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Resource Questionnaire/FHIR Server from package cinc.fhir.ig#current (94 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-COVIDPublicHealthHistoryQuestionnaire.html
Url https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/Questionnaire/COVIDPublicHealthHistoryQuestionnaire
Version 0.3.9
Status draft
Date 2023-07-19
Name COVIDPublicHealthHistoryQuestionnaire
Title COVID19 Public Health History Questionnaire
Experimental False
Realm nz
Authority national
Description Questions about a patient's recent COVID-19 history
Purpose For assessing patient's recent history of COVID-19 for public health purposes

Resources that use this resource

No resources found


Resources that this resource uses

No resources found



Narrative

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

Structure
LinkIdTextCardinalityTypeDescription & Constraintsdoco
.. COVIDPublicHealthHistoryQuestionnaireQuestions about a patient's recent COVID-19 historyQuestionnairehttps://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/Questionnaire/COVIDPublicHealthHistoryQuestionnaire#0.3.9
... summaryQuestions about a patient's recent COVID-19 history0..1display
... p01Public Health History0..1group
.... p01-q01-PlacesVisitedRecentlyquestion 1. Places visited in last 14 days0..1text
.... p01-q02-PrevPositivequestion 2. Previous positive COVID-19 test?1..1boolean
.... p01-q02-1-PrevPositiveMonthquestion 2-1. Month of positive COVID-19 test?1..1choiceEnable When: p01-q02-PrevPositive = true
Options: 12 options
.... p01-q02-2-PrevPositiveYearquestion 2-2. Year of positive COVID-19 test?1..1choiceEnable When: p01-q02-PrevPositive = true
Options: 11 options
.... p01-q03-HighSuspicionOfCOVIDquestion 3. High suspicion of prev. COVID-19?1..1boolean
.... p01-q04-PotentialCloseContactquestion 4. Potential close contact with a COVID-19 positive person in the last 14 days?1..1boolean
.... p01-q05-COVID19Vaccinequestion 5. COVID-19 vaccine?1..1choiceOptions: 3 options
.... p01-q06-dose1-datequestion 6 - 1st Dose. Date0..1date
.... p01-q06-dose1-vaccinequestion 6 - 1st Dose. Vaccine given0..1choiceEnable When: p01-q06-dose1-date exists true
Options: 8 options
.... p01-q06-dose1-countryquestion 6 - 1st Dose. Country where vaccinated0..1choiceEnable When: p01-q06-dose1-date exists true
Value Set: Iso 3166 Part 1: 2 Letter Codes
.... p01-q06-dose2-datequestion 6 - 2nd Dose. Date0..1date
.... p01-q06-dose2-vaccinequestion 6 - 2nd Dose. Vaccine given0..1choiceEnable When: p01-q06-dose2-date exists true
Options: 8 options
.... p01-q06-dose2-countryquestion 6 - 2nd Dose. Country where vaccinated0..1choiceEnable When: p01-q06-dose2-date exists true
Value Set: Iso 3166 Part 1: 2 Letter Codes
.... p01-q06-dose3-datequestion 6 - 3rd Dose. Date0..1date
.... p01-q06-dose3-vaccinequestion 6 - 3rd Dose. Vaccine given0..1choiceEnable When: p01-q06-dose3-date exists true
Options: 8 options
.... p01-q06-dose3-countryquestion 6 - 3rd Dose. Country where vaccinated0..1choiceEnable When: p01-q06-dose3-date exists true
Value Set: Iso 3166 Part 1: 2 Letter Codes

doco Documentation for this format

Option Sets

Answer options for p01-q02-1-PrevPositiveMonth

  • January
  • February
  • March
  • April
  • May
  • June
  • July
  • August
  • September
  • October
  • November
  • December

Answer options for p01-q02-2-PrevPositiveYear

  • 2020
  • 2021
  • 2022
  • 2023
  • 2024
  • 2025
  • 2026
  • 2027
  • 2028
  • 2029
  • 2030

