FHIR IG analytics| Package | fhir.surveillanceIG |
| Resource Type | Questionnaire |
| Id | Questionnaire-VlCaseHospitalization.json |
| FHIR Version | R4 |
| Source | https://build.fhir.org/ig/IntelliSOFT-Consulting/Surveillance-FHIR-IG/Questionnaire-VlCaseHospitalization.html |
| URL | http://example.org/Questionnaire/VlCaseHospitalization |
| Version | 0.1.0 |
| Status | draft |
| Date | 2026-05-04T06:19:40+00:00 |
| Title | VL Case Lab Information |
| Realm | us |
| Authority | hl7 |
| Description | Hospitalization and treatment information for Visceral Leishmaniasis cases |
No resources found
No resources found
Note: links and images are rebased to the (stated) source
Generated Narrative: Questionnaire VlCaseHospitalization
Profile: http://hl7.org/fhir/4.0/StructureDefinition/Questionnaire
| LinkID | Text | Cardinality | Type | Flags | Description & Constraints |
|---|---|---|---|---|---|
  | Hospitalization and treatment information for Visceral Leishmaniasis cases | Questionnaire | http://example.org/Questionnaire/VlCaseHospitalization#0.1.0 | ||
  782742635664 | Treatment/Hospitilazation | 0..1 | group | ||
   428237064956 | IP No | 1..1 | string | ||
| 272556667885 | Hospital Ward | 1..1 | string | ||
 885705999856 | Date of Admission | 1..1 | date | ||
| 150613899880 | Date Leishmaniasis Treatment Started | 1..1 | date | ||
 733604782646 | Treatment Regimen | 1..1 | choice | Options: 5 options | |
| 498949031326 | Other Treatment Regimen ( Specify) | 1..1 | string | Enable When: 733604782646 = Other (Specify). (reg-005) | |
 regimen-dosage | Treatment Regimen Dosage | 1..1 | decimal | ||
| 175945763878 | Number of Treatment Days | 1..1 | choice | Options: 4 options | |
 686824046139 | Number of treatment days (Specify) | 1..1 | integer | Enable When: 175945763878 = Other (Specify) (trtemnt-004) | |
| 723427815459 | Was Treatment Completed? | 0..1 | choice |  | Options: 2 options |
| 342763225855 | Reason for Incomplete Treatment | 1..1 | string | Enable When: 723427815459 = No (no) | |
| 708058904265 | Initial Treatment Outcome | 1..1 | choice | Options: 5 options | |
| 131738268669 | Cause of Death | 1..1 | choice | Enable When: 708058904265 = Death (outcome-005) Options: 6 options | |
| 884379481934 | Was there any reported severe adverse event of drug(s) used? | 1..1 | choice | | Options: 2 options |
| 560909523868 | Input Name(s) of Drug Causing Adverse Event | 1..1 | string | Enable When: 884379481934 = Yes (yes) | |
| 396444399071 | Indicate Description of Severe Adverse Event | 1..1 | string | Enable When: 884379481934 = Yes (yes) | |
| 904748389038 | Any other condition(s) treated during Initial VL treatment? | 1..1 | choice | | Options: 2 options |
| 922498480736 | Name of Other Condition | 1..1 | string | Enable When: 904748389038 = Yes (yes) | |
| Documentation for this format | |||||
Options Sets
Answer options for 733604782646
Answer options for 175945763878
Answer options for 723427815459
Answer options for 708058904265
Answer options for 131738268669
Answer options for 884379481934
Answer options for 904748389038
FHIR
FHIRsmith{
"resourceType": "Questionnaire",
"id": "VlCaseHospitalization",
"meta": {
"profile": [
"http://hl7.org/fhir/4.0/StructureDefinition/Questionnaire"
]
},
"text": {
"status": "extensions",
"div": "<!-- snip (see above) -->"
},
"url": "http://example.org/Questionnaire/VlCaseHospitalization",
"version": "0.1.0",
"title": "VL Case Lab Information",
"status": "draft",
"date": "2026-05-04T06:19:40+00:00",
"publisher": "Kenya National Public Health Institute",
"contact": [
{
"name": "Kenya National Public Health Institute",
"telecom": [
{
"system": "url",
"value": "https://www.nphi.go.ke/"
}
]
},
{
"name": "Kenya National Public Health Institute",
"telecom": [
{
"system": "url",
"value": "https://www.nphi.go.ke/",
"use": "work"
}
]
}
],
"description": "Hospitalization and treatment information for Visceral Leishmaniasis cases",
"jurisdiction": [
{
"coding": [
{
"system": "urn:iso:std:iso:3166",
"code": "KE",
"display": "Kenya"
}
]
}
],
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "page",
"display": "Page"
}
]
}
}
],
"linkId": "782742635664",
"text": "Treatment/Hospitilazation",
"type": "group",
"item": [
{
"linkId": "428237064956",
"text": "IP No",
"type": "string",
"required": true
},
{
"linkId": "272556667885",
"text": "Hospital Ward",
"type": "string",
"required": true
},
{
"extension": [
{
"url": "http://ehelse.no/fhir/StructureDefinition/validationtext",
"valueString": "Cannot be a date in the future"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/maxValue",
"_valueDate": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/cqf-calculatedValue",
"valueExpression": {
"language": "text/fhirpath",
"expression": "today()"
}
}
]
}
}
],
"linkId": "885705999856",
"text": "Date of Admission",
"type": "date",
"required": true
},
{
"extension": [
{
"url": "http://ehelse.no/fhir/StructureDefinition/validationtext",
"valueString": "Cannot be a date in the future"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/maxValue",
"_valueDate": {
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/cqf-calculatedValue",
"valueExpression": {
"language": "text/fhirpath",
"expression": "today()"
}
}
]
}
}
],
"linkId": "150613899880",
"text": "Date Leishmaniasis Treatment Started",
"type": "date",
"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": "733604782646",
"text": "Treatment Regimen",
"type": "choice",
"required": true,
"answerOption": [
{
"valueCoding": {
"code": "reg-001",
"display": "Combination (SSG + Paramomycin)(17 days)"
}
},
{
"valueCoding": {
"code": "reg-002",
"display": "Pentostam (SSG) (30 days)"
}
},
{
"valueCoding": {
"code": "reg-003",
"display": "Glucantime"
}
},
{
"valueCoding": {
"code": "reg-004",
"display": "Liposomal Amphotericin B (6-10 days)"
}
},
{
"valueCoding": {
"code": "reg-005",
"display": "Other (Specify)."
