NHS North West Genomics
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Questionnaire: Prenatal Haemoglobinopathy Ask At Order Entry Questions

Official URL: https://fhir.nwgenomics.nhs.uk/Questionnaire/HaemoglobinopathyPrenatalAskAtOrderEntry 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 Request for Prenatal Diagnosis of Haemoglobinopathies form (DOC4544), used alongside the common core order form - see Order Entry Questions. This form is unusual among the paper forms in naming two patients (maternal and paternal) rather than one - the common core's own Patient group is completed for the mother (the referral's own registered patient - not a "proband" in the classical sense, since prenatal carrier testing doesn't imply an already-affected index case), and this Questionnaire adds a reference to the father via the same NK1-shaped RelatedPerson group as WGS Test Additional Ask At Order Entry Questions - Related Individual (NK1).

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 Request for Prenatal Diagnosis of Haemoglobinopathies form (DOC4544) - see NW Genomics paper test request forms for how this compares to the other paper forms.

Source form: Request for Prenatal Diagnosis of Haemoglobinopathies, DOC4544 (PDF)

Summary

Item Paper Form Field FHIR
Surname/Forename/DoB Free text (Maternal Details) Patient.name / Patient.birthDate
NHS No/Hospital No/Sex Free text Patient.identifier:nhsNumber / Patient.identifier:MedicalRecordNumber / Patient.gender
Address/Postcode Free text Patient.address
Ethnicity/country of origin Local A-H category scheme Patient.extension:ethnicCategory
GP name and address Free text Not yet mapped
Referring Clinician (Referred by, Hospital/Department/Address, Report to, Email, Telephone number, Copy report to) Free text PractitionerRole
Paternal details Second full patient demographic block RelatedPerson (NK1-shaped, Role = Consultand), repeating group
Parental genotypes/reason for referral Free text ServiceRequest.reasonCode.text
Gestation of pregnancy Weeks Observation.valueQuantity
Estimated date of delivery Date Observation.valueDateTime
Fetal sample taken Date + sample type Specimen.collection.collectedDateTime

This is one of only two forms (with WGS Local Test Order) that names a second patient - the common core's own Patient group is completed for the mother throughout, and the father is referenced from here using the same NK1-shaped RelatedPerson group as WGS Test Additional Ask At Order Entry Questions - Related Individual (NK1) and Genetic Clinical Referral - Consultand, under its Consultand role (fixed here, since the mother is always this ServiceRequest's own subject). RelatedPerson.identifier already accommodates the father's own NHS/hospital number when known - the same fields the form asks for - so no detail is lost by using the shared shape rather than a full Patient reference, as this item previously did. Unlike WGS Local Test Order, the roles here never swap - the mother is always this ServiceRequest's own subject, whichever parent's detail is being completed. No Order Placer Number, Account Number/Hospital Spell Identifier, or clinician professional identifier (GMC/GMP) field is present on the paper form.

