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PKG_Lung_Surgery_Filled.xml
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PKG_Lung_Surgery_Filled.xml
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<?xml version="1.0" encoding="utf-8"?>
<?xml-stylesheet type="text/xsl" href="sdctemplate.xslt"?>
<SDCPackage xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns="urn:ihe:qrph:sdc:2016" xmlns:xsd="http://www.w3.org/2001/XMLSchema" xsi:schemaLocation="urn:ihe:qrph:sdc:2016 ../Schemas/RFD+SDCRetrieveForm.xsd" packageID="PKG_Lung_Surgery" version="1.0.0.DRAFT" lineage="LungSurgCCO.357" fullURI="_baseURI=cap.org&_lineage=LungSurgCCO.357&_version=1.0.0.DRAFT&_docType=sdcPKG" >
<XMLPackage>
<FormDesign xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:xsd="http://www.w3.org/2001/XMLSchema" ID="LungSurgCCO.357_1.0.0.DRAFT_sdcFDF" baseURI="cap.org" fullURI="_baseURI=cap.org&_lineage=LungSurgCCO.357&_version=1.0.0.DRAFT&_docType=sdcFDF" formTitle="Lung Surgery CCO" lineage="LungSurgCCO.357" filename="LungSurgCCO.357_1.0.0.DRAFT_sdcFDF.xml" version="1.0.0.DRAFT" xmlns="urn:ihe:qrph:sdc:2016" formInstanceURI="0542f5b8-31e0-43c1-b7d2-eb24fd14da6a" formInstanceVersionURI="0542f5b8-31e0-43c1-b7d2-eb24fd14da6a.ver1">
<Property name="Copyright" type="CAPeCC_static_text" styleClass="copyright" propName="Copyright" val="(c) 2018 Cancer Care Ontario. All rights reserved. License required for use." />
<Property name="GenericHeaderText" type="CAPeCC_static_text" propName="GenericHeaderText" val="CCO Surgical Synoptic Template" />
<Property name="Category" type="CAPeCC_meta" propName="Category" val="Lung" />
<Property name="OfficialName" type="CAPeCC_meta" propName="OfficialName" val="Lung Surgery CCO" />
<Property name="CAP_ProtocolName" type="CAPeCC_meta" propName="CAP_ProtocolName" val="CPAC Lung Surgery Guidelines" />
<Property name="CAP_ProtocolVersion" type="CAPeCC_meta" propName="CAP_ProtocolVersion" />
<Property name="TemplateID" type="CAPeCC_meta" propName="TemplateID" val="357.1000043" />
<Property name="Restrictions" type="CAPeCC_meta" propName="Restrictions" val="This template applies to lung cancer surgery" />
<Property name="CAP_Required" type="CAPeCC_meta" propName="CAP_Required" val="true" />
<Property name="AccreditationDate" type="CAPeCC_meta dt.dateTime" propName="AccreditationDate" val="8/31/2018 12:00:00 AM" />
<Property name="WebPostingDate" type="CAPeCC_meta dt.dateTime" propName="WebPostingDate" val="8/31/2018 12:00:00 AM" />
<Property name="ShortName" type="CAPeCC_meta" propName="ShortName" val="LungSurgCCO" />
<Property name="ApprovalStatus" type="CAPeCC_meta" propName="ReleaseStatus" val="DRAFT" />
<Property name="AJCC_Version" type="CAPeCC_meta" propName="AJCC_Version" val="8" />
<Body name="Body" ID="LungSurgCCO.357_1.0.0.DRAFT_sdcFDF_Body">
<ChildItems name="ch_Body">
<DisplayedItem name="DI_76024" ID="76024.100004300" title="#This template applies to lung cancer surgeries " />
<Section name="S_76026" ID="76026.100004300" title="Administrative and Identification Data">
<ChildItems name="ch_76026_1">
<Section name="S_76217" ID="76217.100004300" title="Administration">
<ChildItems name="ch_76217_1">
<Question name="Q_77471" ID="77471.100004300" title="Report Date">
<ResponseField name="rf_77471_1">
<Response name="rsp_77471_2">
<date name="date_77471_3" />
</Response>
</ResponseField>
</Question>
<Question name="Q_77472" ID="77472.100004300" title="Report Completed by">
<ResponseField name="rf_77472_1">
<Response name="rsp_77472_2">
<string name="str_77472_3" />
</Response>
</ResponseField>
</Question>
<Question name="Q_77473" ID="77473.100004300" title="Report copies to">
<ListField name="lf_77473_1" maxSelections="0">
<List name="lst_77473_2">
<ListItem name="LI_77477" ID="77477.100004300" title="Primary Physician" />
<ListItem name="LI_77475" ID="77475.100004300" title="Medical Oncologist" />
<ListItem name="LI_77476" ID="77476.100004300" title="Radiation Oncologist" />
<ListItem name="LI_77474" ID="77474.100004300" title="Other">
<ChildItems name="ch_77474_1">
<Question name="Q_77559" ID="77559.100004300" title="Specify">
<ResponseField name="rf_77559_1">
<Response name="rsp_77559_2">
<string name="str_77559_3" />
</Response>
</ResponseField>
</Question>
</ChildItems>
</ListItem>
</List>
</ListField>
</Question>
</ChildItems>
</Section>
<Section name="S_76218" ID="76218.100004300" title="Patient Information">
<ChildItems name="ch_76218_1">
<Question name="Q_76428" ID="76428.100004300" title="Patient's Last Name">
<ResponseField name="rf_76428_1">
<Response name="rsp_76428_2">
<string name="str_76428_3" />
</Response>
</ResponseField>
</Question>
<Question name="Q_76432" ID="76432.100004300" title="Patient's First Name">
<ResponseField name="rf_76432_1">
<Response name="rsp_76432_2">
<string name="str_76432_3" />
</Response>
</ResponseField>
</Question>
<Question name="Q_76433" ID="76433.100004300" title="Patient's Middle Name" minCard="0">
<ResponseField name="rf_76433_1">
<Response name="rsp_76433_2">
<string name="str_76433_3" />
</Response>
</ResponseField>
</Question>
<Question name="Q_76434" ID="76434.100004300" title="Patient's Date of Birth">
<ResponseField name="rf_76434_1">
<Response name="rsp_76434_2">
<date name="date_76434_3" />
</Response>
</ResponseField>
</Question>
