Package | csiro.fhir.au.smartforms |
Type | Questionnaire |
Id | Id |
FHIR Version | R4 |
Source | https://smartforms.csiro.au/ig/https://build.fhir.org/ig/aehrc/smart-forms-ig/Questionnaire-AboriginalTorresStraitIslanderHealthCheck.html |
Url | http://www.health.gov.au/assessments/mbs/715 |
Version | 0.2.0-assembled |
Status | draft |
Date | 2024-04-02 |
Name | AboriginalTorresStraitIslanderHealthCheck |
Title | Aboriginal and Torres Strait Islander Health Check |
Experimental | False |
Authority | hl7 |
Description | Aboriginal and Torres Strait Islander Health Check assessment form. |
Copyright | Copyright © 2022+ Australian Government Department of Health and Aged Care - All rights reserved. This content is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License. See https://creativecommons.org/licenses/by-sa/4.0/. |
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Note: links and images are rebased to the (stated) source
Generated Narrative: Questionnaire AboriginalTorresStraitIslanderHealthCheck
StructureLinkID | Text | Cardinality | Type | Flags | Description & Constraints |
---|---|---|---|---|---|
![]() ![]() | Aboriginal and Torres Strait Islander Health Check assessment form. | Questionnaire | http://www.health.gov.au/assessments/mbs/715#0.2.0-assembled | ||
![]() ![]() ![]() | null | 0..1 | group | ||
![]() ![]() ![]() ![]() | About the health check | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() | In progress | 0..1 | display | Enable When: MarkComplete-1 != | |
![]() ![]() ![]() ![]() ![]() | Complete | 0..1 | display | Enable When: MarkComplete-1 = | |
![]() ![]() ![]() ![]() ![]() | Important: The patient record may not be updated with information entered here. Information intended for the patient record should be entered there first. | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Eligible for health check | 0..1 | choice | ![]() ![]() | Value Set: Yes/No/NA |
![]() ![]() ![]() ![]() ![]() ![]() | not claimed 715 or 228 in past nine months | 0..1 | display | ![]() ![]() | |
![]() ![]() ![]() ![]() ![]() | Health check already in progress? | 0..1 | boolean | ![]() ![]() | |
![]() ![]() ![]() ![]() ![]() | Date of last completed health check | 0..1 | date | ||
![]() ![]() ![]() ![]() ![]() | Date this health check commenced | 0..1 | date | ||
![]() ![]() ![]() ![]() ![]() | Mark section as complete | 0..1 | boolean | ||
![]() ![]() ![]() ![]() | Consent | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() | In progress | 0..1 | display | Enable When: MarkComplete-30 != | |
![]() ![]() ![]() ![]() ![]() | Complete | 0..1 | display | Enable When: MarkComplete-30 = | |
![]() ![]() ![]() ![]() ![]() | Consent given after discussion of process and benefits of a health check | 0..1 | choice | ![]() ![]() | Value Set: Yes/No/NA |
![]() ![]() ![]() ![]() ![]() | Consent given by parent/primary carer after discussion of process and benefits of a health check | 0..1 | choice | ![]() ![]() | Value Set: Yes/No/NA |
![]() ![]() ![]() ![]() ![]() | Parent/primary caregiver present | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Parent/primary caregiver is present for health check? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No/NA |
![]() ![]() ![]() ![]() ![]() ![]() | Relationship to child | 0..* | string | Enable When: c72933c7-349f-4fef-94ff-c424c69da6f3 = | |
![]() ![]() ![]() ![]() ![]() | Consent for sharing of information | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Consent given for sharing of information with relevant healthcare providers? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No/NA |
![]() ![]() ![]() ![]() ![]() ![]() | Who/details | 0..* | text | Enable When: 057483ce-f265-46df-a1c5-7a18d492c1ba = | |
![]() ![]() ![]() ![]() ![]() | Date | 0..1 | date | ||
![]() ![]() ![]() ![]() ![]() | Doctor | 0..1 | string | ||
![]() ![]() ![]() ![]() ![]() | Nurse | 0..1 | string | ||
![]() ![]() ![]() ![]() ![]() | Aboriginal and/or Torres Strait Islander Health Worker / Health Practitioner | 0..1 | string | ||
![]() ![]() ![]() ![]() ![]() | Location of health check | 0..1 | open-choice | Options: 3 options | |
![]() ![]() ![]() ![]() ![]() | Location of health check | 0..1 | open-choice | Options: 3 options | |
![]() ![]() ![]() ![]() ![]() | Mark section as complete | 0..1 | boolean | ||
![]() ![]() ![]() ![]() | Patient Details | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() | In progress | 0..1 | display | Enable When: MarkComplete-32 != | |
![]() ![]() ![]() ![]() ![]() | Complete | 0..1 | display | Enable When: MarkComplete-32 = | |
