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Resource Questionnaire/FHIR Server from package cinc.fhir.ig#current (219 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-ActiveMonitoringDay7Survey.html
Url https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/Questionnaire/ActiveMonitoringDay7Survey
Version 0.1.6
Status draft
Date 2024-03-22T03:40:00+00:00
Name ActiveMonitoringDay7Survey
Title Influenza and COVID-19 Booster Vaccination 7 Day Review Questionnaire
Experimental False
Realm nz
Authority national
Description Te Whatu Ora 7-day post Influenza/Covid-19 booster vaccination survey.
Purpose Survey of side effects and overall experience of Influenza/COVID-19 Booster vaccination after 7 days.

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Narrative

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

Structure
LinkIdTextCardinalityTypeDescription & Constraintsdoco
.. ActiveMonitoringDay7SurveyTe Whatu Ora 7-day post Influenza/Covid-19 booster vaccination survey.Questionnairehttps://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/Questionnaire/ActiveMonitoringDay7Survey#0.1.6
... p01page 1. This is the first of two surveys about your vaccine experience. This survey will take approximately five minutes to complete. You will be asked for some demographic data and about any symptoms you have experienced. There is a section at the end for you to comment on any other parts of the vaccine experience.0..1display
... p02page 2. Vaccine Administration0..1group
.... p02-q01-VaccineTypepage 2 question 1. Which vaccine did you receive 7 days ago?1..1choiceOptions: 4 options
.... p02-q01-1-VaccineType.WhichArmpage 2 question 1.1. Were they both given in the arm?1..1choiceEnable When: p02-q01-VaccineType = Both
Options: 4 options
... p03page 3. Health Conditions0..1group
.... p03-q01-LongTermConditionsDo you have any long-term medical conditions?0..1choiceOptions: 3 options
.... p03-q01-1-LongTermConditions.SelectPlease select all the long term conditions that apply.0..*choiceEnable When: p03-q01-LongTermConditions = Yes
Options: 12 options
.... p03-q01-1-1-LongTermConditions.Select.OtherPlease explain any other long term medical conditions you have.0..1textEnable When: p03-q01-1-LongTermConditions.Select = Other
... p04page 4 question 1. Side Effects0..1group
.... p04-q01-SideEffectsDid you have any reactions following your vaccine? This includes any reactions your vaccinator told you to expect AND anything you did not expect that you think might be a reaction, no matter how minor.0..1boolean
... p05page 5 question 12.1. Side Effects Details0..1groupEnable When: p04-q01-SideEffects = true
.... p05-q01-InjectionSiteDisorderDid you experience any injection site reactions (pain, redness, swelling, itching at or near the injection site)?0..1boolean
.... p05-q01-1-InjectionSiteDisorder.SelectPlease select all in select all the injection site reactions that you experienced.0..*choiceEnable When: p05-q01-InjectionSiteDisorder = true
Options: 4 options
.... p05-q01-2-InjectionSiteDisorder.EntireArmDid you have swelling of entire arm?0..1booleanEnable When: p05-q01-InjectionSiteDisorder = true
.... p05-q02-LymphNodeDid you have swelling of lymph nodes under your arm/in the armpit?0..1choiceOptions: 4 options
.... p05-q03-FeverFever (a temperature of 38°C or higher)?0..1boolean
.... p05-q04-ChillsChills (shivering and feeling cold)?0..1boolean
.... p05-q05-RashDid you experience a rash, not near the injection site?1..1boolean
.... p05-q05-1-Rash.WhenStartedWhen did the rash appear?1..1choiceEnable When: p05-q05-Rash = true
Options: 3 options
.... p05-q05-2-Rash.HowLongHow long did the rash last?1..1choiceEnable When: p05-q05-Rash = true
Options: 3 options
.... p05-q05-3-Rash.LocationPlease indicate the location of the rash.0..1choiceEnable When: p05-q05-Rash = true
Options: 5 options
.... p05-q05-3-1-Rash.Location.OtherPlease explain where rash occurred.0..1textEnable When: p05-q05-3-Rash.Location = Other
.... p05-q06-AchesDid you experience headaches, muscle or body aches, or joint aches or pain?1..1boolean
.... p05-q06-1-Aches.SelectPlease select all that apply.1..*choiceEnable When: p05-q06-Aches = true
Options: 4 options
.... p05-q07-DigestiveDisorderDid you experience any gastrointestinal symptoms?1..1boolean
.... p05-q07-1-DigestiveDisorder.SelectPlease select all that gastrointestinal symptoms that apply.1..*choiceEnable When: p05-q07-DigestiveDisorder = true
Options: 6 options
.... p05-q07-1-1-DigestiveDisorder.Select.OtherPlease specify any other gastrointestinal symptoms you experienced.0..1stringEnable When: p05-q07-1-DigestiveDisorder.Select = Other
.... p05-q08-FatigueDid you experience fatigue or tiredness?1..1boolean
.... p05-q09-ChestDid you have any of these Chest Symptoms? - Please select all that apply0..*choiceOptions: 5 options
.... p05-q09-1-Chest.OtherPlease specify other chest symptoms you experienced.1..1textEnable When: p05-q09-Chest = Other
.... p05-q10-HeartDid you experience any of the following heart symptoms? Please select all that apply.1..*choiceOptions: 3 options
.... p05-q10-1-Heart.OtherPlease specify any other heart symptoms you experienced?1..1textEnable When: p05-q10-Heart = Other
.... p05-q11-BreathingDid you experience any difficulty breathing?1..1boolean
.... p05-q12-OtherSymptomsDid you experience any symptoms that were not listed above?1..1boolean
.... p05-q12-1-OtherSymptoms.ExplainWhat other side effects did you experience?0..1textEnable When: p05-q12-OtherSymptoms = true
... p06page 6 question 3.1.1. Symptom Relief0..1groupEnable When: p04-q01-SideEffects = true
.... p06-q01-MissingDaysDid any of the symptoms you reported cause you to miss work, study, or normal daily activities?1..1boolean
.... p06-q01-1-MissingDays.HowManyHow many days did you miss?1..1choiceEnable When: p06-q01-MissingDays = true
Options: 4 options
.... p06-q02-SymptomReliefDid any of the symptoms cause you to seek advice or care from a healthcare professional?1..1boolean
.... p06-q02-1-SymptomRelief.SelectPlease select the type of advice or care you sought.1..*choiceEnable When: p06-q02-SymptomRelief = true
Options: 4 options
.... p06-q02-1-1-SymptomRelief.Select.OtherPlease explain any other advice or care you sought.1..1textEnable When: p06-q02-1-SymptomRelief.Select = Other [Please explain]
.... p06-q03-MedicinesDid you take any over the counter medications to relive the pain/discomfort?1..1boolean
.... p06-q03-1-Medicines.SelectPlease specify what medication you took.1..*choiceEnable When: p06-q03-Medicines = true
Options: 3 options
.... p06-q03-1-1-Medicines.Select.OtherPlease specify any alternate medications you took.1..1textEnable When: p06-q03-1-Medicines.Select = Other
... p07page 7 question 2.1. Vaccine Experience0..1group
.... p07-q01-ExperienceHow would you rate your overall experience getting the vaccine?1..1choiceOptions: 5 options
.... p07-q02-CommentsDo you have any comments about your vaccine experience?1..1boolean
.... p07-q02-1-Comments.ExplainPlease Explain0..1textEnable When: p07-q02-Comments = true
... p08page 8. Thank you for completing the Day 7 survey, your answers have been submitted. You will receive your Day 42 survey in 35 days. Your responses will help contribute to the safety monitoring of the Influenza vaccine. The information you provide is protected by the Privacy Act 2020. 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..1display