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 **Request for Prenatal Diagnosis of Haemoglobinopathies** form (DOC4544), used alongside the [common core order form](Questionnaire-GenomicTestOrder.html) - see [Order Entry Questions](Questionnaire-GenomicTestOrder.html#order-entry-questions). This form is unusual among the paper forms in naming **two** patients (maternal and paternal) rather than one - the common core's own Patient group is completed for the mother (the referral's own registered patient - not a "proband" in the classical sense, since prenatal carrier testing doesn't imply an already-affected index case), and this Questionnaire adds a reference to the father via the same NK1-shaped `RelatedPerson` group as [WGS Test Additional Ask At Order Entry Questions - Related Individual (NK1)](Questionnaire-WGSTestAdditionalAskAtOrderQuestions.html). Questionnaire https://fhir.nwgenomics.nhs.uk/Questionnaire/HaemoglobinopathyPrenatalAskAtOrderEntry#2.2.0
... Patient Maternal Details 0..1 group Definition: Patient
Value Set:
.... LN/45394-4 Surname 0..1 string Definition: Patient.name.family
Value Set:
.... LN/45392-8 Forename 0..1 string Definition: Patient.name.given
Value Set:
.... LN/21112-8 DoB 0..1 date Definition: Patient.birthDate
Value Set:
.... LN/89061-6-patient NHS No 0..1 string Definition: Patient.identifier:nhsNumber
Value Set:
..... LN/89061-6-patient-designNote Distinct linkId from NOS/RelatedIndividual's own NHS Number (if known) item below (LN/89061-6) - that one is the father's, this is the mother's (this order's own Patient). 0..1 display Value Set:
.... LN/46098-0 Sex 0..1 choice Definition: Patient.gender
Value Set: AdministrativeGender
.... LN/76435-7-patient Hospital No 0..1 string Definition: Patient.identifier:MedicalRecordNumber
Value Set:
.... LN/56799-0 Address 0..1 string Definition: Patient.address.line
Value Set:
.... LN/45401-7 Postcode 0..1 string Definition: Patient.address.postalCode
Value Set:
.... LN/32624-9 Ethnicity/country of origin 0..1 choice Definition: Patient.extension:ethnicCategory
Value Set: Ethnicity
..... LN/32624-9-designNote The paper form's own section 5 uses a local A-H category scheme (Mixed/White/Mediterranean/Asian/South East Asian/Black/Arabic/Don't know, several free-text 'please specify country') for both maternal and paternal ethnicity, distinct from - and not yet mapped to - this IG's own Ethnicity ValueSet used here. 0..1 display Value Set:
.... NOS/GPNameAndAddress GP name and address 0..1 string Value Set:
... HealthcareProfessional Referring Clinician 0..1 group Definition: PractitionerRole
Value Set:
.... LN/18705-4 Referred by 0..1 string Definition: PractitionerRole.practitioner.display
Value Set:
.... HL7/ORC-21 Hospital/Department/Address 0..1 string Definition: PractitionerRole.organization.identifier.value
Value Set:
.... NOS/ReportTo Report to 0..1 string Value Set:
.... LN/89058-2 Email 0..1 string Definition: PractitionerRole.telecom.value
Value Set:
.... LN/81230-5 Telephone number 0..1 string Definition: PractitionerRole.telecom.value
Value Set:
.... NOS/CopyReportTo Copy report to 0..1 string Value Set:
..... NOS/CopyReportTo-designNote Same genuinely-additional-person gap identified on the GMS WGS national forms' own Main Contact group and Genomic Test Order - Common Fields We May Have Missed (Copy Report To). 0..1 display Value Set:
... AskAtOrderEntry Ask At Order Entry Questions 0..1 group Value Set:
.... NOS/RelatedIndividual Paternal details (Related Individual, NK1) 0..* group Definition: RelatedPerson
Value Set:
..... NOS/RelatedIndividual-designNote Same NK1-shaped RelatedPerson group as NW Genomic General Ask At Order Questions' own Related Individual (NK1) group (NOS/RelatedIndividual) and Genetic Clinical Referral - Consultand, used here under its Consultand role - the mother remains this ServiceRequest's own subject throughout, unlike WGS Local Test Order's NOS/Proband, so there is no pathway where the roles swap. RelatedPerson.identifier already accommodates the father's own NHS/hospital number when known, the same paper-form fields previously modelled as a full Patient reference - no detail is lost by using the shared shape instead. 0..1 display Value Set:
..... NOS/RelatedIndividualRole Role 1..1 choice Value Set:
Options: 1 option
..... HL7/NK1-2 Name 1..1 string Definition: RelatedPerson.name
Value Set:
..... HL7/NK1-3 Relationship 1..1 choice Definition: RelatedPerson.relationship
Value Set: UK Core Person Relationship Type
..... HL7/NK1.15 Administrative Sex 0..1 choice Definition: RelatedPerson.gender
Value Set: AdministrativeGender
..... HL7/NK1-16 Date of Birth 0..1 date Definition: RelatedPerson.birthDate
Value Set:
..... LN/89061-6 NHS Number (if known) 0..1 string Definition: RelatedPerson.identifier:nhsNumber
Value Set:
..... LN/76435-7 Hospital Number (Medical Record Number), if known 0..1 string Definition: RelatedPerson.identifier:MedicalRecordNumber
Value Set:
..... NOS/RelatedIndividual-patient This order's own Patient (the mother) 1..1 reference Definition: RelatedPerson.patient
Value Set:
.... NOS/ParentalGenotypesReason Parental genotypes/reason for referral 0..1 string Definition: ServiceRequest.reasonCode.text
Value Set:
.... SNM/598151000005105-prenatal-haem Gestation of pregnancy 0..1 integer Definition: Observation.valueQuantity
Value Set:
..... SNM/598151000005105-prenatal-haem-designNote Same question (and code) as Patient gestation in NW Genomic General Ask At Order Questions (SNM/598151000005105) - repeated here because exactly one Ask At Order Entry Questionnaire applies per order, not because this is new content. 0..1 display Value Set:
.... SNM/161714006-prenatal-haem Estimated date of delivery (EDD) 0..1 date Definition: Observation.valueDateTime
Value Set:
..... SNM/161714006-prenatal-haem-designNote Same question (and code) as Patient expected delivery date in NW Genomic General Ask At Order Questions (SNM/161714006) - repeated here because exactly one Ask At Order Entry Questionnaire applies per order, not because this is new content. 0..1 display Value Set:
.... NOS/FetalSampleTaken Date fetal sample taken and sample type 0..1 dateTime Definition: Specimen.collection.collectedDateTime
Value Set:

