| Package | IdHIE.0v |
| Type | Questionnaire |
| Id | Id |
| FHIR Version | R4 |
| Source | https://simplifier.net/resolve?scope=IdHIE.0v@0.0.1&canonical=http://fhir.hie.moh.gov.id/Questionnaire/q-dengue-checklist |
| Url | http://fhir.hie.moh.gov.id/Questionnaire/q-dengue-checklist |
| Version | 1.0.0 |
| Status | active |
| Date | 2023-07-05T03:44:13.9017419+00:00 |
| Name | QDengueChecklist |
| Title | Dengue Assessment Checklist |
| Experimental | False |
| Authority | hl7 |
No resources found
No resources found
FHIR{
"resourceType" : "Questionnaire",
"id" : "q-dengue-checklist",
"meta" : {
"versionId" : "3",
"lastUpdated" : "2023-07-03T12:47:59.716+08:00",
"source" : "#lU4f3puLhNvf40h3"
},
"url" : "http://fhir.hie.moh.gov.id/Questionnaire/q-dengue-checklist",
"version" : "1.0.0",
"name" : "QDengueChecklist",
"title" : "Dengue Assessment Checklist",
"status" : "active",
"date" : "2023-07-05T03:44:13.9017419+00:00",
"item" : [
{
"linkId" : "dengue-cl.1",
"text" : "Recognition",
"type" : "group",
"item" : [
{
"linkId" : "dengue-cl.1.1",
"text" : "Fever",
"type" : "boolean"
},
{
"linkId" : "dengue-cl.1.2",
"text" : "Aches and pain",
"type" : "boolean"
},
{
"linkId" : "dengue-cl.1.3",
"text" : "Nausea and / or vomitting",
"type" : "boolean"
},
{
"linkId" : "dengue-cl.1.4",
"text" : "Rash",
"type" : "boolean"
},
{
"linkId" : "dengue-cl.1.5",
"text" : "Leucopenia",
"type" : "boolean"
},
{
"linkId" : "dengue-cl.1.6",
"text" : "Any warning signs",
"type" : "boolean"
},
{
"linkId" : "dengue-cl.1.7",
"text" : "Remarks",
"type" : "text"
}
]
},
{
"linkId" : "dengue-cl.2",
"text" : "Warning signs",
"type" : "group",
"item" : [
{
"linkId" : "dengue-cl.2.1",
"text" : "Persistent vomiting (3 or more than 3 times over the last 24 hours)",
"type" : "boolean"
},
{
"linkId" : "dengue-cl.2.2",
"text" : "Persistent diarrhea (3 or more than 3 times over the last 24 hours)",
"type" : "boolean"
},
{
"linkId" : "dengue-cl.2.3",
"text" : "Any abdominal pain / tenderness",
"type" : "boolean"
},
{
"linkId" : "dengue-cl.2.4",
"text" : "Lethargy / Restlessness / Confusion",
"type" : "boolean"
},
{
"linkId" : "dengue-cl.2.5",
"text" : "Tender liver",
"type" : "boolean"
},
{
"linkId" : "dengue-cl.2.6",
"text" : "Third space fluid accumulation",
"type" : "boolean"
},
{
"linkId" : "dengue-cl.2.7",
"text" : "Spontaneous bleeding tendencies",
"type" : "boolean"
},
{
"linkId" : "dengue-cl.2.8",
"text" : "Raised HCT with rapid drop in platelet. \nMale age ≤ 60 : HCT >46 \nMale age >60 : HCT > 42 \nFemale all ages : >40",
"type" : "boolean"
},
{
"linkId" : "dengue-cl.2.9",
"text" : "Remarks",
"type" : "text"
}
]
},
{
"linkId" : "dengue-cl.3",
"text" : "Other criteria",
"type" : "group",
"item" : [
{
"linkId" : "dengue-cl.3.1",
"text" : "Syncope",
"type" : "boolean"
},
{
"linkId" : "dengue-cl.3.2",
"text" : "Social factor",
"type" : "boolean"
},
{
"linkId" : "dengue-cl.3.3",
"text" : "Remarks",
"type" : "text"
}
]
},
{
"linkId" : "dengue-cl.4",
"text" : "Special Group",
"type" : "group",
"item" : [
{
