| Package | IdHIE.0v |
| Resource Type | Questionnaire |
| Id | q-dengue-checklist |
| FHIR Version | R4 |
| Source | https://simplifier.net/resolve?scope=IdHIE.0v@0.0.1&canonical=http://fhir.hie.moh.gov.id/Questionnaire/q-dengue-checklist |
| URL | http://fhir.hie.moh.gov.id/Questionnaire/q-dengue-checklist |
| Version | 1.0.0 |
| Status | active |
| Date | 2023-07-05T03:44:13.9017419+00:00 |
| Name | QDengueChecklist |
| Title | Dengue Assessment Checklist |
No resources found
No resources found
No narrative content found in resource
FHIR{
"resourceType": "Questionnaire",
"id": "q-dengue-checklist",
"meta": {
"versionId": "3",
"lastUpdated": "2023-07-03T12:47:59.716+08:00",
"source": "#lU4f3puLhNvf40h3"
},
"url": "http://fhir.hie.moh.gov.id/Questionnaire/q-dengue-checklist",
"version": "1.0.0",
"name": "QDengueChecklist",
"title": "Dengue Assessment Checklist",
"status": "active",
"date": "2023-07-05T03:44:13.9017419+00:00",
"item": [
{
"linkId": "dengue-cl.1",
"text": "Recognition",
"type": "group",
"item": [
{
"linkId": "dengue-cl.1.1",
"text": "Fever",
"type": "boolean"
},
{
"linkId": "dengue-cl.1.2",
"text": "Aches and pain",
"type": "boolean"
},
{
"linkId": "dengue-cl.1.3",
"text": "Nausea and / or vomitting",
"type": "boolean"
},
{
"linkId": "dengue-cl.1.4",
"text": "Rash",
"type": "boolean"
},
{
"linkId": "dengue-cl.1.5",
"text": "Leucopenia",
"type": "boolean"
},
{
"linkId": "dengue-cl.1.6",
"text": "Any warning signs",
"type": "boolean"
},
{
"linkId": "dengue-cl.1.7",
"text": "Remarks",
"type": "text"
}
]
},
{
"linkId": "dengue-cl.2",
"text": "Warning signs",
"type": "group",
"item": [
{
"linkId": "dengue-cl.2.1",
"text": "Persistent vomiting (3 or more than 3 times over the last 24 hours)",
"type": "boolean"
},
{
"linkId": "dengue-cl.2.2",
"text": "Persistent diarrhea (3 or more than 3 times over the last 24 hours)",
"type": "boolean"
},
{
"linkId": "dengue-cl.2.3",
"text": "Any abdominal pain / tenderness",
"type": "boolean"
},
{
"linkId": "dengue-cl.2.4",
"text": "Lethargy / Restlessness / Confusion",
"type": "boolean"
},
{
"linkId": "dengue-cl.2.5",
"text": "Tender liver",
"type": "boolean"
},
{
"linkId": "dengue-cl.2.6",
"text": "Third space fluid accumulation",
"type": "boolean"
},
{
"linkId": "dengue-cl.2.7",
"text": "Spontaneous bleeding tendencies",
"type": "boolean"
},
{
"linkId": "dengue-cl.2.8",
"text": "Raised HCT with rapid drop in platelet. \nMale age ≤ 60 : HCT >46 \nMale age >60 : HCT > 42 \nFemale all ages : >40",
"type": "boolean"
},
{
"linkId": "dengue-cl.2.9",
"text": "Remarks",
"type": "text"
}
]
},
{
"linkId": "dengue-cl.3",
"text": "Other criteria",
"type": "group",
"item": [
{
"linkId": "dengue-cl.3.1",
"text": "Syncope",
"type": "boolean"
},
{
"linkId": "dengue-cl.3.2",
"text": "Social factor",
"type": "boolean"
},
{
"linkId": "dengue-cl.3.3",
"text": "Remarks",
"type": "text"
}
]
},
{
"linkId": "dengue-cl.4",
"text": "Special Group",
"type": "group",
"item": [
{
"linkId": "dengue-cl.4.1",
"text": "Obese",
"type": "boolean"
},
{
"linkId": "dengue-cl.4.2",
"text": "Pregnant",
"type": "boolean"
},
{
"linkId": "dengue-cl.4.3",
"text": "Heart failure / CKD / CLD",
"type": "boolean"
},
{
"linkId": "dengue-cl.4.4",
"text": "Diabetes Mellitus",
"type": "boolean"
},
{
"linkId": "dengue-cl.4.5",
"text": "Hypertension",
"type": "boolean"
},
{
"linkId": "dengue-cl.4.6",
"text": "IHD",
"type": "boolean"
},
{
"linkId": "dengue-cl.4.7",
"text": "COPD",
"type": "boolean"
},
{
"linkId": "dengue-cl.4.8",
"text": "Age > 65",
"type": "boolean"
},
{
"linkId": "dengue-cl.4.9",
"text": "Remarks",
"type": "text"
}
]
},
{
"linkId": "dengue-cl.5",
"text": "Physical Examination and Vital signs",
"type": "group",
"item": [
{
"linkId": "dengue-cl.5.1",
"text": "Physical Examination findings",
"type": "text"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/minValue",
"valueInteger": 1
},
{
"url": "http://hl7.org/fhir/StructureDefinition/maxValue",
"valueInteger": 300
}
],
"linkId": "dengue-cl.5.2",
"code": [
{
"system": "http://loinc.org",
"code": "8480-6",
"display": "Systolic Blood Pressure"
}
],
"text": "Systolic Blood Pressure (mmHg)",
"type": "quantity",
"initial": [
{
"valueQuantity": {
"unit": "mmHg",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/minValue",
