FHIR IG analytics| Package | fhir.surveillanceIG |
| Resource Type | Questionnaire |
| Id | Questionnaire-MpoxSupervisorChecklist.json |
| FHIR Version | R4 |
| Source | https://build.fhir.org/ig/IntelliSOFT-Consulting/Surveillance-FHIR-IG/Questionnaire-MpoxSupervisorChecklist.html |
| URL | http://example.org/Questionnaire/MpoxSupervisorChecklist |
| Version | 0.1.0 |
| Status | active |
| Date | 2025-08-09 |
| Title | Supervisor Checklist |
| Realm | us |
| Authority | hl7 |
| Description | Mpox Supervisor Checklist questionnaire for disease surveillance |
| Purpose | Record all supervisor related activities |
No resources found
No resources found
Note: links and images are rebased to the (stated) source
Generated Narrative: Questionnaire MpoxSupervisorChecklist
Profile: http://hl7.org/fhir/4.0/StructureDefinition/Questionnaire
| LinkID | Text | Cardinality | Type | Flags | Description & Constraints |
|---|---|---|---|---|---|
  | Mpox Supervisor Checklist questionnaire for disease surveillance | Questionnaire | http://example.org/Questionnaire/MpoxSupervisorChecklist#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 | |
| site_name | Vaccination Site Name | 1..1 | string | ||
| site_type | Vaccination Site Type | 1..1 | choice | Options: 3 options | |
 728034137219 | Date | 1..1 | date | ||
| location_widget | GPS Coordinate | 0..1 | group | ||
 latitude | Latitude | 0..1 | decimal | ||
| longitude | Longitude | 0..1 | decimal | ||
| supervisor_name | Supervisor Name | 1..1 | string | ||
| supervisor_level | Supervisor Level | 1..1 | choice | Options: 4 options | |
| planning | Planning | 0..1 | group | ||
| team_movement_plan_available | Team Movement Plan Available? | 1..1 | choice |  | Options: 2 options |
| rcce_strategy_in_place | Risk communication & community engagement (RCCE) strategy in place? | 1..1 | choice | | Options: 2 options |
| healthcare_worker_preparedness | Healthcare Worker Preparedness | 0..1 | group | ||
| trained_on_mpox_vaccine_admin | Vaccinators trained on Mpox vaccine administration? | 1..1 | choice | | Options: 2 options |
| trained_on_aefi_recognition_reporting | Vaccinators trained on AEFI recognition & reporting? | 1..1 | choice | | Options: 2 options |
| trained_on_infection_prevention | Vaccinators trained on infection prevention (hard hygiene, waste disposal)? | 1..1 | choice | | Options: 2 options |
| vaccine_supplies_and_cold_chain | Vaccine supplies and Cold Chain Management | 0..1 | group | ||
| vaccines_with_valid_vvm | Vaccines carrier with foam pad? | 1..1 | choice | | Options: 2 options |
| cold_chain_maintained_temp_logs | Cold chain maintained (2–8°C) with temperature logs? | 1..1 | choice | | Options: 2 options |
| sufficient_supplies_available | Sufficient AD syringes, safety boxes? | 1..1 | choice | | Options: 2 options |
| emergency_stock_reserved | Emergency stock reserved for high-risk areas? | 1..1 | choice | | Options: 2 options |
| backup_generator_or_solar_available | Backup generator/solar system available? | 1..1 | choice | | Enable When: site_type = Static (static) Options: 2 options |
| vaccination_site_setup | Vaccination Site Setup | 0..1 | group | ||
| site_meets_infection_standards | Site meets infection prevention standards (handwashing, distancing)? | 1..1 | choice | | Options: 2 options |
| separate_zones_present | Separate zones: Registration, Screening, Vaccination, Observation? | 1..1 | choice | | Options: 2 options |
| privacy_ensured | Privacy ensured (e.g., curtains for undressing if intradermal)? | 1..1 | choice | | Options: 2 options |
| emergency_kit_available | Emergency kit with adrenaline, 2ml Syringe and needle available? | 1..1 | choice | | Options: 2 options |
| vaccination_process | Vaccination Process | 0..1 | group | ||
| correct_site | Did the vaccinators administer Mpox vaccine in the correct site as per the guidelines (Observation)? | 1..1 | choice | | Options: 2 options |
| correct_route_used | Vaccine administered via correct route? | 1..1 | choice | | Options: 2 options |
| aseptic_technique_followed | Aseptic technique (Dry cotton swap, sterile syringe and needle)? | 1..1 | choice | | Options: 2 options |
| reporting | Reporting | 0..1 | group | ||
