FHIR IG analytics| Package | fhir.surveillanceIG |
| Resource Type | Questionnaire |
| Id | Questionnaire-MpoxTallySheet.json |
| FHIR Version | R4 |
| Source | https://build.fhir.org/ig/IntelliSOFT-Consulting/Surveillance-FHIR-IG/Questionnaire-MpoxTallySheet.html |
| URL | http://example.org/Questionnaire/MpoxTallySheet |
| Version | 0.1.0 |
| Status | active |
| Date | 2026-04-04T09:09:24+00:00 |
| Title | Mpox Tally Sheet |
| Realm | us |
| Authority | hl7 |
| Description | Mpox Tally Sheet questionnaire for disease surveillance |
No resources found
No resources found
Note: links and images are rebased to the (stated) source
Generated Narrative: Questionnaire MpoxTallySheet
Profile: http://hl7.org/fhir/4.0/StructureDefinition/Questionnaire
| LinkID | Text | Cardinality | Type | Flags | Description & Constraints |
|---|---|---|---|---|---|
  | Mpox Tally Sheet questionnaire for disease surveillance | Questionnaire | http://example.org/Questionnaire/MpoxTallySheet#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 | |
| village | Village | 1..1 | string | ||
| team_no | Team No | 1..1 | string | ||
| team_type | Team type | 1..1 | choice | Options: 3 options | |
| campaign_day | Campaign Day | 1..1 | choice | Options: 10 options | |
 728034137219 | Date | 1..1 | date | ||
| supervisor_name | Supervisor Name | 1..1 | string | ||
| supervisor_level | Supervisor Level | 1..1 | choice | Options: 4 options | |
| target_population | Number Reached | 0..1 | group | ||
| hcw_18_39_reported | Were any healthcare workers aged 18–39 years reported? | 1..1 | choice |  | Options: 2 options |
 hcw_18_39_male | Number of male healthcare workers aged 18–39 years reported | 0..1 | integer | Enable When: hcw_18_39_reported = yes (yes) | |
| hcw_18_39_female | Number of female healthcare workers aged 18–39 years reported | 0..1 | integer | Enable When: hcw_18_39_reported = yes (yes) | |
| hcw_18_39_male_no | Number of male healthcare workers aged 18–39 years reported | 0..1 | integer | | Enable When: hcw_18_39_reported = no (no) Initial Value: integer = 0 |
| hcw_18_39_female_no | Number of female healthcare workers aged 18–39 years reported | 0..1 | integer | | Enable When: hcw_18_39_reported = no (no) Initial Value: integer = 0 |
| hcw_40_59_reported | Were any healthcare workers aged 40–59 years reported? | 1..1 | choice | | Options: 2 options |
| hcw_40_59_male | Number of male healthcare workers aged 40–59 years reported | 0..1 | integer | Enable When: hcw_40_59_reported = yes (yes) | |
| hcw_40_59_female | Number of female healthcare workers aged 40–59 years reported | 0..1 | integer | Enable When: hcw_40_59_reported = yes (yes) | |
| hcw_40_59_male_no | Number of male healthcare workers aged 40–59 years reported | 0..1 | integer | | Enable When: hcw_40_59_reported = no (no) Initial Value: integer = 0 |
| hcw_40_59_female_no | Number of female healthcare workers aged 40–59 years reported | 0..1 | integer | | Enable When: hcw_40_59_reported = no (no) Initial Value: integer = 0 |
| hcw_60_plus_reported | Were any healthcare workers aged 60+ years reported? | 1..1 | choice | | Options: 2 options |
| hcw_60_plus_male | Number of male healthcare workers aged 60+ years reported | 0..1 | integer | Enable When: hcw_60_plus_reported = yes (yes) | |
| hcw_60_plus_female | Number of female healthcare workers aged 60+ years reported | 0..1 | integer | Enable When: hcw_60_plus_reported = yes (yes) | |
| hcw_60_plus_male_no | Number of male healthcare workers aged 60+ years reported | 0..1 | integer | | Enable When: hcw_60_plus_reported = no (no) Initial Value: integer = 0 |
| hcw_60_plus_female_no | Number of female healthcare workers aged 60+ years reported | 0..1 | integer | | Enable When: hcw_60_plus_reported = no (no) Initial Value: integer = 0 |
| sw_under_18_reported | Were any sex workers aged under 18 years reported? | 1..1 | choice | | Options: 2 options |
| sw_under_18_male | Number of male sex workers under 18 years reported | 0..1 | integer | Enable When: sw_under_18_reported = yes (yes) | |
| sw_under_18_female | Number of female sex workers aged under 18 years reported | 0..1 | integer | Enable When: sw_under_18_reported = yes (yes) | |
| sw_under_18_male_no | Number of male sex workers aged under 18 years reported | 0..1 | integer | | Enable When: sw_under_18_reported = no (no) Initial Value: integer = 0 |
| sw_under_18_female_no | Number of female sex workers aged under 18 years reported | 0..1 | integer | | Enable When: sw_under_18_reported = no (no) Initial Value: integer = 0 |
| sw_18_39_reported | Were any sex workers aged 18–39 years reported? | 1..1 | choice | | Options: 2 options |
| sw_18_39_male | Number of male sex workers aged 18–39 years reported | 0..1 | integer | Enable When: sw_18_39_reported = yes (yes) | |
| sw_18_39_female | Number of female sex workers aged 18–39 years reported | 0..1 | integer | Enable When: sw_18_39_reported = yes (yes) | |
| sw_18_39_male_no | Number of male sex workers aged 18–39 years reported | 0..1 | integer | | Enable When: sw_18_39_reported = no (no) Initial Value: integer = 0 |
| sw_18_39_female_no | Number of female sex workers aged 18–39 years reported | 0..1 | integer | | Enable When: sw_18_39_reported = no (no) Initial Value: integer = 0 |
| sw_40_59_reported | Were any sex workers aged 40–59 years reported? | 1..1 | choice | | Options: 2 options |
| sw_40_59_male | Number of male sex workers aged 40–59 years reported | 0..1 | integer | Enable When: sw_40_59_reported = yes (yes) | |
| sw_40_59_female | Number of female sex workers aged 40–59 years reported | 0..1 | integer | Enable When: sw_40_59_reported = yes (yes) | |
