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 
<QuestionnaireResponse xmlns="http://hl7.org/fhir">
<id value="order-referral-form-mappedback"/>
<text>
<status value="generated"/>
<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>
</text>
<questionnaire
value="http://fhir.ch/ig/ch-orf/Questionnaire/order-referral-form"/>
<status value="completed"/>
<item>
<linkId value="order"/>
<item>
<linkId value="order.title"/>
<answer>
<valueString value="Order-Referral-Form"/>
</answer>
</item>
<item>
<linkId value="order.type"/>
<answer>
<valueCoding>
<system value="http://snomed.info/sct"/>
<code value="419891008"/>
<display value="Record artifact (record artifact)"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="order.category"/>
<answer>
<valueCoding>
<system value="http://snomed.info/sct"/>
<code value="721963009"/>
<display value="Order (record artifact)"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="order.placerOrderIdentifier"/>
<answer>
<valueString value="123"/>
</answer>
</item>
<item>
<linkId value="order.placerOrderIdentifierDomain"/>
<answer>
<valueString value="urn:oid:2.999.1.3.4.5.6.7"/>
</answer>
</item>
<item>
<linkId value="order.fillerOrderIdentifier"/>
<answer>
<valueString value="456"/>
</answer>
</item>
<item>
<linkId value="order.fillerOrderIdentifierDomain"/>
<answer>
<valueString value="urn:oid:2.999.7.8.9.10.11"/>
</answer>
</item>
<item>
<linkId value="order.precedentDocumentIdentifier"/>
<answer>
<valueString value="1622f2fb-6ba3-4532-9aed-35b158def187"/>
</answer>
</item>
<item>
<linkId value="order.notificationContactDocument"/>
<item>
<linkId value="order.notificationContactDocument.practitioner"/>
<item>
<linkId value="order.notificationContactDocument.practitioner.title"/>
<answer>
<valueString value="Dr. med."/>
</answer>
</item>
<item>
<linkId
value="order.notificationContactDocument.practitioner.familyName"/>
<answer>
<valueString value="Röntgen"/>
</answer>
</item>
<item>
<linkId
value="order.notificationContactDocument.practitioner.givenName"/>
<answer>
<valueString value="Hans"/>
</answer>
</item>
<item>
<linkId value="order.notificationContactDocument.practitioner.phone"/>
<answer>
<valueString value="044 412 00 99"/>
</answer>
</item>
<item>
<linkId value="order.notificationContactDocument.practitioner.email"/>
<answer>
<valueString value="hans.roentgen@kantonsspital.ch"/>
</answer>
</item>
</item>
</item>
<item>
<linkId value="order.notificationContactDocumentResponse"/>
<item>
<linkId value="order.notificationContactDocumentResponse.practitioner"/>
<item>
<linkId
value="order.notificationContactDocumentResponse.practitioner.title"/>
<answer>
<valueString value="Dr. med."/>
</answer>
</item>
<item>
<linkId
value="order.notificationContactDocumentResponse.practitioner.familyName"/>
<answer>
<valueString value="Meier"/>
</answer>
</item>
<item>
<linkId
value="order.notificationContactDocumentResponse.practitioner.givenName"/>
<answer>
<valueString value="Sabine"/>
</answer>
</item>
<item>
<linkId
value="order.notificationContactDocumentResponse.practitioner.phone"/>
<answer>
<valueString value="044 333 22 11"/>
</answer>
</item>
<item>
<linkId
value="order.notificationContactDocumentResponse.practitioner.email"/>
<answer>
<valueString value="sabine.meier@praxisseeblick.ch"/>
</answer>
</item>
</item>
</item>
<item>
<linkId value="order.priority"/>
<answer>
<valueCoding>
<system value="http://hl7.org/fhir/request-priority"/>
<code value="routine"/>
</valueCoding>
</answer>
</item>
</item>
<item>
<linkId value="receiver"/>
<item>
<linkId value="receiver.practitioner"/>
<item>
<linkId value="receiver.practitioner.title"/>
<answer>
<valueString value="Dr. med."/>
</answer>
</item>
<item>
<linkId value="receiver.practitioner.familyName"/>
<answer>
<valueString value="Röntgen"/>
</answer>
</item>
<item>
<linkId value="receiver.practitioner.givenName"/>
<answer>
<valueString value="Hans"/>
</answer>
</item>
<item>
<linkId value="receiver.practitioner.gln"/>
<answer>
<valueString value="7601000066878"/>
