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Resource Questionnaire/FHIR Server from package cinc.fhir.ig#current (125 ms)

Package cinc.fhir.ig
Type Questionnaire
Id Id
FHIR Version R4
Source https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/Questionnaire-ActiveMonitoringDay42Survey.html
Url https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/Questionnaire/ActiveMonitoringDay42Survey
Version 0.1.6
Status draft
Date 2024-03-22T03:40:00+00:00
Name ActiveMonitoringDay42Survey
Title Influenza and COVID-19 Booster Vaccination 42 Day Review Questionnaire
Experimental False
Realm nz
Authority national
Description Te Whatu Ora 42-day post Influenza/Covid-19 booster vaccination survey.
Purpose Survey of side effects and overall experience of Influenza/COVID-19 Booster vaccination after 42 days.

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Narrative

Note: links and images are rebased to the (stated) source

Structure
LinkIdTextCardinalityTypeDescription & Constraintsdoco
.. ActiveMonitoringDay42SurveyTe Whatu Ora 42-day post Influenza/Covid-19 booster vaccination survey.Questionnairehttps://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/Questionnaire/ActiveMonitoringDay42Survey#0.1.6
... p01page 1. This is the final survey about your vaccine experience. This survey will take approximately five minutes to complete. There is a section at the end for you to comment on any parts of the vaccine experience that are not covered in the questionnaire.0..1display
... p02-q01-Vaccincationpage 2 question 1. Did you receive a dose of the COVID-19 bivalent or flu vaccine about six weeks ago?1..1choiceOptions: 4 options
... p03page 3 question 1.1.1. Vaccine Administration0..1groupEnable When:
.... p03-q01-VaccineAdministration.SurveyResponseDid you respond to the day 7 survey?1..1choiceOptions: 3 options
.... p03-q01-1-VaccineAdministration.SurveyResponse.WhyWhy did you not respond to the day 7 survey? Select all that apply1..*choiceEnable When: p03-q01-VaccineAdministration.SurveyResponse = No
Options: 6 options
.... p03-q01-1-1-VaccineAdministration.SurveyResponse.OtherPlease specify.1..1textEnable When: p03-q01-1-VaccineAdministration.SurveyResponse.Why = Other
... p04page 4 question 2.1.1. Adverse Reactions0..1groupEnable When:
.... p04-q01-AdverseReactionsDid you report experiencing any reactions to your vaccine on the day 7 survey?1..1choiceOptions: 3 options
.... p04-q01-1-AdverseReactions.StillAre you still experiencing those reactions reported on the day 7 survey?1..1choiceEnable When: p04-q01-AdverseReactions = Yes
Options: 3 options
.... p04-q02-MedicalAdviceSince the last survey have you sought medical help/ advice related to your vaccination?0..1boolean
.... p04-q02-1-MedicalAdvice.SelectPlease select all that apply1..*choiceEnable When: p04-q02-MedicalAdvice = true
Options: 8 options
.... p04-q02-1-1-MedicalAdvice.Select.OtherPlease specify.0..1textEnable When: p04-q02-1-MedicalAdvice.Select = Other
... p05page 5 question 1.3.1. Rare Diagnoses0..1groupEnable When:
.... p05-q01-MedicalConditionSince the day 7 survey, have you been diagnosed by a medical professional with a medical condition?1..1boolean
.... p05-q01-1-MedicalCondition.SelectPlease select all that apply1..*choiceEnable When: p05-q01-MedicalCondition = true
Options: 15 options
.... p05-q01-1-1-MedicalCondition.Select.OtherPlease specify which other conditions.1..1textEnable When: p05-q01-1-MedicalCondition.Select = Diagnosis of any other new conditions
.... p05-q01-2-MedicalCondition.HelpSince seeking medical help, has the issue gone away, or is being managed successfully?1..1booleanEnable When: p05-q01-MedicalCondition = true
.... p05-q01-3-MedicalCondition.MissingDaysHave you missed any days of work, study, or normal daily activities as a result of the diagnosis?1..1booleanEnable When: p05-q01-MedicalCondition = true
.... p05-q01-3-1-MedicalCondition.MissingDays.HowManyHow many days did you miss?1..1choiceEnable When: p05-q01-3-MedicalCondition.MissingDays = true
Options: 4 options
... p06page 6 question 1. Virus Infection0..1groupEnable When:
.... p06-q01-VirusInfectionSince receiving the vaccine, have you been diagnosed with COVID-19 or flu?1..1choiceOptions: 5 options
... p07page 7 question 1.1. Vaccine Experience1..1groupEnable When:
.... p07-q01-VaccineExperienceDo you have any other comments about your experience?1..1boolean
.... p07-q01-1-VaccineExperience.ExplainPlease Explain1..1textEnable When: p07-q01-VaccineExperience = true
... p08Thank you for completing the Day 42 survey. Your answers have been submitted. Your responses will help contribute to the safety monitoring of the vaccine(s) you received. The data collected by these surveys will be made publicly available once enough data has been collected. The information you provided is protected by the Privacy act of 2020 and by the safeguards we have in place. Please remember this is a survey only and your answers will not result in a medical response. If you have any concerns about your health, ring Healthline at 0800 611 116 or speak to your healthcare professional. If you experience any of these symptoms of myocarditis and pericarditis: tightness, heaviness, discomfort, pressure or pain in your chest or neck; difficulty breathing or catching your breath; feeling faint, dizzy, or light-headed; fluttering, racing, or pounding heart, or feeling like it's 'skipping beats', seek medical help promptly and mention your vaccination.0..1displayEnable When: p02-q01-Vaccincation exists true

doco Documentation for this format

Option Sets

Answer options for p02-q01-Vaccincation

  • null#null ("Yes, COVID-19 booster")
  • null#null ("Yes, flu")
  • null#null ("Yes, both")
  • null#null ("No")