| sw_40_59_male_no | Number of male sex workers aged 40–59 years reported | 0..1 | integer | | Enable When: sw_40_59_reported = no (no) Initial Value: integer = 0 |
| sw_40_59_female_no | Number of female sex workers aged 40–59 years reported | 0..1 | integer | | Enable When: sw_40_59_reported = no (no) Initial Value: integer = 0 |
| sw_60_plus_reported | Were any sex workers aged 60+ years reported? | 1..1 | choice | | Options: 2 options |
| sw_60_plus_male | Number of male sex workers aged 60+ years reported | 0..1 | integer | Enable When: sw_60_plus_reported = yes (yes) | |
| sw_60_plus_female | Number of female sex workers aged 60+ years reported | 0..1 | integer | Enable When: sw_60_plus_reported = yes (yes) | |
| sw_60_plus_male_no | Number of male sex workers aged 60+ years reported | 0..1 | integer | | Enable When: sw_60_plus_reported = no (no) Initial Value: integer = 0 |
| sw_60_plus_female_no | Number of female sex workers aged 60+ years reported | 0..1 | integer | | Enable When: sw_60_plus_reported = no (no) Initial Value: integer = 0 |
| td_18_39_reported | Were any truck drivers aged 18–39 years reported? | 1..1 | choice | | Options: 2 options |
| td_18_39_male | Number of male truck drivers aged 18–39 years reported | 0..1 | integer | Enable When: td_18_39_reported = yes (yes) | |
| td_18_39_female | Number of female truck drivers aged 18–39 years reported | 0..1 | integer | Enable When: td_18_39_reported = yes (yes) | |
| td_18_39_male_no | Number of male truck drivers aged 18–39 years reported | 0..1 | integer | | Enable When: td_18_39_reported = no (no) Initial Value: integer = 0 |
| td_18_39_female_no | Number of female truck drivers aged 18–39 years reported | 0..1 | integer | | Enable When: td_18_39_reported = no (no) Initial Value: integer = 0 |
| td_40_59_reported | Were any truck drivers aged 40–59 years reported? | 1..1 | choice | | Options: 2 options |
| td_40_59_male | Number of male truck drivers aged 40–59 years reported | 0..1 | integer | Enable When: td_40_59_reported = yes (yes) | |
| td_40_59_female | Number of female truck drivers aged 40–59 years reported | 0..1 | integer | Enable When: td_40_59_reported = yes (yes) | |
| td_40_59_male_no | Number of male truck drivers aged 40–59 years reported | 0..1 | integer | | Enable When: td_40_59_reported = no (no) Initial Value: integer = 0 |
| td_40_59_female_no | Number of female truck drivers aged 40–59 years reported | 0..1 | integer | | Enable When: td_40_59_reported = no (no) Initial Value: integer = 0 |
| td_60_plus_reported | Were any truck drivers aged 60+ years reported? | 1..1 | choice | | Options: 2 options |
| td_60_plus_male | Number of male truck drivers aged 60+ years reported | 0..1 | integer | Enable When: td_60_plus_reported = yes (yes) | |
| td_60_plus_female | Number of female truck drivers aged 60+ years reported | 0..1 | integer | Enable When: td_60_plus_reported = yes (yes) | |
| td_60_plus_male_no | Number of male truck drivers aged 60+ years reported | 0..1 | integer | | Enable When: td_60_plus_reported = no (no) Initial Value: integer = 0 |
| td_60_plus_female_no | Number of female truck drivers aged 60+ years reported | 0..1 | integer | | Enable When: td_60_plus_reported = no (no) Initial Value: integer = 0 |
| others_18_39_reported | Were any others aged 18–39 years reported? | 1..1 | choice | | Options: 2 options |
| others_18_39_male | Number of male others aged 18–39 years reported | 0..1 | integer | Enable When: others_18_39_reported = yes (yes) | |
| others_18_39_female | Number of female others aged 18–39 years reported | 0..1 | integer | Enable When: others_18_39_reported = yes (yes) | |
| others_18_39_male_no | Number of male others aged 18–39 years reported | 0..1 | integer | | Enable When: others_18_39_reported = no (no) Initial Value: integer = 0 |
| others_18_39_female_no | Number of female others aged 18–39 years reported | 0..1 | integer | | Enable When: others_18_39_reported = no (no) Initial Value: integer = 0 |
| others_40_59_reported | Were any others aged 40–59 years reported? | 1..1 | choice | | Options: 2 options |
| others_40_59_male | Number of male others aged 40–59 years reported | 0..1 | integer | Enable When: others_40_59_reported = yes (yes) | |
| others_40_59_female | Number of female others aged 40–59 years reported | 0..1 | integer | Enable When: others_40_59_reported = yes (yes) | |
| others_40_59_male_no | Number of male others aged 40–59 years reported | 0..1 | integer | | Enable When: others_40_59_reported = no (no) Initial Value: integer = 0 |
| others_40_59_female_no | Number of female others aged 40–59 years reported | 0..1 | integer | | Enable When: others_40_59_reported = no (no) Initial Value: integer = 0 |
| others_60_plus_reported | Were any others aged 60+ years reported? | 1..1 | choice | | Options: 2 options |
| others_60_plus_male | Number of male others aged 60+ years reported | 0..1 | integer | Enable When: others_60_plus_reported = yes (yes) | |
| others_60_plus_female | Number of female others aged 60+ years reported | 0..1 | integer | Enable When: others_60_plus_reported = yes (yes) | |
| others_60_plus_male_no | Number of male others aged 60+ years reported | 0..1 | integer | | Enable When: others_60_plus_reported = no (no) Initial Value: integer = 0 |
| others_60_plus_female_no | Number of female others aged 60+ years reported | 0..1 | integer | | Enable When: others_60_plus_reported = no (no) Initial Value: integer = 0 |
| contact_under_18_reported | Were any contacts aged under 18 years reported? | 1..1 | choice | | Options: 2 options |
