Resource Questionnaire/FHIR Server from package ca.on.oh.mha-pds#0.9.0-alpha-1.9.7.38 (63 ms)

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{
  "resourceType" : "Questionnaire",
  "url" : "http://ontariohealth.ca/fhir/StructureDefinition/ca-on-mha-clinical-summary-questionnaire-template",
  "title" : "MHA Clinical Summary Questionnaire Template",
  "status" : "draft",
  "description" : "Sample questionnaire using all questions from the admission clinical summary questionnaire",
  "purpose" : "To serve as a model to support MHA admission questionnaires.",
  "item" : [
    {
      "linkId" : "Q1",
      "text" : "Symptoms of Clinical Concern",
      "type" : "choice",
      "repeats" : true,
      "answerValueSet" : "http://ontariohealth.ca/fhir/ValueSet/mha-presenting-concerns"
    },
    {
      "linkId" : "Q2",
      "text" : "Behavioural Addictions and/or Problematic Substance Use",
      "type" : "choice",
      "repeats" : true,
      "answerValueSet" : "http://ontariohealth.ca/fhir/ValueSet/mha-behavioural-addictions-problematic-substance-use"
    },
    {
      "linkId" : "Q3",
      "text" : "Other Reasons for Seeking Service",
      "type" : "choice",
      "repeats" : true,
      "answerValueSet" : "http://ontariohealth.ca/fhir/ValueSet/mha-reasons-for-seeking-advice"
    },
    {
      "linkId" : "Q4",
      "text" : "Prescribed pharmacotherapy or anti-craving medication for alcohol use disorder",
      "type" : "group",
      "item" : [
        {
          "linkId" : "Q4-a",
          "text" : "Are you receiving prescribed pharmacotherapy or anti-craving medication for alcohol use disorder?",
          "type" : "choice",
          "answerOption" : [
            {
              "valueString" : "Yes"
            },
            {
              "valueString" : "No"
            },
            {
              "valueString" : "Asked but declined"
            }
          ]
        },
        {
          "linkId" : "Q4-b",
          "text" : "What anti-craving medication prescribed?",
          "type" : "choice",
          "repeats" : true,
          "enableWhen" : [
            {
              "question" : "Q3-a",
              "operator" : "=",
              "answerString" : "Yes"
            }
          ],
          "answerValueSet" : "http://ontariohealth.ca/fhir/ValueSet/mha-anti-craving-medication"
        }
      ]
    },
    {
      "linkId" : "Q5",
      "text" : "Prescribed pharmacotherapy or Opioid agonist therapy for Opioid Use Disorder",
      "type" : "group",
      "item" : [
        {
          "linkId" : "Q5-a",
          "text" : "Are you receiving prescribed pharmacotherapy or Opioid agonist therapy for Opioid Use Disorder?",
          "type" : "choice",
          "answerOption" : [
            {
              "valueString" : "Yes"
            },
            {
              "valueString" : "No"
            },
            {
              "valueString" : "Asked but declined"
            }
          ]
        },
        {
          "linkId" : "Q5-b",
          "text" : "What opioid Agonist therapy is prescribed?",
          "type" : "choice",
          "enableWhen" : [
            {
              "question" : "Q4-a",
              "operator" : "=",
              "answerString" : "Yes"
            }
          ],
          "answerValueSet" : "http://ontariohealth.ca/fhir/ValueSet/opioid-agonist-medication"
        }
      ]
    },
    {
      "linkId" : "Q6",
      "text" : "Gambing Problem Identified",
      "type" : "choice",
      "answerValueSet" : "http://ontariohealth.ca/fhir/ValueSet/gambling-problem-identified"
    },
    {
      "linkId" : "Q7",
      "text" : "Reason for Non-completion of Gambling Data Form",
      "type" : "choice",
      "answerValueSet" : "http://ontariohealth.ca/fhir/ValueSet/mha-gambling-data-form-non-completion-reason"
    },
    {
      "linkId" : "Q8",
      "text" : "Gambling Treatment Plan Status",
      "type" : "choice",
      "answerValueSet" : "http://ontariohealth.ca/fhir/ValueSet/gambling-treatment-plan-status"
    }
  ],
  "text" : {
  }
}

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