![]() ![]() ![]() ![]() ![]() | Important: The patient record may not be updated with information entered here. Information intended for the patient record should be entered there first. | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Name | 0..1 | string | ![]() ![]() | |
![]() ![]() ![]() ![]() ![]() | Preferred name | 0..1 | string | ![]() ![]() | |
![]() ![]() ![]() ![]() ![]() | Preferred pronouns | 0..1 | choice | ![]() ![]() | Value Set: Australian Pronouns |
![]() ![]() ![]() ![]() ![]() | Gender identity | 0..1 | choice | ![]() ![]() | Value Set: Gender Identity Response |
![]() ![]() ![]() ![]() ![]() | Administrative gender | 0..1 | choice | ![]() ![]() | Value Set: AdministrativeGender |
![]() ![]() ![]() ![]() ![]() | Sex assigned at birth | 0..1 | choice | ![]() ![]() | Value Set: Biological Sex |
![]() ![]() ![]() ![]() ![]() | Date of birth | 0..1 | date | ![]() ![]() | |
![]() ![]() ![]() ![]() ![]() | Age | 0..1 | integer | ![]() ![]() | |
![]() ![]() ![]() ![]() ![]() | Aboriginal and/or Torres Strait Islander status | 0..1 | choice | ![]() ![]() | Value Set: Aboriginal and/or Torres Strait Islander |
![]() ![]() ![]() ![]() ![]() | Parents/primary carer/s | 0..* | choice | Value Set: Primary Carer Of Parent Or Grandparent | |
![]() ![]() ![]() ![]() ![]() | Other family | 0..* | string | ||
![]() ![]() ![]() ![]() ![]() ![]() | details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Other | 0..* | string | ||
![]() ![]() ![]() ![]() ![]() ![]() | details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Parents/primary carer/s details | 0..* | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Name of parent/primary carer | 0..1 | string | ||
![]() ![]() ![]() ![]() ![]() ![]() | Relationship to child | 0..1 | string | ||
![]() ![]() ![]() ![]() ![]() | Home address | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | No fixed address | 0..1 | boolean | Definition: Address.extension:noFixedAddress | |
![]() ![]() ![]() ![]() ![]() ![]() | null | 0..* | group | Enable When: 311d83bb-f22e-4f60-9b50-b6e38dd2059b != | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | Street address | 0..1 | string | Definition: Address.line | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | City | 0..1 | string | Definition: Address.city | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | State | 0..1 | choice | Definition: Address.state Value Set: Australian States and Territories | |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | Postcode | 0..1 | string | Definition: Address.postalCode | |
![]() ![]() ![]() ![]() ![]() | Postal address | 0..* | group | ![]() ![]() | |
![]() ![]() ![]() ![]() ![]() ![]() | Purpose of use | 0..1 | string | Definition: Address.use | |
![]() ![]() ![]() ![]() ![]() ![]() | Address | 0..1 | string | Definition: Address.line | |
![]() ![]() ![]() ![]() ![]() ![]() | City | 0..1 | string | Definition: Address.city | |
![]() ![]() ![]() ![]() ![]() ![]() | State | 0..1 | choice | Definition: Address.state Value Set: Australian States and Territories | |
![]() ![]() ![]() ![]() ![]() ![]() | Postcode | 0..1 | string | Definition: Address.postalCode | |
![]() ![]() ![]() ![]() ![]() | Home phone | 0..* | string | ||
![]() ![]() ![]() ![]() ![]() | Mobile phone | 0..* | string | ||
![]() ![]() ![]() ![]() ![]() | Emergency contact | 0..* | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Name | 0..1 | string | ||
![]() ![]() ![]() ![]() ![]() ![]() | Relationship to child | 0..1 | string | ||
![]() ![]() ![]() ![]() ![]() ![]() | Relationship to patient | 0..1 | string | ||
![]() ![]() ![]() ![]() ![]() ![]() | Phone | 0..* | string | ||
![]() ![]() ![]() ![]() ![]() | Medicare number | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Number | 0..1 | string | ||
![]() ![]() ![]() ![]() ![]() ![]() | Reference number | 0..1 | string | ||
![]() ![]() ![]() ![]() ![]() ![]() | Expiry | 0..1 | string | ||
![]() ![]() ![]() ![]() ![]() | Pensioner Card Number | 0..1 | string | Max Length: 10 | |
![]() ![]() ![]() ![]() ![]() | Health Care Card Number | 0..1 | string | Max Length: 10 | |
![]() ![]() ![]() ![]() ![]() | Registered for Closing the Gap PBS Co-payment Measure (CTG) | 0..1 | choice | ![]() ![]() | Value Set: Yes/No/NA |
![]() ![]() ![]() ![]() ![]() | Child has a birth certificate | 0..1 | choice | ![]() ![]() | Value Set: Yes/No/NA |
![]() ![]() ![]() ![]() ![]() | My Aged Care | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Registered for My Aged Care | 0..1 | choice | ![]() ![]() | Value Set: Yes/No/NA |
