NHS North West Genomics
2.2.5 - ci-build
NHS North West Genomics
2.2.5 - ci-build
NHS North West Genomics - Local Development build (v2.2.5) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
| Draft as of 2026-11-05 |
<Questionnaire xmlns="http://hl7.org/fhir">
<id value="HLATestsTransplantAskAtOrderEntry"/>
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<profile
value="https://fhir.nwgenomics.nhs.uk/StructureDefinition/NWQuestionnaire"/>
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<language value="en"/>
<text>
<status value="extensions"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: Questionnaire HLATestsTransplantAskAtOrderEntry</b></p><a name="HLATestsTransplantAskAtOrderEntry"> </a><a name="hcHLATestsTransplantAskAtOrderEntry"> </a><div style="display: inline-block; background-color: #fbffeb; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-NWQuestionnaire.html">Questionnaire</a></p></div><b>Structure</b><table border="1" cellpadding="0" cellspacing="0" class="xhtTableBorder1"><tr class="xhtRowBorder2"><th scope="col" style="" class="hierarchy xhtCellBorder1"><a href="https://hl7.org/fhir/R4/formats.html#table" title="The linkID for the item">LinkID</a></th><th scope="col" style="" class="hierarchy xhtCellBorder1"><a href="https://hl7.org/fhir/R4/formats.html#table" title="Text for the item">Text</a></th><th scope="col" style="" class="hierarchy xhtCellBorder1"><a href="https://hl7.org/fhir/R4/formats.html#table" title="Minimum and Maximum # of times the item can appear in the instance">Cardinality</a></th><th scope="col" style="" class="hierarchy xhtCellBorder1"><a href="https://hl7.org/fhir/R4/formats.html#table" title="The type of the item">Type</a></th><th scope="col" style="" class="hierarchy xhtCellBorder1"><a href="https://hl7.org/fhir/R4/formats.html#table" title="Additional information about the item">Description & Constraints</a><span style="float: right"><a href="https://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="data:image/png;base64,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" alt="doco" style="background-color: inherit"/></a></span></th></tr><tr class="xhtRowBorder1 xhtRowEven"><td style="background-image: url(tbl_bck1.png)" class="hierarchy xhtCellBorder1 xhtCellNoWrap"><img src="tbl_spacer.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="icon_q_root.gif" alt="" style="background-color: white; background-color: inherit" title="QuestionnaireRoot" class="hierarchy"/> </td><td style="" class="hierarchy xhtCellBorder1">**Ask At Order Entry Questions** used alongside the [common core order
form](StructureDefinition-GenomicTestOrder.html) for the "HLA Tests - Transplant" order
screen within Histocompatibility and Immunogenetics orders (SNOMED CT
`909871000000100`) - see
[Order Entry Questions](StructureDefinition-GenomicTestOrder.html#order-entry-questions) and
[Histocompatibility and Immunogenetics](https://github.com/nw-gmsa/nw-gmsa-use-cases/blob/main/HistocompatibilityAndImmunogenetics.md#ask-at-order-entry-questions).
For the sibling Chimerism testing order screen, see
[Chimerism Test Additional Ask At Order Entry Questions](Questionnaire-ChimerismTestAdditionalAskAtOrderQuestions.html).
Extracted from the `NTE` segments (each carrying HL7 v2 Table 0105-style comment type
`OSQ`) of a live Histotrac `ORM^O01` order - see the worked
[example](https://github.com/nw-gmsa/nw-gmsa-use-cases/blob/main/HistocompatibilityAndImmunogenetics.md#ask-at-order-entry-questions) for the
full message. Each `NTE-3` value uses a local `Label:->Value` convention (e.g.
`HLA Type:->Patient`), split below into a question/answer pair.
**Research summary (no NHS England-published order-comms/interoperability standard was
found for these fields)**: NHS England's published pathology standards
([Pathology Test and Results Standard](https://standards.nhs.uk/published-standards/pathology-test-and-results-standard),
[SNOMED CT for pathology reporting](https://digital.nhs.uk/services/pathology-standards-and-implementation/snomed-ct-for-pathology-reporting))
do not cover Histocompatibility and Immunogenetics (H&I) order entry specifically. The
relevant national body is **NHS Blood and Transplant (NHSBT)**, not NHS England: its
[INF136 "User Guide for Histocompatibility and Immunogenetics Diagnostics
Services"](https://nhsbtdbe.blob.core.windows.net/umbraco-assets-corp/29939/inf136.pdf)
defines six national H&I request forms (Table 2) including `FRM1008` "H&I Organ
Transplant (Patients and Donors)" and `FRM1010` "H&I Haematopoietic Stem Cell
Transplantation (Recipients & Donors)", plus a sample-requirements table listing
"HLA type of **patient, donors or family members**" for Solid Organ Transplantation -
confirming HLA Type is a fixed national list, not free text, even though NHSBT does not
publish a FHIR/LOINC/SNOMED binding for it. NHSBT's Solid Organ Transplantation section
(4.5.1) also describes 24-hour on-call cover for "**renal** and, where appropriate,
**cardiothoracic** transplantation", with liver/other transplant types noted separately
as not having HLA match as a primary factor - consistent with Patient Type being a
small, fixed list. The professional bodies **BSHI** (British Society for
Histocompatibility and Immunogenetics) and **BTS** (British Transplantation Society)
jointly publish clinical guidelines (e.g. the
[2015 BTS/BSHI antibody characterisation guideline](https://bts.org.uk/wp-content/uploads/2016/09/06_BTS_BSHI_Antibodies-1.pdf))
but not data/interoperability standards. This IG's own dependency,
