FHIR IG analytics| Package | iknl.fhir.r4.pzp |
| Resource Type | Questionnaire |
| Id | Questionnaire-ACP-zib2020.json |
| FHIR Version | R4 |
| Source | https://build.fhir.org/ig/IKNL/PZP-FHIR-R4/Questionnaire-ACP-zib2020.html |
| URL | https://api.iknl.nl/docs/pzp/r4/Questionnaire/ACP-zib2020 |
| Version | 1.0.0-rc2 |
| Status | draft |
| Date | 2026-03-03T13:11:59+00:00 |
| Name | ACPzib2020 |
| Title | Uniform vastleggen proactieve zorgpanning (PZP) o.b.v. zibs2020 - ReleaseCandidate2 03-03-2026 |
| Description | This form was developed to clearly document agreements resulting from the advance care planning (ACP) process. It is NOT a checklist. It can only be completed by a healthcare provider after a professional and nuanced conversation. For advice on conducting these conversations, please refer to the guideline for advance care planning in the palliative phase and Palliaweb, see https://palliaweb.nl/zorgpraktijk/proactieve-zorgplanning. Enter 'unknown' if a topic is not discussed or if the patient does not (yet) have an opinion.When transferring to a long-term care setting, consider adding conversation records about advance care planning (ACP) to the transfer documents. |
| Purpose | This form was developed to clearly document agreements resulting from the advance care planning (ACP) process. |
| Copyright | This form is subject to copyright, user rights and a disclaimer, as specified for all IKNL information standards. For details, see the paragraph on Gebruikersrechten en disclaimer at https://iknl.nl/onderzoek/eenheid-van-taal. |
No resources found
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Note: links and images are rebased to the (stated) source
Generated Narrative: Questionnaire ACP-zib2020
Structure| LinkID | Text | Cardinality | Type | Flags | Description & Constraints |
|---|---|---|---|---|---|
  ACPzib2020 | This form was developed to clearly document agreements resulting from the advance care planning (ACP) process. It is NOT a checklist. It can only be completed by a healthcare provider after a professional and nuanced conversation. For advice on conducting these conversations, please refer to the guideline for advance care planning in the palliative phase and Palliaweb, see https://palliaweb.nl/zorgpraktijk/proactieve-zorgplanning. Enter 'unknown' if a topic is not discussed or if the patient does not (yet) have an opinion.When transferring to a long-term care setting, consider adding conversation records about advance care planning (ACP) to the transfer documents. | Questionnaire | https://api.iknl.nl/docs/pzp/r4/Questionnaire/ACP-zib2020#1.0.0-rc2 | ||
  963 | Datum van invullen | 0..1 | dateTime | ||
 7 | Naam patiënt | 0..1 | group | ||
  964 | Voornamen | 0..1 | string | ||
| 965 | Voorvoegsels | 0..1 | string | ||
 966 | Achternaam | 0..1 | string | ||
 967 | Geboortedatum patiënt | 0..1 | date | ||
| 8 | Gesprek gevoerd door: | 0..1 | group | ||
| 16 | Naam zorgverlener | 0..1 | group | ||
| 968 | Voornamen | 0..1 | string | ||
| 969 | Voorvoegsels | 0..1 | string | ||
| 970 | Achternaam | 0..1 | string | ||
 1405 | Functie (Specialisme) | 0..1 | choice | Options: 6 options | |
| 26 | 1. Wilsbekwaamheid & Wettelijke vertegenwoordiging | 0..1 | group | ||
| 1406 | Is de patiënt op dit moment wilsbekwaam m.b.t. medische behandelbeslissingen? | 0..1 | choice | Options: 2 options | |
| 1407 | Toelichting | 0..1 | string | ||
| 29 | Bij wilsonbekwaamheid m.b.t. medische behandelbeslissingen is/wordt de wettelijke vertegenwoordiger: | 0..1 | group | ||
 30 | a). Naam wettelijk vertegenwoordiger | 0..1 | group | ||
| 973 | Voornamen | 0..1 | string | ||
