FHIR IG analytics| Package | hl7.fhir.be.patient-monitoring |
| Resource Type | Questionnaire |
| Id | Questionnaire-homehosp-azacitidine.json |
| FHIR Version | R4 |
| Source | https://build.fhir.org/ig/hl7-be/patient-monitoring/Questionnaire-homehosp-azacitidine.html |
| URL | http://hl7belgium.org/fhir/patient-monitoring/Questionnaire/homehosp-azacitidine |
| Version | 0.1.0 |
| Status | active |
| Date | 2026-05-27T09:31:20+00:00 |
| Name | HomehospAzacitidineQuestionnaireDefinition |
| Title | Azacitidine |
| Realm | be |
| Authority | hl7 |
| Description | Questionnaire containing the necessary information for the home hospitalization of a patient treated with Azacitidine. |
No resources found
No resources found
Note: links and images are rebased to the (stated) source
Generated Narrative: Questionnaire homehosp-azacitidine
Structure| LinkID | Text | Cardinality | Type | Description & Constraints |
|---|---|---|---|---|
  HomehospAzacitidineQuestionnaireDefinition | Questionnaire containing the necessary information for the home hospitalization of a patient treated with Azacitidine. | Questionnaire | http://hl7belgium.org/fhir/patient-monitoring/Questionnaire/homehosp-azacitidine#0.1.0 | |
  NursingAssessment | Verpleegkundig assessment | 0..1 | group | |
 MedicationStorage | MedicationStorage | 0..1 | group | |
 A1_MedicationStorage | Zijn er opmerkingen of bezorgdheden omtrent de (correcte) thuisbewaring van de medicatie? | 1..1 | choice | Options: 2 options |
  A2_MedicationStorageSpecify | > Indien opmerkingen of bezorgdheid: specifieer | 0..1 | string | Enable When: A1_MedicationStorage = Improper storage of medication (SNOMED CT#424363005) |
| ObservationParameters | Observatie parameters | 0..1 | group | |
 B1_BodyTemperature | Lichaamstemperatuur: | 1..1 | decimal | |
| B2_HeartRate | Pols: | 1..1 | decimal | |
| B3_SystolicBloodPressure | Bloeddruk systolisch: | 1..1 | decimal | |
| B4_DiastolicBloodPressure | Bloeddruk diastolisch: | 1..1 | decimal | |
| B5_OxygenSaturation | Zuurstofsaturatie (enkel uitvoeren bij hoest en kortademigheid) | 0..1 | decimal | |
| Contraindications | Contraindications | 0..1 | group | |
| C1_ContraindicationPresent | Zijn er tegenindicaties voor toediening? | 1..1 | choice | Value Set: Yes / No Value Set |
 C2_ContraindicationSpecify | > Indien 'ja': specifieer | 0..1 | display | Enable When: C1_ContraindicationPresent = Yes (SNOMED CT#373066001) |
| C3_FeverChills | Koorts , koude rillingen, zich ziek voelen | 1..1 | choice | Value Set: Yes / No Value Set |
| C4_OralIntake | Geen orale intake (tgv verminderde eetlust of smaakverandering) | 1..1 | choice | Value Set: Yes / No Value Set |
| C5_SevereNausea | Ernstige misselijkheid (dwz misselijkheid met onvoldoende orale intake) | 1..1 | choice | Value Set: Yes / No Value Set |
| C6_SevereDyspnea | Toegenomen kortademigheid en/of ernstige kortademigheid (dwz kortademigheid in rust/zonder inspanning en/of kortademigheid die hindert bij de dagelijkse activiteiten) (Trastuzumab, Azacitidine) | 1..1 | choice | Value Set: Yes / No Value Set |
| C7_NewCoughDyspnea | Nieuwe of toegenomen productieve of droge hoest, met of zonder dyspnoe | 1..1 | choice | Value Set: Yes / No Value Set |
