| Package | csiro.fhir.au.smartforms |
| Resource Type | Questionnaire |
| Id | Consent |
| FHIR Version | R4 |
| Source | https://smartforms.csiro.au/ig/https://build.fhir.org/ig/aehrc/smart-forms-ig/Questionnaire-Consent.html |
| URL | http://www.health.gov.au/assessments/mbs/715/Consent |
| Version | 0.3.0 |
| Status | draft |
| Date | 2025-03-14 |
| Name | Consent |
| Title | Aboriginal and Torres Strait Islander Health Check - Consent |
| Realm | au |
| 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/. |
No resources found
No resources found
Note: links and images are rebased to the (stated) source
Generated Narrative: Questionnaire Consent
Profiles: Advanced Rendering Questionnaire, SDC Modular Questionnaire, Populatable Questionnaire - Expression
| LinkID | Text | Cardinality | Type | Flags | Description & Constraints |
|---|---|---|---|---|---|
  Consent | Questionnaire | http://www.health.gov.au/assessments/mbs/715/Consent#0.3.0 | |||
  1016f79d-9756-4daf-b6ee-29add134b34f | Consent | 0..1 | group | ||
   CD-in-progress-30 | In progress | 0..1 | display | Enable When: MarkComplete-30 != | |
| CD-complete-30 | Complete | 0..1 | display | Enable When: MarkComplete-30 = | |
 d1e1ab3d-1c6c-430b-8ae7-af56b8f0af55 | Consent given after discussion of process and benefits of a health check | 0..1 | choice |  | Value Set: Yes/No/NA |
| 7fa8bc57-f3f9-4ddc-bf9b-12a9b9885dbd | Consent given by parent/primary carer after discussion of process and benefits of a health check | 0..1 | choice | | Value Set: Yes/No/NA |
| 80a6a405-49a4-44fb-bff3-212902096b95 | Parent/primary caregiver present | 0..1 | group | ||
 c72933c7-349f-4fef-94ff-c424c69da6f3 | Parent/primary caregiver is present for health check? | 0..1 | choice | | Value Set: Yes/No/NA |
 b7d116f9-0425-4cf1-8cde-fbf4dfaee550 | Relationship to child | 0..* | string | Enable When: c72933c7-349f-4fef-94ff-c424c69da6f3 = | |
| d8c88bff-75ea-476f-8f83-e9b72fc9e1a0 | Consent for sharing of information | 0..1 | group | ||
| 057483ce-f265-46df-a1c5-7a18d492c1ba | Consent given for sharing of information with relevant healthcare providers? | 0..1 | choice | | Value Set: Yes/No/NA |
 43517c44-5cd2-4d9a-9f18-d6bf8124f4ae | Who/details | 0..* | text | Enable When: 057483ce-f265-46df-a1c5-7a18d492c1ba = | |
 84162f36-f4af-4509-b178-ef2a3849d0b6 | Date | 0..1 | date | ||
| 0f92eb2d-4629-4215-96f8-46722a2efa73 | Doctor | 0..1 | string | ||
| 8b94a129-3aab-4d13-bb6d-7a748f5c41e5 | Nurse | 0..1 | string | ||
| 2a517291-e2f1-4f66-ad1f-ae5b091d2f8a | Aboriginal and/or Torres Strait Islander Health Worker / Health Practitioner | 0..1 | string | ||
| 5bbfb4a3-a667-4ef2-98c2-76e76da55c03 | Location of health check | 0..1 | open-choice | Options: 3 options | |
| 9a51c056-021d-445d-8eaa-2123a69aa9c2 | Location of health check | 0..1 | open-choice | Options: 3 options | |
 MarkComplete-30 | Mark section as complete | 0..1 | boolean | ||
| Documentation for this format | |||||
Options Sets
Answer options for 5bbfb4a3-a667-4ef2-98c2-76e76da55c03
Answer options for 9a51c056-021d-445d-8eaa-2123a69aa9c2
ValueSet #YesNoNA
Expansion based on codesystem expandedYes-NoIndicator v2.1.0 (CodeSystem)
This value set contains 3 concepts
| Code | System | Display (en-US) | Definition |
| Y | http://terminology.hl7.org/CodeSystem/v2-0532 | Yes | Yes |
| N | http://terminology.hl7.org/CodeSystem/v2-0532 | No | No |
| NA | http://terminology.hl7.org/CodeSystem/v2-0532 | N/A | not applicable |
FHIR{
"resourceType": "Questionnaire",
"id": "Consent",
"meta": {
"profile": [
"http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-render",