[HL7's Genomics Reporting IG - Histocompatibility and Immunogenetic
Reporting](http://hl7.org/fhir/uv/genomics-reporting/histocompatibility.html), profiles
structured HLA genotype/haplotype *results* (LOINC `84413-4` Genotype display name,
`48018-6` Gene studied, `13298-5` HLA-A [Type], the GL String and HGNC systems) but does
not address order-entry "ask at order" questions like these. See each item below for
LOINC panels and UK code lists relevant to that specific question.</td><td style="" class="hierarchy xhtCellBorder1"/><td style="" class="hierarchy xhtCellBorder1">Questionnaire</td><td style="" class="hierarchy xhtCellBorder1">https://fhir.nwgenomics.nhs.uk/Questionnaire/HLATestsTransplantAskAtOrderEntry#2.2.5</td></tr>
<tr class="xhtRowBorder1 xhtRowOdd"><td style="background-image: url(tbl_bck01.png)" id="item.AskAtOrderEntry" class="hierarchy xhtCellBorder1 xhtCellNoWrap"><img src="tbl_spacer.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="" style="background-color: #F7F7F7; background-color: inherit" title="group" class="hierarchy"/> AskAtOrderEntry</td><td style="" class="hierarchy xhtCellBorder1">Ask At Order Entry Questions</td><td style="" class="hierarchy xhtCellBorder1">0..1</td><td style="" class="hierarchy xhtCellBorder1"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group">group</a></td><td style="" class="hierarchy xhtCellBorder1"/></tr>
<tr class="xhtRowBorder1 xhtRowEven"><td style="background-image: url(tbl_bck011.png)" id="item.HistoIG/patient_test" class="hierarchy xhtCellBorder1 xhtCellNoWrap"><img src="tbl_spacer.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="" style="background-color: white; background-color: inherit" title="coding" class="hierarchy"/> <span style="position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0" class="sr-only">AskAtOrderEntry / </span>HistoIG/patient_test</td><td style="" class="hierarchy xhtCellBorder1">Patient Test(s)</td><td style="" class="hierarchy xhtCellBorder1">0..*</td><td style="" class="hierarchy xhtCellBorder1"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="" class="hierarchy xhtCellBorder1">Definition: <a href="http://hl7.org/fhir/R4/servicerequest.html#ServiceRequest.orderDetail">ServiceRequest.orderDetail</a><br/>Options: <a href="#opt-item.HistoIG/patient_test">5 options</a></td></tr>
<tr class="xhtRowBorder1 xhtRowOdd"><td style="background-image: url(tbl_bck0110.png)" id="item.HistoIG/patient_test-designNote" class="hierarchy xhtCellBorder1 xhtCellNoWrap"><img src="tbl_spacer.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="icon-q-display.png" alt="" style="background-color: #F7F7F7; background-color: inherit" title="display" class="hierarchy"/> <span style="position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0" class="sr-only">AskAtOrderEntry / HistoIG/patient_test / </span>HistoIG/patient_test-designNote</td><td style="" class="hierarchy xhtCellBorder1">Histotrac NTE-3 (CommentType=OSQ): restates the OBR-4 test name. Mapped to
`ServiceRequest.orderDetail` rather than `ServiceRequest.code` - the base
[Genomic Test Order](StructureDefinition-GenomicTestOrder.html)'s own Test Code item
already targets `ServiceRequest.code` (single-cardinality), so reusing it here
would conflict with no `enableWhen` to say which item wins.
`ServiceRequest.orderDetail` is repeating and intended for exactly this kind of
further order qualifier, and matches this item's own `repeats = true` (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,
shown identically regardless of Patient Type (Stem cell or Renal) - coded against
the [Histotrac](CodeSystem-Histotrac.html) CodeSystem (the order-detail
restatement codes Histotrac itself uses alongside its Test Code, bound via
[HistotracOrderDetail](ValueSet-HistotracOrderDetail.html)) - rather than the
local `NWGMSA` codes the Hive order-entry UI's own checkboxes use for the
order-entry *selection* itself. [Chimerism Test Additional Ask At Order Entry
Questions](Questionnaire-ChimerismTestAdditionalAskAtOrderQuestions.html) used to
follow the same `patient_test` pattern, since dropped - see
[Outstanding Issues](https://github.com/nw-gmsa/nw-gmsa-use-cases/blob/main/HistocompatibilityAndImmunogenetics.md#outstanding-issues)
item 7.</td><td style="" class="hierarchy xhtCellBorder1">0..1</td><td style="" class="hierarchy xhtCellBorder1"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-display">display</a></td><td style="" class="hierarchy xhtCellBorder1"/></tr>
<tr class="xhtRowBorder1 xhtRowEven"><td style="background-image: url(tbl_bck0100.png)" id="item.HistoIG/patient_test-reference" class="hierarchy xhtCellBorder1 xhtCellNoWrap"><img src="tbl_spacer.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="icon-q-display.png" alt="" style="background-color: white; background-color: inherit" title="display" class="hierarchy"/> <span style="position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0" class="sr-only">AskAtOrderEntry / HistoIG/patient_test / </span>HistoIG/patient_test-reference</td><td style="" class="hierarchy xhtCellBorder1">No MFT/NHS England code set was found for these five specific test names, but
LOINC has panels the Histotrac test catalogue could map onto if a coded
alternative to the `Histotrac` codes is wanted: 102092-4 (HLA-ABDR typing
panel), 96615-0/96629-1 (HLA-A/B/C class I typing, high/low resolution), 94492-6
(HLA-DQA1/DQB1 typing), 72905-3 (Neutrophil Ab and HLA Ab screen panel), 94428-0
(HLA class I and II IgG panel), and 80737-0 (Calculated panel reactive antibody).