"linkId" : "dengue-cl.4.1",
"text" : "Obese",
"type" : "boolean"
},
{
"linkId" : "dengue-cl.4.2",
"text" : "Pregnant",
"type" : "boolean"
},
{
"linkId" : "dengue-cl.4.3",
"text" : "Heart failure / CKD / CLD",
"type" : "boolean"
},
{
"linkId" : "dengue-cl.4.4",
"text" : "Diabetes Mellitus",
"type" : "boolean"
},
{
"linkId" : "dengue-cl.4.5",
"text" : "Hypertension",
"type" : "boolean"
},
{
"linkId" : "dengue-cl.4.6",
"text" : "IHD",
"type" : "boolean"
},
{
"linkId" : "dengue-cl.4.7",
"text" : "COPD",
"type" : "boolean"
},
{
"linkId" : "dengue-cl.4.8",
"text" : "Age > 65",
"type" : "boolean"
},
{
"linkId" : "dengue-cl.4.9",
"text" : "Remarks",
"type" : "text"
}
]
},
{
"linkId" : "dengue-cl.5",
"text" : "Physical Examination and Vital signs",
"type" : "group",
"item" : [
{
"linkId" : "dengue-cl.5.1",
"text" : "Physical Examination findings",
"type" : "text"
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/minValue",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/maxValue",
"valueInteger" : 300
}
],
"linkId" : "dengue-cl.5.2",
"code" : [
{
"system" : "http://loinc.org",
"code" : "8480-6",
"display" : "Systolic Blood Pressure"
}
],
"text" : "Systolic Blood Pressure (mmHg)",
"type" : "quantity",
"initial" : [
{
"valueQuantity" : {
"unit" : "mmHg",
"system" : "http://unitsofmeasure.org",
"code" : "mm[Hg]"
}
}
]
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/minValue",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/maxValue",
"valueInteger" : 250
}
],
"linkId" : "dengue-cl.5.3",
"code" : [
{
"system" : "http://loinc.org",
"code" : "8462-4",
"display" : "Diastolic Blood Pressure"
}
],
"text" : "Diastolic Blood Pressure (mmHg)",
"type" : "quantity",
"initial" : [
{
"valueQuantity" : {
"unit" : "mmHg",
"system" : "http://unitsofmeasure.org",
"code" : "mm[Hg]"
}
}
]
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/minValue-my-core",
"valueInteger" : 0
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/maxValue-my-core",
"valueInteger" : 400
}
],
"linkId" : "dengue-cl.5.4",
"text" : "Heart Rate (/min)",
"type" : "quantity",
"initial" : [
{
"valueQuantity" : {
"unit" : "/min",
"system" : "http://unitsofmeasure.org",
"code" : "/min"
}
}
]
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/minValue-my-core",
"valueInteger" : 0
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/maxValue-my-core",
"valueInteger" : 100
}
],
"linkId" : "dengue-cl.5.5",
"text" : "Body Temperature (°C)",
"type" : "quantity",
"initial" : [
{
"valueQuantity" : {
"unit" : "°C",
"system" : "http://unitsofmeasure.org",
"code" : "Cel"
}
}
]
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/minValue-my-core",
"valueInteger" : 0
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/maxValue-my-core",
"valueInteger" : 100
}
],
"linkId" : "dengue-cl.5.6",
"text" : "Oxygen Saturation (%)",
"type" : "quantity",
"initial" : [
{
"valueQuantity" : {
"unit" : "%",
"system" : "http://unitsofmeasure.org",
"code" : "%"
}
}
]
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/minValue-my-core",