"http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-modular",
"http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-pop-exp"
]
},
"text": {
"status": "extensions",
"div": "<!-- snip (see above) -->"
},
"contained": [
{
"resourceType": "ValueSet",
"id": "YesNoNA",
"url": "https://smartforms.csiro.au/ig/ValueSet/YesNoNA",
"name": "YesNoNA",
"title": "Yes/No/NA",
"status": "draft",
"experimental": false,
"description": "Concepts for Yes, No and Not applicable",
"compose": {
"include": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0532",
"concept": [
{
"code": "Y",
"display": "Yes"
},
{
"code": "N",
"display": "No"
},
{
"code": "NA",
"display": "N/A"
}
]
}
]
},
"expansion": {
"identifier": "urn:uuid:7fce8cc7-b936-4258-921d-923629b04439",
"timestamp": "2025-05-01T10:00:47+10:00",
"total": 3,
"offset": 0,
"parameter": [
{
"name": "displayLanguage",
"valueCode": "en-US"
},
{
"name": "count",
"valueInteger": 1000
},
{
"name": "offset",
"valueInteger": 0
},
{
"name": "excludeNested",
"valueBoolean": false
},
{
"name": "used-codesystem",
"valueUri": "http://terminology.hl7.org/CodeSystem/v2-0532|2.1.0"
}
],
"contains": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0532",
"code": "Y",
"display": "Yes"
},
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0532",
"code": "N",
"display": "No"
},
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0532",
"code": "NA",
"display": "N/A"
}
]
}
}
],
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-assemble-expectation",
"valueCode": "assemble-child"
},
{
"extension": [
{
"url": "name",
"valueCoding": {
"system": "http://hl7.org/fhir/uv/sdc/CodeSystem/launchContext",
"code": "patient"
}
},
{
"url": "type",
"valueCode": "Patient"
},
{
"url": "description",
"valueString": "The patient that is to be used to pre-populate the form"
}
],
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-launchContext"
},
{
"extension": [
{
"url": "name",
"valueCoding": {
"system": "http://hl7.org/fhir/uv/sdc/CodeSystem/launchContext",
"code": "user"
}
},
{
"url": "type",
"valueCode": "Practitioner"
},
{
"url": "description",
"valueString": "The practitioner user that is to be used to pre-populate the form"
}
],
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-launchContext"
},
{
"extension": [
{
"url": "name",
"valueCoding": {
"system": "http://hl7.org/fhir/uv/sdc/CodeSystem/launchContext",
"code": "encounter"
}
},
{
"url": "type",
"valueCode": "Encounter"
},
{
"url": "description",
"valueString": "The encounter that is to be used to pre-populate the form"
}
],
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-launchContext"
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-assembleContext",
"valueString": "age"
},
{
"url": "http://hl7.org/fhir/5.0/StructureDefinition/extension-Questionnaire.versionAlgorithm[x]",
"valueCoding": {
"system": "http://hl7.org/fhir/version-algorithm",
"code": "semver"
}
}
],
"url": "http://www.health.gov.au/assessments/mbs/715/Consent",
"version": "0.3.0",
"name": "Consent",
"title": "Aboriginal and Torres Strait Islander Health Check - Consent",
"status": "draft",
"experimental": false,
"subjectType": [
"Patient"
],
"date": "2025-03-14",
"publisher": "AEHRC CSIRO",
"contact": [
{
"name": "AEHRC CSIRO",
"telecom": [
{
"system": "url",
"value": "https://confluence.csiro.au/display/PCDQFPhase2/Primary+Care+Data+Quality+Foundations+-+Phase+2"
}
]
}
],
"jurisdiction": [
{
"coding": [
{
"system": "urn:iso:std:iso:3166",
"code": "AU",
"display": "Australia"
}
]
}
],
