FHIR IG analytics| Package | fhir.surveillanceIG |
| Resource Type | Questionnaire |
| Id | Questionnaire-AfpCaseReport.json |
| FHIR Version | R4 |
| Source | https://build.fhir.org/ig/IntelliSOFT-Consulting/Surveillance-FHIR-IG/Questionnaire-AfpCaseReport.html |
| URL | http://example.org/Questionnaire/AfpCaseReport |
| Version | 0.1.0 |
| Status | draft |
| Date | 2026-04-02T20:27:34+00:00 |
| Title | AFP Surveillance |
| Realm | us |
| Authority | hl7 |
| Description | AFP Surveillance questionnaire for disease surveillance |
No resources found
No resources found
Note: links and images are rebased to the (stated) source
Generated Narrative: Questionnaire AfpCaseReport
Profile: http://hl7.org/fhir/4.0/StructureDefinition/Questionnaire
| LinkID | Text | Cardinality | Type | Flags | Description & Constraints |
|---|---|---|---|---|---|
  | AFP Surveillance questionnaire for disease surveillance | Questionnaire | http://example.org/Questionnaire/AfpCaseReport#0.1.0 | ||
  151479012557 | Reporting Site | 0..1 | group | ||
  user_role | User Role | 0..1 | string |  | |
| user_facility | User Facility | 0..1 | string | | |
| user_ward | User Ward | 0..1 | string | | |
| user_sub_county | User Sub County | 0..1 | string | | |
| user_county | User County | 0..1 | string | | |
| facility_level | null | 0..1 | group | Enable When: user_role = VACCINATOR | |
 294367770999 | County | 1..1 | reference | ||
| 819946803642 | Sub County | 1..1 | reference | ||
| 819943434 | Ward | 1..1 | reference | ||
| 819946803677 | Health Facility | 1..1 | reference | ||
  438862163919 | Type of health facility | 1..1 | choice | Options: 3 options | |
| sub_county_level | null | 0..1 | group | Enable When: user_role = SUBCOUNTY_DISEASE_SURVEILLANCE_OFFICER | |
| 294367770999_sub_county | County | 1..1 | reference | ||
| 819946803642_sub_county | Sub County | 1..1 | reference | ||
| 819943434_sub_county | Ward | 1..1 | reference | ||
| 819946803677_sub_county | Health Facility | 1..1 | reference | ||
| 438862163919_sub_county | Type of health facility | 1..1 | choice | Options: 3 options | |
| county_level | null | 0..1 | group | Enable When: user_role = COUNTY_DISEASE_SURVEILLANCE_OFFICER | |
| 294367770999_county | County | 1..1 | reference | ||
| 819946803642_county | Sub County | 1..1 | reference | ||
| 819943434_county | Ward | 1..1 | reference | ||
| 819946803677_county | Health Facility | 1..1 | reference | ||
| 438862163919_county | Type of health facility | 1..1 | choice | Options: 3 options | |
| national_level | null | 0..1 | group | Enable When: user_role = ADMINISTRATOR | |
| 294367770999_national | County | 1..1 | reference | ||
| 819946803642_national | Sub County | 1..1 | reference | ||
| 819943434_national | Ward | 1..1 | reference | ||
| 819946803677_national | Health Facility | 1..1 | reference | ||
| 438862163919_national | Type of health facility | 1..1 | choice | Options: 3 options | |
| 992818778559 | EPID No | 0..1 | string |  | |
| 359809652429 | Case Demographics | 0..1 | group | ||
| 873240407472 | First name | 1..1 | string | ||
| 246751846436 | Middle name | 0..1 | string | ||
| 486402457213 | Surname/Family name | 1..1 | string | ||
| 929966324957 | Sex | 1..1 | choice |  | Options: 2 options |
 262588607153_helpText | What is the sex of the patient? | 0..1 | display | ||
| 442636360588 | Date of Birth known or unknown? | 1..1 | choice | | Options: 2 options |
| 258271896621_helpText | Date of birth of the patient (DD/MM/YYYY) | 0..1 | display | ||
 257830485990 | Date of Birth. | 1..1 | date | Enable When: 442636360588 = Known (known) | |
| age-at-onset | Age at Onset | 0..1 | string | | Initial Value: string = 0 |
 492731638700 | Age in Years | 1..1 | integer | Enable When: 442636360588 = Unknown (unknown) | |
| 185726989867 | Age in Months | 0..1 | integer | Enable When: 442636360588 = Unknown (unknown) | |
| 828303331247 | Age in Days | 0..1 | integer | Enable When: 442636360588 = Unknown (unknown) | |
| 856448027666 | Name of Parent/Guardian. | 1..1 | string | ||
| 576318206363 | Telephone no. of parent/guardian. | 1..1 | string | ||
| telephone-hint | 07xxxxxxxx | 0..1 | display | ||
| a4-county | County | 1..1 | reference | ||
| a3-sub-county | Sub County | 1..1 | reference | ||
| a2-ward | Ward | 1..1 | reference | ||
| residence-details | Residence (Village/Estate/Hse No). | 1..1 | string | ||
| 946232932304 | Neighborhood major landmark. | 1..1 | string | ||
| 487686858194 | Name Nearest Health Facility. | 1..1 | string | ||
| 110761799063 | Town/City/Location. | 1..1 | string | ||