| 974 | Voorvoegsels | 0..1 | string | ||
| 975 | Achternaam | 0..1 | string | ||
| 39 | b). Contactgegevens wettelijk vertegenwoordiger | 0..1 | group | ||
| 40 | Telefoonnummers | 0..* | group | ||
| 976 | Telefoonnummer | 0..1 | string | ||
| 977 | TelecomType | 0..1 | choice | Options: 4 options | |
| 978 | NummerSoort | 0..1 | choice | Options: 3 options | |
| 979 | Toelichting | 0..1 | string | ||
| 41 | EmailAdressen | 0..* | group | ||
| 980 | EmailAdres | 0..1 | string | ||
| 981 | EmailSoort | 0..1 | choice | Options: 2 options | |
| 982 | c). Relatie tot patiënt (1) | 0..* | choice | Options: 6 options | |
| 411 | Anders, namelijk: | 0..1 | string | Enable When: 982 = | |
| 983 | c). Relatie tot patiënt (2) | 0..1 | choice | Options: 10 options | |
| 408 | Anders, namelijk: | 0..1 | string | Enable When: 983 = | |
| 984 | d). Is de wettelijk vertegenwoordiger ook de eerste contactpersoon? | 0..1 | choice | Options: 2 options | |
| 53 | e). Naam eerste contactpersoon | 0..1 | group | Enable When: 984 = | |
| 985 | Voornamen | 0..1 | string | ||
| 986 | Voorvoegsels | 0..1 | string | ||
| 987 | Achternaam | 0..1 | string | ||
| 61 | f). Contactgegevens eerste contactpersoon | 0..1 | group | Enable When: 984 = | |
| 62 | Telefoonnummers | 0..* | group | ||
| 988 | Telefoonnummer | 0..1 | string | ||
| 989 | TelecomType | 0..1 | choice | Options: 4 options | |
| 990 | NummerSoort | 0..1 | choice | Options: 3 options | |
| 991 | Toelichting | 0..1 | string | ||
| 66 | EmailAdressen | 0..* | group | ||
| 992 | EmailAdres | 0..1 | string | ||
| 993 | EmailSoort | 0..1 | choice | Options: 2 options | |
| 1644 | Rol | 0..1 | choice |  | Enable When: 984 = Options: 1 option |
| 995 | g). Relatie tot patiënt | 0..1 | choice | Enable When: 984 = Options: 10 options | |
| 412 | Anders, namelijk: | 0..1 | string | Enable When: 995 = | |
| 78 | 2. Gesprek gevoerd in bijzijn van | 0..1 | group | ||
| 82 | Patiënt | 0..1 | choice | Options: 1 option | |
| 997 | Rol | 0..* | choice | Options: 4 options | |
| 414 | Anders, namelijk: | 0..1 | string | ||
| 998 | Relatie tot patiënt | 0..* | choice | Options: 10 options | |
| 413 | Anders, namelijk: | 0..1 | string | Enable When: 998 = | |
| 586 | 3. Belangrijkste overeengekomen doel van medisch beleid | 0..1 | group | ||
| 1408 | Belangrijkste doel van behandeling ([MetingNaam]) | 0..1 | choice | | Options: 1 option |
| 999 | Doel ([MetingWaarde]) | 0..1 | choice | Options: 4 options | |
| 83 | 4. Behandelgrenzen | 0..1 | group | ||
| 1409 | a). Reanimatie | 0..1 | group | ||
| 1410 | Behandeling | 0..1 | choice | | Options: 1 option |
| 1386 | BehandelBesluit | 0..1 | choice | Options: 4 options | |
| 1001 | SpecificatieAnders | 0..1 | string | Enable When: 1386 = | |
| 1002 | Toelichting | 0..1 | string | ||
| 1411 | b). Kunstmatige invasieve beademing | 0..1 | group | ||
| 1412 | Behandeling | 0..1 | choice | | Options: 1 option |
| 1387 | BehandelBesluit | 0..1 | choice | Options: 4 options | |
| 1388 | SpecificatieAnders | 0..1 | string | Enable When: 1387 = | |
| 1389 | Toelichting | 0..1 | string | ||
| 1413 | c). Opname op intensive care | 0..1 | group | ||
| 1414 | Behandeling | 0..1 | choice | | Options: 1 option |
| 1390 | BehandelBesluit | 0..1 | choice | Options: 4 options | |
| 1391 | SpecificatieAnders | 0..1 | string | Enable When: 1390 = | |
| 1392 | Toelichting | 0..1 | string | ||
| 1415 | d). Opname in ziekenhuis | 0..1 | group | ||
| 1416 | Behandeling | 0..1 | choice | | Options: 1 option |
| 1393 | BehandelBesluit | 0..1 | choice | Options: 4 options | |