Not the NHS England Genomic Test Directory (England-GenomicTestDirectory) - H&I is
not part of that catalogue.</td><td style="" class="hierarchy xhtCellBorder1">0..1</td><td style="" class="hierarchy xhtCellBorder1"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-display">display</a></td><td style="" class="hierarchy xhtCellBorder1"/></tr>
<tr class="xhtRowBorder1 xhtRowOdd"><td style="background-image: url(tbl_bck011.png)" id="item.HistoIG/hla_type" class="hierarchy xhtCellBorder1 xhtCellNoWrap"><img src="tbl_spacer.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="" style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> <span style="position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0" class="sr-only">AskAtOrderEntry / </span>HistoIG/hla_type</td><td style="" class="hierarchy xhtCellBorder1">HLA Type</td><td style="" class="hierarchy xhtCellBorder1">1..1</td><td style="" class="hierarchy xhtCellBorder1"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="" class="hierarchy xhtCellBorder1">Definition: <a href="http://hl7.org/fhir/R4/observation.html#Observation.valueCodeableConcept">Observation.valueCodeableConcept</a><br/>Options: <a href="#opt-item.HistoIG/hla_type">2 options</a></td></tr>
<tr class="xhtRowBorder1 xhtRowEven"><td style="background-image: url(tbl_bck0110.png)" id="item.HistoIG/hla_type-designNote" class="hierarchy xhtCellBorder1 xhtCellNoWrap"><img src="tbl_spacer.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="icon-q-display.png" alt="" style="background-color: white; background-color: inherit" title="display" class="hierarchy"/> <span style="position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0" class="sr-only">AskAtOrderEntry / HistoIG/hla_type / </span>HistoIG/hla_type-designNote</td><td style="" class="hierarchy xhtCellBorder1">Whose HLA is being typed - carried as an Observation referenced from
ServiceRequest.supportingInfo, the same Ask at Order Entry pattern used by
dWGS's Family Structure/Participant Type. Confirmed as a 2-value list (Patient,
Donor) from the Hive/Histotrac order-entry UI screenshots - coded locally
against the `NWGMSA` CodeSystem as no NHSBT/NHS England-published
FHIR/LOINC/SNOMED binding exists.</td><td style="" class="hierarchy xhtCellBorder1">0..1</td><td style="" class="hierarchy xhtCellBorder1"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-display">display</a></td><td style="" class="hierarchy xhtCellBorder1"/></tr>
<tr class="xhtRowBorder1 xhtRowOdd"><td style="background-image: url(tbl_bck0100.png)" id="item.HistoIG/hla_type-reference" class="hierarchy xhtCellBorder1 xhtCellNoWrap"><img src="tbl_spacer.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="icon-q-display.png" alt="" style="background-color: #F7F7F7; background-color: inherit" title="display" class="hierarchy"/> <span style="position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0" class="sr-only">AskAtOrderEntry / HistoIG/hla_type / </span>HistoIG/hla_type-reference</td><td style="" class="hierarchy xhtCellBorder1">NHSBT's INF136 (Table 2) names a national request form "H&I Organ Transplant
(Patients and Donors)" (FRM1008), and its sample-requirements table lists "HLA
type of patient, donors or family members" for Solid Organ Transplantation -
wider than the Patient/Donor pair the Hive UI actually offers. A separate
national form, "H&I Haematopoietic Stem Cell Transplantation (Recipients &
Donors)" (FRM1010), uses Recipient/Donor instead of Patient/Donor for that
transplant type. No NHSBT-published FHIR/LOINC/SNOMED binding exists for either,
and Hive does not appear to expose a Family Member/Recipient option here.</td><td style="" class="hierarchy xhtCellBorder1">0..1</td><td style="" class="hierarchy xhtCellBorder1"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-display">display</a></td><td style="" class="hierarchy xhtCellBorder1"/></tr>
<tr class="xhtRowBorder1 xhtRowEven"><td style="background-image: url(tbl_bck011.png)" id="item.HistoIG/patient_type" class="hierarchy xhtCellBorder1 xhtCellNoWrap"><img src="tbl_spacer.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="" style="background-color: white; background-color: inherit" title="coding" class="hierarchy"/> <span style="position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0" class="sr-only">AskAtOrderEntry / </span>HistoIG/patient_type</td><td style="" class="hierarchy xhtCellBorder1">Patient Type</td><td style="" class="hierarchy xhtCellBorder1">0..1</td><td style="" class="hierarchy xhtCellBorder1"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="" class="hierarchy xhtCellBorder1">Definition: <a href="http://hl7.org/fhir/R4/observation.html#Observation.valueCodeableConcept">Observation.valueCodeableConcept</a><br/>Options: <a href="#opt-item.HistoIG/patient_type">3 options</a></td></tr>
<tr class="xhtRowBorder1 xhtRowOdd"><td style="background-image: url(tbl_bck0110.png)" id="item.HistoIG/patient_type-designNote" class="hierarchy xhtCellBorder1 xhtCellNoWrap"><img src="tbl_spacer.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="icon-q-display.png" alt="" style="background-color: #F7F7F7; background-color: inherit" title="display" class="hierarchy"/> <span style="position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0" class="sr-only">AskAtOrderEntry / HistoIG/patient_type / </span>HistoIG/patient_type-designNote</td><td style="" class="hierarchy xhtCellBorder1">Transplant context - carried as an Observation referenced from
ServiceRequest.supportingInfo. Confirmed as a 3-value list (Stem cell, Renal,
Thoracic) from the Hive/Histotrac order-entry UI - coded locally against the
`NWGMSA` CodeSystem. When Patient Type is "Renal" the Hive UI also shows an
Organ picker (see `HistoIG/organ` below); no Organ field is shown for Stem
cell/Thoracic.</td><td style="" class="hierarchy xhtCellBorder1">0..1</td><td style="" class="hierarchy xhtCellBorder1"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-display">display</a></td><td style="" class="hierarchy xhtCellBorder1"/></tr>
<tr class="xhtRowBorder1 xhtRowEven"><td style="background-image: url(tbl_bck0100.png)" id="item.HistoIG/patient_type-reference" class="hierarchy xhtCellBorder1 xhtCellNoWrap"><img src="tbl_spacer.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="icon-q-display.png" alt="" style="background-color: white; background-color: inherit" title="display" class="hierarchy"/> <span style="position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0" class="sr-only">AskAtOrderEntry / HistoIG/patient_type / </span>HistoIG/patient_type-reference</td><td style="" class="hierarchy xhtCellBorder1">NHSBT's INF136 (4.5.1) describes 24-hour on-call cover for "renal and, where
appropriate, cardiothoracic transplantation" as the two Solid Organ
Transplantation categories with routine H&I on-call support, and the Hive UI's
"Thoracic" option lines up with that "cardiothoracic" wording (not "Cardiac").
