Generated Narrative: Questionnaire 4-sepsis version: 1; Last updated: 2019-04-01 20:17:53+0000 Profiles: CH ORF Questionnaire, SDCBaseQuestionnaire, Extractable Questionnaire - StructureMap Structure LinkID Text Cardinality Type Flags Description & Constraints<img src="[binary]" alt="doco" style="background-color: inherit"/> LabOrderFormExample Questionnaire http://fhir.ch/ig/ch-lab-order/Questionnaire/4-sepsis#3.0.0-ballot order Auftrag 1..1 group order.placerOrderIdentifier Auftragsnummer des Auftraggebers 0..1 string order.placerOrderIdentifierDomain Identifier Domain der Auftragsnummer des Auftraggebers 0..1 string order.fillerOrderIdentifier Auftragsnummer des Auftragsempfängers 0..1 string order.fillerOrderIdentifierDomain Identifier Domain der Auftragsnummer des Auftragsempfängers 0..1 string order.precedentDocumentIdentifier Identifier des Vorgängerdokuments 0..1 string order.notificationContactDocument Dringender Benachrichtigungskontakt für dieses Dokument 0..1 group order.notificationContactDocument.practitioner Zu benachrichtigende Person 0..1 group order.notificationContactDocument.practitioner.title Titel 0..1 string order.notificationContactDocument.practitioner.familyName Name 0..1 string order.notificationContactDocument.practitioner.givenName Vorname 0..1 string order.notificationContactDocument.practitioner.phone Telefon 0..1 string order.notificationContactDocument.practitioner.email E-Mail 0..1 string order.notificationContactDocumentResponse Dringender Benachrichtigungskontakt für die Antwort auf dieses Dokument 0..1 group order.notificationContactDocumentResponse.practitioner Zu benachrichtigende Person 0..1 group order.notificationContactDocumentResponse.practitioner.title Titel 0..1 string order.notificationContactDocumentResponse.practitioner.familyName Name 0..1 string order.notificationContactDocumentResponse.practitioner.givenName Vorname 0..1 string order.notificationContactDocumentResponse.practitioner.phone Telefon 0..1 string order.notificationContactDocumentResponse.practitioner.email E-Mail 0..1 string order.priority Auftragspriorität 0..1 choice Options: 4 options receiver Empfänger 0..1 group receiver.practitioner Empfangende Person 0..1 group receiver.practitioner.title Titel 0..1 string receiver.practitioner.familyName Name 0..1 string receiver.practitioner.givenName Vorname 0..1 string receiver.practitioner.gln GLN 0..1 string receiver.practitioner.zsr ZSR 0..1 string receiver.practitioner.phone Telefon 0..1 string receiver.practitioner.email E-Mail 0..1 string receiver.organization Empfangende Organisation 0..1 group receiver.organization.name Name der Organisation 0..1 string receiver.organization.gln GLN 0..1 string Definition: receiver.organization.streetAddressLine Strasse, Hausnummer, Postfach etc. 0..* string receiver.organization.postalCode PLZ 0..1 string receiver.organization.city Ort 0..1 string receiver.organization.country Land 0..1 string patient Patient 1..1 group patient.familyName Name 0..1 string patient.maidenName Ledigname 0..1 string patient.givenName Vorname 0..1 string patient.localPid Lokale Patienten-ID 0..1 string patient.birthDate Geburtsdatum 0..1 date patient.gender Geschlecht 0..1 choice Options: 3 options patient.maritalStatus Zivilstand 0..1 choice Definition: Patient.maritalStatus Options: 8 options patient.phone Telefon 0..1 string patient.email E-Mail 0..1 string patient.streetAddressLine Strasse, Hausnummer, Postfach etc. 0..* string patient.postalCode PLZ 0..1 string patient.city Ort 0..1 string patient.country Land 0..1 string patient.languageOfCorrespondance Korrespondenssprache 0..1 choice Definition: Patient.communication:languageOfCorrespondance Value Set: DocumentEntry.languageCode patient.contactperson Kontaktperson 0..1 group Definition: Patient.contact patient.contactperson.relationship Beziehung 0..1 string Definition: Patient.contact.relationship.text patient.contactperson.familyName Name 0..1 string Definition: Patient.contact.name.family patient.contactperson.givenName Vorname 0..1 string Definition: Patient.contact.name.given patient.contactperson.phone Telefon 0..