Answer options for p03-q01-VaccineAdministration.SurveyResponse

  • null#null ("Yes")
  • null#null ("No")
  • null#null ("Unsure")

Answer options for p03-q01-1-VaccineAdministration.SurveyResponse.Why

  • null#null ("Did not have enough time")
  • null#null ("Survey was too long")
  • null#null ("Did not understand the questions")
  • null#null ("Did not receive a day 7 survey")
  • null#null ("Forgot to respond")
  • null#null ("Other")

Answer options for p04-q01-AdverseReactions

  • null#null ("Yes")
  • null#null ("No")
  • null#null ("Unsure")

Answer options for p04-q01-1-AdverseReactions.Still

  • null#null ("Yes")
  • null#null ("No")
  • null#null ("Unsure")

Answer options for p04-q02-1-MedicalAdvice.Select

  • null#null ("Phone advice from a helpline (e.g. Healthline)")
  • null#null ("Care from a GP clinic (including the clinic nurse, a doctor, or a phone call with a person at the GP clinic).")
  • null#null ("Visit to a hospital emergency department")
  • null#null ("Marae")
  • null#null ("Rongoā clinic")
  • null#null ("Whānau Ora navigator")
  • null#null ("Māori Health Provider")
  • null#null ("Other")

Answer options for p05-q01-1-MedicalCondition.Select

  • http://snomed.info/sct#40956001 ("Guillain-Barré syndrome")
  • http://snomed.info/sct#193093009 ("Bell's palsy")
  • http://snomed.info/sct#21018002 ("Inflamed nerves or nerve degradation (Neuritis or Neuropathy)")
  • http://snomed.info/sct#81308009 ("Any other neurological condition")
  • http://snomed.info/sct#91175000 ("Seizure")
  • http://snomed.info/sct#41497008 ("Febrile seizure")
  • http://snomed.info/sct#50920009 ("Myocarditis")
  • http://snomed.info/sct#3238004 ("Pericarditis")
  • http://snomed.info/sct#49601007 ("Other Heart issues")
  • http://snomed.info/sct#27550009 ("Blood vessel issues")
  • null#null ("Blood and lymphatic system disorders")
  • http://snomed.info/sct#414029004 ("Immune system disorders")
  • http://snomed.info/sct#39579001 ("Anaphylaxis (severe allergic reaction)")
  • http://snomed.info/sct#385627004 ("Cellulitis (skin infection)")
  • null#null ("Diagnosis of any other new conditions")

Answer options for p05-q01-3-1-MedicalCondition.MissingDays.HowMany

  • null#null ("Less than 1 day")
  • null#null ("1 day")
  • null#null ("2 days")
  • null#null ("3 days or more")

Answer options for p06-q01-VirusInfection

  • null#null ("Yes, COVID-19")
  • null#null ("Yes, flu")
  • null#null ("Yes, Both")
  • null#null ("Yes, but don’t know which one")
  • null#null ("No")

