CH ORF (R4)
0.10.0 - STU 1 Ballot
CH ORF (R4)
0.10.0 - STU 1 Ballot
This page is part of the CH ORF (R4) (v0.10.0: STU 1) based on FHIR R4. . For a full list of available versions, see the Directory of published versions 
{
"resourceType" : "QuestionnaireResponse",
"id" : "order-referral-form-mappedback",
"text" : {
"status" : "generated",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><p><b>questionnaire</b>: <a href=\"http://fhir.ch/ig/ch-orf/Questionnaire/order-referral-form\">http://fhir.ch/ig/ch-orf/Questionnaire/order-referral-form</a></p><p><b>status</b>: completed</p><blockquote><p><b>item</b></p><p><b>linkId</b>: order</p><blockquote><p><b>item</b></p><p><b>linkId</b>: order.title</p><h3>Answers</h3><table class=\"grid\"><tr><td>-</td></tr><tr><td>*</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: order.type</p><h3>Answers</h3><table class=\"grid\"><tr><td>-</td></tr><tr><td>*</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: order.category</p><h3>Answers</h3><table class=\"grid\"><tr><td>-</td></tr><tr><td>*</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: order.placerOrderIdentifier</p><h3>Answers</h3><table class=\"grid\"><tr><td>-</td></tr><tr><td>*</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: order.placerOrderIdentifierDomain</p><h3>Answers</h3><table class=\"grid\"><tr><td>-</td></tr><tr><td>*</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: order.fillerOrderIdentifier</p><h3>Answers</h3><table class=\"grid\"><tr><td>-</td></tr><tr><td>*</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: order.fillerOrderIdentifierDomain</p><h3>Answers</h3><table class=\"grid\"><tr><td>-</td></tr><tr><td>*</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: order.precedentDocumentIdentifier</p><h3>Answers</h3><table class=\"grid\"><tr><td>-</td></tr><tr><td>*</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: order.notificationContactDocument</p><h3>Items</h3><table class=\"grid\"><tr><td>-</td></tr><tr><td>*</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: order.notificationContactDocumentResponse</p><h3>Items</h3><table class=\"grid\"><tr><td>-</td></tr><tr><td>*</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: order.priority</p><h3>Answers</h3><table class=\"grid\"><tr><td>-</td></tr><tr><td>*</td></tr></table></blockquote></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: receiver</p><blockquote><p><b>item</b></p><p><b>linkId</b>: receiver.practitioner</p><h3>Items</h3><table class=\"grid\"><tr><td>-</td></tr><tr><td>*</td></tr><tr><td>*</td></tr><tr><td>*</td></tr><tr><td>*</td></tr><tr><td>*</td></tr><tr><td>*</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: receiver.organization</p><h3>Items</h3><table class=\"grid\"><tr><td>-</td></tr><tr><td>*</td></tr><tr><td>*</td></tr><tr><td>*</td></tr><tr><td>*</td></tr><tr><td>*</td></tr></table></blockquote></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: patient</p><blockquote><p><b>item</b></p><p><b>linkId</b>: patient.familyName</p><h3>Answers</h3><table class=\"grid\"><tr><td>-</td></tr><tr><td>*</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: patient.maidenName</p><h3>Answers</h3><table class=\"grid\"><tr><td>-</td></tr><tr><td>*</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: patient.givenName</p><h3>Answers</h3><table class=\"grid\"><tr><td>-</td></tr><tr><td>*</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: patient.localPid</p><h3>Answers</h3><table class=\"grid\"><tr><td>-</td></tr><tr><td>*</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: patient.localPidDomain</p><h3>Answers</h3><table class=\"grid\"><tr><td>-</td></tr><tr><td>*</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: patient.birthDate</p><h3>Answers</h3><table class=\"grid\"><tr><td>-</td></tr><tr><td>*</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: patient.gender</p><h3>Answers</h3><table class=\"grid\"><tr><td>-</td></tr><tr><td>*</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: patient.phone</p><h3>Answers</h3><table class=\"grid\"><tr><td>-</td></tr><tr><td>*</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: