Universal API Implementation Guide
1.1.19 - ci-build
Universal API Implementation Guide - Local Development build (v1.1.19). See the Directory of published versions
| Active as of 2024-02-19 |
@prefix fhir: <http://hl7.org/fhir/> .
@prefix owl: <http://www.w3.org/2002/07/owl#> .
@prefix rdfs: <http://www.w3.org/2000/01/rdf-schema#> .
@prefix xsd: <http://www.w3.org/2001/XMLSchema#> .
# - resource -------------------------------------------------------------------
a fhir:Questionnaire;
fhir:nodeRole fhir:treeRoot;
fhir:Resource.id [ fhir:value "questionnaireAlecensa"];
fhir:DomainResource.text [
fhir:Narrative.status [ fhir:value "generated" ];
fhir:Narrative.div "<div xmlns=\"http://www.w3.org/1999/xhtml\"><table border=\"1\" cellpadding=\"0\" cellspacing=\"0\" style=\"border: 1px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;\"><tr style=\"border: 2px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top\"><th style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://build.fhir.org/formats.html#table\" title=\"The linkId for the item\">LinkId</a></th><th style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://build.fhir.org/formats.html#table\" title=\"Text for the item\">Text</a></th><th style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://build.fhir.org/formats.html#table\" title=\"Minimum and Maximum # of times the the itemcan appear in the instance\">Cardinality</a></th><th style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://build.fhir.org/formats.html#table\" title=\"The type of the item\">Type</a></th><th style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://build.fhir.org/formats.html#table\" title=\"Additional information about the item\">Description & Constraints</a><span style=\"float: right\"><a href=\"http://build.fhir.org/formats.html#table\" title=\"Legend for this format\"><img src=\"http://build.fhir.org/help16.png\" alt=\"doco\" style=\"background-color: inherit\"/></a></span></th></tr><tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_q_root.gif\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"QuestionnaireRoot\" class=\"hierarchy\"/> Alecensa</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Example of questionnaire to be filled out when submitting enrollment bundle for product Alecensa.</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Questionnaire</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">https://fhir.developer.gene.com/Questionnaire/questionnaireAlecensa#1.1.19</td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)\" id=\"item.applied-for-bipa\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-boolean.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Boolean\" class=\"hierarchy\"/> applied-for-bipa</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">BIPA Service Request Applied?</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://build.fhir.org/codesystem-item-type.html#item-type-boolean\">boolean</a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)\" id=\"item.applied-for-starter\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-boolean.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Boolean\" class=\"hierarchy\"/> applied-for-starter</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Starter Service Request Applied?</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://build.fhir.org/codesystem-item-type.html#item-type-boolean\">boolean</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)\" id=\"item.applied-for-copay\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-boolean.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Boolean\" class=\"hierarchy\"/> applied-for-copay</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Copay Service Request Applied?</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://build.fhir.org/codesystem-item-type.html#item-type-boolean\">boolean</a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)\" id=\"item.applied-for-appeals\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-boolean.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Boolean\" class=\"hierarchy\"/> applied-for-appeals</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Appeals Service Request Applied?