![]() ![]() ![]() ![]() ![]() ![]() | My Aged Care Number | 0..1 | string | Enable When: 7165c072-e3d8-4564-9d1d-d17f6807787c = | |
![]() ![]() ![]() ![]() ![]() | National Disability Insurance Scheme | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Registered for NDIS | 0..1 | choice | ![]() ![]() | Value Set: Yes/No/NA |
![]() ![]() ![]() ![]() ![]() ![]() | NDIS Number | 0..1 | string | Enable When: 924b4500-53ac-4c4e-831b-7ab5569ff981 = | |
![]() ![]() ![]() ![]() ![]() | Children | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Do you have children? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No/NA |
![]() ![]() ![]() ![]() ![]() ![]() | Number of children | 0..1 | integer | Enable When: e90b436b-2751-4e07-a40c-adfe951b6528 = | |
![]() ![]() ![]() ![]() ![]() ![]() | Number of children in your care | 0..1 | integer | Enable When: e90b436b-2751-4e07-a40c-adfe951b6528 = | |
![]() ![]() ![]() ![]() ![]() | Someone's carer | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Are you responsible for caring for someone else? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No/NA |
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | text | Enable When: a08271f1-194b-4fe9-91f9-4f3398858eb0 = | |
![]() ![]() ![]() ![]() ![]() | Your carer | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Do you have a carer? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No/NA |
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | text | Enable When: d05558fb-a3cc-4bd6-b803-b672b36b9c51 = | |
![]() ![]() ![]() ![]() ![]() | Providers | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Are name and contact details of other key providers (eg case workers, support services) up to date? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No/NA |
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Advance care planning | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Enduring Power of Attorney | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | Enduring Power of Attorney | 0..1 | choice | ![]() ![]() | Value Set: Yes/No/NA |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | Discussed today | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | Advance Health Directive | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() ![]() | Advance Health Directive | 0..1 | choice | ![]() ![]() | Value Set: Yes/No/NA |
![]() ![]() ![]() ![]() ![]() ![]() ![]() | Discussed today | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Mark section as complete | 0..1 | boolean | ||
![]() ![]() ![]() ![]() | Current health/patient priorities | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() | In progress | 0..1 | display | Enable When: MarkComplete-5 != | |
![]() ![]() ![]() ![]() ![]() | Complete | 0..1 | display | Enable When: MarkComplete-5 = | |
![]() ![]() ![]() ![]() ![]() | What are the important things for you in this health check today? | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Is there anything you are worried about? | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Is there anything that you are worried about with your child's health or wellbeing? | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Child Health Book | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Does your child have a Child Health Book? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No |
![]() ![]() ![]() ![]() ![]() ![]() | Is it up to date? | 0..1 | choice | ![]() ![]() | Enable When: 2655e0e1-fe4b-431e-87af-30d4ff1aca76 = Value Set: Yes/No |
![]() ![]() ![]() ![]() ![]() | Do you have any specific health goals? Is there anything in particular about your health and wellbeing that you would like to improve? | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Health priorities, actions and follow-up | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Mark section as complete | 0..1 | boolean | ||
![]() ![]() ![]() ![]() | Medical history and current problems | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() | In progress | 0..1 | display | Enable When: MarkComplete-17 != | |
![]() ![]() ![]() ![]() ![]() | Complete | 0..1 | display | Enable When: MarkComplete-17 = | |
![]() ![]() ![]() ![]() ![]() | Important: The patient record may not be updated with information entered here. Information intended for the patient record should be entered there first. | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Gestation at birth | 0..1 | decimal | ||
![]() ![]() ![]() ![]() ![]() ![]() | weeks | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Birth weight | 0..1 | decimal | ||