doco Documentation for this format

Options Sets

Answer options for NOS/RelatedIndividualRole

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

Profile: Questionnaire

Maternal Details

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

Surname

Forename

DoB

NHS No

Distinct linkId from NOS/RelatedIndividual's own NHS Number (if known) item below (LN/89061-6) - that one is the father's, this is the mother's (this order's own Patient).

  • linkId: LN/89061-6-patient-designNote
  • Answers:

Sex

Hospital No

Address

Postcode

Ethnicity/country of origin

The paper form's own section 5 uses a local A-H category scheme (Mixed/White/Mediterranean/Asian/South East Asian/Black/Arabic/Don't know, several free-text 'please specify country') for both maternal and paternal ethnicity, distinct from - and not yet mapped to - this IG's own Ethnicity ValueSet used here.

  • linkId: LN/32624-9-designNote
  • Answers:

GP name and address

  • linkId: NOS/GPNameAndAddress
  • Answers:

Referring Clinician

Referred by

Hospital/Department/Address

Report to

  • linkId: NOS/ReportTo
  • Answers:

Email

Telephone number

Copy report to

  • linkId: NOS/CopyReportTo
  • Answers:

Same genuinely-additional-person gap identified on the GMS WGS national forms' own Main Contact group and Genomic Test Order - Common Fields We May Have Missed (Copy Report To).

  • linkId: NOS/CopyReportTo-designNote
  • Answers:

Ask At Order Entry Questions

  • linkId: AskAtOrderEntry
  • Answers:

Paternal details (Related Individual, NK1)

Same NK1-shaped RelatedPerson group as NW Genomic General Ask At Order Questions' own Related Individual (NK1) group (NOS/RelatedIndividual) and Genetic Clinical Referral - Consultand, used here under its Consultand role - the mother remains this ServiceRequest's own subject throughout, unlike WGS Local Test Order's NOS/Proband, so there is no pathway where the roles swap. RelatedPerson.identifier already accommodates the father's own NHS/hospital number when known, the same paper-form fields previously modelled as a full Patient reference - no detail is lost by using the shared shape instead.

