NHS North West Genomics
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Questionnaire: H&I Haematopoietic Stem Cell Transplantation (Recipients & Donors) Ask At Order Entry

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

Ask At Order Entry Questions for NHS Blood and Transplant's (NHSBT) national H&I Haematopoietic Stem Cell Transplantation (Recipients & Donors) request form (FRM1010, form "3C" in NHSBT's own numbering) - see NHSBT's published form and Histocompatibility and Immunogenetics.

Unlike the sibling HLA Tests - Transplant and Chimerism Test Additional Ask At Order Entry Questions - both extracted from a live Hive/Histotrac ORM^O01 order - this Questionnaire is modelled directly from NHSBT's own paper request form, since no live system message for it has been sourced. It is not derivedFrom/extends Genomic Test Order: this form is submitted directly to NHSBT (a national body, not NW GLH/MFT), so its own Patient/Requester fields are restored here rather than assumed available from the common core order form - the same reason HRD and Tumour BRCA restores its own Patient/ Healthcare Professional groups.

A separate form must be completed for each individual - the same physical form is used both for the patient being transplanted and for each family member/potential donor being tested, distinguished only by which "Complete for…" section is filled in. This is modelled below as a Role choice with enableWhen-conditioned items, since FHIR Questionnaire has no native "delete as applicable" concept.

The HLA Typing, Chimerism Analysis and HLA Specific Antibody Testing checkboxes on this form overlap with (but are not identical to) the test-selection lists already modelled as Patient Test(s) on the sibling HLA/Chimerism Questionnaires above - this form uses NHSBT's own coarser Class I/Class I+II and Total/Lineage-specific categories rather than Hive's finer-grained checklist, so they are modelled here as their own items rather than reusing those answerOption lists.

No NHSBT-published FHIR/LOINC/SNOMED binding was found for any of this form's own fields (Role, CMV Status, Time to transplant, HLA Typing scope, Chimerism Analysis type) - all coded locally against the NWGMSA CodeSystem, the same approach taken for the sibling H&I Questionnaires above. Field mappings below are this IG's own best-effort candidates, not confirmed against a live order message.

