FHIR IG analytics| Package | fhir.surveillanceIG |
| Resource Type | Questionnaire |
| Id | Questionnaire-MpoxRegister.json |
| FHIR Version | R4 |
| Source | https://build.fhir.org/ig/IntelliSOFT-Consulting/Surveillance-FHIR-IG/Questionnaire-MpoxRegister.html |
| URL | http://example.org/Questionnaire/MpoxRegister |
| Version | 0.1.0 |
| Status | active |
| Date | 2026-05-04T06:19:40+00:00 |
| Title | Mpox Register |
| Realm | us |
| Authority | hl7 |
| Description | Mpox vaccination register questionnaire |
No resources found
No resources found
Note: links and images are rebased to the (stated) source
Generated Narrative: Questionnaire MpoxRegister
Profile: http://hl7.org/fhir/4.0/StructureDefinition/Questionnaire
| LinkID | Text | Cardinality | Type | Flags | Description & Constraints |
|---|---|---|---|---|---|
  | Mpox vaccination register questionnaire | Questionnaire | http://example.org/Questionnaire/MpoxRegister#0.1.0 | ||
  151479012557 | Reporting Site | 0..1 | group | ||
  546255966914 | Hospital/Facility Location | 0..1 | display | ||
 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 |  | |
| client_information | Client Information | 0..1 | group | ||
| 873240407472 | First Name | 1..1 | string | ||
| 246751846436 | Middle Name | 0..1 | string | ||
| 486402457213 | Last Name | 1..1 | string | ||
| dob_known | Is Date of Birth known? | 1..1 | choice |  | Options: 2 options |
 257830485990 | Date of Birth | 1..1 | date | Enable When: dob_known = Yes (yes) | |
| calculated_age | Age | 1..1 | string | | Enable When: dob_known = Yes (yes) |
| age-group | Age Details | 0..1 | group | Enable When: dob_known = No (no) | |
 492731638700 | Age in Years | 1..1 | integer | ||
| 185726989867 | Age in Months | 0..1 | integer | ||
| 828303331247 | Age in Days | 0..1 | integer | ||
| 929966324957 | Gender | 0..1 | choice | | Options: 2 options |
| occupation | Occupation | 1..1 | choice | Options: 4 options | |
| occupation-other | Please specify other occupation | 1..1 | string | Enable When: occupation = Other (occupation-codes#OTH) | |
| nationality | Nationality | 0..1 | choice | Options: 2 options | |
| country_of_origin | If Non-Kenyan, specify country of origin | 1..1 | string | Enable When: nationality = Non-Kenyan (unknown#NON) | |
| patient-identify-type | Identification Type | 1..1 | choice | Options: 2 options | |
| PR-id-value | Identification Number | 1..1 | string | ||
| a4-county | County | 1..1 | reference | Enable When: nationality = Kenyan (unknown#KE) | |
| a3-sub-county | Sub County | 1..1 | reference | Enable When: nationality = Kenyan (unknown#KE) | |
| a2-ward | Ward | 1..1 | reference | Enable When: nationality = Kenyan (unknown#KE) | |
| PR-address-village | Village | 1..1 | string | ||
| 754217593839 | Phone Number | 1..1 | string | ||
| 2.1 | 07xxxxxxxx | 0..1 | display | ||
| location_widget | GPS Coordinate | 0..1 | group | ||
  latitude | Latitude | 0..1 | decimal | ||
| longitude | Longitude | 0..1 | decimal | ||
| screening | Screening | 0..1 | group | ||
| contact_mpox | Contact of Mpox Case | 0..1 | choice | | Options: 2 options |
| allergic_history | Allergic History | 0..1 | choice | | Options: 2 options |
| dosage | Dose Information | 0..1 | group | ||
| vaccine_name | Vaccine name | 0..1 | choice | | Options: 3 options |
| date_given | Date Given | 1..1 | date | ||
| batch_no | Batch Number | 1..1 | string | ||
| vaccination_center | Name of Vaccination Center | 1..1 | string | ||
| supervisor_name | Supervisor Name | 1..1 | string | ||
| supervisor_level | Supervisor Level | 1..1 | choice | Options: 4 options | |
| 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 dob_known
Answer options for 929966324957
Answer options for occupation
Answer options for nationality
Answer options for patient-identify-type
Answer options for contact_mpox