Stem cell is a third category the Hive UI groups here rather than treating as a
separate transplant type. No NHSBT/NHS England LOINC/SNOMED binding was found
for this field.</td><td style="" class="hierarchy xhtCellBorder1">0..1</td><td style="" class="hierarchy xhtCellBorder1"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-display">display</a></td><td style="" class="hierarchy xhtCellBorder1"/></tr>
<tr class="xhtRowBorder1 xhtRowOdd"><td style="background-image: url(tbl_bck011.png)" id="item.HistoIG/organ" class="hierarchy xhtCellBorder1 xhtCellNoWrap"><img src="tbl_spacer.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="" style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> <span style="position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0" class="sr-only">AskAtOrderEntry / </span>HistoIG/organ</td><td style="" class="hierarchy xhtCellBorder1">Organ</td><td style="" class="hierarchy xhtCellBorder1">0..1</td><td style="" class="hierarchy xhtCellBorder1"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="" class="hierarchy xhtCellBorder1">Definition: <a href="http://hl7.org/fhir/R4/specimen.html#Specimen.collection.bodySite">Specimen.collection.bodySite</a><br/>Options: <a href="#opt-item.HistoIG/organ">5 options</a></td></tr>
<tr class="xhtRowBorder1 xhtRowEven"><td style="background-image: url(tbl_bck0110.png)" id="item.HistoIG/organ-designNote" class="hierarchy xhtCellBorder1 xhtCellNoWrap"><img src="tbl_spacer.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="icon-q-display.png" alt="" style="background-color: white; background-color: inherit" title="display" class="hierarchy"/> <span style="position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0" class="sr-only">AskAtOrderEntry / HistoIG/organ / </span>HistoIG/organ-designNote</td><td style="" class="hierarchy xhtCellBorder1">The organ relevant to the transplant - the body site the specimen was collected
from. Confirmed as this 5-value list (plus a free-text
"Other" box, not modelled here) from the Hive/Histotrac order-entry UI, only shown
there when Patient Type is "Renal". The three single-organ values (Kidney,
Pancreas, Islets) are now coded against SNOMED CT from the FHIR [body-site value
set](https://hl7.org/fhir/R4/valueset-body-site.html) - `64033007` "Kidney
structure", `15776009` "Pancreatic structure", and `78696007` "Endocrine
pancreatic structure" for Islets (the closest single body-structure concept to
"Islets of Langerhans" available - islet tissue is the endocrine pancreas, there
is no separate discrete "Islet of Langerhans structure" concept). The two
"Simultaneous..." combination transplants remain coded against `NWGMSA`, since
neither is itself a single SNOMED CT body-site concept.</td><td style="" class="hierarchy xhtCellBorder1">0..1</td><td style="" class="hierarchy xhtCellBorder1"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-display">display</a></td><td style="" class="hierarchy xhtCellBorder1"/></tr>
<tr class="xhtRowBorder1 xhtRowOdd"><td style="background-image: url(tbl_bck0100.png)" id="item.HistoIG/organ-reference" class="hierarchy xhtCellBorder1 xhtCellNoWrap"><img src="tbl_spacer.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="icon-q-display.png" alt="" style="background-color: #F7F7F7; background-color: inherit" title="display" class="hierarchy"/> <span style="position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0" class="sr-only">AskAtOrderEntry / HistoIG/organ / </span>HistoIG/organ-reference</td><td style="" class="hierarchy xhtCellBorder1">NHS Digital's UK-specific "Solid organ transplant codes" (ORGTRANSP_COD)
reference set (part of the NHS Digital Primary Care Domain Refsets, ~364 codes,
https://www.opencodelists.org/codelist/nhsd-primary-care-domain-refsets/orgtransp_cod/)
remains a candidate alternative binding, not adopted here since it is a UK
reference set rather than the FHIR body-site value set the SNOMED CT codes above
are drawn from. Neither source has a single code for a combination transplant
such as "Simultaneous Pancreas/Kidney", which is why those two remain local
`NWGMSA` codes rather than SNOMED CT.</td><td style="" class="hierarchy xhtCellBorder1">0..1</td><td style="" class="hierarchy xhtCellBorder1"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-display">display</a></td><td style="" class="hierarchy xhtCellBorder1"/></tr>
<tr class="xhtRowBorder1 xhtRowEven"><td style="background-image: url(tbl_bck001.png)" id="item.HistoIG/specimen_source" class="hierarchy xhtCellBorder1 xhtCellNoWrap"><img src="tbl_spacer.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="" style="background-color: white; background-color: inherit" title="coding" class="hierarchy"/> <span style="position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0" class="sr-only">AskAtOrderEntry / </span>HistoIG/specimen_source</td><td style="" class="hierarchy xhtCellBorder1">Specimen Source</td><td style="" class="hierarchy xhtCellBorder1">0..1</td><td style="" class="hierarchy xhtCellBorder1"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="" class="hierarchy xhtCellBorder1">Definition: <a href="http://hl7.org/fhir/R4/specimen.html#Specimen.type.coding.code">Specimen.type.coding.code</a><br/>Options: <a href="#opt-item.HistoIG/specimen_source">3 options</a></td></tr>
<tr class="xhtRowBorder1 xhtRowOdd"><td style="background-image: url(tbl_bck0010.png)" id="item.HistoIG/specimen_source-designNote" class="hierarchy xhtCellBorder1 xhtCellNoWrap"><img src="tbl_spacer.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="icon-q-display.png" alt="" style="background-color: #F7F7F7; background-color: inherit" title="display" class="hierarchy"/> <span style="position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0" class="sr-only">AskAtOrderEntry / HistoIG/specimen_source / </span>HistoIG/specimen_source-designNote</td><td style="" class="hierarchy xhtCellBorder1">Confirmed as this 3-value list (Blood, Buccal, plus a free-text "Other" box, not