"copyright": "Copyright © 2022+ Australian Government Department of Health and Aged Care - All rights reserved.\nThis content is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.\nSee https://creativecommons.org/licenses/by-sa/4.0/.\n",
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "%age.exists()"
}
}
],
"linkId": "1016f79d-9756-4daf-b6ee-29add134b34f",
"text": "Consent",
"type": "group",
"repeats": false,
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "https://smartforms.csiro.au/ig/CodeSystem/QuestionnaireItemControlExtended",
"code": "context-display"
}
]
}
}
],
"linkId": "CD-in-progress-30",
"text": "In progress",
"_text": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString": "<div title=\"In progress\" xmlns=\"http://www.w3.org/1999/xhtml\">\r\n\t<div style=\"display: flex; flex-direction: row;\">\r\n\t\t<img width='24' height='24' src='data:image/svg+xml;base64,\r\n\t\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' \r\n\t\tstyle=\"align-self: center;\"/>\r\n\t</div>\r\n</div>"
}
]
},
"type": "display",
"enableWhen": [
{
"question": "MarkComplete-30",
"operator": "!=",
"answerBoolean": true
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "https://smartforms.csiro.au/ig/CodeSystem/QuestionnaireItemControlExtended",
"code": "context-display"
}
]
}
}
],
"linkId": "CD-complete-30",
"text": "Complete",
"_text": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString": "<div title=\"Section completed\" xmlns=\"http://www.w3.org/1999/xhtml\">\r\n\t<div style=\"display: flex; flex-direction: row;\">\r\n\t\t<img width='24' height='24' src='data:image/svg+xml;base64,PHN2ZyB4bWxucz0iaHR0cDovL3d3dy53My5vcmcvMjAwMC9zdmciIHdpZHRoPSIxZW0iIGhlaWdodD0iMWVtIiB2aWV3Qm94PSIwIDAgMjQgMjQiPjxwYXRoIGZpbGw9IiMyZTdkMzIiIGQ9Ik0yMCAxMmE4IDggMCAwIDEtOCA4YTggOCAwIDAgMS04LThhOCA4IDAgMCAxIDgtOGMuNzYgMCAxLjUuMTEgMi4yLjMxbDEuNTctMS41N0E5LjgyMiA5LjgyMiAwIDAgMCAxMiAyQTEwIDEwIDAgMCAwIDIgMTJhMTAgMTAgMCAwIDAgMTAgMTBhMTAgMTAgMCAwIDAgMTAtMTBNNy45MSAxMC4wOEw2LjUgMTEuNUwxMSAxNkwyMSA2bC0xLjQxLTEuNDJMMTEgMTMuMTdsLTMuMDktMy4wOVoiLz48L3N2Zz4='\r\n\t\tstyle=\"align-self: center;\"/>\r\n\t</div>\r\n</div>"
}
]
},
"type": "display",
"enableWhen": [
{
"question": "MarkComplete-30",
"operator": "=",
"answerBoolean": true
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "%age > 12"
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button"
}
]
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
"valueCode": "horizontal"
}
],
"linkId": "d1e1ab3d-1c6c-430b-8ae7-af56b8f0af55",
"text": "Consent given after discussion of process and benefits of a health check",
"type": "choice",
"repeats": false,
"answerValueSet": "#YesNoNA"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "%age <= 12"
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button"
}
]
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
"valueCode": "horizontal"
}
],
"linkId": "7fa8bc57-f3f9-4ddc-bf9b-12a9b9885dbd",
"text": "Consent given by parent/primary carer after discussion of process and benefits of a health check",
"type": "choice",
"repeats": false,
"answerValueSet": "#YesNoNA"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "%age <= 24"
}
}
],
"linkId": "80a6a405-49a4-44fb-bff3-212902096b95",
"text": "Parent/primary caregiver present",
"type": "group",
"repeats": false,
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button"
}
]
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
"valueCode": "horizontal"
}
],
"linkId": "c72933c7-349f-4fef-94ff-c424c69da6f3",
"text": "Parent/primary caregiver is present for health check?",
"type": "choice",
"repeats": false,
"answerValueSet": "#YesNoNA"
},
{