Answer options for allergic_history
Answer options for vaccine_name
Answer options for supervisor_level
FHIR
FHIRsmith{
"resourceType": "Questionnaire",
"id": "MpoxRegister",
"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": "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": "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/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/uv/sdc/StructureDefinition/sdc-questionnaire-entryMode",
"valueCode": "prior-edit"
}
],
"url": "http://example.org/Questionnaire/MpoxRegister",
"version": "0.1.0",
"title": "Mpox Register",
"status": "active",
"date": "2026-05-04T06:19:40+00:00",
"publisher": "Kenya National Public Health Institute",
"contact": [
{
"name": "Kenya National Public Health Institute",
"telecom": [
{
"system": "url",
"value": "https://www.nphi.go.ke/"
}
]
},
{
"name": "Kenya National Public Health Institute",
"telecom": [
{
"system": "url",
"value": "https://www.nphi.go.ke/",
"use": "work"
}
]
}
],
"description": "Mpox vaccination register questionnaire",
"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": [
{
"linkId": "546255966914",
"text": "Hospital/Facility Location",
"type": "display"
},
{
"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": {
"code": "Faith Based",
"display": "Faith Based"
}
}
]
}
]
},
{
"linkId": "sub_county_level",
"type": "group",
"enableWhen": [
{
"question": "user_role",
"operator": "=",
"answerString": "SUBCOUNTY_DISEASE_SURVEILLANCE_OFFICER"
}
],
"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_sub_county",
"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_sub_county",
"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?partof={{%selectedSubCountyNameSubCounty}}&_sort=name"
}
},
{
"extension": [
{
"url": "path",
"valueString": "name"
},
{
"url": "forDisplay",
"valueBoolean": true
}
],
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-choiceColumn"
}
],
"linkId": "819943434_sub_county",
"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?partof={{%selectedWardNameSubCounty}}&_sort=name"
}
},
{
"extension": [
{
"url": "path",
"valueString": "name"
},
{
"url": "forDisplay",
"valueBoolean": true
}
],
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-choiceColumn"
}
],
"linkId": "819946803677_sub_county",
"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_sub_county",
"text": "Type of health facility",
"type": "choice",
"required": true,
"answerOption": [
{
"valueCoding": {
"code": "Private",
"display": "Private"
}
},
{
"valueCoding": {
"code": "Public",
"display": "Public"
}
},
{
"valueCoding": {
"code": "Faith Based",
"display": "Faith Based"
}
}
]
}
]
},
{
"linkId": "county_level",
"type": "group",
"enableWhen": [
{
"question": "user_role",
"operator": "=",
"answerString": "COUNTY_DISEASE_SURVEILLANCE_OFFICER"
}
],
"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_county",
"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?partof={{%selectedCountyNameCounty}}&_sort=name"
}
},
{
"extension": [
{
"url": "path",
"valueString": "name"
},
{
"url": "forDisplay",
"valueBoolean": true
}
],
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-choiceColumn"
}
],
"linkId": "819946803642_county",
"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?partof={{%selectedSubCountyNameCounty}}&_sort=name"
}
},
{
"extension": [
{
"url": "path",
"valueString": "name"
},
{
"url": "forDisplay",
"valueBoolean": true
}
],
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-choiceColumn"
}
],
"linkId": "819943434_county",
"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?partof={{%selectedWardNameCounty}}&_sort=name"
}
},
{
"extension": [
{
"url": "path",
"valueString": "name"
},
{
"url": "forDisplay",
"valueBoolean": true
}
],
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-choiceColumn"
}
],
"linkId": "819946803677_county",
"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_county",
