| Package | csiro.fhir.au.smartforms |
| Resource Type | Questionnaire |
| Id | EyeHealth |
| FHIR Version | R4 |
| Source | https://smartforms.csiro.au/ig/https://build.fhir.org/ig/aehrc/smart-forms-ig/Questionnaire-EyeHealth.html |
| URL | http://www.health.gov.au/assessments/mbs/715/EyeHealth |
| Version | 0.3.0 |
| Status | draft |
| Date | 2025-03-14 |
| Name | EyeHealth |
| Title | Aboriginal and Torres Strait Islander Health Check - Eye Health |
| 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 EyeHealth
Structure| LinkID | Text | Cardinality | Type | Flags | Description & Constraints |
|---|---|---|---|---|---|
  EyeHealth | Questionnaire | http://www.health.gov.au/assessments/mbs/715/EyeHealth#0.3.0 | |||
  961da481-1698-4a1d-962b-a9c2185e335a | Eye health | 0..1 | group | ||
   CD-in-progress-8 | In progress | 0..1 | display | Enable When: MarkComplete-8 != | |
| CD-complete-8 | Complete | 0..1 | display | Enable When: MarkComplete-8 = | |
| 0e30de87-8d5a-4b7a-893a-f1791c4f31c5 | Vision concerns | 0..1 | group | ||
  bc49ee24-62a8-4252-a5ee-9c68bfed601c | Is there anything that you are worried about with your child's vision? | 0..1 | choice |  | Value Set: Yes/No |
| 6286346d-c805-4519-8e82-bf364a215c58 | Is there anything that you are worried about with your vision? | 0..1 | choice | | Value Set: Yes/No |
 468770e4-af95-4377-8af5-280deb585e01 | Details | 0..1 | text | Enable When: | |
| 25d3e4b6-8c71-4c17-8f5a-aca90e232ed2 | Eye examination | 0..1 | group | ||
| cb1b9349-2dd1-4bdd-904b-a529458e3b98 | Red reflex (up to six months) | 0..1 | group | ||
 47ce0b44-ac12-4a1d-8657-2cc741a29d3a | Left eye | 0..1 | string | ||
| 3f192141-0845-44d6-85ad-94f0295e062f | Right eye | 0..1 | string | ||
| 3ff41163-549f-4834-8817-151144613988 | Evidence of squint or other abnormality | 0..1 | group | ||
| 83e65791-a04a-42e4-b3f2-1e552b8e8044 | Left eye | 0..1 | string | ||
| 2dd18bad-9491-436f-a2db-a4ed6022ac5c | Right eye | 0..1 | string | ||
| 2c0e12a5-2650-4886-8f50-405dc0ead9c5 | Visual acuity | 0..1 | group | ||
| 43825f29-c720-40a5-9fd1-de50ee35479c | Left eye | 0..1 | string | ||
| e98428b4-bc8d-4272-a803-757a84813c3c | Right eye | 0..1 | string | ||
| bac129ef-a5c0-4d94-915c-ceadc6016594 | Trachoma Check (endemic areas) | 0..1 | group | ||
| 202b5b91-541e-4a72-b1f6-1d474b59b7a3 | Left eye | 0..1 | choice | Options: 2 options | |
| 6ae69487-345e-46a0-a8db-b1356671ee59 | Right eye | 0..1 | choice | Options: 2 options | |
| 8dcdc04c-7655-4b47-88eb-8425f0cdc0d0 | Health priorities, actions and follow-up | 0..1 | text | ||
 MarkComplete-8 | Mark section as complete | 0..1 | boolean | ||
| Documentation for this format | |||||
Options Sets
Answer options for 202b5b91-541e-4a72-b1f6-1d474b59b7a3
Answer options for 6ae69487-345e-46a0-a8db-b1356671ee59
ValueSet #YesNo
Expansion based on codesystem expandedYes-NoIndicator v2.1.0 (CodeSystem)
This value set contains 2 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 |
FHIR{
"resourceType": "Questionnaire",
"id": "EyeHealth",
"meta": {
"profile": [
"http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-render",
"http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-modular"
]
},
"text": {
"status": "extensions",
"div": "<!-- snip (see above) -->"
},
"contained": [
{
"resourceType": "ValueSet",
"id": "YesNo",
"url": "https://smartforms.csiro.au/ig/ValueSet/YesNo",
"name": "YesNo",
"title": "Yes/No",
"status": "draft",
"experimental": false,
"description": "Concepts for Yes and No",
"compose": {
"include": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0532",
"concept": [
{
"code": "Y",
"display": "Yes"
},
{
"code": "N",
"display": "No"
}
]
}
]
},
"expansion": {
"identifier": "urn:uuid:41cccc66-fd57-4bc4-bab1-8c5c878d95f7",
"timestamp": "2025-05-01T10:00:50+10:00",
"total": 2,
"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"
}
]
}
}
],
"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/EyeHealth",
"version": "0.3.0",
"name": "EyeHealth",
"title": "Aboriginal and Torres Strait Islander Health Check - Eye Health",
"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": "961da481-1698-4a1d-962b-a9c2185e335a",