patient.email</p><h3>Answers</h3><table class=\"grid\"><tr><td>-</td></tr><tr><td>*</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: patient.streetAddressLine</p><h3>Answers</h3><table class=\"grid\"><tr><td>-</td></tr><tr><td>*</td></tr><tr><td>*</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: patient.postalCode</p><h3>Answers</h3><table class=\"grid\"><tr><td>-</td></tr><tr><td>*</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: patient.city</p><h3>Answers</h3><table class=\"grid\"><tr><td>-</td></tr><tr><td>*</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: patient.country</p><h3>Answers</h3><table class=\"grid\"><tr><td>-</td></tr><tr><td>*</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: patient.contactperson</p><h3>Items</h3><table class=\"grid\"><tr><td>-</td></tr><tr><td>*</td></tr><tr><td>*</td></tr><tr><td>*</td></tr><tr><td>*</td></tr><tr><td>*</td></tr></table></blockquote></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: requestedEncounter</p><blockquote><p><b>item</b></p><p><b>linkId</b>: requestedEncounter.class</p><h3>Answers</h3><table class=\"grid\"><tr><td>-</td></tr><tr><td>*</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: requestedEncounter.desiredAccommodation</p><h3>Answers</h3><table class=\"grid\"><tr><td>-</td></tr><tr><td>*</td></tr></table></blockquote></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: coverage</p><blockquote><p><b>item</b></p><p><b>linkId</b>: coverage.kvg</p><h3>Items</h3><table class=\"grid\"><tr><td>-</td></tr><tr><td>*</td></tr><tr><td>*</td></tr></table></blockquote></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: sender</p><blockquote><p><b>item</b></p><p><b>linkId</b>: sender.author</p><h3>Items</h3><table class=\"grid\"><tr><td>-</td></tr><tr><td>*</td></tr><tr><td>*</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: sender.dataenterer</p><h3>Items</h3><table class=\"grid\"><tr><td>-</td></tr><tr><td>*</td></tr></table></blockquote></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: receiverCopies</p><blockquote><p><b>item</b></p><p><b>linkId</b>: receiverCopy</p><h3>Items</h3><table class=\"grid\"><tr><td>-</td></tr><tr><td>*</td></tr><tr><td>*</td></tr><tr><td>*</td></tr><tr><td>*</td></tr><tr><td>*</td></tr><tr><td>*</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: receiverCopy</p><h3>Items</h3><table class=\"grid\"><tr><td>-</td></tr><tr><td>*</td></tr><tr><td>*</td></tr><tr><td>*</td></tr><tr><td>*</td></tr><tr><td>*</td></tr><tr><td>*</td></tr><tr><td>*</td></tr><tr><td>*</td></tr></table></blockquote></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: note</p><blockquote><p><b>item</b></p><p><b>linkId</b>: note.text</p><h3>Answers</h3><table class=\"grid\"><tr><td>-</td></tr><tr><td>*</td></tr></table></blockquote></blockquote></div>"
},
"questionnaire" : "http://fhir.ch/ig/ch-orf/Questionnaire/order-referral-form",
"status" : "completed",
"item" : [
{
"linkId" : "order",
"item" : [
{
"linkId" : "order.title",
"answer" : [
{
"valueString" : "Order-Referral-Form"
}
]
},
{
"linkId" : "order.type",
"answer" : [
{
"valueCoding" : {
"system" : "http://snomed.info/sct",
"code" : "419891008",
"display" : "Record artifact (record artifact)"
}
}
]
},
{
"linkId" : "order.category",
"answer" : [
{
"valueCoding" : {
"system" : "http://snomed.info/sct",
"code" : "721963009",
"display" : "Order (record artifact)"
}
}
]
},
{
"linkId" : "order.placerOrderIdentifier",
"answer" : [
{
"valueString" : "123"
}
]
},
{
"linkId" : "order.placerOrderIdentifierDomain",
"answer" : [
{
"valueString" : "urn:oid:2.999.1.3.4.5.6.7"
}
]
},
{
"linkId" : "order.fillerOrderIdentifier",
"answer" : [
{
"valueString" : "456"
}
]
},
{
"linkId" : "order.fillerOrderIdentifierDomain",
"answer" : [
{
"valueString" : "urn:oid:2.999.7.8.9.10.11"
}
]
},
{
"linkId" : "order.precedentDocumentIdentifier",
"answer" : [
{
"valueString" : "1622f2fb-6ba3-4532-9aed-35b158def187"
}
]
},
{
"linkId" : "order.notificationContactDocument",
"item" : [
{
"linkId" : "order.notificationContactDocument.practitioner",
"item" : [
{
"linkId" : "order.notificationContactDocument.practitioner.title",
"answer" : [
{
"valueString" : "Dr. med."