| contact_under_18_male | Number of male contacts aged under 18 years reported | 0..1 | integer | Enable When: contact_under_18_reported = yes (yes) | |
| contact_under_18_female | Number of female contacts aged under 18 years reported | 0..1 | integer | Enable When: contact_under_18_reported = yes (yes) | |
| contact_under_18_male_no | Number of male contacts aged under 18 years reported | 0..1 | integer | | Enable When: contact_under_18_reported = no (no) Initial Value: integer = 0 |
| contact_under_18_female_no | Number of female contacts aged under 18 years reported | 0..1 | integer | | Enable When: contact_under_18_reported = no (no) Initial Value: integer = 0 |
| contact_18_39_reported | Were any contacts aged 18–39 years reported? | 1..1 | choice | | Options: 2 options |
| contact_18_39_male | Number of male contacts aged 18–39 years reported | 0..1 | integer | Enable When: contact_18_39_reported = yes (yes) | |
| contact_18_39_female | Number of female contacts aged 18–39 years reported | 0..1 | integer | Enable When: contact_18_39_reported = yes (yes) | |
| contact_18_39_male_no | Number of male contacts aged 18–39 years reported | 0..1 | integer | | Enable When: contact_18_39_reported = no (no) Initial Value: integer = 0 |
| contact_18_39_female_no | Number of female contacts aged 18–39 years reported | 0..1 | integer | | Enable When: contact_18_39_reported = no (no) Initial Value: integer = 0 |
| contact_40_59_reported | Were any contacts aged 40–59 years reported? | 1..1 | choice | | Options: 2 options |
| contact_40_59_male | Number of male contacts aged 40–59 years reported | 0..1 | integer | Enable When: contact_40_59_reported = yes (yes) | |
| contact_40_59_female | Number of female contacts aged 40–59 years reported | 0..1 | integer | Enable When: contact_40_59_reported = yes (yes) | |
| contact_40_59_male_no | Number of male contacts aged 40–59 years reported | 0..1 | integer | | Enable When: contact_40_59_reported = no (no) Initial Value: integer = 0 |
| contact_40_59_female_no | Number of female contacts aged 40–59 years reported | 0..1 | integer | | Enable When: contact_40_59_reported = no (no) Initial Value: integer = 0 |
| contact_60_plus_reported | Were any contacts aged 60+ years reported? | 1..1 | choice | | Options: 2 options |
| contact_60_plus_male | Number of male contacts aged 60+ years reported | 0..1 | integer | Enable When: contact_60_plus_reported = yes (yes) | |
| contact_60_plus_female | Number of female contacts aged 60+ years reported | 0..1 | integer | Enable When: contact_60_plus_reported = yes (yes) | |
| contact_60_plus_male_no | Number of male contacts aged 60+ years reported | 0..1 | integer | | Enable When: contact_60_plus_reported = no (no) Initial Value: integer = 0 |
| contact_60_plus_female_no | Number of female contacts aged 60+ years reported | 0..1 | integer | | Enable When: contact_60_plus_reported = no (no) Initial Value: integer = 0 |
| utilization_aefi_mpox_surveilance | Vaccine Utilization, AEFI and Mpox Surveillance | 0..1 | group | ||
 vaccine_received | Number of doses of vaccine received | 1..1 | integer | ||
| vaccine_used | Number of vaccine doses used | 1..1 | integer | ||
| vaccine_remaining | Number of vaccine doses remaining | 1..1 | integer | ||
| aefi | AEFI | 0..1 | display | ||
| aefi_yes_no | Reported AEFI? | 1..1 | choice | | Options: 2 options |
| aefi_count | Number of vaccinee with reported AEFI | 1..1 | integer | Enable When: aefi_yes_no = yes (yes) | |
| surveilance | Surveilance | 0..1 | display | ||
| mpox_suspected_case_count | No. of Mpox Suspected Case detected | 1..1 | integer | ||
| rumour_tracking | Rumour Tracking | 0..1 | display | ||
| rumour_reported | Were any rumours reported | 1..1 | choice | | Options: 2 options |
| rumour_details | What was the rumour about | 1..1 | string | Enable When: rumour_reported = Yes (yes) | |
| rumour_escalated | Were they escalated | 1..1 | choice | | Enable When: rumour_reported = Yes (yes) Options: 2 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 team_type
Answer options for campaign_day
Answer options for supervisor_level
Answer options for hcw_18_39_reported
Answer options for hcw_40_59_reported
Answer options for hcw_60_plus_reported
Answer options for sw_under_18_reported
Answer options for sw_18_39_reported
Answer options for sw_40_59_reported
Answer options for sw_60_plus_reported
Answer options for td_18_39_reported
Answer options for td_40_59_reported
Answer options for td_60_plus_reported
Answer options for others_18_39_reported
Answer options for others_40_59_reported
Answer options for others_60_plus_reported
Answer options for contact_under_18_reported
Answer options for contact_18_39_reported
Answer options for contact_40_59_reported
Answer options for contact_60_plus_reported
Answer options for aefi_yes_no
Answer options for rumour_reported
Answer options for rumour_escalated
FHIR
FHIRsmith{
"resourceType": "Questionnaire",
"id": "MpoxTallySheet",
"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/MpoxTallySheet",
"version": "0.1.0",
"title": "Mpox Tally Sheet",
"status": "active",
"date": "2026-04-04T09:09:24+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 Tally Sheet questionnaire for disease surveillance",
"jurisdiction": [
{
"coding": [
{
"system": "urn:iso:std:iso:3166",
"code": "KE",
"display": "Kenya"
}
]
}
],
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "page",
"display": "Page"
}
]
}
}
],
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"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
}
],
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"text": "User Role",