<Question name="Q_76435" ID="76435.100004300" title="Patient ID">
<ResponseField name="rf_76435_1">
<Response name="rsp_76435_2">
<string name="str_76435_3" />
</Response>
</ResponseField>
</Question>
<Question name="Q_76436" ID="76436.100004300" title="Patient ID Type">
<ListField name="lf_76436_1">
<List name="lst_76436_2">
<ListItem name="LI_76634" ID="76634.100004300" title="OHIP" />
<ListItem name="LI_76635" ID="76635.100004300" title="Military/RCMP" />
<ListItem name="LI_76636" ID="76636.100004300" title="Indigenous " />
<ListItem name="LI_76633" ID="76633.100004300" title="Other ">
<ChildItems name="ch_76633_1">
<Question name="Q_77560" ID="77560.100004300" title="Specify">
<ResponseField name="rf_77560_1">
<Response name="rsp_77560_2">
<string name="str_77560_3" />
</Response>
</ResponseField>
</Question>
</ChildItems>
</ListItem>
</List>
</ListField>
</Question>
<Question name="Q_76427" ID="76427.100004300" title="Patient Hospital Number">
<ResponseField name="rf_76427_1">
<Response name="rsp_76427_2">
<string name="str_76427_3" />
</Response>
</ResponseField>
</Question>
<Question name="Q_76426" ID="76426.100004300" title="Patient Gender">
<ListField name="lf_76426_1">
<List name="lst_76426_2">
<ListItem name="LI_76639" ID="76639.100004300" title="Male" />
<ListItem name="LI_76637" ID="76637.100004300" title="Female" />
<ListItem name="LI_76638" ID="76638.100004300" title="Specify ">
<ChildItems name="ch_76638_1">
<Question name="Q_77561" ID="77561.100004300" title="Specify">
<ResponseField name="rf_77561_1">
<Response name="rsp_77561_2">
<string name="str_77561_3" />
</Response>
</ResponseField>
</Question>
</ChildItems>
</ListItem>
</List>
</ListField>
</Question>
<Question name="Q_76437" ID="76437.100004300" title="Date of Admission">
<ResponseField name="rf_76437_1">
<Response name="rsp_76437_2">
<date name="date_76437_3" />
</Response>
</ResponseField>
</Question>
<Question name="Q_76438" ID="76438.100004300" title="Patient Street Address" minCard="0">
<ResponseField name="rf_76438_1">
<Response name="rsp_76438_2">
<string name="str_76438_3" />
</Response>
</ResponseField>
</Question>
<Question name="Q_76439" ID="76439.100004300" title="Date of Referral">
<ResponseField name="rf_76439_1">
<Response name="rsp_76439_2">
<date name="date_76439_3" />
</Response>
</ResponseField>
</Question>
<Question name="Q_76431" ID="76431.100004300" title="Date of Consult">
<ResponseField name="rf_76431_1">
<Response name="rsp_76431_2">
<date name="date_76431_3" />
</Response>
</ResponseField>
</Question>
<Question name="Q_76430" ID="76430.100004300" title="Date of Decision to Treat">
<ResponseField name="rf_76430_1">
<Response name="rsp_76430_2">
<date name="date_76430_3" />
</Response>
</ResponseField>
</Question>
<Question name="Q_76429" ID="76429.100004300" title="Is patient a trial participant" minCard="0">
<ListField name="lf_76429_1">
<List name="lst_76429_2">
<ListItem name="LI_76641" ID="76641.100004300" title="Yes" />
<ListItem name="LI_76640" ID="76640.100004300" title="No" />
</List>
</ListField>
</Question>
</ChildItems>
</Section>
<Section name="S_76121" ID="76121.100004300" title="Provider Details">
<ChildItems name="ch_76121_1">
<Question name="Q_76440" ID="76440.100004300" title="Provider Last Name">
<ResponseField name="rf_76440_1">
<Response name="rsp_76440_2">
<string name="str_76440_3" />
</Response>
</ResponseField>
</Question>
<Question name="Q_76445" ID="76445.100004300" title="Provider First Name">
<ResponseField name="rf_76445_1">
<Response name="rsp_76445_2">
<string name="str_76445_3" />
</Response>
</ResponseField>
</Question>
<Question name="Q_76446" ID="76446.100004300" title="Provider Identifier Type">
<ResponseField name="rf_76446_1">
<Response name="rsp_76446_2">
<string name="str_76446_3" />
</Response>
</ResponseField>
</Question>
<Question name="Q_76441" ID="76441.100004300" title="Provider ID">
<ResponseField name="rf_76441_1">
<Response name="rsp_76441_2">
<string name="str_76441_3" />
</Response>
</ResponseField>
</Question>
<!--should be optional repeating section "Assistants" can't see as repeating on transform-->
<Section name="S_AKG_4" ID="S_AKG_4" title="Assistants" minCard="0" maxCard="0">
<ChildItems>
<Question name="Q_76442" ID="76442.100004300" title="Assistant Last Name" minCard="0">
<ResponseField name="rf_76442_1">
<Response name="rsp_76442_2">
<string name="str_76442_3" />
</Response>
</ResponseField>
</Question>
<Question name="Q_76443" ID="76443.100004300" title="Assistant First Name" minCard="0">
<ResponseField name="rf_76443_1">
<Response name="rsp_76443_2">
<string name="str_76443_3" />
</Response>
</ResponseField>
</Question>
</ChildItems>
</Section>
<Question name="Q_76444" ID="76444.100004300" title="Anesthesiologist Last Name" minCard="0">
<ResponseField name="rf_76444_1">
<Response name="rsp_76444_2">
<string name="str_76444_3" />
</Response>
</ResponseField>
</Question>
<Question name="Q_76623" ID="76623.100004300" title="Anesthesiologist First Name" minCard="0">
<ResponseField name="rf_akg_4">
<Response name="r_akg_4">
<string name="str_akg4" />
</Response>
</ResponseField>
</Question>
<!--should be optional repeating section "Other Physicians Involved" can't see as repeating on transform-->
<Section name="s_akg_6" ID="s_akg_6" title="Other Physcians Involved" minCard="0" maxCard="0">