 509826995484_helpText | The specific town, city, or geographical location of residence. | 0..1 | display | ||
| 451840456960 | Case Information | 0..1 | group | ||
| 502488184403 | Date of Investigation. | 1..1 | date | ||
| 502488184403_helpText | The date when the affected individual first sought medical care. | 0..1 | display | ||
| 426321975477 | Date of Notification. | 1..1 | date | ||
| 426321975477_helpText | The date when the health facility reported the case to the sub-county and national health authorities. | 0..1 | display | ||
| 171292274939 | Notified by? | 1..1 | choice | Options: 4 options | |
| 336643888536 | Was the patient admitted? | 1..1 | choice | | Options: 2 options |
| 336643888536_helpText | Was the patient hospitalized? | 0..1 | display | ||
| 507199621281 | Date of admission. | 1..1 | date | Enable When: 336643888536 = Yes (yes) | |
| 507199621281_helpText | The date when the patient was admitted to a healthcare facility. | 0..1 | display | ||
| 525996604810 | IP/OP No. | 1..1 | string | ||
| 525996604810_helpText | Inpatient (IP) or Outpatient (OP) number assigned by the health facility. | 0..1 | display | ||
| 735342695013 | Clinical Information | 0..1 | group | ||
| 728034137219 | Date of onset of paralysis. | 1..1 | date | ||
| 932108244312 | Fever at onset of paralysis? | 1..1 | choice | | Options: 2 options |
| 396371836778 | Is paralysis of sudden onset? | 1..1 | choice | | Options: 2 options |
| 917680711879 | Progressive Paralysis < 3 days? | 1..1 | choice | | Options: 2 options |
| 917680711879_helpText | Was the progression of paralysis less than 3 days? | 0..1 | display | ||
| 776980947995 | Is paralysiss flaccid(floppy)? | 1..1 | choice | | Options: 2 options |
| 679475123276 | Is the paralysis asymmetric? | 1..1 | choice | | Options: 2 options |
| 828001350323 | Site of paralysis (check all that apply) | 1..* | choice | Options: 5 options | |
| 815911574910 | Specify other site of Paralysis | 1..1 | string | Enable When: 828001350323 = Other (Specify) (othersite) | |
| 249388449455 | Paralyzed limb sensitive to pain? | 1..1 | choice | | Options: 2 options |
| 638592165160 | Was there any injection just before onset of paralysis? | 1..1 | choice | | Options: 2 options |
| 701518392602 | Site of injection ( check all that applies). | 0..* | choice | Enable When: 638592165160 = Yes (yes) Options: 10 options | |
| 564450145870 | After Investigation, was this a true AFP? | 0..1 | choice | | Options: 2 options |
| 212304573462 | Outcome | 0..1 | choice | | Options: 3 options |
| 446305443608 | Vaccination History for disease under investigation | 0..1 | group | ||
| 970455623029 | Was the patient vaccinated against illness (including campaign)? | 1..1 | choice | | Options: 3 options |
| 970455623029_helpText | Was the patient vaccinated against illness (including campaign)? | 0..1 | display | ||
| 886125589225 | Number of doses administered(Excluding birth OPV Dose) | 1..1 | integer | Enable When: 970455623029 = Yes (yes) | |
| 886125589225_helpText | The total number of polio vaccines administered (excluding birth OPV) | 0..1 | display | ||
| 413372430071 | Date of OPV dose at birth. | 1..1 | date | Enable When: 970455623029 = Yes (yes) | |
| 671158128551 | Date of 1st dose. | 1..1 | date | Enable When: 970455623029 = Yes (yes) | |
| 286826008175 | Date of 2nd dose. | 0..1 | date | Enable When: 886125589225 > 1 | |
| 705067672267 | Date of 3rd Dose. | 0..1 | date | Enable When: 886125589225 > 2 | |
| 974686716540 | Date of 4th Dose. | 0..1 | date | Enable When: 886125589225 > 3 | |
| 597572769623 | If more than 4 doses, date of last dose. | 0..1 | date | Enable When: 886125589225 > 4 | |
| 597572769623_helpText | If more than 4 doses, date of last dose. | 0..1 | display | ||
| 610048088023 | Were there any vaccines given in last 30 days? | 0..1 | choice | | Enable When: 970455623029 = Yes (yes) Options: 3 options |
| 610048088023_helpText | Were there any vaccines given in the last 30 days? | 0..1 | display | ||
| 960020813971 | if yes, confirm number of days/interval | 1..1 | integer | Enable When: 610048088023 = Yes (yes) | |
| 910678978959 | Date of last OPV dose received through SIA. | 1..1 | date | Enable When: 970455623029 = Yes (yes) | |
| 910678978959_helpText | Date of last OPV dose administered during Supplementary Immunization Activity (SIA) e.g. vaccination campaigns. | 0..1 | display | ||
| 774679982525 | Total OPV (bOPV/mOPV2) doses received through SIA. | 1..1 | integer | Enable When: 970455623029 = Yes (yes) | |