"type": "string"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-hidden",
"valueBoolean": true
}
],
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"text": "User Facility",
"type": "string"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-hidden",
"valueBoolean": true
}
],
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"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",
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{
"question": "user_role",
"operator": "=",
"answerString": "VACCINATOR"
}
],
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{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-answerExpression",
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"language": "application/x-fhir-query",
"expression": "Location?_id={{%assignedCounty}}&_sort=name"
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},
{
"extension": [
{
"url": "path",
"valueString": "name"
},
{
"url": "forDisplay",
"valueBoolean": true
}
],
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-choiceColumn"
}
],
"linkId": "294367770999",
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"type": "reference",
"required": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-answerExpression",
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"language": "application/x-fhir-query",
"expression": "Location?_id={{%assignedSubCounty}}&_sort=name"
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},
{
"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",
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"required": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-answerExpression",
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"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",
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"required": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
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{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
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"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",
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{
"question": "user_role",
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"answerString": "SUBCOUNTY_DISEASE_SURVEILLANCE_OFFICER"
}
],
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-answerExpression",
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"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",
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"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"
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},
{
"extension": [
{
"url": "path",
"valueString": "name"
},
{
"url": "forDisplay",
"valueBoolean": true
}
],
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-choiceColumn"
}
],
"linkId": "819946803642_sub_county",
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"required": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-answerExpression",
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"expression": "Location?partof={{%selectedSubCountyNameSubCounty}}&_sort=name"
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},
{
"extension": [
{
"url": "path",
"valueString": "name"
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{
"url": "forDisplay",
"valueBoolean": true
}
],
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-choiceColumn"
}
],
"linkId": "819943434_sub_county",
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"required": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-answerExpression",
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"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",
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"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",
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{
"valueCoding": {
"code": "Private",
"display": "Private"
}
},
{
"valueCoding": {
"code": "Public",
"display": "Public"
}
},
{
"valueCoding": {
"code": "Faith Based",
"display": "Faith Based"
}
}
]
}
]
},
{
"linkId": "county_level",
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{
"question": "user_role",
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}
],
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{
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{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-answerExpression",
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"expression": "Location?_id={{%assignedCounty}}&_sort=name"
}
},
{
"extension": [
{
"url": "path",
"valueString": "name"
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{
"url": "forDisplay",
"valueBoolean": true
}
],
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-choiceColumn"
}
],
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"required": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-answerExpression",
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},
{
"extension": [
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"url": "path",
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{
"url": "forDisplay",
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],
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-choiceColumn"
}
],
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},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-answerExpression",
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},
{
"extension": [
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"url": "path",
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{
"url": "forDisplay",
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}
],
