{ "resourceType" : "Questionnaire", "id" : "HRDTumourBRCAAskAtOrderEntry", "meta" : { "profile" : ["https://fhir.nwgenomics.nhs.uk/StructureDefinition/NWQuestionnaire"] }, "language" : "en", "text" : { "status" : "extensions", "div" : "

Generated Narrative: Questionnaire HRDTumourBRCAAskAtOrderEntry

Profile: Questionnaire

Structure\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
LinkIDTextCardinalityTypeDescription & Constraints\"doco\"
\".\"\".\" **For analysis purposes only - not an active or planned project.**\n\n**Ask At Order Entry Questions** for the NW GLH paper **HRD and Tumour BRCA Test\nRequest Form** (GB-27189), used alongside the [common core order\nform](Questionnaire-GenomicTestOrder.html) - see [Order Entry\nQuestions](Questionnaire-GenomicTestOrder.html#order-entry-questions). This\nform is specific to newly-diagnosed advanced high-grade epithelial ovarian,\nfallopian tube or primary peritoneal cancer (HRD test, performed by Myriad\nGenetics Inc. in the United States) and its relapsed-disease tumour BRCA-only\npathway.Questionnairehttps://fhir.nwgenomics.nhs.uk/Questionnaire/HRDTumourBRCAAskAtOrderEntry#2.2.0
\".\"\".\"\".\" PatientPatient details0..1groupDefinition: Patient
\".\"\".\"\".\"\".\" LN/45392-8Forename0..1stringDefinition: Patient.name.given
\".\"\".\"\".\"\".\" LN/45394-4Surname0..1stringDefinition: Patient.name.family
\".\"\".\"\".\"\".\" LN/21112-8DoB (DD/MM/YY)0..1dateDefinition: Patient.birthDate
\".\"\".\"\".\"\".\" LN/46098-0Sex0..1choiceDefinition: Patient.gender
Value Set: AdministrativeGender
\".\"\".\"\".\"\".\" LN/89061-6NHS number0..1stringDefinition: Patient.identifier:nhsNumber
\".\"\".\"\".\"\".\" LN/76435-7Hospital number0..1stringDefinition: Patient.identifier:MedicalRecordNumber
\".\"\".\"\".\" HealthcareProfessionalReferrers details0..1groupDefinition: PractitionerRole
\".\"\".\"\".\"\".\" LN/18705-4Name0..1stringDefinition: PractitionerRole.practitioner.display
\".\"\".\"\".\"\".\" NOS/ReferrerPositionPosition0..1string
\".\"\".\"\".\"\".\"\".\" NOS/ReferrerPosition-designNoteNo clean FHIR field identified for the referrer's job title, as distinct from their clinical specialty/department below.0..1display
\".\"\".\"\".\"\".\" HL7/ORC-21NHS hospital0..1stringDefinition: PractitionerRole.organization.identifier.value
\".\"\".\"\".\"\".\" LN/18707-0Department0..1choiceDefinition: PractitionerRole.specialty.coding.code
Value Set: UK Core Practice Setting Code
\".\"\".\"\".\"\".\" LN/81230-5Telephone number0..1stringDefinition: PractitionerRole.telecom.value
\".\"\".\"\".\"\".\" NOS/PreferredReportMethodPreferred method of report0..1choiceOptions: 2 options
\".\"\".\"\".\"\".\"\".\" NOS/PreferredReportMethod-designNoteEmail requires a secure account per the paper form's own footnote - no clean FHIR field identified for this preference.0..1display
\".\"\".\"\".\"\".\" LN/89058-2Email/ fax (1)0..1stringDefinition: PractitionerRole.telecom.value
\".\"\".\"\".\"\".\" NOS/EmailFax2Email/ fax (2)0..1stringDefinition: PractitionerRole.telecom.value
\".\"\".\"\".\"\".\"\".\" NOS/EmailFax2-designNoteThis form's own second, alternative contact method - maps to a second repeat of PractitionerRole.telecom, distinct from Email/ fax (1) above.0..1display
\".\"\".\"\".\"\".\" NOS/ReportingAddressReporting address0..1string
\".\"\".\"\".\" AskAtOrderEntryAsk At Order Entry Questions0..1group
\".\"\".\"\".\"\".\" NOS/HRDPathwayPathway1..1choiceDefinition: ServiceRequest.code
Options: 2 options
\".\"\".\"\".\"\".\" NOS/NewlyDiagnosedAdvancedDiseaseConfirmationConfirm the patient has newly diagnosed, advanced (FIGO stages III and IV) high-grade epithelial ovarian, fallopian tube or primary peritoneal cancer0..1booleanDefinition: 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)
\".\"\".\"\".\"\".\" NOS/RelapsedDiseaseConfirmationConfirm 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..1booleanDefinition: Observation.valueBoolean
Enable When: NOS/HRDPathway = Ovarian Carcinoma, Multi-target NGS panel - small variant (BRCA1, BRCA2, SMARCA4) (NHS England Genomic Test Code#M2.1)
\".\"\".\"\".\"\".\" NOS/MyriadInternationalTransferConsentConsent 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 analysis0..1booleanDefinition: 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)
\".\"\".\"\".\"\".\" NOS/PathologistNamePathologist0..1stringDefinition: Observation.valueString
\".\"\".\"\".\"\".\" NOS/PathologyHospitalPathology hospital0..1stringDefinition: Observation.valueString
\".\"\".\"\".\"\".\" NOS/NeoplasticCellContentApproximate % neoplastic nuclei in tumour area highlighted0..1quantityDefinition: Observation.valueQuantity
\".\"\".\"\".\"\".\"\".\" NOS/NeoplasticCellContent-designNoteSpecimen.accessionIdentifier (pathology block/sample number) is already captured by the common core order form's Specimen group - not repeated here.0..1display