Source

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padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_q_root.gif\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"QuestionnaireRoot\" class=\"hierarchy\"/> ActiveMonitoringDay42Survey</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Te Whatu Ora 42-day post Influenza/Covid-19 booster vaccination survey.</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Questionnaire</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/Questionnaire/ActiveMonitoringDay42Survey#0.1.6</td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)\" id=\"item.p01\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-display.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Display\" class=\"hierarchy\"/> p01</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 1. This is the final survey about your vaccine experience. This survey will take approximately five minutes to complete. There is a section at the end for you to comment on any parts of the vaccine experience that are not covered in the questionnaire.</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-display\">display</a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)\" id=\"item.p02-q01-Vaccincation\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Coding\" class=\"hierarchy\"/> p02-q01-Vaccincation</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 2 question 1. Did you receive a dose of the COVID-19 bivalent or flu vaccine about six weeks ago?</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.p02-q01-Vaccincation\">4 options</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)\" id=\"item.p03\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Group\" class=\"hierarchy\"/> p03</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 3 question 1.1.1. Vaccine Administration</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <ul><li><a href=\"#item.p02-q01-Vaccincation\">p02-q01-Vaccincation</a> = Yes, flu</li><li><a href=\"#item.p02-q01-Vaccincation\">p02-q01-Vaccincation</a> = Yes, COVID-19 booster</li><li><a href=\"#item.p02-q01-Vaccincation\">p02-q01-Vaccincation</a> = Yes, both</li></ul></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.p03-q01-VaccineAdministration.SurveyResponse\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Coding\" class=\"hierarchy\"/> p03-q01-VaccineAdministration.SurveyResponse</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Did you respond to the day 7 survey?</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.p03-q01-VaccineAdministration.SurveyResponse\">3 options</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.p03-q01-1-VaccineAdministration.SurveyResponse.Why\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Coding\" class=\"hierarchy\"/> p03-q01-1-VaccineAdministration.SurveyResponse.Why</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Why did you not respond to the day 7 survey? Select all that apply</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..*</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.p03-q01-VaccineAdministration.SurveyResponse\">p03-q01-VaccineAdministration.SurveyResponse</a> = No</span><br/>Options: <a href=\"#opt-item.p03-q01-1-VaccineAdministration.SurveyResponse.Why\">6 options</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)\" id=\"item.p03-q01-1-1-VaccineAdministration.SurveyResponse.Other\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-text.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Text\" class=\"hierarchy\"/> p03-q01-1-1-VaccineAdministration.SurveyResponse.Other</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Please specify.</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-text\">text</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.p03-q01-1-VaccineAdministration.SurveyResponse.Why\">p03-q01-1-VaccineAdministration.SurveyResponse.Why</a> = Other</span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)\" id=\"item.p04\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Group\" class=\"hierarchy\"/> p04</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 4 question 2.1.1. Adverse Reactions</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <ul><li><a href=\"#item.p02-q01-Vaccincation\">p02-q01-Vaccincation</a> = Yes, COVID-19 booster</li><li><a href=\"#item.p02-q01-Vaccincation\">p02-q01-Vaccincation</a> = Yes, flu</li><li><a href=\"#item.p02-q01-Vaccincation\">p02-q01-Vaccincation</a> = Yes, both</li></ul></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.p04-q01-AdverseReactions\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Coding\" class=\"hierarchy\"/> p04-q01-AdverseReactions</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Did you report experiencing any reactions to your vaccine on the day 7 survey?</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.p04-q01-AdverseReactions\">3 options</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.p04-q01-1-AdverseReactions.Still\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Coding\" class=\"hierarchy\"/> p04-q01-1-AdverseReactions.Still</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Are you still experiencing those reactions reported on the day 7 survey?</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.p04-q01-AdverseReactions\">p04-q01-AdverseReactions</a> = Yes</span><br/>Options: <a href=\"#opt-item.p04-q01-1-AdverseReactions.Still\">3 options</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.p04-q02-MedicalAdvice\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-boolean.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Boolean\" class=\"hierarchy\"/> p04-q02-MedicalAdvice</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Since the last survey have you sought medical help/ advice related to your vaccination?</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-boolean\">boolean</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.p04-q02-1-MedicalAdvice.Select\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Coding\" class=\"hierarchy\"/> p04-q02-1-MedicalAdvice.Select</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Please select all that apply</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..*</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.p04-q02-MedicalAdvice\">p04-q02-MedicalAdvice</a> = true</span><br/>Options: <a href=\"#opt-item.p04-q02-1-MedicalAdvice.Select\">8 options</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)\" id=\"item.p04-q02-1-1-MedicalAdvice.Select.Other\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-text.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Text\" class=\"hierarchy\"/> p04-q02-1-1-MedicalAdvice.Select.Other</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Please specify.