"text": "Type of health facility",
"type": "choice",
"required": true,
"answerOption": [
{
"valueCoding": {
"code": "Private",
"display": "Private"
}
},
{
"valueCoding": {
"code": "Public",
"display": "Public"
}
},
{
"valueCoding": {
"code": "Faith Based",
"display": "Faith Based"
}
}
]
}
]
},
{
"linkId": "national_level",
"type": "group",
"enableWhen": [
{
"question": "user_role",
"operator": "=",
"answerString": "ADMINISTRATOR"
}
],
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-answerExpression",
"valueExpression": {
"language": "application/x-fhir-query",
"expression": "Location?partof=Location/0&_sort=name"
}
},
{
"extension": [
{
"url": "path",
"valueString": "name"
},
{
"url": "forDisplay",
"valueBoolean": true
}
],
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-choiceColumn"
}
],
"linkId": "294367770999_national",
"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?partof={{%selectedCountyNameNational}}&_sort=name"
}
},
{
"extension": [
{
"url": "path",
"valueString": "name"
},
{
"url": "forDisplay",
"valueBoolean": true
}
],
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-choiceColumn"
}
],
"linkId": "819946803642_national",
"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?partof={{%selectedSubCountyNameNational}}&_sort=name"
}
},
{
"extension": [
{
"url": "path",
"valueString": "name"
},
{
"url": "forDisplay",
"valueBoolean": true
}
],
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-choiceColumn"
}
],
"linkId": "819943434_national",
"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?partof={{%selectedWardNameNational}}&_sort=name"
}
},
{
"extension": [
{
"url": "path",
"valueString": "name"
},
{
"url": "forDisplay",
"valueBoolean": true
}
],
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-choiceColumn"
}
],
"linkId": "819946803677_national",
"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_national",
"text": "Type of health facility",
"type": "choice",
"required": true,
"answerOption": [
{
"valueCoding": {
"code": "Private",
"display": "Private"
}
},
{
"valueCoding": {
"code": "Public",
"display": "Public"
}
},
{
"valueCoding": {
"code": "Faith Based",
"display": "Faith Based"
}
}
]
}
]
},
{
"linkId": "992818778559",
"text": "EPID No",
"type": "string",
"readOnly": true
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "page",
"display": "Page"
}
]
}
}
],
"linkId": "client_information",
"text": "Client Information",
"type": "group",
"item": [
{
"linkId": "873240407472",
"text": "First Name",
"type": "string",
"required": true
},
{
"linkId": "246751846436",
"text": "Middle Name",
"type": "string"
},
{
"linkId": "486402457213",
"text": "Last Name",
"type": "string",
"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": "dob_known",
"text": "Is Date of Birth known?",
"type": "choice",
"required": true,
"answerOption": [
{
"valueCoding": {
"code": "yes",
"display": "Yes"
}
},
{
"valueCoding": {
"code": "no",
"display": "No"
}
}
]
},
{
"extension": [
{
"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()"
}
}
]
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/entryFormat",
"valueString": "dd-mm-yyyy"
}
],
"linkId": "257830485990",
"text": "Date of Birth",
"type": "date",
"enableWhen": [
{
"question": "dob_known",
"operator": "=",
"answerCoding": {
"code": "yes",
"display": "Yes"
}
}
],
"required": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-hidden",
"valueBoolean": true
}
],
"linkId": "calculated_age",
"text": "Age",
"type": "string",
"enableWhen": [
{
"question": "dob_known",
"operator": "=",
"answerCoding": {
"code": "yes",
"display": "Yes"
}
}
],
"required": true
},
{
"linkId": "age-group",
"text": "Age Details",
"type": "group",
"enableWhen": [
{
"question": "dob_known",
"operator": "=",
"answerCoding": {
"code": "no",
"display": "No"
}
}
],
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/maxValue",
