Notice
- Important: This guidance is under active development by NHS England and content may be added or updated on a regular basis.
- This Implementation Guide is currently in Draft and SHOULD NOT be used for development or active implementation without express direction from the NHS England Genomics Unit.
QuestionnaireResponse-RoD-PheobeSmithamMother-Example
Example of a filled RoD Form.
| QuestionnaireResponse |
| id : QuestionnaireResponse-RoD-PheobeSmithamMother-Example |
| questionnaire : https://fhir.nhs.uk/Questionnaire/NHSDigital-Questionnaire-Genomics-Example |
| status : completed |
| basedOn |
| reference : ServiceRequest/ServiceRequest-WGSTestOrderForm-TrioTestingProband-Example |
| subject |
| reference : Patient/Patient-PheobeSmithamMother-Example |
| identifier |
| system : https://fhir.nhs.uk/Id/nhs-number |
| value : 9449307246 |
| authored : 2023-09-15 |
| author |
| identifier |
| system : https://fhir.nhs.uk/Id/sds-role-profile-id |
| value : 9999999996 |
| source |
| reference : Patient/Patient-PheobeSmithamMother-Example |
| identifier |
| system : https://fhir.nhs.uk/Id/nhs-number |
| value : 9449307246 |
| item |
| linkId : patientDetails |
| text : Patient Details |
| item |
| linkId : givenName |
| text : First Name |
| answer |
| value : Alice |
| item |
| linkId : familyName |
| text : Last Name |
| answer |
| value : Smitham |
| item |
| linkId : nhs_Number |
| text : NHS number (or postcode if not not known) |
| answer |
| value : 9449307246 |
| item |
| linkId : birthDate |
| text : Date of Birth |
| answer |
| value : 1983-03-22 |
| item |
| linkId : declaration4 |
| text : Confirmation of Your Genomic Test and Research Choices |
| item |
| linkId : confirmation |
| text : I confirm that I have had the opportunity to discuss information about genomic testing, I agree to the genomic test, and my research choice is indicated below. |
| item |
| linkId : researchConfirmation1 |
| text : I have discussed taking part in the National Genomic Research Library. If your answer to A is NO then please ignore B and sign directly below |
| answer |
| value : True |
| item |
| linkId : researchConfirmation2 |
| text : I agree that my data and remainder sample may contribute to the National Genomic Research Library |
| answer |
| value : True |
| item |
| linkId : isRespondentAttorney |
| text : Are you completing this form on behalf of someone? |
| answer |
| value : False |
| item |
| linkId : patientValidation |
| text : Patient Validation |
| item |
| linkId : patientNamecombined |
| text : Patient Name |
| answer |
| value : Alice Smitham |
| item |
| linkId : patientSignature |
| text : Signature |
| answer |
| value : AliceSmitham |
| item |
| linkId : datePatientCompletedForm |
| text : Date |
| answer |
| value : 2023-09-15 |
| item |
| linkId : declaration5 |
| text : Healthcare professional use only |
| item |
| linkId : healthcareProfessional |
| text : To be completed by the healthcare professional recording the patient’s choices. |
| item |
| linkId : patientCategory |
| text : Patient category |
| answer |
| value |
| system : https://fhir.nhs.uk/CodeSystem/patient-choice-category-genomics |
| code : adult-own-choice |
| display : Adult(made their own choice) |
| item |
| linkId : testType |
| text : Test type |
| answer |
| value |
| system : https://fhir.nhs.uk/CodeSystem/test-type-genomics |
| code : RID-WGS |
| display : Rare and Inherited Diseases - WGS |
| item |
| linkId : remoteConsent |
| text : Remote consent, recorded remotely by clinician, no patient signature |
| answer |
| value : True |
| item |
| linkId : responsibleClinician |
| text : Responsible clinician |
| answer |
| value : Dr. Eugene Smith |
| item |
| linkId : patientMRN |
| text : Hospital number |
| answer |
| value : NA |
| item |
| linkId : healthcareProfessionalName |
| text : Healthcare professional name |
| answer |
| value : Dr. Eugene Smith |
| item |
| linkId : healthcareProfessionalSignature |
| text : Signature |
| answer |
| value : Dr. Eugene Smith |
| item |
| linkId : datehealthcareProfessionalCompletedForm |
| text : Date |
| answer |
| value : 2023-09-15 |
{
],
}
},
},
}
},
{
{
},
{
},
{
]
},
{
}
]
},
{
{
"text": "I confirm that I have had the opportunity to discuss information about genomic testing, I agree to the genomic test, and my research choice is indicated below.",
{
"text": "I have discussed taking part in the National Genomic Research Library. If your answer to A is NO then please ignore B and sign directly below",
]
},
{
"text": "I agree that my data and remainder sample may contribute to the National Genomic Research Library",
]
}
]
}
]
},
{
]
},
{
{
]
},
{
},
{
]
}
]
},
{
{
{
{
}
}
]
},
{
{
}
}
]
},
{
]
},
{
]
},
{
},
{
]
},
{
]
},
{
]
}
]
}
]
}
]
}
</basedOn>
<questionnaire value="https://fhir.nhs.uk/Questionnaire/NHSDigital-Questionnaire-Genomics-Example" />
</identifier>
</subject>
</identifier>
</author>
</identifier>
</source>
</answer>
</item>
</answer>
</item>
</answer>
</item>
</answer>
</item>
</item>
<text value="I confirm that I have had the opportunity to discuss information about genomic testing, I agree to the genomic test, and my research choice is indicated below." />
<text value="I have discussed taking part in the National Genomic Research Library. If your answer to A is NO then please ignore B and sign directly below" />
</answer>
</item>
<text value="I agree that my data and remainder sample may contribute to the National Genomic Research Library" />
</answer>
</item>
</item>
</item>
</answer>
</item>
</answer>
</item>
</answer>
</item>
</answer>
</item>
</item>
</valueCoding>
</answer>
</item>
</valueCoding>
</answer>
</item>
</answer>
</item>
</answer>
</item>
</answer>
</item>
</answer>
</item>
</answer>
</item>
</answer>
</item>
</item>
</item>
</QuestionnaireResponse>