* string Definition: Patient.contact.telecom.value patient.contactperson.email E-Mail 0..1 string Definition: Patient.contact.telecom.value sender Absender 1..1 group sender.author Verantwortlicher 1..1 group sender.author.practitioner Verantwortliche Person 0..1 group sender.author.practitioner.title Titel 0..1 string sender.author.practitioner.familyName Name 0..1 string sender.author.practitioner.givenName Vorname 0..1 string sender.author.practitioner.gln GLN 0..1 string sender.author.practitioner.zsr ZSR 0..1 string sender.author.practitioner.phone Telefon 0..1 string sender.author.practitioner.email E-Mail 0..1 string sender.author.organization Verantwortliche Organisation 0..1 group sender.author.organization.name Name der Organisation 0..1 string sender.author.organization.streetAddressLine Strasse, Hausnummer, Postfach etc. 0..* string sender.author.organization.postalCode PLZ 0..1 string sender.author.organization.city Ort 0..1 string sender.author.organization.country Land 0..1 string sender.dataenterer Erfasser 0..1 group sender.dataenterer.practitioner Erfassende Person 0..1 group sender.dataenterer.practitioner.familyName Name 0..1 string sender.dataenterer.practitioner.givenName Vorname 0..1 string sender.dataenterer.practitioner.phone Telefon 0..1 string sender.dataenterer.practitioner.email E-Mail 0..1 string receiverCopies Kopieempfänger 0..1 group receiverCopy Kopieempfangende Organisation oder Person 0..* group Definition: PractitionerRole receiverCopy.organization.name Name der Organisation 0..1 string Definition: PractitionerRole.practitioner receiverCopy.practitionerRole.practitioner.title Titel 0..1 string Definition: HumanName.prefix receiverCopy.practitionerRole.practitioner.familyName Name 0..1 string Definition: HumanName.family receiverCopy.practitionerRole.practitioner.givenName Vorname 0..1 string Definition: HumanName.given receiverCopy.practitionerRole.practitioner.phone Telefon 0..1 string Definition: ContactPoint.value receiverCopy.practitionerRole.practitioner.email E-Mail 0..1 string Definition: ContactPoint.value receiverCopy.title Titel 0..1 string Definition: PractitionerRole.organization receiverCopy.practitionerRole.organization.name Name der Organisation 0..1 string Definition: Organization.name receiverCopy.practitionerRole.organization.streetAddressLine Strasse, Hausnummer, Postfach etc. 0..* string Definition: Address.line receiverCopy.practitionerRole.organization.postalCode PLZ 0..1 string Definition: Address.postalCode receiverCopy.practitionerRole.organization.city Ort 0..1 string Definition: Address.city receiverCopy.practitionerRole.organization.country Land 0..1 string Definition: Address.country receiverCopy.familyName Name 0..1 string receiverCopy.givenName Vorname 0..1 string receiverCopy.phone Telefon 0..1 string receiverCopy.email E-Mail 0..1 string receiverCopy.streetAddressLine Strasse, Hausnummer, Postfach etc. 0..* string receiverCopy.postalCode PLZ 0..1 string receiverCopy.city Ort 0..1 string receiverCopy.country Land 0..1 string receiverCopy.patient Patient selbst 0..1 boolean Definition: Patient receiverCopy.relatedPerson Andere Person 0..* group Definition: RelatedPerson receiverCopy.relatedPerson.familyName Name 0..1 string Definition: RelatedPerson.name.family receiverCopy.relatedPerson.givenName Vorame 0..1 string Definition: RelatedPerson.name.given receiverCopy.relatedPerson.phone Telefon 0..* string Definition: RelatedPerson.telecom.value receiverCopy.relatedPerson.email E-Mail 0..1 string Definition: RelatedPerson.telecom.value receiverCopy.relatedPerson.streetAddressLine Strasse, Hausnummer, Postfach etc. 0..