Structured Data Capture
3.0.0-preview - STU 3 International flag

This page is part of the Structured Data Capture FHIR IG (v3.0.0-preview: STU 3 Draft) based on FHIR R4. The current version which supercedes this version is 3.0.0. For a full list of available versions, see the Directory of published versions

: SDC-Response to Diagnosis NCI Standard Template - XML Representation

Page standards status: Informative

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<QuestionnaireResponse xmlns="http://hl7.org/fhir">
  <id value="questionnaireresponse-sdc-profile-example"/>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml">
			<h1>Diagnosis NCI Standard Template</h1>
			<h2>Mandatory Diagnosis Questions</h2>
			<pre>These items must be included when this data is collected for reporting.

  <b>Date of Current Pathologic Diagnosis</b>: 02/18/2003
  <b>Diagnosis Type</b>                      : Primary Diagnosis__
  <b>Primary Site</b>                        : Left Ovary
</pre>
			<h2>Conditional Diagnosis Questions</h2>
			<pre>There are business rules to indicate situations under which these elements should be used on a case report form.

  <b>Diagnosis Time Point</b>: Restaging
</pre>
			<h2>Optional Diagnosis Conditions</h2>
			<pre>There is no requirement for inclusion of these elements on the case report form. If the design and scientific questions posed in the study dictate the need to collect this type of data, these elements should be included.

  <b>Reviewing Pathologist</b>: Harold Ornada
  <b>MedDRA Source Code</b>   : __________
  <b>Assessment Method</b>    : Histological Procedure
  <b>Tumor Grade</b>          : Moderately Differentiated</pre>
		</div>
  </text>
  <questionnaire value="http://hl7.org/fhir/uv/sdc/Questionnaire/3921052v1.0"/>
  <status value="completed"/>
  <authored value="2014-01-21"/>
  <item>
    <linkId value="3921053v1.0"/>
    <text value="Mandatory Diagnosis Questions"/>
    <item>
      <linkId value="3921059v1.0"/>
      <text value="Date of Current Pathologic Diagnosis"/>
      <answer>
        <valueString value="2003-02-18"/>
      </answer>
    </item>
    <item>
      <linkId value="3921060v1.0"/>
      <text value="Diagnosis Type"/>
      <answer>
        <valueCoding>
          <system
                  value="http://example.org/nci.nih.gov/xml/owl/cadsr/form/form_design_identifier/3921052v1.0/question_identifier#3921060v1.0-cs"/>
          <code value="Primary"/>
          <display value="Primary Diagnosis"/>
        </valueCoding>
      </answer>
    </item>
    <item>
      <linkId value="3921065v1.0"/>
      <text value="Primary Site"/>
      <answer>
        <valueString value="Left Ovary"/>
      </answer>
    </item>
  </item>
  <item>
    <linkId value="3921066v1.0"/>
    <text value="Conditional Diagnosis Questions"/>
    <item>
      <linkId value="3921071v1.0"/>
      <text value="Diagnosis Time Point"/>
      <answer>
        <valueCoding>
          <system
                  value="http://example.org/nci.nih.gov/xml/owl/cadsr/form/form_design_identifier/3921052v1.0/question_identifier#3921071v1.0-cs"/>
          <code value="At Restaging"/>
          <display value="Restaging"/>
        </valueCoding>
      </answer>
    </item>
  </item>
  <item>
    <linkId value="3921077v1.0"/>
    <text value="Optional Diagnosis Questions"/>
    <item>
      <linkId value="3921079v1.0"/>
      <text value="Reviewing Pathologist"/>
      <answer>
        <valueString value="Harold Ornada"/>
      </answer>
    </item>
    <item>
      <linkId value="3921080v1.0"/>
      <text value="MedDRA disease code"/>
    </item>
    <item>
      <linkId value="3921081v1.0"/>
      <text value="Assessment Method"/>
      <answer>
        <valueCoding>
          <system
                  value="http://example.org/nci.nih.gov/xml/owl/cadsr/form/form_design_identifier/3921052v1.0/question_identifier#3921081v1.0-cs"/>
          <code value="Histologic"/>
          <display value="Histological Procedure"/>
        </valueCoding>
      </answer>
    </item>
    <item>
      <linkId value="3921085v1.0"/>
      <text value="Tumor grade"/>
      <answer>
        <valueCoding>
          <system
                  value="http://example.org/nci.nih.gov/xml/owl/cadsr/form/form_design_identifier/3921052v1.0/question_identifier#3921085v1.0-cs"/>
          <code value="G2"/>
          <display value="Moderately Differentiated"/>
        </valueCoding>
      </answer>
    </item>
  </item>
</QuestionnaireResponse>