}
]
},
{
"linkId" : "order.notificationContactDocument.practitioner.familyName",
"answer" : [
{
"valueString" : "Röntgen"
}
]
},
{
"linkId" : "order.notificationContactDocument.practitioner.givenName",
"answer" : [
{
"valueString" : "Hans"
}
]
},
{
"linkId" : "order.notificationContactDocument.practitioner.phone",
"answer" : [
{
"valueString" : "044 412 00 99"
}
]
},
{
"linkId" : "order.notificationContactDocument.practitioner.email",
"answer" : [
{
"valueString" : "hans.roentgen@kantonsspital.ch"
}
]
}
]
}
]
},
{
"linkId" : "order.notificationContactDocumentResponse",
"item" : [
{
"linkId" : "order.notificationContactDocumentResponse.practitioner",
"item" : [
{
"linkId" : "order.notificationContactDocumentResponse.practitioner.title",
"answer" : [
{
"valueString" : "Dr. med."
}
]
},
{
"linkId" : "order.notificationContactDocumentResponse.practitioner.familyName",
"answer" : [
{
"valueString" : "Meier"
}
]
},
{
"linkId" : "order.notificationContactDocumentResponse.practitioner.givenName",
"answer" : [
{
"valueString" : "Sabine"
}
]
},
{
"linkId" : "order.notificationContactDocumentResponse.practitioner.phone",
"answer" : [
{
"valueString" : "044 333 22 11"
}
]
},
{
"linkId" : "order.notificationContactDocumentResponse.practitioner.email",
"answer" : [
{
"valueString" : "sabine.meier@praxisseeblick.ch"
}
]
}
]
}
]
},
{
"linkId" : "order.priority",
"answer" : [
{
"valueCoding" : {
"system" : "http://hl7.org/fhir/request-priority",
"code" : "routine"
}
}
]
}
]
},
{
"linkId" : "receiver",
"item" : [
{
"linkId" : "receiver.practitioner",
"item" : [
{
"linkId" : "receiver.practitioner.title",
"answer" : [
{
"valueString" : "Dr. med."
}
]
},
{
"linkId" : "receiver.practitioner.familyName",
"answer" : [
{
"valueString" : "Röntgen"
}
]
},
{
"linkId" : "receiver.practitioner.givenName",
"answer" : [
{
"valueString" : "Hans"
}
]
},
{
"linkId" : "receiver.practitioner.gln",
"answer" : [
{
"valueString" : "7601000066878"
}
]
},
{
"linkId" : "receiver.practitioner.phone",
"answer" : [
{
"valueString" : "044 412 00 99"
}
]
},
{
"linkId" : "receiver.practitioner.email",
"answer" : [
{
"valueString" : "hans.roentgen@kantonsspital.ch"
}
]
}
]
},
{
"linkId" : "receiver.organization",
"item" : [
{
"linkId" : "receiver.organization.name",
"answer" : [
{
"valueString" : "Kantonsspital"
}
]
},
{
"linkId" : "receiver.organization.streetAddressLine",
"answer" : [
{
"valueString" : "Kantonsstrasse 14"
},
{
"valueString" : "Postfach 14"
}
]
},
{
"linkId" : "receiver.organization.postalCode",
"answer" : [
{
"valueString" : "8000"
}
]
},
{
"linkId" : "receiver.organization.city",
"answer" : [
{
"valueString" : "Zürich"
}
]
},
{
"linkId" : "receiver.organization.country",
"answer" : [
{
"valueString" : "Schweiz"