</answer>
</item>
<item>
<linkId value="receiver.practitioner.phone"/>
<answer>
<valueString value="044 412 00 99"/>
</answer>
</item>
<item>
<linkId value="receiver.practitioner.email"/>
<answer>
<valueString value="hans.roentgen@kantonsspital.ch"/>
</answer>
</item>
</item>
<item>
<linkId value="receiver.organization"/>
<item>
<linkId value="receiver.organization.name"/>
<answer>
<valueString value="Kantonsspital"/>
</answer>
</item>
<item>
<linkId value="receiver.organization.streetAddressLine"/>
<answer>
<valueString value="Kantonsstrasse 14"/>
</answer>
<answer>
<valueString value="Postfach 14"/>
</answer>
</item>
<item>
<linkId value="receiver.organization.postalCode"/>
<answer>
<valueString value="8000"/>
</answer>
</item>
<item>
<linkId value="receiver.organization.city"/>
<answer>
<valueString value="Zürich"/>
</answer>
</item>
<item>
<linkId value="receiver.organization.country"/>
<answer>
<valueString value="Schweiz"/>
</answer>
</item>
</item>
</item>
<item>
<linkId value="patient"/>
<item>
<linkId value="patient.familyName"/>
<answer>
<valueString value="Musterfrau"/>
</answer>
</item>
<item>
<linkId value="patient.maidenName"/>
<answer>
<valueString value="Ledigname"/>
</answer>
</item>
<item>
<linkId value="patient.givenName"/>
<answer>
<valueString value="Erika"/>
</answer>
</item>
<item>
<linkId value="patient.localPid"/>
<answer>
<valueString value="11.22.33.4567"/>
</answer>
</item>
<item>
<linkId value="patient.localPidDomain"/>
<answer>
<valueString value="urn:oid:2.999.1.2.3.4"/>
</answer>
</item>
<item>
<linkId value="patient.birthDate"/>
<answer>
<valueDate value="1970-03-14"/>
</answer>
</item>
<item>
<linkId value="patient.gender"/>
<answer>
<valueCoding>
<system value="http://hl7.org/fhir/administrative-gender"/>
<code value="female"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="patient.phone"/>
<answer>
<valueString value="079 979 79 79"/>
</answer>
</item>
<item>
<linkId value="patient.email"/>
<answer>
<valueString value="erika@musterfrau.ch"/>
</answer>
</item>
<item>
<linkId value="patient.streetAddressLine"/>
<answer>
<valueString value="Musterweg"/>
</answer>
<answer>
<valueString value="6a"/>
</answer>
</item>
<item>
<linkId value="patient.postalCode"/>
<answer>
<valueString value="8000"/>
</answer>
</item>
<item>
<linkId value="patient.city"/>
<answer>
<valueString value="Zürich"/>
</answer>
</item>
<item>
<linkId value="patient.country"/>
<answer>
<valueString value="Schweiz"/>
</answer>
</item>
<item>
<linkId value="patient.contactperson"/>
<item>
<linkId value="patient.contactperson.relationship"/>
<answer>
<valueString value="Guter Freund"/>
</answer>
</item>
<item>
<linkId value="patient.contactperson.familyName"/>
<answer>
<valueString value="Freund"/>
</answer>
</item>
<item>
<linkId value="patient.contactperson.givenName"/>
<answer>
<valueString value="Max"/>
</answer>
</item>
<item>
<linkId value="patient.contactperson.phone"/>
<answer>
<valueString value="079 111 22 33"/>
</answer>
</item>
<item>
<linkId value="patient.contactperson.email"/>
<answer>
<valueString value="max@freund.ch"/>
</answer>
</item>
</item>
</item>
<item>
<linkId value="requestedEncounter"/>
<item>
<linkId value="requestedEncounter.class"/>
<answer>
<valueCoding>
<system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
<code value="EMER"/>
<display value="Notfall"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="requestedEncounter.desiredAccommodation"/>
<answer>
<valueCoding>
<system value="http://terminology.hl7.org/CodeSystem/v3-ActCode"/>
<code value="SP"/>
<display value="Zweierzimmer"/>
</valueCoding>
</answer>
</item>
</item>
<item>
<linkId value="coverage"/>
<item>
<linkId value="coverage.kvg"/>
<item>
<linkId value="coverage.kvg.name"/>
<answer>
<valueString value="Sanitas"/>
</answer>
</item>
<item>
<linkId value="coverage.kvg.insuranceCardNumber"/>
<answer>
<valueString value="80756015090002647590"/>
</answer>
</item>
</item>
</item>
<item>
<linkId value="sender"/>
<item>
<linkId value="sender.author"/>
<item>