</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://build.fhir.org/codesystem-item-type.html#item-type-boolean\">boolean</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)\" id=\"item.applied-for-pf\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-boolean.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Boolean\" class=\"hierarchy\"/> applied-for-pf</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Patient Foundation Service Request Applied?</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://build.fhir.org/codesystem-item-type.html#item-type-boolean\">boolean</a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)\" id=\"item.alecensa-nsclc\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Coding\" class=\"hierarchy\"/> alecensa-nsclc</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Metastatic non-small cell lung cancer (NSCLC)?</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://build.fhir.org/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <ul><li><a href=\"#item.applied-for-copay\">applied-for-copay</a> = true</li><li><a href=\"#item.applied-for-starter\">applied-for-starter</a> = true</li></ul></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)\" id=\"item.contact-patient\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-boolean.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Boolean\" class=\"hierarchy\"/> contact-patient</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Do not contact patient</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://build.fhir.org/codesystem-item-type.html#item-type-boolean\">boolean</a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)\" id=\"item.alecensa-confirmed-positive-alk\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Coding\" class=\"hierarchy\"/> alecensa-confirmed-positive-alk</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Confirmed positive for anaplastic lymphoma kinase (ALK)?</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://build.fhir.org/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <ul><li><a href=\"#item.applied-for-copay\">applied-for-copay</a> = true</li><li><a href=\"#item.applied-for-starter\">applied-for-starter</a> = true</li></ul></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)\" id=\"item.prescription-plan\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-boolean.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Boolean\" class=\"hierarchy\"/> prescription-plan</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Is this a Prescription plan?</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://build.fhir.org/codesystem-item-type.html#item-type-boolean\">boolean</a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)\" id=\"item.treatment-started\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-boolean.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Boolean\" class=\"hierarchy\"/> treatment-started</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Has treatment started?</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://build.fhir.org/codesystem-item-type.html#item-type-boolean\">boolean</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <ul><li><a href=\"#item.applied-for-copay\">applied-for-copay</a> = true</li><li><a href=\"#item.applied-for-starter\">applied-for-starter</a> = true</li></ul></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)\" id=\"item.prior-auth\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-boolean.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Boolean\" class=\"hierarchy\"/> prior-auth</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Is prior authorization in place?</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://build.fhir.org/codesystem-item-type.html#item-type-boolean\">boolean</a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <ul><li><a href=\"#item.applied-for-bipa\">applied-for-bipa</a> = true</li><li><a href=\"#item.applied-for-starter\">applied-for-starter</a> = true</li></ul></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)\" id=\"item.auth\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-boolean.