"valueInteger" : 0
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/maxValue-my-core",
"valueInteger" : 80
}
],
"linkId" : "dengue-cl.5.7",
"text" : "Respiratory Rate (/min)",
"type" : "quantity",
"initial" : [
{
"valueQuantity" : {
"unit" : "/min",
"system" : "http://unitsofmeasure.org",
"code" : "/min"
}
}
]
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/minValue",
"valueInteger" : 0
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/maxValue",
"valueInteger" : 10
}
],
"linkId" : "dengue-cl.5.8",
"text" : "Pain score",
"type" : "quantity"
}
]
},
{
"linkId" : "dengue-cl.6",
"text" : "Blood investigation",
"type" : "group",
"item" : [
{
"linkId" : "dengue-cl.6.1",
"text" : "White cell counts",
"type" : "string"
},
{
"linkId" : "dengue-cl.6.2",
"text" : "Hb",
"type" : "string"
},
{
"linkId" : "dengue-cl.6.3",
"text" : "HCT",
"type" : "string"
},
{
"linkId" : "dengue-cl.6.4",
"text" : "Platelet",
"type" : "string"
},
{
"linkId" : "dengue-cl.6.5",
"text" : "Dengue Point of Care checklist (Combo / Rapid checklist)",
"type" : "string"
}
]
},
{
"linkId" : "dengue-cl.7",
"text" : "Severe Dengue",
"type" : "group",
"item" : [
{
"linkId" : "dengue-cl.7.1",
"text" : "Hypotension SBP <90 or MAP <60 or SBP drop > 40mmHg from known baseline",
"type" : "boolean"
},
{
"linkId" : "dengue-cl.7.2",
"text" : "Shock Index: HR > SBP or abnormal CCTVR",
"type" : "boolean"
},
{
"linkId" : "dengue-cl.7.3",
"text" : "Third Space fluid accumulation with respiratory distress",
"type" : "boolean"
},
{
"linkId" : "dengue-cl.7.4",
"text" : "Altered concious level",
"type" : "boolean"
},
{
"linkId" : "dengue-cl.7.5",
"text" : "Any bleed GI / non mucosal and non cutaneous / non physiological",
"type" : "boolean"
},
{
"linkId" : "dengue-cl.7.6",
"text" : "Specific organ dysfunction",
"type" : "boolean"
},
{
"linkId" : "dengue-cl.7.7",
"text" : "Remarks",
"type" : "text"
}
]
},
{
"linkId" : "dengue-cl.8",
"text" : "Onset of illness",
"type" : "group",
"item" : [
{
"linkId" : "dengue-cl.8,1",
"text" : "Fever onset",
"type" : "dateTime"
},
{
"linkId" : "dengue-cl.8.2",
"text" : "Critical phase onset",
"type" : "dateTime"
}
]
},
{
"linkId" : "dengue-cl.9",
"text" : "Phase of illness",
"type" : "choice",
"answerOption" : [
{
"valueCoding" : {
"code" : "01",
"display" : "Febrile"
}
},
{
"valueCoding" : {
"code" : "02",
"display" : "Critical"
}
},
{
"valueCoding" : {
"code" : "03",
"display" : "Recovery"
}
}
]
},
{
"linkId" : "dengue-cl.10",
"text" : "Diagnosis",
"type" : "choice",
"answerOption" : [
{
"valueCoding" : {
"code" : "01",
"display" : "Dengue fever without warning signs"
}
},
{
"valueCoding" : {
"code" : "02",
"display" : "Dengue fever with warning signs"
}
},
{
"valueCoding" : {
"code" : "03",
"display" : "Severe Dengue"
}
}
]
},
{
"linkId" : "dengue-cl.11",
"text" : "Management",
"type" : "group",
"item" : [
{
"linkId" : "dengue-cl.11.1",
"text" : "Management / Plans",
"type" : "text"
}
]
}
],
"text" : {
}
}
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