| Package | MyHIE.v4-test |
| Resource Type | Questionnaire |
| Id | q-hajj-12 |
| FHIR Version | R4 |
| Source | https://simplifier.net/resolve?scope=MyHIE.v4-test@2.1.0-alpha&canonical=http://fhir.hie.moh.gov.my/Questionnaire/q-hajj-12 |
| URL | http://fhir.hie.moh.gov.my/Questionnaire/q-hajj-12 |
| Version | 1.0.0 |
| Status | active |
| Date | 2023-12-08T21:49:01.1801787+00:00 |
| Name | QHajj12 |
| Title | Pemeriksaan Kesihatan |
No resources found
No resources found
No narrative content found in resource
FHIR{
"resourceType": "Questionnaire",
"id": "q-hajj-12",
"url": "http://fhir.hie.moh.gov.my/Questionnaire/q-hajj-12",
"version": "1.0.0",
"name": "QHajj12",
"title": "Pemeriksaan Kesihatan",
"status": "active",
"date": "2023-12-08T21:49:01.1801787+00:00",
"item": [
{
"linkId": "hajj-12.1",
"text": "Pemeriksaan Sistem AM",
"type": "group",
"item": [
{
"linkId": "hajj-12.1.1",
"text": "Jaundice",
"type": "boolean"
},
{
"linkId": "hajj-12.1.2",
"text": "Cyanosis",
"type": "boolean"
},
{
"linkId": "hajj-12.1.3",
"text": "Clubbing",
"type": "boolean"
},
{
"linkId": "hajj-12.1.4",
"text": "Pallor",
"type": "boolean"
},
{
"linkId": "hajj-12.1.5",
"text": "Pedal Oedema",
"type": "boolean"
}
]
},
{
"linkId": "hajj-12.2",
"text": "Pemeriksaan Sistem Khusus",
"type": "group",
"item": [
{
"linkId": "hajj-12.2.1",
"text": "Head & Neck",
"type": "choice",
"answerOption": [
{
"valueCoding": {
"code": "00",
"display": "Normal"
}
},
{
"valueCoding": {
"code": "01",
"display": "Abnormal"
}
}
]
},
{
"linkId": "hajj-12.2.2",
"text": "Ear, Nose & Throat",
"type": "choice",
"answerOption": [
{
"valueCoding": {
"code": "00",
"display": "Normal"
}
},
{
"valueCoding": {
"code": "01",
"display": "Abnormal"
}
}
]
},
{
"linkId": "hajj-12.2.3",
"text": "Thyroid",
"type": "choice",
"answerOption": [
{
"valueCoding": {
"code": "00",
"display": "Normal"
}
},
{
"valueCoding": {
"code": "01",
"display": "Abnormal"
}
}
]
},
{
"linkId": "hajj-12.2.4",
"text": "Lymph Nodes",
"type": "choice",
"answerOption": [
{
"valueCoding": {
"code": "00",
"display": "Normal"
}
},
{
"valueCoding": {
"code": "01",
"display": "Abnormal"
}
}
]
},
{
"linkId": "hajj-12.2.5",
"text": "Sistem Kardiovaskular",
"type": "choice",
"answerOption": [
{
"valueCoding": {
"code": "00",
"display": "Normal"
}
},
{
"valueCoding": {
"code": "01",
"display": "Abnormal"
}
}
]
},
{
"linkId": "hajj-12.2.6",
"text": "Sistem Respiratori",
"type": "choice",
"answerOption": [
{
"valueCoding": {
"code": "00",
"display": "Normal"
}
},
{
"valueCoding": {
"code": "01",
"display": "Abnormal"
}
}
]
},
{
"linkId": "hajj-12.2.7",
"text": "Sistem Gastrointestinal",
"type": "choice",
"answerOption": [
{
"valueCoding": {
"code": "00",
"display": "Normal"
}
},
{
"valueCoding": {
"code": "01",
"display": "Abnormal"
}
}
]
},
{
"linkId": "hajj-12.2.8",
"text": "Liver",
"type": "choice",
"answerOption": [
{
"valueCoding": {
"code": "02",
"display": "Palpable"
}
},
{
"valueCoding": {
"code": "03",
"display": "Not Palpable"
}
}
]
},
{
"linkId": "hajj-12.2.9",
"text": "Spleen",
"type": "choice",
"answerOption": [
{
"valueCoding": {
"code": "02",
"display": "Palpable"
}
},
{
"valueCoding": {
"code": "03",
"display": "Not Palpable"
}
}
]
},
{
"linkId": "hajj-12.2.10",
"text": "Ascites",
"type": "boolean",
"item": [
{
"linkId": "hajj-12.2.10.1",
"text": "Describe",
"type": "text"
}
]
},
{
"linkId": "hajj-12.2.11",
"text": "Hernia",
"type": "boolean",
"item": [
{
"linkId": "hajj-12.2.11.1",
"text": "Describe",
"type": "text"
}
]
},
{
"linkId": "hajj-12.2.12",
"text": "Mass",
"type": "boolean",
"item": [
{
"linkId": "hajj-12.2.12.1",
"text": "Describe",
"type": "text"
}
]
}
]
},
{
"linkId": "hajj-12.3",
"text": "Sistem Genitourinari",
"type": "group",
"item": [
{
"linkId": "hajj-12.3.1",
"text": "Kidney",
"type": "choice",
"answerOption": [
{
"valueCoding": {
"code": "02",
"display": "Palpable"
}
},
{
"valueCoding": {
"code": "03",
"display": "Not Palpable"
}
}
]
},
{
"linkId": "hajj-12.3.2",
"text": "Lain-lain",
"type": "text"
}
]
},
{
"linkId": "hajj-12.4",
"text": "Sistem Saraf",