Answer options for p01-q05-COVID19Vaccine

  • null#null ("Full")
  • null#null ("Partial")
  • null#null ("Nil")

Answer options for p01-q06-dose1-vaccine

  • null#207 ("Moderna")
  • null#208 ("Pfizer/BioNtech")
  • null#210 ("AstraZeneca / Covishield")
  • null#211 ("Novavax")
  • null#212 ("Janssen")
  • null#505 ("Sputnik V")
  • null#510 ("Sinopharm")
  • null#511 ("CoronaVac")

Answer options for p01-q06-dose2-vaccine

  • null#207 ("Moderna")
  • null#208 ("Pfizer/BioNtech")
  • null#210 ("AstraZeneca / Covishield")
  • null#211 ("Novavax")
  • null#212 ("Janssen")
  • null#505 ("Sputnik V")
  • null#510 ("Sinopharm")
  • null#511 ("CoronaVac")

Answer options for p01-q06-dose3-vaccine

  • null#207 ("Moderna")
  • null#208 ("Pfizer/BioNtech")
  • null#210 ("AstraZeneca / Covishield")
  • null#211 ("Novavax")
  • null#212 ("Janssen")
  • null#505 ("Sputnik V")
  • null#510 ("Sinopharm")
  • null#511 ("CoronaVac")