![]() ![]() ![]() ![]() ![]() ![]() | kg | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Medical history and current problems list | 0..* | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Condition | 0..1 | open-choice | Value Set: Clinical Condition | |
![]() ![]() ![]() ![]() ![]() ![]() | Clinical Status | 0..1 | choice | Value Set: Condition Clinical Status Codes | |
![]() ![]() ![]() ![]() ![]() ![]() | Onset Date | 0..1 | date | ||
![]() ![]() ![]() ![]() ![]() ![]() | Recorded Date | 0..1 | date | ||
![]() ![]() ![]() ![]() ![]() | New diagnoses list | 0..* | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Condition | 0..1 | open-choice | Value Set: Clinical Condition | |
![]() ![]() ![]() ![]() ![]() ![]() | Clinical Status | 0..1 | choice | Value Set: Condition Clinical Status Codes | |
![]() ![]() ![]() ![]() ![]() ![]() | Onset Date | 0..1 | date | ||
![]() ![]() ![]() ![]() ![]() ![]() | Recorded Date | 0..1 | date | ||
![]() ![]() ![]() ![]() ![]() | Health priorities, actions and follow-up | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Mark section as complete | 0..1 | boolean | ||
![]() ![]() ![]() ![]() | Regular medications: check if still required, appropriate dose, understanding of medication and adherence | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() | In progress | 0..1 | display | Enable When: MarkComplete-23 != | |
![]() ![]() ![]() ![]() ![]() | Complete | 0..1 | display | Enable When: MarkComplete-23 = | |
![]() ![]() ![]() ![]() ![]() | Does your child take any regular medications (prescribed, over-the-counter, traditional, complementary and alternative)? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No |
![]() ![]() ![]() ![]() ![]() | Do you take any regular medications (prescribed, over-the-counter, traditional, complementary and alternative)? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No |
![]() ![]() ![]() ![]() ![]() | Up to date in the health record? | 0..1 | boolean | Enable When: | |
![]() ![]() ![]() ![]() ![]() | Medication understanding and adherence has been checked with patient | 0..1 | boolean | Enable When: | |
![]() ![]() ![]() ![]() ![]() | Health priorities, actions and follow-up | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Mark section as complete | 0..1 | boolean | ||
![]() ![]() ![]() ![]() | Allergies/adverse reactions | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() | In progress | 0..1 | display | Enable When: MarkComplete-3 != | |
![]() ![]() ![]() ![]() ![]() | Complete | 0..1 | display | Enable When: MarkComplete-3 = | |
![]() ![]() ![]() ![]() ![]() | Up to date in the health record? | 0..1 | boolean | ||
![]() ![]() ![]() ![]() ![]() | Health priorities, actions and follow-up | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Mark section as complete | 0..1 | boolean | ||
![]() ![]() ![]() ![]() | Family history | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() | In progress | 0..1 | display | Enable When: MarkComplete-9 != | |
![]() ![]() ![]() ![]() ![]() | Complete | 0..1 | display | Enable When: MarkComplete-9 = | |
![]() ![]() ![]() ![]() ![]() | Provide relevant family history information | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Provide relevant family history information (including diabetes, heart disease, cancer, mental health) | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Health priorities, actions and follow-up | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Mark section as complete | 0..1 | boolean | ||
![]() ![]() ![]() ![]() | Social and emotional wellbeing | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() | In progress | 0..1 | display | Enable When: MarkComplete-27 != | |
![]() ![]() ![]() ![]() ![]() | Complete | 0..1 | display | Enable When: MarkComplete-27 = | |
![]() ![]() ![]() ![]() ![]() | Stressful life events | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Have there been any particular stressful life events that are impacting on you/your health lately? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No |
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | text | Enable When: e7297156-cfed-4437-b877-c345f744168b = | |
![]() ![]() ![]() ![]() ![]() | Social and emotional wellbeing assessment: consider tools such as Aboriginal and Torres Strait Islander Youth Social Emotional Wellbeing assessment question guide or HEEADSSS | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Consider conversation about social connection, which could include questions about sports/hobbies/clubs/other activities | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Health priorities, actions and follow-up | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Mark section as complete | 0..1 | boolean | ||
