| 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.my/Questionnaire/01-001-0001 |
| Url | http://fhir.hie.moh.gov.my/Questionnaire/01-001-0001 |
| Version | 1.0.0 |
| Status | active |
| Date | 2023-03-30T22:48:32.9749675+00:00 |
| Name | questionnaire-bbis-01-001-0001 |
| Title | BBIS - Reporting Form For Transfusion-Related Adverse Event |
| Experimental | False |
| Authority | hl7 |
No resources found
No resources found
FHIR{
"resourceType" : "Questionnaire",
"meta" : {
"profile" : [
"http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire|2.7"
],
"tag" : [
{
"code" : "lformsVersion: 29.2.1"
}
]
},
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/variable",
"valueExpression" : {
"language" : "text/fhirpath"
}
}
],
"url" : "http://fhir.hie.moh.gov.my/Questionnaire/01-001-0001",
"version" : "1.0.0",
"name" : "questionnaire-bbis-01-001-0001",
"title" : "BBIS - Reporting Form For Transfusion-Related Adverse Event",
"status" : "active",
"date" : "2023-03-30T22:48:32.9749675+00:00",
"publisher" : "Malaysia MOH - HIE Steering Committee",
"item" : [
{
"text" : "Section A: Recipient Details",
"type" : "group",
"required" : false,
"item" : [
{
"text" : "Hospital",
"type" : "string",
"required" : false
},
{
"text" : "Ward",
"type" : "string",
"required" : false
}
]
},
{
"text" : "SECTION C: Onset of Adverse Event",
"type" : "group",
"required" : false,
"item" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "radio-button",
"display" : "Radio Button"
}
],
"text" : "Radio Button"
}
}
],
"text" : "Onset",
"type" : "choice",
"required" : false,
"answerOption" : [
{
"valueCoding" : {
"display" : "Immediate"
}
},
{
"valueCoding" : {
"display" : "Delay"
}
}
]
}
]
},
{
"text" : "SECTION D: Blood Component Implicated In Adverse Event",
"type" : "group",
"required" : false,
"item" : [
{
"text" : "Blood component implicated",
"type" : "group",
"required" : false,
"item" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "check-box",
"display" : "Check-box"
}
],
"text" : "Check-box"
}
}
],
"text" : "Whole Blood",
"type" : "choice",
"required" : false,
"repeats" : true,
"answerOption" : [
{
"valueCoding" : {
"display" : "Whole Blood"
}
},
{
"valueCoding" : {
"display" : "Irradiated"
}
},
{
"valueCoding" : {
"display" : "Filtered"
}
}
]
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "check-box",
"display" : "Check-box"
}
],
"text" : "Check-box"
}
}
],
"text" : "Packed Cells",
"type" : "choice",
"required" : false,
"repeats" : true,
"answerOption" : [
{
"valueCoding" : {
"display" : "Packed Cells"
}
},
{
"valueCoding" : {
"display" : "Irradiated"
}
}
]
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "check-box",
"display" : "Check-box"
}
],
"text" : "Check-box"
}
}
],
"text" : "Apheresis Platelet",
"type" : "choice",
"required" : false,
"repeats" : true,
"answerOption" : [
{
"valueCoding" : {
"display" : "Apheresis Platelet"
}
},
{
"valueCoding" : {
"display" : "Irradiated"
}
},
{
"valueCoding" : {
"display" : "Pathogen Inactivated"
}
}
]
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "check-box",
"display" : "Check-box"
}
],
"text" : "Check-box"
}
}
],
"text" : "Random Platelet",
"type" : "choice",
"required" : false,
"repeats" : true,
"answerOption" : [
{
"valueCoding" : {
"display" : "Random Platelet"
}
},
{
"valueCoding" : {
"display" : "Irradiated"
}
}
]
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "check-box",
"display" : "Check-box"
}
],
"text" : "Check-box"
}
}
],
"text" : "Fresh Frozen Plasma",
"type" : "choice",
"required" : false,
"repeats" : true,
"answerOption" : [
{
"valueCoding" : {
"display" : "Fresh Frozen Plasma"
}
}
]
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "check-box",
"display" : "Check-box"
}
],
"text" : "Check-box"
}
}
],
"text" : "Cryoprecipitate",
"type" : "choice",
"required" : false,
"repeats" : true,
"answerOption" : [
{
"valueCoding" : {
"display" : "Cryoprecipitate"
}
},
{
"valueCoding" : {
"display" : "Pathogen Inactivated"