| 774679982525_helpText | Total number of OPV doses administered during Supplementary Immunization Activity (SIA) e.g. vaccination campaigns. | 0..1 | display | ||
| 440401067645 | Total OPV (bOPV/mOPV2/) doses received through RI. | 1..1 | integer | Enable When: 970455623029 = Yes (yes) | |
| 440401067645_helpText | Total number of OPV doses administered during Routine Immunization (RI). | 0..1 | display | ||
| 799376740588 | Total IPV doses received through SIA | 1..1 | integer | Enable When: 970455623029 = Yes (yes) | |
| 799376740588_helpText | Total number of IPV doses administered during Supplementary Immunization Activity (SIA) e.g. vaccination campaigns. | 0..1 | display | ||
| 999346763880 | Total IPV doses received through RI. | 1..1 | integer | Enable When: 970455623029 = Yes (yes) | |
| 999346763880_helpText | Total number of IPV doses administered during Routine Immunization (RI). | 0..1 | display | ||
| 766122504504 | Date of last IPV dose received through RI or SIA. | 1..1 | date | Enable When: 970455623029 = Yes (yes) | |
| 766122504504_helpText | Date of last IPV dose administered during Routine Immunization (RI) OR Supplementary Immunization Activity (SIA) e.g. vaccination campaigns. | 0..1 | display | ||
| 650080600932 | Source of RI vaccination Information. | 1..1 | choice | | Enable When: 970455623029 = Yes (yes) Options: 3 options |
| 650080600932_helpText | What is the source of Routine Vaccination Information. | 0..1 | display | ||
| 511517897367 | Immunocompromised status suspected? | 0..1 | choice | | Options: 3 options |
| 350784256533 | Stool Specimen Collection Information | 0..1 | group | ||
| 737703942433 | Date 1st specimen collected. | 1..1 | date | ||
| 737703942433_helpText | Collect the first date when the case is investigated. | 0..1 | display | ||
| 711388438654 | Date 2nd specimen collected. | 1..1 | date | ||
| 808177332790 | Date Specimen sent to the national level | 1..1 | date | ||
| Documentation for this format | |||||
Options Sets
Answer options for 438862163919
Answer options for 438862163919_sub_county
Answer options for 438862163919_county
Answer options for 438862163919_national
Answer options for 929966324957
Answer options for 442636360588
Answer options for 171292274939
Answer options for 336643888536
Answer options for 932108244312
Answer options for 396371836778
Answer options for 917680711879
Answer options for 776980947995
Answer options for 679475123276
Answer options for 828001350323
Answer options for 249388449455
Answer options for 638592165160
Answer options for 701518392602
Answer options for 564450145870
Answer options for 212304573462
Answer options for 970455623029
Answer options for 610048088023
Answer options for 650080600932
Answer options for 511517897367
FHIR
FHIRsmith{
"resourceType": "Questionnaire",
"id": "AfpCaseReport",
"meta": {
"profile": [
"http://hl7.org/fhir/4.0/StructureDefinition/Questionnaire"
]
},
"text": {
"status": "extensions",
"div": "<!-- snip (see above) -->"
},
"extension": [
{
"extension": [
{
"url": "name",
"valueCoding": {
"system": "http://hl7.org/fhir/uv/sdc/CodeSystem/launchContext",
"code": "patient"
}
},
{
"url": "type",
"valueCode": "Patient"
}
],
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-launchContext"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/variable",
"valueExpression": {
"name": "countyName",
"language": "text/fhirpath",
"expression": "%resource.descendants().where(linkId='294367770999').answer.value.reference"
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/variable",
"valueExpression": {
"name": "patientCountyName",
"language": "text/fhirpath",
"expression": "%resource.descendants().where(linkId='a4-county').answer.value.reference"
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/variable",
"valueExpression": {
"name": "patientSubCountyName",
"language": "text/fhirpath",
"expression": "%resource.descendants().where(linkId='a3-sub-county').answer.value.reference"
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/variable",
"valueExpression": {
"name": "selectedSubCountyName",
"language": "text/fhirpath",
"expression": "%resource.descendants().where(linkId='819946803642').answer.value.reference"
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/variable",
"valueExpression": {
"name": "selectedWardName",
"language": "text/fhirpath",
"expression": "%resource.descendants().where(linkId='819943434').answer.value.reference"
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/variable",
"valueExpression": {