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Boolean\" class=\"hierarchy\"/> auth</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Authorization #</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://build.fhir.org/codesystem-item-type.html#item-type-boolean\">boolean</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.prior-auth\">prior-auth</a> = true</span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)\" id=\"item.alecensa-drug-allergies\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"String\" class=\"hierarchy\"/> alecensa-drug-allergies</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Drug Allergies?</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://build.fhir.org/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.applied-for-pf\">applied-for-pf</a> = true</span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)\" id=\"item.alecensa-other-drug-allergies\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"String\" class=\"hierarchy\"/> alecensa-other-drug-allergies</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Other Drug Allergies?</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://build.fhir.org/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.alecensa-drug-allergies\">alecensa-drug-allergies</a> = Other</span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)\" id=\"item.alecensa-other-prescription\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"String\" class=\"hierarchy\"/> alecensa-other-prescription</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Other Medicines Prescribed</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://build.fhir.org/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.applied-for-pf\">applied-for-pf</a> = true</span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)\" id=\"item.shipment-options\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"String\" class=\"hierarchy\"/> shipment-options</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Shipment Options</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://build.fhir.org/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.applied-for-pf\">applied-for-pf</a> = true</span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)\" id=\"item.ship-to\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"String\" class=\"hierarchy\"/> ship-to</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Ship To</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://build.fhir.org/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <ul><li><a href=\"#item.applied-for-pf\">applied-for-pf</a> = true</li><li><a href=\"#item.applied-for-starter\">applied-for-starter</a> = true</li></ul></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)\" id=\"item.re-verify-benefits\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Coding\" class=\"hierarchy\"/> re-verify-benefits</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Re-verify benefits at PA expiration</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://build.fhir.org/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <ul><li><a href=\"#item.applied-for-bipa\">applied-for-bipa</a> = true</li><li><a href=\"#item.applied-for-starter\">applied-for-starter</a> = true</li></ul></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)\" id=\"item.onsite-pharmacy-name\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"String\" class=\"hierarchy\"/> onsite-pharmacy-name</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Onsite Pharmacy Name (Optional)</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://build.fhir.org/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.onsite-pharmacy\">onsite-pharmacy</a> = true</span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)\" id=\"item.line-of-therapy\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Coding\" class=\"hierarchy\"/> line-of-therapy</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Line of therapy?</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://build.fhir.org/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.applied-for-copay\">applied-for-copay</a> = true</span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)\" id=\"item.line-of-therapy-other\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"String\" class=\"hierarchy\"/> line-of-therapy-other</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Line of therapy-other?