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-choiceColumn"
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],
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},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-answerExpression",
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},
{
"extension": [
{
"url": "path",
"valueString": "name"
},
{
"url": "forDisplay",
"valueBoolean": true
}
],
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-choiceColumn"
}
],
"linkId": "819946803677_county",
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"required": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
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"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
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}
}
],
"linkId": "438862163919_county",
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{
"valueCoding": {
"code": "Private",
"display": "Private"
}
},
{
"valueCoding": {
"code": "Public",
"display": "Public"
}
},
{
"valueCoding": {
"code": "Faith Based",
"display": "Faith Based"
}
}
]
}
]
},
{
"linkId": "national_level",
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{
"question": "user_role",
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"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",
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"required": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-answerExpression",
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},
{
"extension": [
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"url": "path",
"valueString": "name"
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{
"url": "forDisplay",
"valueBoolean": true
}
],
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-choiceColumn"
}
],
"linkId": "819946803642_national",
"text": "Sub County",
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"required": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-answerExpression",
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"expression": "Location?partof={{%selectedSubCountyNameNational}}&_sort=name"
}
},
{
"extension": [
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"url": "path",
"valueString": "name"
},
{
"url": "forDisplay",
"valueBoolean": true
}
],
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-choiceColumn"
}
],
"linkId": "819943434_national",
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"required": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-answerExpression",
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"expression": "Location?partof={{%selectedWardNameNational}}&_sort=name"
}
},
{
"extension": [
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"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",
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"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"
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]
}
}
],
"linkId": "438862163919_national",
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"required": true,
"answerOption": [
{
"valueCoding": {
"code": "Private",
"display": "Private"
}
},
{
"valueCoding": {
"code": "Public",
"display": "Public"
}
},
{
"valueCoding": {
"code": "Faith Based",
"display": "Faith Based"
}
}
]
}
]
},
{
"linkId": "village",
"text": "Village",
"type": "string",
"required": true
},
{
"linkId": "team_no",
"text": "Team No",
"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": "team_type",
"text": "Team 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://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
]
}
}
],
"linkId": "campaign_day",
"text": "Campaign Day",
"type": "choice",
"required": true,
"answerOption": [
{
"valueCoding": {
"code": "1",
"display": "Day 1"
}
},
{
"valueCoding": {
"code": "2",
"display": "Day 2"
}
},
{
"valueCoding": {
"code": "3",
"display": "Day 3"
}
},
{
"valueCoding": {
"code": "4",
"display": "Day 4"
}
},
{
"valueCoding": {
"code": "5",
"display": "Day 5"
}
},
{
"valueCoding": {
"code": "6",
"display": "Day 6"
}
},
{
"valueCoding": {
"code": "7",
"display": "Day 7"
}
},
{
"valueCoding": {
"code": "8",
"display": "Day 8"
}
},
{
"valueCoding": {
"code": "9",
"display": "Day 9"
}
},
{
"valueCoding": {
"code": "10",
"display": "Day 10"
}
}
]
},
{
"extension": [
{
"url": "http://ehelse.no/fhir/StructureDefinition/validationtext",
"valueString": "Cannot be a date in the future"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/entryFormat",
"valueString": "dd-mm-yyyy"
},
{
"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
},
{
"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": "target_population",
"text": "Number Reached",
"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": "hcw_18_39_reported",
"text": "Were any healthcare workers aged 18–39 years reported?",
"type": "choice",
"required": true,
"answerOption": [
{
"valueCoding": {
"code": "yes",
"display": "Yes"
}
},
{
"valueCoding": {
"code": "no",
"display": "No"
}
}
]
},
{
"linkId": "hcw_18_39_male",
"text": "Number of male healthcare workers aged 18–39 years reported",
"type": "integer",
"enableWhen": [
{
"question": "hcw_18_39_reported",
"operator": "=",
"answerCoding": {
"code": "yes"
}
}
]
},
{
"linkId": "hcw_18_39_female",
"text": "Number of female healthcare workers aged 18–39 years reported",
"type": "integer",
"enableWhen": [
{
"question": "hcw_18_39_reported",
"operator": "=",
"answerCoding": {
"code": "yes"
}
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-hidden",
"valueBoolean": true
}
],
"linkId": "hcw_18_39_male_no",
"text": "Number of male healthcare workers aged 18–39 years reported",
"type": "integer",
"enableWhen": [