doco Documentation for this format

Option Sets

Answer options for p02-q01-VaccineType

  • null#null ("Flu")
  • null#null ("COVID Booster")
  • null#null ("Both")
  • null#null ("Don't Know")

Answer options for p02-q01-1-VaccineType.WhichArm

  • null#null ("Same arm.")
  • null#null ("Different arms.")
  • null#null ("Don't Know.")
  • null#null ("No.")

Answer options for p03-q01-LongTermConditions

  • null#null ("Yes")
  • null#null ("No")
  • null#null ("Prefer not to answer")

Answer options for p03-q01-1-LongTermConditions.Select

  • http://snomed.info/sct#85828009 ("Autoimmune conditions (eg. arthritis)")
  • http://snomed.info/sct#32709003 ("Alcohol or other drug addictions")
  • http://snomed.info/sct#195967001 ("Asthma")
  • http://snomed.info/sct#363346000 ("Cancer")
  • http://snomed.info/sct#82423001 ("Chronic pain")
  • http://snomed.info/sct#13645005 ("Chronic obstructive pulmonary disease")
  • http://snomed.info/sct#73211009 ("Diabetes")
  • http://snomed.info/sct#770924008 ("Gout")
  • http://snomed.info/sct#56265001 ("Heart disease")
  • http://snomed.info/sct#74732009 ("Mental health condition")
  • http://snomed.info/sct#414916001 ("Obesity")
  • null#null ("Other")

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

  • null#95388000 ("Pain")
  • null#95380007 ("Redness")
  • null#213340005 ("Swelling")
  • null#95379009 ("Itching")

Answer options for p05-q02-LymphNode

  • null#null ("Yes, under one arm.")
  • null#null ("Yes, under both arms.")
  • null#null ("No")
  • null#null ("Don't know")

Answer options for p05-q05-1-Rash.WhenStarted

  • null#null ("Within 1 hour after vaccination")
  • null#null ("Within a day after vaccination")
  • null#null ("More than a day after vaccination")

Answer options for p05-q05-2-Rash.HowLong

  • null#null ("Less than 30 minutes")
  • null#null ("30 minutes to 24 hours")
  • null#null ("More than 24 hours")

Answer options for p05-q05-3-Rash.Location

  • null#null ("Face")
  • null#null ("Body")
  • null#null ("Arms")
  • null#null ("Legs")
  • null#null ("Other")

Answer options for p05-q06-1-Aches.Select

  • http://snomed.info/sct#25064002 ("Headache")
  • http://snomed.info/sct#68962001 ("Muscle/body aches")
  • http://snomed.info/sct#57676002 ("Joint pain")
  • null#null ("Pain/irritation of the mouth and throat")

Answer options for p05-q07-1-DigestiveDisorder.Select

  • http://snomed.info/sct#422587007 ("Nausea")
  • http://snomed.info/sct#422400008 ("Vomiting")
  • http://snomed.info/sct#62315008 ("Diarrhoea")
  • http://snomed.info/sct#21522001 ("Abdominal Pain")
  • http://snomed.info/sct#79890006 ("Loss of appetite")
  • null#null ("Other")

Answer options for p05-q09-Chest

  • http://snomed.info/sct#29857009 ("Chest Pain")
  • null#null ("Chest Heaviness")
  • http://snomed.info/sct#23924001 ("Chest Tightness")
  • null#null ("Chest Discomfort")
  • null#null ("Other")

Answer options for p05-q10-Heart

  • http://snomed.info/sct#80313002 ("Palpitations")
  • http://snomed.info/sct#248648003 ("Heart racing or pounding")
  • null#null ("Other")

Answer options for p06-q01-1-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-q02-1-SymptomRelief.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 ("Other")

Answer options for p06-q03-1-Medicines.Select

  • http://snomed.info/sct#387517004 ("Paracetamol")
  • http://snomed.info/sct#387207008 ("Ibuprofen")
  • null#null ("Other")

Answer options for p07-q01-Experience

  • null#null ("Very Poor")
  • null#null ("Poor")
  • null#null ("Average")
  • null#null ("Good")
  • null#null ("Very Good")