"text": "Eye health",
"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-8",
"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-8",
"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-8",
"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-8",
"operator": "=",
"answerBoolean": true
}
]
},
{
"linkId": "0e30de87-8d5a-4b7a-893a-f1791c4f31c5",
"text": "Vision concerns",
"type": "group",
"repeats": false,
"item": [
{
"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": "bc49ee24-62a8-4252-a5ee-9c68bfed601c",
"text": "Is there anything that you are worried about with your child's vision?",
"type": "choice",
"repeats": false,
"answerValueSet": "#YesNo"
},
{
"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": "6286346d-c805-4519-8e82-bf364a215c58",
"text": "Is there anything that you are worried about with your vision?",
"type": "choice",
"repeats": false,
"answerValueSet": "#YesNo"
},
{
"linkId": "468770e4-af95-4377-8af5-280deb585e01",
"text": "Details",
"type": "text",
"enableWhen": [
{
"question": "bc49ee24-62a8-4252-a5ee-9c68bfed601c",
"operator": "=",
"answerCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v2-0136",
"code": "Y"
}
},
{
"question": "6286346d-c805-4519-8e82-bf364a215c58",
"operator": "=",
"answerCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v2-0136",
"code": "Y"
}
}
],
"enableBehavior": "any",
"repeats": false
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "grid"
}
]
}
}
],
"linkId": "25d3e4b6-8c71-4c17-8f5a-aca90e232ed2",
"text": "Eye examination",
"type": "group",
"repeats": false,
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "%age < 1"
}
}
],
"linkId": "cb1b9349-2dd1-4bdd-904b-a529458e3b98",
"text": "Red reflex (up to six months)",
"type": "group",
"repeats": false,
"item": [
{
"linkId": "47ce0b44-ac12-4a1d-8657-2cc741a29d3a",
"text": "Left eye",
"type": "string",
"repeats": false
},
{
"linkId": "3f192141-0845-44d6-85ad-94f0295e062f",
"text": "Right eye",
"type": "string",
"repeats": false
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "%age <= 12"
}
}
],
"linkId": "3ff41163-549f-4834-8817-151144613988",
"text": "Evidence of squint or other abnormality",
"type": "group",
"repeats": false,
"item": [
{
"linkId": "83e65791-a04a-42e4-b3f2-1e552b8e8044",
"text": "Left eye",
"type": "string",
"repeats": false
},
{
"linkId": "2dd18bad-9491-436f-a2db-a4ed6022ac5c",
"text": "Right eye",
"type": "string",
"repeats": false
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "%age >= 3"
}
}
],
"linkId": "2c0e12a5-2650-4886-8f50-405dc0ead9c5",
"text": "Visual acuity",
"type": "group",
"repeats": false,
"item": [
{
"linkId": "43825f29-c720-40a5-9fd1-de50ee35479c",
"text": "Left eye",
"type": "string",
"repeats": false
},
{
"linkId": "e98428b4-bc8d-4272-a803-757a84813c3c",
"text": "Right eye",
"type": "string",
"repeats": false
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
"valueExpression": {
"language": "text/fhirpath",
"expression": "%age >= 25"
}
}
],
"linkId": "bac129ef-a5c0-4d94-915c-ceadc6016594",
"text": "Trachoma Check (endemic areas)",
"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": "check-box"
}
]
}
}
],
"linkId": "202b5b91-541e-4a72-b1f6-1d474b59b7a3",
"text": "Left eye",
"type": "choice",
"repeats": false,
"answerOption": [
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "60332004",
"display": "Trichiasis"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "95726001",
"display": "Corneal scar"
}
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "check-box"
}
]
}
}
],
"linkId": "6ae69487-345e-46a0-a8db-b1356671ee59",
"text": "Right eye",
"type": "choice",
"repeats": false,
"answerOption": [
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "60332004",
"display": "Trichiasis"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "95726001",
"display": "Corneal scar"
}
}
]
}
]
}
]
},
{
"linkId": "8dcdc04c-7655-4b47-88eb-8425f0cdc0d0",
"text": "Health priorities, actions and follow-up",
"type": "text",
"repeats": false
},
{
"linkId": "MarkComplete-8",
"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
}
]
}
]
}