"name": "selectedFacilityName",
"language": "text/fhirpath",
"expression": "%resource.descendants().where(linkId='819943434').answer.value.reference"
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/variable",
"valueExpression": {
"name": "assignedCounty",
"language": "text/fhirpath",
"expression": "%resource.descendants().where(linkId='user_county').answer.value"
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/variable",
"valueExpression": {
"name": "assignedRole",
"language": "text/fhirpath",
"expression": "%resource.descendants().where(linkId='user_role').answer.value"
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/variable",
"valueExpression": {
"name": "assignedSubCounty",
"language": "text/fhirpath",
"expression": "%resource.descendants().where(linkId='user_sub_county').answer.value"
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/variable",
"valueExpression": {
"name": "assignedWard",
"language": "text/fhirpath",
"expression": "%resource.descendants().where(linkId='user_ward').answer.value"
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/variable",
"valueExpression": {
"name": "assignedFacility",
"language": "text/fhirpath",
"expression": "%resource.descendants().where(linkId='user_facility').answer.value"
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/variable",
"valueExpression": {
"name": "selectedCountyNameCounty",
"language": "text/fhirpath",
"expression": "%resource.descendants().where(linkId='294367770999_county').answer.value.reference"
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/variable",
"valueExpression": {
"name": "selectedSubCountyNameCounty",
"language": "text/fhirpath",
"expression": "%resource.descendants().where(linkId='819946803642_county').answer.value.reference"
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/variable",
"valueExpression": {
"name": "selectedWardNameCounty",
"language": "text/fhirpath",
"expression": "%resource.descendants().where(linkId='819943434_county').answer.value.reference"
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/variable",
"valueExpression": {
"name": "selectedCountyNameSubCounty",
"language": "text/fhirpath",
"expression": "%resource.descendants().where(linkId='294367770999_sub_county').answer.value.reference"
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/variable",
"valueExpression": {
"name": "selectedSubCountyNameSubCounty",
"language": "text/fhirpath",
"expression": "%resource.descendants().where(linkId='819946803642_sub_county').answer.value.reference"
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/variable",
"valueExpression": {
"name": "selectedWardNameSubCounty",
"language": "text/fhirpath",
"expression": "%resource.descendants().where(linkId='819943434_sub_county').answer.value.reference"
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/variable",
"valueExpression": {
"name": "selectedCountyNameNational",
"language": "text/fhirpath",
"expression": "%resource.descendants().where(linkId='294367770999_national').answer.value.reference"
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/variable",
"valueExpression": {
"name": "selectedSubCountyNameNational",
"language": "text/fhirpath",
"expression": "%resource.descendants().where(linkId='819946803642_national').answer.value.reference"
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/variable",
"valueExpression": {
"name": "selectedWardNameNational",
"language": "text/fhirpath",
"expression": "%resource.descendants().where(linkId='819943434_national').answer.value.reference"
}
},
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-entryMode",
"valueCode": "prior-edit"
}
],
"url": "http://example.org/Questionnaire/AfpCaseReport",
"version": "0.1.0",
"title": "AFP Surveillance",
"status": "draft",
"date": "2026-04-02T20:27:34+00:00",
"publisher": "intellisoftConsulting",
"contact": [
{
"name": "intellisoftConsulting",
"telecom": [
{
"system": "url",
"value": "http://example.org/example-publisher"
}
]
},
{
"name": "IntelliSOFT Consulting Ltd.",
"telecom": [
{
"system": "email",
"value": "info@intellisoftkenya.com",
"use": "work"
}
]
}
],
"description": "AFP Surveillance questionnaire for disease surveillance",
"jurisdiction": [
{
"coding": [
{
"system": "urn:iso:std:iso:3166",
"code": "KE",
"display": "Kenya"
}
]
}
],
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "page",
"display": "Page"
}
]
}
}
],
"linkId": "151479012557",
"text": "Reporting Site",
"type": "group",
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-hidden",
"valueBoolean": true
}
],