Source

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  "id" : "ActiveMonitoringDay7Survey",
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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\"/> ActiveMonitoringDay7Survey</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 7-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/ActiveMonitoringDay7Survey#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 first of two surveys about your vaccine experience. This survey will take approximately five minutes to complete. You will be asked for some demographic data and about any symptoms you have experienced. There is a section at the end for you to comment on any other parts of the vaccine experience.</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_bck11.png)\" id=\"item.p02\" 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\"/> p02</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. Vaccine Administration</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\"/></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.p02-q01-VaccineType\" 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\"/> p02-q01-VaccineType</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 2 question 1. Which vaccine did you receive 7 days ago?</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.p02-q01-VaccineType\">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_bck100.png)\" id=\"item.p02-q01-1-VaccineType.WhichArm\" 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: white; background-color: inherit\" title=\"Coding\" class=\"hierarchy\"/> p02-q01-1-VaccineType.WhichArm</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 1.1. Were they both given in the arm?</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\">Enable When: <span><a href=\"#item.p02-q01-VaccineType\">p02-q01-VaccineType</a> = Both</span><br/>Options: <a href=\"#opt-item.p02-q01-1-VaccineType.WhichArm\">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. Health Conditions</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\"/></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-LongTermConditions\" 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-LongTermConditions</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Do you have any long-term medical conditions?</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-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-LongTermConditions\">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-LongTermConditions.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\"/> p03-q01-1-LongTermConditions.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 the long term conditions 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\">0..*</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-LongTermConditions\">p03-q01-LongTermConditions</a> = Yes</span><br/>Options: <a href=\"#opt-item.p03-q01-1-LongTermConditions.Select\">12 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-LongTermConditions.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\"/> p03-q01-1-1-LongTermConditions.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 explain any other long term medical conditions you have.</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.p03-q01-1-LongTermConditions.Select\">p03-q01-1-LongTermConditions.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.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 1. Side Effects</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\"/></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-q01-SideEffects\" 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-boolean.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Boolean\" class=\"hierarchy\"/> p04-q01-SideEffects</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 have any reactions following your vaccine? This includes any reactions your vaccinator told you to expect AND anything you did not expect that you think might be a reaction, no matter how minor.</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_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 12.1. Side Effects Details</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: <span><a href=\"#item.p04-q01-SideEffects\">p04-q01-SideEffects</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-InjectionSiteDisorder\" 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-InjectionSiteDisorder</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 experience any injection site reactions (pain, redness, swelling, itching at or near the injection site)?</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.p05-q01-1-InjectionSiteDisorder.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-InjectionSiteDisorder.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 in select all the injection site reactions that you experienced.</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</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-InjectionSiteDisorder\">p05-q01-InjectionSiteDisorder</a> = true</span><br/>Options: <a href=\"#opt-item.p05-q01-1-InjectionSiteDisorder.Select\">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_bck110.png)\" id=\"item.p05-q01-2-InjectionSiteDisorder.EntireArm\" 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-q01-2-InjectionSiteDisorder.EntireArm</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 have swelling of entire arm?</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\">Enable When: <span><a href=\"#item.p05-q01-InjectionSiteDisorder\">p05-q01-InjectionSiteDisorder</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_bck110.png)\" id=\"item.p05-q02-LymphNode\" 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-q02-LymphNode</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Did you have swelling of lymph nodes under your arm/in the armpit?</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-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.p05-q02-LymphNode\">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_bck110.png)\" id=\"item.p05-q03-Fever\" 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-q03-Fever</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Fever (a temperature of 38°C or higher)?</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.p05-q04-Chills\" 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-q04-Chills</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Chills (shivering and feeling cold)?</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-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_bck110.png)\" id=\"item.p05-q05-Rash\" 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-q05-Rash</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 experience a rash, not near the injection site?</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-q05-1-Rash.WhenStarted\" 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-q05-1-Rash.WhenStarted</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">When did the rash appear?</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-q05-Rash\">p05-q05-Rash</a> = true</span><br/>Options: <a href=\"#opt-item.p05-q05-1-Rash.WhenStarted\">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.p05-q05-2-Rash.HowLong\" 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\"/> p05-q05-2-Rash.HowLong</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">How long did the rash last?</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\">Enable When: <span><a href=\"#item.p05-q05-Rash\">p05-q05-Rash</a> = true</span><br/>Options: <a href=\"#opt-item.p05-q05-2-Rash.HowLong\">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.p05-q05-3-Rash.Location\" 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-q05-3-Rash.Location</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Please indicate the location of the rash.</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-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-q05-Rash\">p05-q05-Rash</a> = true</span><br/>Options: <a href=\"#opt-item.p05-q05-3-Rash.Location\">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_bck110.png)\" id=\"item.p05-q05-3-1-Rash.Location.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-q05-3-1-Rash.Location.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 explain where rash occurred.</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.p05-q05-3-Rash.Location\">p05-q05-3-Rash.Location</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_bck110.png)\" id=\"item.p05-q06-Aches\" 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-q06-Aches</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Did you experience headaches, muscle or body aches, or joint aches or pain?</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_bck110.png)\" id=\"item.p05-q06-1-Aches.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: white; background-color: inherit\" title=\"Coding\" class=\"hierarchy\"/> p05-q06-1-Aches.Select</td><td style=\"vertical-align: top; text-align : left; background-color: white; 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: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">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\">Enable When: <span><a href=\"#item.p05-q06-Aches\">p05-q06-Aches</a> = true</span><br/>Options: <a href=\"#opt-item.p05-q06-1-Aches.Select\">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_bck110.png)\" id=\"item.p05-q07-DigestiveDisorder\" 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-q07-DigestiveDisorder</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Did you experience any gastrointestinal symptoms?</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_bck110.png)\" id=\"item.p05-q07-1-DigestiveDisorder.