<ChildItems>
<Question name="Q_76624" ID="76624.100004300" title="Other Involved Physicians Last Name" minCard="0">
<ResponseField name="rf_akg_2">
<Response name="r_akg_2">
<string name="str_akg2" />
</Response>
</ResponseField>
</Question>
<Question name="Q_76626" ID="76626.100004300" title="Other Involved Physicians First Name" minCard="0">
<ResponseField name="rf_akg_3">
<Response name="r_akg_3">
<string name="str_akg3" />
</Response>
</ResponseField>
</Question>
<Question name="Q_76625" ID="76625.100004300" title="Other Involved Physicians Role" minCard="0">
<ListField name="lf_76625_1">
<List name="lst_76625_2">
<ListItem name="LI_76645" ID="76645.100004300" title="Respirologist" />
<ListItem name="LI_76646" ID="76646.100004300" title="Oncologist" />
<ListItem name="LI_76647" ID="76647.100004300" title="Patient family doctor " />
<ListItem name="LI_76642" ID="76642.100004300" title="Referring Physician " />
<ListItem name="LI_76643" ID="76643.100004300" title="Admitting Physician " />
<ListItem name="LI_76644" ID="76644.100004300" title="Other ">
<ChildItems name="ch_76644_1">
<Question name="Q_77562" ID="77562.100004300" title="Specify">
<ResponseField name="rf_77562_1">
<Response name="rsp_77562_2">
<string name="str_77562_3" />
</Response>
</ResponseField>
</Question>
</ChildItems>
</ListItem>
</List>
</ListField>
</Question>
</ChildItems>
</Section>
</ChildItems>
</Section>
<Section name="S_76202" ID="76202.100004300" title="Surgical Delivery Location Details">
<ChildItems name="ch_76202_1">
<Question name="Q_76203" ID="76203.100004300" title="Service Delivery Location Name">
<!-- should be site specific value list -->
<ResponseField name="rf_76203_1">
<Response name="rsp_76203_2">
<string name="str_76203_3" />
</Response>
</ResponseField>
</Question>
<Question name="Q_76134" ID="76134.100004300" title="Service Delivery Location Identifier Code">
<!--should be value list representing the unique identifier of the Primary Health Care (PHC) Service Delivery Location where the patient received care-->
<ResponseField name="rf_76134_1">
<Response name="rsp_76134_2">
<string name="str_76134_3" />
</Response>
</ResponseField>
</Question>
</ChildItems>
</Section>
</ChildItems>
</Section>
<Section name="S_76027" ID="76027.100004300" title="Procedure Planned and Performed
">
<ChildItems name="ch_76027_1">
<Question name="Q_76449" ID="76449.100004300" title="Date of Surgery">
<ResponseField name="rf_76449_1">
<Response name="rsp_76449_2">
<string name="str_76449_3" />
</Response>
</ResponseField>
</Question>
<Question name="Q_76450" ID="76450.100004300" title="Operative Urgency">
<ListField name="lf_76450_1">
<List name="lst_76450_2">
<ListItem name="LI_76648" ID="76648.100004300" title="Elective" />
<ListItem name="LI_76649" ID="76649.100004300" title="Urgent/Emergent" />
</List>
</ListField>
</Question>
<Question name="Q_76451" ID="76451.100004300" title="Surgical Objectives" minCard="0">
<ListField name="lf_76451_1">
<List name="lst_76451_2">
<ListItem name="LI_76650" ID="76650.100004300" title="Palliative " />
<ListItem name="LI_76651" ID="76651.100004300" title="Curative" />
<ListItem name="LI_76652" ID="76652.100004300" title="Diagnostic Intervention" />
<ListItem name="LI_76653" ID="76653.100004300" title="Staging" />
<ListItem name="LI_76654" ID="76654.100004300" title="Other ">
<ChildItems name="ch_76654_1">
<Question name="Q_77558" ID="77558.100004300" title="Specify">
<ResponseField name="rf_77558_1">
<Response name="rsp_77558_2">
<string name="str_77558_3" />
</Response>
</ResponseField>
</Question>
</ChildItems>
</ListItem>
</List>
</ListField>
</Question>
<Question name="Q_76452" ID="76452.100004300" title="Pre-Operative diagnosis (Indication for surgery)">
<ListField name="lf_76452_1">
<List name="lst_76452_2">
<ListItem name="LI_76655" ID="76655.100004300" title="Lung Primary Cancer" />
<ListItem name="LI_76656" ID="76656.100004300" title="Mediastinal tumor " />
<ListItem name="LI_76657" ID="76657.100004300" title="Tracheal tumor" />
<ListItem name="LI_76658" ID="76658.100004300" title="Malignant Mesothelioma " />
<ListItem name="LI_76659" ID="76659.100004300" title="Chest Wall neoplasm " />
<ListItem name="LI_76660" ID="76660.100004300" title="Lung Metastases " />
<ListItem name="LI_76661" ID="76661.100004300" title="Bronchopleural Fistual " />
<ListItem name="LI_76662" ID="76662.100004300" title="Pleura Empyema " />
<ListItem name="LI_76663" ID="76663.100004300" title="Pleural Effusion " />
<ListItem name="LI_76664" ID="76664.100004300" title="Lymphadenopathy " />
<ListItem name="LI_77357" ID="77357.100004300" title="Solitary pulmonary nodule" />
<ListItem name="LI_76665" ID="76665.100004300" title="Other ">
<ChildItems name="ch_76665_1">
<Question name="Q_77557" ID="77557.100004300" title="Specify">
<ResponseField name="rf_77557_1">
<Response name="rsp_77557_2">
<string name="str_77557_3" />
</Response>
</ResponseField>
</Question>
</ChildItems>
</ListItem>
</List>
</ListField>
</Question>
<Question name="Q_76453" ID="76453.100004300" title="Pre-Operative preamble" minCard="0">
<ResponseField name="rf_76453_1">
<Response name="rsp_76453_2">
<string name="str_76453_3" />
</Response>
</ResponseField>
</Question>
<Question name="Q_76447" ID="76447.100004300" title="Post-Operative diangosis same as pre-operative diagnosis">