| 1394 | SpecificatieAnders | 0..1 | string | Enable When: 1393 = | |
| 1395 | Toelichting | 0..1 | string | ||
| 1417 | e). Behandeling met antibiotica | 0..1 | group | ||
| 1418 | Behandeling | 0..1 | choice | | Options: 1 option |
| 1396 | BehandelBesluit | 0..1 | choice | Options: 4 options | |
| 1397 | SpecificatieAnders | 0..1 | string | Enable When: 1396 = | |
| 1398 | Toelichting | 0..1 | string | ||
| 1419 | f). Toediening van een bloedproduct | 0..1 | group | ||
| 1420 | Behandeling | 0..1 | choice | | Options: 1 option |
| 1399 | BehandelBesluit | 0..1 | choice | Options: 4 options | |
| 1400 | SpecificatieAnders | 0..1 | string | Enable When: 1399 = | |
| 1401 | Toelichting | 0..1 | string | ||
| 1421 | g). Overige behandelgrenzen | 0..1 | group | ||
| 1422 | Behandeling | 0..1 | choice | | Options: 1 option |
| 1402 | BehandelBesluit | 0..1 | choice | Options: 3 options | |
| 1404 | Toelichting | 0..1 | string | ||
| 1006 | h). Heeft de patiënt een ICD? | 0..1 | choice | Options: 3 options | |
| 1008 | ProductType van ICD | 0..1 | choice | Enable When: 1006 = Options: 6 options | |
| 1009 | Toelichting | 0..1 | string | Enable When: 1006 = | |
| 1425 | i). Is er een afspraak over het moment van uitzetten ICD? | 0..1 | group | Enable When: 1006 = | |
| 1426 | Behandeling van uitzetten ICD (Behandeling) | 0..1 | choice | | Options: 1 option |
| 1005 | Afspraak uitzetten ICD (BehandelBesluit) | 0..1 | choice | Enable When: 1006 = Options: 3 options | |
| 1010 | Toelichting gemaakte afspraken | 0..1 | string | ||
| 107 | 5. Behandelwensen | 0..1 | group | ||
| 1427 | a). Wat zouden zorgverleners, volgens de patiënt, moeten weten om goede zorg te kunnen verlenen? Heeft deze patiënt specifieke wensen met betrekking tot zijn zorg? (incl. culturele/religieuze/sociale/spirituele aspecten) | 0..1 | group | ||
| 1428 | Wens en verwachting patient ([MetingNaam]) | 0..1 | choice | | Options: 1 option |
| 1190 | Wens en verwachting patient ([MetingWaarde]) | 0..1 | string | ||
| 1429 | b). Gewenste plek van overlijden | 0..1 | group | ||
| 1430 | Gewenste plek van overlijden ([MetingNaam]) | 0..1 | choice | | Options: 1 option |
| 1191 | Voorkeursplek ([MetingWaarde]) | 0..1 | choice | Options: 6 options | |
| 1192 | Toelichting | 0..1 | string | ||
| 1431 | c). Euthanasie standpunt | 0..1 | group | ||
| 1432 | Euthanasie standpunt ([MetingNaam]) | 0..1 | choice | | Options: 1 option |
| 1193 | Euthanasie standpunt ([MetingWaarde]) | 0..1 | choice | Options: 4 options | |
| 1194 | Toelichting | 0..1 | string | ||
| 1433 | d). Keuze orgaandonatie vastgelegd in donorregister? | 0..1 | group | ||
| 1434 | Keuze orgaandonatie vastgelegd in donorregister? ([MetingNaam]) | 0..1 | choice | | Options: 1 option |
| 1435 | Keuze orgaandonatie in donorregister ([MetingWaarde]) | 0..1 | choice | Options: 3 options | |
| 598 | 6. Wat verder nog belangrijk is | 0..1 | group | ||
| 1436 | Wat verder nog belangrijk is ([MetingNaam]) | 0..1 | choice | | Options: 1 option |
| 1196 | Wat verder nog belangrijk is ([MetingWaarde]) | 0..1 | string | ||
| 115 | 7. Eerder vastgelegde behandelwensen | 0..1 | group | ||
| 1197 | a). Heeft de patiënt eerder behandelafspraken vastgelegd? | 0..1 | choice | Options: 3 options | |
| 1198 | Toelichting | 0..1 | string | ||
| 1199 | b). Staan in eerder vastgelegde behandelafspraken andere wensen dan nu in deze verklaring? | 0..1 | choice | Enable When: 1197 = Options: 3 options | |
| 119 | 8. Informatie delen | 0..1 | group | ||
| 1200 | a). Heeft u patient geïnformeerd over eigen verantwoordelijkheid om deze behandelafspraken met naasten te bespreken? | 0..1 | choice | Options: 2 options | |