"valueInteger": 999
}
],
"linkId": "492731638700",
"text": "Age in Years",
"type": "integer",
"required": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/maxValue",
"valueInteger": 11
}
],
"linkId": "185726989867",
"text": "Age in Months",
"type": "integer"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/maxValue",
"valueInteger": 31
}
],
"linkId": "828303331247",
"text": "Age in Days",
"type": "integer"
}
]
},
{
"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": "929966324957",
"text": "Gender",
"type": "choice",
"answerOption": [
{
"valueCoding": {
"system": "http://hl7.org/fhir/administrative-gender",
"code": "female",
"display": "Female"
}
},
{
"valueCoding": {
"system": "http://hl7.org/fhir/administrative-gender",
"code": "male",
"display": "Male"
}
}
]
},
{
"linkId": "occupation",
"text": "Occupation",
"type": "choice",
"required": true,
"answerOption": [
{
"valueCoding": {
"system": "http://example.org/fhir/CodeSystem/occupation-codes",
"code": "HCW",
"display": "Health Care Worker"
}
},
{
"valueCoding": {
"system": "http://example.org/fhir/CodeSystem/occupation-codes",
"code": "SW",
"display": "Sex Worker"
}
},
{
"valueCoding": {
"system": "http://example.org/fhir/CodeSystem/occupation-codes",
"code": "TD",
"display": "Truck Driver"
}
},
{
"valueCoding": {
"system": "http://example.org/fhir/CodeSystem/occupation-codes",
"code": "OTH",
"display": "Other"
}
}
]
},
{
"linkId": "occupation-other",
"text": "Please specify other occupation",
"type": "string",
"enableWhen": [
{
"question": "occupation",
"operator": "=",
"answerCoding": {
"system": "http://example.org/fhir/CodeSystem/occupation-codes",
"code": "OTH",
"display": "Other"
}
}
],
"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": "nationality",
"text": "Nationality",
"type": "choice",
"answerOption": [
{
"valueCoding": {
"system": "urn:iso:std:iso:3166",
"code": "KE",
"display": "Kenyan"
}
},
{
"valueCoding": {
"system": "urn:iso:std:iso:3166",
"code": "NON",
"display": "Non-Kenyan"
}
}
]
},
{
"linkId": "country_of_origin",
"text": "If Non-Kenyan, specify country of origin",
"type": "string",
"enableWhen": [
{
"question": "nationality",
"operator": "=",
"answerCoding": {
"system": "urn:iso:std:iso:3166",
"code": "NON",
"display": "Non-Kenyan"
}
}
],
"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": "patient-identify-type",
"text": "Identification Type",
"type": "choice",
"required": true,
"answerOption": [
{
"valueCoding": {
"system": "http://hl7.org/fhir/administrative-identifier",
"code": "nationalId",
"display": "National ID"
}
},
{
"valueCoding": {
"system": "http://hl7.org/fhir/administrative-identifier",
"code": "passport",
"display": "Passport"
}
}
]
},
{
"linkId": "PR-id-value",
"text": "Identification Number",
"type": "string",
"required": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-answerExpression",
"valueExpression": {
"language": "application/x-fhir-query",
"expression": "Location?partof=Location/0&_sort=name"
}
},
{
"extension": [
{
"url": "path",
"valueString": "name"
},
{
"url": "forDisplay",
"valueBoolean": true
}
],
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-choiceColumn"
}
],
"linkId": "a4-county",
"text": "County",
"type": "reference",
"enableWhen": [
{
"question": "nationality",
"operator": "=",
"answerCoding": {
"system": "urn:iso:std:iso:3166",
"code": "KE",
"display": "Kenyan"
}
}
],
"required": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-answerExpression",
"valueExpression": {
"language": "application/x-fhir-query",
"expression": "Location?partof={{%patientCountyName}}"
}
},
{
"extension": [
{
"url": "path",
"valueString": "name"
},
{
"url": "forDisplay",
"valueBoolean": true
}
],
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-choiceColumn"
}
],
"linkId": "a3-sub-county",
"text": "Sub County",
"type": "reference",
"enableWhen": [
{