Source

{
  "resourceType" : "Questionnaire",
  "id" : "COVIDPublicHealthHistoryQuestionnaire",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><b>Structure</b><table border=\"1\" cellpadding=\"0\" cellspacing=\"0\" style=\"border: 1px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;\"><tr style=\"border: 2px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top\"><th 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/formats.html#table\" title=\"The linkId for the item\">LinkId</a></th><th 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/formats.html#table\" title=\"Text for the item\">Text</a></th><th 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/formats.html#table\" title=\"Minimum and Maximum # of times the the itemcan appear in the instance\">Cardinality</a></th><th 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/formats.html#table\" title=\"The type of the item\">Type</a></th><th 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/formats.html#table\" title=\"Additional information about the item\">Description &amp; Constraints</a><span style=\"float: right\"><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\"/></a></span></th></tr><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_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\"/> COVIDPublicHealthHistoryQuestionnaire</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Questions about a patient's recent COVID-19 history</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/COVIDPublicHealthHistoryQuestionnaire#0.3.9</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.summary\" 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\"/> summary</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Questions about a patient's recent COVID-19 history</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_bck01.png)\" id=\"item.p01\" 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-group.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Group\" class=\"hierarchy\"/> p01</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Public Health History</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_bck010.png)\" id=\"item.p01-q01-PlacesVisitedRecently\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.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\"/> p01-q01-PlacesVisitedRecently</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">question 1. Places visited in last 14 days</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\"/></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_bck010.png)\" id=\"item.p01-q02-PrevPositive\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.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\"/> p01-q02-PrevPositive</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">question 2. Previous positive COVID-19 test?</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_bck010.png)\" id=\"item.p01-q02-1-PrevPositiveMonth\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.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\"/> p01-q02-1-PrevPositiveMonth</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">question 2-1. Month of positive COVID-19 test?</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.p01-q02-PrevPositive\">p01-q02-PrevPositive</a> = true</span><br/>Options: <a href=\"#opt-item.p01-q02-1-PrevPositiveMonth\">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_bck010.png)\" id=\"item.p01-q02-2-PrevPositiveYear\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.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\"/> p01-q02-2-PrevPositiveYear</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">question 2-2. Year of positive COVID-19 test?</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.p01-q02-PrevPositive\">p01-q02-PrevPositive</a> = true</span><br/>Options: <a href=\"#opt-item.p01-q02-2-PrevPositiveYear\">11 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_bck010.png)\" id=\"item.p01-q03-HighSuspicionOfCOVID\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.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\"/> p01-q03-HighSuspicionOfCOVID</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">question 3. High suspicion of prev. COVID-19?</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_bck010.png)\" id=\"item.p01-q04-PotentialCloseContact\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.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\"/> p01-q04-PotentialCloseContact</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">question 4. Potential close contact with a COVID-19 positive person in the last 14 days?</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_bck010.png)\" id=\"item.p01-q05-COVID19Vaccine\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.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\"/> p01-q05-COVID19Vaccine</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">question 5. COVID-19 vaccine?</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.p01-q05-COVID19Vaccine\">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_bck010.png)\" id=\"item.p01-q06-dose1-date\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-date.