| 1201 | b). Patiënt gaat akkoord met het delen van deze behandelafspraken met andere betrokken hulpverleners | 0..1 | choice | Options: 2 options | |
| Documentation for this format | |||||
Options Sets
Answer options for 1405
Answer options for 1406
Answer options for 977
Answer options for 978
Answer options for 981
Answer options for 982
Answer options for 983
Answer options for 984
Answer options for 989
Answer options for 990
Answer options for 993
Answer options for 1644
Answer options for 995
Answer options for 82
Answer options for 997
Answer options for 998
Answer options for 1408
Answer options for 999
Answer options for 1410
Answer options for 1386
Answer options for 1412
Answer options for 1387
Answer options for 1414
Answer options for 1390
Answer options for 1416
Answer options for 1393
Answer options for 1418
Answer options for 1396
Answer options for 1420
Answer options for 1399
Answer options for 1422
Answer options for 1402
Answer options for 1006
Answer options for 1008
Answer options for 1426
Answer options for 1005
Answer options for 1428
Answer options for 1430
Answer options for 1191
Answer options for 1432
Answer options for 1193
Answer options for 1434
Answer options for 1435
Answer options for 1436
Answer options for 1197
Answer options for 1199
Answer options for 1200
Answer options for 1201
FHIR
FHIRsmith{
"resourceType": "Questionnaire",
"id": "ACP-zib2020",
"text": {
"status": "extensions",
"div": "<!-- snip (see above) -->"
},
"url": "https://api.iknl.nl/docs/pzp/r4/Questionnaire/ACP-zib2020",
"version": "1.0.0-rc2",
"name": "ACPzib2020",
"title": "Uniform vastleggen proactieve zorgpanning (PZP) o.b.v. zibs2020 - ReleaseCandidate2 03-03-2026",
"status": "draft",
"experimental": false,
"date": "2026-03-03T13:11:59+00:00",
"publisher": "IKNL",
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{
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"value": "https://iknl.nl/"
},
{
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],
"description": "This form was developed to clearly document agreements resulting from the advance care planning (ACP) process. It is NOT a checklist. It can only be completed by a healthcare provider after a professional and nuanced conversation. For advice on conducting these conversations, please refer to the guideline for advance care planning in the palliative phase and Palliaweb, see https://palliaweb.nl/zorgpraktijk/proactieve-zorgplanning. \nEnter 'unknown' if a topic is not discussed or if the patient does not (yet) have an opinion.When transferring to a long-term care setting, consider adding conversation records about advance care planning (ACP) to the transfer documents.",
"purpose": "This form was developed to clearly document agreements resulting from the advance care planning (ACP) process.",
"copyright": "This form is subject to copyright, user rights and a disclaimer, as specified for all IKNL information standards. For details, see the paragraph on Gebruikersrechten en disclaimer at https://iknl.nl/onderzoek/eenheid-van-taal.",
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{
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{
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},
{
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"text": "Functie (Specialisme)",
"type": "choice",
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"answerOption": [
{
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{
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{
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{
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"display": "Physician assistant"