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: white; background-color: inherit\" title=\"Coding\" class=\"hierarchy\"/> p05-q07-1-DigestiveDisorder.Select</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Please select all that gastrointestinal symptoms that apply.</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">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\">Enable When: <span><a href=\"#item.p05-q07-DigestiveDisorder\">p05-q07-DigestiveDisorder</a> = true</span><br/>Options: <a href=\"#opt-item.p05-q07-1-DigestiveDisorder.Select\">6 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.p05-q07-1-1-DigestiveDisorder.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-string.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"String\" class=\"hierarchy\"/> p05-q07-1-1-DigestiveDisorder.Select.Other</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Please specify any other gastrointestinal symptoms you experienced.</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-string\">string</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-q07-1-DigestiveDisorder.Select\">p05-q07-1-DigestiveDisorder.Select</a> = Other</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-q08-Fatigue\" 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-q08-Fatigue</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 experience fatigue or tiredness?</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-q09-Chest\" 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-q09-Chest</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Did you have any of these Chest Symptoms? - 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\">0..*</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.p05-q09-Chest\">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_bck110.png)\" id=\"item.p05-q09-1-Chest.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-q09-1-Chest.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 other chest symptoms you experienced.</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-q09-Chest\">p05-q09-Chest</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_bck110.png)\" id=\"item.p05-q10-Heart\" 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-q10-Heart</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Did you experience any of the following heart symptoms? 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\">Options: <a href=\"#opt-item.p05-q10-Heart\">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.p05-q10-1-Heart.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-q10-1-Heart.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 any other heart symptoms you experienced?</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-q10-Heart\">p05-q10-Heart</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_bck110.png)\" id=\"item.p05-q11-Breathing\" 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-q11-Breathing</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Did you experience any difficulty breathing?</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_bck110.png)\" id=\"item.p05-q12-OtherSymptoms\" 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-q12-OtherSymptoms</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 experience any symptoms that were not listed above?</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_bck100.png)\" id=\"item.p05-q12-1-OtherSymptoms.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: #F7F7F7; background-color: inherit\" title=\"Text\" class=\"hierarchy\"/> p05-q12-1-OtherSymptoms.Explain</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">What other side effects did you experience?</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-text\">text</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-q12-OtherSymptoms\">p05-q12-OtherSymptoms</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_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 3.1.1. Symptom Relief</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: <span><a href=\"#item.p04-q01-SideEffects\">p04-q01-SideEffects</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_bck110.png)\" id=\"item.p06-q01-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: #F7F7F7; background-color: inherit\" title=\"Boolean\" class=\"hierarchy\"/> p06-q01-MissingDays</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Did any of the symptoms you reported cause you to miss work, study, or normal daily activities?</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_bck110.png)\" id=\"item.p06-q01-1-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.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\"/> p06-q01-1-MissingDays.HowMany</td><td style=\"vertical-align: top; text-align : left; background-color: white; 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: 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\">Enable When: <span><a href=\"#item.p06-q01-MissingDays\">p06-q01-MissingDays</a> = true</span><br/>Options: <a href=\"#opt-item.p06-q01-1-MissingDays.HowMany\">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_bck110.png)\" id=\"item.p06-q02-SymptomRelief\" 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\"/> p06-q02-SymptomRelief</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Did any of the symptoms cause you to seek advice or care from a healthcare professional?</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_bck110.png)\" id=\"item.p06-q02-1-SymptomRelief.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: white; background-color: inherit\" title=\"Coding\" class=\"hierarchy\"/> p06-q02-1-SymptomRelief.Select</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Please select the type of advice or care you sought.</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">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\">Enable When: <span><a href=\"#item.p06-q02-SymptomRelief\">p06-q02-SymptomRelief</a> = true</span><br/>Options: <a href=\"#opt-item.p06-q02-1-SymptomRelief.Select\">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_bck110.png)\" id=\"item.p06-q02-1-1-SymptomRelief.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: #F7F7F7; background-color: inherit\" title=\"Text\" class=\"hierarchy\"/> p06-q02-1-1-SymptomRelief.Select.Other</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Please explain any other advice or care you sought.</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-text\">text</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.p06-q02-1-SymptomRelief.Select\">p06-q02-1-SymptomRelief.Select</a> = Other [Please explain]</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.p06-q03-Medicines\" 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\"/> p06-q03-Medicines</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 take any over the counter medications to relive the pain/discomfort?</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.p06-q03-1-Medicines.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\"/> p06-q03-1-Medicines.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 specify what medication you took.</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.p06-q03-Medicines\">p06-q03-Medicines</a> = true</span><br/>Options: <a href=\"#opt-item.p06-q03-1-Medicines.Select\">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_bck100.png)\" id=\"item.p06-q03-1-1-Medicines.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\"/> p06-q03-1-1-Medicines.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 any alternate medications you took.</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.p06-q03-1-Medicines.Select\">p06-q03-1-Medicines.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.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: #F7F7F7; background-color: inherit\" title=\"Group\" class=\"hierarchy\"/> p07</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 7 question 2.1. Vaccine Experience</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\"/></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.p07-q01-Experience\" 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\"/> p07-q01-Experience</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">How would you rate your overall experience getting the vaccine?</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.p07-q01-Experience\">5 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.p07-q02-Comments\" 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-q02-Comments</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 comments about your vaccine 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-q02-1-Comments.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-q02-1-Comments.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\">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.p07-q02-Comments\">p07-q02-Comments</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\">page 8. Thank you for completing the Day 7 survey, your answers have been submitted. You will receive your Day 42 survey in 35 days. Your responses will help contribute to the safety monitoring of the Influenza vaccine. The information you provide is protected by the Privacy Act 2020. 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\"/></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-VaccineType\"> </a><p><b>Answer options for p02-q01-VaccineType</b></p><ul><li style=\"font-size: 11px\">null#null (&quot;Flu&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;COVID Booster&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Both&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Don't Know&quot;)</li></ul><a name=\"opt-item.p02-q01-1-VaccineType.WhichArm\"> </a><p><b>Answer options for p02-q01-1-VaccineType.WhichArm</b></p><ul><li style=\"font-size: 11px\">null#null (&quot;Same arm.&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Different arms.&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Don't Know.