| data_entered_in_nphiis | Vaccination data entered in National Public Health Intelligence platform daily (NPHIIS)? | 1..1 | choice | | Options: 2 options |
| any_aefis | Was there an AEFI? | 1..1 | choice | | Options: 2 options |
| aefi_reported_immediately | AEFIs reported immediately to the team supervisor? | 1..1 | choice | | Enable When: any_aefis = Yes (yes) Options: 2 options |
| data_collection_tools_available | Data Collection tools available and adequate? | 1..1 | choice | | Options: 2 options |
| which_tool | Which Tool? | 1..* | choice | Enable When: data_collection_tools_available = Yes (yes) Options: 2 options | |
| infection_prevention_and_waste | Infection Prevention & Waste Disposal | 0..1 | group | ||
| ppe_used | PPE used by all vaccinators (gowns)? | 1..1 | choice | | Options: 2 options |
| sharps_in_safety_boxes | Sharps in WHO-approved safety boxes? | 1..1 | choice | | Options: 2 options |
| biomedical_waste_disposed_correctly | Is the generated healthcare waste properly segregated? | 1..1 | choice | | Options: 2 options |
| community_engagement | Community Engagement | 0..1 | group | ||
| rumors_addressed | Rumors addressed via hotline/community leaders? | 1..1 | choice | | Options: 2 options |
| sensitization_materials_local_languages | Sensitization materials in local languages (Swahili, vernacular)? | 1..1 | choice | | Options: 2 options |
| post_vaccination | Post-Vaccination | 0..1 | group | ||
| observation_after_vaccination | Recipients observed for 15+ minutes post-vaccination? | 1..1 | choice | | Options: 2 options |
| aefi_forms_ready | Have the AEFI forms been filled at the facility level and cascaded to the sub-county? | 1..1 | choice | | Enable When: any_aefis = Yes (yes) Options: 2 options |
| rumour_tracking | Rumor Tracking | 0..1 | group | ||
| mpox_rumor_heard | Have you heard any rumors / hesitancy on Mpox vaccine? | 1..1 | choice | | Options: 2 options |
| mpox_rumor_options | If yes, select all that apply | 1..* | choice | Enable When: mpox_rumor_heard = yes (yes) Options: 6 options | |
| mpox_rumor_other_specify | If other kindly specify | 1..1 | string | Enable When: mpox_rumor_options = other (other) | |
| mpox_rumor_action | State what you did with the rumor | 1..1 | string | Enable When: mpox_rumor_heard = yes (yes) | |
| mpox_rumor_source_trusted | Did you trust the source of the rumor? | 1..1 | choice | | Enable When: mpox_rumor_heard = yes (yes) Options: 2 options |
| mpox_rumor_investigated | Was the rumor investigated? | 1..1 | choice | | Enable When: mpox_rumor_heard = yes (yes) Options: 2 options |
 mpox_rumor_steps_taken | Which steps did you take to address the rumor? | 1..1 | text | Enable When: mpox_rumor_heard = yes (yes) | |
| supervisors_final_assessment | Supervisor's Final Assessment | 0..1 | group | ||
 any_challenges | Were there any challenges? | 1..1 | choice | | Options: 2 options |
| key_challenges | Key challenges: | 1..1 | string | Enable When: any_challenges = yes (yes) | |
| corrective_actions_taken | Corrective actions taken for gaps. | 1..1 | string | Enable When: key_challenges exists true | |
| recommendations_for_next_phase | Recommendations for next phase | 1..1 | string | ||
| 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 site_type
Answer options for supervisor_level
Answer options for team_movement_plan_available
Answer options for rcce_strategy_in_place
Answer options for trained_on_mpox_vaccine_admin
Answer options for trained_on_aefi_recognition_reporting
Answer options for trained_on_infection_prevention
Answer options for vaccines_with_valid_vvm
Answer options for cold_chain_maintained_temp_logs
Answer options for sufficient_supplies_available
Answer options for emergency_stock_reserved
Answer options for backup_generator_or_solar_available
Answer options for site_meets_infection_standards
Answer options for separate_zones_present
Answer options for privacy_ensured
Answer options for emergency_kit_available
Answer options for correct_site
Answer options for correct_route_used
Answer options for aseptic_technique_followed
Answer options for data_entered_in_nphiis
Answer options for any_aefis
Answer options for aefi_reported_immediately
Answer options for data_collection_tools_available
Answer options for which_tool
Answer options for ppe_used
Answer options for sharps_in_safety_boxes