"type": "group",
"item": [
{
"linkId": "6hajj-12.4.1",
"text": "Motor",
"type": "choice",
"answerOption": [
{
"valueCoding": {
"code": "00",
"display": "Normal"
}
},
{
"valueCoding": {
"code": "01",
"display": "Abnormal"
}
}
]
},
{
"linkId": "hajj-12.4.2",
"text": "Sensory",
"type": "choice",
"answerOption": [
{
"valueCoding": {
"code": "00",
"display": "Normal"
}
},
{
"valueCoding": {
"code": "01",
"display": "Abnormal"
}
}
]
},
{
"linkId": "hajj-12.4.3",
"text": "Reflexes",
"type": "choice",
"answerOption": [
{
"valueCoding": {
"code": "00",
"display": "Normal"
}
},
{
"valueCoding": {
"code": "01",
"display": "Abnormal"
}
}
]
},
{
"linkId": "hajj-12.4.4",
"text": "Payudara",
"type": "choice",
"answerOption": [
{
"valueCoding": {
"code": "00",
"display": "Normal"
}
},
{
"valueCoding": {
"code": "01",
"display": "Abnormal"
}
}
]
},
{
"linkId": "hajj-12.4.5",
"text": "Foot Examination",
"type": "choice",
"answerOption": [
{
"valueCoding": {
"code": "00",
"display": "Normal"
}
},
{
"valueCoding": {
"code": "01",
"display": "Abnormal"
}
}
]
},
{
"linkId": "hajj-12.4.6",
"text": "Lain-lain",
"type": "text"
},
{
"linkId": "hajj-12.4.7",
"text": "Functional Class",
"type": "choice",
"answerOption": [
{
"valueCoding": {
"code": "04",
"display": "I"
}
},
{
"valueCoding": {
"code": "05",
"display": "II"
}
},
{
"valueCoding": {
"code": "06",
"display": "III"
}
},
{
"valueCoding": {
"code": "07",
"display": "IV"
}
}
]
}
]
},
{
"linkId": "hajj-12.5",
"text": "Saringan Modified Barthel Index (MBI)",
"type": "group",
"item": [
{
"linkId": "hajj-12.5.1",
"text": "Kebersihan diri",
"type": "choice",
"answerOption": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 0
}
],
"valueCoding": {
"code": "08",
"display": "Perlukan bantuan sepenuhnya"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 1
}
],
"valueCoding": {
"code": "09",
"display": "Perlukan bantuan maksima"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 3
}
],
"valueCoding": {
"code": "10",
"display": "Perlukan bantuan sederhana"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 4
}
],
"valueCoding": {
"code": "11",
"display": "Perlukan bantuan minima"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 5
}
],
"valueCoding": {
"code": "12",
"display": "Berdikari sepenuhnya"
}
}
]
},
{
"linkId": "hajj-12.5.2",
"text": "Mandi",
"type": "choice",
"answerOption": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 0
}
],
"valueCoding": {
"code": "08",
"display": "Perlukan bantuan sepenuhnya"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 1
}
],
"valueCoding": {
"code": "09",
"display": "Perlukan bantuan maksima"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 3
}
],
"valueCoding": {
"code": "10",
"display": "Perlukan bantuan sederhana"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 4
}
],
"valueCoding": {
"code": "11",
"display": "Perlukakn bantuan minima"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 5
}
],
"valueCoding": {
"code": "12",
"display": "Berdikari sepenuhnya"
}
}
]
},
{
"linkId": "hajj-12.5.3",
"text": "Kemahiran ke tandas (Toileting)",
"type": "choice",
"answerOption": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 0
}
],
"valueCoding": {
"code": "08",
"display": "Perlukan bantuan sepenuhnya"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 2
}
],
"valueCoding": {
"code": "09",
"display": "Perlukan bantuan maksima"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 5
}
],
"valueCoding": {
"code": "10",
"display": "Perlukan bantuan sederhana"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 6
}
],
"valueCoding": {
"code": "11",
"display": "Perlukan bantuan minima"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 10
}
],
"valueCoding": {
"code": "12",
"display": "Berdikari sepenuhnya"
}
}
]
},
{
"linkId": "hajj-12.5.4",
"text": "Menaiki Tangga",
"type": "choice",
"answerOption": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 0
}
],
"valueCoding": {
"code": "08",
"display": "Perlukan bantuan sepenuhnya"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 2
}
],
"valueCoding": {