![]() ![]() ![]() ![]() | Social history: Information about family and child's living arrangements | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() | In progress | 0..1 | display | Enable When: MarkComplete-28 != | |
![]() ![]() ![]() ![]() ![]() | Complete | 0..1 | display | Enable When: MarkComplete-28 = | |
![]() ![]() ![]() ![]() ![]() | Who lives in your household? / Who does the child live with? | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Stressful life events | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Have there been any stressful life events that would cause you or your child to be upset? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No |
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | text | Enable When: 062f5234-686a-4bf3-afcd-3fcd988afd6c = | |
![]() ![]() ![]() ![]() ![]() | If indicated, ask about depression and other mental health concerns | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Health priorities, actions and follow-up | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Mark section as complete | 0..1 | boolean | ||
![]() ![]() ![]() ![]() | Home and family | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() | In progress | 0..1 | display | Enable When: MarkComplete-12 != | |
![]() ![]() ![]() ![]() ![]() | Complete | 0..1 | display | Enable When: MarkComplete-12 = | |
![]() ![]() ![]() ![]() ![]() | Who do you live with? | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Housing stability | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Do you have stable housing? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No |
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | text | Enable When: a7542da8-aad6-4a80-8b5b-806ca11d68d2 = | |
![]() ![]() ![]() ![]() ![]() | Home safety | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() ![]() | Do you feel safe at home? | 0..1 | choice | ![]() ![]() | Value Set: Yes/No |
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | text | Enable When: 6f73d1ee-dd8e-419a-9142-ede367200e3b = | |
![]() ![]() ![]() ![]() ![]() | Health priorities, actions and follow-up | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Mark section as complete | 0..1 | boolean | ||
![]() ![]() ![]() ![]() | Learning and development | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() | In progress | 0..1 | display | Enable When: MarkComplete-15 != | |
![]() ![]() ![]() ![]() ![]() | Complete | 0..1 | display | Enable When: MarkComplete-15 = | |
![]() ![]() ![]() ![]() ![]() | Is there anything that you are worried about with your child's development? | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Is there anything that you are worried about with your child's learning? | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Is there anything that you are worried about with your child's behaviour? | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Is there anything that you are worried about with your child's sleep? | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | Details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | What childcare/early learning centre/kindergarten does your child go to? How often? | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | How often does your child miss childcare/early learning centre/kindergarten? | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Is there anything you are worried about at school? | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | How often does your child miss school? | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Is your child having any difficulties making friends? | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Are there any other concerns about your child's learning and development | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() ![]() | details | 0..1 | display | ||
![]() ![]() ![]() ![]() ![]() | Health priorities, actions and follow-up | 0..1 | text | ||
![]() ![]() ![]() ![]() ![]() | Mark section as complete | 0..1 | boolean | ||
![]() ![]() ![]() ![]() | Learning and work | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() | In progress | 0..1 | display | Enable When: MarkComplete-33 != | |
![]() ![]() ![]() ![]() ![]() | Complete | 0..1 | display | Enable When: MarkComplete-33 = | |
![]() ![]() ![]() ![]() ![]() | Learning | 0..1 | group | ||
![]() ![]() ![]() ![]() ![]() |