</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-text\">text</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.p04-q02-1-MedicalAdvice.Select\">p04-q02-1-MedicalAdvice.Select</a> = Other</span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)\" id=\"item.p05\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Group\" class=\"hierarchy\"/> p05</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 5 question 1.3.1. Rare Diagnoses</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <ul><li><a href=\"#item.p02-q01-Vaccincation\">p02-q01-Vaccincation</a> = Yes, COVID-19 booster</li><li><a href=\"#item.p02-q01-Vaccincation\">p02-q01-Vaccincation</a> = Yes, flu</li><li><a href=\"#item.p02-q01-Vaccincation\">p02-q01-Vaccincation</a> = Yes, both</li></ul></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.p05-q01-MedicalCondition\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-boolean.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Boolean\" class=\"hierarchy\"/> p05-q01-MedicalCondition</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Since the day 7 survey, have you been diagnosed by a medical professional with a medical condition?</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-boolean\">boolean</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.p05-q01-1-MedicalCondition.Select\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Coding\" class=\"hierarchy\"/> p05-q01-1-MedicalCondition.Select</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Please select all that apply</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..*</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.p05-q01-MedicalCondition\">p05-q01-MedicalCondition</a> = true</span><br/>Options: <a href=\"#opt-item.p05-q01-1-MedicalCondition.Select\">15 options</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.p05-q01-1-1-MedicalCondition.Select.Other\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-text.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Text\" class=\"hierarchy\"/> p05-q01-1-1-MedicalCondition.Select.Other</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Please specify which other conditions.</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-text\">text</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.p05-q01-1-MedicalCondition.Select\">p05-q01-1-MedicalCondition.Select</a> = Diagnosis of any other new conditions</span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.p05-q01-2-MedicalCondition.Help\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-boolean.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Boolean\" class=\"hierarchy\"/> p05-q01-2-MedicalCondition.Help</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Since seeking medical help, has the issue gone away, or is being managed successfully?</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-boolean\">boolean</a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.p05-q01-MedicalCondition\">p05-q01-MedicalCondition</a> = true</span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.p05-q01-3-MedicalCondition.MissingDays\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-boolean.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Boolean\" class=\"hierarchy\"/> p05-q01-3-MedicalCondition.MissingDays</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Have you missed any days of work, study, or normal daily activities as a result of the diagnosis?</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-boolean\">boolean</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.p05-q01-MedicalCondition\">p05-q01-MedicalCondition</a> = true</span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)\" id=\"item.p05-q01-3-1-MedicalCondition.MissingDays.HowMany\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Coding\" class=\"hierarchy\"/> p05-q01-3-1-MedicalCondition.MissingDays.HowMany</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">How many days did you miss?</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.p05-q01-3-MedicalCondition.MissingDays\">p05-q01-3-MedicalCondition.MissingDays</a> = true</span><br/>Options: <a href=\"#opt-item.p05-q01-3-1-MedicalCondition.MissingDays.HowMany\">4 options</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)\" id=\"item.p06\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Group\" class=\"hierarchy\"/> p06</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 6 question 1. Virus Infection</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <ul><li><a href=\"#item.p02-q01-Vaccincation\">p02-q01-Vaccincation</a> = Yes, COVID-19 booster</li><li><a href=\"#item.p02-q01-Vaccincation\">p02-q01-Vaccincation</a> = Yes, flu</li><li><a href=\"#item.p02-q01-Vaccincation\">p02-q01-Vaccincation</a> = Yes, both</li></ul></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)\" id=\"item.p06-q01-VirusInfection\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Coding\" class=\"hierarchy\"/> p06-q01-VirusInfection</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Since receiving the vaccine, have you been diagnosed with COVID-19 or flu?</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.p06-q01-VirusInfection\">5 options</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)\" id=\"item.p07\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Group\" class=\"hierarchy\"/> p07</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 7 question 1.1. Vaccine Experience</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <ul><li><a href=\"#item.p02-q01-Vaccincation\">p02-q01-Vaccincation</a> = Yes, COVID-19 booster</li><li><a href=\"#item.p02-q01-Vaccincation\">p02-q01-Vaccincation</a> = Yes, flu</li><li><a href=\"#item.p02-q01-Vaccincation\">p02-q01-Vaccincation</a> = Yes, both</li></ul></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)\" id=\"item.p07-q01-VaccineExperience\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-boolean.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Boolean\" class=\"hierarchy\"/> p07-q01-VaccineExperience</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Do you have any other comments about your experience?</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-boolean\">boolean</a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)\" id=\"item.p07-q01-1-VaccineExperience.Explain\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-text.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Text\" class=\"hierarchy\"/> p07-q01-1-VaccineExperience.Explain</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Please Explain</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-text\">text</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.p07-q01-VaccineExperience\">p07-q01-VaccineExperience</a> = true</span></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck00.png)\" id=\"item.p08\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-display.