modelled here) from the Hive/Histotrac order-entry UI's HLA panel - narrower than
the EU/UK/NW-compatible [Specimen Type](ValueSet-specimen-type.html) value set
previously bound here (`answerValueSet = Canonical(SpecimenType)`). Blood and
Buccal are now coded against SNOMED CT codes drawn from that same [Specimen
Type](ValueSet-specimen-type.html) value set - `119297000` "Blood specimen" and
`733104004` "Swab from buccal mucosa" - the same `119297000` code [Chimerism Test
Additional Ask At Order Entry
Questions](Questionnaire-ChimerismTestAdditionalAskAtOrderQuestions.html)'s own
`ChimIG/specimen_source` item uses for its "Blood (PB)" option. Other remains a
local `NWGMSA` code, since [Specimen Type](ValueSet-specimen-type.html) has no
single generic "other/unspecified" concept to match Hive's free-text catch-all.
Deliberately given its own `HistoIG/specimen_source` linkId rather than reusing
the base [Genomic Test Order](StructureDefinition-GenomicTestOrder.html)'s own
`LN/66746-9` Specimen Type item (same `code`/LOINC `66746-9`, so the semantic link
is kept via `code`) - the two questions are asked at different points for
different purposes in Hive, and 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`.</td><td style="" class="hierarchy xhtCellBorder1">0..1</td><td style="" class="hierarchy xhtCellBorder1"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-display">display</a></td><td style="" class="hierarchy xhtCellBorder1"/></tr>
<tr class="xhtRowBorder1 xhtRowEven"><td style="background-image: url(tbl_bck0000.png)" id="item.HistoIG/specimen_source-reference" class="hierarchy xhtCellBorder1 xhtCellNoWrap"><img src="tbl_spacer.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="" style="background-color: inherit" class="hierarchy"/><img src="icon-q-display.png" alt="" style="background-color: white; background-color: inherit" title="display" class="hierarchy"/> <span style="position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0" class="sr-only">AskAtOrderEntry / HistoIG/specimen_source / </span>HistoIG/specimen_source-reference</td><td style="" class="hierarchy xhtCellBorder1">NHSBT's INF136 Table 5 (sample requirements) shows nearly every H&I test uses
peripheral blood (EDTA and/or clotted, varying by test), with spleen/lymph node
as the exception for deceased-donor crossmatching - consistent with Hive's Blood
option. No dedicated NHS-published specimen-type binding specific to H&I was
found; the generic [Specimen Type](ValueSet-specimen-type.html) SNOMED CT codes
above are used instead for Blood/Buccal.</td><td style="" class="hierarchy xhtCellBorder1">0..1</td><td style="" class="hierarchy xhtCellBorder1"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-display">display</a></td><td style="" class="hierarchy xhtCellBorder1"/></tr>
<tr><td colspan="5" class="hierarchy"><br/><a href="https://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="data:image/png;base64,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" alt="doco" style="background-color: inherit"/> Documentation for this format</a></td></tr></table><hr/><p><b>Options Sets</b></p><a name="opt-item.HistoIG/patient_test"> </a><p><b>Answer options for HistoIG/patient_test </b></p><ul><li style="font-size: 11px">https://fhir.nwgenomics.nhs.uk/CodeSystem/Histotrac#HLATypingAntibodyScreening ("HLA Typing + Antibody Screening")</li><li style="font-size: 11px">https://fhir.nwgenomics.nhs.uk/CodeSystem/Histotrac#HLAAntibodyScreening ("HLA Antibody Screening")</li><li style="font-size: 11px">https://fhir.nwgenomics.nhs.uk/CodeSystem/Histotrac#HLATypeRecipient ("HLA Type Recipient")</li><li style="font-size: 11px">https://fhir.nwgenomics.nhs.uk/CodeSystem/Histotrac#DSA ("DSA")</li><li style="font-size: 11px">https://fhir.nwgenomics.nhs.uk/CodeSystem/Histotrac#HLAAutoXM ("HLA Auto XM")</li></ul><a name="opt-item.HistoIG/hla_type"> </a><p><b>Answer options for HistoIG/hla_type </b></p><ul><li style="font-size: 11px">https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#Patient ("Patient")</li><li style="font-size: 11px">https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#Donor ("Donor")</li></ul><a name="opt-item.HistoIG/patient_type"> </a><p><b>Answer options for HistoIG/patient_type </b></p><ul><li style="font-size: 11px">https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#StemCell ("Stem cell")</li><li style="font-size: 11px">https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#Renal ("Renal")</li><li style="font-size: 11px">https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#Thoracic ("Thoracic")</li></ul><a name="opt-item.HistoIG/organ"> </a><p><b>Answer options for HistoIG/organ </b></p><ul><li style="font-size: 11px">http://snomed.info/sct#64033007 ("Kidney structure")</li><li style="font-size: 11px">http://snomed.info/sct#15776009 ("Pancreatic structure")</li><li style="font-size: 11px">http://snomed.info/sct#78696007 ("Endocrine pancreatic structure")</li><li style="font-size: 11px">https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#SimultaneousPancreasKidney ("Simultaneous Pancreas/Kidney")</li><li style="font-size: 11px">https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#SimultaneousIsletKidney ("Simultaneous Islet/Kidney")</li></ul><a name="opt-item.HistoIG/specimen_source"> </a><p><b>Answer options for HistoIG/specimen_source </b></p><ul><li style="font-size: 11px">http://snomed.info/sct#119297000 ("Blood specimen")</li><li style="font-size: 11px">http://snomed.info/sct#733104004 ("Swab from buccal mucosa")</li><li style="font-size: 11px">https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#HistoOther ("Other")</li></ul></div>