</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://build.fhir.org/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.line-of-therapy\">line-of-therapy</a> = other</span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)\" id=\"item.preferred-sp\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"String\" class=\"hierarchy\"/> preferred-sp</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Preferred Specialty Pharmacy (Optional)</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://build.fhir.org/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.specialty-pharmacy\">specialty-pharmacy</a> = true</span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)\" id=\"item.onsite-pharmacy\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Coding\" class=\"hierarchy\"/> onsite-pharmacy</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Onsite Pharmacy?</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://build.fhir.org/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <ul><li><a href=\"#item.applied-for-bipa\">applied-for-bipa</a> = true</li><li><a href=\"#item.applied-for-starter\">applied-for-starter</a> = true</li></ul></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck00.png)\" id=\"item.specialty-pharmacy\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Coding\" class=\"hierarchy\"/> specialty-pharmacy</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Specialty Pharmacy?</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://build.fhir.org/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <ul><li><a href=\"#item.applied-for-bipa\">applied-for-bipa</a> = true</li><li><a href=\"#item.applied-for-starter\">applied-for-starter</a> = true</li></ul></td></tr>\r\n<tr><td colspan=\"5\" class=\"hierarchy\"><br/><a href=\"http://build.fhir.org/formats.html#table\" title=\"Legend for this format\"><img src=\"http://build.fhir.org/help16.png\" alt=\"doco\" style=\"background-color: inherit\"/> Documentation for this format</a></td></tr></table></div>"
];
fhir:Questionnaire.url [ fhir:value "https://fhir.developer.gene.com/Questionnaire/questionnaireAlecensa"];
fhir:Questionnaire.version [ fhir:value "1.1.19"];
fhir:Questionnaire.name [ fhir:value "Alecensa"];
fhir:Questionnaire.title [ fhir:value "Alecensa"];
fhir:Questionnaire.status [ fhir:value "active"];
fhir:Questionnaire.date [ fhir:value "2024-02-19T15:49:59-08:00"^^xsd:dateTime];
fhir:Questionnaire.contact [
fhir:index 0;
fhir:ContactDetail.name [ fhir:value "Krzysztof Wilczek" ];
fhir:ContactDetail.telecom [
fhir:index 0;
fhir:ContactPoint.system [ fhir:value "email" ];
fhir:ContactPoint.value [ fhir:value "mailto:wilczekk@gene.com" ] ]
];
fhir:Questionnaire.description [ fhir:value "Example of questionnaire to be filled out when submitting enrollment bundle for product Alecensa."];
fhir:Questionnaire.item [
fhir:index 0;
fhir:Questionnaire.item.linkId [ fhir:value "applied-for-bipa" ];
fhir:Questionnaire.item.text [ fhir:value "BIPA Service Request Applied?" ];
fhir:Questionnaire.item.type [ fhir:value "boolean" ];
fhir:Questionnaire.item.required [ fhir:value "false"^^xsd:boolean ]
], [
fhir:index 1;
fhir:Questionnaire.item.linkId [ fhir:value "applied-for-starter" ];
fhir:Questionnaire.item.text [ fhir:value "Starter Service Request Applied?" ];
fhir:Questionnaire.item.type [ fhir:value "boolean" ];
fhir:Questionnaire.item.required [ fhir:value "false"^^xsd:boolean ]
], [
fhir:index 2;
fhir:Questionnaire.item.linkId [ fhir:value "applied-for-copay" ];
fhir:Questionnaire.item.text [ fhir:value "Copay Service Request Applied?" ];
fhir:Questionnaire.item.type [ fhir:value "boolean" ];
fhir:Questionnaire.item.required [ fhir:value "false"^^xsd:boolean ]
], [
fhir:index 3;
fhir:Questionnaire.item.linkId [ fhir:value "applied-for-appeals" ];
fhir:Questionnaire.item.text [ fhir:value "Appeals Service Request Applied?" ];
fhir:Questionnaire.item.type [ fhir:value "boolean" ];
fhir:Questionnaire.item.required [ fhir:value "false"^^xsd:boolean ]
], [
fhir:index 4;
fhir:Questionnaire.item.linkId [ fhir:value "applied-for-pf" ];
fhir:Questionnaire.item.text [ fhir:value "Patient Foundation Service Request Applied?" ];
fhir:Questionnaire.item.type [ fhir:value "boolean" ];
fhir:Questionnaire.item.required [ fhir:value "false"^^xsd:boolean ]
], [