"code": "09",
"display": "Perlukan bantuan maksima"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 5
}
],
"valueCoding": {
"code": "10",
"display": "Perlukan bantuan sederhana"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 6
}
],
"valueCoding": {
"code": "11",
"display": "Perlukan bantuan minima"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 10
}
],
"valueCoding": {
"code": "12",
"display": "Berdikari sepenuhnya"
}
}
]
},
{
"linkId": "hajj-12.5.5",
"text": "Memakai pakaian",
"type": "choice",
"answerOption": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 0
}
],
"valueCoding": {
"code": "08",
"display": "Perlukan bantuan sepenuhnya"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 2
}
],
"valueCoding": {
"code": "09",
"display": "Perlukan bantuan maksima"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 5
}
],
"valueCoding": {
"code": "10",
"display": "Perlukan bantuan sederhana"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 6
}
],
"valueCoding": {
"code": "11",
"display": "Perlukan bantuan minima"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 10
}
],
"valueCoding": {
"code": "12",
"display": "Berdikari sepenuhnya"
}
}
]
},
{
"linkId": "hajj-12.5.6",
"text": "Makan & minum",
"type": "choice",
"answerOption": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 0
}
],
"valueCoding": {
"display": "Perlukan bantuan sepenuhnya"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 2
}
],
"valueCoding": {
"display": "Perlukan bantuan maksima"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 5
}
],
"valueCoding": {
"display": "Perlukan bantuan sederhana"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 6
}
],
"valueCoding": {
"display": "Perlukan bantuan minima"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 10
}
],
"valueCoding": {
"display": "Berdikari sepenuhnya"
}
}
]
},
{
"linkId": "hajj-12.5.7",
"text": "Kawalan pembuangan air kecil",
"type": "choice",
"answerOption": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 0
}
],
"valueCoding": {
"code": "08",
"display": "Perlukan bantuan sepenuhnya"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 2
}
],
"valueCoding": {
"code": "09",
"display": "Perlukan bantuan maksima"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 5
}
],
"valueCoding": {
"code": "10",
"display": "Perlukan bantuan sederhana"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 6
}
],
"valueCoding": {
"code": "11",
"display": "Perlukan bantuan minima"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 10
}
],
"valueCoding": {
"code": "12",
"display": "Berdikari sepenuhnya"
}
}
]
},
{
"linkId": "hajj-12.5.8",
"text": "Kawalan pembuangan air besar",
"type": "choice",
"answerOption": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 0
}
],
"valueCoding": {
"code": "08",
"display": "Perlukan bantuan sepenuhnya"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 2
}
],
"valueCoding": {
"code": "09",
"display": "Perlukan bantuan maksima"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 5
}
],
"valueCoding": {
"code": "10",
"display": "Perlukan bantuan sederhana"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 6
}
],
"valueCoding": {
"code": "11",
"display": "Perlukan bantuan minima"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 10
}
],
"valueCoding": {
"code": "12",
"display": "Berdikari sepenuhnya"
}
}
]
},
{
"linkId": "7hajj-12.5.9",
"text": "Pemindahan ke kerusi / katil",
"type": "choice",
"answerOption": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 0
}
],
"valueCoding": {
"code": "08",
"display": "Perlukan bantuan sepenuhnya"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 3
}
],
"valueCoding": {
"code": "09",
"display": "Perlukan bantuan maksima"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 8
}
],
"valueCoding": {
"code": "10",
"display": "Perlukan bantuan sederhana"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 12
}
],
"valueCoding": {
"code": "11",
"display": "Perlukan bantuan minima"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 15
}
],