<ListField name="lf_76447_1">
<List name="lst_76447_2">
<ListItem name="LI_76667" ID="76667.100004300" title="Yes" />
<ListItem name="LI_76668" ID="76668.100004300" title="No" />
</List>
</ListField>
</Question>
<Question name="Q_77496" ID="77496.100004300" title="Post-Operative Diagnosis">
<ListField name="lf_77496_1">
<List name="lst_77496_2">
<ListItem name="LI_77497" ID="77497.100004300" title="Lung Primary cancer" />
<ListItem name="LI_77500" ID="77500.100004300" title="Other">
<ChildItems name="ch_77500_1">
<Question name="Q_77512" ID="77512.100004300" title="Specify">
<ResponseField name="rf_77512_1">
<Response name="rsp_77512_2">
<string name="str_77512_3" />
</Response>
</ResponseField>
</Question>
</ChildItems>
</ListItem>
<ListItem name="LI_77502" ID="77502.100004300" title="Mediastinal tumor" />
<ListItem name="LI_77503" ID="77503.100004300" title="Tracheal tumor" />
<ListItem name="LI_77504" ID="77504.100004300" title="Malignant Mesothelioma" />
<ListItem name="LI_77505" ID="77505.100004300" title="Chest Wall neoplasm" />
<ListItem name="LI_77506" ID="77506.100004300" title="Lung Metastases" />
<ListItem name="LI_77507" ID="77507.100004300" title="Bronchopleural Fistual" />
<ListItem name="LI_77508" ID="77508.100004300" title="Pleura Empyema" />
<ListItem name="LI_77509" ID="77509.100004300" title="Plural Effusion" />
<ListItem name="LI_77513" ID="77513.100004300" title="Solitary pulmonary nodule" />
<ListItem name="LI_77514" ID="77514.100004300" title="Lymphadenopathy" />
</List>
</ListField>
</Question>
<Section name="S_76454" ID="76454.100004300" title="Reoperation and Previous Surgeries" minCard="0">
<ChildItems name="ch_76454_1">
<Question name="Q_77430" ID="77430.100004300" title="Re-operation on a previously operated side" minCard="0">
<ListField name="lf_77430_1">
<List name="lst_77430_2">
<ListItem name="LI_77431" ID="77431.100004300" title="Yes" />
<ListItem name="LI_77432" ID="77432.100004300" title="No" />
</List>
</ListField>
</Question>
</ChildItems>
</Section>
</ChildItems>
</Section>
<Section name="S_76205" ID="76205.100004300" title="Preoperative Assessment">
<ChildItems name="ch_76205_1">
<Section name="S_76458" ID="76458.100004300" title="Clinical Findings">
<ChildItems name="ch_76458_1">
<Question name="Q_76459" ID="76459.100004300" title="Body Mass Index (BMI)" minCard="0">
<ListField name="lf_76459_1">
<List name="lst_76459_2">
<ListItem name="LI_76689" ID="76689.100004300" title="Very severely underweight (less than 15.0)" />
<ListItem name="LI_76690" ID="76690.100004300" title="Severely underweight (15.0 to <16.0)" />
<ListItem name="LI_76691" ID="76691.100004300" title="Underweight (16.0 to <18.5)" />
<ListItem name="LI_76692" ID="76692.100004300" title="Normal (18.5 to <25)" />
<ListItem name="LI_76693" ID="76693.100004300" title="Overweight (25 to <30)" />
<ListItem name="LI_76694" ID="76694.100004300" title="Moderately obese (30 to <35)" />
<ListItem name="LI_76695" ID="76695.100004300" title="Severely obese (35 to 40)" />
<ListItem name="LI_76696" ID="76696.100004300" title="Very severely obese (over 40)" />
</List>
</ListField>
</Question>
<Question name="Q_76460" ID="76460.100004300" title="Means of Presentation" minCard="0">
<ListField name="lf_76460_1">
<List name="lst_76460_2">
<ListItem name="LI_76697" ID="76697.100004300" title="Asymptomatic" />
<ListItem name="LI_76698" ID="76698.100004300" title="Symptomatic" />
</List>
</ListField>
</Question>
<Question name="Q_76461" ID="76461.100004300" title="Symptoms" minCard="0">
<ListField name="lf_76461_1">
<List name="lst_76461_2">
<ListItem name="LI_76699" ID="76699.100004300" title="SVC Syndrome" />
<ListItem name="LI_76700" ID="76700.100004300" title="Hemoptysis " />
<ListItem name="LI_76701" ID="76701.100004300" title="Horner's " />
<ListItem name="LI_76702" ID="76702.100004300" title="Weight Loss" />
<ListItem name="LI_76704" ID="76704.100004300" title="Dysphagia" />
<ListItem name="LI_76705" ID="76705.100004300" title="Cough" />
<ListItem name="LI_76706" ID="76706.100004300" title="Shortness of breath" />
<ListItem name="LI_76707" ID="76707.100004300" title="Voice change" />
<ListItem name="LI_76708" ID="76708.100004300" title="Pain (chest) " />
<ListItem name="LI_76709" ID="76709.100004300" title="Other ">
<ChildItems name="ch_76709_1">
<Question name="Q_77563" ID="77563.100004300" title="Specific">
<ResponseField name="rf_77563_1">
<Response name="rsp_77563_2">
<string name="str_77563_3" />
</Response>
</ResponseField>
</Question>
</ChildItems>
</ListItem>
</List>
</ListField>
</Question>
<Question name="Q_76462" ID="76462.100004300" title="Active Smoker" minCard="0">
<ListField name="lf_76462_1">
<List name="lst_76462_2">
<ListItem name="LI_76710" ID="76710.100004300" title="Yes" />
<ListItem name="LI_76711" ID="76711.100004300" title="No" />
<ListItem name="LI_76712" ID="76712.100004300" title="Quit within 30 days " />
</List>
</ListField>
</Question>
<Question name="Q_76463" ID="76463.100004300" title="Was pre-operative chemotherapy given for this malignancy?" minCard="0">
<ListField name="lf_76463_1">
<List name="lst_76463_2">
<ListItem name="LI_77528" ID="77528.100004300" title="Yes">
<ChildItems name="ch_77528_1">
<Question name="Q_77529" ID="77529.100004300" title="Describe chemotherapy treatment, reasons and results:" minCard="0">