fhir:index 5;
fhir:Questionnaire.item.linkId [ fhir:value "alecensa-nsclc" ];
fhir:Questionnaire.item.text [ fhir:value "Metastatic non-small cell lung cancer (NSCLC)?" ];
fhir:Questionnaire.item.type [ fhir:value "choice" ];
fhir:Questionnaire.item.enableWhen [
fhir:index 0;
fhir:Questionnaire.item.enableWhen.question [ fhir:value "applied-for-copay" ];
fhir:Questionnaire.item.enableWhen.operator [ fhir:value "=" ];
fhir:Questionnaire.item.enableWhen.answerBoolean [ fhir:value "true"^^xsd:boolean ] ], [
fhir:index 1;
fhir:Questionnaire.item.enableWhen.question [ fhir:value "applied-for-starter" ];
fhir:Questionnaire.item.enableWhen.operator [ fhir:value "=" ];
fhir:Questionnaire.item.enableWhen.answerBoolean [ fhir:value "true"^^xsd:boolean ] ];
fhir:Questionnaire.item.enableBehavior [ fhir:value "any" ];
fhir:Questionnaire.item.required [ fhir:value "true"^^xsd:boolean ]
], [
fhir:index 6;
fhir:Questionnaire.item.linkId [ fhir:value "contact-patient" ];
fhir:Questionnaire.item.text [ fhir:value "Do not contact patient" ];
fhir:Questionnaire.item.type [ fhir:value "boolean" ];
fhir:Questionnaire.item.required [ fhir:value "true"^^xsd:boolean ]
], [
fhir:index 7;
fhir:Questionnaire.item.linkId [ fhir:value "alecensa-confirmed-positive-alk" ];
fhir:Questionnaire.item.text [ fhir:value "Confirmed positive for anaplastic lymphoma kinase (ALK)?" ];
fhir:Questionnaire.item.type [ fhir:value "choice" ];
fhir:Questionnaire.item.enableWhen [
fhir:index 0;
fhir:Questionnaire.item.enableWhen.question [ fhir:value "applied-for-copay" ];
fhir:Questionnaire.item.enableWhen.operator [ fhir:value "=" ];
fhir:Questionnaire.item.enableWhen.answerBoolean [ fhir:value "true"^^xsd:boolean ] ], [
fhir:index 1;
fhir:Questionnaire.item.enableWhen.question [ fhir:value "applied-for-starter" ];
fhir:Questionnaire.item.enableWhen.operator [ fhir:value "=" ];
fhir:Questionnaire.item.enableWhen.answerBoolean [ fhir:value "true"^^xsd:boolean ] ];
fhir:Questionnaire.item.enableBehavior [ fhir:value "any" ];
fhir:Questionnaire.item.required [ fhir:value "true"^^xsd:boolean ]
], [
fhir:index 8;
fhir:Questionnaire.item.linkId [ fhir:value "prescription-plan" ];
fhir:Questionnaire.item.text [ fhir:value "Is this a Prescription plan?" ];
fhir:Questionnaire.item.type [ fhir:value "boolean" ];
fhir:Questionnaire.item.required [ fhir:value "true"^^xsd:boolean ]
], [
fhir:index 9;
fhir:Questionnaire.item.linkId [ fhir:value "treatment-started" ];
fhir:Questionnaire.item.text [ fhir:value "Has treatment started?" ];
fhir:Questionnaire.item.type [ fhir:value "boolean" ];
fhir:Questionnaire.item.enableWhen [
fhir:index 0;
fhir:Questionnaire.item.enableWhen.question [ fhir:value "applied-for-copay" ];
fhir:Questionnaire.item.enableWhen.operator [ fhir:value "=" ];
fhir:Questionnaire.item.enableWhen.answerBoolean [ fhir:value "true"^^xsd:boolean ] ], [
fhir:index 1;
fhir:Questionnaire.item.enableWhen.question [ fhir:value "applied-for-starter" ];
fhir:Questionnaire.item.enableWhen.operator [ fhir:value "=" ];
fhir:Questionnaire.item.enableWhen.answerBoolean [ fhir:value "true"^^xsd:boolean ] ];
fhir:Questionnaire.item.enableBehavior [ fhir:value "any" ];
fhir:Questionnaire.item.required [ fhir:value "true"^^xsd:boolean ]
], [
fhir:index 10;
fhir:Questionnaire.item.linkId [ fhir:value "prior-auth" ];
fhir:Questionnaire.item.text [ fhir:value "Is prior authorization in place?" ];
fhir:Questionnaire.item.type [ fhir:value "boolean" ];
fhir:Questionnaire.item.enableWhen [
fhir:index 0;
fhir:Questionnaire.item.enableWhen.question [ fhir:value "applied-for-bipa" ];
fhir:Questionnaire.item.enableWhen.operator [ fhir:value "=" ];
fhir:Questionnaire.item.enableWhen.answerBoolean [ fhir:value "true"^^xsd:boolean ] ], [
fhir:index 1;
fhir:Questionnaire.item.enableWhen.question [ fhir:value "applied-for-starter" ];
fhir:Questionnaire.item.enableWhen.operator [ fhir:value "=" ];
fhir:Questionnaire.item.enableWhen.answerBoolean [ fhir:value "true"^^xsd:boolean ] ];
fhir:Questionnaire.item.enableBehavior [ fhir:value "any" ];
fhir:Questionnaire.item.required [ fhir:value "true"^^xsd:boolean ]
], [
fhir:index 11;
fhir:Questionnaire.item.linkId [ fhir:value "auth" ];
fhir:Questionnaire.item.text [ fhir:value "Authorization #" ];
fhir:Questionnaire.item.type [ fhir:value "boolean" ];