| C8_GeneralDecline | Algemene achteruitgang | 1..1 | choice | Value Set: Yes / No Value Set |
| C9_Other | Andere: (indien van toepassing) | 0..1 | string | |
| C10_ContactCareTeam | > Indien tegenindicatie(s): gelieve contact op te nemen met het zorgteam in het ziekenhuis | 0..1 | display | Enable When: C1_ContraindicationPresent = Yes (SNOMED CT#373066001) |
| C11_Decision | Beslissing na overleg ziekenhuis | 0..1 | choice | Options: 3 options |
| C12_DecisionSpecify | > Indien andere: specifieer | 0..1 | string | Enable When: C11_Decision = andere |
| SymptomBurden | SymptomBurden | 0..1 | group | |
 D1_Nausea | Misselijkheid | 0..1 | choice | Value Set: ONCO Symptom Grade Scale (CTCAE 0–3) |
| D2_Vomiting | Braken | 0..1 | choice | Value Set: ONCO Symptom Grade Scale (CTCAE 0–3) |
| D3_DecreasedAppetite | Verminderde eetlust of smaakverandering | 0..1 | choice | Value Set: ONCO Symptom Grade Scale (CTCAE 0–3) |
| D4_Diarrhea | Buikloop | 0..1 | choice | Value Set: ONCO Symptom Grade Scale (CTCAE 0–3) |
| D5_Constipation | Verstopping | 0..1 | choice | Value Set: ONCO Symptom Grade Scale (CTCAE 0–3) |
| D6_Fatigue | Vermoeidheid/futloosheid | 0..1 | choice | Value Set: ONCO Symptom Grade Scale (CTCAE 0–3) |
| D7_Pain | Pijn | 0..1 | choice | Value Set: ONCO Symptom Grade Scale (CTCAE 0–3) |
| D8_SkinRash | Huiduitslag | 0..1 | choice | Value Set: ONCO Symptom Grade Scale (CTCAE 0–3) |
| D9_PsychosocialBurden | Psychosociale belasting | 0..1 | choice | Value Set: ONCO Symptom Grade Scale (CTCAE 0–3) |
| D10_Dyspnea | Kortademigheid | 0..1 | choice | Value Set: ONCO Symptom Grade Scale (CTCAE 0–3) |
| D11_Cough | Hoest | 0..1 | choice | Value Set: ONCO Symptom Grade Scale (CTCAE 0–3) |
| D12_OtherObservations | Andere nevenwerkingen of relevante klinische en psychosociale observaties (gelieve bij klinische bezorgdheid contact te nemen met het ziekenhuis voor bespreking) | 0..1 | string | |
| Assignment | Assignment | 0..1 | group | |
| MedicationPreparation | Voorbereiding medicatietoediening | 0..1 | group | |
| E1_PreparationCorrect | Kon de medicatie worden bereid volgens de procedure? | 1..1 | choice | Value Set: Yes / No Value Set |
| E2_ContactCareTeam | > Indien 'nee': gelieve contact op te nemen met het zorgteam in het ziekenhuis | 0..1 | display | Enable When: E1_PreparationCorrect = No (SNOMED CT#373067005) |
| MedicationAdministration | MedicationAdministration | 0..1 | group | |
| E3_AdministrationCorrect | Kon de medicatie exact volgens de procedure worden toegediend (er waren geen afwijkingen)? | 1..1 | choice | Value Set: Yes / No Value Set |
| E4_SpecifyNo | > Indien 'nee': specifieer | 0..1 | string | Enable When: E3_AdministrationCorrect = No (SNOMED CT#373067005) |
| QualityMonitoring | (Kwaliteits)opvolging | 0..1 | group | |
| F1_CommentsRegistration | Zijn er opmerkingen of bezorgdheden omtrent de aanmelding van deze patient, de gegevensdeling vanuit het ziekenhuis, de communicatie door en het contact met het ziekenhuis, de beschikbaarheid van de materialen, of andere aspecten van de transmurale samenwerking rond thuishospitalisatie oncologie, dan kan je deze hier noteren. Alvast dank. | 0..1 | string | |
| Documentation for this format | ||||
Options Sets
Answer options for A1_MedicationStorage
Answer options for C11_Decision
FHIR