Profile: Questionnaire

Structure
LinkIDTextCardinalityTypeDescription & Constraintsdoco
.. **Ask At Order Entry Questions** for NHS Blood and Transplant's (NHSBT) national **H&I Haematopoietic Stem Cell Transplantation (Recipients & Donors)** request form (`FRM1010`, form "3C" in NHSBT's own numbering) - see [NHSBT's published form](https://nhsbtdbe.blob.core.windows.net/umbraco-assets-corp/31364/3c-haematopoietic-stem-cell-transplantation-recipients-donors.pdf) and [Histocompatibility and Immunogenetics](HistocompatibilityAndImmunogenetics.html#ask-at-order-entry-questions). Unlike the sibling [HLA Tests - Transplant](Questionnaire-HLATestsTransplantAskAtOrderEntry.html) and [Chimerism Test Additional Ask At Order Entry Questions](Questionnaire-ChimerismTestAdditionalAskAtOrderQuestions.html) - both extracted from a live Hive/Histotrac `ORM^O01` order - this Questionnaire is modelled directly from NHSBT's own **paper request form**, since no live system message for it has been sourced. It is **not** `derivedFrom`/`extends` [Genomic Test Order](Questionnaire-GenomicTestOrder.html): this form is submitted directly to NHSBT (a national body, not NW GLH/MFT), so its own Patient/Requester fields are restored here rather than assumed available from the common core order form - the same reason [HRD and Tumour BRCA](Questionnaire-HRDTumourBRCAAskAtOrderEntry.html) restores its own Patient/ Healthcare Professional groups. **A separate form must be completed for each individual** - the same physical form is used both for the patient being transplanted and for each family member/potential donor being tested, distinguished only by which "Complete for..." section is filled in. This is modelled below as a `Role` choice with `enableWhen`-conditioned items, since FHIR Questionnaire has no native "delete as applicable" concept. The **HLA Typing**, **Chimerism Analysis** and **HLA Specific Antibody Testing** checkboxes on this form overlap with (but are not identical to) the test-selection lists already modelled as `Patient Test(s)` on the sibling HLA/Chimerism Questionnaires above - this form uses NHSBT's own coarser Class I/Class I+II and Total/Lineage-specific categories rather than Hive's finer-grained checklist, so they are modelled here as their own items rather than reusing those `answerOption` lists. **No NHSBT-published FHIR/LOINC/SNOMED binding was found** for any of this form's own fields (Role, CMV Status, Time to transplant, HLA Typing scope, Chimerism Analysis type) - all coded locally against the `NWGMSA` CodeSystem, the same approach taken for the sibling H&I Questionnaires above. Field mappings below are this IG's own best-effort candidates, not confirmed against a live order message. Questionnaire https://fhir.nwgenomics.nhs.uk/Questionnaire/HSCTRecipientsAndDonorsAskAtOrderEntry#2.2.0
... PatientOrDonor Patient/Donor 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/CHI number 0..1 string Definition: Patient.identifier:nhsNumber
Value Set:
.... LN/76435-7 Hospital number 0..1 string Definition: Patient.identifier:MedicalRecordNumber
Value Set:
.... NOS/Ethnicity Ethnicity 0..1 string Definition: Patient.extension:ethnicCategory
Value Set:
... HealthcareProfessional Requester details 0..1 group Definition: PractitionerRole
Value Set:
.... LN/18705-4 Name of Requester 0..1 string Definition: PractitionerRole.practitioner.display
Value Set:
.... NOS/ConsultantName Name of Consultant 0..1 string Value Set:
..... NOS/ConsultantName-designNote No clean FHIR field identified that's distinct from Name of Requester above, since PractitionerRole only carries one practitioner - candidate second PractitionerRole if the requester and responsible consultant need to be distinguished. 0..1 display Value Set:
.... LN/18707-0 Department 0..1 choice Definition: PractitionerRole.specialty.coding.code
Value Set: UK Core Practice Setting Code
.... HL7/ORC-21 Hospital Name, Full Address and ODS code 0..1 string Definition: PractitionerRole.organization.identifier.value
Value Set:
.... LN/81230-5 Contact No. 0..1 string Definition: PractitionerRole.telecom.value
Value Set:
.... NOS/PurchaseOrderNumber Purchase Order No. (if applicable) 0..1 string Value Set:
... AskAtOrderEntry Ask At Order Entry Questions 0..1 group Value Set:
.... HSCT/role This form is for 1..1 choice Value Set:
Options: 2 options
..... HSCT/role-designNote The form itself is not a `Role` field - it is inferred from which of the form's two boxed sections ("Complete for Patient only" vs "Complete for Family Member / Potential Donor") is filled in. Modelled explicitly here as a single choice so the conditional items below can be driven by `enableWhen`, since a "separate form must be completed for each individual" per the form's own instruction. 0..1 display Value Set:
.... HSCT/cmv_status CMV Status 0..1 choice Definition: Observation.valueCodeableConcept
Enable When: HSCT/role = Patient (NW GMSA Codes#Patient)
Value Set:
Options: 3 options
..... HSCT/cmv_status-designNote Carried as an Observation referenced from ServiceRequest.supportingInfo, coded locally against `NWGMSA` since NHSBT does not publish a binding for this field's own answer list (a 3-value Positive/Negative/Don't know list, distinct from a plain boolean). LOINC has CMV serology panels (e.g. IgG antibody presence) that are candidate `code` bindings for the Observation itself, not yet confirmed against a live message. 0..1 display Value Set:
.... HSCT/cmv_status_date CMV Status: Date tested 0..1 date Definition: Observation.effectiveDateTime
Enable When: HSCT/role = Patient (NW GMSA Codes#Patient)
Value Set:
.... HSCT/time_to_transplant Time to transplant 0..1 string Enable When: HSCT/role = Patient (NW GMSA Codes#Patient)
Value Set:
..... HSCT/time_to_transplant-designNote Free text on the form (no defined unit/format) - modelled as a plain string rather than a Quantity/duration. 0..1 display Value Set:
.... HSCT/sibling_count The total number of siblings available to be tested 0..1 integer Enable When: HSCT/role = Patient (NW GMSA Codes#Patient)
Value Set:
.... HSCT/relationship_to_patient Relationship to patient 0..1 string Definition: RelatedPerson.relationship
Enable When: HSCT/role = Family Member / Potential Donor (NW GMSA Codes#FamilyMemberPotentialDonor)
Value Set:
..... HSCT/relationship_to_patient-designNote Free text on the form (e.g. Sibling, Parent) - the FHIR v3 RoleCode family-member value set (http://terminology.hl7.org/ValueSet/v3-FamilyMember) is a candidate coded binding, not yet confirmed against a live message. 0..1 display Value Set:
.... HSCT/linked_patient_name Patient's Name 0..1 string Definition: RelatedPerson.patient.display
Enable When: HSCT/role = Family Member / Potential Donor (NW GMSA Codes#FamilyMemberPotentialDonor)
Value Set:
.... HSCT/linked_patient_dob Patient's DOB 0..1 date Enable When: HSCT/role = Family Member / Potential Donor (NW GMSA Codes#FamilyMemberPotentialDonor)
Value Set:
.... HSCT/linked_patient_nhs_number Patient's NHS No. 0..1 string Definition: RelatedPerson.patient.identifier
Enable When: HSCT/role = Family Member / Potential Donor (NW GMSA Codes#FamilyMemberPotentialDonor)
Value Set:
..... HSCT/linked_patient_nhs_number-designNote Links this Family Member/Potential Donor's own RelatedPerson resource back to the actual Patient this form is testing in relation to - the same NHS Number reused, not re-declared as a separate Patient. 0..1 display Value Set:
.... HSCT/linked_patient_hospital_number Patient's Hospital No. 0..1 string Enable When: HSCT/role = Family Member / Potential Donor (NW GMSA Codes#FamilyMemberPotentialDonor)
Value Set:
.... NOS/ClinicalInformation Diagnosis / Treatment / Test Reason / Relevant Clinical Information 0..1 text Definition: ServiceRequest.reasonCode
Value Set:
.... HSCT/hla_typing HLA Typing 0..1 choice Definition: ServiceRequest.code
Value Set:
Options: 2 options
..... HSCT/hla_typing-designNote A coarser scope choice than the 5-value `Patient Test(s)` checklist on [HLA Tests - Transplant](Questionnaire-HLATestsTransplantAskAtOrderEntry.html#HistoIG/patient_test) (HLA Typing + Antibody Screening, HLA Antibody Screening, HLA Type Recipient, DSA, HLA Auto XM) - this form only distinguishes Class I vs Class I+II, not that finer test breakdown. Coded locally against `NWGMSA`, same rationale as that item. 0..1 display Value Set:
.... HSCT/chimerism_analysis Chimerism Analysis 0..1 choice Definition: ServiceRequest.code
Value Set:
Options: 2 options
..... HSCT/chimerism_analysis-designNote A coarser scope choice than the 5-value `Patient Test(s)` checklist on [Chimerism Test Additional Ask At Order Entry Questions](Questionnaire-ChimerismTestAdditionalAskAtOrderQuestions.html#ChimIG/patient_test) (Chimerism Peripheral Blood, CD3, CD15, CD19, Lineage Other) - this form only distinguishes Total/Whole Blood vs Lineage specific, not that finer lineage breakdown. Coded locally against `NWGMSA`, same rationale as that item. 0..1 display Value Set:
.... HSCT/chimerism_lineage_specify Lineage specific: please specify 0..1 string Enable When: HSCT/chimerism_analysis = Lineage specific (NW GMSA Codes#ChimerismLineageSpecificHSCT)
Value Set:
.... HSCT/hla_specific_antibody_testing HLA specific antibody testing (6ml clotted (serum)) 0..1 boolean Definition: ServiceRequest.code
Value Set:
Do you require a volunteer donor search if no family match? 0..1 boolean Definition: ServiceRequest.code
Value Set:
..... HSCT/volunteer_donor_search-designNote Triggers a separate national volunteer stem cell donor registry search - out of scope for this IG's own data model, captured here as the order-entry request flag only. 0..1 display Value Set:

doco Documentation for this format

Options Sets

Answer options for HSCT/role

  • https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#Patient ("Patient")
  • https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#FamilyMemberPotentialDonor ("Family Member / Potential Donor")

Answer options for HSCT/cmv_status

  • https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#CMVPositive ("Positive")
  • https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#CMVNegative ("Negative")
  • https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#CMVDontKnow ("Don't know")

Answer options for HSCT/hla_typing

  • https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#HLAClassITyping ("HLA Class I type")
  • https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#HLAClassIAndIITyping ("HLA Class I and Class II type")

Answer options for HSCT/chimerism_analysis

  • https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#ChimerismTotalWholeBlood ("Total / Whole Blood")
  • https://fhir.nwgenomics.nhs.uk/CodeSystem/NWGMSA#ChimerismLineageSpecificHSCT ("Lineage specific")

Profile: Questionnaire

Patient/Donor details

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

Forename

Surname

DOB (DD/MM/YY)

Sex

NHS/CHI number

Hospital number

Ethnicity

Requester details

Name of Requester

Name of Consultant

  • linkId: NOS/ConsultantName
  • Answers:

No clean FHIR field identified that's distinct from Name of Requester above, since PractitionerRole only carries one practitioner - candidate second PractitionerRole if the requester and responsible consultant need to be distinguished.

  • linkId: NOS/ConsultantName-designNote
  • Answers:

Department

Hospital Name, Full Address and ODS code

Contact No.

Purchase Order No. (if applicable)

  • linkId: NOS/PurchaseOrderNumber
  • Answers:

Ask At Order Entry Questions

  • linkId: AskAtOrderEntry
  • Answers:

This form is for*

The form itself is not a `Role` field - it is inferred from which of the form's two boxed sections ("Complete for Patient only" vs "Complete for Family Member / Potential Donor") is filled in. Modelled explicitly here as a single choice so the conditional items below can be driven by `enableWhen`, since a "separate form must be completed for each individual" per the form's own instruction.

  • linkId: HSCT/role-designNote
  • Answers:

CMV Status

Carried as an Observation referenced from ServiceRequest.supportingInfo, coded locally against `NWGMSA` since NHSBT does not publish a binding for this field's own answer list (a 3-value Positive/Negative/Don't know list, distinct from a plain boolean). LOINC has CMV serology panels (e.g. IgG antibody presence) that are candidate `code` bindings for the Observation itself, not yet confirmed against a live message.

  • linkId: HSCT/cmv_status-designNote
  • Answers:

CMV Status: Date tested

Time to transplant

  • linkId: HSCT/time_to_transplant
  • Enable When: todo
  • Answers:

Free text on the form (no defined unit/format) - modelled as a plain string rather than a Quantity/duration.

  • linkId: HSCT/time_to_transplant-designNote
  • Answers:

The total number of siblings available to be tested

  • linkId: HSCT/sibling_count
  • Enable When: todo
  • Answers:

Relationship to patient

Free text on the form (e.g. Sibling, Parent) - the FHIR v3 RoleCode family-member value set (http://terminology.hl7.org/ValueSet/v3-FamilyMember) is a candidate coded binding, not yet confirmed against a live message.

  • linkId: HSCT/relationship_to_patient-designNote
  • Answers:

Patient's Name

Patient's DOB

  • linkId: HSCT/linked_patient_dob
  • Enable When: todo
  • Answers:

Patient's NHS No.

Links this Family Member/Potential Donor's own RelatedPerson resource back to the actual Patient this form is testing in relation to - the same NHS Number reused, not re-declared as a separate Patient.

  • linkId: HSCT/linked_patient_nhs_number-designNote
  • Answers:

Patient's Hospital No.

  • linkId: HSCT/linked_patient_hospital_number
  • Enable When: todo
  • Answers:

Diagnosis / Treatment / Test Reason / Relevant Clinical Information

HLA Typing

A coarser scope choice than the 5-value `Patient Test(s)` checklist on [HLA Tests - Transplant](Questionnaire-HLATestsTransplantAskAtOrderEntry.html#HistoIG/patient_test) (HLA Typing + Antibody Screening, HLA Antibody Screening, HLA Type Recipient, DSA, HLA Auto XM) - this form only distinguishes Class I vs Class I+II, not that finer test breakdown. Coded locally against `NWGMSA`, same rationale as that item.