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Display\" class=\"hierarchy\"/> p08</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Thank you for completing the Day 42 survey. Your answers have been submitted. Your responses will help contribute to the safety monitoring of the vaccine(s) you received. The data collected by these surveys will be made publicly available once enough data has been collected. The information you provided is protected by the Privacy act of 2020 and by the safeguards we have in place. Please remember this is a survey only and your answers will not result in a medical response. If you have any concerns about your health, ring Healthline at 0800 611 116 or speak to your healthcare professional. If you experience any of these symptoms of myocarditis and pericarditis: tightness, heaviness, discomfort, pressure or pain in your chest or neck; difficulty breathing or catching your breath; feeling faint, dizzy, or light-headed; fluttering, racing, or pounding heart, or feeling like it's 'skipping beats', seek medical help promptly and mention your vaccination.</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-display\">display</a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.p02-q01-Vaccincation\">p02-q01-Vaccincation</a> exists true</span></td></tr>\r\n<tr><td colspan=\"5\" class=\"hierarchy\"><br/><a href=\"http://hl7.org/fhir/R4/formats.html#table\" title=\"Legend for this format\"><img src=\"data:image/png;base64,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\" alt=\"doco\" style=\"background-color: inherit\"/> Documentation for this format</a></td></tr></table><hr/><p><b>Option Sets</b></p><a name=\"opt-item.p02-q01-Vaccincation\"> </a><p><b>Answer options for p02-q01-Vaccincation</b></p><ul><li style=\"font-size: 11px\">null#null (&quot;Yes, COVID-19 booster&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Yes, flu&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Yes, both&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;No&quot;)</li></ul><a name=\"opt-item.p03-q01-VaccineAdministration.SurveyResponse\"> </a><p><b>Answer options for p03-q01-VaccineAdministration.SurveyResponse</b></p><ul><li style=\"font-size: 11px\">null#null (&quot;Yes&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;No&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Unsure&quot;)</li></ul><a name=\"opt-item.p03-q01-1-VaccineAdministration.SurveyResponse.Why\"> </a><p><b>Answer options for p03-q01-1-VaccineAdministration.SurveyResponse.Why</b></p><ul><li style=\"font-size: 11px\">null#null (&quot;Did not have enough time&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Survey was too long&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Did not understand the questions&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Did not receive a day 7 survey&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Forgot to respond&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Other&quot;)</li></ul><a name=\"opt-item.p04-q01-AdverseReactions\"> </a><p><b>Answer options for p04-q01-AdverseReactions</b></p><ul><li style=\"font-size: 11px\">null#null (&quot;Yes&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;No&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Unsure&quot;)</li></ul><a name=\"opt-item.p04-q01-1-AdverseReactions.Still\"> </a><p><b>Answer options for p04-q01-1-AdverseReactions.Still</b></p><ul><li style=\"font-size: 11px\">null#null (&quot;Yes&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;No&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Unsure&quot;)</li></ul><a name=\"opt-item.p04-q02-1-MedicalAdvice.Select\"> </a><p><b>Answer options for p04-q02-1-MedicalAdvice.Select</b></p><ul><li style=\"font-size: 11px\">null#null (&quot;Phone advice from a helpline (e.g. Healthline)&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Care from a GP clinic (including the clinic nurse, a doctor, or a phone call with a person at the GP clinic).&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Visit to a hospital emergency department&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Marae&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Rongoā clinic&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Whānau Ora navigator&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Māori Health Provider&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Other&quot;)</li></ul><a name=\"opt-item.p05-q01-1-MedicalCondition.Select\"> </a><p><b>Answer options for p05-q01-1-MedicalCondition.Select</b></p><ul><li style=\"font-size: 11px\">http://snomed.info/sct#40956001 (&quot;Guillain-Barré syndrome&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#193093009 (&quot;Bell's palsy&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#21018002 (&quot;Inflamed nerves or nerve degradation (Neuritis or Neuropathy)&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#81308009 (&quot;Any other neurological condition&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#91175000 (&quot;Seizure&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#41497008 (&quot;Febrile seizure&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#50920009 (&quot;Myocarditis&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#3238004 (&quot;Pericarditis&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#49601007 (&quot;Other Heart issues&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#27550009 (&quot;Blood vessel issues&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Blood and lymphatic system disorders&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#414029004 (&quot;Immune system disorders&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#39579001 (&quot;Anaphylaxis (severe allergic reaction)&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#385627004 (&quot;Cellulitis (skin infection)&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Diagnosis of any other new conditions&quot;)</li></ul><a name=\"opt-item.p05-q01-3-1-MedicalCondition.MissingDays.HowMany\"> </a><p><b>Answer options for p05-q01-3-1-MedicalCondition.MissingDays.HowMany</b></p><ul><li style=\"font-size: 11px\">null#null (&quot;Less than 1 day&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;1 day&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;2 days&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;3 days or more&quot;)</li></ul><a name=\"opt-item.p06-q01-VirusInfection\"> </a><p><b>Answer options for p06-q01-VirusInfection</b></p><ul><li style=\"font-size: 11px\">null#null (&quot;Yes, COVID-19&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Yes, flu&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Yes, Both&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Yes, but don’t know which one&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;No&quot;)</li></ul></div>"
  },
  "url" : "https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/Questionnaire/ActiveMonitoringDay42Survey",
  "identifier" : [
    {
      "use" : "official",
      "value" : "ActiveMonitoringDay42Survey",
      "period" : {
        "start" : "2023-07-19"
      }
    },
    {
      "use" : "temp",
      "value" : "Questionnaire-ActiveMonitoring-Day42SurveyQuestionnaire",
      "period" : {
        "end" : "2023-07-19"