}
}
]
},
{
"linkId": "498949031326",
"text": "Other Treatment Regimen ( Specify)",
"type": "string",
"enableWhen": [
{
"question": "733604782646",
"operator": "=",
"answerCoding": {
"code": "reg-005",
"display": "Other (Specify)."
}
}
],
"required": true
},
{
"linkId": "regimen-dosage",
"text": "Treatment Regimen Dosage",
"type": "decimal",
"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": "175945763878",
"text": "Number of Treatment Days",
"type": "choice",
"required": true,
"answerOption": [
{
"valueCoding": {
"code": "trtemnt-001",
"display": "6-10 Days"
}
},
{
"valueCoding": {
"code": "trtemnt-002",
"display": "17 Days"
}
},
{
"valueCoding": {
"code": "trtemnt-003",
"display": "30 Days"
}
},
{
"valueCoding": {
"code": "trtemnt-004",
"display": "Other (Specify)"
}
}
]
},
{
"linkId": "686824046139",
"text": "Number of treatment days (Specify)",
"type": "integer",
"enableWhen": [
{
"question": "175945763878",
"operator": "=",
"answerCoding": {
"code": "trtemnt-004",
"display": "Other (Specify)"
}
}
],
"required": true
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "radio-button",
"display": "Radio Button"
}
]
}
},
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation",
"valueCode": "horizontal"
}
],
"linkId": "723427815459",
"text": "Was Treatment Completed?",
"type": "choice",
"answerOption": [
{
"valueCoding": {
"code": "yes",
"display": "Yes"
}
},
{
"valueCoding": {
"code": "no",
"display": "No"
}
}
]
},
{
"linkId": "342763225855",
"text": "Reason for Incomplete Treatment",
"type": "string",
"enableWhen": [
{
"question": "723427815459",
"operator": "=",
"answerCoding": {
"code": "no",
"display": "No"
}
}
],
"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": "708058904265",
"text": "Initial Treatment Outcome",
"type": "choice",
"required": true,
"answerOption": [
{
"valueCoding": {
"code": "outcome-001",
"display": "Initial cure"
}
},
{
"valueCoding": {
"code": "outcome-002",
"display": "Probable non-response"
}
},
{
"valueCoding": {
"code": "outcome-003",
"display": "Confirmed non-response"
}
},
{
"valueCoding": {
"code": "outcome-004",
"display": "Default"
}
},
{
"valueCoding": {
"code": "outcome-005",
"display": "Death"
}
}
]
},
{
"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": "131738268669",
"text": "Cause of Death",
"type": "choice",
"enableWhen": [
{
"question": "708058904265",
"operator": "=",
"answerCoding": {
"code": "outcome-005",
"display": "Death"
}
}
],
"required": true,
"answerOption": [
{
"valueCoding": {
"code": "death-cause-001",
"display": "Unknown"
}
},
{
"valueCoding": {
"code": "death-cause-002",
"display": "VL"
}
},
{
"valueCoding": {
"code": "death-cause-003",
"display": "HIV"
}
},
{
"valueCoding": {
"code": "death-cause-004",
"display": "Other disease"
}
},
{
"valueCoding": {
"code": "death-cause-005",
"display": "SAE"
}
},
{
"valueCoding": {
"code": "death-cause-006",
"display": "Non-medical condition"
}
}
]
},
{
"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": "884379481934",
"text": "Was there any reported severe adverse event of drug(s) used?",
"type": "choice",
"required": true,
"answerOption": [
{
"valueCoding": {
"code": "yes",
"display": "Yes"
}
},
{
"valueCoding": {
"code": "no",
"display": "No"
}
}
]
},
{
"linkId": "560909523868",
"text": "Input Name(s) of Drug Causing Adverse Event",
"type": "string",
"enableWhen": [
{
"question": "884379481934",
"operator": "=",
"answerCoding": {
"code": "yes",
"display": "Yes"
}
}
],
"required": true
},
{
"linkId": "396444399071",
"text": "Indicate Description of Severe Adverse Event",
"type": "string",
"enableWhen": [
{
"question": "884379481934",
"operator": "=",
"answerCoding": {
"code": "yes",
"display": "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": "904748389038",
"text": "Any other condition(s) treated during Initial VL treatment?",
"type": "choice",
"required": true,
"answerOption": [
{
"valueCoding": {
"code": "yes",
"display": "Yes"
}
},
{
"valueCoding": {
"code": "no",
"display": "No"
}
}
]
},
{
"linkId": "922498480736",
"text": "Name of Other Condition",
"type": "string",
"enableWhen": [
{
"question": "904748389038",
"operator": "=",
"answerCoding": {
"code": "yes",
"display": "Yes"
}
}
],
"required": true
}
]
}
]
}