<ResponseField name="rf_77529_1">
<Response name="rsp_77529_2">
<string name="str_77529_3" />
</Response>
</ResponseField>
</Question>
</ChildItems>
</ListItem>
<ListItem name="LI_77531" ID="77531.100004300" title="No" />
</List>
</ListField>
</Question>
<Question name="Q_77551" ID="77551.100004300" title="Was pre-operative radiotherapy given for this malignancy?" minCard="0">
<ListField name="lf_77551_1">
<List name="lst_77551_2">
<ListItem name="LI_77552" ID="77552.100004300" title="Yes">
<ChildItems name="ch_77552_1">
<Question name="Q_77555" ID="77555.100004300" title="Dose of pre-op radiation given (Gy):" minCard="0">
<ResponseField name="rf_77555_1">
<Response name="rsp_77555_2">
<string name="str_77555_3" />
</Response>
</ResponseField>
</Question>
<Question name="Q_77556" ID="77556.100004300" title="Describe radiotherapy treatment, reasons and results:" minCard="0">
<ResponseField name="rf_77556_1">
<Response name="rsp_77556_2">
<string name="str_77556_3" />
</Response>
</ResponseField>
</Question>
</ChildItems>
</ListItem>
<ListItem name="LI_77553" ID="77553.100004300" title="No" />
</List>
</ListField>
</Question>
</ChildItems>
</Section>
<Question name="Q_76414" ID="76414.100004300" title="Pre-op Physiologic Workup">
<ListField name="lf_76414_1">
<List name="lst_76414_2" />
</ListField>
<ChildItems name="ch_76414_3">
<Question name="Q_76467" ID="76467.100004300" title="FEV1 obtained pre-op
" minCard="0">
<ListField name="lf_76467_1">
<List name="lst_76467_2">
<ListItem name="LI_77564" ID="77564.100004300" title="Yes" />
<ListItem name="LI_77565" ID="77565.100004300" title="No" />
<ListItem name="LI_77566" ID="77566.100004300" title="Not applicable" />
</List>
</ListField>
</Question>
<Question name="Q_76468" ID="76468.100004300" title="FEV1% predicted pre-op
" minCard="0">
<ListField name="lf_76468_1">
<List name="lst_76468_2">
<ListItem name="LI_76723" ID="76723.100004300" title="Unable to Obtain " />
</List>
</ListField>
<ChildItems name="ch_76468_3">
<Question name="Q_76722" ID="76722.100004300" title="%:">
<ResponseField name="rf_76722_1">
<Response name="rsp_76722_2">
<string name="str_76722_3" />
</Response>
</ResponseField>
</Question>
</ChildItems>
</Question>
<Question name="Q_76469" ID="76469.100004300" title="FEV1% predicted pre-op: Litres Per Minute">
<ResponseField name="rf_76469_1">
<Response name="rsp_76469_2">
<string name="dec_76469_3"/>
</Response>
</ResponseField>
</Question>
<Question name="Q_76470" ID="76470.100004300" title="FVC% predicted pre-op" minCard="0">
<ResponseField name="rf_76470_1">
<Response name="rsp_76470_2">
<string name="str_76470_3" />
</Response>
</ResponseField>
</Question>
<Question name="Q_76471" ID="76471.100004300" title="Corrected DLCO% predicted pre-op" minCard="0">
<ListField name="lf_76471_1">
<List name="lst_76471_2">
<ListItem name="LI_77568" ID="77568.100004300" title="Unable to obtain" />
</List>
</ListField>
<ChildItems name="ch_76471_3">
<Question name="Q_77567" ID="77567.100004300" title="%">
<ResponseField name="rf_77567_1">
<Response name="rsp_77567_2">
<string name="str_77567_3" />
</Response>
</ResponseField>
</Question>
</ChildItems>
</Question>
<Question name="Q_76472" ID="76472.100004300" title="VO2 max pre-op" minCard="0">
<ListField name="lf_76472_1">
<List name="lst_76472_2">
<ListItem name="LI_76726" ID="76726.100004300" title="Yes">
<ChildItems name="ch_76726_1">
<Question name="Q_77569" ID="77569.100004300" title="VO2 max pre-op result (ml/kg/min)" minCard="0">
<ResponseField name="rf_77569_1">
<Response name="rsp_77569_2">
<string name="dec_77569_3" />
</Response>
</ResponseField>
</Question>
</ChildItems>
</ListItem>
<ListItem name="LI_76727" ID="76727.100004300" title="No" />
</List>
</ListField>
</Question>
<Question name="Q_76474" ID="76474.100004300" title="Pre-op ABG PaO" minCard="0">
<ListField name="lf_76474_1">
<List name="lst_76474_2">
<ListItem name="LI_76737" ID="76737.100004300" title="Yes">
<ChildItems name="ch_76737_1">
<Question name="Q_76736" ID="76736.100004300" title="ABG PaO Result (mmHg)" minCard="0">
<ResponseField name="rf_76736_1">
<Response name="rsp_76736_2">
<string name="str_76736_3" />
</Response>
</ResponseField>
</Question>
<Question name="Q_76738" ID="76738.100004300" title="ABG PaCO2 Result (mmHg)" minCard="0">
<ResponseField name="rf_76738_1">
<Response name="rsp_76738_2">
<string name="str_76738_3" />
</Response>
</ResponseField>
</Question>
</ChildItems>
</ListItem>
<ListItem name="LI_76735" ID="76735.100004300" title="No" />
</List>
</ListField>
</Question>
<Question name="Q_76479" ID="76479.100004300" title="Other ABG Results" minCard="0">
<ResponseField name="rf_76479_1">
<Response name="rsp_76479_2">
<string name="str_76479_3" />
</Response>
</ResponseField>
</Question>
<Question name="Q_76480" ID="76480.100004300" title="Quantitative VQ Pre-op" minCard="0">
<ListField name="lf_76480_1">
<List name="lst_76480_2">
<ListItem name="LI_77604" ID="77604.100004300" title="Yes">
<ChildItems name="ch_77604_1">
<Question name="Q_77607" ID="77607.100004300" title="Result of pre-op Quantitative VQ test" minCard="0">
<ResponseField name="rf_77607_1">
<Response name="rsp_77607_2">
<string name="str_77607_3" />
</Response>
</ResponseField>
</Question>
</ChildItems>
</ListItem>