      }
    }
  ],
  "version" : "0.1.6",
  "name" : "ActiveMonitoringDay42Survey",
  "title" : "Influenza and COVID-19 Booster Vaccination 42 Day Review Questionnaire",
  "status" : "draft",
  "subjectType" : [
    "Patient"
  ],
  "date" : "2024-03-22T03:40:00+00:00",
  "publisher" : "Te Whatu Ora",
  "contact" : [
    {
      "name" : "Te Whatu Ora",
      "telecom" : [
        {
          "system" : "url",
          "value" : "https://www.tewhatuora.govt.nz/"
        }
      ]
    },
    {
      "name" : "David Grainger",
      "telecom" : [
        {
          "system" : "email",
          "value" : "david.grainger@middleware.co.nz",
          "use" : "work"
        }
      ]
    }
  ],
  "description" : "Te Whatu Ora 42-day post Influenza/Covid-19 booster vaccination survey.",
  "useContext" : [
    {
      "code" : {
        "system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
        "code" : "workflow",
        "display" : "Workflow Setting"
      },
      "valueCodeableConcept" : {
        "text" : "Vaccination Side Effect Questionnaire"
      }
    }
  ],
  "jurisdiction" : [
    {
      "coding" : [
        {
          "system" : "urn:iso:std:iso:3166",
          "code" : "NZ",
          "display" : "New Zealand"
        }
      ]
    }
  ],
  "purpose" : "Survey of side effects and overall experience of Influenza/COVID-19 Booster vaccination after 42 days.",
  "code" : [
    {
      "system" : "http://snomed.info/sct",
      "code" : "293104008",
      "display" : "Vaccine adverse reaction"
    }
  ],
  "item" : [
    {
      "linkId" : "p01",
      "prefix" : "page 1",
      "text" : "This is the final survey about your vaccine experience. This survey will take approximately five minutes to complete. There is a section at the end for you to comment on any parts of the vaccine experience that are not covered in the questionnaire.",
      "type" : "display"
    },
    {
      "linkId" : "p02-q01-Vaccincation",
      "prefix" : "page 2 question 1",
      "text" : "Did you receive a dose of the COVID-19 bivalent or flu vaccine about six weeks ago?",
      "type" : "choice",
      "required" : true,
      "answerOption" : [
        {
          "valueCoding" : {
            "display" : "Yes, COVID-19 booster"
          }
        },
        {
          "valueCoding" : {
            "display" : "Yes, flu"
          }
        },
        {
          "valueCoding" : {
            "display" : "Yes, both"
          }
        },
        {
          "valueCoding" : {
            "display" : "No"
          }
        }
      ]
    },
    {
      "linkId" : "p03",
      "prefix" : "page 3 question 1.1.1",
      "text" : "Vaccine Administration",
      "type" : "group",
      "enableWhen" : [
        {
          "question" : "p02-q01-Vaccincation",
          "operator" : "=",
          "answerCoding" : {
            "display" : "Yes, flu"
          }
        },
        {
          "question" : "p02-q01-Vaccincation",
          "operator" : "=",
          "answerCoding" : {
            "display" : "Yes, COVID-19 booster"
          }
        },
        {
          "question" : "p02-q01-Vaccincation",
          "operator" : "=",
          "answerCoding" : {
            "display" : "Yes, both"
          }
        }
      ],
      "enableBehavior" : "any",
      "item" : [
        {
          "linkId" : "p03-q01-VaccineAdministration.SurveyResponse",
          "text" : "Did you respond to the day 7 survey?",
          "type" : "choice",
          "required" : true,
          "answerOption" : [
            {
              "valueCoding" : {
                "display" : "Yes"
              }
            },
            {
              "valueCoding" : {
                "display" : "No"
              }
            },
            {
              "valueCoding" : {
                "display" : "Unsure"
              }
            }
          ]
        },
        {
          "linkId" : "p03-q01-1-VaccineAdministration.SurveyResponse.Why",
          "text" : "Why did you not respond to the day 7 survey? Select all that apply",
          "type" : "choice",
          "enableWhen" : [
            {
              "question" : "p03-q01-VaccineAdministration.SurveyResponse",
              "operator" : "=",
              "answerCoding" : {
                "display" : "No"
              }
            }
          ],
          "enableBehavior" : "all",
          "required" : true,
          "repeats" : true,
          "answerOption" : [
            {
              "valueCoding" : {
                "display" : "Did not have enough time"
              }
            },
            {
              "valueCoding" : {
                "display" : "Survey was too long"
              }
            },
            {
              "valueCoding" : {
                "display" : "Did not understand the questions"
              }
            },
            {
              "valueCoding" : {
                "display" : "Did not receive a day 7 survey"
              }
            },
            {
              "valueCoding" : {
                "display" : "Forgot to respond"
              }
            },
            {
              "valueCoding" : {
                "display" : "Other"
              }
            }
          ]
        },
        {
          "linkId" : "p03-q01-1-1-VaccineAdministration.SurveyResponse.Other",
          "text" : "Please specify.",
          "type" : "text",
          "enableWhen" : [
            {
              "question" : "p03-q01-1-VaccineAdministration.SurveyResponse.Why",
              "operator" : "=",
              "answerCoding" : {
                "display" : "Other"
              }
            }
          ],
          "required" : true
        }
      ]
    },
    {
      "linkId" : "p04",
      "prefix" : "page 4 question 2.1.1",
      "text" : "Adverse Reactions",
      "type" : "group",
      "enableWhen" : [
        {
          "question" : "p02-q01-Vaccincation",
          "operator" : "=",
          "answerCoding" : {
            "display" : "Yes, COVID-19 booster"
          }
        },
        {
          "question" : "p02-q01-Vaccincation",
          "operator" : "=",
          "answerCoding" : {
            "display" : "Yes, flu"
          }
        },
        {
          "question" : "p02-q01-Vaccincation",
          "operator" : "=",
          "answerCoding" : {
            "display" : "Yes, both"
          }
        }
      ],
      "enableBehavior" : "any",
      "item" : [
        {
          "linkId" : "p04-q01-AdverseReactions",
          "text" : "Did you report experiencing any reactions to your vaccine on the day 7 survey?",
          "type" : "choice",
          "required" : true,
          "repeats" : false,
          "answerOption" : [
            {
              "valueCoding" : {
                "display" : "Yes"
              }
            },
            {
              "valueCoding" : {
                "display" : "No"
              }
            },