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Date\" class=\"hierarchy\"/> p01-q06-dose1-date</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">question 6 - 1st Dose. Date</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-date\">date</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_bck010.png)\" id=\"item.p01-q06-dose1-vaccine\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.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\"/> p01-q06-dose1-vaccine</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">question 6 - 1st Dose. Vaccine given</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.p01-q06-dose1-date\">p01-q06-dose1-date</a> exists true</span><br/>Options: <a href=\"#opt-item.p01-q06-dose1-vaccine\">8 options</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)\" id=\"item.p01-q06-dose1-country\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.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\"/> p01-q06-dose1-country</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">question 6 - 1st Dose. Country where vaccinated</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\">Enable When: <span><a href=\"#item.p01-q06-dose1-date\">p01-q06-dose1-date</a> exists true</span><br/>Value Set: <a href=\"http://hl7.org/fhir/R4/valueset-iso3166-1-2.html\">Iso 3166 Part 1: 2 Letter Codes</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_bck010.png)\" id=\"item.p01-q06-dose2-date\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-date.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Date\" class=\"hierarchy\"/> p01-q06-dose2-date</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">question 6 - 2nd Dose. Date</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-date\">date</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_bck010.png)\" id=\"item.p01-q06-dose2-vaccine\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.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\"/> p01-q06-dose2-vaccine</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">question 6 - 2nd Dose. Vaccine given</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\">Enable When: <span><a href=\"#item.p01-q06-dose2-date\">p01-q06-dose2-date</a> exists true</span><br/>Options: <a href=\"#opt-item.p01-q06-dose2-vaccine\">8 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_bck010.png)\" id=\"item.p01-q06-dose2-country\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.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\"/> p01-q06-dose2-country</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">question 6 - 2nd Dose. Country where vaccinated</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.p01-q06-dose2-date\">p01-q06-dose2-date</a> exists true</span><br/>Value Set: <a href=\"http://hl7.org/fhir/R4/valueset-iso3166-1-2.html\">Iso 3166 Part 1: 2 Letter Codes</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_bck010.png)\" id=\"item.p01-q06-dose3-date\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-date.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Date\" class=\"hierarchy\"/> p01-q06-dose3-date</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">question 6 - 3rd Dose. Date</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-date\">date</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_bck010.png)\" id=\"item.p01-q06-dose3-vaccine\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.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\"/> p01-q06-dose3-vaccine</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">question 6 - 3rd Dose. Vaccine given</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.p01-q06-dose3-date\">p01-q06-dose3-date</a> exists true</span><br/>Options: <a href=\"#opt-item.p01-q06-dose3-vaccine\">8 options</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck000.png)\" id=\"item.p01-q06-dose3-country\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.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\"/> p01-q06-dose3-country</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">question 6 - 3rd Dose. Country where vaccinated</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\">Enable When: <span><a href=\"#item.p01-q06-dose3-date\">p01-q06-dose3-date</a> exists true</span><br/>Value Set: <a href=\"http://hl7.org/fhir/R4/valueset-iso3166-1-2.html\">Iso 3166 Part 1: 2 Letter Codes</a></td></tr>\r\n<tr><td colspan=\"5\" class=\"hierarchy\"><br/><a href=\"http://hl7.org/fhir/R4/formats.html#table\" title=\"Legend for this format\"><img src=\"data:image/png;base64,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\" alt=\"doco\" style=\"background-color: inherit\"/> Documentation for this format</a></td></tr></table><hr/><p><b>Option Sets</b></p><a name=\"opt-item.p01-q02-1-PrevPositiveMonth\"> </a><p><b>Answer options for p01-q02-1-PrevPositiveMonth</b></p><ul><li style=\"font-size: 11px\">January</li><li style=\"font-size: 11px\">February</li><li style=\"font-size: 11px\">March</li><li style=\"font-size: 11px\">April</li><li style=\"font-size: 11px\">May</li><li style=\"font-size: 11px\">June</li><li style=\"font-size: 11px\">July</li><li style=\"font-size: 11px\">August</li><li style=\"font-size: 11px\">September</li><li style=\"font-size: 11px\">October</li><li style=\"font-size: 11px\">November</li><li style=\"font-size: 11px\">December</li></ul><a name=\"opt-item.p01-q02-2-PrevPositiveYear\"> </a><p><b>Answer options for