| Package | IdHIE.0v |
| Resource Type | Questionnaire |
| Id | q-hpt-note |
| FHIR Version | R4 |
| Source | https://simplifier.net/resolve?scope=IdHIE.0v@0.0.1&canonical=http://fhir.hie.moh.gov.id/Questionnaire/q-hpt-note |
| URL | http://fhir.hie.moh.gov.id/Questionnaire/q-hpt-note |
| Version | 1.0.0 |
| Status | active |
| Date | 2023-07-05T03:44:13.9017419+00:00 |
| Name | QHptNoteA |
| Title | Hypertension Clerking Note |
| Description | Hypertension Clerking Note |
No resources found
No resources found
No narrative content found in resource
FHIR{
"resourceType": "Questionnaire",
"id": "q-hpt-note",
"meta": {
"versionId": "3",
"lastUpdated": "2023-07-03T12:51:08.149+08:00",
"source": "#jS2dmFPeh8XPuhZs"
},
"url": "http://fhir.hie.moh.gov.id/Questionnaire/q-hpt-note",
"version": "1.0.0",
"name": "QHptNoteA",
"title": "Hypertension Clerking Note",
"status": "active",
"date": "2023-07-05T03:44:13.9017419+00:00",
"description": "Hypertension Clerking Note",
"item": [
{
"linkId": "hpt-note.1",
"text": "Concomitant Disease",
"type": "group",
"item": [
{
"linkId": "hpt-note.1.1",
"text": "Diabetes Mellitus",
"type": "boolean"
},
{
"linkId": "hpt-note.1.2",
"text": "Renal Disease",
"type": "boolean"
},
{
"linkId": "hpt-note.1.3",
"text": "Heart Failure",
"type": "boolean"
},
{
"linkId": "hpt-note.1.4",
"text": "Gout",
"type": "boolean"
},
{
"linkId": "hpt-note.1.5",
"text": "Concomitant Disease Remarks",
"type": "text"
}
]
},
{
"linkId": "hpt-note.2",
"text": "Past Medical Admissions for Hypertension",
"type": "group",
"item": [
{
"linkId": "hpt-note.2.1",
"text": "Any ward admissions for Hypertension Emergencies",
"type": "boolean"
},
{
"linkId": "hpt-note.2.2",
"text": "Any emergency department encounters",
"type": "boolean"
},
{
"linkId": "hpt-note.2.3",
"text": "Past Medical Admissions Remarks",
"type": "text"
}
]
},
{
"linkId": "hpt-note.3",
"text": "Medication Summary",
"type": "group",
"item": [
{
"linkId": "hpt-note.3.1",
"text": "Findings",
"type": "text"
}
]
},
{
"linkId": "hpt-note.4",
"text": "Smoking History",
"type": "group",
"item": [
{
"linkId": "hpt-note.4.1",
"text": "Starting Date of Smoking",
"type": "dateTime"
},
{
"linkId": "hpt-note.4.2",
"text": "How many cigarettes per day",
"type": "integer"
},
{
"linkId": "hpt-note.4.3",
"text": "Pack years of smoking (years)",
"type": "integer"
}
]
},
{
"linkId": "hpt-note.5",
"text": "Social History",
"type": "group",
"item": [
{
"linkId": "hpt-note.5.1",
"text": "Findings",
"type": "text"
}
]
},
{
"linkId": "hpt-note.6",
"text": "Family History",
"type": "group",
"item": [
{
"linkId": "hpt-note.6.1",
"text": "Findings",
"type": "text"
}
]
},
{
"linkId": "hpt-note.7",
"text": "Symptoms",
"type": "group",
"item": [
{
"linkId": "hpt-note.7.1",
"text": "Visual Disturbances",
"type": "boolean"
},
{
"linkId": "hpt-note.7.2",
"text": "Chest pain",
"type": "boolean"
},
{
"linkId": "hpt-note.7.3",
"text": "Lower limb swellings",
"type": "boolean"
},
{
"linkId": "hpt-note.7.4",
"text": "Headache",
"type": "boolean"
},
{
"linkId": "hpt-note.7.5",
"text": "Vomiting",
"type": "boolean"
},
{
"linkId": "hpt-note.7.6",
"text": "Limb weakness",
"type": "boolean"
},
{
"linkId": "hpt-note.7.7",
"text": "Shortness of breath",
"type": "boolean"
},
{
"linkId": "hpt-note.7.8",
"text": "Symptoms Remarks",
"type": "text"
}
]
},
{
"linkId": "hpt-note.8",
"text": "History of Presenting Illness Summary",
"type": "group",
"item": [
{
"linkId": "hpt-note.8.1",
"text": "Findings",
"type": "text"
}
]
},
{
"linkId": "hpt-note.9",
"text": "Initial Vital Signs",
"type": "group",
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/minValue-my-core",