  • linkId: NOS/RelatedIndividual-designNote
  • Answers:

Role*

Name*

Relationship*

Administrative Sex

Date of Birth

NHS Number (if known)

Hospital Number (Medical Record Number), if known

This order's own Patient (the mother)*

Parental genotypes/reason for referral

Gestation of pregnancy

Same question (and code) as Patient gestation in NW Genomic General Ask At Order Questions (SNM/598151000005105) - repeated here because exactly one Ask At Order Entry Questionnaire applies per order, not because this is new content.

  • linkId: SNM/598151000005105-prenatal-haem-designNote
  • Answers:

Estimated date of delivery (EDD)

Same question (and code) as Patient expected delivery date in NW Genomic General Ask At Order Questions (SNM/161714006) - repeated here because exactly one Ask At Order Entry Questionnaire applies per order, not because this is new content.

  • linkId: SNM/161714006-prenatal-haem-designNote
  • Answers:

Date fetal sample taken and sample type

Profile: Questionnaire

LinkIDDescription & Constraintsdoco
.. Patient Definition: Patient
Value Set:
... LN/45394-4 Definition: Patient.name.family
Value Set:
... LN/45392-8 Definition: Patient.name.given
Value Set:
... LN/21112-8 Definition: Patient.birthDate
Value Set:
... LN/89061-6-patient Definition: Patient.identifier:nhsNumber
Value Set:
.... LN/89061-6-patient-designNote Value Set:
... LN/46098-0 Definition: Patient.gender
Value Set: AdministrativeGender
... LN/76435-7-patient Definition: Patient.identifier:MedicalRecordNumber
Value Set:
... LN/56799-0 Definition: Patient.address.line
Value Set:
... LN/45401-7 Definition: Patient.address.postalCode
Value Set:
... LN/32624-9 Definition: Patient.extension:ethnicCategory
Value Set: Ethnicity
.... LN/32624-9-designNote Value Set:
... NOS/GPNameAndAddress Value Set:
.. HealthcareProfessional Definition: PractitionerRole
Value Set:
... LN/18705-4 Definition: PractitionerRole.practitioner.display
Value Set:
... HL7/ORC-21 Definition: PractitionerRole.organization.identifier.value
Value Set:
... NOS/ReportTo Value Set:
... LN/89058-2 Definition: PractitionerRole.telecom.value
Value Set:
... LN/81230-5 Definition: PractitionerRole.telecom.value
Value Set:
... NOS/CopyReportTo Value Set:
.... NOS/CopyReportTo-designNote Value Set:
.. AskAtOrderEntry Value Set:
... NOS/RelatedIndividual Definition: RelatedPerson
Value Set:
.... NOS/RelatedIndividual-designNote Value Set:
.... NOS/RelatedIndividualRole Value Set:
Options: 1 option
.... HL7/NK1-2 Definition: RelatedPerson.name
Value Set:
.... HL7/NK1-3 Definition: RelatedPerson.relationship
Value Set: UK Core Person Relationship Type
.... HL7/NK1.15 Definition: RelatedPerson.gender
Value Set: AdministrativeGender
.... HL7/NK1-16 Definition: RelatedPerson.birthDate
Value Set:
.... LN/89061-6 Definition: RelatedPerson.identifier:nhsNumber
Value Set:
.... LN/76435-7 Definition: RelatedPerson.identifier:MedicalRecordNumber
Value Set:
.... NOS/RelatedIndividual-patient Definition: RelatedPerson.patient
Value Set:
... NOS/ParentalGenotypesReason Definition: ServiceRequest.reasonCode.text
Value Set:
... SNM/598151000005105-prenatal-haem Definition: Observation.valueQuantity
Value Set:
.... SNM/598151000005105-prenatal-haem-designNote Value Set:
... SNM/161714006-prenatal-haem Definition: Observation.valueDateTime
Value Set:
.... SNM/161714006-prenatal-haem-designNote Value Set:
... NOS/FetalSampleTaken Definition: Specimen.collection.collectedDateTime
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.