NHS North West Genomics
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Questionnaire: HRD and Tumour BRCA Ask At Order Entry Questions

Official URL: https://fhir.nwgenomics.nhs.uk/Questionnaire/HRDTumourBRCAAskAtOrderEntry Version: 2.2.0
Unknown as of 2026-09-20 Computable Name:

For analysis purposes only - not an active or planned project.

Ask At Order Entry Questions for the NW GLH paper HRD and Tumour BRCA Test Request Form (GB-27189), used alongside the common core order form - see Order Entry Questions. This form is specific to newly-diagnosed advanced high-grade epithelial ovarian, fallopian tube or primary peritoneal cancer (HRD test, performed by Myriad Genetics Inc. in the United States) and its relapsed-disease tumour BRCA-only pathway.

This Questionnaire is compared against Genomic Test Order - see NW GLH Paper Test Request Forms - but does not yet declare derivedFrom/extends it: unlike the Ask At Order Entry Questionnaires that originated from an existing digital order-entry screen (see Order Entry Questions), this one hasn't yet been processed into the specific electronic Ask At Order Entry shape that relationship implies for use in an actual order. It structures the NW GLH paper HRD and Tumour BRCA Test Request Form (GB-27189) - see NW Genomics paper test request forms for how this compares to the other paper forms.

Source form: HRD and Tumour BRCA Test Request Form (PDF)

Summary

Item Paper Form Field FHIR
Forename/Surname Free text Patient.name
DoB (DD/MM/YY)/Sex Free text Patient.birthDate / Patient.gender
NHS number/Hospital number Free text Patient.identifier:nhsNumber / Patient.identifier:MedicalRecordNumber
Referrer's Name/Position/NHS hospital/Department Free text PractitionerRole
Telephone number Free text PractitionerRole.telecom.value
Preferred method of report Email*/Fax (tick boxes) not yet mapped
Email/ fax (1) and (2) Free text PractitionerRole.telecom.value (repeating)
Reporting address Free text not yet mapped
Pathway HRD test / Tumour BRCA test only / Relapsed tumour BRCA test only (tick boxes) ServiceRequest.code ($GTD#M2.5 / M2.1)
Newly diagnosed disease confirmation Confirmation checkbox Observation.valueBoolean
Relapsed disease confirmation Confirmation checkbox Observation.valueBoolean
International transfer consent Consent statement (Myriad, USA) Observation.valueBoolean
Pathologist / Pathology hospital Free text Observation.valueString
Neoplastic cell content Approx. % neoplastic nuclei Observation.valueQuantity

Specimen/pathology-block detail beyond Pathologist, Pathology hospital and Neoplastic cell content (above) is captured by the common core Genomic Test Order Questionnaire's own Specimen group and is not repeated here - this form has no Order Placer Number, Account Number/Hospital Spell Identifier, or clinician professional identifier (GMC/GMP) field.