&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;No.&quot;)</li></ul><a name=\"opt-item.p03-q01-LongTermConditions\"> </a><p><b>Answer options for p03-q01-LongTermConditions</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;Prefer not to answer&quot;)</li></ul><a name=\"opt-item.p03-q01-1-LongTermConditions.Select\"> </a><p><b>Answer options for p03-q01-1-LongTermConditions.Select</b></p><ul><li style=\"font-size: 11px\">http://snomed.info/sct#85828009 (&quot;Autoimmune conditions (eg. arthritis)&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#32709003 (&quot;Alcohol or other drug addictions&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#195967001 (&quot;Asthma&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#363346000 (&quot;Cancer&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#82423001 (&quot;Chronic pain&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#13645005 (&quot;Chronic obstructive pulmonary disease&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#73211009 (&quot;Diabetes&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#770924008 (&quot;Gout&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#56265001 (&quot;Heart disease&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#74732009 (&quot;Mental health condition&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#414916001 (&quot;Obesity&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Other&quot;)</li></ul><a name=\"opt-item.p05-q01-1-InjectionSiteDisorder.Select\"> </a><p><b>Answer options for p05-q01-1-InjectionSiteDisorder.Select</b></p><ul><li style=\"font-size: 11px\">null#95388000 (&quot;Pain&quot;)</li><li style=\"font-size: 11px\">null#95380007 (&quot;Redness&quot;)</li><li style=\"font-size: 11px\">null#213340005 (&quot;Swelling&quot;)</li><li style=\"font-size: 11px\">null#95379009 (&quot;Itching&quot;)</li></ul><a name=\"opt-item.p05-q02-LymphNode\"> </a><p><b>Answer options for p05-q02-LymphNode</b></p><ul><li style=\"font-size: 11px\">null#null (&quot;Yes, under one arm.&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Yes, under both arms.&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;No&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Don't know&quot;)</li></ul><a name=\"opt-item.p05-q05-1-Rash.WhenStarted\"> </a><p><b>Answer options for p05-q05-1-Rash.WhenStarted</b></p><ul><li style=\"font-size: 11px\">null#null (&quot;Within 1 hour after vaccination&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Within a day after vaccination&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;More than a day after vaccination&quot;)</li></ul><a name=\"opt-item.p05-q05-2-Rash.HowLong\"> </a><p><b>Answer options for p05-q05-2-Rash.HowLong</b></p><ul><li style=\"font-size: 11px\">null#null (&quot;Less than 30 minutes&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;30 minutes to 24 hours&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;More than 24 hours&quot;)</li></ul><a name=\"opt-item.p05-q05-3-Rash.Location\"> </a><p><b>Answer options for p05-q05-3-Rash.Location</b></p><ul><li style=\"font-size: 11px\">null#null (&quot;Face&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Body&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Arms&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Legs&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Other&quot;)</li></ul><a name=\"opt-item.p05-q06-1-Aches.Select\"> </a><p><b>Answer options for p05-q06-1-Aches.Select</b></p><ul><li style=\"font-size: 11px\">http://snomed.info/sct#25064002 (&quot;Headache&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#68962001 (&quot;Muscle/body aches&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#57676002 (&quot;Joint pain&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Pain/irritation of the mouth and throat&quot;)</li></ul><a name=\"opt-item.p05-q07-1-DigestiveDisorder.Select\"> </a><p><b>Answer options for p05-q07-1-DigestiveDisorder.Select</b></p><ul><li style=\"font-size: 11px\">http://snomed.info/sct#422587007 (&quot;Nausea&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#422400008 (&quot;Vomiting&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#62315008 (&quot;Diarrhoea&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#21522001 (&quot;Abdominal Pain&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#79890006 (&quot;Loss of appetite&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Other&quot;)</li></ul><a name=\"opt-item.p05-q09-Chest\"> </a><p><b>Answer options for p05-q09-Chest</b></p><ul><li style=\"font-size: 11px\">http://snomed.info/sct#29857009 (&quot;Chest Pain&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Chest Heaviness&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#23924001 (&quot;Chest Tightness&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Chest Discomfort&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Other&quot;)</li></ul><a name=\"opt-item.p05-q10-Heart\"> </a><p><b>Answer options for p05-q10-Heart</b></p><ul><li style=\"font-size: 11px\">http://snomed.info/sct#80313002 (&quot;Palpitations&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#248648003 (&quot;Heart racing or pounding&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Other&quot;)</li></ul><a name=\"opt-item.p06-q01-1-MissingDays.HowMany\"> </a><p><b>Answer options for p06-q01-1-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-q02-1-SymptomRelief.Select\"> </a><p><b>Answer options for p06-q02-1-SymptomRelief.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;Other&quot;)</li></ul><a name=\"opt-item.p06-q03-1-Medicines.Select\"> </a><p><b>Answer options for p06-q03-1-Medicines.Select</b></p><ul><li style=\"font-size: 11px\">http://snomed.info/sct#387517004 (&quot;Paracetamol&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#387207008 (&quot;Ibuprofen&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Other&quot;)</li></ul><a name=\"opt-item.p07-q01-Experience\"> </a><p><b>Answer options for p07-q01-Experience</b></p><ul><li style=\"font-size: 11px\">null#null (&quot;Very Poor&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Poor&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Average&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Good&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Very Good&quot;)</li></ul></div>"
  },
  "url" : "https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/Questionnaire/ActiveMonitoringDay7Survey",
  "identifier" : [
    {
      "use" : "official",
      "value" : "ActiveMonitoringDay7Survey",
      "period" : {
        "start" : "2023-07-19"
      }
    },
    {
      "use" : "temp",
      "value" : "Questionnaire-ActiveMonitoring-Day7SurveyQuestionnaire",
      "period" : {
        "end" : "2023-07-19"
      }
    }
  ],
  "version" : "0.1.6",
  "name" : "ActiveMonitoringDay7Survey",
  "title" : "Influenza and COVID-19 Booster Vaccination 7 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 7-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 7 days.",
  "code" : [
    {
      "system" : "http://snomed.info/sct",
      "code" : "293104008",
      "display" : "Vaccine adverse reaction"
    }
  ],
  "item" : [
    {
      "linkId" : "p01",
      "prefix" : "page 1",
      "text" : "This is the first of two surveys about your vaccine experience. This survey will take approximately five minutes to complete. You will be asked for some demographic data and about any symptoms you have experienced. There is a section at the end for you to comment on any other parts of the vaccine experience.",
      "type" : "display"
    },
    {
      "linkId" : "p02",
      "prefix" : "page 2",
      "text" : "Vaccine Administration",
      "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" : "drop-down",
                    "display" : "Drop down"
                  }
                ],
                "text" : "Drop down"
              }
            }
          ],
          "linkId" : "p02-q01-VaccineType",
          "prefix" : "page 2 question 1",
          "text" : "Which vaccine did you receive 7 days ago?",
          "type" : "choice",
          "required" : true,
          "answerOption" : [
            {
              "valueCoding" : {
                "display" : "Flu"
              }
            },
            {
              "valueCoding" : {
                "display" : "COVID Booster"
              }
            },
            {
              "valueCoding" : {
                "display" : "Both"
              }
            },
            {
              "valueCoding" : {
                "display" : "Don't Know"
              }
            }
          ]
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/questionnaire-item-control",
                    "code" : "drop-down",
                    "display" : "Drop down"
                  }
                ],
                "text" : "Drop down"
              }
            }
          ],
          "linkId" : "p02-q01-1-VaccineType.WhichArm",
          "prefix" : "page 2 question 1.1",
          "text" : "Were they both given in the arm?",
          "type" : "choice",
          "enableWhen" : [
            {
              "question" : "p02-q01-VaccineType",
              "operator" : "=",
              "answerCoding" : {
                "display" : "Both"
              }
            }
          ],
          "enableBehavior" : "all",
          "required" : true,
          "answerOption" : [
            {
              "valueCoding" : {
                "display" : "Same arm."
              }
            },
            {
              "valueCoding" : {
                "display" : "Different arms."
              }
            },
            {
              "valueCoding" : {
                "display" : "Don't Know."
              }
            },
            {
              "valueCoding" : {