}
}
]
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "check-box",
"display" : "Check-box"
}
],
"text" : "Check-box"
}
}
],
"text" : "Cryosupernatant/Liver Plasma",
"type" : "choice",
"required" : false,
"repeats" : true,
"answerOption" : [
{
"valueCoding" : {
"display" : "Cryosupernatant/Liver Plasma"
}
}
]
},
{
"text" : "Others",
"type" : "text",
"required" : false,
"maxLength" : 4000,
"item" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "help",
"display" : "Help-Button"
}
],
"text" : "Help-Button"
}
}
],
"linkId" : "undefined-help",
"text" : "Please specify (Max 4000 Characters)",
"type" : "display"
}
]
}
]
}
]
},
{
"text" : "SECTION E: Date Rection Occured",
"type" : "group",
"required" : false,
"item" : [
{
"text" : "Date reaction occured",
"type" : "dateTime",
"required" : false
}
]
},
{
"text" : "SECTION F: Relevant Clinical History",
"type" : "group",
"required" : false,
"item" : [
{
"text" : "Patient Diagnosis",
"type" : "string",
"required" : false
}
]
},
{
"text" : "SECTION I: Patient Outcome From The Adverse Event",
"type" : "group",
"required" : false,
"item" : [
{
"text" : "Recovered",
"type" : "boolean",
"required" : false
},
{
"text" : "Imputability",
"type" : "group",
"required" : false,
"item" : [
{
"text" : "Excluded / Unlikely",
"type" : "boolean",
"required" : false,
"item" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "help",
"display" : "Help-Button"
}
],
"text" : "Help-Button"
}
}
],
"linkId" : "undefined-help",
"text" : "When there is conclusive evidence beyond reasonable doubt that the complication can be attributed to other causes",
"type" : "display"
}
]
},
{
"text" : "Possible",
"type" : "boolean",
"required" : false,
"item" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "help",
"display" : "Help-Button"
}
],
"text" : "Help-Button"
}
}
],
"linkId" : "undefined-help",
"text" : "Evidence is indeterminate for attributing the adverse event to the transfusion",
"type" : "display"
}
]
},
{
"text" : "Likely / Probable",
"type" : "boolean",
"required" : false,
"item" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "help",
"display" : "Help-Button"
}
],
"text" : "Help-Button"
}
}
],
"linkId" : "undefined-help",
"text" : "When the evidence is clearly in favour of the reaction",
"type" : "display"
}
]
},
{
"text" : "Confirmed / Definite",
"type" : "boolean",
"required" : false,
"item" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "help",
"display" : "Help-Button"
}
],
"text" : "Help-Button"
}
}
],
"linkId" : "undefined-help",
"text" : "When there is conclusive evidence beyond reasonable doubt for the relation",
"type" : "display"
}
]
},
{
"text" : "Comment",
"type" : "text",
"required" : false,
"item" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "help",
"display" : "Help-Button"
}
],
"text" : "Help-Button"
}
}
],
"linkId" : "undefined-help",
"text" : "(Max 4000 Characters)",
"type" : "display"
}
]
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "help",
"display" : "Help-Button"
}
],
"text" : "Help-Button"
}
}
],
"linkId" : "undefined-help",
"text" : "Relation between adverse event and transfusion",
"type" : "display"
}
]
}
]
},
{
"text" : "SECTION J: Type Of Adverse Event",
"type" : "group",
"required" : false,
"item" : [
{
"text" : "Incorrect Blood Component/Product Transfused",
"type" : "group",
"required" : false,
"item" : [
{
"text" : "Acute Immune Haemolytic Anaemia",
"type" : "boolean",
"required" : false,
"item" : [
{
"text" : "ABO incompatible",
"type" : "boolean",
"required" : false
},
{
"text" : "Other red cell incompatibility",
"type" : "boolean",
"required" : false,
"item" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "help",
"display" : "Help-Button"
}
],
"text" : "Help-Button"
}
}
],
"linkId" : "undefined-help",
"text" : "e.g. Rh positive given to Rh negative",
"type" : "display"
}
]
}
]
},
{
"text" : "Blood is compatible but meant for another patient",
"type" : "boolean",
"required" : false