"valueInteger": 1
},
{
"url": "http://hl7.org/fhir/StructureDefinition/maxValue",
"valueInteger": 250
}
],
"linkId": "dengue-cl.5.3",
"code": [
{
"system": "http://loinc.org",
"code": "8462-4",
"display": "Diastolic Blood Pressure"
}
],
"text": "Diastolic Blood Pressure (mmHg)",
"type": "quantity",
"initial": [
{
"valueQuantity": {
"unit": "mmHg",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/minValue-my-core",
"valueInteger": 0
},
{
"url": "http://hl7.org/fhir/StructureDefinition/maxValue-my-core",
"valueInteger": 400
}
],
"linkId": "dengue-cl.5.4",
"text": "Heart Rate (/min)",
"type": "quantity",
"initial": [
{
"valueQuantity": {
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/minValue-my-core",
"valueInteger": 0
},
{
"url": "http://hl7.org/fhir/StructureDefinition/maxValue-my-core",
"valueInteger": 100
}
],
"linkId": "dengue-cl.5.5",
"text": "Body Temperature (°C)",
"type": "quantity",
"initial": [
{
"valueQuantity": {
"unit": "°C",
"system": "http://unitsofmeasure.org",
"code": "Cel"
}
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/minValue-my-core",
"valueInteger": 0
},
{
"url": "http://hl7.org/fhir/StructureDefinition/maxValue-my-core",
"valueInteger": 100
}
],
"linkId": "dengue-cl.5.6",
"text": "Oxygen Saturation (%)",
"type": "quantity",
"initial": [
{
"valueQuantity": {
"unit": "%",
"system": "http://unitsofmeasure.org",
"code": "%"
}
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/minValue-my-core",
"valueInteger": 0
},
{
"url": "http://hl7.org/fhir/StructureDefinition/maxValue-my-core",
"valueInteger": 80
}
],
"linkId": "dengue-cl.5.7",
"text": "Respiratory Rate (/min)",
"type": "quantity",
"initial": [
{
"valueQuantity": {
"unit": "/min",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/minValue",
"valueInteger": 0
},
{
"url": "http://hl7.org/fhir/StructureDefinition/maxValue",
"valueInteger": 10
}
],
"linkId": "dengue-cl.5.8",
"text": "Pain score",
"type": "quantity"
}
]
},
{
"linkId": "dengue-cl.6",
"text": "Blood investigation",
"type": "group",
"item": [
{
"linkId": "dengue-cl.6.1",
"text": "White cell counts",
"type": "string"
},
{
"linkId": "dengue-cl.6.2",
"text": "Hb",
"type": "string"
},
{
"linkId": "dengue-cl.6.3",
"text": "HCT",
"type": "string"
},
{
"linkId": "dengue-cl.6.4",
"text": "Platelet",
"type": "string"
},
{
"linkId": "dengue-cl.6.5",
"text": "Dengue Point of Care checklist (Combo / Rapid checklist)",
"type": "string"
}
]
},
{
"linkId": "dengue-cl.7",
"text": "Severe Dengue",
"type": "group",
"item": [
{
"linkId": "dengue-cl.7.1",
"text": "Hypotension SBP <90 or MAP <60 or SBP drop > 40mmHg from known baseline",
"type": "boolean"
},
{
"linkId": "dengue-cl.7.2",
"text": "Shock Index: HR > SBP or abnormal CCTVR",
"type": "boolean"
},
{
"linkId": "dengue-cl.7.3",
"text": "Third Space fluid accumulation with respiratory distress",
"type": "boolean"
},
{
"linkId": "dengue-cl.7.4",
"text": "Altered concious level",
"type": "boolean"
},
{
"linkId": "dengue-cl.7.5",
"text": "Any bleed GI / non mucosal and non cutaneous / non physiological",
"type": "boolean"
},
{
"linkId": "dengue-cl.7.6",
"text": "Specific organ dysfunction",
"type": "boolean"
},
{
"linkId": "dengue-cl.7.7",
"text": "Remarks",
"type": "text"
}
]
},
{
"linkId": "dengue-cl.8",
"text": "Onset of illness",
"type": "group",
"item": [
{
"linkId": "dengue-cl.8,1",
"text": "Fever onset",
"type": "dateTime"
},
{
"linkId": "dengue-cl.8.2",
"text": "Critical phase onset",
"type": "dateTime"
}
]
},
{
"linkId": "dengue-cl.9",
"text": "Phase of illness",
"type": "choice",
"answerOption": [
{
"valueCoding": {
"code": "01",
"display": "Febrile"
}
},
{
"valueCoding": {
"code": "02",
"display": "Critical"
}
},
{
"valueCoding": {
"code": "03",
"display": "Recovery"
}
}
]
},
{
"linkId": "dengue-cl.10",
"text": "Diagnosis",
"type": "choice",
"answerOption": [
{
"valueCoding": {
"code": "01",
"display": "Dengue fever without warning signs"
}
},
{
"valueCoding": {
"code": "02",
"display": "Dengue fever with warning signs"
}
},
{
"valueCoding": {
"code": "03",
"display": "Severe Dengue"
}
}
]
},
{
"linkId": "dengue-cl.11",
"text": "Management",
"type": "group",
"item": [
{
"linkId": "dengue-cl.11.1",
"text": "Management / Plans",
"type": "text"
}
]
}
]
}