"valueInteger": 1
},
{
"url": "http://hl7.org/fhir/StructureDefinition/maxValue-my-core",
"valueInteger": 300
}
],
"linkId": "hpt-note.9.1",
"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-my-core",
"valueInteger": 1
},
{
"url": "http://hl7.org/fhir/StructureDefinition/maxValue-my-core",
"valueInteger": 250
}
],
"linkId": "hpt-note.9.2",
"code": [
{
"system": "http://loinc.org",
"code": "8462-4",
"display": "Diastolic Blood Pressure"
}
],
"text": "Diastolic Blood Pressure (mmHg)",
"type": "quantity",
"enableWhen": [
{
"question": "hpt-note.9.1",
"operator": "exists",
"answerBoolean": true
}
],
"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": "hpt-note.9.9",
"text": "Heart Rate (/min)",
"type": "quantity",
"initial": [
{
"valueQuantity": {
"unit": "per minute",
"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": "hpt-note.9.10",
"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": 100
}
],
"linkId": "hpt-note.9.11",
"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": 10
}
],
"linkId": "hpt-note.9.12",
"text": "Pain score",
"type": "quantity"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/minValue-my-core",
"valueInteger": 0
},
{
"url": "http://hl7.org/fhir/StructureDefinition/maxValue-my-core",
"valueInteger": 80
}
],
"linkId": "hpt-note.9.13",
"text": "Respiratory Rate (/min)",
"type": "quantity",
"initial": [
{
"valueQuantity": {
"unit": "per minute",
"system": "http://unitsofmeasure.org",
"code": "/min"
}
}
]
}
]
},
{
"linkId": "hpt-note.10",
"text": "Blood Pressure Second Reading",
"type": "group",
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/minValue-my-core",
"valueInteger": 1
},
{
"url": "http://hl7.org/fhir/StructureDefinition/maxValue-my-core",
"valueInteger": 300
}
],
"linkId": "hpt-note.10.1",
"code": [
{
"system": "http://loinc.org",
"code": "8480-6",
"display": "Systolic Blood Pressure"
}
],
"text": "Systolic Blood Pressure Second Reading (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": 1
},
{
"url": "http://hl7.org/fhir/StructureDefinition/maxValue-my-core",
"valueInteger": 250
}
],
"linkId": "hpt-note.10.2",
"code": [
{
"system": "http://loinc.org",
"code": "8462-4",
"display": "Diastolic Blood Pressure"
}
],
"text": "Diastolic Blood Pressure Second Reading (mmHg)",
"type": "quantity",
"enableWhen": [
{
"question": "hpt-note.10.1",
"operator": "exists",
"answerBoolean": true
}
],
"initial": [
{
"valueQuantity": {
"unit": "mmHg",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
}
]
},
{
"linkId": "hpt-note.10.3",
"text": "Recorded Time",
"type": "dateTime"
}
]
},
{
"linkId": "hpt-note.11",
"text": "Blood Pressure Standing",
"type": "group",
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/minValue-my-core",
"valueInteger": 1
},
{
"url": "http://hl7.org/fhir/StructureDefinition/maxValue-my-core",
"valueInteger": 300
}
],
"linkId": "hpt-note.11.1",
"code": [
{
"system": "http://loinc.org",
"code": "8480-6",
"display": "Systolic Blood Pressure"
}
],
"text": "Systolic Blood Pressure Standing (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": 1
},
{
"url": "http://hl7.org/fhir/StructureDefinition/maxValue-my-core",
"valueInteger": 250
}
],
"linkId": "hpt-note.11.2",
"code": [
{
"system": "http://loinc.org",
"code": "8462-4",
"display": "Diastolic Blood Pressure"
}
],
"text": "Diastolic Blood Pressure Standing (mmHg)",
"type": "quantity",
"enableWhen": [
{
"question": "hpt-note.11.1",
"operator": "exists",
"answerBoolean": true
}
],
"initial": [
{
"valueQuantity": {
"unit": "mmHg",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
}
]
},
{
"linkId": "hpt-note.11.3",
"text": "Recorded Time",