<ListItem name="LI_77606" ID="77606.100004300" title="No" />
</List>
</ListField>
</Question>
<Question name="Q_76478" ID="76478.100004300" title="Result of post-op predicted FEV1" minCard="0">
<ListField name="lf_76478_1">
<List name="lst_76478_2">
<ListItem name="LI_77598" ID="77598.100004300" title="Yes">
<ChildItems name="ch_77598_1">
<Question name="Q_77600" ID="77600.100004300" title="FEV1 pre-op result (ml/kg/min)" minCard="0">
<ResponseField name="rf_77600_1">
<Response name="rsp_77600_2">
<string name="str_77600_3" />
</Response>
</ResponseField>
</Question>
</ChildItems>
</ListItem>
<ListItem name="LI_77599" ID="77599.100004300" title="No" />
</List>
</ListField>
</Question>
<Question name="Q_77578" ID="77578.100004300" title="Post-op predicted DLCO%" minCard="0">
<ListField name="lf_77578_1">
<List name="lst_77578_2">
<ListItem name="LI_77594" ID="77594.100004300" title="Yes">
<ChildItems name="ch_77594_1">
<Question name="Q_77597" ID="77597.100004300" title="DLCO% result (ml/kg/min)" minCard="0">
<ResponseField name="rf_77597_1">
<Response name="rsp_77597_2">
<string name="str_77597_3" />
</Response>
</ResponseField>
</Question>
</ChildItems>
</ListItem>
<ListItem name="LI_77595" ID="77595.100004300" title="No" />
</List>
</ListField>
</Question>
<Question name="Q_76485" ID="76485.100004300" title="Other post-op physiologic results">
<ResponseField name="rf_76485_1">
<Response name="rsp_76485_2">
<string name="str_76485_3" />
</Response>
</ResponseField>
</Question>
<Question name="Q_76484" ID="76484.100004300" title="6 minute walk pre-op" minCard="0">
<ListField name="lf_76484_1">
<List name="lst_76484_2">
<ListItem name="LI_76749" ID="76749.100004300" title="Yes">
<ChildItems name="ch_76749_1">
<Question name="Q_76748" ID="76748.100004300" title="Metres walked:" minCard="0">
<ResponseField name="rf_76748_1">
<Response name="rsp_76748_2">
<string name="ce_76748_3" />
</Response>
</ResponseField>
</Question>
</ChildItems>
</ListItem>
<ListItem name="LI_77576" ID="77576.100004300" title="No" />
</List>
</ListField>
</Question>
<Question name="Q_76486" ID="76486.100004300" title="Patient discussed at multi-disciplinary meeting" minCard="0">
<ListField name="lf_76486_1">
<List name="lst_76486_2">
<ListItem name="LI_76752" ID="76752.100004300" title="Yes" />
<ListItem name="LI_76753" ID="76753.100004300" title="No" />
<ListItem name="LI_76751" ID="76751.100004300" title="Not Indicated" />
</List>
</ListField>
</Question>
</ChildItems>
</Question>
<Section name="S_76415" ID="76415.100004300" title="Diagnostic Investigations">
<ChildItems name="ch_76415_1">
<Question name="Q_76487" ID="76487.100004300" title="Pre-operative imaging done?">
<ListField name="lf_76487_1" maxSelections="0">
<List name="lst_76487_2">
<ListItem name="LI_76757" ID="76757.100004300" title="CT Head" />
<ListItem name="LI_76758" ID="76758.100004300" title="CT Chest" />
<ListItem name="LI_76754" ID="76754.100004300" title="CT Abdomen" />
<ListItem name="LI_76755" ID="76755.100004300" title="MRI Head" />
<ListItem name="LI_76756" ID="76756.100004300" title="PET Scan" />
<ListItem name="LI_76759" ID="76759.100004300" title="Bone Scan" />
<ListItem name="LI_76760" ID="76760.100004300" title="Other ">
<ChildItems name="ch_76760_1">
<Question name="Q_77608" ID="77608.100004300" title="Specify">
<ResponseField name="rf_77608_1">
<Response name="rsp_77608_2">
<string name="str_77608_3" />
</Response>
</ResponseField>
</Question>
</ChildItems>
</ListItem>
</List>
</ListField>
</Question>
<Question name="Q_76491" ID="76491.100004300" title="Description of Findings" minCard="0">
<ResponseField name="rf_76491_1">
<Response name="rsp_76491_2">
<string name="str_76491_3" />
</Response>
</ResponseField>
</Question>
</ChildItems>
</Section>
<Section name="S_76213" ID="76213.100004300" title="Co-Morbidity">
<ChildItems name="ch_76213_1">
<Question name="Q_76493" ID="76493.100004300" title="Pertinent Co-morbidities" minCard="0">
<ListField name="lf_76493_1" maxSelections="0">
<List name="lst_76493_2">
<ListItem name="LI_76761" ID="76761.100004300" title="Bronchiectasis" />
<ListItem name="LI_76762" ID="76762.100004300" title="Chronic obstructive pulmonary disease" />
<ListItem name="LI_76763" ID="76763.100004300" title="Pulmonary fibrosis" />
<ListItem name="LI_76764" ID="76764.100004300" title="Tuberculosis" />
<ListItem name="LI_76765" ID="76765.100004300" title="Asthma" />
<ListItem name="LI_76766" ID="76766.100004300" title="Diabetes" />
<ListItem name="LI_76767" ID="76767.100004300" title="Liver disease" />
<ListItem name="LI_76768" ID="76768.100004300" title="Connective tissue disease" />
<ListItem name="LI_76769" ID="76769.100004300" title="Other tumors (benign)" />
<ListItem name="LI_76770" ID="76770.100004300" title="Other cancers" />
<ListItem name="LI_76771" ID="76771.100004300" title="Leukemia/Lymphoma" />
<ListItem name="LI_76772" ID="76772.100004300" title="Metastatic cancer" />
<ListItem name="LI_76773" ID="76773.100004300" title="Previous trauma requiring surgery" />
<ListItem name="LI_76774" ID="76774.100004300" title="Congestive heart failure" />
<ListItem name="LI_76775" ID="76775.100004300" title="Coronary artery disease" />
<ListItem name="LI_76776" ID="76776.100004300" title="Peripheral vascular disease" />
<ListItem name="LI_76777" ID="76777.100004300" title="History of cerebrovascular disease" />