"linkId": "user_role",
"text": "User Role",
"type": "string"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-hidden",
"valueBoolean": true
}
],
"linkId": "user_facility",
"text": "User Facility",
"type": "string"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-hidden",
"valueBoolean": true
}
],
"linkId": "user_ward",
"text": "User Ward",
"type": "string"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-hidden",
"valueBoolean": true
}
],
"linkId": "user_sub_county",
"text": "User Sub County",
"type": "string"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-hidden",
"valueBoolean": true
}
],
"linkId": "user_county",
"text": "User County",
"type": "string"
},
{
"linkId": "facility_level",
"type": "group",
"enableWhen": [
{
"question": "user_role",
"operator": "=",
"answerString": "VACCINATOR"
}
],
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-answerExpression",
"valueExpression": {
"language": "application/x-fhir-query",
"expression": "Location?_id={{%assignedCounty}}&_sort=name"
}
},
{
"extension": [
{
"url": "path",
"valueString": "name"
},
{
"url": "forDisplay",
"valueBoolean": true
}
],
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-choiceColumn"
}
],
"linkId": "294367770999",
"text": "County",
"type": "reference",
"required": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-answerExpression",
"valueExpression": {
"language": "application/x-fhir-query",
"expression": "Location?_id={{%assignedSubCounty}}&_sort=name"
}
},
{
"extension": [
{
"url": "path",
"valueString": "name"
},
{
"url": "forDisplay",
"valueBoolean": true
}
],
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-choiceColumn"
}
],
"linkId": "819946803642",
"text": "Sub County",
"type": "reference",
"required": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-answerExpression",
"valueExpression": {
"language": "application/x-fhir-query",
"expression": "Location?_id={{%assignedWard}}&_sort=name"
}
},
{
"extension": [
{
"url": "path",
"valueString": "name"
},
{
"url": "forDisplay",
"valueBoolean": true
}
],
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-choiceColumn"
}
],
"linkId": "819943434",
"text": "Ward",
"type": "reference",
"required": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-answerExpression",
"valueExpression": {
"language": "application/x-fhir-query",
"expression": "Location?_id={{%assignedFacility}}&_sort=name"
}
},
{
"extension": [
{
"url": "path",
"valueString": "name"
},
{
"url": "forDisplay",
"valueBoolean": true
}
],
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-choiceColumn"
}
],
"linkId": "819946803677",
"text": "Health Facility",
"type": "reference",
"required": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "438862163919",
"text": "Type of health facility",
"type": "choice",
"required": true,
"answerOption": [
{
"valueCoding": {
"code": "Private",
"display": "Private"
}
},
{
"valueCoding": {
"code": "Public",
"display": "Public"
}
},
{
"valueCoding": {
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}
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],
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{
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],
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"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-choiceColumn"
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],
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{
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"required": true
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{
"linkId": "946232932304",
"text": "Neighborhood major landmark.",
"type": "string",
"required": true
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{
"linkId": "487686858194",
"text": "Name Nearest Health Facility.",
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"required": true
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{
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],
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]
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]
},
{
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],
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"expression": "today()"
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],
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}
],
"linkId": "502488184403_helpText",
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]
},
{
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"valueString": "d/M/y"
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"valueString": "Cannot be a date in the future"