FHIRsmith{
"resourceType": "Questionnaire",
"id": "homehosp-azacitidine",
"meta": {
"profile": [
"http://hl7belgium.org/fhir/patient-monitoring/StructureDefinition/homehosp-onco-azacitidine"
]
},
"text": {
"status": "extensions",
"div": "<!-- snip (see above) -->"
},
"url": "http://hl7belgium.org/fhir/patient-monitoring/Questionnaire/homehosp-azacitidine",
"identifier": [
{
"system": "urn:ietf:rfc:3986",
"value": "urn:oid:2.16.840.1.113883.4.642.40.54.35.1"
}
],
"version": "0.1.0",
"name": "HomehospAzacitidineQuestionnaireDefinition",
"title": "Azacitidine",
"status": "active",
"subjectType": [
"Patient"
],
"date": "2026-05-27T09:31:20+00:00",
"publisher": "HL7 Belgium",
"contact": [
{
"name": "HL7 Belgium",
"telecom": [
{
"system": "url",
"value": "http://example.com/committees"
},
{
"system": "email",
"value": "my-group@example.com"
}
]
},
{
"name": "Bob Smith",
"telecom": [
{
"system": "email",
"value": "bobsmith@example.com",
"use": "work"
}
]
}
],
"description": "Questionnaire containing the necessary information for the home hospitalization of a patient treated with Azacitidine.",
"jurisdiction": [
{
"coding": [
{
"system": "urn:iso:std:iso:3166",
"code": "BE",
"display": "Belgium"
}
]
}
],
"item": [
{
"linkId": "NursingAssessment",
"text": "Verpleegkundig assessment",
"type": "group",
"item": [
{
"linkId": "MedicationStorage",
"text": "MedicationStorage",
"type": "group",
"item": [
{
"linkId": "A1_MedicationStorage",
"code": [
{
"system": "http://snomed.info/sct",
"code": "422413002",
"display": "Ability to store medications"
}
],
"text": "Zijn er opmerkingen of bezorgdheden omtrent de (correcte) thuisbewaring van de medicatie?",
"type": "choice",
"required": true,
"answerOption": [
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "710977001",
"display": "Safe storage and management of medication"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "424363005",
"display": "Improper storage of medication"
}
}
]
},
{
"linkId": "A2_MedicationStorageSpecify",
"text": "> Indien opmerkingen of bezorgdheid: specifieer",
"type": "string",
"enableWhen": [
{
"question": "A1_MedicationStorage",
"operator": "=",
"answerCoding": {
"system": "http://snomed.info/sct",
"code": "424363005",
"display": "Improper storage of medication"
}
}
]
}
]
},
{
"linkId": "ObservationParameters",
"text": "Observatie parameters",
"type": "group",
"item": [
{
"linkId": "B1_BodyTemperature",
"code": [
{
"system": "http://loinc.org",
"code": "8310-5",
"display": "Body temperature"
}
],
"text": "Lichaamstemperatuur:",
"type": "decimal",
"required": true
},
{
"linkId": "B2_HeartRate",
"code": [
{
"system": "http://snomed.info/sct",
"code": "364075005",
"display": "Heart rate"
}
],
"text": "Pols:",
"type": "decimal",
"required": true
},
{
"linkId": "B3_SystolicBloodPressure",
"code": [
{
"system": "http://loinc.org",
"code": "8480-6",
"display": "Systolic blood pressure"
}
],
"text": "Bloeddruk systolisch:",
"type": "decimal",
"required": true
},
{
"linkId": "B4_DiastolicBloodPressure",
"code": [
{
"system": "http://loinc.org",
"code": "8462-4",
"display": "Diastolic blood pressure"
}
],
"text": "Bloeddruk diastolisch:",
"type": "decimal",
"required": true
},
{
"linkId": "B5_OxygenSaturation",
"code": [
{
"system": "http://loinc.org",
"code": "2708-6",