"valueCoding": {
"code": "12",
"display": "Berdikari sepenuhnya"
}
}
]
},
{
"linkId": "hajj-12.5.10",
"text": "Pergerakkan",
"type": "choice",
"answerOption": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 0
}
],
"valueCoding": {
"code": "08",
"display": "Perlukan bantuan sepenuhnya"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 3
}
],
"valueCoding": {
"code": "09",
"display": "Perlukan bantuan maksima"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 8
}
],
"valueCoding": {
"code": "10",
"display": "Perlukan bantuan sederhana"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 12
}
],
"valueCoding": {
"code": "11",
"display": "Perlukan bantuan minima"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 15
}
],
"valueCoding": {
"code": "12",
"display": "Berdikari sepenuhnya"
}
}
]
},
{
"linkId": "hajj-12.5.11",
"text": "Penggunaan kerusi roda (skor hanya jika pesakit perlu bantuan sepenuhnya untuk bergerak dan telah dilatih berkerusi roda)",
"type": "choice",
"answerOption": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 0
}
],
"valueCoding": {
"code": "08",
"display": "Perlukan bantuan sepenuhnya"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 1
}
],
"valueCoding": {
"code": "09",
"display": "Perlukan bantuan maksima"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 3
}
],
"valueCoding": {
"code": "10",
"display": "Perlukan bantuan sederhana"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 4
}
],
"valueCoding": {
"code": "11",
"display": "Perlukan bantuan minima"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 4
}
],
"valueCoding": {
"code": "12",
"display": "Berdikari sepenuhnya"
}
}
]
},
{
"linkId": "4881245263956",
"text": "Jumlah markah",
"type": "quantity"
}
]
},
{
"linkId": "hajj-12.6",
"text": "Saringan Status Kesihatan Mental",
"type": "group",
"item": [
{
"linkId": "hajj-12.6.1",
"text": "Sedih (atau susah hati)",
"type": "choice",
"answerOption": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 0
}
],
"valueCoding": {
"code": "13",
"display": "Tiada"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 1
}
],
"valueCoding": {
"code": "14",
"display": "Kadang-kadang"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 2
}
],
"valueCoding": {
"code": "15",
"display": "Kerap"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 3
}
],
"valueCoding": {
"code": "16",
"display": "Sentiasa"
}
}
]
},
{
"linkId": "hajj-12.6.2",
"text": "Mudah marah",
"type": "choice",
"answerOption": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 0
}
],
"valueCoding": {
"code": "13",
"display": "Tiada"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 1
}
],
"valueCoding": {
"code": "14",
"display": "Kadang-kadang"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 2
}
],
"valueCoding": {
"code": "15",
"display": "Kerap"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 3
}
],
"valueCoding": {
"code": "16",
"display": "Sentiasa"
}
}
]
},
{
"linkId": "hajj-12.6.3",
"text": "Tidak minat bercakap",
"type": "choice",
"answerOption": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 0
}
],
"valueCoding": {
"code": "13",
"display": "Tiada"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 1
}
],
"valueCoding": {
"code": "14",
"display": "Kadang-kadang"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 2
}
],
"valueCoding": {
"code": "15",
"display": "Kerap"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 3
}
],
"valueCoding": {
"code": "16",
"display": "Sentiasa"
}
}
]
},
{
"linkId": "hajj-12.6.4",
"text": "Kerap terjaga dari tidur",
"type": "choice",
"answerOption": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 0
}
],
"valueCoding": {
"code": "12",
"display": "Tiada"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 1
}
],
"valueCoding": {
"code": "13",
"display": "Kadang-kadang"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 2
}
],
"valueCoding": {
"code": "14",
"display": "Kerap"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 3
}
],
"valueCoding": {
"code": "15",
"display": "Sentiasa"
}
}
]
},
{
"linkId": "hajj-12.6.5",