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{
"url": "http://hl7.org/fhir/StructureDefinition/maxValue",
"_valueDate": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/cqf-calculatedValue",
"valueExpression": {
"language": "text/fhirpath",
"expression": "today()"
}
}
]
}
},
{
"extension": [
{
"url": "key",
"valueId": "constraint-1"
},
{
"url": "requirements",
"valueString": "The date should be before the date of Investigation"
},
{
"url": "severity",
"valueCode": "error"
},
{
"url": "expression",
"valueString": "%context.answer.value <= %resource.descendants().where(linkId='502488184403').answer.value"
},
{
"url": "human",
"valueString": "The date should be before the date of Investigation"
},
{
"url": "location",
"valueString": "502488184403"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-constraint"
}
],
"linkId": "426321975477",
"text": "Date of Notification.",
"type": "date",
"required": true,
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "help",
"display": "Help-Button"
}
]
}
}
],
"linkId": "426321975477_helpText",
"text": "The date when the health facility reported the case to the sub-county and national health authorities.",
"type": "display"
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "171292274939",
"text": "Notified by? ",
"type": "choice",
"required": true,
"answerOption": [
{
"valueCoding": {
"display": "Health Worker/focal person in reporting site"
}
},
{
"valueCoding": {
"display": "Community Health Volunteer"
}
},
{
"valueCoding": {
"display": "Community Informant"
}
},
{
"valueCoding": {
"display": "Alternative Health Care Provider(traditionalhealer, herbalist, etc))"
}
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
}
]
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
"valueCode": "horizontal"
}
],
"linkId": "336643888536",
"text": "Was the patient admitted?",
"type": "choice",
"required": true,
"answerOption": [
{
"valueCoding": {
"code": "yes",
"display": "Yes"
}
},
{
"valueCoding": {
"code": "no",
"display": "No"
}
}
],
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "help",
"display": "Help-Button"
}
]
}
}
],
"linkId": "336643888536_helpText",
"text": "Was the patient hospitalized?",
"type": "display"
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/entryFormat",
"valueString": "d/M/y"
},
{
"url": "http://ehelse.no/fhir/StructureDefinition/validationtext",
"valueString": "Cannot be a date in the future"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/maxValue",
"_valueDate": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/cqf-calculatedValue",
"valueExpression": {
"language": "text/fhirpath",
"expression": "today()"
}
}
]
}
}
],
"linkId": "507199621281",
"text": "Date of admission.",
"type": "date",
"enableWhen": [
{
"question": "336643888536",
"operator": "=",
"answerCoding": {
"code": "yes",
"display": "Yes"
}
}
],
"required": true,
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "help",
"display": "Help-Button"
}
]
}
}
],
"linkId": "507199621281_helpText",
"text": "The date when the patient was admitted to a healthcare facility.",
"type": "display"
}
]
},
{
"linkId": "525996604810",
"text": "IP/OP No.",
"type": "string",
"required": true,
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "help",
"display": "Help-Button"
}
]
}
}
],
"linkId": "525996604810_helpText",
"text": "Inpatient (IP) or Outpatient (OP) number assigned by the health facility.",
"type": "display"
}
]
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "page",
"display": "Page"
}
]
}
}
],
"linkId": "735342695013",
"text": "Clinical Information",
"type": "group",
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/entryFormat",
"valueString": "d/M/y"
},
{
"url": "http://ehelse.no/fhir/StructureDefinition/validationtext",
"valueString": "Cannot be a date in the future"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/maxValue",
"_valueDate": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/cqf-calculatedValue",
"valueExpression": {
"language": "text/fhirpath",
"expression": "today()"
}
}
]
}
},
{
"extension": [
{
"url": "key",
"valueId": "constraint-1"
},
{
"url": "requirements",
"valueString": "The date should be before the date of Investigation"
},
{
"url": "severity",
"valueCode": "error"
},
{
"url": "expression",
"valueString": "%context.answer.value <= %resource.descendants().where(linkId='502488184403').answer.value"
},
{
"url": "human",
"valueString": "The date should be before the date of Investigation"
},
{
"url": "location",