fhir:Questionnaire.item.enableWhen [
fhir:index 0;
fhir:Questionnaire.item.enableWhen.question [ fhir:value "prior-auth" ];
fhir:Questionnaire.item.enableWhen.operator [ fhir:value "=" ];
fhir:Questionnaire.item.enableWhen.answerBoolean [ fhir:value "true"^^xsd:boolean ] ];
fhir:Questionnaire.item.required [ fhir:value "true"^^xsd:boolean ]
], [
fhir:index 12;
fhir:Questionnaire.item.linkId [ fhir:value "alecensa-drug-allergies" ];
fhir:Questionnaire.item.text [ fhir:value "Drug Allergies?" ];
fhir:Questionnaire.item.type [ fhir:value "string" ];
fhir:Questionnaire.item.enableWhen [
fhir:index 0;
fhir:Questionnaire.item.enableWhen.question [ fhir:value "applied-for-pf" ];
fhir:Questionnaire.item.enableWhen.operator [ fhir:value "=" ];
fhir:Questionnaire.item.enableWhen.answerBoolean [ fhir:value "true"^^xsd:boolean ] ];
fhir:Questionnaire.item.required [ fhir:value "true"^^xsd:boolean ]
], [
fhir:index 13;
fhir:Questionnaire.item.linkId [ fhir:value "alecensa-other-drug-allergies" ];
fhir:Questionnaire.item.text [ fhir:value "Other Drug Allergies?" ];
fhir:Questionnaire.item.type [ fhir:value "string" ];
fhir:Questionnaire.item.enableWhen [
fhir:index 0;
fhir:Questionnaire.item.enableWhen.question [ fhir:value "alecensa-drug-allergies" ];
fhir:Questionnaire.item.enableWhen.operator [ fhir:value "=" ];
fhir:Questionnaire.item.enableWhen.answerString [ fhir:value "Other" ] ];
fhir:Questionnaire.item.required [ fhir:value "true"^^xsd:boolean ]
], [
fhir:index 14;
fhir:Questionnaire.item.linkId [ fhir:value "alecensa-other-prescription" ];
fhir:Questionnaire.item.text [ fhir:value "Other Medicines Prescribed" ];
fhir:Questionnaire.item.type [ fhir:value "string" ];
fhir:Questionnaire.item.enableWhen [
fhir:index 0;
fhir:Questionnaire.item.enableWhen.question [ fhir:value "applied-for-pf" ];
fhir:Questionnaire.item.enableWhen.operator [ fhir:value "=" ];
fhir:Questionnaire.item.enableWhen.answerBoolean [ fhir:value "true"^^xsd:boolean ] ];
fhir:Questionnaire.item.required [ fhir:value "true"^^xsd:boolean ]
], [
fhir:index 15;
fhir:Questionnaire.item.linkId [ fhir:value "shipment-options" ];
fhir:Questionnaire.item.text [ fhir:value "Shipment Options" ];
fhir:Questionnaire.item.type [ fhir:value "string" ];
fhir:Questionnaire.item.enableWhen [
fhir:index 0;
fhir:Questionnaire.item.enableWhen.question [ fhir:value "applied-for-pf" ];
fhir:Questionnaire.item.enableWhen.operator [ fhir:value "=" ];
fhir:Questionnaire.item.enableWhen.answerBoolean [ fhir:value "true"^^xsd:boolean ] ];
fhir:Questionnaire.item.required [ fhir:value "true"^^xsd:boolean ]
], [
fhir:index 16;
fhir:Questionnaire.item.linkId [ fhir:value "ship-to" ];
fhir:Questionnaire.item.text [ fhir:value "Ship To" ];
fhir:Questionnaire.item.type [ fhir:value "string" ];
fhir:Questionnaire.item.enableWhen [
fhir:index 0;
fhir:Questionnaire.item.enableWhen.question [ fhir:value "applied-for-pf" ];
fhir:Questionnaire.item.enableWhen.operator [ fhir:value "=" ];
fhir:Questionnaire.item.enableWhen.answerBoolean [ fhir:value "true"^^xsd:boolean ] ], [
fhir:index 1;
fhir:Questionnaire.item.enableWhen.question [ fhir:value "applied-for-starter" ];
fhir:Questionnaire.item.enableWhen.operator [ fhir:value "=" ];
fhir:Questionnaire.item.enableWhen.answerBoolean [ fhir:value "true"^^xsd:boolean ] ];
fhir:Questionnaire.item.enableBehavior [ fhir:value "any" ];
fhir:Questionnaire.item.required [ fhir:value "true"^^xsd:boolean ]
], [
fhir:index 17;
fhir:Questionnaire.item.linkId [ fhir:value "re-verify-benefits" ];
fhir:Questionnaire.item.text [ fhir:value "Re-verify benefits at PA expiration" ];
fhir:Questionnaire.item.type [ fhir:value "choice" ];
fhir:Questionnaire.item.enableWhen [
fhir:index 0;
fhir:Questionnaire.item.enableWhen.question [ fhir:value "applied-for-bipa" ];
fhir:Questionnaire.item.enableWhen.operator [ fhir:value "=" ];
fhir:Questionnaire.item.enableWhen.answerBoolean [ fhir:value "true"^^xsd:boolean ] ], [
fhir:index 1;
fhir:Questionnaire.item.enableWhen.question [ fhir:value "applied-for-starter" ];
fhir:Questionnaire.item.enableWhen.operator [ fhir:value "=" ];
fhir:Questionnaire.item.enableWhen.answerBoolean [ fhir:value "true"^^xsd:boolean ] ];
fhir:Questionnaire.item.enableBehavior [ fhir:value "any" ];