{
"question": "hcw_18_39_reported",
"operator": "=",
"answerCoding": {
"code": "no"
}
}
],
"initial": [
{
"valueInteger": 0
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-hidden",
"valueBoolean": true
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"linkId": "others_18_39_male_no",
"text": "Number of male others aged 18–39 years reported",
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"enableWhen": [
{
"question": "others_18_39_reported",
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"answerCoding": {
"code": "no"
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}
],
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{
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}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-hidden",
"valueBoolean": true
}
],
"linkId": "others_18_39_female_no",
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"enableWhen": [
{
"question": "others_18_39_reported",
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"answerCoding": {
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}
],
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}
]
},
{
"extension": [
{
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"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
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]
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
"valueCode": "horizontal"
}
],
"linkId": "others_40_59_reported",
"text": "Were any others aged 40–59 years reported?",
"type": "choice",
"required": true,
"answerOption": [
{
"valueCoding": {
"code": "yes",
"display": "Yes"
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},
{
"valueCoding": {
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"display": "No"
}
}
]
},
{
"linkId": "others_40_59_male",
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{
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"operator": "=",
"answerCoding": {
"code": "yes"
}
}
]
},
{
"linkId": "others_40_59_female",
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"enableWhen": [
{
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"answerCoding": {
"code": "yes"
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}
]
},
{
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"valueBoolean": true
}
],
"linkId": "others_40_59_male_no",
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"enableWhen": [
{
"question": "others_40_59_reported",
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"answerCoding": {
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}
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}
]
},
{
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{
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"valueBoolean": true
}
],
"linkId": "others_40_59_female_no",
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{
"question": "others_40_59_reported",
"operator": "=",
"answerCoding": {
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}
],
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}
]
},
{
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}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
"valueCode": "horizontal"
}
],
"linkId": "others_60_plus_reported",
"text": "Were any others aged 60+ years reported?",
"type": "choice",
"required": true,
"answerOption": [
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"valueCoding": {
"code": "yes",
"display": "Yes"
}
},
{
"valueCoding": {
"code": "no",
"display": "No"
}
}
]
},
{
"linkId": "others_60_plus_male",
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{
"question": "others_60_plus_reported",
"operator": "=",
"answerCoding": {
"code": "yes"
}
}
]
},
{
"linkId": "others_60_plus_female",
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"enableWhen": [
{
"question": "others_60_plus_reported",
"operator": "=",
"answerCoding": {
"code": "yes"
}
}
]
},
{
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{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-hidden",
"valueBoolean": true
}
],
"linkId": "others_60_plus_male_no",
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{
"question": "others_60_plus_reported",
"operator": "=",
"answerCoding": {
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}
],
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}
]
},
{
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"valueBoolean": true
}
],
"linkId": "others_60_plus_female_no",
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{
"question": "others_60_plus_reported",
"operator": "=",
"answerCoding": {
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}
],
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}
]
},
{
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"display": "Radio Button"
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}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
"valueCode": "horizontal"
}
],
"linkId": "contact_under_18_reported",
"text": "Were any contacts aged under 18 years reported?",
"type": "choice",
"required": true,
"answerOption": [
{
"valueCoding": {
"code": "yes",
"display": "Yes"
}
},
{
"valueCoding": {
"code": "no",
"display": "No"
}
}
]
},
{
"linkId": "contact_under_18_male",
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"enableWhen": [
{
"question": "contact_under_18_reported",
"operator": "=",
"answerCoding": {
"code": "yes"
}
}
]
},
{
"linkId": "contact_under_18_female",
"text": "Number of female contacts aged under 18 years reported",
"type": "integer",
"enableWhen": [
{
"question": "contact_under_18_reported",
"operator": "=",
"answerCoding": {
"code": "yes"
}
}
]
},
{