<ListItem name="LI_76778" ID="76778.100004300" title="Renal failure" />
<ListItem name="LI_76779" ID="76779.100004300" title="Renal failure requiring dialysis" />
<ListItem name="LI_76780" ID="76780.100004300" title="Hypertension" />
<ListItem name="LI_76781" ID="76781.100004300" title="Interstitial fibrosis" />
<ListItem name="LI_76782" ID="76782.100004300" title="Myocardial infarct" />
<ListItem name="LI_76783" ID="76783.100004300" title="Peptic ulcer disease" />
<ListItem name="LI_76784" ID="76784.100004300" title="Hemiplegia" />
<ListItem name="LI_76785" ID="76785.100004300" title="HIV/AIDS" />
<ListItem name="LI_76786" ID="76786.100004300" title="Dementia" />
<ListItem name="LI_76787" ID="76787.100004300" title="Other ">
<ChildItems name="ch_76787_1">
<Question name="Q_77609" ID="77609.100004300" title="Specify">
<ResponseField name="rf_77609_1">
<Response name="rsp_77609_2">
<string name="str_77609_3" />
</Response>
</ResponseField>
</Question>
</ChildItems>
</ListItem>
</List>
</ListField>
</Question>
</ChildItems>
</Section>
</ChildItems>
</Section>
<Section name="S_76029" ID="76029.100004300" title="Pre-Operative Pathology and Staging">
<ChildItems name="ch_76029_1">
<Section name="S_76416" ID="76416.100004300" title="Pre-operative Pathology">
<ChildItems name="ch_76416_1">
<Question name="Q_76497" ID="76497.100004300" title="Pathology attained?">
<ListField name="lf_76497_1">
<List name="lst_76497_2">
<ListItem name="LI_76788" ID="76788.100004300" title="Yes" />
<ListItem name="LI_76789" ID="76789.100004300" title="No" />
<ListItem name="LI_76790" ID="76790.100004300" title="Non-Diagnostic " />
</List>
</ListField>
</Question>
<Question name="Q_76494" ID="76494.100004300" title="Pre-operative biopsy/ staging?">
<ListField name="lf_76494_1" maxSelections="0">
<List name="lst_76494_2">
<ListItem name="LI_76791" ID="76791.100004300" title="Bronchoscopy " />
<ListItem name="LI_76793" ID="76793.100004300" title="EBUS" />
<ListItem name="LI_76794" ID="76794.100004300" title="VATS biopsy " />
<ListItem name="LI_76795" ID="76795.100004300" title="Percutaneous " />
<ListItem name="LI_76799" ID="76799.100004300" title="Transthoracic Needle" />
<ListItem name="LI_76800" ID="76800.100004300" title="Biopsy " />
<ListItem name="LI_76796" ID="76796.100004300" title="Mediastinoscopy " />
<ListItem name="LI_76797" ID="76797.100004300" title="Pleural Fluid Analysis " />
<ListItem name="LI_76798" ID="76798.100004300" title="Endoscopic Ultrasound (EUS)" />
<ListItem name="LI_76801" ID="76801.100004300" title="Other ">
<ChildItems name="ch_76801_1">
<Question name="Q_77610" ID="77610.100004300" title="Specify">
<ResponseField name="rf_77610_1">
<Response name="rsp_77610_2">
<string name="str_77610_3" />
</Response>
</ResponseField>
</Question>
</ChildItems>
</ListItem>
<ListItem name="LI_76802" ID="76802.100004300" title="None" selectionDeselectsSiblings="1" />
</List>
</ListField>
</Question>
<Question name="Q_76495" ID="76495.100004300" title="Pathology Diagnosis Comments">
<ResponseField name="rf_76495_1">
<Response name="rsp_76495_2">
<string name="str_76495_3" />
</Response>
</ResponseField>
</Question>
</ChildItems>
</Section>
<Section name="S_Marg_Status_76177" ID="76177.100004300" title="Clinical Stage">
<ChildItems name="ch_76177_1">
<Question name="Q_76628" ID="76628.100004300" title="T Stage">
<ListField name="lf_76628_1">
<List name="lst_76628_2">
<ListItem name="LI_76803" ID="76803.100004300" title="Tx Primary tumor cannot
be assessed, or tumor
proven by the presence of
malignant cells in sputum
or bronchial washings but
not visualized by imaging or
bronchoscopy" />
<ListItem name="LI_76804" ID="76804.100004300" title="T0 No evidence of primary
tumor" />
<ListItem name="LI_76805" ID="76805.100004300" title="Tis Carcinoma in situ" />
<ListItem name="LI_76806" ID="76806.100004300" title="T1 Tumor 3 cm or less
in greatest dimension,
surrounded by lung of
visceral pleura, without
bronchoscopic evidence
of invasion more proximal
than the lobar bronchus (for
example, not in the main
bronchus)" />
<ListItem name="LI_76807" ID="76807.100004300" title="T1a Tumor 2 cm or less in
greatest dimension
" />
<ListItem name="LI_76808" ID="76808.100004300" title="T1b Tumor more than 2 cm
but 3 cm or less in greatest
dimension
" />
<ListItem name="LI_76809" ID="76809.100004300" title="T2 Tumor with more
than 3 cm but 7 cm or
less or tumor with any of
the following features (T2
tumors with these features
are classified T2a if 5 cm
or less); Involves main
bronchus, 2cm o more
distal to the carina; invades
visceral pleura (PL1 or PL2);
associated the atelectasis
or obstructive pneumonitis
that extends to the hilar
region but does not involve
the entire lung" />
<ListItem name="LI_76810" ID="76810.100004300" title="T2a Tumor more than 3cm
but 5 cm or less in greatest
dimension" />
<ListItem name="LI_76811" ID="76811.100004300" title="T2b Tumor more than
5 cm but 7 cm or less in
greatest dimension" selected="true"/>
<ListItem name="LI_76812" ID="76812.100004300" title="T3 Tumor more than 7 cm or one that directly invades any of the following: parietal pleura (PL3), chest wall (including superior sulcus tumors), diaphragm, phrenic nerve, mediastinal pleura, parietal pericardium; or tumor in the main bronchus less than 2 cm distal to