"text": "Sakit-sakit badan / sendi",
"type": "choice",
"answerOption": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 0
}
],
"valueCoding": {
"code": "13",
"display": "Tiada"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 1
}
],
"valueCoding": {
"code": "14",
"display": "Kadang-kadang"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 2
}
],
"valueCoding": {
"code": "15",
"display": "Kerap"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 3
}
],
"valueCoding": {
"code": "16",
"display": "Sentiasa"
}
}
]
},
{
"linkId": "hajj-12.6.6",
"text": "Hilang minat pada perkara yang biasa dinikmati",
"type": "choice",
"answerOption": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 0
}
],
"valueCoding": {
"code": "13",
"display": "Tiada"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 1
}
],
"valueCoding": {
"code": "14",
"display": "Kadang-kadang"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 2
}
],
"valueCoding": {
"code": "15",
"display": "Kerap"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 3
}
],
"valueCoding": {
"code": "16",
"display": "Sentiasa"
}
}
]
},
{
"linkId": "hajj-12.6.7",
"text": "Menangis atau rasa hendak menangis",
"type": "choice",
"answerOption": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 0
}
],
"valueCoding": {
"code": "13",
"display": "Tiada"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 1
}
],
"valueCoding": {
"code": "14",
"display": "Kadang-kadang"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 2
}
],
"valueCoding": {
"code": "15",
"display": "Kerap"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 3
}
],
"valueCoding": {
"code": "16",
"display": "Sentiasa"
}
}
]
},
{
"linkId": "hajj-12.6.8",
"text": "Rasa sunyi",
"type": "choice",
"answerOption": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 0
}
],
"valueCoding": {
"code": "13",
"display": "Tiada"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 1
}
],
"valueCoding": {
"code": "14",
"display": "Kadang-kadang"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 2
}
],
"valueCoding": {
"code": "15",
"display": "Kerap"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 3
}
],
"valueCoding": {
"code": "16",
"display": "Sentiasa"
}
}
]
},
{
"linkId": "hajj-12.6.9",
"text": "Takut pada sesuatu objek atau keadaan",
"type": "choice",
"answerOption": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 0
}
],
"valueCoding": {
"code": "13",
"display": "Tiada"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 1
}
],
"valueCoding": {
"code": "14",
"display": "Kadang-kadang"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 2
}
],
"valueCoding": {
"code": "15",
"display": "Kerap"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 3
}
],
"valueCoding": {
"code": "16",
"display": "Sentiasa"
}
}
]
},
{
"linkId": "hajj-12.6.10",
"text": "Badan lemah, lesu dan tidak bertenaga",
"type": "choice",
"answerOption": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 0
}
],
"valueCoding": {
"code": "13",
"display": "Tiada"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 1
}
],
"valueCoding": {
"code": "14",
"display": "Kadang-kadang"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 2
}
],
"valueCoding": {
"code": "15",
"display": "Kerap"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 3
}
],
"valueCoding": {
"code": "16",
"display": "Sentiasa"
}
}
]
},
{
"linkId": "hajj-12.6.11",
"text": "Tidak suka bercampur dengan orang lain (menyendiri)",
"type": "choice",
"answerOption": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 0
}
],
"valueCoding": {
"code": "13",
"display": "Tiada"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 1
}
],
"valueCoding": {
"code": "14",
"display": "Kadang-kadang"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 2
}
],
"valueCoding": {
"code": "15",
"display": "Kerap"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 3
}
],
"valueCoding": {
"code": "16",
"display": "Sentiasa"
}
}
]
},
{
"linkId": "hajj-12.6.12",
"text": "Perasaan ingin mati",
"type": "choice",