"valueString": "502488184403"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-constraint"
}
],
"linkId": "728034137219",
"text": "Date of onset of paralysis.",
"type": "date",
"required": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
}
]
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
"valueCode": "horizontal"
}
],
"linkId": "932108244312",
"text": "Fever at onset of paralysis?",
"type": "choice",
"required": true,
"answerOption": [
{
"valueCoding": {
"code": "yes",
"display": "Yes"
}
},
{
"valueCoding": {
"code": "no",
"display": "No"
}
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
}
]
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
"valueCode": "horizontal"
}
],
"linkId": "396371836778",
"text": "Is paralysis of sudden onset?",
"type": "choice",
"required": true,
"answerOption": [
{
"valueCoding": {
"code": "yes",
"display": "Yes"
}
},
{
"valueCoding": {
"code": "no",
"display": "No"
}
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
}
]
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
"valueCode": "horizontal"
}
],
"linkId": "917680711879",
"text": "Progressive Paralysis < 3 days?",
"type": "choice",
"required": true,
"answerOption": [
{
"valueCoding": {
"code": "yes",
"display": "Yes"
}
},
{
"valueCoding": {
"code": "no",
"display": "No"
}
}
],
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "help",
"display": "Help-Button"
}
]
}
}
],
"linkId": "917680711879_helpText",
"text": "Was the progression of paralysis less than 3 days?",
"type": "display"
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
}
]
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
"valueCode": "horizontal"
}
],
"linkId": "776980947995",
"text": "Is paralysiss flaccid(floppy)?",
"type": "choice",
"required": true,
"answerOption": [
{
"valueCoding": {
"code": "yes",
"display": "Yes"
}
},
{
"valueCoding": {
"code": "no",
"display": "No"
}
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
}
]
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
"valueCode": "horizontal"
}
],
"linkId": "679475123276",
"text": "Is the paralysis asymmetric?",
"type": "choice",
"required": true,
"answerOption": [
{
"valueCoding": {
"code": "yes",
"display": "Yes"
}
},
{
"valueCoding": {
"code": "no",
"display": "No"
}
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "check-box",
"display": "Check Box"
}
]
}
}
],
"linkId": "828001350323",
"text": "Site of paralysis (check all that apply)",
"type": "choice",
"required": true,
"repeats": true,
"answerOption": [
{
"valueCoding": {
"code": "la",
"display": "LA"
}
},
{
"valueCoding": {
"code": "ll",
"display": "LL"
}
},
{
"valueCoding": {
"code": "ra",
"display": "RA"
}
},
{
"valueCoding": {
"code": "rl",
"display": "RL"
}
},
{
"valueCoding": {
"code": "othersite",
"display": "Other (Specify)"
}
}
]
},
{
"linkId": "815911574910",
"text": "Specify other site of Paralysis",
"type": "string",
"enableWhen": [
{
"question": "828001350323",
"operator": "=",
"answerCoding": {
"code": "othersite",
"display": "Other (Specify)"
}
}
],
"required": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
}
]
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
"valueCode": "horizontal"
}
],
"linkId": "249388449455",
"text": "Paralyzed limb sensitive to pain?",
"type": "choice",
"required": true,
"answerOption": [
{
"valueCoding": {
"code": "yes",
"display": "Yes"
}
},
{
"valueCoding": {
"code": "no",
"display": "No"
}
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
}
]
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
"valueCode": "horizontal"
}
],
"linkId": "638592165160",
"text": "Was there any injection just before onset of paralysis?",
"type": "choice",
"required": true,
"answerOption": [
{
"valueCoding": {
"code": "yes",
"display": "Yes"
}
},
{
"valueCoding": {
"code": "no",
"display": "No"
}
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "check-box",
"display": "Check Box"
}
]
}
}
],
"linkId": "701518392602",
"text": "Site of injection ( check all that applies).",
"type": "choice",
"enableWhen": [
{
"question": "638592165160",
"operator": "=",
"answerCoding": {
"code": "yes",
"display": "Yes"
}
}
],
"repeats": true,
"answerOption": [
{
"valueCoding": {
"code": "arm",
"display": "Left Arm"
}
},
{
"valueCoding": {
"code": "forearm",
"display": "Left Forearm"
}
},
{
"valueCoding": {
"code": "thigh",
"display": "Left Buttock"
}
},
{
"valueCoding": {
"code": "leg",
"display": "Left Thigh"
}
},
{
"valueCoding": {
"display": "Left Leg"
}
},
{
"valueCoding": {
"display": "Right Arm"
}
},
{
"valueCoding": {
"display": "Right Forearm"
}
},
{