fhir:Questionnaire.item.required [ fhir:value "true"^^xsd:boolean ]
], [
fhir:index 18;
fhir:Questionnaire.item.linkId [ fhir:value "onsite-pharmacy-name" ];
fhir:Questionnaire.item.text [ fhir:value "Onsite Pharmacy Name (Optional)" ];
fhir:Questionnaire.item.type [ fhir:value "string" ];
fhir:Questionnaire.item.enableWhen [
fhir:index 0;
fhir:Questionnaire.item.enableWhen.question [ fhir:value "onsite-pharmacy" ];
fhir:Questionnaire.item.enableWhen.operator [ fhir:value "=" ];
fhir:Questionnaire.item.enableWhen.answerBoolean [ fhir:value "true"^^xsd:boolean ] ];
fhir:Questionnaire.item.required [ fhir:value "false"^^xsd:boolean ]
], [
fhir:index 19;
fhir:Questionnaire.item.linkId [ fhir:value "line-of-therapy" ];
fhir:Questionnaire.item.text [ fhir:value "Line of therapy?" ];
fhir:Questionnaire.item.type [ fhir:value "choice" ];
fhir:Questionnaire.item.enableWhen [
fhir:index 0;
fhir:Questionnaire.item.enableWhen.question [ fhir:value "applied-for-copay" ];
fhir:Questionnaire.item.enableWhen.operator [ fhir:value "=" ];
fhir:Questionnaire.item.enableWhen.answerBoolean [ fhir:value "true"^^xsd:boolean ] ];
fhir:Questionnaire.item.required [ fhir:value "true"^^xsd:boolean ]
], [
fhir:index 20;
fhir:Questionnaire.item.linkId [ fhir:value "line-of-therapy-other" ];
fhir:Questionnaire.item.text [ fhir:value "Line of therapy-other?" ];
fhir:Questionnaire.item.type [ fhir:value "string" ];
fhir:Questionnaire.item.enableWhen [
fhir:index 0;
fhir:Questionnaire.item.enableWhen.question [ fhir:value "line-of-therapy" ];
fhir:Questionnaire.item.enableWhen.operator [ fhir:value "=" ];
fhir:Questionnaire.item.enableWhen.answerString [ fhir:value "other" ] ];
fhir:Questionnaire.item.required [ fhir:value "false"^^xsd:boolean ]
], [
fhir:index 21;
fhir:Questionnaire.item.linkId [ fhir:value "preferred-sp" ];
fhir:Questionnaire.item.text [ fhir:value "Preferred Specialty Pharmacy (Optional)" ];
fhir:Questionnaire.item.type [ fhir:value "string" ];
fhir:Questionnaire.item.enableWhen [
fhir:index 0;
fhir:Questionnaire.item.enableWhen.question [ fhir:value "specialty-pharmacy" ];
fhir:Questionnaire.item.enableWhen.operator [ fhir:value "=" ];
fhir:Questionnaire.item.enableWhen.answerBoolean [ fhir:value "true"^^xsd:boolean ] ];
fhir:Questionnaire.item.required [ fhir:value "false"^^xsd:boolean ]
], [
fhir:index 22;
fhir:Questionnaire.item.linkId [ fhir:value "onsite-pharmacy" ];
fhir:Questionnaire.item.text [ fhir:value "Onsite Pharmacy?" ];
fhir:Questionnaire.item.type [ fhir:value "choice" ];
fhir:Questionnaire.item.enableWhen [
fhir:index 0;
fhir:Questionnaire.item.enableWhen.question [ fhir:value "applied-for-bipa" ];
fhir:Questionnaire.item.enableWhen.operator [ fhir:value "=" ];
fhir:Questionnaire.item.enableWhen.answerBoolean [ fhir:value "true"^^xsd:boolean ] ], [
fhir:index 1;
fhir:Questionnaire.item.enableWhen.question [ fhir:value "applied-for-starter" ];
fhir:Questionnaire.item.enableWhen.operator [ fhir:value "=" ];
fhir:Questionnaire.item.enableWhen.answerBoolean [ fhir:value "true"^^xsd:boolean ] ];
fhir:Questionnaire.item.enableBehavior [ fhir:value "any" ];
fhir:Questionnaire.item.required [ fhir:value "true"^^xsd:boolean ]
], [
fhir:index 23;
fhir:Questionnaire.item.linkId [ fhir:value "specialty-pharmacy" ];
fhir:Questionnaire.item.text [ fhir:value "Specialty Pharmacy?" ];
fhir:Questionnaire.item.type [ fhir:value "choice" ];
fhir:Questionnaire.item.enableWhen [
fhir:index 0;
fhir:Questionnaire.item.enableWhen.question [ fhir:value "applied-for-bipa" ];
fhir:Questionnaire.item.enableWhen.operator [ fhir:value "=" ];
fhir:Questionnaire.item.enableWhen.answerBoolean [ fhir:value "true"^^xsd:boolean ] ], [
fhir:index 1;
fhir:Questionnaire.item.enableWhen.question [ fhir:value "applied-for-starter" ];
fhir:Questionnaire.item.enableWhen.operator [ fhir:value "=" ];
fhir:Questionnaire.item.enableWhen.answerBoolean [ fhir:value "true"^^xsd:boolean ] ];
fhir:Questionnaire.item.enableBehavior [ fhir:value "any" ];
fhir:Questionnaire.item.required [ fhir:value "true"^^xsd:boolean ]
].
# - ontology header ------------------------------------------------------------
a owl:Ontology;
owl:imports fhir:fhir.ttl.
IG © 2021+ . Package gene.com.fhir.uapi#1.1.19 based on FHIR 4.3.0. Generated 2024-02-19
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