</text>
<extension
url="http://hl7.org/fhir/StructureDefinition/artifact-versionAlgorithm">
<valueCoding>
<system value="http://hl7.org/fhir/version-algorithm"/>
<code value="semver"/>
</valueCoding>
</extension>
<url
value="https://fhir.nwgenomics.nhs.uk/Questionnaire/HLATestsTransplantAskAtOrderEntry"/>
<version value="2.2.5"/>
<title value="HLA Tests - Transplant Ask At Order Entry"/>
<derivedFrom
value="https://fhir.nwgenomics.nhs.uk/Questionnaire/GenomicTestOrder|2.2.5">🔗
<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="2026-11-05T06:40:21+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="**Ask At Order Entry Questions** used alongside the [common core order
form](StructureDefinition-GenomicTestOrder.html) for the "HLA Tests - Transplant" order
screen within Histocompatibility and Immunogenetics orders (SNOMED CT
`909871000000100`) - see
[Order Entry Questions](StructureDefinition-GenomicTestOrder.html#order-entry-questions) and
[Histocompatibility and Immunogenetics](https://github.com/nw-gmsa/nw-gmsa-use-cases/blob/main/HistocompatibilityAndImmunogenetics.md#ask-at-order-entry-questions).
For the sibling Chimerism testing order screen, see
[Chimerism Test Additional Ask At Order Entry Questions](Questionnaire-ChimerismTestAdditionalAskAtOrderQuestions.html).
Extracted from the `NTE` segments (each carrying HL7 v2 Table 0105-style comment type
`OSQ`) of a live Histotrac `ORM^O01` order - see the worked
[example](https://github.com/nw-gmsa/nw-gmsa-use-cases/blob/main/HistocompatibilityAndImmunogenetics.md#ask-at-order-entry-questions) for the
full message. Each `NTE-3` value uses a local `Label:->Value` convention (e.g.
`HLA Type:->Patient`), split below into a question/answer pair.
**Research summary (no NHS England-published order-comms/interoperability standard was
found for these fields)**: NHS England's published pathology standards
([Pathology Test and Results Standard](https://standards.nhs.uk/published-standards/pathology-test-and-results-standard),
[SNOMED CT for pathology reporting](https://digital.nhs.uk/services/pathology-standards-and-implementation/snomed-ct-for-pathology-reporting))
do not cover Histocompatibility and Immunogenetics (H&I) order entry specifically. The
relevant national body is **NHS Blood and Transplant (NHSBT)**, not NHS England: its
[INF136 "User Guide for Histocompatibility and Immunogenetics Diagnostics
Services"](https://nhsbtdbe.blob.core.windows.net/umbraco-assets-corp/29939/inf136.pdf)
defines six national H&I request forms (Table 2) including `FRM1008` "H&I Organ
Transplant (Patients and Donors)" and `FRM1010` "H&I Haematopoietic Stem Cell
Transplantation (Recipients & Donors)", plus a sample-requirements table listing
"HLA type of **patient, donors or family members**" for Solid Organ Transplantation -
confirming HLA Type is a fixed national list, not free text, even though NHSBT does not
publish a FHIR/LOINC/SNOMED binding for it. NHSBT's Solid Organ Transplantation section
(4.5.1) also describes 24-hour on-call cover for "**renal** and, where appropriate,
**cardiothoracic** transplantation", with liver/other transplant types noted separately
as not having HLA match as a primary factor - consistent with Patient Type being a
small, fixed list. The professional bodies **BSHI** (British Society for
Histocompatibility and Immunogenetics) and **BTS** (British Transplantation Society)
jointly publish clinical guidelines (e.g. the
[2015 BTS/BSHI antibody characterisation guideline](https://bts.org.uk/wp-content/uploads/2016/09/06_BTS_BSHI_Antibodies-1.pdf))
but not data/interoperability standards. This IG's own dependency,
[HL7's Genomics Reporting IG - Histocompatibility and Immunogenetic
Reporting](http://hl7.org/fhir/uv/genomics-reporting/histocompatibility.html), profiles
structured HLA genotype/haplotype *results* (LOINC `84413-4` Genotype display name,
`48018-6` Gene studied, `13298-5` HLA-A [Type], the GL String and HGNC systems) but does
not address order-entry "ask at order" questions like these. See each item below for
LOINC panels and UK code lists relevant to that specific question."/>
<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="HistoIG/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/Histotrac"/>
<code value="HLATypingAntibodyScreening"/>
<display value="HLA Typing + Antibody Screening"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system
value="https://fhir.nwgenomics.nhs.uk/CodeSystem/Histotrac"/>
<code value="HLAAntibodyScreening"/>
<display value="HLA Antibody Screening"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system
value="https://fhir.nwgenomics.nhs.uk/CodeSystem/Histotrac"/>
<code value="HLATypeRecipient"/>
<display value="HLA Type Recipient"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system
value="https://fhir.nwgenomics.nhs.uk/CodeSystem/Histotrac"/>
<code value="DSA"/>
<display value="DSA"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system
value="https://fhir.nwgenomics.nhs.uk/CodeSystem/Histotrac"/>
<code value="HLAAutoXM"/>
<display value="HLA Auto XM"/>
</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="HistoIG/patient_test-designNote"/>
<text
value="Histotrac NTE-3 (CommentType=OSQ): restates the OBR-4 test name. Mapped to
`ServiceRequest.orderDetail` rather than `ServiceRequest.code` - the base
[Genomic Test Order](StructureDefinition-GenomicTestOrder.html)'s own Test Code item
already targets `ServiceRequest.code` (single-cardinality), so reusing it here
would conflict with no `enableWhen` to say which item wins.