\"doco\" Documentation for this format

Options Sets

Answer options for NOS/PreferredReportMethod

Answer options for NOS/HRDPathway

" }, "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/artifact-versionAlgorithm", "valueCoding" : { "system" : "http://hl7.org/fhir/version-algorithm", "code" : "semver" } }], "url" : "https://fhir.nwgenomics.nhs.uk/Questionnaire/HRDTumourBRCAAskAtOrderEntry", "version" : "2.2.0", "title" : "HRD and Tumour BRCA Ask At Order Entry Questions", "status" : "unknown", "date" : "2026-09-20T05:53:36+00:00", "publisher" : "NHS North West Genomics", "contact" : [{ "telecom" : [{ "system" : "url", "value" : "https://www.nwgenomics.nhs.uk/contact-us" }] }], "description" : "**For analysis purposes only - not an active or planned project.**\n\n**Ask At Order Entry Questions** for the NW GLH paper **HRD and Tumour BRCA Test\nRequest Form** (GB-27189), used alongside the [common core order\nform](Questionnaire-GenomicTestOrder.html) - see [Order Entry\nQuestions](Questionnaire-GenomicTestOrder.html#order-entry-questions). This\nform is specific to newly-diagnosed advanced high-grade epithelial ovarian,\nfallopian tube or primary peritoneal cancer (HRD test, performed by Myriad\nGenetics Inc. in the United States) and its relapsed-disease tumour BRCA-only\npathway.", "jurisdiction" : [{ "coding" : [{ "system" : "urn:iso:std:iso:3166", "code" : "GB", "display" : "United Kingdom of Great Britain and Northern Ireland" }] }], "item" : [{ "linkId" : "Patient", "definition" : "http://hl7.org/fhir/StructureDefinition/Patient#Patient", "text" : "Patient details", "type" : "group", "item" : [{ "linkId" : "LN/45392-8", "definition" : "http://hl7.org/fhir/StructureDefinition/Patient#Patient.name.given", "code" : [{ "system" : "http://loinc.org", "code" : "45392-8" }], "text" : "Forename", "type" : "string" }, { "linkId" : "LN/45394-4", "definition" : "http://hl7.org/fhir/StructureDefinition/Patient#Patient.name.family", "code" : [{ "system" : "http://loinc.org", "code" : "45394-4" }], "text" : "Surname", "type" : "string" }, { "linkId" : "LN/21112-8", "definition" : "http://hl7.org/fhir/StructureDefinition/Patient#Patient.birthDate", "code" : [{ "system" : "http://loinc.org", "code" : "21112-8" }], "text" : "DoB (DD/MM/YY)", "type" : "date" }, { "linkId" : "LN/46098-0", "definition" : "http://hl7.org/fhir/StructureDefinition/Patient#Patient.gender", "code" : [{ "system" : "http://loinc.org", "code" : "46098-0" }], "text" : "Sex", "type" : "choice", "answerValueSet" : "http://hl7.org/fhir/ValueSet/administrative-gender" }, { "linkId" : "LN/89061-6", "definition" : "http://hl7.org/fhir/StructureDefinition/Patient#Patient.identifier:nhsNumber", "code" : [{ "system" : "http://loinc.org", "code" : "89061-6" }], "text" : "NHS number", "type" : "string" }, { "linkId" : "LN/76435-7", "definition" : "http://hl7.org/fhir/StructureDefinition/Patient#Patient.identifier:MedicalRecordNumber", "code" : [{ "system" : "http://loinc.org", "code" : "76435-7" }], "text" : "Hospital number", "type" : "string" }] }, { "linkId" : "HealthcareProfessional", "definition" : "http://hl7.org/fhir/StructureDefinition/PractitionerRole#PractitionerRole", "text" : "Referrers details", "type" : "group", "item" : [{ "linkId" : "LN/18705-4", "definition" : "http://hl7.org/fhir/StructureDefinition/PractitionerRole#PractitionerRole.practitioner.display", "code" : [{ "system" : "http://loinc.org", "code" : "18705-4" }], "text" : "Name", "type" : "string" }, { "linkId" : "NOS/ReferrerPosition", "text" : "Position", "type" : "string", "item" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept" : { "coding" : [{ "system" : "http://hl7.org/fhir/questionnaire-item-control", "code" : "help" }] } }], "linkId" : "NOS/ReferrerPosition-designNote", "text" : "No clean FHIR field identified for the referrer's job title, as distinct from their clinical specialty/department below.", "type" : "display" }] }, { "linkId" : "HL7/ORC-21", "definition" : "http://hl7.org/fhir/StructureDefinition/PractitionerRole#PractitionerRole.organization.identifier.value", "text" : "NHS hospital", "type" : "string" }, { "linkId" : "LN/18707-0", "definition" : "http://hl7.org/fhir/StructureDefinition/PractitionerRole#PractitionerRole.specialty.coding.code", "code" : [{ "system" : "http://loinc.org", "code" : "18707-0" }], "text" : "Department", "type" : "choice", "answerValueSet" : "https://fhir.hl7.org.uk/ValueSet/UKCore-PracticeSettingCode" }, { "linkId" : "LN/81230-5", "definition" : "http://hl7.org/fhir/StructureDefinition/PractitionerRole#PractitionerRole.telecom.value", "code" : [{ "system" : "http://loinc.org", "code" : "81230-5" }], "text" : "Telephone number", "type" : "string" }, { "linkId" : "NOS/PreferredReportMethod", "text" : "Preferred method of report", "type" : "choice", "answerOption" : [{ "valueCoding" : { "system" : "https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA", "code" : "ReportMethodEmail" } }, { "valueCoding" : { "system" : "https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA", "code" : "ReportMethodFax" } }], "item" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept" : { "coding" : [{ "system" : "http://hl7.org/fhir/questionnaire-item-control", "code" : "help" }] } }], "linkId" : "NOS/PreferredReportMethod-designNote", "text" : "Email requires a secure account per the paper form's own footnote - no clean FHIR field identified for this preference.", "type" : "display" }] }, { "linkId" : "LN/89058-2", "definition" : "http://hl7.org/fhir/StructureDefinition/PractitionerRole#PractitionerRole.telecom.value", "code" : [{ "system" : "http://loinc.org", "code" : "89058-2", "display" : "Contact email address" }], "text" : "Email/ fax (1)", "type" : "string" }, { "linkId" : "NOS/EmailFax2", "definition" : "http://hl7.org/fhir/StructureDefinition/PractitionerRole#PractitionerRole.telecom.value", "text" : "Email/ fax (2)", "type" : "string", "item" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept" : { "coding" : [{ "system" : "http://hl7.org/fhir/questionnaire-item-control", "code" : "help" }] } }], "linkId" : "NOS/EmailFax2-designNote", "text" : "This form's own second, alternative contact method - maps to a second repeat of PractitionerRole.telecom, distinct from Email/ fax (1) above.", "type" : "display" }] }, { "linkId" : "NOS/ReportingAddress", "text" : "Reporting address", "type" : "string" }] }, { "linkId" : "AskAtOrderEntry", "text" : "Ask At Order Entry Questions", "type" : "group", "item" : [{ "linkId" : "NOS/HRDPathway", "definition" : "http://hl7.org/fhir/StructureDefinition/ServiceRequest#ServiceRequest.code", "text" : "Pathway", "type" : "choice", "required" : true, "answerOption" : [{ "valueCoding" : { "system" : "https://fhir.nhs.uk/CodeSystem/England-GenomicTestDirectory", "code" : "M2.5", "display" : "HRD status (includes tumour BRCA