p01-q02-2-PrevPositiveYear</b></p><ul><li style=\"font-size: 11px\">2020</li><li style=\"font-size: 11px\">2021</li><li style=\"font-size: 11px\">2022</li><li style=\"font-size: 11px\">2023</li><li style=\"font-size: 11px\">2024</li><li style=\"font-size: 11px\">2025</li><li style=\"font-size: 11px\">2026</li><li style=\"font-size: 11px\">2027</li><li style=\"font-size: 11px\">2028</li><li style=\"font-size: 11px\">2029</li><li style=\"font-size: 11px\">2030</li></ul><a name=\"opt-item.p01-q05-COVID19Vaccine\"> </a><p><b>Answer options for p01-q05-COVID19Vaccine</b></p><ul><li style=\"font-size: 11px\">null#null (&quot;Full&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Partial&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Nil&quot;)</li></ul><a name=\"opt-item.p01-q06-dose1-vaccine\"> </a><p><b>Answer options for p01-q06-dose1-vaccine</b></p><ul><li style=\"font-size: 11px\">null#207 (&quot;Moderna&quot;)</li><li style=\"font-size: 11px\">null#208 (&quot;Pfizer/BioNtech&quot;)</li><li style=\"font-size: 11px\">null#210 (&quot;AstraZeneca / Covishield&quot;)</li><li style=\"font-size: 11px\">null#211 (&quot;Novavax&quot;)</li><li style=\"font-size: 11px\">null#212 (&quot;Janssen&quot;)</li><li style=\"font-size: 11px\">null#505 (&quot;Sputnik V&quot;)</li><li style=\"font-size: 11px\">null#510 (&quot;Sinopharm&quot;)</li><li style=\"font-size: 11px\">null#511 (&quot;CoronaVac&quot;)</li></ul><a name=\"opt-item.p01-q06-dose2-vaccine\"> </a><p><b>Answer options for p01-q06-dose2-vaccine</b></p><ul><li style=\"font-size: 11px\">null#207 (&quot;Moderna&quot;)</li><li style=\"font-size: 11px\">null#208 (&quot;Pfizer/BioNtech&quot;)</li><li style=\"font-size: 11px\">null#210 (&quot;AstraZeneca / Covishield&quot;)</li><li style=\"font-size: 11px\">null#211 (&quot;Novavax&quot;)</li><li style=\"font-size: 11px\">null#212 (&quot;Janssen&quot;)</li><li style=\"font-size: 11px\">null#505 (&quot;Sputnik V&quot;)</li><li style=\"font-size: 11px\">null#510 (&quot;Sinopharm&quot;)</li><li style=\"font-size: 11px\">null#511 (&quot;CoronaVac&quot;)</li></ul><a name=\"opt-item.p01-q06-dose3-vaccine\"> </a><p><b>Answer options for p01-q06-dose3-vaccine</b></p><ul><li style=\"font-size: 11px\">null#207 (&quot;Moderna&quot;)</li><li style=\"font-size: 11px\">null#208 (&quot;Pfizer/BioNtech&quot;)</li><li style=\"font-size: 11px\">null#210 (&quot;AstraZeneca / Covishield&quot;)</li><li style=\"font-size: 11px\">null#211 (&quot;Novavax&quot;)</li><li style=\"font-size: 11px\">null#212 (&quot;Janssen&quot;)</li><li style=\"font-size: 11px\">null#505 (&quot;Sputnik V&quot;)</li><li style=\"font-size: 11px\">null#510 (&quot;Sinopharm&quot;)</li><li style=\"font-size: 11px\">null#511 (&quot;CoronaVac&quot;)</li></ul></div>"
  },
  "url" : "https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/Questionnaire/COVIDPublicHealthHistoryQuestionnaire",
  "identifier" : [
    {
      "use" : "official",
      "value" : "COVIDRegularHealthCheckQuestionnaire",
      "period" : {
        "start" : "2023-07-01"
      }
    }
  ],
  "version" : "0.3.9",
  "name" : "COVIDPublicHealthHistoryQuestionnaire",
  "title" : "COVID19 Public Health History Questionnaire",
  "status" : "draft",
  "experimental" : false,
  "subjectType" : [
    "Patient"
  ],
  "date" : "2023-07-19",
  "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" : "Questions about a patient's recent COVID-19 history",
  "useContext" : [
    {
      "code" : {
        "system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
        "code" : "workflow",
        "display" : "Workflow Setting"
      },
      "valueCodeableConcept" : {
        "text" : "COVID Public Health History Questionnaire"
      }
    }
  ],
  "jurisdiction" : [
    {
      "coding" : [
        {
          "system" : "urn:iso:std:iso:3166",
          "code" : "NZ",
          "display" : "New Zealand"
        }
      ]
    }
  ],
  "purpose" : "For assessing patient's recent history of COVID-19 for public health purposes",
  "code" : [
    {
      "system" : "http://snomed.info/sct",
      "code" : "292508471000119105",
      "display" : "History of disease caused by severe acute respiratory syndrome coronavirus 2 (situation)"
    }
  ],
  "item" : [
    {
      "linkId" : "summary",
      "text" : "Questions about a patient's recent COVID-19 history",
      "type" : "display"
    },
    {
      "linkId" : "p01",
      "text" : "Public Health History",
      "type" : "group",
      "item" : [
        {
          "linkId" : "p01-q01-PlacesVisitedRecently",
          "prefix" : "question 1",
          "text" : "Places visited in last 14 days",
          "type" : "text",
          "required" : false
        },
        {
          "linkId" : "p01-q02-PrevPositive",
          "prefix" : "question 2",
          "text" : "Previous positive COVID-19 test?",
          "type" : "boolean",
          "required" : true
        },
        {
          "linkId" : "p01-q02-1-PrevPositiveMonth",
          "prefix" : "question 2-1",
          "text" : "Month of positive COVID-19 test?",
          "type" : "choice",
          "enableWhen" : [
            {
              "question" : "p01-q02-PrevPositive",
              "operator" : "=",
              "answerBoolean" : true
            }
          ],
          "enableBehavior" : "any",