"linkId": "b7d116f9-0425-4cf1-8cde-fbf4dfaee550",
"text": "Relationship to child",
"type": "string",
"enableWhen": [
{
"question": "c72933c7-349f-4fef-94ff-c424c69da6f3",
"operator": "=",
"answerCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v2-0136",
"code": "Y"
}
}
],
"repeats": true
}
]
},
{
"linkId": "d8c88bff-75ea-476f-8f83-e9b72fc9e1a0",
"text": "Consent for sharing of information",
"type": "group",
"repeats": false,
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button"
}
]
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
"valueCode": "horizontal"
}
],
"linkId": "057483ce-f265-46df-a1c5-7a18d492c1ba",
"text": "Consent given for sharing of information with relevant healthcare providers?",
"type": "choice",
"repeats": false,
"answerValueSet": "#YesNoNA"
},
{
"linkId": "43517c44-5cd2-4d9a-9f18-d6bf8124f4ae",
"text": "Who/details",
"type": "text",
"enableWhen": [
{
"question": "057483ce-f265-46df-a1c5-7a18d492c1ba",
"operator": "=",
"answerCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v2-0136",
"code": "Y"
}
}
],
"repeats": true
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-initialExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "today()"
}
}
],
"linkId": "84162f36-f4af-4509-b178-ef2a3849d0b6",
"text": "Date",
"type": "date",
"repeats": false
},
{
"linkId": "0f92eb2d-4629-4215-96f8-46722a2efa73",
"text": "Doctor",
"type": "string",
"repeats": false
},
{
"linkId": "8b94a129-3aab-4d13-bb6d-7a748f5c41e5",
"text": "Nurse",
"type": "string",
"repeats": false
},
{
"linkId": "2a517291-e2f1-4f66-ad1f-ae5b091d2f8a",
"text": "Aboriginal and/or Torres Strait Islander Health Worker / Health Practitioner",
"type": "string",
"repeats": false
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "%age > 5"
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button"
}
]
}
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-openLabel",
"valueString": "Other, please specify"
}
],
"linkId": "5bbfb4a3-a667-4ef2-98c2-76e76da55c03",
"text": "Location of health check",
"type": "open-choice",
"repeats": false,
"answerOption": [
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "257585005",
"display": "Clinic"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "264362003",
"display": "Home"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "257698009",
"display": "School"
}
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "%age <= 5"
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button"
}
]
}
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-openLabel",
"valueString": "Other, please specify"
}
],
"linkId": "9a51c056-021d-445d-8eaa-2123a69aa9c2",
"text": "Location of health check",
"type": "open-choice",
"repeats": false,
"answerOption": [
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "257585005",
"display": "Clinic"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "264362003",
"display": "Home"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "224848004",
"display": "Early learning centre"
}
}
]
},
{
"linkId": "MarkComplete-30",
"text": "Mark section as complete",
"_text": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
"valueString": "<div xmlns=\"http://www.w3.org/1999/xhtml\">\r\n<head>\r\n <style type=\"text/css\">\r\n .alert {\r\n padding: 0.875rem;\r\n margin-bottom: 1rem;\r\n font-size: 0.875rem;\r\n color: #29712D;\r\n border-radius: 0.5rem;\r\n background-color: #D9E8DA;\r\n font-weight: 700;\r\n max-width: 205px;\r\n }\r\n </style>\r\n</head>\r\n<body>\r\n<div class=\"alert\">Mark section as complete</div>\r\n</body>\r\n</div>"
}
]
},
"type": "boolean",
"repeats": false
}
]
}
]
}