FHIR IG analytics| Package | hl7.fhir.be.patient-monitoring |
| Resource Type | Questionnaire |
| Id | Questionnaire-homehosp-fulvestrant.json |
| FHIR Version | R4 |
| Source | https://build.fhir.org/ig/hl7-be/patient-monitoring/Questionnaire-homehosp-fulvestrant.html |
| URL | http://hl7belgium.org/fhir/patient-monitoring/Questionnaire/homehosp-fulvestrant |
| Version | 0.1.0 |
| Status | active |
| Date | 2026-05-27T09:31:20+00:00 |
| Name | HomehospFulvestrantQuestionnaireDefinition |
| Title | Fulvestrant |
| Realm | be |
| Authority | hl7 |
| Description | Questionnaire containing the necessary information for the home hospitalization of a patient treated with Fulvestrant (Faslodex®). |
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Note: links and images are rebased to the (stated) source
Generated Narrative: Questionnaire homehosp-fulvestrant
Structure| LinkID | Text | Cardinality | Type | Description & Constraints |
|---|---|---|---|---|
  HomehospFulvestrantQuestionnaireDefinition | Questionnaire containing the necessary information for the home hospitalization of a patient treated with Fulvestrant (Faslodex®). | Questionnaire | http://hl7belgium.org/fhir/patient-monitoring/Questionnaire/homehosp-fulvestrant#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 | |
| 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_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) |
| C5_Decision | Beslissing na overleg ziekenhuis | 0..1 | choice | Options: 3 options |
| C6_DecisionSpecify | > Indien andere: specifieer | 0..1 | string | Enable When: C5_Decision = andere |
| SideEffects | SideEffects | 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_MuscleAndJointPain | Spier- en gewrichtspijn | 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 | |
| MedicationAdministration | MedicationAdministration | 0..1 | group | |
| E1_AdministrationCorrect | Kon de medicatie exact volgens de procedure worden toegediend (er waren geen afwijkingen)? | 1..1 | choice | Value Set: Yes / No Value Set |
| E2_SpecifyNo | > Indien 'nee': specifieer | 0..1 | string | Enable When: E1_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 C5_Decision
FHIR
FHIRsmith{
"resourceType": "Questionnaire",
"id": "homehosp-fulvestrant",
"meta": {
"profile": [
"http://hl7belgium.org/fhir/patient-monitoring/StructureDefinition/homehosp-onco-fulvestrant"
]
},
"text": {
"status": "extensions",
"div": "<!-- snip (see above) -->"
},
"url": "http://hl7belgium.org/fhir/patient-monitoring/Questionnaire/homehosp-fulvestrant",
"identifier": [
{
"system": "urn:ietf:rfc:3986",
"value": "urn:oid:2.16.840.1.113883.4.642.40.54.35.5"
}
],
"version": "0.1.0",
"name": "HomehospFulvestrantQuestionnaireDefinition",
"title": "Fulvestrant",
"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 Fulvestrant (Faslodex®).",
"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": "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_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": "C5_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": "C6_DecisionSpecify",
"code": [
{
"system": "http://snomed.info/sct",
"code": "1156698007",
"display": "Review of current supply of medication"
}
],
"text": "> Indien andere: specifieer",
"type": "string",
"enableWhen": [
{
"question": "C5_Decision",
"operator": "=",
"answerString": "andere"
}
]
}
]
},
{
"linkId": "SideEffects",
"text": "SideEffects",
"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_MuscleAndJointPain",
"code": [
{
"system": "http://snomed.info/sct",
"code": "57676002",
"display": "Joint pain"
}
],
"text": "Spier- en gewrichtspijn",
"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": "MedicationAdministration",
"text": "MedicationAdministration",
"type": "group",
"item": [
{
"linkId": "E1_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": "E2_SpecifyNo",
"text": "> Indien 'nee': specifieer",
"type": "string",
"enableWhen": [
{
"question": "E1_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"
}
]
}
]
}