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{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-hidden",
"valueBoolean": true
}
],
"linkId": "contact_under_18_male_no",
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{
"question": "contact_under_18_reported",
"operator": "=",
"answerCoding": {
"code": "no"
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}
],
"initial": [
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"valueInteger": 0
}
]
},
{
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{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-hidden",
"valueBoolean": true
}
],
"linkId": "contact_under_18_female_no",
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"enableWhen": [
{
"question": "contact_under_18_reported",
"operator": "=",
"answerCoding": {
"code": "no"
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}
],
"initial": [
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}
]
},
{
"extension": [
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}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
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],
"linkId": "contact_18_39_reported",
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"required": true,
"answerOption": [
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"code": "yes",
"display": "Yes"
}
},
{
"valueCoding": {
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"display": "No"
}
}
]
},
{
"linkId": "contact_18_39_male",
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"operator": "=",
"answerCoding": {
"code": "yes"
}
}
]
},
{
"linkId": "contact_18_39_female",
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"enableWhen": [
{
"question": "contact_18_39_reported",
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"answerCoding": {
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}
]
},
{
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"valueBoolean": true
}
],
"linkId": "contact_18_39_male_no",
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{
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"operator": "=",
"answerCoding": {
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}
],
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}
]
},
{
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{
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"valueBoolean": true
}
],
"linkId": "contact_18_39_female_no",
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"enableWhen": [
{
"question": "contact_18_39_reported",
"operator": "=",
"answerCoding": {
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}
],
"initial": [
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]
},
{
"extension": [
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}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
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}
],
"linkId": "contact_40_59_reported",
"text": "Were any contacts aged 40–59 years reported?",
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"required": true,
"answerOption": [
{
"valueCoding": {
"code": "yes",
"display": "Yes"
}
},
{
"valueCoding": {
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"display": "No"
}
}
]
},
{
"linkId": "contact_40_59_male",
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{
"question": "contact_40_59_reported",
"operator": "=",
"answerCoding": {
"code": "yes"
}
}
]
},
{
"linkId": "contact_40_59_female",
"text": "Number of female contacts aged 40–59 years reported",
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"enableWhen": [
{
"question": "contact_40_59_reported",
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"answerCoding": {
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}
]
},
{
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"valueBoolean": true
}
],
"linkId": "contact_40_59_male_no",
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"enableWhen": [
{
"question": "contact_40_59_reported",
"operator": "=",
"answerCoding": {
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}
],
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}
]
},
{
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{
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"valueBoolean": true
}
],
"linkId": "contact_40_59_female_no",
"text": "Number of female contacts aged 40–59 years reported",
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"enableWhen": [
{
"question": "contact_40_59_reported",
"operator": "=",
"answerCoding": {
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}
],
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]
},
{
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}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
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],
"linkId": "contact_60_plus_reported",
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"required": true,
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"valueCoding": {
"code": "yes",
"display": "Yes"
}
},
{
"valueCoding": {
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}
]
},
{
"linkId": "contact_60_plus_male",
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{
"question": "contact_60_plus_reported",
"operator": "=",
"answerCoding": {
"code": "yes"
}
}
]
},
{
"linkId": "contact_60_plus_female",
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"type": "integer",
"enableWhen": [
{
"question": "contact_60_plus_reported",
"operator": "=",
"answerCoding": {
"code": "yes"
}
}
]
},
{
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{
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"valueBoolean": true
}
],
"linkId": "contact_60_plus_male_no",
"text": "Number of male contacts aged 60+ years reported",