* string Definition: RelatedPerson.address.line receiverCopy.relatedPerson.postalCode PLZ 0..1 string Definition: RelatedPerson.address.postalCode receiverCopy.relatedPerson.city Ort 0..1 string Definition: RelatedPerson.address.city receiverCopy.relatedPerson.country Land 0..1 string Definition: RelatedPerson.address.country consent Einverständniserklärung 0..1 group Definition: ServiceRequest.supportingInfo consent.treatment Einverständnis des Patienten zur Behandlung 0..1 string consent.patientPrivacy Einverständnis des Patienten zum Datenschutz 0..1 string consent.research Einverständnis des Patienten zur Forschung 0..1 string consent.advancedCareDirective Patientenverfügung 0..1 string coverage Kostenträger 0..1 group Definition: insurance coverage.uvg Unfallversicherung (nach UVG) 0..1 string coverage.kvg Grundversicherung (nach KVG) 0..1 string coverage.vvg Zusatzversicherung (nach VVG) 0..1 string coverage.vvgOther Andere (nach VVG) 0..1 string previousResult Vorheriges Untersuchungsresultat 0..1 group Definition: ServiceRequest.supportingInfo previousResult.result Untersuchungsresultat 0..* string hematology Hematology 0..1 group lab Laborwerte 0..* choice Options: 5 options microbiology Mikrobiologie 0..1 group culture Blood by Culture 0..* choice Options: 1 option id-susc Bacterial Identification and Susceptibility 0..* choice Options: 1 option cc clinical chemistry 0..1 group crp CRP 0..* choice Options: 4 options <img src="[binary]" alt="doco" style="background-color: inherit"/> Documentation for this format Options Sets Answer options for order.priority http://hl7.org/fhir/request-priority#routine ("Routine") http://hl7.org/fhir/request-priority#urgent ("Urgent") http://hl7.org/fhir/request-priority#asap ("ASAP") http://hl7.org/fhir/request-priority#stat ("STAT") Answer options for patient.gender http://hl7.org/fhir/administrative-gender#male ("Male") http://hl7.org/fhir/administrative-gender#female ("Female") http://hl7.org/fhir/administrative-gender#other ("Other") Answer options for patient.maritalStatus http://fhir.ch/ig/ch-core/CodeSystem/ech-11-maritalstatus#1 ("ledig") http://fhir.ch/ig/ch-core/CodeSystem/ech-11-maritalstatus#2 ("verheiratet") http://fhir.ch/ig/ch-core/CodeSystem/ech-11-maritalstatus#3 ("verwitwet") http://fhir.ch/ig/ch-core/CodeSystem/ech-11-maritalstatus#4 ("geschieden") http://fhir.ch/ig/ch-core/CodeSystem/ech-11-maritalstatus#5 ("unverheiratet") http://fhir.ch/ig/ch-core/CodeSystem/ech-11-maritalstatus#6 ("in eingetragener Partnerschaft") http://fhir.ch/ig/ch-core/CodeSystem/ech-11-maritalstatus#7 ("aufgelöste Partnerschaft") http://fhir.ch/ig/ch-core/CodeSystem/ech-11-maritalstatus#9 ("unbekannt") Answer options for lab http://loinc.org#24360-0 ("Hemoglobin and Hematocrit panel - Blood") http://loinc.org#43113-0 ("Hemoglobin electrophoresis panel in Blood") http://loinc.org#57021-8 ("CBC W Auto Differential panel - Blood") http://loinc.org#58410-2 ("CBC panel - Blood by Automated count") http://loinc.org#57021-8 ("CBC W Auto Differential panel - Blood") Answer options for culture http://loinc.org#90423-5 ("Microorganism preliminary growth detection panel - Blood by Culture") Answer options for id-susc http://loinc.org#85421-6 ("Bacterial identification and susceptibility panel - Isolate") Answer options for crp http://loinc.org#1988-5 ("C reactive protein [Mass/Volume] in Serum or Plasma") http://loinc.org#76485-2 ("C reactive protein [Moles/volume] in Serum or Plasma") http://loinc.org#30522-7 ("C reactive protein [Mass/volume] in Serum or Plasma by High sensitivity method") http://loinc.org#76486-0 ("C reactive protein [Moles/volume] in Serum or Plasma by High sensitivity method")
The practitioner that is to be used to pre-populate the form
Identifier Domain der Auftragsnummer des Auftraggebers
Identifier Domain der Auftragsnummer des Auftragsempfängers
Dringender Benachrichtigungskontakt für dieses Dokument
Dringender Benachrichtigungskontakt für die Antwort auf dieses Dokument
Kopieempfangende Organisation oder Person
Einverständnis des Patienten zur Behandlung
Einverständnis des Patienten zum Datenschutz
Einverständnis des Patienten zur Forschung
Hemoglobin electrophoresis panel in Blood
Microorganism preliminary growth detection panel - Blood by Culture
Bacterial Identification and Susceptibility
Bacterial identification and susceptibility panel - Isolate
C reactive protein [Mass/Volume] in Serum or Plasma
C reactive protein [Moles/volume] in Serum or Plasma
C reactive protein [Mass/volume] in Serum or Plasma by High sensitivity method
C reactive protein [Moles/volume] in Serum or Plasma by High sensitivity method