Answer options for biomedical_waste_disposed_correctly
Answer options for rumors_addressed
Answer options for sensitization_materials_local_languages
Answer options for observation_after_vaccination
Answer options for aefi_forms_ready
Answer options for mpox_rumor_heard
Answer options for mpox_rumor_options
Answer options for mpox_rumor_source_trusted
Answer options for mpox_rumor_investigated
Answer options for any_challenges
FHIR
FHIRsmith{
"resourceType": "Questionnaire",
"id": "MpoxSupervisorChecklist",
"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": "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/MpoxSupervisorChecklist",
"version": "0.1.0",
"title": "Supervisor Checklist",
"status": "active",
"date": "2025-08-09",
"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": "Mpox Supervisor Checklist questionnaire for disease surveillance",
"jurisdiction": [
{
"coding": [
{
"system": "urn:iso:std:iso:3166",
"code": "KE",
"display": "Kenya"
}
]
}
],
"purpose": "Record all supervisor related activities",
"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": "site_name",
"text": "Vaccination Site 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": "site_type",
"text": "Vaccination Site Type",
"type": "choice",
"required": true,
"answerOption": [
{
"valueCoding": {
"code": "static",
"display": "Static"
}
},
{
"valueCoding": {
"code": "temporary_fixed",
"display": "Temporary Fixed"
}
},
{
"valueCoding": {
"code": "mobile_sites",
"display": "Mobile sites"
}
}
]
},
{
"extension": [
{
"url": "http://ehelse.no/fhir/StructureDefinition/validationtext",
"valueString": "Cannot be a date in the future"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/entryFormat",
"valueString": "d/M/y"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/maxValue",
"_valueDate": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/cqf-calculatedValue",
"valueExpression": {
"language": "text/fhirpath",
"expression": "today()"
}
}
]
}
}
],
"linkId": "728034137219",
"text": "Date",
"type": "date",
"required": true
},
{
"extension": [
{
"url": "https://github.com/google/android-fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "https://github.com/google/android-fhir/questionnaire-item-control",
"code": "location-widget"
}
]
}
}
],
"linkId": "location_widget",
"text": "GPS Coordinate",
"type": "group",
"item": [
{
"extension": [
{
"url": "gps-coordinate",
"valueString": "latitude"
}
],
"linkId": "latitude",
"text": "Latitude",
"type": "decimal"
},
{
"extension": [
{
"url": "gps-coordinate",
"valueString": "longitude"
}
],
"linkId": "longitude",
"text": "Longitude",
"type": "decimal"
}
]
},
{
"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"
}
}
]
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "page",
"display": "Page"
}
]
}
}
],
"linkId": "planning",
"text": "Planning",
"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": "team_movement_plan_available",
"text": "Team Movement Plan Available?",
"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": "rcce_strategy_in_place",
"text": "Risk communication & community engagement (RCCE) strategy in place?",
"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": "page",
"display": "Page"
}
]
}
}
],
"linkId": "healthcare_worker_preparedness",
"text": "Healthcare Worker Preparedness",
"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": "trained_on_mpox_vaccine_admin",
"text": "Vaccinators trained on Mpox vaccine administration?",
"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": "trained_on_aefi_recognition_reporting",
"text": "Vaccinators trained on AEFI recognition & reporting?",
"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": "trained_on_infection_prevention",
"text": "Vaccinators trained on infection prevention (hard hygiene, waste disposal)?",
"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": "page",
"display": "Page"
}
]
}
}
],
"linkId": "vaccine_supplies_and_cold_chain",
"text": "Vaccine supplies and Cold Chain Management",
"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": "vaccines_with_valid_vvm",
"text": "Vaccines carrier with foam pad?",
"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": "cold_chain_maintained_temp_logs",
"text": "Cold chain maintained (2–8°C) with temperature logs?",