                "display" : "No."
              }
            }
          ]
        }
      ]
    },
    {
      "linkId" : "p03",
      "prefix" : "page 3",
      "text" : "Health Conditions",
      "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" : "drop-down",
                    "display" : "Drop down"
                  }
                ],
                "text" : "Drop down"
              }
            }
          ],
          "linkId" : "p03-q01-LongTermConditions",
          "text" : "Do you have any long-term medical conditions?",
          "type" : "choice",
          "required" : false,
          "answerOption" : [
            {
              "valueCoding" : {
                "display" : "Yes"
              }
            },
            {
              "valueCoding" : {
                "display" : "No"
              }
            },
            {
              "valueCoding" : {
                "display" : "Prefer not to answer"
              }
            }
          ]
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/questionnaire-item-control",
                    "code" : "drop-down",
                    "display" : "Drop down"
                  }
                ],
                "text" : "Drop down"
              }
            }
          ],
          "linkId" : "p03-q01-1-LongTermConditions.Select",
          "text" : "Please select all the long term conditions that apply.",
          "type" : "choice",
          "enableWhen" : [
            {
              "question" : "p03-q01-LongTermConditions",
              "operator" : "=",
              "answerCoding" : {
                "display" : "Yes"
              }
            }
          ],
          "enableBehavior" : "all",
          "required" : false,
          "repeats" : true,
          "answerOption" : [
            {
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "85828009",
                "display" : "Autoimmune conditions (eg. arthritis)"
              }
            },
            {
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "32709003",
                "display" : "Alcohol or other drug addictions"
              }
            },
            {
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "195967001",
                "display" : "Asthma"
              }
            },
            {
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "363346000",
                "display" : "Cancer"
              }
            },
            {
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "82423001",
                "display" : "Chronic pain"
              }
            },
            {
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "13645005",
                "display" : "Chronic obstructive pulmonary disease"
              }
            },
            {
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "73211009",
                "display" : "Diabetes"
              }
            },
            {
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "770924008",
                "display" : "Gout"
              }
            },
            {
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "56265001",
                "display" : "Heart disease"
              }
            },
            {
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "74732009",
                "display" : "Mental health condition"
              }
            },
            {
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "414916001",
                "display" : "Obesity"
              }
            },
            {
              "valueCoding" : {
                "display" : "Other"
              }
            }
          ]
        },
        {
          "linkId" : "p03-q01-1-1-LongTermConditions.Select.Other",
          "text" : "Please explain any other long term medical conditions you have.",
          "type" : "text",
          "enableWhen" : [
            {
              "question" : "p03-q01-1-LongTermConditions.Select",
              "operator" : "=",
              "answerCoding" : {
                "display" : "Other"
              }
            }
          ],
          "enableBehavior" : "all",
          "required" : false
        }
      ]
    },
    {
      "linkId" : "p04",
      "prefix" : "page 4 question 1",
      "text" : "Side Effects",
      "type" : "group",
      "required" : false,
      "item" : [
        {
          "linkId" : "p04-q01-SideEffects",
          "text" : "Did you have any reactions following your vaccine? This includes any reactions your vaccinator told you to expect AND anything you did not expect that you think might be a reaction, no matter how minor.",
          "type" : "boolean",
          "required" : false
        }
      ]
    },
    {
      "linkId" : "p05",
      "prefix" : "page 5 question 12.1",
      "text" : "Side Effects Details",
      "type" : "group",
      "enableWhen" : [
        {
          "question" : "p04-q01-SideEffects",
          "operator" : "=",
          "answerBoolean" : true
        }
      ],
      "enableBehavior" : "all",
      "required" : false,
      "item" : [
        {
          "linkId" : "p05-q01-InjectionSiteDisorder",
          "code" : [
            {
              "system" : "http://snomed.info/sct",
              "code" : "95376002",
              "display" : "Injection site disorder"
            }
          ],
          "text" : "Did you experience any injection site reactions (pain, redness, swelling, itching at or near the injection site)?",
          "type" : "boolean",
          "required" : false
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/questionnaire-item-control",
                    "code" : "drop-down",
                    "display" : "Drop down"
                  }
                ],
                "text" : "Drop down"
              }
            }
          ],
          "linkId" : "p05-q01-1-InjectionSiteDisorder.Select",
          "text" : "Please select all in select all the injection site reactions that you experienced.",
          "type" : "choice",
          "enableWhen" : [
            {
              "question" : "p05-q01-InjectionSiteDisorder",
              "operator" : "=",
              "answerBoolean" : true
            }
          ],
          "enableBehavior" : "all",
          "required" : false,
          "repeats" : true,
          "answerOption" : [
            {
              "valueCoding" : {
                "code" : "95388000",
                "display" : "Pain"
              }
            },
            {
              "valueCoding" : {
                "code" : "95380007",
                "display" : "Redness"
              }
            },
            {
              "valueCoding" : {
                "code" : "213340005",
                "display" : "Swelling"
              }
            },
            {
              "valueCoding" : {
                "code" : "95379009",
                "display" : "Itching"
              }
            }
          ]
        },
        {
          "linkId" : "p05-q01-2-InjectionSiteDisorder.EntireArm",
          "text" : "Did you have swelling of entire arm?",
          "type" : "boolean",
          "enableWhen" : [
            {
              "question" : "p05-q01-InjectionSiteDisorder",
              "operator" : "=",
              "answerBoolean" : true
            }
          ],
          "required" : false
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/questionnaire-item-control",
                    "code" : "drop-down",
                    "display" : "Drop down"
                  }
                ],
                "text" : "Drop down"
              }
            }
          ],
          "linkId" : "p05-q02-LymphNode",
          "code" : [
            {
              "system" : "http://snomed.info/sct",
              "code" : "30746006",
              "display" : "Lymphadenopathy"
            }
          ],
          "text" : "Did you have swelling of lymph nodes under your arm/in the armpit?",
          "type" : "choice",
          "required" : false,
          "answerOption" : [
            {
              "valueCoding" : {
                "display" : "Yes, under one arm."
              }
            },
            {
              "valueCoding" : {
                "display" : "Yes, under both arms."
              }
            },
            {
              "valueCoding" : {
                "display" : "No"
              }
            },
            {
              "valueCoding" : {
                "display" : "Don't know"
              }
            }
          ]
        },
        {
          "linkId" : "p05-q03-Fever",
          "code" : [
            {
              "system" : "http://snomed.info/sct",
              "code" : "386661006",
              "display" : "Fever or high temperature"
            }
          ],
          "text" : "Fever (a temperature of 38°C or higher)?",
          "type" : "boolean",
          "required" : false
        },
        {
          "linkId" : "p05-q04-Chills",
          "code" : [
            {
              "system" : "http://snomed.info/sct",
              "code" : "274640006",
              "display" : "Chills, shivering or feeling cold"
            }
          ],
          "text" : "Chills (shivering and feeling cold)?",
          "type" : "boolean",
          "required" : false
        },
        {
          "linkId" : "p05-q05-Rash",
          "code" : [
            {
              "system" : "http://snomed.info/sct",
              "code" : "271807003",
              "display" : "Rash"
            }
          ],
          "text" : "Did you experience a rash, not near the injection site?",
          "type" : "boolean",
          "required" : true
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/questionnaire-item-control",
                    "code" : "drop-down",
                    "display" : "Drop down"