"display": "Oxygen saturation in Arterial blood"
}
],
"text": "Zuurstofsaturatie (enkel uitvoeren bij hoest en kortademigheid)",
"type": "decimal"
}
]
},
{
"linkId": "Contraindications",
"text": "Contraindications",
"type": "group",
"item": [
{
"linkId": "C1_ContraindicationPresent",
"code": [
{
"system": "http://snomed.info/sct",
"code": "395008009",
"display": "Medication stopped - contra-indication"
}
],
"text": "Zijn er tegenindicaties voor toediening?",
"type": "choice",
"required": true,
"answerValueSet": "http://hl7belgium.org/fhir/patient-monitoring/ValueSet/YesNoVS"
},
{
"linkId": "C2_ContraindicationSpecify",
"text": "> Indien 'ja': specifieer",
"type": "display",
"enableWhen": [
{
"question": "C1_ContraindicationPresent",
"operator": "=",
"answerCoding": {
"system": "http://snomed.info/sct",
"code": "373066001",
"display": "Yes"
}
}
]
},
{
"linkId": "C3_FeverChills",
"code": [
{
"system": "http://snomed.info/sct",
"code": "39104002",
"display": "Illness"
}
],
"text": "Koorts , koude rillingen, zich ziek voelen",
"type": "choice",
"required": true,
"answerValueSet": "http://hl7belgium.org/fhir/patient-monitoring/ValueSet/YesNoVS"
},
{
"linkId": "C4_OralIntake",
"code": [
{
"system": "http://snomed.info/sct",
"code": "247318005",
"display": "Abnormal taste in mouth"
}
],
"text": "Geen orale intake (tgv verminderde eetlust of smaakverandering)",
"type": "choice",
"required": true,
"answerValueSet": "http://hl7belgium.org/fhir/patient-monitoring/ValueSet/YesNoVS"
},
{
"linkId": "C5_SevereNausea",
"code": [
{
"system": "http://snomed.info/sct",
"code": "73335002",
"display": "Increased nausea and vomiting"
}
],
"text": "Ernstige misselijkheid (dwz misselijkheid met onvoldoende orale intake)",
"type": "choice",
"required": true,
"answerValueSet": "http://hl7belgium.org/fhir/patient-monitoring/ValueSet/YesNoVS"
},
{
"linkId": "C6_SevereDyspnea",
"code": [
{
"system": "http://snomed.info/sct",
"code": "297216006",
"display": "Increasing breathlessness"
}
],
"text": "Toegenomen kortademigheid en/of ernstige kortademigheid (dwz kortademigheid in rust/zonder inspanning en/of kortademigheid die hindert bij de dagelijkse activiteiten) (Trastuzumab, Azacitidine)",
"type": "choice",
"required": true,
"answerValueSet": "http://hl7belgium.org/fhir/patient-monitoring/ValueSet/YesNoVS"
},
{
"linkId": "C7_NewCoughDyspnea",
"code": [
{
"system": "http://snomed.info/sct",
"code": "11833005",
"display": "Dry cough"
}
],
"text": "Nieuwe of toegenomen productieve of droge hoest, met of zonder dyspnoe",
"type": "choice",
"required": true,
"answerValueSet": "http://hl7belgium.org/fhir/patient-monitoring/ValueSet/YesNoVS"
},
{
"linkId": "C8_GeneralDecline",
"code": [
{
"system": "http://snomed.info/sct",
"code": "154091000119106",
"display": "Decline in functional status"
}
],
"text": "Algemene achteruitgang",
"type": "choice",
"required": true,
"answerValueSet": "http://hl7belgium.org/fhir/patient-monitoring/ValueSet/YesNoVS"
},
{
"linkId": "C9_Other",
"code": [
{
"system": "http://snomed.info/sct",
"code": "438833006",
"display": "Administration of drug or medicament contraindicated"
}
],
"text": "Andere: (indien van toepassing)",
"type": "string"
},
{
"linkId": "C10_ContactCareTeam",