          "required" : true,
          "answerOption" : [
            {
              "valueString" : "January"
            },
            {
              "valueString" : "February"
            },
            {
              "valueString" : "March"
            },
            {
              "valueString" : "April"
            },
            {
              "valueString" : "May"
            },
            {
              "valueString" : "June"
            },
            {
              "valueString" : "July"
            },
            {
              "valueString" : "August"
            },
            {
              "valueString" : "September"
            },
            {
              "valueString" : "October"
            },
            {
              "valueString" : "November"
            },
            {
              "valueString" : "December"
            }
          ]
        },
        {
          "linkId" : "p01-q02-2-PrevPositiveYear",
          "prefix" : "question 2-2",
          "text" : "Year of positive COVID-19 test?",
          "type" : "choice",
          "enableWhen" : [
            {
              "question" : "p01-q02-PrevPositive",
              "operator" : "=",
              "answerBoolean" : true
            }
          ],
          "enableBehavior" : "any",
          "required" : true,
          "answerOption" : [
            {
              "valueDate" : "2020"
            },
            {
              "valueDate" : "2021"
            },
            {
              "valueDate" : "2022"
            },
            {
              "valueDate" : "2023"
            },
            {
              "valueDate" : "2024"
            },
            {
              "valueDate" : "2025"
            },
            {
              "valueDate" : "2026"
            },
            {
              "valueDate" : "2027"
            },
            {
              "valueDate" : "2028"
            },
            {
              "valueDate" : "2029"
            },
            {
              "valueDate" : "2030"
            }
          ]
        },
        {
          "linkId" : "p01-q03-HighSuspicionOfCOVID",
          "prefix" : "question 3",
          "text" : "High suspicion of prev. COVID-19?",
          "type" : "boolean",
          "required" : true
        },
        {
          "linkId" : "p01-q04-PotentialCloseContact",
          "prefix" : "question 4",
          "text" : "Potential close contact with a COVID-19 positive person in the last 14 days?",
          "type" : "boolean",
          "required" : true
        },
        {
          "linkId" : "p01-q05-COVID19Vaccine",
          "prefix" : "question 5",
          "text" : "COVID-19 vaccine?",
          "type" : "choice",
          "required" : true,
          "answerOption" : [
            {
              "valueCoding" : {
                "display" : "Full"
              }
            },
            {
              "valueCoding" : {
                "display" : "Partial"
              }
            },
            {
              "valueCoding" : {
                "display" : "Nil"
              }
            }
          ]
        },
        {
          "linkId" : "p01-q06-dose1-date",
          "prefix" : "question 6 - 1st Dose",
          "text" : "Date",
          "type" : "date",
          "required" : false,
          "repeats" : false
        },
        {
          "linkId" : "p01-q06-dose1-vaccine",
          "prefix" : "question 6 - 1st Dose",
          "text" : "Vaccine given",
          "type" : "choice",
          "enableWhen" : [
            {
              "question" : "p01-q06-dose1-date",
              "operator" : "exists",
              "answerBoolean" : true
            }
          ],
          "enableBehavior" : "any",
          "required" : false,
          "repeats" : false,
          "answerOption" : [
            {
              "valueCoding" : {
                "code" : "207",
                "display" : "Moderna"
              }
            },
            {
              "valueCoding" : {
                "code" : "208",
                "display" : "Pfizer/BioNtech"
              }
            },
            {
              "valueCoding" : {
                "code" : "210",
                "display" : "AstraZeneca / Covishield"
              }
            },
            {
              "valueCoding" : {
                "code" : "211",
                "display" : "Novavax"
              }
            },
            {
              "valueCoding" : {
                "code" : "212",
                "display" : "Janssen"
              }
            },
            {
              "valueCoding" : {
                "code" : "505",
                "display" : "Sputnik V"
              }
            },
            {
              "valueCoding" : {
                "code" : "510",
                "display" : "Sinopharm"
              }
            },
            {
              "valueCoding" : {
                "code" : "511",
                "display" : "CoronaVac"
              }
            }
          ]
        },
        {
          "linkId" : "p01-q06-dose1-country",
          "prefix" : "question 6 - 1st Dose",
          "text" : "Country where vaccinated",
          "type" : "choice",
          "enableWhen" : [
            {
              "question" : "p01-q06-dose1-date",