                  }
                ],
                "text" : "Drop down"
              }
            }
          ],
          "linkId" : "p05-q05-1-Rash.WhenStarted",
          "text" : "When did the rash appear?",
          "type" : "choice",
          "enableWhen" : [
            {
              "question" : "p05-q05-Rash",
              "operator" : "=",
              "answerBoolean" : true
            }
          ],
          "enableBehavior" : "all",
          "required" : true,
          "answerOption" : [
            {
              "valueCoding" : {
                "display" : "Within 1 hour after vaccination"
              }
            },
            {
              "valueCoding" : {
                "display" : "Within a day after vaccination"
              }
            },
            {
              "valueCoding" : {
                "display" : "More than a day after vaccination"
              }
            }
          ]
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/questionnaire-item-control",
                    "code" : "drop-down",
                    "display" : "Drop down"
                  }
                ],
                "text" : "Drop down"
              }
            }
          ],
          "linkId" : "p05-q05-2-Rash.HowLong",
          "text" : "How long did the rash last?",
          "type" : "choice",
          "enableWhen" : [
            {
              "question" : "p05-q05-Rash",
              "operator" : "=",
              "answerBoolean" : true
            }
          ],
          "enableBehavior" : "all",
          "required" : true,
          "answerOption" : [
            {
              "valueCoding" : {
                "display" : "Less than 30 minutes"
              }
            },
            {
              "valueCoding" : {
                "display" : "30 minutes to 24 hours"
              }
            },
            {
              "valueCoding" : {
                "display" : "More than 24 hours"
              }
            }
          ]
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/questionnaire-item-control",
                    "code" : "drop-down",
                    "display" : "Drop down"
                  }
                ],
                "text" : "Drop down"
              }
            }
          ],
          "linkId" : "p05-q05-3-Rash.Location",
          "text" : "Please indicate the location of the rash.",
          "type" : "choice",
          "enableWhen" : [
            {
              "question" : "p05-q05-Rash",
              "operator" : "=",
              "answerBoolean" : true
            }
          ],
          "required" : false,
          "answerOption" : [
            {
              "valueCoding" : {
                "display" : "Face"
              }
            },
            {
              "valueCoding" : {
                "display" : "Body"
              }
            },
            {
              "valueCoding" : {
                "display" : "Arms"
              }
            },
            {
              "valueCoding" : {
                "display" : "Legs"
              }
            },
            {
              "valueCoding" : {
                "display" : "Other"
              }
            }
          ]
        },
        {
          "linkId" : "p05-q05-3-1-Rash.Location.Other",
          "text" : "Please explain where rash occurred.",
          "type" : "text",
          "enableWhen" : [
            {
              "question" : "p05-q05-3-Rash.Location",
              "operator" : "=",
              "answerCoding" : {
                "display" : "Other"
              }
            }
          ],
          "enableBehavior" : "all",
          "required" : false
        },
        {
          "linkId" : "p05-q06-Aches",
          "text" : "Did you experience headaches, muscle or body aches, or joint aches or pain?",
          "type" : "boolean",
          "required" : true
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/questionnaire-item-control",
                    "code" : "drop-down",
                    "display" : "Drop down"
                  }
                ],
                "text" : "Drop down"
              }
            }
          ],
          "linkId" : "p05-q06-1-Aches.Select",
          "text" : "Please select all that apply.",
          "type" : "choice",
          "enableWhen" : [
            {
              "question" : "p05-q06-Aches",
              "operator" : "=",
              "answerBoolean" : true
            }
          ],
          "enableBehavior" : "all",
          "required" : true,
          "repeats" : true,
          "answerOption" : [
            {
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "25064002",
                "display" : "Headache"
              }
            },
            {
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "68962001",
                "display" : "Muscle/body aches"
              }
            },
            {
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "57676002",
                "display" : "Joint pain"
              }
            },
            {
              "valueCoding" : {
                "display" : "Pain/irritation of the mouth and throat"
              }
            }
          ]
        },
        {
          "linkId" : "p05-q07-DigestiveDisorder",
          "code" : [
            {
              "system" : "http://snomed.info/sct",
              "code" : "53619000",
              "display" : "Disorder of digestive system"
            }
          ],
          "text" : "Did you experience any gastrointestinal symptoms?",
          "type" : "boolean",
          "required" : true
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/questionnaire-item-control",
                    "code" : "drop-down",
                    "display" : "Drop down"
                  }
                ],
                "text" : "Drop down"
              }
            }
          ],
          "linkId" : "p05-q07-1-DigestiveDisorder.Select",
          "text" : "Please select all that gastrointestinal symptoms that apply.",
          "type" : "choice",
          "enableWhen" : [
            {
              "question" : "p05-q07-DigestiveDisorder",
              "operator" : "=",
              "answerBoolean" : true
            }
          ],
          "required" : true,
          "repeats" : true,
          "answerOption" : [
            {
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "422587007",
                "display" : "Nausea"
              }
            },
            {
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "422400008",
                "display" : "Vomiting"
              }
            },
            {
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "62315008",
                "display" : "Diarrhoea"
              }
            },
            {
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "21522001",
                "display" : "Abdominal Pain"
              }
            },
            {
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "79890006",
                "display" : "Loss of appetite"
              }
            },
            {
              "valueCoding" : {
                "display" : "Other"
              }
            }
          ]
        },
        {
          "linkId" : "p05-q07-1-1-DigestiveDisorder.Select.Other",
          "text" : "Please specify any other gastrointestinal symptoms you experienced.",
          "type" : "string",
          "enableWhen" : [
            {
              "question" : "p05-q07-1-DigestiveDisorder.Select",
              "operator" : "=",
              "answerCoding" : {
                "display" : "Other"
              }
            }
          ],
          "required" : false
        },
        {
          "linkId" : "p05-q08-Fatigue",
          "code" : [
            {
              "system" : "http://snomed.info/sct",
              "code" : "84229001",
              "display" : "Fatigue"
            }
          ],
          "text" : "Did you experience fatigue or tiredness?",
          "type" : "boolean",
          "required" : true
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/questionnaire-item-control",
                    "code" : "drop-down",
                    "display" : "Drop down"
                  }
                ],
                "text" : "Drop down"
              }
            }
          ],
          "linkId" : "p05-q09-Chest",
          "text" : "Did you have any of these Chest Symptoms? - Please select all that apply",
          "type" : "choice",
          "required" : false,
          "repeats" : true,
          "answerOption" : [
            {
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "29857009",
                "display" : "Chest Pain"
              }
            },
            {
              "valueCoding" : {
                "display" : "Chest Heaviness"
              }
            },
            {
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "23924001",
                "display" : "Chest Tightness"
              }
            },
            {
              "valueCoding" : {
                "display" : "Chest Discomfort"
              }
            },
            {
              "valueCoding" : {
                "display" : "Other"
              }
            }
          ]
        },
        {
          "linkId" : "p05-q09-1-Chest.Other",
          "text" : "Please specify other chest symptoms you experienced.",
          "type" : "text",
          "enableWhen" : [
            {
              "question" : "p05-q09-Chest",
              "operator" : "=",
              "answerCoding" : {
                "display" : "Other"
              }
            }
          ],
          "enableBehavior" : "all",
          "required" : true