"text": "> Indien tegenindicatie(s): gelieve contact op te nemen met het zorgteam in het ziekenhuis",
"type": "display",
"enableWhen": [
{
"question": "C1_ContraindicationPresent",
"operator": "=",
"answerCoding": {
"system": "http://snomed.info/sct",
"code": "373066001",
"display": "Yes"
}
}
]
},
{
"linkId": "C11_Decision",
"code": [
{
"system": "http://snomed.info/sct",
"code": "182836005",
"display": "Medication review"
}
],
"text": "Beslissing na overleg ziekenhuis",
"type": "choice",
"answerOption": [
{
"valueString": "toediening"
},
{
"valueString": "geen toediening"
},
{
"valueString": "andere"
}
]
},
{
"linkId": "C12_DecisionSpecify",
"code": [
{
"system": "http://snomed.info/sct",
"code": "1156698007",
"display": "Review of current supply of medication"
}
],
"text": "> Indien andere: specifieer",
"type": "string",
"enableWhen": [
{
"question": "C11_Decision",
"operator": "=",
"answerString": "andere"
}
]
}
]
},
{
"linkId": "SymptomBurden",
"text": "SymptomBurden",
"type": "group",
"item": [
{
"linkId": "D1_Nausea",
"code": [
{
"system": "http://snomed.info/sct",
"code": "422587007",
"display": "Nausea"
}
],
"text": "Misselijkheid",
"type": "choice",
"answerValueSet": "http://hl7belgium.org/fhir/patient-monitoring/ValueSet/onco-symptom-grade"
},
{
"linkId": "D2_Vomiting",
"code": [
{
"system": "http://snomed.info/sct",
"code": "249497008",
"display": "Vomiting symptom"
}
],
"text": "Braken",
"type": "choice",
"answerValueSet": "http://hl7belgium.org/fhir/patient-monitoring/ValueSet/onco-symptom-grade"
},
{
"linkId": "D3_DecreasedAppetite",
"code": [
{
"system": "http://snomed.info/sct",
"code": "64379006",
"display": "Decrease in appetite"
}
],
"text": "Verminderde eetlust of smaakverandering",
"type": "choice",
"answerValueSet": "http://hl7belgium.org/fhir/patient-monitoring/ValueSet/onco-symptom-grade"
},
{
"linkId": "D4_Diarrhea",
"code": [
{
"system": "http://snomed.info/sct",
"code": "62315008",
"display": "Diarrhea"
}
],
"text": "Buikloop",
"type": "choice",
"answerValueSet": "http://hl7belgium.org/fhir/patient-monitoring/ValueSet/onco-symptom-grade"
},
{
"linkId": "D5_Constipation",
"code": [
{
"system": "http://snomed.info/sct",
"code": "14760008",
"display": "Constipation"
}
],
"text": "Verstopping",
"type": "choice",
"answerValueSet": "http://hl7belgium.org/fhir/patient-monitoring/ValueSet/onco-symptom-grade"
},
{
"linkId": "D6_Fatigue",
"code": [
{
"system": "http://snomed.info/sct",
"code": "224960004",
"display": "Tired"
}
],
"text": "Vermoeidheid/futloosheid",
"type": "choice",
"answerValueSet": "http://hl7belgium.org/fhir/patient-monitoring/ValueSet/onco-symptom-grade"
},
{
"linkId": "D7_Pain",
"code": [
{
"system": "http://snomed.info/sct",
"code": "112104007",
"display": "Localized pain"
}
],
"text": "Pijn",
"type": "choice",
"answerValueSet": "http://hl7belgium.org/fhir/patient-monitoring/ValueSet/onco-symptom-grade"
},
{
"linkId": "D8_SkinRash",
"code": [
{
"system": "http://snomed.info/sct",
"code": "271807003",
"display": "Eruption"
}
],
"text": "Huiduitslag",
"type": "choice",
"answerValueSet": "http://hl7belgium.org/fhir/patient-monitoring/ValueSet/onco-symptom-grade"
},
{
"linkId": "D9_PsychosocialBurden",
"code": [
{
"system": "http://snomed.info/sct",
"code": "384821006",
"display": "Mental state, behaviour and/or psychosocial function finding"
