| 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-tb-note |
| Url | http://fhir.hie.moh.gov.id/Questionnaire/q-tb-note |
| Version | 1.0.0 |
| Status | active |
| Date | 2023-07-05T03:44:13.9017419+00:00 |
| Name | QTbNote |
| Title | TB Clerking Template |
| Experimental | False |
| Authority | hl7 |
No resources found
No resources found
FHIR{
"resourceType" : "Questionnaire",
"id" : "q-tb-note",
"meta" : {
"versionId" : "3",
"lastUpdated" : "2023-07-03T12:49:31.901+08:00",
"source" : "#4cyS4XNkvUOq5plk"
},
"url" : "http://fhir.hie.moh.gov.id/Questionnaire/q-tb-note",
"version" : "1.0.0",
"name" : "QTbNote",
"title" : "TB Clerking Template",
"status" : "active",
"date" : "2023-07-05T03:44:13.9017419+00:00",
"item" : [
{
"linkId" : "tb-note.1",
"text" : "Special Group",
"type" : "group",
"item" : [
{
"linkId" : "tb-note.1.1",
"text" : "TB Contact",
"type" : "boolean"
},
{
"linkId" : "tb-note.1.2",
"text" : "Pregnancy",
"type" : "boolean"
},
{
"linkId" : "tb-note.1.3",
"text" : "Other comorbids (e.g Diabetes Mellitus or Hypertension)",
"type" : "boolean"
},
{
"linkId" : "tb-note.1.4",
"text" : "Immunocompromised (e.g. on immunosupressants / HIV)",
"type" : "boolean"
},
{
"linkId" : "tb-note.1.5",
"text" : "Special Group Remarks",
"type" : "text"
}
]
},
{
"linkId" : "tb-note.2",
"text" : "Past Medical / Surgical History",
"type" : "group",
"item" : [
{
"linkId" : "tb-note.2.1",
"text" : "Past Medical History",
"type" : "text"
},
{
"linkId" : "tb-note.2.2",
"text" : "Past Surgical History",
"type" : "text"
}
]
},
{
"linkId" : "tb-note.3",
"text" : "Medication History",
"type" : "group",
"item" : [
{
"linkId" : "tb-note.3.1",
"text" : "Medication Details",
"type" : "text"
}
]
},
{
"linkId" : "tb-note.4",
"text" : "Social and Family History",
"type" : "group",
"item" : [
{
"linkId" : "tb-note.4.2",
"text" : "Social History",
"type" : "text"
},
{
"linkId" : "tb-note.4.1",
"text" : "Family History",
"type" : "text"
}
]
},
{
"linkId" : "tb-note.5",
"text" : "Symptoms",
"type" : "group",
"item" : [
{
"linkId" : "tb-note.5.1",
"text" : "Cough",
"type" : "boolean"
},
{
"linkId" : "tb-note.5.2",
"text" : "Fever",
"type" : "boolean"
},
{
"linkId" : "tb-note.5.3",
"text" : "Night Sweats",
"type" : "boolean"
},
{
"linkId" : "tb-note.5.4",
"text" : "Haemoptysis",
"type" : "boolean"
},
{
"linkId" : "tb-note.5.5",
"text" : "Weight loss",
"type" : "boolean"
},
{
"linkId" : "tb-note.5.6",
"text" : "Chest pain",
"type" : "boolean"
},
{
"linkId" : "tb-note.5.7",
"text" : "Shortness of breath",
"type" : "boolean"
},
{
"linkId" : "tb-note.5.8",
"text" : "Lethargy",
"type" : "boolean"
},
{
"linkId" : "tb-note.5.9",
"text" : "Symptoms Remark",
"type" : "text"
}
]
},
{
"linkId" : "tb-note.6",
"text" : "History of Presenting Illness Summary",
"type" : "group",
"item" : [
{
"linkId" : "tb-note.6.1",
"text" : "Findings",
"type" : "text"
}
]
},
{
"linkId" : "tb-note.7",
"text" : "Vital Signs",
"type" : "group",
"item" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/minValue-my-core",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/maxValue-my-core",
"valueInteger" : 300
}
],
"linkId" : "tb-note.7.1",
"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-my-core",
"valueInteger" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/maxValue-my-core",
"valueInteger" : 250
}
],
"linkId" : "tb-note.7.2",
"code" : [
{
"system" : "http://loinc.org",
"code" : "8462-4",
"display" : "Diastolic Blood Pressure"
}
],
"text" : "Diastolic Blood Pressure (mmHg)",
"type" : "quantity",
"enableWhen" : [
{
"question" : "tb-note.7.1",
"operator" : "exists",
"answerBoolean" : true
}
],
"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" : "tb-note.7.3",
"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" : "tb-note.7.4",
"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" : "tb-note.7.5",
"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" : "tb-note.7.6",
"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" : 1
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/maxValue",
"valueInteger" : 10
}
],
"linkId" : "tb-note.7.7",
"text" : "Pain score",
"type" : "quantity"
}
]
},
{
"linkId" : "tb-note.8",
"text" : "Physical Examination",
"type" : "group",
"item" : [
{
"linkId" : "tb-note.8.1",
"text" : "Findings",
"type" : "text"
}
]
},
{
"linkId" : "tb-note.9",
"text" : "Investigations / Special Test",
"type" : "group",
"item" : [
{
"linkId" : "tb-note.9.1",
"text" : "Findings",
"type" : "text"
}
]
},
{
"linkId" : "tb-note.10",
"text" : "Imaging",
"type" : "group",
"item" : [
{
"linkId" : "tb-note.10.1",
"text" : "Chest X ray Intepretation",
"type" : "text"
}
]
},
{
"linkId" : "tb-note.11",
"text" : "Diagnosis",
"type" : "group",
"item" : [
{
"linkId" : "tb-note.11.1",
"text" : "Diagnosis",
"type" : "text"
}
]
},
{
"linkId" : "tb-note.12",
"text" : "Management / Treatment",
"type" : "group",
"item" : [
{
"linkId" : "tb-note.12.1",
"text" : "Management Summary",
"type" : "text"
}
]
},
{
"linkId" : "tb-note.13",
"text" : "Notification of Infectious Disease",
"type" : "group",
"item" : [
{
"linkId" : "tb-note.13.1",
"text" : "Spoken To",
"type" : "text"
},
{
"linkId" : "tb-note.13.2",
"text" : "Time of Notification",
"type" : "dateTime"
}
]
},
{
"linkId" : "tb-note.14",
"text" : "TCA Date",
"type" : "group",
"item" : [
{
"linkId" : "tb-note.14.1",
"text" : "Date",
"type" : "dateTime"
}
]
},
{
"linkId" : "tb-note.15",
"text" : "Referral",
"type" : "group",
"item" : [
{
"linkId" : "tb-note.15.1",
"text" : "Reason for Referral",
"type" : "text"
},
{
"linkId" : "tb-note.15.2",
"text" : "Spoken To",
"type" : "string"
},
{
"linkId" : "tb-note.15.3",
"text" : "Time of Referral",
"type" : "dateTime"
}
]
}
],
"text" : {
}
}
XIG built as of ??metadata-date??. Found ??metadata-resources?? resources in ??metadata-packages?? packages.