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/questionnaire-item-control",
                    "code" : "drop-down",
                    "display" : "Drop down"
                  }
                ],
                "text" : "Drop down"
              }
            }
          ],
          "linkId" : "p05-q10-Heart",
          "text" : "Did you experience any of the following heart symptoms? Please select all that apply.",
          "type" : "choice",
          "required" : true,
          "repeats" : true,
          "answerOption" : [
            {
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "80313002",
                "display" : "Palpitations"
              }
            },
            {
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "248648003",
                "display" : "Heart racing or pounding"
              }
            },
            {
              "valueCoding" : {
                "display" : "Other"
              }
            }
          ]
        },
        {
          "linkId" : "p05-q10-1-Heart.Other",
          "text" : "Please specify any other heart symptoms you experienced?",
          "type" : "text",
          "enableWhen" : [
            {
              "question" : "p05-q10-Heart",
              "operator" : "=",
              "answerCoding" : {
                "display" : "Other"
              }
            }
          ],
          "enableBehavior" : "all",
          "required" : true
        },
        {
          "linkId" : "p05-q11-Breathing",
          "code" : [
            {
              "system" : "http://snomed.info/sct",
              "code" : "230145002",
              "display" : "Difficulty breathing"
            }
          ],
          "text" : "Did you experience any difficulty breathing?",
          "type" : "boolean",
          "required" : true
        },
        {
          "linkId" : "p05-q12-OtherSymptoms",
          "text" : "Did you experience any symptoms that were not listed above?",
          "type" : "boolean",
          "required" : true
        },
        {
          "linkId" : "p05-q12-1-OtherSymptoms.Explain",
          "text" : "What other side effects did you experience?",
          "type" : "text",
          "enableWhen" : [
            {
              "question" : "p05-q12-OtherSymptoms",
              "operator" : "=",
              "answerBoolean" : true
            }
          ],
          "enableBehavior" : "all",
          "required" : false
        }
      ]
    },
    {
      "linkId" : "p06",
      "prefix" : "page 6 question 3.1.1",
      "text" : "Symptom Relief",
      "type" : "group",
      "enableWhen" : [
        {
          "question" : "p04-q01-SideEffects",
          "operator" : "=",
          "answerBoolean" : true
        }
      ],
      "enableBehavior" : "all",
      "required" : false,
      "item" : [
        {
          "linkId" : "p06-q01-MissingDays",
          "text" : "Did any of the symptoms you reported cause you to miss work, study, or normal daily activities?",
          "type" : "boolean",
          "required" : true
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/questionnaire-item-control",
                    "code" : "drop-down",
                    "display" : "Drop down"
                  }
                ],
                "text" : "Drop down"
              }
            }
          ],
          "linkId" : "p06-q01-1-MissingDays.HowMany",
          "text" : "How many days did you miss?",
          "type" : "choice",
          "enableWhen" : [
            {
              "question" : "p06-q01-MissingDays",
              "operator" : "=",
              "answerBoolean" : true
            }
          ],
          "enableBehavior" : "all",
          "required" : true,
          "answerOption" : [
            {
              "valueCoding" : {
                "display" : "Less than 1 day"
              }
            },
            {
              "valueCoding" : {
                "display" : "1 day"
              }
            },
            {
              "valueCoding" : {
                "display" : "2 days"
              }
            },
            {
              "valueCoding" : {
                "display" : "3 days or more"
              }
            }
          ]
        },
        {
          "linkId" : "p06-q02-SymptomRelief",
          "text" : "Did any of the symptoms cause you to seek advice or care from a healthcare professional?",
          "type" : "boolean",
          "required" : true
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/questionnaire-item-control",
                    "code" : "drop-down",
                    "display" : "Drop down"
                  }
                ],
                "text" : "Drop down"
              }
            }
          ],
          "linkId" : "p06-q02-1-SymptomRelief.Select",
          "text" : "Please select the type of advice or care you sought.",
          "type" : "choice",
          "enableWhen" : [
            {
              "question" : "p06-q02-SymptomRelief",
              "operator" : "=",
              "answerBoolean" : true
            }
          ],
          "enableBehavior" : "all",
          "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" : "Other"
              }
            }
          ]
        },
        {
          "linkId" : "p06-q02-1-1-SymptomRelief.Select.Other",
          "text" : "Please explain any other advice or care you sought.",
          "type" : "text",
          "enableWhen" : [
            {
              "question" : "p06-q02-1-SymptomRelief.Select",
              "operator" : "=",
              "answerCoding" : {
                "display" : "Other [Please explain]"
              }
            }
          ],
          "enableBehavior" : "all",
          "required" : true
        },
        {
          "linkId" : "p06-q03-Medicines",
          "text" : "Did you take any over the counter medications to relive the pain/discomfort?",
          "type" : "boolean",
          "required" : true
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/questionnaire-item-control",
                    "code" : "drop-down",
                    "display" : "Drop down"
                  }
                ],
                "text" : "Drop down"
              }
            }
          ],
          "linkId" : "p06-q03-1-Medicines.Select",
          "text" : "Please specify what medication you took.",
          "type" : "choice",
          "enableWhen" : [
            {
              "question" : "p06-q03-Medicines",
              "operator" : "=",
              "answerBoolean" : true
            }
          ],
          "enableBehavior" : "all",
          "required" : true,
          "repeats" : true,
          "answerOption" : [
            {
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "387517004",
                "display" : "Paracetamol"
              }
            },
            {
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "387207008",
                "display" : "Ibuprofen"
              }
            },
            {
              "valueCoding" : {
                "display" : "Other"
              }
            }
          ]
        },
        {
          "linkId" : "p06-q03-1-1-Medicines.Select.Other",
          "text" : "Please specify any alternate medications you took.",
          "type" : "text",
          "enableWhen" : [
            {
              "question" : "p06-q03-1-Medicines.Select",
              "operator" : "=",
              "answerCoding" : {
                "display" : "Other"
              }
            }
          ],
          "required" : true
        }
      ]
    },
    {
      "linkId" : "p07",
      "prefix" : "page 7 question 2.1",
      "text" : "Vaccine Experience",
      "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" : "drop-down",
                    "display" : "Drop down"
                  }
                ],
                "text" : "Drop down"
              }
            }
          ],
          "linkId" : "p07-q01-Experience",
          "text" : "How would you rate your overall experience getting the vaccine?",
          "type" : "choice",
          "required" : true,
          "answerOption" : [
            {
              "valueCoding" : {
                "display" : "Very Poor"
              }
            },
            {
              "valueCoding" : {
                "display" : "Poor"
              }
            },
            {
              "valueCoding" : {
                "display" : "Average"
              }
            },
            {
              "valueCoding" : {
                "display" : "Good"
              }
            },
            {
              "valueCoding" : {
                "display" : "Very Good"
              }
            }
          ]
        },
        {
          "linkId" : "p07-q02-Comments",
          "text" : "Do you have any comments about your vaccine experience?",
          "type" : "boolean",
          "required" : true
        },
        {
          "linkId" : "p07-q02-1-Comments.Explain",
          "text" : "Please Explain",
          "type" : "text",
          "enableWhen" : [
            {
              "question" : "p07-q02-Comments",
              "operator" : "=",
              "answerBoolean" : true
            }
          ],
          "enableBehavior" : "all",
          "required" : false
        }
      ]
    },
    {
      "linkId" : "p08",
      "prefix" : "page 8",
      "text" : "Thank you for completing the Day 7 survey, your answers have been submitted. You will receive your Day 42 survey in 35 days. Your responses will help contribute to the safety monitoring of the Influenza vaccine. The information you provide is protected by the Privacy Act 2020. 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"
    }
  ]
}

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