  • linkId: HSCT/hla_typing-designNote
  • Answers:

Chimerism Analysis

A coarser scope choice than the 5-value `Patient Test(s)` checklist on [Chimerism Test Additional Ask At Order Entry Questions](Questionnaire-ChimerismTestAdditionalAskAtOrderQuestions.html#ChimIG/patient_test) (Chimerism Peripheral Blood, CD3, CD15, CD19, Lineage Other) - this form only distinguishes Total/Whole Blood vs Lineage specific, not that finer lineage breakdown. Coded locally against `NWGMSA`, same rationale as that item.

  • linkId: HSCT/chimerism_analysis-designNote
  • Answers:

Lineage specific: please specify

  • linkId: HSCT/chimerism_lineage_specify
  • Enable When: todo
  • Answers:

HLA specific antibody testing (6ml clotted (serum))

Do you require a volunteer donor search if no family match?

Triggers a separate national volunteer stem cell donor registry search - out of scope for this IG's own data model, captured here as the order-entry request flag only.

  • linkId: HSCT/volunteer_donor_search-designNote
  • Answers:

Profile: Questionnaire

LinkIDDescription & Constraintsdoco
.. PatientOrDonor 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:
... NOS/Ethnicity Definition: Patient.extension:ethnicCategory
Value Set:
.. HealthcareProfessional Definition: PractitionerRole
Value Set:
... LN/18705-4 Definition: PractitionerRole.practitioner.display
Value Set:
... NOS/ConsultantName Value Set:
.... NOS/ConsultantName-designNote Value Set:
... LN/18707-0 Definition: PractitionerRole.specialty.coding.code
Value Set: UK Core Practice Setting Code
... HL7/ORC-21 Definition: PractitionerRole.organization.identifier.value
Value Set:
... LN/81230-5 Definition: PractitionerRole.telecom.value
Value Set:
... NOS/PurchaseOrderNumber Value Set:
.. AskAtOrderEntry Value Set:
... HSCT/role Value Set:
Options: 2 options
.... HSCT/role-designNote Value Set:
... HSCT/cmv_status Definition: Observation.valueCodeableConcept
Enable When: Not done yet
Value Set:
Options: 3 options
.... HSCT/cmv_status-designNote Value Set:
... HSCT/cmv_status_date Definition: Observation.effectiveDateTime
Enable When: Not done yet
Value Set:
... HSCT/time_to_transplant Enable When: Not done yet
Value Set:
.... HSCT/time_to_transplant-designNote Value Set:
... HSCT/sibling_count Enable When: Not done yet
Value Set:
... HSCT/relationship_to_patient Definition: RelatedPerson.relationship
Enable When: Not done yet
Value Set:
.... HSCT/relationship_to_patient-designNote Value Set:
... HSCT/linked_patient_name Definition: RelatedPerson.patient.display
Enable When: Not done yet
Value Set:
... HSCT/linked_patient_dob Enable When: Not done yet
Value Set:
... HSCT/linked_patient_nhs_number Definition: RelatedPerson.patient.identifier
Enable When: Not done yet
Value Set:
.... HSCT/linked_patient_nhs_number-designNote Value Set:
... HSCT/linked_patient_hospital_number Enable When: Not done yet
Value Set:
... NOS/ClinicalInformation Definition: ServiceRequest.reasonCode
Value Set:
... HSCT/hla_typing Definition: ServiceRequest.code
Value Set:
Options: 2 options
.... HSCT/hla_typing-designNote Value Set:
... HSCT/chimerism_analysis Definition: ServiceRequest.code
Value Set:
Options: 2 options
.... HSCT/chimerism_analysis-designNote Value Set:
... HSCT/chimerism_lineage_specify Enable When: Not done yet
Value Set:
... HSCT/hla_specific_antibody_testing Definition: ServiceRequest.code
Value Set:
... HSCT/volunteer_donor_search Definition: ServiceRequest.code
Value Set:
.... HSCT/volunteer_donor_search-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.