the carina but without involvement of the carina; or associated atelectasis or obstructive pneumonitis of the entire lung or a separate tumor nodule(s) in the same lobe
" />
<ListItem name="LI_76813" ID="76813.100004300" title="T4 Tumor of any size that invades any of the following: mediastinum, heart, great vessels, trachea, recurrent laryngeal nerve, esophagus, vertebral body, carina, separate tumor nodule(s) in a different ipsilateral lobe" />
</List>
</ListField>
</Question>
<Question name="Q_76629" ID="76629.100004300" title="N Stage">
<ListField name="lf_76629_1">
<List name="lst_76629_2">
<ListItem name="LI_76814" ID="76814.100004300" title="Nx Regional lymph nodes cannot be assessed" />
<ListItem name="LI_76815" ID="76815.100004300" title="N0 No regional lymph node metastases" />
<ListItem name="LI_76816" ID="76816.100004300" title="N1 Metastasis in ipsilateral peribronchial and/or ipsilateral hilar nodes and intrapulmonary nodes including involvement by direct extension" />
<ListItem name="LI_76817" ID="76817.100004300" title="N2 Metastasis in ipsilateral mediastinal and/or subcarinal lymph node(s)" selected="true"/>
<ListItem name="LI_76818" ID="76818.100004300" title="N3 Metastasis in contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or supraclavicular lymph node(s)" />
</List>
</ListField>
</Question>
<Question name="Q_76630" ID="76630.100004300" title="M Stage">
<ListField name="lf_76630_1">
<List name="lst_76630_2">
<ListItem name="LI_76819" ID="76819.100004300" title="M0 No distant metastasis" />
<ListItem name="LI_76820" ID="76820.100004300" title="M1 Distant metastasis" selected="true"/>
<ListItem name="LI_76821" ID="76821.100004300" title="M1a Separate tumor nodule(s) in a contralateral lobe, tumor with pleural nodules or malignant pleural (or pericardial) effusion" />
<ListItem name="LI_76822" ID="76822.100004300" title="M1b Distant metastasis (in extrathoracic organs)" />
</List>
</ListField>
</Question>
<Question name="Q_76631" ID="76631.100004300" title="Clinical Stage">
<ListField name="lf_76631_1">
<List name="lst_76631_2">
<ListItem name="LI_76823" ID="76823.100004300" title="Occult Carcinoma" />
<ListItem name="LI_76824" ID="76824.100004300" title="Stage 0" />
<ListItem name="LI_76825" ID="76825.100004300" title="Stage IA" />
<ListItem name="LI_76826" ID="76826.100004300" title="Stage IB" />
<ListItem name="LI_76827" ID="76827.100004300" title="Stage IIA" />
<ListItem name="LI_76828" ID="76828.100004300" title="Stage IIIA" />
<ListItem name="LI_76829" ID="76829.100004300" title="Stage IIIB" />
<ListItem name="LI_76830" ID="76830.100004300" title="Stage IV" />
</List>
</ListField>
</Question>
<Question name="Q_76498" ID="76498.100004300" title="Clinical Staging Version (AJCC)" minCard="0">
<ResponseField name="rf_76498_1">
<Response name="rsp_76498_2">
<string name="str_76498_3" />
</Response>
</ResponseField>
</Question>
</ChildItems>
</Section>
</ChildItems>
</Section>
<Section name="S_76069" ID="76069.100004300" title="Operative Procedure">
<ChildItems name="ch_76069_1">
<Section name="S_76418" ID="76418.100004300" title="Sign-In and Briefing" minCard="0">
<ChildItems name="ch_76418_1">
<Question name="Q_76516" ID="76516.100004300" title="Consent for treatment obtained" minCard="0">
<ListField name="lf_76516_1">
<List name="lst_76516_2">
<ListItem name="LI_76831" ID="76831.100004300" title="Yes" />
<ListItem name="LI_76832" ID="76832.100004300" title="No" />
</List>
</ListField>
</Question>
<Question name="Q_76517" ID="76517.100004300" title="Time of Surgery Started" minCard="0">
<ResponseField name="rf_76517_1">
<Response name="rsp_76517_2">
<string name="dt_76517_3" />
</Response>
</ResponseField>
</Question>
<Question name="Q_76518" ID="76518.100004300" title="Time of Surgery Ended" minCard="0">
<ResponseField name="rf_76518_1">
<Response name="rsp_76518_2">
<string name="str_76518_3" />
</Response>
</ResponseField>
</Question>
<Question name="Q_76519" ID="76519.100004300" title="Surgical Safety Checklist performed?" minCard="0">
<ListField name="lf_76519_1">
<List name="lst_76519_2">
<ListItem name="LI_77515" ID="77515.100004300" title="Yes" />
<ListItem name="LI_77516" ID="77516.100004300" title="No" />
</List>
</ListField>
</Question>
<Question name="Q_76520" ID="76520.100004300" title="Were any pressure point protection procedures performed?" minCard="0">
<ListField name="lf_76520_1">
<List name="lst_76520_2">
<ListItem name="LI_77517" ID="77517.100004300" title="Yes" />
<ListItem name="LI_77518" ID="77518.100004300" title="No" />
</List>
</ListField>
</Question>
<Question name="Q_76521" ID="76521.100004300" title="Patient Position">
<ListField name="lf_76521_1">
<List name="lst_76521_2">
<ListItem name="LI_76837" ID="76837.100004300" title="Supine" />
<ListItem name="LI_76838" ID="76838.100004300" title="Left Lateral" />
<ListItem name="LI_76839" ID="76839.100004300" title="Right Lateral" />
<ListItem name="LI_76840" ID="76840.100004300" title="Prone" />
<ListItem name="LI_76841" ID="76841.100004300" title="Lithotomy" />
<ListItem name="LI_76842" ID="76842.100004300" title="Other ">
<ChildItems name="ch_76842_1">
<Question name="Q_77611" ID="77611.100004300" title="Specify">
<ResponseField name="rf_77611_1">
<Response name="rsp_77611_2">
<string name="str_77611_3" />