"type": "integer",
"enableWhen": [
{
"question": "contact_60_plus_reported",
"operator": "=",
"answerCoding": {
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}
],
"initial": [
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"valueInteger": 0
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-hidden",
"valueBoolean": true
}
],
"linkId": "contact_60_plus_female_no",
"text": "Number of female contacts aged 60+ years reported",
"type": "integer",
"enableWhen": [
{
"question": "contact_60_plus_reported",
"operator": "=",
"answerCoding": {
"code": "no"
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}
],
"initial": [
{
"valueInteger": 0
}
]
}
]
},
{
"linkId": "utilization_aefi_mpox_surveilance",
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"type": "group",
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/maxValue",
"valueInteger": 9999
}
],
"linkId": "vaccine_received",
"text": "Number of doses of vaccine received",
"type": "integer",
"required": true
},
{
"extension": [
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"url": "http://hl7.org/fhir/StructureDefinition/maxValue",
"valueInteger": 9999
},
{
"extension": [
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"url": "key",
"valueId": "constraint-1"
},
{
"url": "requirements",
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},
{
"url": "severity",
"valueCode": "error"
},
{
"url": "expression",
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},
{
"url": "human",
"valueString": "Doses used cannot be more than the doses received"
},
{
"url": "location",
"valueString": "1"
}
],
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}
],
"linkId": "vaccine_used",
"text": "Number of vaccine doses used",
"type": "integer",
"required": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/maxValue",
"valueInteger": 9999
},
{
"extension": [
{
"url": "key",
"valueId": "constraint-1"
},
{
"url": "requirements",
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},
{
"url": "severity",
"valueCode": "error"
},
{
"url": "expression",
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},
{
"url": "human",
"valueString": "Doses used cannot be more than the doses received"
},
{
"url": "location",
"valueString": "1"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-constraint"
}
],
"linkId": "vaccine_remaining",
"text": "Number of vaccine doses remaining",
"type": "integer",
"required": true
},
{
"linkId": "aefi",
"text": "AEFI",
"type": "display"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
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"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
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}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
"valueCode": "horizontal"
}
],
"linkId": "aefi_yes_no",
"text": "Reported AEFI?",
"type": "choice",
"required": true,
"answerOption": [
{
"valueCoding": {
"code": "yes",
"display": "Yes"
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},
{
"valueCoding": {
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},
{
"extension": [
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},
{
"extension": [
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"url": "key",
"valueId": "constraint-1"
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{
"url": "requirements",
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{
"url": "severity",
"valueCode": "error"
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{
"url": "expression",
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},
{
"url": "human",
"valueString": "AEFI count cannot be more than the doses used"
},
{
"url": "location",
"valueString": "1"
}
],
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-constraint"
}
],
"linkId": "aefi_count",
"text": "Number of vaccinee with reported AEFI",
"type": "integer",
"enableWhen": [
{
"question": "aefi_yes_no",
"operator": "=",
"answerCoding": {
"code": "yes"
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}
],
"required": true
},
{
"linkId": "surveilance",
"text": "Surveilance",
"type": "display"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/maxValue",
"valueInteger": 9999
}
],
"linkId": "mpox_suspected_case_count",
"text": "No. of Mpox Suspected Case detected",
"type": "integer",
"required": true
},
{
"linkId": "rumour_tracking",
"text": "Rumour Tracking",
"type": "display"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
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]
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
"valueCode": "horizontal"
}
],
"linkId": "rumour_reported",
"text": "Were any rumours reported",
"type": "choice",
"required": true,
"answerOption": [
{
"valueCoding": {
"code": "yes",
"display": "Yes"
}
},
{
"valueCoding": {
"code": "no",
"display": "No"
}
}
]
},
{
"linkId": "rumour_details",
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"type": "string",
"enableWhen": [
{
"question": "rumour_reported",
"operator": "=",
"answerCoding": {
"code": "yes",
"display": "Yes"
}
}
],
"required": true
},
{
"extension": [
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"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
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"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": "rumour_escalated",
"text": "Were they escalated",
"type": "choice",
"enableWhen": [
{
"question": "rumour_reported",
"operator": "=",
"answerCoding": {
"code": "yes",
"display": "Yes"
}
}
],
"required": true,
"answerOption": [
{
"valueCoding": {
"code": "yes",
"display": "Yes"
}
},
{
"valueCoding": {
"code": "no",
"display": "No"
}
}
]
}
]
}
]
}