              "operator" : "exists",
              "answerBoolean" : true
            }
          ],
          "enableBehavior" : "any",
          "required" : false,
          "repeats" : false,
          "answerValueSet" : "http://hl7.org/fhir/ValueSet/iso3166-1-2"
        },
        {
          "linkId" : "p01-q06-dose2-date",
          "prefix" : "question 6 - 2nd Dose",
          "text" : "Date",
          "type" : "date",
          "required" : false,
          "repeats" : false
        },
        {
          "linkId" : "p01-q06-dose2-vaccine",
          "prefix" : "question 6 - 2nd Dose",
          "text" : "Vaccine given",
          "type" : "choice",
          "enableWhen" : [
            {
              "question" : "p01-q06-dose2-date",
              "operator" : "exists",
              "answerBoolean" : true
            }
          ],
          "enableBehavior" : "any",
          "required" : false,
          "repeats" : false,
          "answerOption" : [
            {
              "valueCoding" : {
                "code" : "207",
                "display" : "Moderna"
              }
            },
            {
              "valueCoding" : {
                "code" : "208",
                "display" : "Pfizer/BioNtech"
              }
            },
            {
              "valueCoding" : {
                "code" : "210",
                "display" : "AstraZeneca / Covishield"
              }
            },
            {
              "valueCoding" : {
                "code" : "211",
                "display" : "Novavax"
              }
            },
            {
              "valueCoding" : {
                "code" : "212",
                "display" : "Janssen"
              }
            },
            {
              "valueCoding" : {
                "code" : "505",
                "display" : "Sputnik V"
              }
            },
            {
              "valueCoding" : {
                "code" : "510",
                "display" : "Sinopharm"
              }
            },
            {
              "valueCoding" : {
                "code" : "511",
                "display" : "CoronaVac"
              }
            }
          ]
        },
        {
          "linkId" : "p01-q06-dose2-country",
          "prefix" : "question 6 - 2nd Dose",
          "text" : "Country where vaccinated",
          "type" : "choice",
          "enableWhen" : [
            {
              "question" : "p01-q06-dose2-date",
              "operator" : "exists",
              "answerBoolean" : true
            }
          ],
          "enableBehavior" : "any",
          "required" : false,
          "repeats" : false,
          "answerValueSet" : "http://hl7.org/fhir/ValueSet/iso3166-1-2"
        },
        {
          "linkId" : "p01-q06-dose3-date",
          "prefix" : "question 6 - 3rd Dose",
          "text" : "Date",
          "type" : "date",
          "required" : false,
          "repeats" : false
        },
        {
          "linkId" : "p01-q06-dose3-vaccine",
          "prefix" : "question 6 - 3rd Dose",
          "text" : "Vaccine given",
          "type" : "choice",
          "enableWhen" : [
            {
              "question" : "p01-q06-dose3-date",
              "operator" : "exists",
              "answerBoolean" : true
            }
          ],
          "enableBehavior" : "any",
          "required" : false,
          "repeats" : false,
          "answerOption" : [
            {
              "valueCoding" : {
                "code" : "207",
                "display" : "Moderna"
              }
            },
            {
              "valueCoding" : {
                "code" : "208",
                "display" : "Pfizer/BioNtech"
              }
            },
            {
              "valueCoding" : {
                "code" : "210",
                "display" : "AstraZeneca / Covishield"
              }
            },
            {
              "valueCoding" : {
                "code" : "211",
                "display" : "Novavax"
              }
            },
            {
              "valueCoding" : {
                "code" : "212",
                "display" : "Janssen"
              }
            },
            {
              "valueCoding" : {
                "code" : "505",
                "display" : "Sputnik V"
              }
            },
            {
              "valueCoding" : {
                "code" : "510",
                "display" : "Sinopharm"
              }
            },
            {
              "valueCoding" : {
                "code" : "511",
                "display" : "CoronaVac"
              }
            }
          ]
        },
        {
          "linkId" : "p01-q06-dose3-country",
          "prefix" : "question 6 - 3rd Dose",
          "text" : "Country where vaccinated",
          "type" : "choice",
          "enableWhen" : [
            {
              "question" : "p01-q06-dose3-date",
              "operator" : "exists",
              "answerBoolean" : true
            }
          ],
          "enableBehavior" : "any",
          "required" : false,
          "repeats" : false,
          "answerValueSet" : "http://hl7.org/fhir/ValueSet/iso3166-1-2"
        }
      ]
    }
  ]
}

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