value="Address"/> <type value="string"/> </item> <item> <linkId value="LN/89058-2"/> <definition value="http://hl7.org/fhir/StructureDefinition/PractitionerRole#PractitionerRole.telecom.value"/> <code> <system value="http://loinc.org"/> <code value="89058-2"/> <display value="Contact email address"/> </code> <text value="Email"/> <type value="string"/> </item> </item> <item> <linkId value="AskAtOrderEntry"/> <text value="Ask At Order Entry Questions"/> <type value="group"/> <item> <linkId value="NOS/FamilyHistoryPedigree"/> <definition value="http://hl7.org/fhir/StructureDefinition/ServiceRequest#ServiceRequest.note"/> <text value="Family history/pedigree: other affected individuals, parental consanguinity, ethnicity"/> <type value="string"/> </item> <item> <linkId value="Audiogram"/> <text value="Audiogram"/> <type value="group"/> <item> <linkId value="NOS/AudiogramFindings"/> <definition value="http://hl7.org/fhir/StructureDefinition/Observation#Observation.valueString"/> <text value="Audiogram findings (serial if relevant)"/> <type value="string"/> </item> <item> <linkId value="NOS/AudiogramSeverityRight"/> <definition value="http://hl7.org/fhir/StructureDefinition/Observation#Observation.valueQuantity"/> <code> <system value="https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA"/> <code value="AudiogramSeverityRight"/> </code> <text value="Severity - right ear"/> <type value="integer"/> </item> <item> <linkId value="NOS/AudiogramSeverityLeft"/> <definition value="http://hl7.org/fhir/StructureDefinition/Observation#Observation.valueQuantity"/> <code> <system value="https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA"/> <code value="AudiogramSeverityLeft"/> </code> <text value="Severity - left ear"/> <type value="integer"/> </item> <item> <linkId value="NOS/AudiogramProgression"/> <definition value="http://hl7.org/fhir/StructureDefinition/Observation#Observation.valueString"/> <code> <system value="https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA"/> <code value="AudiogramProgression"/> </code> <text value="Progression"/> <type value="string"/> </item> </item> <item> <linkId value="NOS/SuspectedSyndromicDiagnosis"/> <definition value="http://hl7.org/fhir/StructureDefinition/ServiceRequest#ServiceRequest.reasonCode"/> <text value="Clinically suspected syndromic diagnosis"/> <type value="choice"/> <repeats value="true"/> <answerOption> <valueCoding> <system value="https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA"/> <code value="DeafnessSyndromePendred"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA"/> <code value="DeafnessSyndromeUsher"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA"/> <code value="DeafnessSyndromeJervellLangeNielsen"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA"/> <code value="DeafnessSyndromeWaardenburg"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA"/> <code value="DeafnessSyndromeBranchioOtoRenal"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA"/> <code value="DeafnessSyndromeWolfram"/> </valueCoding> </answerOption> </item> <item> <linkId value="NOS/DeafnessRiskFactors"/> <definition value="http://hl7.org/fhir/StructureDefinition/Observation#Observation.valueCodeableConcept"/> <text value="Risk factors"/> <type value="choice"/> <repeats value="true"/> <answerOption> <valueCoding> <system value="https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA"/> <code value="DeafnessRiskFactorPrematurity"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA"/> <code value="DeafnessRiskFactorHyperbilirubinemia"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA"/> <code value="DeafnessRiskFactorProlongedNNUStay"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA"/> <code value="DeafnessRiskFactorOtotoxicMedication"/> </valueCoding> </answerOption> </item> <item> <linkId value="SNM/113091000-mri"/> <definition value="http://hl7.org/fhir/StructureDefinition/Observation#Observation.valueBoolean"/> <code> <system value="http://snomed.info/sct"/> <code value="113091000"/> <display value="Magnetic resonance imaging (procedure)"/> </code> <text value="MRI performed?"/> <type value="boolean"/> </item> <item> <linkId value="NOS/MRIFindings"/> <definition value="http://hl7.org/fhir/StructureDefinition/Observation#Observation.valueString"/> <text value="MRI findings"/> <type value="string"/> <enableWhen> <question value="SNM/113091000-mri"/> <operator value="="/> <answerBoolean value="true"/> </enableWhen> </item> </item> </Questionnaire>