}
]
}
]
}
]
},
{
"linkId" : "patient",
"item" : [
{
"linkId" : "patient.familyName",
"answer" : [
{
"valueString" : "Musterfrau"
}
]
},
{
"linkId" : "patient.maidenName",
"answer" : [
{
"valueString" : "Ledigname"
}
]
},
{
"linkId" : "patient.givenName",
"answer" : [
{
"valueString" : "Erika"
}
]
},
{
"linkId" : "patient.localPid",
"answer" : [
{
"valueString" : "11.22.33.4567"
}
]
},
{
"linkId" : "patient.localPidDomain",
"answer" : [
{
"valueString" : "urn:oid:2.999.1.2.3.4"
}
]
},
{
"linkId" : "patient.birthDate",
"answer" : [
{
"valueDate" : "1970-03-14"
}
]
},
{
"linkId" : "patient.gender",
"answer" : [
{
"valueCoding" : {
"system" : "http://hl7.org/fhir/administrative-gender",
"code" : "female"
}
}
]
},
{
"linkId" : "patient.phone",
"answer" : [
{
"valueString" : "079 979 79 79"
}
]
},
{
"linkId" : "patient.email",
"answer" : [
{
"valueString" : "erika@musterfrau.ch"
}
]
},
{
"linkId" : "patient.streetAddressLine",
"answer" : [
{
"valueString" : "Musterweg"
},
{
"valueString" : "6a"
}
]
},
{
"linkId" : "patient.postalCode",
"answer" : [
{
"valueString" : "8000"
}
]
},
{
"linkId" : "patient.city",
"answer" : [
{
"valueString" : "Zürich"
}
]
},
{
"linkId" : "patient.country",
"answer" : [
{
"valueString" : "Schweiz"
}
]
},
{
"linkId" : "patient.contactperson",
"item" : [
{
"linkId" : "patient.contactperson.relationship",
"answer" : [
{
"valueString" : "Guter Freund"
}
]
},
{
"linkId" : "patient.contactperson.familyName",
"answer" : [
{
"valueString" : "Freund"
}
]
},
{
"linkId" : "patient.contactperson.givenName",
"answer" : [
{
"valueString" : "Max"
}
]
},
{
"linkId" : "patient.contactperson.phone",
"answer" : [
{
"valueString" : "079 111 22 33"
}
]
},
{
"linkId" : "patient.contactperson.email",
"answer" : [
{
"valueString" : "max@freund.ch"
}
]
}
]
}
]
},
{
"linkId" : "requestedEncounter",
"item" : [
{
"linkId" : "requestedEncounter.class",
"answer" : [
{
"valueCoding" : {
"system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code" : "EMER",
"display" : "Notfall"
}
}
]
},
{
"linkId" : "requestedEncounter.desiredAccommodation",
"answer" : [
{
"valueCoding" : {
"system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code" : "SP",
"display" : "Zweierzimmer"
}
}
]
}
]
},
{
"linkId" : "coverage",
"item" : [
{
"linkId" : "coverage.kvg",
"item" : [
{
"linkId" : "coverage.kvg.name",
"answer" : [
{
"valueString" : "Sanitas"
}
]
},
{
"linkId" : "coverage.kvg.insuranceCardNumber",
"answer" : [
{
"valueString" : "80756015090002647590"
}
]
}
]
}
]
},
{
"linkId" : "sender",
"item" : [
{
"linkId" : "sender.author",
"item" : [
{
"linkId" : "sender.author.practitioner",
"item" : [
{
"linkId" : "sender.author.practitioner.title",
"answer" : [
{
"valueString" : "Dr. med."
