ICHOM Patient Centered Outcomes Measure Set for Breast Cancer
1.0.0 - trial-use International flag

This page is part of the ICHOM FHIR Implementation Guide: Breast Cancer (v1.0.0: STU 1) based on FHIR R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions

Questionnaire: ClinicalResponseBaseline (Experimental)

Official URL: http://hl7.org/fhir/uv/ichom-breast-cancer/Questionnaire/ClinicalResponseBaseline Version: 1.0.0
Standards status: Informative Computable Name: ClinicalResponseBaseline

Clinical response questionnaire at baseline (first doctors’ visit)

LinkIdTextCardinalityTypeFlagsDescription & Constraintsdoco
.. ClinicalResponseBaselineClinical response questionnaire at baseline (first doctors' visit)Questionnairehttp://hl7.org/fhir/uv/ichom-breast-cancer/Questionnaire/ClinicalResponseBaseline#1.0.0
... General-Information-ClinicalGeneral information1..1group
.... NA-ClinicalWhat is the patient's medical record number?1..1stringExpressions:
.... LastName-ClinicalWhat is the patient's last name?1..1stringExpressions:
... DemographicsDemographic factors1..1group
.... SexIndicate the sex of the patient at birth:1..1choiceValue Set: AdministrativeGender
Expressions:
  • Initial Value: %expandedGender.expansion.contains.where(code=%patient.gender)
.... YearOfBirthIn what year was the patient born?1..1integerMax Length: 4
Expressions:
... Clinical-FactorsClinical factors1..1group
.... HeightIndicate the patient's body height1..1quantityicon
.... WeightIndicate the patient's weight.1..1quantityicon
.... LATERALIndicate the laterality of breast cancer1..1choiceValue Set: Laterality of breast cancer ValueSet
.... FIRSTBCIndicate if this is the first breast cancer1..1choiceValue Set: Yes, No and Unknown Valueset
.... NewBCIndicate if this is a new cancer on contralateral or ipsilateral breast1..1choiceEnable When: FIRSTBC = No (expandedYes-NoIndicator#N)
Value Set: Laterality of new cancer ValueSet
... Tumor-FactorsTumor factors1..1group
.... HistologicalDateKnownIs the date of histological diagnosis known?1..1boolean
.... HistologicalDiagnosisDateIndicate the initial date of histological diagnosis:1..1dateEnable When: HistologicalDateKnown = true
.... HISTOTYPEIndicate the histologic type of the tumor (select all that apply)1..*choiceValue Set: Histological type of the tumor ValueSet
.... MUTBCIndicate if the patient carries a germline mutation predisposing breast cancer1..*choiceValue Set: Germline Mutation ValueSet
.... GRADEINVIndicate the grade of the invasive component of tumor1..1choiceValue Set: Grading of tumor ValueSet
.... GRADEDCISIndicate the tumor grade of DCIS component of tumor1..1choiceValue Set: Grading of tumor ValueSet
.... TNMCT_BREASTIndicate the clinical tumor stage (per AJCC 8th Ed.):1..1choiceValue Set: TNM Primary Tumor ValueSet
.... TNMCN_BREASTIndicate the clinical nodal stage (per AJCC 8th Ed.):1..1choiceValue Set: TNM Regional Nodes ValueSet
.... TNMCM_BREASTIndicate the clinical distant metastasis (per AJCC 8th Ed.):1..1choiceValue Set: TNM Distant Metastases ValueSet
.... ERSTATUSIndicate if the estrogen receptor status is positive:1..1choiceValue Set: Estrogen receptor status ValueSet
.... PRSTATUSIndicate if the progesterone receptor status is positive:1..1choiceValue Set: Progesterone receptor status ValueSet
.... HER2STATUSIndicate if the HER2 receptor status is positive:1..1choiceValue Set: HER2 receptor status ValueSet
.... MolecularProfilingIndicate if a molecular profiling tool was used. If so, which one?1..1choiceValue Set: Molecular profiling
.... MammaprintIndicate the mammaprint score on a scale of 0.000 to 1.0001..1decimalEnable When: MolecularProfiling = Mammaprint Score (Molecular Profiling CodeSystem#mammaprint)
.... OncotypeIndicate the oncotype score on a scale of 0 to 1001..1decimalEnable When: MolecularProfiling = Oncotype Score (Molecular Profiling CodeSystem#oncotype)
.... EndopredictIndicate the endopredict score on a scale of 1.1 to 6.21..1decimalEnable When: MolecularProfiling = Endopredict Score (Molecular Profiling CodeSystem#endopredict)
... Treatment-VariablesTreatment variables1..1group
.... MultMeetIndicate if a multidisciplinary meeting was conducted1..1choiceValue Set: Yes, No and Unknown Valueset
.... MultRecTreatmentsWhich treatments did the multidisciplinary team recommend (select all that apply)?1..*choiceEnable When: MultMeet = Yes (expandedYes-NoIndicator#Y)
Value Set: Recommended treatment types ValueSet

doco Documentation for this format