"question": "nationality",
"operator": "=",
"answerCoding": {
"system": "urn:iso:std:iso:3166",
"code": "KE",
"display": "Kenyan"
}
}
],
"required": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-answerExpression",
"valueExpression": {
"language": "application/x-fhir-query",
"expression": "Location?partof={{%patientSubCountyName}}&_sort=name"
}
},
{
"extension": [
{
"url": "path",
"valueString": "name"
},
{
"url": "forDisplay",
"valueBoolean": true
}
],
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-choiceColumn"
}
],
"linkId": "a2-ward",
"text": "Ward",
"type": "reference",
"enableWhen": [
{
"question": "nationality",
"operator": "=",
"answerCoding": {
"system": "urn:iso:std:iso:3166",
"code": "KE",
"display": "Kenyan"
}
}
],
"required": true
},
{
"linkId": "PR-address-village",
"text": "Village",
"type": "string",
"required": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "phone-number",
"display": "Phone Number"
}
]
}
},
{
"url": "http://ehelse.no/fhir/StructureDefinition/validationtext",
"valueString": "Enter a valid mobile number. Strings and special characters aren't allowed"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/regex",
"valueString": "^\\d{10,10}[%content%]quot;
}
],
"linkId": "754217593839",
"text": "Phone Number",
"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": "flyover",
"display": "Fly-over"
}
]
}
}
],
"linkId": "2.1",
"text": "07xxxxxxxx",
"type": "display"
}
]
},
{
"linkId": "location_widget",
"text": "GPS Coordinate",
"type": "group",
"item": [
{
"linkId": "latitude",
"text": "Latitude",
"type": "decimal"
},
{
"linkId": "longitude",
"text": "Longitude",
"type": "decimal"
}
]
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "page",
"display": "Page"
}
]
}
}
],
"linkId": "screening",
"text": "Screening",
"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": "contact_mpox",
"text": "Contact of Mpox Case",
"type": "choice",
"answerOption": [
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v2-0136",
"code": "yes",
"display": "Yes"
}
},
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v2-0136",
"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": "allergic_history",
"text": "Allergic History",
"type": "choice",
"answerOption": [
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v2-0136",
"code": "yes",
"display": "Yes"
}
},
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v2-0136",
"code": "no",
"display": "No"
}
}
]
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "page",
"display": "Page"
}
]
}
}
],
"linkId": "dosage",
"text": "Dose Information",
"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": "vaccine_name",
"text": "Vaccine name",
"type": "choice",
"answerOption": [
{
"valueCoding": {
"code": "MVA-BN",
"display": "MVA-BN"
}
},
{
"valueCoding": {
"code": "LC16",
"display": "LC16"
}
},
{
"valueCoding": {
"code": "ACAM2000",
"display": "ACAM 2000"
}
}
]
},
{
"extension": [
{
"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()"
}
}
]
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/entryFormat",
"valueString": "dd-mm-yyyy"
}
],
"linkId": "date_given",
"text": "Date Given",
"type": "date",
"required": true
},
{
"linkId": "batch_no",
"text": "Batch Number",
"type": "string",
"required": true
},
{
"linkId": "vaccination_center",
"text": "Name of Vaccination Center",
"type": "string",
"required": true
},
{
"linkId": "supervisor_name",
"text": "Supervisor Name",
"type": "string",
"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": "supervisor_level",
"text": "Supervisor Level",
"type": "choice",
"required": true,
"answerOption": [
{
"valueCoding": {
"code": "National",
"display": "National"
}
},
{
"valueCoding": {
"code": "County",
"display": "County"
}
},
{
"valueCoding": {
"code": "Sub County",
"display": "Sub County"
}
},
{
"valueCoding": {
"code": "Partner",
"display": "Partner"
}
}
]
}
]
}
]
}