Profile: Questionnaire

Structure
LinkIDTextCardinalityTypeDescription & Constraintsdoco
.. **For analysis purposes only - not an active or planned project.** **Ask At Order Entry Questions** for the NW GLH paper **HRD and Tumour BRCA Test Request Form** (GB-27189), used alongside the [common core order form](Questionnaire-GenomicTestOrder.html) - see [Order Entry Questions](Questionnaire-GenomicTestOrder.html#order-entry-questions). This form is specific to newly-diagnosed advanced high-grade epithelial ovarian, fallopian tube or primary peritoneal cancer (HRD test, performed by Myriad Genetics Inc. in the United States) and its relapsed-disease tumour BRCA-only pathway. Questionnaire https://fhir.nwgenomics.nhs.uk/Questionnaire/HRDTumourBRCAAskAtOrderEntry#2.2.0
... Patient Patient details 0..1 group Definition: Patient
Value Set:
.... LN/45392-8 Forename 0..1 string Definition: Patient.name.given
Value Set:
.... LN/45394-4 Surname 0..1 string Definition: Patient.name.family
Value Set:
.... LN/21112-8 DoB (DD/MM/YY) 0..1 date Definition: Patient.birthDate
Value Set:
.... LN/46098-0 Sex 0..1 choice Definition: Patient.gender
Value Set: AdministrativeGender
.... LN/89061-6 NHS number 0..1 string Definition: Patient.identifier:nhsNumber
Value Set:
.... LN/76435-7 Hospital number 0..1 string Definition: Patient.identifier:MedicalRecordNumber
Value Set:
... HealthcareProfessional Referrers details 0..1 group Definition: PractitionerRole
Value Set:
.... LN/18705-4 Name 0..1 string Definition: PractitionerRole.practitioner.display
Value Set:
.... NOS/ReferrerPosition Position 0..1 string Value Set:
..... NOS/ReferrerPosition-designNote No clean FHIR field identified for the referrer's job title, as distinct from their clinical specialty/department below. 0..1 display Value Set:
.... HL7/ORC-21 NHS hospital 0..1 string Definition: PractitionerRole.organization.identifier.value
Value Set:
.... LN/18707-0 Department 0..1 choice Definition: PractitionerRole.specialty.coding.code
Value Set: UK Core Practice Setting Code
.... LN/81230-5 Telephone number 0..1 string Definition: PractitionerRole.telecom.value
Value Set:
.... NOS/PreferredReportMethod Preferred method of report 0..1 choice Value Set:
Options: 2 options
..... NOS/PreferredReportMethod-designNote Email requires a secure account per the paper form's own footnote - no clean FHIR field identified for this preference. 0..1 display Value Set:
.... LN/89058-2 Email/ fax (1) 0..1 string Definition: PractitionerRole.telecom.value
Value Set:
.... NOS/EmailFax2 Email/ fax (2) 0..1 string Definition: PractitionerRole.telecom.value
Value Set:
..... NOS/EmailFax2-designNote This form's own second, alternative contact method - maps to a second repeat of PractitionerRole.telecom, distinct from Email/ fax (1) above. 0..1 display Value Set:
.... NOS/ReportingAddress Reporting address 0..1 string Value Set:
... AskAtOrderEntry Ask At Order Entry Questions 0..1 group Value Set:
.... NOS/HRDPathway Pathway 1..1 choice Definition: ServiceRequest.code
Value Set:
Options: 2 options
.... NOS/NewlyDiagnosedAdvancedDiseaseConfirmation Confirm the patient has newly diagnosed, advanced (FIGO stages III and IV) high-grade epithelial ovarian, fallopian tube or primary peritoneal cancer 0..1 boolean Definition: Observation.valueBoolean
Enable When: NOS/HRDPathway = Ovarian Carcinoma, HRD status (either positive for BRCA 1 and/or 2, or HRD positive) (NHS England Genomic Test Code#M2.5)
Value Set:
.... NOS/RelapsedDiseaseConfirmation Confirm the patient has relapsed high-grade epithelial ovarian, fallopian tube or primary peritoneal cancer and has already received one or more treatment for their disease (second line or beyond) 0..1 boolean Definition: Observation.valueBoolean
Enable When: NOS/HRDPathway = Ovarian Carcinoma, Multi-target NGS panel - small variant (BRCA1, BRCA2, SMARCA4) (NHS England Genomic Test Code#M2.1)
Value Set:
.... NOS/MyriadInternationalTransferConsent Consent obtained for tissue, pathology report and personal details (name, NHS number, date of birth) to be sent to Myriad laboratory in the United States for analysis 0..1 boolean Definition: Observation.valueBoolean
Enable When: NOS/HRDPathway = Ovarian Carcinoma, HRD status (either positive for BRCA 1 and/or 2, or HRD positive) (NHS England Genomic Test Code#M2.5)
Value Set:
.... NOS/PathologistName Pathologist 0..1 string Definition: Observation.valueString
Value Set:
.... NOS/PathologyHospital Pathology hospital 0..1 string Definition: Observation.valueString
Value Set:
.... NOS/NeoplasticCellContent Approximate % neoplastic nuclei in tumour area highlighted 0..1 quantity Definition: Observation.valueQuantity
Value Set:
..... NOS/NeoplasticCellContent-designNote Specimen.accessionIdentifier (pathology block/sample number) is already captured by the common core order form's Specimen group - not repeated here. 0..1 display Value Set:

doco Documentation for this format

Options Sets

Answer options for NOS/PreferredReportMethod

  • https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#ReportMethodEmail
  • https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#ReportMethodFax

Answer options for NOS/HRDPathway

  • https://fhir.nhs.uk/CodeSystem/England-GenomicTestDirectory#M2.5 ("HRD status (includes tumour BRCA results)")
  • https://fhir.nhs.uk/CodeSystem/England-GenomicTestDirectory#M2.1 ("Tumour BRCA test only")

Profile: Questionnaire

Patient details

  • linkId: Patient
  • Definition:: Patient
  • Answers:

Forename

Surname

DoB (DD/MM/YY)

Sex

NHS number

Hospital number

Referrers details

Name

Position

  • linkId: NOS/ReferrerPosition
  • Answers:

No clean FHIR field identified for the referrer's job title, as distinct from their clinical specialty/department below.

