FHIR IG analytics| Package | fhir.surveillanceIG |
| Resource Type | Questionnaire |
| Id | Questionnaire-VlCaseSixMonthsFollowup.json |
| FHIR Version | R4 |
| Source | https://build.fhir.org/ig/IntelliSOFT-Consulting/Surveillance-FHIR-IG/Questionnaire-VlCaseSixMonthsFollowup.html |
| URL | http://example.org/Questionnaire/VlCaseSixMonthsFollowup |
| Version | 0.1.0 |
| Status | draft |
| Date | 2026-05-04T06:19:40+00:00 |
| Title | VL Case Lab Information |
| Realm | us |
| Authority | hl7 |
| Description | Six months follow-up examination questionnaire for Visceral Leishmaniasis cases |
No resources found
No resources found
Note: links and images are rebased to the (stated) source
Generated Narrative: Questionnaire VlCaseSixMonthsFollowup
Profile: http://hl7.org/fhir/4.0/StructureDefinition/Questionnaire
| LinkID | Text | Cardinality | Type | Flags | Description & Constraints |
|---|---|---|---|---|---|
  | Six months follow-up examination questionnaire for Visceral Leishmaniasis cases | Questionnaire | http://example.org/Questionnaire/VlCaseSixMonthsFollowup#0.1.0 | ||
  768949210140 | Six (6) Months Follow Up Examination | 0..1 | group | ||
   598716788113 | Date of Follow-up Examination | 0..1 | date | ||
 854349915390 | Final Treatment Outcome | 0..1 | choice | Options: 4 options | |
| 207948215604 | Cause of Death at Follow-up | 0..1 | choice | Enable When: 854349915390 = Death (treatment-out-003) Options: 6 options | |
| 598808996682 | Any Signs or Symptoms of PKDL? | 0..1 | choice |  | Options: 2 options |
 601245092289 | Remarks/Notes | 0..1 | string | ||
| 183599052402 | Clinician's Name (Follow-up) | 0..1 | string | ||
| 864740040168 | Clinician's Date (Follow-up) | 0..1 | date | ||
| 962832844710 | Clinician's Signature (Follow-up) | 0..1 | string | ||
| Documentation for this format | |||||
Options Sets
Answer options for 854349915390
Answer options for 207948215604
Answer options for 598808996682
FHIR
FHIRsmith{
"resourceType": "Questionnaire",
"id": "VlCaseSixMonthsFollowup",
"meta": {
"profile": [
"http://hl7.org/fhir/4.0/StructureDefinition/Questionnaire"
]
},
"text": {
"status": "extensions",
"div": "<!-- snip (see above) -->"
},
"url": "http://example.org/Questionnaire/VlCaseSixMonthsFollowup",
"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": "Six months follow-up examination questionnaire 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": "768949210140",
"text": "Six (6) Months Follow Up Examination",
"type": "group",
"item": [
{
"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": "598716788113",
"text": "Date of Follow-up Examination",
"type": "date"
},
{
"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": "854349915390",
"text": "Final Treatment Outcome",
"type": "choice",
"answerOption": [
{
"valueCoding": {
"code": "treatment-out-001",
"display": "Final (definitive)cure"
}
},
{
"valueCoding": {
"code": "treatment-out-002",
"display": "Relapse"
}
},
{
"valueCoding": {
"code": "treatment-out-003",
"display": "Death"
}
},
{
"valueCoding": {
"code": "treatment-out-004",
"display": "Lost to follow up"
}
}
]
},
{
"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": "207948215604",
"text": "Cause of Death at Follow-up",
"type": "choice",
"enableWhen": [
{
"question": "854349915390",
"operator": "=",
"answerCoding": {
"code": "treatment-out-003",
"display": "Death"
}
}
],
"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": "Non medical condition"
}
},
{
"valueCoding": {
"code": "death-cause-005",
"display": "SAE"
}
},
{
"valueCoding": {
"code": "death-cause-006",
"display": "Other disease (specify)"
}
}
]
},
{
"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": "598808996682",
"text": "Any Signs or Symptoms of PKDL?",
"type": "choice",
"answerOption": [
{
"valueCoding": {
"code": "yes",
"display": "Yes"
}
},
{
"valueCoding": {
"code": "no",
"display": "No"
}
}
]
},
{
"linkId": "601245092289",
"text": "Remarks/Notes",
"type": "string"
},
{
"linkId": "183599052402",
"text": "Clinician's Name (Follow-up)",
"type": "string"
},
{
"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": "864740040168",
"text": "Clinician's Date (Follow-up)",
"type": "date"
},
{
"linkId": "962832844710",
"text": "Clinician's Signature (Follow-up)",
"type": "string"
}
]
}
]
}