"answerOption": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 0
}
],
"valueCoding": {
"code": "13",
"display": "Tiada"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 1
}
],
"valueCoding": {
"code": "14",
"display": "Kadang-kadang"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 2
}
],
"valueCoding": {
"code": "15",
"display": "Kerap"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 3
}
],
"valueCoding": {
"code": "16",
"display": "Sentiasa"
}
}
]
},
{
"linkId": "hajj-12.6.13",
"text": "Kurang daya ingatan atau mudah terlupa",
"type": "choice",
"answerOption": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 0
}
],
"valueCoding": {
"code": "13",
"display": "Tiada"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 1
}
],
"valueCoding": {
"code": "14",
"display": "Kadang-kadang"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 2
}
],
"valueCoding": {
"code": "15",
"display": "Kerap"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 3
}
],
"valueCoding": {
"code": "16",
"display": "Sentiasa"
}
}
]
},
{
"linkId": "hajj-12.6.14",
"text": "Otot tegang",
"type": "choice",
"answerOption": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 0
}
],
"valueCoding": {
"code": "13",
"display": "Tiada"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 1
}
],
"valueCoding": {
"code": "14",
"display": "Kadang-kadang"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 2
}
],
"valueCoding": {
"code": "15",
"display": "Kerap"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 3
}
],
"valueCoding": {
"code": "16",
"display": "Sentiasa"
}
}
]
},
{
"linkId": "hajj-12.6.15",
"text": "Keyakinan pada diri sendiri yang berlebihan",
"type": "choice",
"answerOption": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 0
}
],
"valueCoding": {
"code": "13",
"display": "Tiada"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 1
}
],
"valueCoding": {
"code": "14",
"display": "Kadang-kadang"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 2
}
],
"valueCoding": {
"code": "15",
"display": "Kerap"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 3
}
],
"valueCoding": {
"code": "16",
"display": "Sentiasa"
}
}
]
},
{
"linkId": "hajj-12.6.16",
"text": "Buah fikiran yang pantas seolah berlumba-lumba",
"type": "choice",
"answerOption": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 0
}
],
"valueCoding": {
"code": "13",
"display": "Tiada"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 1
}
],
"valueCoding": {
"code": "14",
"display": "Kadang-kadang"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 2
}
],
"valueCoding": {
"code": "15",
"display": "Kerap"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 3
}
],
"valueCoding": {
"code": "16",
"display": "Sentiasa"
}
}
]
},
{
"linkId": "hajj-12.6.17",
"text": "Kurang keyakinan pada diri sendiri",
"type": "choice",
"answerOption": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 0
}
],
"valueCoding": {
"code": "13",
"display": "Tiada"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 1
}
],
"valueCoding": {
"code": "14",
"display": "Kadang-kadang"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 2
}
],
"valueCoding": {
"code": "15",
"display": "Kerap"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 3
}
],
"valueCoding": {
"code": "16",
"display": "Sentiasa"
}
}
]
},
{
"linkId": "hajj-12.6.18",
"text": "Rasa tiada jalan keluar",
"type": "choice",
"answerOption": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 0
}
],
"valueCoding": {
"code": "13",
"display": "Tiada"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 1
}
],
"valueCoding": {
"code": "14",
"display": "Kadang-kadang"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 2
}
],
"valueCoding": {
"code": "15",
"display": "Kerap"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 3
}
],
"valueCoding": {
"code": "16",
"display": "Sentiasa"
}
}
]
},
{
"linkId": "16.6.19",
"text": "Rasa seronok",
"type": "choice",
"answerOption": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 0
}
],
"valueCoding": {
"code": "13",
"display": "Tiada"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 1