"type": "dateTime"
}
]
},
{
"linkId": "hpt-note.12",
"text": "Blood Pressure Seated",
"type": "group",
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/minValue-my-core",
"valueInteger": 1
},
{
"url": "http://hl7.org/fhir/StructureDefinition/maxValue-my-core",
"valueInteger": 300
}
],
"linkId": "hpt-note.12.1",
"text": "Systolic Blood Pressure Seated (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": 1
},
{
"url": "http://hl7.org/fhir/StructureDefinition/maxValue-my-core",
"valueInteger": 250
}
],
"linkId": "hpt-note.12.2",
"code": [
{
"system": "http://loinc.org",
"code": "8462-4",
"display": "Diastolic Blood Pressure"
}
],
"text": "Diastolic Blood Pressure Seated (mmHg)",
"type": "quantity",
"enableWhen": [
{
"question": "hpt-note.12.1",
"operator": "exists",
"answerBoolean": true
}
],
"initial": [
{
"valueQuantity": {
"unit": "mmHg",
"system": "http://unitsofmeasure.org",
"code": "mm[Hg]"
}
}
]
},
{
"linkId": "hpt-note.12.3",
"text": "Recorded Time",
"type": "dateTime"
}
]
},
{
"linkId": "hpt-note.13",
"text": "Central Nervous System Examinations",
"type": "group",
"item": [
{
"linkId": "hpt-note.13.1",
"text": "Findings",
"type": "text"
}
]
},
{
"linkId": "hpt-note.14",
"text": "Eye Examination",
"type": "group",
"item": [
{
"linkId": "hpt-note.14.1",
"text": "Findings",
"type": "text"
}
]
},
{
"linkId": "hpt-note.15",
"text": "Cranial Nerves Examination",
"type": "group",
"item": [
{
"linkId": "hpt-note.15.1",
"text": "Findings",
"type": "text"
}
]
},
{
"linkId": "hpt-note.16",
"text": "Cardiac Examination",
"type": "group",
"item": [
{
"linkId": "hpt-note.16.1",
"text": "Findings",
"type": "text"
}
]
},
{
"linkId": "hpt-note.17",
"text": "General Endocrine Examination",
"type": "group",
"item": [
{
"linkId": "hpt-note.17.1",
"text": "Findings",
"type": "text"
}
]
},
{
"linkId": "hpt-note.18",
"text": "Abdominal Examination",
"type": "group",
"item": [
{
"linkId": "hpt-note.18.1",
"text": "Findings",
"type": "text"
}
]
},
{
"linkId": "hpt-note.19",
"text": "Respiratory Examination",
"type": "group",
"item": [
{
"linkId": "hpt-note.19.1",
"text": "Findings",
"type": "text"
}
]
},
{
"linkId": "hpt-note.20",
"text": "General Examination Findings Summary",
"type": "group",
"item": [
{
"linkId": "hpt-note.20.1",
"text": "Findings",
"type": "text"
}
]
},
{
"linkId": "hpt-note.21",
"text": "Investigations / Special Test",
"type": "group",
"item": [
{
"linkId": "hpt-note.21.1",
"text": "Fundoscopy",
"type": "text"
},
{
"linkId": "hpt-note.21.2",
"text": "Fundoscopy",
"type": "text"
},
{
"linkId": "hpt-note.21.3",
"text": "US KUB Findings",
"type": "text"
},
{
"linkId": "hpt-note.21.4",
"text": "CT Scan Findings",
"type": "text"
},
{
"linkId": "hpt-note.21.5",
"text": "Xray Findings",
"type": "text"
},
{
"linkId": "hpt-note.21.6",
"text": "General Investigations / Summary",
"type": "text"
}
]
},
{
"linkId": "hpt-note.22",
"text": "Diagnosis",
"type": "group",
"item": [
{
"linkId": "hpt-note.22.1",
"text": "Diagnosis",
"type": "text"
}
]
},
{
"linkId": "hpt-note.23",
"text": "Management / Treatment",
"type": "group",
"item": [
{
"linkId": "hpt-note.23.1",
"text": "Management Summary",
"type": "text"
}
]
},
{
"linkId": "hpt-note.24",
"text": "TCA Date",
"type": "group",
"item": [
{
"linkId": "hpt-note.24.1",
"text": "Date",
"type": "dateTime"
}
]
},
{
"linkId": "hpt-note.25",
"text": "Referral",
"type": "group",
"item": [
{
"linkId": "hpt-note.25.1",
"text": "Reason for Referral",
"type": "text"
},
{
"linkId": "hpt-note.25.2",
"text": "Spoken To",
"type": "string"
},
{
"linkId": "hpt-note.25.3",
"text": "Time of Referral made",
"type": "dateTime"
}
]
}
]
}