results)" } }, { "valueCoding" : { "system" : "https://fhir.nhs.uk/CodeSystem/England-GenomicTestDirectory", "code" : "M2.1", "display" : "Tumour BRCA test only" } }] }, { "linkId" : "NOS/NewlyDiagnosedAdvancedDiseaseConfirmation", "definition" : "http://hl7.org/fhir/StructureDefinition/Observation#Observation.valueBoolean", "code" : [{ "system" : "https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA", "code" : "NewlyDiagnosedAdvancedDiseaseConfirmation" }], "text" : "Confirm the patient has newly diagnosed, advanced (FIGO stages III and IV) high-grade epithelial ovarian, fallopian tube or primary peritoneal cancer", "type" : "boolean", "enableWhen" : [{ "question" : "NOS/HRDPathway", "operator" : "=", "answerCoding" : { "system" : "https://fhir.nhs.uk/CodeSystem/England-GenomicTestDirectory", "code" : "M2.5" } }] }, { "linkId" : "NOS/RelapsedDiseaseConfirmation", "definition" : "http://hl7.org/fhir/StructureDefinition/Observation#Observation.valueBoolean", "code" : [{ "system" : "https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA", "code" : "RelapsedDiseaseConfirmation" }], "text" : "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)", "type" : "boolean", "enableWhen" : [{ "question" : "NOS/HRDPathway", "operator" : "=", "answerCoding" : { "system" : "https://fhir.nhs.uk/CodeSystem/England-GenomicTestDirectory", "code" : "M2.1" } }] }, { "linkId" : "NOS/MyriadInternationalTransferConsent", "definition" : "http://hl7.org/fhir/StructureDefinition/Observation#Observation.valueBoolean", "code" : [{ "system" : "https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA", "code" : "MyriadInternationalTransferConsent" }], "text" : "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", "type" : "boolean", "enableWhen" : [{ "question" : "NOS/HRDPathway", "operator" : "=", "answerCoding" : { "system" : "https://fhir.nhs.uk/CodeSystem/England-GenomicTestDirectory", "code" : "M2.5" } }] }, { "linkId" : "NOS/PathologistName", "definition" : "http://hl7.org/fhir/StructureDefinition/Observation#Observation.valueString", "code" : [{ "system" : "https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA", "code" : "PathologistName" }], "text" : "Pathologist", "type" : "string" }, { "linkId" : "NOS/PathologyHospital", "definition" : "http://hl7.org/fhir/StructureDefinition/Observation#Observation.valueString", "code" : [{ "system" : "https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA", "code" : "PathologyHospital" }], "text" : "Pathology hospital", "type" : "string" }, { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-unit", "valueCoding" : { "system" : "http://unitsofmeasure.org", "code" : "%", "display" : "%" } }], "linkId" : "NOS/NeoplasticCellContent", "definition" : "http://hl7.org/fhir/StructureDefinition/Observation#Observation.valueQuantity", "code" : [{ "system" : "https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA", "code" : "NeoplasticCellContent" }], "text" : "Approximate % neoplastic nuclei in tumour area highlighted", "type" : "quantity", "item" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept" : { "coding" : [{ "system" : "http://hl7.org/fhir/questionnaire-item-control", "code" : "help" }] } }], "linkId" : "NOS/NeoplasticCellContent-designNote", "text" : "Specimen.accessionIdentifier (pathology block/sample number) is already captured by the common core order form's Specimen group - not repeated here.", "type" : "display" }] }] }] }