}
],
"text": "Psychosociale belasting",
"type": "choice",
"answerValueSet": "http://hl7belgium.org/fhir/patient-monitoring/ValueSet/onco-symptom-grade"
},
{
"linkId": "D10_Dyspnea",
"code": [
{
"system": "http://snomed.info/sct",
"code": "267036007",
"display": "Dyspnea"
}
],
"text": "Kortademigheid",
"type": "choice",
"answerValueSet": "http://hl7belgium.org/fhir/patient-monitoring/ValueSet/onco-symptom-grade"
},
{
"linkId": "D11_Cough",
"code": [
{
"system": "http://snomed.info/sct",
"code": "49727002",
"display": "Cough"
}
],
"text": "Hoest",
"type": "choice",
"answerValueSet": "http://hl7belgium.org/fhir/patient-monitoring/ValueSet/onco-symptom-grade"
},
{
"linkId": "D12_OtherObservations",
"code": [
{
"system": "http://snomed.info/sct",
"code": "365275006",
"display": "General well-being finding"
}
],
"text": "Andere nevenwerkingen of relevante klinische en psychosociale observaties\n(gelieve bij klinische bezorgdheid contact te nemen met het ziekenhuis voor bespreking)",
"type": "string"
}
]
}
]
},
{
"linkId": "Assignment",
"text": "Assignment",
"type": "group",
"item": [
{
"linkId": "MedicationPreparation",
"text": "Voorbereiding medicatietoediening",
"type": "group",
"item": [
{
"linkId": "E1_PreparationCorrect",
"code": [
{
"system": "http://snomed.info/sct",
"code": "385796006",
"display": "Medication prefill preparation"
}
],
"text": "Kon de medicatie worden bereid volgens de procedure?",
"type": "choice",
"required": true,
"answerValueSet": "http://hl7belgium.org/fhir/patient-monitoring/ValueSet/YesNoVS"
},
{
"linkId": "E2_ContactCareTeam",
"text": "> Indien 'nee': gelieve contact op te nemen met het zorgteam in het ziekenhuis",
"type": "display",
"enableWhen": [
{
"question": "E1_PreparationCorrect",
"operator": "=",
"answerCoding": {
"system": "http://snomed.info/sct",
"code": "373067005",
"display": "No"
}
}
]
}
]
},
{
"linkId": "MedicationAdministration",
"text": "MedicationAdministration",
"type": "group",
"item": [
{
"linkId": "E3_AdministrationCorrect",
"code": [
{
"system": "http://snomed.info/sct",
"code": "373149000",
"display": "Medication administered following procedure"
}
],
"text": "Kon de medicatie exact volgens de procedure worden toegediend (er waren geen afwijkingen)?",
"type": "choice",
"required": true,
"answerValueSet": "http://hl7belgium.org/fhir/patient-monitoring/ValueSet/YesNoVS"
},
{
"linkId": "E4_SpecifyNo",
"text": "> Indien 'nee': specifieer",
"type": "string",
"enableWhen": [
{
"question": "E3_AdministrationCorrect",
"operator": "=",
"answerCoding": {
"system": "http://snomed.info/sct",
"code": "373067005",
"display": "No"
}
}
]
}
]
}
]
},
{
"linkId": "QualityMonitoring",
"text": "(Kwaliteits)opvolging",
"type": "group",
"item": [
{
"linkId": "F1_CommentsRegistration",
"code": [
{
"system": "http://snomed.info/sct",
"code": "276238005",
"display": "Comments on own writing"
}
],
"text": "Zijn er opmerkingen of bezorgdheden omtrent de aanmelding van deze patient, de gegevensdeling vanuit het ziekenhuis, de communicatie door en het contact met het ziekenhuis, de beschikbaarheid van de materialen, of andere aspecten van de transmurale samenwerking rond thuishospitalisatie oncologie, dan kan je deze hier noteren. Alvast dank.",
"type": "string"
}
]
}
]
}