<linkId value="sender.author.practitioner"/>
<item>
<linkId value="sender.author.practitioner.title"/>
<answer>
<valueString value="Dr. med."/>
</answer>
</item>
<item>
<linkId value="sender.author.practitioner.familyName"/>
<answer>
<valueString value="Meier"/>
</answer>
</item>
<item>
<linkId value="sender.author.practitioner.givenName"/>
<answer>
<valueString value="Sabine"/>
</answer>
</item>
<item>
<linkId value="sender.author.practitioner.gln"/>
<answer>
<valueString value="7601000034321"/>
</answer>
</item>
<item>
<linkId value="sender.author.practitioner.phone"/>
<answer>
<valueString value="044 333 22 11"/>
</answer>
</item>
<item>
<linkId value="sender.author.practitioner.email"/>
<answer>
<valueString value="sabine.meier@praxisseeblick.ch"/>
</answer>
</item>
</item>
<item>
<linkId value="sender.author.organization"/>
<item>
<linkId value="sender.author.organization.name"/>
<answer>
<valueString value="Praxis Seeblick"/>
</answer>
</item>
<item>
<linkId value="sender.author.organization.streetAddressLine"/>
<answer>
<valueString value="Seestrasse 133"/>
</answer>
<answer>
<valueString value="Haus C"/>
</answer>
</item>
<item>
<linkId value="sender.author.organization.postalCode"/>
<answer>
<valueString value="8000"/>
</answer>
</item>
<item>
<linkId value="sender.author.organization.city"/>
<answer>
<valueString value="Zürich"/>
</answer>
</item>
<item>
<linkId value="sender.author.organization.country"/>
<answer>
<valueString value="Schweiz"/>
</answer>
</item>
</item>
</item>
<item>
<linkId value="sender.dataenterer"/>
<item>
<linkId value="sender.dataenterer.practitioner"/>
<item>
<linkId value="sender.dataenterer.practitioner.familyName"/>
<answer>
<valueString value="Boss"/>
</answer>
</item>
<item>
<linkId value="sender.dataenterer.practitioner.givenName"/>
<answer>
<valueString value="Stabilo"/>
</answer>
</item>
<item>
<linkId value="sender.dataenterer.practitioner.phone"/>
<answer>
<valueString value="044 333 22 12"/>
</answer>
</item>
<item>
<linkId value="sender.dataenterer.practitioner.email"/>
<answer>
<valueString value="stabilo.boss@praxisseeblick.ch"/>
</answer>
</item>
</item>
</item>
</item>
<item>
<linkId value="receiverCopies"/>
<item>
<linkId value="receiverCopy"/>
<item>
<linkId value="receiverCopy.organization.name"/>
<answer>
<valueString value="Praxis Seeblick"/>
</answer>
</item>
<item>
<linkId value="receiverCopy.title"/>
<answer>
<valueString value="Dr. med."/>
</answer>
</item>
<item>
<linkId value="receiverCopy.familyName"/>
<answer>
<valueString value="Meier"/>
</answer>
</item>
<item>
<linkId value="receiverCopy.givenName"/>
<answer>
<valueString value="Sabine"/>
</answer>
</item>
<item>
<linkId value="receiverCopy.phone"/>
<answer>
<valueString value="044 333 22 11"/>
</answer>
</item>
<item>
<linkId value="receiverCopy.email"/>
<answer>
<valueString value="sabine.meier@praxisseeblick.ch"/>
</answer>
</item>
</item>
<item>
<linkId value="receiverCopy"/>
<item>
<linkId value="receiverCopy.familyName"/>
<answer>
<valueString value="Musterfrau"/>
</answer>
</item>
<item>
<linkId value="receiverCopy.givenName"/>
<answer>
<valueString value="Erika"/>
</answer>
</item>
<item>
<linkId value="receiverCopy.phone"/>
<answer>
<valueString value="079 979 79 79"/>
</answer>
</item>
<item>
<linkId value="receiverCopy.email"/>
<answer>
<valueString value="erika@musterfrau.ch"/>
</answer>
</item>
<item>
<linkId value="receiverCopy.streetAddressLine"/>
<answer>
<valueString value="Musterweg"/>
</answer>
<answer>
<valueString value="6a"/>
</answer>
</item>
<item>
<linkId value="receiverCopy.postalCode"/>
<answer>
<valueString value="8000"/>
</answer>
</item>
<item>
<linkId value="receiverCopy.city"/>
<answer>
<valueString value="Zürich"/>
</answer>
</item>
<item>
<linkId value="receiverCopy.country"/>
<answer>
<valueString value="Schweiz"/>
</answer>
</item>
</item>
</item>
<item>
<linkId value="note"/>
<item>
<linkId value="note.text"/>
<answer>
<valueString value="Bemerkung/Kommentar"/>
</answer>
</item>
</item>
</QuestionnaireResponse>