"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": "sufficient_supplies_available",
"text": "Sufficient AD syringes, safety boxes?",
"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": "emergency_stock_reserved",
"text": "Emergency stock reserved for high-risk areas?",
"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": "backup_generator_or_solar_available",
"text": "Backup generator/solar system available?",
"type": "choice",
"enableWhen": [
{
"question": "site_type",
"operator": "=",
"answerCoding": {
"code": "static",
"display": "Static"
}
}
],
"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": "page",
"display": "Page"
}
]
}
}
],
"linkId": "vaccination_site_setup",
"text": "Vaccination Site Setup",
"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": "site_meets_infection_standards",
"text": "Site meets infection prevention standards (handwashing, distancing)?",
"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": "separate_zones_present",
"text": "Separate zones: Registration, Screening, Vaccination, Observation?",
"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": "privacy_ensured",
"text": "Privacy ensured (e.g., curtains for undressing if intradermal)?",
"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": "emergency_kit_available",
"text": "Emergency kit with adrenaline, 2ml Syringe and needle available?",
"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": "page",
"display": "Page"
}
]
}
}
],
"linkId": "vaccination_process",
"text": "Vaccination Process",
"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": "correct_site",
"text": "Did the vaccinators administer Mpox vaccine in the correct site as per the guidelines (Observation)?",
"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": "correct_route_used",
"text": "Vaccine administered via correct route?",
"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": "aseptic_technique_followed",
"text": "Aseptic technique (Dry cotton swap, sterile syringe and needle)?",
"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": "page",
"display": "Page"
}
]
}
}
],
"linkId": "reporting",
"text": "Reporting",
"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": "data_entered_in_nphiis",
"text": "Vaccination data entered in National Public Health Intelligence platform daily (NPHIIS)?",
"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": "any_aefis",
"text": "Was there an AEFI?",
"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": "aefi_reported_immediately",
"text": "AEFIs reported immediately to the team supervisor?",
"type": "choice",
"enableWhen": [
{
"question": "any_aefis",
"operator": "=",
"answerCoding": {
"code": "yes",
"display": "Yes"
}
}
],
"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": "data_collection_tools_available",
"text": "Data Collection tools available and adequate?",
"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": "which_tool",
"text": "Which Tool?",
"type": "choice",
"enableWhen": [
{
"question": "data_collection_tools_available",
"operator": "=",
"answerCoding": {
"code": "yes",
"display": "Yes"
}
}
],
"required": true,
"repeats": true,
"answerOption": [
{
"valueCoding": {
"code": "Tally_Sheet",
"display": "Tally Sheet"
}
},
{
"valueCoding": {
"code": "AEFI_form",
"display": "AEFI form"
}
}
]
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "page",
"display": "Page"
}
]
}
}
],
"linkId": "infection_prevention_and_waste",
"text": "Infection Prevention & Waste Disposal",
"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": "ppe_used",
"text": "PPE used by all vaccinators (gowns)?",
"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": "sharps_in_safety_boxes",
"text": "Sharps in WHO-approved safety boxes?",
"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": "biomedical_waste_disposed_correctly",
"text": "Is the generated healthcare waste properly segregated?",
"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": "page",
"display": "Page"
}
]
}
}
],
"linkId": "community_engagement",
"text": "Community Engagement",
"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": "rumors_addressed",
"text": "Rumors addressed via hotline/community leaders?",
"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": "sensitization_materials_local_languages",