  • linkId: NOS/ReferrerPosition-designNote
  • Answers:

NHS hospital

Department

Telephone number

Preferred method of report

Email requires a secure account per the paper form's own footnote - no clean FHIR field identified for this preference.

  • linkId: NOS/PreferredReportMethod-designNote
  • Answers:

Email/ fax (1)

Email/ fax (2)

This form's own second, alternative contact method - maps to a second repeat of PractitionerRole.telecom, distinct from Email/ fax (1) above.

  • linkId: NOS/EmailFax2-designNote
  • Answers:

Reporting address

  • linkId: NOS/ReportingAddress
  • Answers:

Ask At Order Entry Questions

  • linkId: AskAtOrderEntry
  • Answers:

Pathway*

Confirm the patient has newly diagnosed, advanced (FIGO stages III and IV) high-grade epithelial ovarian, fallopian tube or primary peritoneal cancer

Confirm the patient has relapsed high-grade epithelial ovarian, fallopian tube or primary peritoneal cancer and has already received one or more treatment for their disease (second line or beyond)

Consent obtained for tissue, pathology report and personal details (name, NHS number, date of birth) to be sent to Myriad laboratory in the United States for analysis

Pathologist

Pathology hospital

Approximate % neoplastic nuclei in tumour area highlighted

Specimen.accessionIdentifier (pathology block/sample number) is already captured by the common core order form's Specimen group - not repeated here.

  • linkId: NOS/NeoplasticCellContent-designNote
  • Answers:

Profile: Questionnaire

LinkIDDescription & Constraintsdoco
.. Patient Definition: Patient
Value Set:
... LN/45392-8 Definition: Patient.name.given
Value Set:
... LN/45394-4 Definition: Patient.name.family
Value Set:
... LN/21112-8 Definition: Patient.birthDate
Value Set:
... LN/46098-0 Definition: Patient.gender
Value Set: AdministrativeGender
... LN/89061-6 Definition: Patient.identifier:nhsNumber
Value Set:
... LN/76435-7 Definition: Patient.identifier:MedicalRecordNumber
Value Set:
.. HealthcareProfessional Definition: PractitionerRole
Value Set:
... LN/18705-4 Definition: PractitionerRole.practitioner.display
Value Set:
... NOS/ReferrerPosition Value Set:
.... NOS/ReferrerPosition-designNote Value Set:
... HL7/ORC-21 Definition: PractitionerRole.organization.identifier.value
Value Set:
... LN/18707-0 Definition: PractitionerRole.specialty.coding.code
Value Set: UK Core Practice Setting Code
... LN/81230-5 Definition: PractitionerRole.telecom.value
Value Set:
... NOS/PreferredReportMethod Value Set:
Options: 2 options
.... NOS/PreferredReportMethod-designNote Value Set:
... LN/89058-2 Definition: PractitionerRole.telecom.value
Value Set:
... NOS/EmailFax2 Definition: PractitionerRole.telecom.value
Value Set:
.... NOS/EmailFax2-designNote Value Set:
... NOS/ReportingAddress Value Set:
.. AskAtOrderEntry Value Set:
... NOS/HRDPathway Definition: ServiceRequest.code
Value Set:
Options: 2 options
... NOS/NewlyDiagnosedAdvancedDiseaseConfirmation Definition: Observation.valueBoolean
Enable When: Not done yet
Value Set:
... NOS/RelapsedDiseaseConfirmation Definition: Observation.valueBoolean
Enable When: Not done yet
Value Set:
... NOS/MyriadInternationalTransferConsent Definition: Observation.valueBoolean
Enable When: Not done yet
Value Set:
... NOS/PathologistName Definition: Observation.valueString
Value Set:
... NOS/PathologyHospital Definition: Observation.valueString
Value Set:
... NOS/NeoplasticCellContent Definition: Observation.valueQuantity
Value Set:
.... NOS/NeoplasticCellContent-designNote Value Set:

doco Documentation for this format

Test this Questionnaire

Try this questionnaire out:

Responses for this Questionnaire

There are currently no QuestionnaireResponse instances for this Questionnaire defined in this IG.