Care Coordination and 360 Referrals (Proof of Concept)
0.1.0 - proof-of-concept United Kingdom flag

Care Coordination and 360 Referrals (Proof of Concept) - Local Development build (v0.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Questionnaire: Exercise on referral - referrer's form (Experimental)

Official URL: https://fhir.acmeexample.org.uk/PatientCareCoordination/Questionnaire/ExerciseReferralForm Version: 0.1.0
Draft as of 2026-11-03 Computable Name: ExerciseReferralForm

Illustrative referral form completed by the referring clinician when the referral is made (ask at order entry). Items with a LOINC code are also sent as Observations.

LinkIDTextCardinalityTypeDescription & Constraintsdoco
ExerciseReferralForm Illustrative referral form completed by the referring clinician when the referral is made (ask at order entry). Items with a LOINC code are also sent as Observations. Questionnaire https://fhir.acmeexample.org.uk/PatientCareCoordination/Questionnaire/ExerciseReferralForm#0.1.0
ExerciseReferralForm / reason Reason for referral 1..1 string Value Set:
ExerciseReferralForm / systolic Resting systolic blood pressure (mmHg) 1..1 integer Value Set:
ExerciseReferralForm / diastolic Resting diastolic blood pressure (mmHg) 1..1 integer Value Set:
ExerciseReferralForm / heart-rate Resting heart rate (beats per minute) 0..1 integer Value Set:
ExerciseReferralForm / bmi Body mass index 0..1 decimal Value Set:
ExerciseReferralForm / conditions Relevant conditions 0..* string Value Set:
ExerciseReferralForm / suitable Is the patient medically suitable for supervised exercise? 1..1 boolean Value Set:
ExerciseReferralForm / precautions Precautions or exercise restrictions 0..1 text Value Set:

doco Documentation for this format

Reason for referral*

  • linkId: reason
  • Answers:

Resting systolic blood pressure (mmHg)*

  • linkId: systolic
  • Answers:

Resting diastolic blood pressure (mmHg)*

  • linkId: diastolic
  • Answers:

Resting heart rate (beats per minute)

  • linkId: heart-rate
  • Answers:

Body mass index

  • linkId: bmi
  • Answers:

Relevant conditions

  • linkId: conditions
  • Answers:

Is the patient medically suitable for supervised exercise?*

  • linkId: suitable
  • Answers:

Precautions or exercise restrictions

  • linkId: precautions
  • Answers:

LinkIDDescription & Constraintsdoco
reason Value Set:
systolic Value Set:
diastolic Value Set:
heart-rate Value Set:
bmi Value Set:
conditions Value Set:
suitable Value Set:
precautions Value Set:

doco Documentation for this format

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Responses for this Questionnaire