},
{
"text" : "Others",
"type" : "boolean",
"required" : false,
"item" : [
{
"text" : "Special requirement not met",
"type" : "boolean",
"required" : false,
"item" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "help",
"display" : "Help-Button"
}
],
"text" : "Help-Button"
}
}
],
"linkId" : "undefined-help",
"text" : "e.g. irradiated, filtered, phenotyped",
"type" : "display"
}
]
},
{
"text" : "Inappropriate transfusion",
"type" : "boolean",
"required" : false,
"item" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "help",
"display" : "Help-Button"
}
],
"text" : "Help-Button"
}
}
],
"linkId" : "undefined-help",
"text" : "e.g. wrong component",
"type" : "display"
}
]
}
]
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "help",
"display" : "Help-Button"
}
],
"text" : "Help-Button"
}
}
],
"linkId" : "undefined-help",
"text" : "Proceed to SECTION K for 'IBCT'",
"type" : "display"
}
]
},
{
"text" : "Delayed Heamolytic Transfusion Reaction",
"type" : "boolean",
"required" : false
},
{
"text" : "Non-immune haemolytic reaction",
"type" : "boolean",
"required" : false,
"item" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "help",
"display" : "Help-Button"
}
],
"text" : "Help-Button"
}
}
],
"linkId" : "undefined-help",
"text" : "Due to mechanical factor, osmotic, heat, cold, etc",
"type" : "display"
}
]
},
{
"text" : "Febrile Non-Haemolytic Transfusion Reaction (FNHTR)",
"type" : "boolean",
"required" : false
},
{
"text" : "Allergic Reaction",
"type" : "boolean",
"required" : false,
"item" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "radio-button",
"display" : "Radio Button"
}
],
"text" : "Radio Button"
}
}
],
"text" : "Allergic Reaction",
"type" : "choice",
"required" : false,
"answerOption" : [
{
"valueCoding" : {
"display" : "Mild (Rash/Urticaria)"
}
},
{
"valueCoding" : {
"display" : "Moderate (Anaphylactoid)"
}
},
{
"valueCoding" : {
"display" : "Severe (Anaphylactic Transfusion Reaction)"
}
}
]
}
]
},
{
"text" : "Transfusion-Related Acute Lung Injury (TRALI)",
"type" : "boolean",
"required" : false
},
{
"text" : "Transfusion-Associated Circulatory Overload (TACO)",
"type" : "boolean",
"required" : false
},
{
"text" : "Transfusion-Associated Dyspnoea (TAD)",
"type" : "boolean",
"required" : false
},
{
"text" : "Transfusion-Associated Graft-versus-Host Disease (TA-GvHD)",
"type" : "boolean",
"required" : false
},
{
"text" : "Post-Transfusion Purpura (PTP)",
"type" : "boolean",
"required" : false
},
{
"text" : "Post-Transfusion Infection: Virus",
"type" : "boolean",
"required" : false,
"item" : [
{
"text" : "Please specify",
"type" : "text",
"required" : true
}
]
},
{
"text" : "Post-Transfusion Infection: Bacteria",
"type" : "boolean",
"required" : false,
"item" : [
{
"text" : "Please specify",
"type" : "text",
"required" : true
}
]
},
{
"text" : "Post-Transfusion Infection: Parasite",
"type" : "boolean",
"required" : false,
"item" : [
{
"text" : "Please specify",
"type" : "text",
"required" : true
}
]
},
{
"text" : "Handling and storage error",
"type" : "boolean",
"required" : false
},
{
"text" : "Equipment related (e.g. faulty waterbath, transfusion set, etc)",
"type" : "boolean",
"required" : false
},
{
"text" : "Unclassifiable Complication of Transfusion",
"type" : "boolean",
"required" : false,
"item" : [
{
"text" : "Please specify",
"type" : "text",
"required" : true
}
]
},
{
"text" : "Not Related To Transfusion",
"type" : "boolean",
"required" : false,
"item" : [
{
"text" : "Please specify",
"type" : "text",
"required" : true
}
]
},
{
"text" : "Hypotensive Transfusion Reaction",
"type" : "boolean",
"required" : false
},
{
"text" : "Others",
"type" : "boolean",
"required" : false,
"item" : [
{
"text" : "File Upload",
"type" : "attachment",
"required" : false
},
{
"text" : "Please specify",
"type" : "text",
"required" : true
}
]
}
]
}
],
"text" : {
}
}
XIG built as of ??metadata-date??. Found ??metadata-resources?? resources in ??metadata-packages?? packages.