            {
              "valueCoding" : {
                "display" : "Unsure"
              }
            }
          ]
        },
        {
          "linkId" : "p04-q01-1-AdverseReactions.Still",
          "text" : "Are you still experiencing those reactions reported on the day 7 survey?",
          "type" : "choice",
          "enableWhen" : [
            {
              "question" : "p04-q01-AdverseReactions",
              "operator" : "=",
              "answerCoding" : {
                "display" : "Yes"
              }
            }
          ],
          "enableBehavior" : "all",
          "required" : true,
          "repeats" : false,
          "answerOption" : [
            {
              "valueCoding" : {
                "display" : "Yes"
              }
            },
            {
              "valueCoding" : {
                "display" : "No"
              }
            },
            {
              "valueCoding" : {
                "display" : "Unsure"
              }
            }
          ]
        },
        {
          "linkId" : "p04-q02-MedicalAdvice",
          "text" : "Since the last survey have you sought medical help/ advice related to your vaccination?",
          "type" : "boolean",
          "repeats" : false
        },
        {
          "linkId" : "p04-q02-1-MedicalAdvice.Select",
          "text" : "Please select all that apply",
          "type" : "choice",
          "enableWhen" : [
            {
              "question" : "p04-q02-MedicalAdvice",
              "operator" : "=",
              "answerBoolean" : true
            }
          ],
          "required" : true,
          "repeats" : true,
          "answerOption" : [
            {
              "valueCoding" : {
                "display" : "Phone advice from a helpline (e.g. Healthline)"
              }
            },
            {
              "valueCoding" : {
                "display" : "Care from a GP clinic (including the clinic nurse, a doctor, or a phone call with a person at the GP clinic)."
              }
            },
            {
              "valueCoding" : {
                "display" : "Visit to a hospital emergency department"
              }
            },
            {
              "valueCoding" : {
                "display" : "Marae"
              }
            },
            {
              "valueCoding" : {
                "display" : "Rongoā clinic"
              }
            },
            {
              "valueCoding" : {
                "display" : "Whānau Ora navigator"
              }
            },
            {
              "valueCoding" : {
                "display" : "Māori Health Provider"
              }
            },
            {
              "valueCoding" : {
                "display" : "Other"
              }
            }
          ]
        },
        {
          "linkId" : "p04-q02-1-1-MedicalAdvice.Select.Other",
          "text" : "Please specify.",
          "type" : "text",
          "enableWhen" : [
            {
              "question" : "p04-q02-1-MedicalAdvice.Select",
              "operator" : "=",
              "answerCoding" : {
                "display" : "Other"
              }
            }
          ],
          "enableBehavior" : "all"
        }
      ]
    },
    {
      "linkId" : "p05",
      "prefix" : "page 5 question 1.3.1",
      "text" : "Rare Diagnoses",
      "type" : "group",
      "enableWhen" : [
        {
          "question" : "p02-q01-Vaccincation",
          "operator" : "=",
          "answerCoding" : {
            "display" : "Yes, COVID-19 booster"
          }
        },
        {
          "question" : "p02-q01-Vaccincation",
          "operator" : "=",
          "answerCoding" : {
            "display" : "Yes, flu"
          }
        },
        {
          "question" : "p02-q01-Vaccincation",
          "operator" : "=",
          "answerCoding" : {
            "display" : "Yes, both"
          }
        }
      ],
      "enableBehavior" : "any",
      "item" : [
        {
          "linkId" : "p05-q01-MedicalCondition",
          "text" : "Since the day 7 survey, have you been diagnosed by a medical professional with a medical condition?",
          "type" : "boolean",
          "required" : true
        },
        {
          "linkId" : "p05-q01-1-MedicalCondition.Select",
          "text" : "Please select all that apply",
          "type" : "choice",
          "enableWhen" : [
            {
              "question" : "p05-q01-MedicalCondition",
              "operator" : "=",
              "answerBoolean" : true
            }
          ],
          "required" : true,
          "repeats" : true,
          "answerOption" : [
            {
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "40956001",
                "display" : "Guillain-Barré syndrome"
              }
            },
            {
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "193093009",
                "display" : "Bell's palsy"
              }
            },
            {
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "21018002",
                "display" : "Inflamed nerves or nerve degradation (Neuritis or Neuropathy)"
              }
            },
            {
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "81308009",
                "display" : "Any other neurological condition"
              }
            },
            {
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "91175000",
                "display" : "Seizure"
              }
            },
            {
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "41497008",
                "display" : "Febrile seizure"
              }
            },
            {
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "50920009",
                "display" : "Myocarditis"
              }
            },
            {
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "3238004",
                "display" : "Pericarditis"
              }
            },
            {
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "49601007",
                "display" : "Other Heart issues"
              }
            },
            {
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "27550009",
                "display" : "Blood vessel issues"
              }
            },
            {
              "valueCoding" : {
                "display" : "Blood and lymphatic system disorders"
              }
            },
            {
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "414029004",
                "display" : "Immune system disorders"
              }
            },
            {
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "39579001",
                "display" : "Anaphylaxis (severe allergic reaction)"
              }
            },
            {
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "385627004",
                "display" : "Cellulitis (skin infection)"
              }
            },
            {