"valueCoding": {
"display": "Right Buttock"
}
},
{
"valueCoding": {
"display": "Right Thigh"
}
},
{
"valueCoding": {
"display": "Right Leg"
}
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
}
]
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
"valueCode": "horizontal"
}
],
"linkId": "564450145870",
"text": "After Investigation, was this a true AFP?",
"type": "choice",
"answerOption": [
{
"valueCoding": {
"code": "yes",
"display": "Yes"
}
},
{
"valueCoding": {
"code": "no",
"display": "No"
}
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
}
]
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
"valueCode": "horizontal"
}
],
"linkId": "212304573462",
"text": "Outcome",
"type": "choice",
"answerOption": [
{
"valueCoding": {
"code": "hospitilized",
"display": "Still Hospitized"
}
},
{
"valueCoding": {
"code": "dead",
"display": "Dead"
}
},
{
"valueCoding": {
"code": "alive",
"display": "Alive"
}
}
]
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "page",
"display": "Page"
}
]
}
}
],
"linkId": "446305443608",
"text": "Vaccination History for disease under investigation",
"type": "group",
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
}
]
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
"valueCode": "horizontal"
}
],
"linkId": "970455623029",
"text": "Was the patient vaccinated against illness (including campaign)? ",
"type": "choice",
"required": true,
"answerOption": [
{
"valueCoding": {
"code": "yes",
"display": "Yes"
}
},
{
"valueCoding": {
"code": "no",
"display": "No"
}
},
{
"valueCoding": {
"code": "unknown",
"display": "Unknown"
}
}
],
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "help",
"display": "Help-Button"
}
]
}
}
],
"linkId": "970455623029_helpText",
"text": "Was the patient vaccinated against illness (including campaign)? ",
"type": "display"
}
]
},
{
"linkId": "886125589225",
"text": "Number of doses administered(Excluding birth OPV Dose)",
"type": "integer",
"enableWhen": [
{
"question": "970455623029",
"operator": "=",
"answerCoding": {
"code": "yes",
"display": "Yes"
}
}
],
"required": true,
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "help",
"display": "Help-Button"
}
]
}
}
],
"linkId": "886125589225_helpText",
"text": "The total number of polio vaccines administered (excluding birth OPV)",
"type": "display"
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/entryFormat",
"valueString": "d/M/y"
},
{
"url": "http://ehelse.no/fhir/StructureDefinition/validationtext",
"valueString": "Cannot be a date in the future"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/maxValue",
"_valueDate": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/cqf-calculatedValue",
"valueExpression": {
"language": "text/fhirpath",
"expression": "today()"
}
}
]
}
}
],
"linkId": "413372430071",
"text": "Date of OPV dose at birth.",
"type": "date",
"enableWhen": [
{
"question": "970455623029",
"operator": "=",
"answerCoding": {
"code": "yes",
"display": "Yes"
}
}
],
"required": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/entryFormat",
"valueString": "d/M/y"
},
{
"url": "http://ehelse.no/fhir/StructureDefinition/validationtext",
"valueString": "Cannot be a date in the future"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/maxValue",
"_valueDate": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/cqf-calculatedValue",
"valueExpression": {
"language": "text/fhirpath",
"expression": "today()"
}
}
]
}
}
],
"linkId": "671158128551",
"text": "Date of 1st dose.",
"type": "date",
"enableWhen": [
{
"question": "970455623029",
"operator": "=",
"answerCoding": {
"code": "yes",
"display": "Yes"
}
}
],
"required": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/entryFormat",
"valueString": "d/M/y"
},
{
"url": "http://ehelse.no/fhir/StructureDefinition/validationtext",
"valueString": "Cannot be a date in the future"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/maxValue",
"_valueDate": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/cqf-calculatedValue",
"valueExpression": {
"language": "text/fhirpath",
"expression": "today()"
}
}
]
}
},
{
"extension": [
{
"url": "key",
"valueId": "constraint-1"
},
{
"url": "requirements",
"valueString": "The date should be after the date of the 1st dose"
},
{
"url": "severity",
"valueCode": "error"
},
{
"url": "expression",
"valueString": "%context.answer.value >= %resource.descendants().where(linkId='671158128551').answer.value"
},
{
"url": "human",
"valueString": "The date should be after the date of the 1st dose"
},
{
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