}
]
},
{
"linkId" : "sender.author.practitioner.familyName",
"answer" : [
{
"valueString" : "Meier"
}
]
},
{
"linkId" : "sender.author.practitioner.givenName",
"answer" : [
{
"valueString" : "Sabine"
}
]
},
{
"linkId" : "sender.author.practitioner.gln",
"answer" : [
{
"valueString" : "7601000034321"
}
]
},
{
"linkId" : "sender.author.practitioner.phone",
"answer" : [
{
"valueString" : "044 333 22 11"
}
]
},
{
"linkId" : "sender.author.practitioner.email",
"answer" : [
{
"valueString" : "sabine.meier@praxisseeblick.ch"
}
]
}
]
},
{
"linkId" : "sender.author.organization",
"item" : [
{
"linkId" : "sender.author.organization.name",
"answer" : [
{
"valueString" : "Praxis Seeblick"
}
]
},
{
"linkId" : "sender.author.organization.streetAddressLine",
"answer" : [
{
"valueString" : "Seestrasse 133"
},
{
"valueString" : "Haus C"
}
]
},
{
"linkId" : "sender.author.organization.postalCode",
"answer" : [
{
"valueString" : "8000"
}
]
},
{
"linkId" : "sender.author.organization.city",
"answer" : [
{
"valueString" : "Zürich"
}
]
},
{
"linkId" : "sender.author.organization.country",
"answer" : [
{
"valueString" : "Schweiz"
}
]
}
]
}
]
},
{
"linkId" : "sender.dataenterer",
"item" : [
{
"linkId" : "sender.dataenterer.practitioner",
"item" : [
{
"linkId" : "sender.dataenterer.practitioner.familyName",
"answer" : [
{
"valueString" : "Boss"
}
]
},
{
"linkId" : "sender.dataenterer.practitioner.givenName",
"answer" : [
{
"valueString" : "Stabilo"
}
]
},
{
"linkId" : "sender.dataenterer.practitioner.phone",
"answer" : [
{
"valueString" : "044 333 22 12"
}
]
},
{
"linkId" : "sender.dataenterer.practitioner.email",
"answer" : [
{
"valueString" : "stabilo.boss@praxisseeblick.ch"
}
]
}
]
}
]
}
]
},
{
"linkId" : "receiverCopies",
"item" : [
{
"linkId" : "receiverCopy",
"item" : [
{
"linkId" : "receiverCopy.organization.name",
"answer" : [
{
"valueString" : "Praxis Seeblick"
}
]
},
{
"linkId" : "receiverCopy.title",
"answer" : [
{
"valueString" : "Dr. med."
}
]
},
{
"linkId" : "receiverCopy.familyName",
"answer" : [
{
"valueString" : "Meier"
}
]
},
{
"linkId" : "receiverCopy.givenName",
"answer" : [
{
"valueString" : "Sabine"
}
]
},
{
"linkId" : "receiverCopy.phone",
"answer" : [
{
"valueString" : "044 333 22 11"
}
]
},
{
"linkId" : "receiverCopy.email",
"answer" : [
{
"valueString" : "sabine.meier@praxisseeblick.ch"
}
]
}
]
},
{
"linkId" : "receiverCopy",
"item" : [
{
"linkId" : "receiverCopy.familyName",
"answer" : [
{
"valueString" : "Musterfrau"
}
]
},
{
"linkId" : "receiverCopy.givenName",
"answer" : [
{
"valueString" : "Erika"
}
]
},
{
"linkId" : "receiverCopy.phone",
"answer" : [
{
"valueString" : "079 979 79 79"
}
]
},
{
"linkId" : "receiverCopy.email",
"answer" : [
{
"valueString" : "erika@musterfrau.ch"
}
]
},
{
"linkId" : "receiverCopy.streetAddressLine",
"answer" : [
{
"valueString" : "Musterweg"
},
{
"valueString" : "6a"
}
]
},
{
"linkId" : "receiverCopy.postalCode",
"answer" : [
{
"valueString" : "8000"
}
]
},
{
"linkId" : "receiverCopy.city",
"answer" : [
{
"valueString" : "Zürich"
}
]
},
{
"linkId" : "receiverCopy.country",
"answer" : [
{
"valueString" : "Schweiz"
}
]
}
]
}
]
},
{
"linkId" : "note",
"item" : [
{
"linkId" : "note.text",
"answer" : [
{
"valueString" : "Bemerkung/Kommentar"
}
]
}
]
}
]
}