              "valueCoding" : {
                "display" : "Diagnosis of any other new conditions"
              }
            }
          ]
        },
        {
          "linkId" : "p05-q01-1-1-MedicalCondition.Select.Other",
          "text" : "Please specify which other conditions.",
          "type" : "text",
          "enableWhen" : [
            {
              "question" : "p05-q01-1-MedicalCondition.Select",
              "operator" : "=",
              "answerCoding" : {
                "display" : "Diagnosis of any other new conditions"
              }
            }
          ],
          "enableBehavior" : "all",
          "required" : true
        },
        {
          "linkId" : "p05-q01-2-MedicalCondition.Help",
          "text" : "Since seeking medical help, has the issue gone away, or is being managed successfully?",
          "type" : "boolean",
          "enableWhen" : [
            {
              "question" : "p05-q01-MedicalCondition",
              "operator" : "=",
              "answerBoolean" : true
            }
          ],
          "enableBehavior" : "all",
          "required" : true
        },
        {
          "linkId" : "p05-q01-3-MedicalCondition.MissingDays",
          "text" : "Have you missed any days of work, study, or normal daily activities as a result of the diagnosis?",
          "type" : "boolean",
          "enableWhen" : [
            {
              "question" : "p05-q01-MedicalCondition",
              "operator" : "=",
              "answerBoolean" : true
            }
          ],
          "required" : true
        },
        {
          "linkId" : "p05-q01-3-1-MedicalCondition.MissingDays.HowMany",
          "text" : "How many days did you miss?",
          "type" : "choice",
          "enableWhen" : [
            {
              "question" : "p05-q01-3-MedicalCondition.MissingDays",
              "operator" : "=",
              "answerBoolean" : true
            }
          ],
          "enableBehavior" : "all",
          "required" : true,
          "repeats" : false,
          "answerOption" : [
            {
              "valueCoding" : {
                "display" : "Less than 1 day"
              }
            },
            {
              "valueCoding" : {
                "display" : "1 day"
              }
            },
            {
              "valueCoding" : {
                "display" : "2 days"
              }
            },
            {
              "valueCoding" : {
                "display" : "3 days or more"
              }
            }
          ]
        }
      ]
    },
    {
      "linkId" : "p06",
      "prefix" : "page 6 question 1",
      "text" : "Virus Infection",
      "type" : "group",
      "enableWhen" : [
        {
          "question" : "p02-q01-Vaccincation",
          "operator" : "=",
          "answerCoding" : {
            "display" : "Yes, COVID-19 booster"
          }
        },
        {
          "question" : "p02-q01-Vaccincation",
          "operator" : "=",
          "answerCoding" : {
            "display" : "Yes, flu"
          }
        },
        {
          "question" : "p02-q01-Vaccincation",
          "operator" : "=",
          "answerCoding" : {
            "display" : "Yes, both"
          }
        }
      ],
      "enableBehavior" : "any",
      "item" : [
        {
          "linkId" : "p06-q01-VirusInfection",
          "text" : "Since receiving the vaccine, have you been diagnosed with COVID-19 or flu?",
          "type" : "choice",
          "required" : true,
          "repeats" : false,
          "answerOption" : [
            {
              "valueCoding" : {
                "display" : "Yes, COVID-19"
              }
            },
            {
              "valueCoding" : {
                "display" : "Yes, flu"
              }
            },
            {
              "valueCoding" : {
                "display" : "Yes, Both"
              }
            },
            {
              "valueCoding" : {
                "display" : "Yes, but don’t know which one"
              }
            },
            {
              "valueCoding" : {
                "display" : "No"
              }
            }
          ]
        }
      ]
    },
    {
      "linkId" : "p07",
      "prefix" : "page 7 question 1.1",
      "text" : "Vaccine Experience",
      "type" : "group",
      "enableWhen" : [
        {
          "question" : "p02-q01-Vaccincation",
          "operator" : "=",
          "answerCoding" : {
            "display" : "Yes, COVID-19 booster"
          }
        },
        {
          "question" : "p02-q01-Vaccincation",
          "operator" : "=",
          "answerCoding" : {
            "display" : "Yes, flu"
          }
        },
        {
          "question" : "p02-q01-Vaccincation",
          "operator" : "=",
          "answerCoding" : {
            "display" : "Yes, both"
          }
        }
      ],
      "enableBehavior" : "any",
      "required" : true,
      "item" : [
        {
          "linkId" : "p07-q01-VaccineExperience",
          "text" : "Do you have any other comments about your experience?",
          "type" : "boolean",
          "required" : true
        },
        {
          "linkId" : "p07-q01-1-VaccineExperience.Explain",
          "text" : "Please Explain",
          "type" : "text",
          "enableWhen" : [
            {
              "question" : "p07-q01-VaccineExperience",
              "operator" : "=",
              "answerBoolean" : true
            }
          ],
          "enableBehavior" : "all",
          "required" : true,
          "repeats" : false
        }
      ]
    },
    {
      "linkId" : "p08",
      "text" : "Thank you for completing the Day 42 survey. Your answers have been submitted. Your responses will help contribute to the safety monitoring of the vaccine(s) you received. The data collected by these surveys will be made publicly available once enough data has been collected. The information you provided is protected by the Privacy act of 2020 and by the safeguards we have in place. Please remember this is a survey only and your answers will not result in a medical response. If you have any concerns about your health, ring Healthline at 0800 611 116 or speak to your healthcare professional. If you experience any of these symptoms of myocarditis and pericarditis: tightness, heaviness, discomfort, pressure or pain in your chest or neck; difficulty breathing or catching your breath; feeling faint, dizzy, or light-headed; fluttering, racing, or pounding heart, or feeling like it's 'skipping beats', seek medical help promptly and mention your vaccination.",
      "type" : "display",
      "enableWhen" : [
        {
          "question" : "p02-q01-Vaccincation",
          "operator" : "exists",
          "answerBoolean" : true
        }
      ],
      "enableBehavior" : "all"
    }
  ]
}

XIG built as of ??metadata-date??. Found ??metadata-resources?? resources in ??metadata-packages?? packages.