`ServiceRequest.orderDetail` is repeating and intended for exactly this kind of
further order qualifier, and matches this item's own `repeats = true` (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,
shown identically regardless of Patient Type (Stem cell or Renal) - coded against
the [Histotrac](CodeSystem-Histotrac.html) CodeSystem (the order-detail
restatement codes Histotrac itself uses alongside its Test Code, bound via
[HistotracOrderDetail](ValueSet-HistotracOrderDetail.html)) - rather than the
local `NWGMSA` codes the Hive order-entry UI's own checkboxes use for the
order-entry *selection* itself. [Chimerism Test Additional Ask At Order Entry
Questions](Questionnaire-ChimerismTestAdditionalAskAtOrderQuestions.html) used to
follow the same `patient_test` pattern, since dropped - see
[Outstanding Issues](https://github.com/nw-gmsa/nw-gmsa-use-cases/blob/main/HistocompatibilityAndImmunogenetics.md#outstanding-issues)
item 7."/>
<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="HistoIG/patient_test-reference"/>
<text
value="No MFT/NHS England code set was found for these five specific test names, but
LOINC has panels the Histotrac test catalogue could map onto if a coded
alternative to the `Histotrac` codes is wanted: 102092-4 (HLA-ABDR typing
panel), 96615-0/96629-1 (HLA-A/B/C class I typing, high/low resolution), 94492-6
(HLA-DQA1/DQB1 typing), 72905-3 (Neutrophil Ab and HLA Ab screen panel), 94428-0
(HLA class I and II IgG panel), and 80737-0 (Calculated panel reactive antibody).
Not the NHS England Genomic Test Directory (England-GenomicTestDirectory) - H&I is
not part of that catalogue."/>
<type value="display"/>
</item>
</item>
<item>
<linkId value="HistoIG/hla_type"/>
<definition
value="http://hl7.org/fhir/StructureDefinition/Observation#Observation.valueCodeableConcept"/>
<text value="HLA Type"/>
<type value="choice"/>
<required value="true"/>
<answerOption>
<valueCoding>
<system value="https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA"/>
<code value="Patient"/>
<display value="Patient"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA"/>
<code value="Donor"/>
<display value="Donor"/>
</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="HistoIG/hla_type-designNote"/>
<text
value="Whose HLA is being typed - carried as an Observation referenced from
ServiceRequest.supportingInfo, the same Ask at Order Entry pattern used by
dWGS's Family Structure/Participant Type. Confirmed as a 2-value list (Patient,
Donor) from the Hive/Histotrac order-entry UI screenshots - coded locally
against the `NWGMSA` CodeSystem as no NHSBT/NHS England-published
FHIR/LOINC/SNOMED binding exists."/>
<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="HistoIG/hla_type-reference"/>
<text
value="NHSBT's INF136 (Table 2) names a national request form "H&I Organ Transplant
(Patients and Donors)" (FRM1008), and its sample-requirements table lists "HLA
type of patient, donors or family members" for Solid Organ Transplantation -
wider than the Patient/Donor pair the Hive UI actually offers. A separate
national form, "H&I Haematopoietic Stem Cell Transplantation (Recipients &
Donors)" (FRM1010), uses Recipient/Donor instead of Patient/Donor for that
transplant type. No NHSBT-published FHIR/LOINC/SNOMED binding exists for either,
and Hive does not appear to expose a Family Member/Recipient option here."/>
<type value="display"/>
</item>
</item>
<item>
<linkId value="HistoIG/patient_type"/>
<definition
value="http://hl7.org/fhir/StructureDefinition/Observation#Observation.valueCodeableConcept"/>
<text value="Patient Type"/>
<type value="choice"/>
<answerOption>
<valueCoding>
<system value="https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA"/>
<code value="StemCell"/>
<display value="Stem cell"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA"/>
<code value="Renal"/>
<display value="Renal"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA"/>
<code value="Thoracic"/>
<display value="Thoracic"/>
</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="HistoIG/patient_type-designNote"/>
<text
value="Transplant context - carried as an Observation referenced from
ServiceRequest.supportingInfo. Confirmed as a 3-value list (Stem cell, Renal,
Thoracic) from the Hive/Histotrac order-entry UI - coded locally against the
`NWGMSA` CodeSystem. When Patient Type is "Renal" the Hive UI also shows an
Organ picker (see `HistoIG/organ` below); no Organ field is shown for Stem
cell/Thoracic."/>
<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="HistoIG/patient_type-reference"/>
<text
value="NHSBT's INF136 (4.5.1) describes 24-hour on-call cover for "renal and, where
appropriate, cardiothoracic transplantation" as the two Solid Organ
Transplantation categories with routine H&I on-call support, and the Hive UI's
"Thoracic" option lines up with that "cardiothoracic" wording (not "Cardiac").