"text": "Sensitization materials in local languages (Swahili, vernacular)?",
"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": "page",
"display": "Page"
}
]
}
}
],
"linkId": "post_vaccination",
"text": "Post-Vaccination",
"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": "observation_after_vaccination",
"text": "Recipients observed for 15+ minutes post-vaccination?",
"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": "aefi_forms_ready",
"text": "Have the AEFI forms been filled at the facility level and cascaded to the sub-county?",
"type": "choice",
"enableWhen": [
{
"question": "any_aefis",
"operator": "=",
"answerCoding": {
"code": "yes",
"display": "Yes"
}
}
],
"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": "page",
"display": "Page"
}
]
}
}
],
"linkId": "rumour_tracking",
"text": "Rumor Tracking",
"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": "mpox_rumor_heard",
"text": "Have you heard any rumors / hesitancy on Mpox vaccine?",
"type": "choice",
"required": true,
"answerOption": [
{
"valueCoding": {
"code": "yes",
"display": "Yes"
}
},
{
"valueCoding": {
"code": "no",
"display": "No"
}
}
]
},
{
"linkId": "mpox_rumor_options",
"text": "If yes, select all that apply",
"type": "choice",
"enableWhen": [
{
"question": "mpox_rumor_heard",
"operator": "=",
"answerCoding": {
"code": "yes"
}
}
],
"required": true,
"repeats": true,
"answerOption": [
{
"valueCoding": {
"code": "death",
"display": "Mpox vaccine can cause death"
}
},
{
"valueCoding": {
"code": "infertility",
"display": "Mpox vaccine can cause infertility"
}
},
{
"valueCoding": {
"code": "depopulation",
"display": "Mpox vaccine is Bill and Melinda depopulation agenda"
}
},
{
"valueCoding": {
"code": "unsafe",
"display": "Mpox vaccine is not safe and can cause serious side effects"
}
},
{
"valueCoding": {
"code": "covid_finish",
"display": "Mpox vaccine is a way of finishing the COVID-19 vaccine"
}
},
{
"valueCoding": {
"code": "other",
"display": "Other"
}
}
]
},
{
"linkId": "mpox_rumor_other_specify",
"text": "If other kindly specify",
"type": "string",
"enableWhen": [
{
"question": "mpox_rumor_options",
"operator": "=",
"answerCoding": {
"code": "other"
}
}
],
"required": true
},
{
"linkId": "mpox_rumor_action",
"text": "State what you did with the rumor",
"type": "string",
"enableWhen": [
{
"question": "mpox_rumor_heard",
"operator": "=",
"answerCoding": {
"code": "yes"
}
}
],
"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": "mpox_rumor_source_trusted",
"text": "Did you trust the source of the rumor?",
"type": "choice",
"enableWhen": [
{
"question": "mpox_rumor_heard",
"operator": "=",
"answerCoding": {
"code": "yes"
}
}
],
"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": "mpox_rumor_investigated",
"text": "Was the rumor investigated?",
"type": "choice",
"enableWhen": [
{
"question": "mpox_rumor_heard",
"operator": "=",
"answerCoding": {
"code": "yes"
}
}
],
"required": true,
"answerOption": [
{
"valueCoding": {
"code": "yes",
"display": "Yes"
}
},
{
"valueCoding": {
"code": "no",
"display": "No"
}
}
]
},
{
"linkId": "mpox_rumor_steps_taken",
"text": "Which steps did you take to address the rumor?",
"type": "text",
"enableWhen": [
{
"question": "mpox_rumor_heard",
"operator": "=",
"answerCoding": {
"code": "yes"
}
}
],
"required": 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": "supervisors_final_assessment",
"text": "Supervisor's Final Assessment",
"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": "any_challenges",
"text": "Were there any challenges?",
"type": "choice",
"required": true,
"answerOption": [
{
"valueCoding": {
"code": "yes",
"display": "Yes"
}
},
{
"valueCoding": {
"code": "no",
"display": "No"
}
}
]
},
{
"linkId": "key_challenges",
"text": "Key challenges:",
"type": "string",
"enableWhen": [
{
"question": "any_challenges",
"operator": "=",
"answerCoding": {
"code": "yes"
}
}
],
"required": true
},
{
"linkId": "corrective_actions_taken",
"text": "Corrective actions taken for gaps.",
"type": "string",
"enableWhen": [
{
"question": "key_challenges",
"operator": "exists",
"answerBoolean": true
}
],
"required": true
},
{
"linkId": "recommendations_for_next_phase",
"text": "Recommendations for next phase",
"type": "string",
"required": true
}
]
}
]
}