}
],
"valueCoding": {
"code": "14",
"display": "Kadang-kadang"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 2
}
],
"valueCoding": {
"code": "15",
"display": "Kerap"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 3
}
],
"valueCoding": {
"code": "16",
"display": "Sentiasa"
}
}
]
},
{
"linkId": "hajj-12.6.20",
"text": "Susah hendak menyesuaikan diri dengan keadaan",
"type": "choice",
"answerOption": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 0
}
],
"valueCoding": {
"code": "13",
"display": "Tiada"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 1
}
],
"valueCoding": {
"code": "14",
"display": "Kadang-kadang"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 2
}
],
"valueCoding": {
"code": "15",
"display": "Kerap"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 3
}
],
"valueCoding": {
"code": "16",
"display": "Sentiasa"
}
}
]
},
{
"linkId": "hajj-12.6.21",
"text": "Jumlah markah",
"type": "quantity"
}
]
},
{
"linkId": "hajj-12.7",
"text": "Elderly Cognitive Assessment Questionnaire (Please refer to score table)",
"type": "group",
"item": [
{
"linkId": "hajj-12.7.1",
"text": "I want you to remember this number. Can you repeat after me (eg: 2710) I shall be testing you again in 10 mins.",
"type": "quantity"
},
{
"linkId": "hajj-12.7.2",
"text": "How old are you?",
"type": "quantity"
},
{
"linkId": "hajj-12.7.3",
"text": "When is your birthday? Or in which year were you born?",
"type": "quantity"
},
{
"linkId": "hajj-12.7.4",
"text": "What day of the week is today?",
"type": "quantity"
},
{
"linkId": "hajj-12.7.5",
"text": "What is the date today?",
"type": "quantity"
},
{
"linkId": "hajj-12.7.6",
"text": "What is the month today?",
"type": "quantity"
},
{
"linkId": "hajj-12.7.7",
"text": "What is the year today?",
"type": "string"
},
{
"linkId": "hajj-12.7.8",
"text": "What is this place called (eg. clinic, hospital)? Not Necessary to give name of place",
"type": "quantity"
},
{
"linkId": "hajj-12.7.9",
"text": "What is his / her job (eg. nurse, doctor)?",
"type": "quantity"
},
{
"linkId": "hajj-12.7.10",
"text": "Can you recall the number again?",
"type": "quantity"
},
{
"linkId": "hajj-12.7.11",
"text": "Jumlah markah",
"type": "quantity"
},
{
"linkId": "hajj-12.7.12",
"text": "Remarks",
"type": "text"
}
]
},
{
"linkId": "hajj-12.8",
"text": "Ujian Makmal Wajib",
"type": "group",
"item": [
{
"linkId": "hajj-12.8.1",
"text": "Paras Haemoglobin",
"type": "quantity"
},
{
"linkId": "hajj-12.8.2",
"text": "Random Blood Sugar",
"type": "quantity"
}
]
},
{
"linkId": "hajj-12.9",
"text": "Lain-lain Ujian (Jika Terdapat Indikasi)",
"type": "group",
"item": [
{
"linkId": "hajj-12.9.1",
"text": "X-Ray Dada",
"type": "text"
},
{
"linkId": "hajj-12.9.2",
"text": "Full Blood Count (FBC)",
"type": "choice",
"answerOption": [
{
"valueCoding": {
"code": "00",
"display": "Normal"
}
},
{
"valueCoding": {
"code": "01",
"display": "Abnormal"
}
}
]
},
{
"linkId": "hajj-12.9.3",
"text": "Fasting Blood Sugar (FBS) / OGTT",
"type": "choice",
"answerOption": [
{
"valueCoding": {
"code": "00",
"display": "Normal"
}
},
{
"valueCoding": {
"code": "01",
"display": "Abnormal"
}
}
]
},
{
"linkId": "hajj-12.9.4",
"text": "HbA1c",
"type": "quantity"
},
{
"linkId": "hajj-12.9.5",
"text": "Renal profile",
"type": "choice",
"answerOption": [
{
"valueCoding": {
"code": "00",
"display": "Normal"
}
},
{
"valueCoding": {
"code": "01",
"display": "Abnormal"
}
}
]
},
{
"linkId": "hajj-12.9.6",
"text": "Electrocardiogram (ECG)",
"type": "text"
},
{
"linkId": "hajj-12.9.7",
"text": "67UPT (If LNMP more than 4 weeks)",
"type": "text"
},
{
"linkId": "hajj-12.9.8",
"text": "Lain-lain",
"type": "text"
},
{
"linkId": "hajj-12.9.9",
"text": "Catatan",
"type": "text"
}
]
},
{
"linkId": "hajj-12.10",
"text": "Pemeriksaan Gigi",
"type": "group",
"item": [
{
"linkId": "hajj-12.10.1",
"text": "Tarikh Pemeriksaan",
"type": "dateTime"
},
{
"linkId": "hajj-12.10.2",
"text": "Tempat Pemeriksaan",
"type": "string"
},
{
"linkId": "hajj-12.10.3",
"text": "Catatan",
"type": "text"
}
]
}
]
}