Stem cell is a third category the Hive UI groups here rather than treating as a
separate transplant type. No NHSBT/NHS England LOINC/SNOMED binding was found
for this field."/>
<type value="display"/>
</item>
</item>
<item>
<linkId value="HistoIG/organ"/>
<definition
value="http://hl7.org/fhir/StructureDefinition/Specimen#Specimen.collection.bodySite"/>
<text value="Organ"/>
<type value="choice"/>
<answerOption>
<valueCoding>
<system value="http://snomed.info/sct"/>
<code value="64033007"/>
<display value="Kidney structure"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://snomed.info/sct"/>
<code value="15776009"/>
<display value="Pancreatic structure"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://snomed.info/sct"/>
<code value="78696007"/>
<display value="Endocrine pancreatic structure"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA"/>
<code value="SimultaneousPancreasKidney"/>
<display value="Simultaneous Pancreas/Kidney"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA"/>
<code value="SimultaneousIsletKidney"/>
<display value="Simultaneous Islet/Kidney"/>
</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="HistoIG/organ-designNote"/>
<text
value="The organ relevant to the transplant - the body site the specimen was collected
from. Confirmed as this 5-value list (plus a free-text
"Other" box, not modelled here) from the Hive/Histotrac order-entry UI, only shown
there when Patient Type is "Renal". The three single-organ values (Kidney,
Pancreas, Islets) are now coded against SNOMED CT from the FHIR [body-site value
set](https://hl7.org/fhir/R4/valueset-body-site.html) - `64033007` "Kidney
structure", `15776009` "Pancreatic structure", and `78696007` "Endocrine
pancreatic structure" for Islets (the closest single body-structure concept to
"Islets of Langerhans" available - islet tissue is the endocrine pancreas, there
is no separate discrete "Islet of Langerhans structure" concept). The two
"Simultaneous..." combination transplants remain coded against `NWGMSA`, since
neither is itself a single SNOMED CT body-site concept."/>
<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="HistoIG/organ-reference"/>
<text
value="NHS Digital's UK-specific "Solid organ transplant codes" (ORGTRANSP_COD)
reference set (part of the NHS Digital Primary Care Domain Refsets, ~364 codes,
https://www.opencodelists.org/codelist/nhsd-primary-care-domain-refsets/orgtransp_cod/)
remains a candidate alternative binding, not adopted here since it is a UK
reference set rather than the FHIR body-site value set the SNOMED CT codes above
are drawn from. Neither source has a single code for a combination transplant
such as "Simultaneous Pancreas/Kidney", which is why those two remain local
`NWGMSA` codes rather than SNOMED CT."/>
<type value="display"/>
</item>
</item>
<item>
<linkId value="HistoIG/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="http://snomed.info/sct"/>
<code value="119297000"/>
<display value="Blood specimen"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://snomed.info/sct"/>
<code value="733104004"/>
<display value="Swab from buccal mucosa"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA"/>
<code value="HistoOther"/>
<display value="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="HistoIG/specimen_source-designNote"/>
<text
value="Confirmed as this 3-value list (Blood, Buccal, plus a free-text "Other" box, not
modelled here) from the Hive/Histotrac order-entry UI's HLA panel - narrower than
the EU/UK/NW-compatible [Specimen Type](ValueSet-specimen-type.html) value set
previously bound here (`answerValueSet = Canonical(SpecimenType)`). Blood and
Buccal are now coded against SNOMED CT codes drawn from that same [Specimen
Type](ValueSet-specimen-type.html) value set - `119297000` "Blood specimen" and
`733104004` "Swab from buccal mucosa" - the same `119297000` code [Chimerism Test
Additional Ask At Order Entry
Questions](Questionnaire-ChimerismTestAdditionalAskAtOrderQuestions.html)'s own
`ChimIG/specimen_source` item uses for its "Blood (PB)" option. Other remains a
local `NWGMSA` code, since [Specimen Type](ValueSet-specimen-type.html) has no
single generic "other/unspecified" concept to match Hive's free-text catch-all.
Deliberately given its own `HistoIG/specimen_source` linkId rather than reusing
the base [Genomic Test Order](StructureDefinition-GenomicTestOrder.html)'s own
`LN/66746-9` Specimen Type item (same `code`/LOINC `66746-9`, so the semantic link
is kept via `code`) - the two questions are asked at different points for
different purposes in Hive, and 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`."/>
<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="HistoIG/specimen_source-reference"/>
<text
value="NHSBT's INF136 Table 5 (sample requirements) shows nearly every H&I test uses
peripheral blood (EDTA and/or clotted, varying by test), with spleen/lymph node
as the exception for deceased-donor crossmatching - consistent with Hive's Blood
option. No dedicated NHS-published specimen-type binding specific to H&I was
found; the generic [Specimen Type](ValueSet-specimen-type.html) SNOMED CT codes
above are used instead for Blood/Buccal."/>
<type value="display"/>
</item>
</item>
</item>
</Questionnaire>