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{
"valueCoding": {
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}
}
]
}
]
},
{
"linkId": "26",
"prefix": "1",
"text": "Wilsbekwaamheid & Wettelijke vertegenwoordiging",
"type": "group",
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"item": [
{
"linkId": "1406",
"text": "Is de patiënt op dit moment wilsbekwaam m.b.t. medische behandelbeslissingen?",
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"answerOption": [
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},
{
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"item": [
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"repeats": false
}
]
},
{
"linkId": "29",
"text": "Bij wilsonbekwaamheid m.b.t. medische behandelbeslissingen is/wordt de wettelijke vertegenwoordiger:",
"type": "group",
"repeats": false,
"item": [
{
"linkId": "30",
"prefix": "a)",
"text": "Naam wettelijk vertegenwoordiger",
"type": "group",
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"item": [
{
"linkId": "973",
"text": "Voornamen",
"type": "string",
"required": false,
"repeats": false
},
{
"linkId": "974",
"text": "Voorvoegsels",
"type": "string",
"required": false,
"repeats": false
},
{
"linkId": "975",
"text": "Achternaam",
"type": "string",
"required": false,
"repeats": false
}
]
},
{
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"prefix": "b)",
"text": "Contactgegevens wettelijk vertegenwoordiger",
"type": "group",
"repeats": false,
"item": [
{
"linkId": "40",
"text": "Telefoonnummers",
"type": "group",
"repeats": true,
"item": [
{
"linkId": "976",
"text": "Telefoonnummer",
"type": "string",
"required": false,
"repeats": false
},
{
"linkId": "977",
"text": "TelecomType",
"type": "choice",
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"repeats": false,
"answerOption": [
{
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}
},
{
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},
{
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{
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"code": "MC",
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]
},
{
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"text": "NummerSoort",
"type": "choice",
"required": false,
"repeats": false,
"answerOption": [
{
"valueCoding": {
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}
},
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-AddressUse",
"code": "TMP",
"display": "Tijdelijk telefoonnummer"
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},
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-AddressUse",
"code": "WP",
"display": "Zakelijk telefoonnummer"
}
}
]
},
{
"linkId": "979",
"text": "Toelichting",
"type": "string",
"required": false,
"repeats": false
}
]
},
{
"linkId": "41",
"text": "EmailAdressen",
"type": "group",
"repeats": true,
"item": [
{
"linkId": "980",
"text": "EmailAdres",
"type": "string",
"required": false,
"repeats": false
},
{
"linkId": "981",
"text": "EmailSoort",
"type": "choice",
"required": false,
"repeats": false,
"answerOption": [
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-AddressUse",
"code": "HP",
"display": "Privé e-mailadres"
}
},
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-AddressUse",
"code": "WP",
"display": "Zakelijk e-mailadres"
}
}
]
}
]
}
]
},
{
"linkId": "982",
"prefix": "c)",
"text": "Relatie tot patiënt (1)",
"type": "choice",
"required": false,
"repeats": true,
"answerOption": [
{
"valueCoding": {
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.22.472",
"code": "24",
"display": "Wettelijke vertegenwoordiger"
},
"initialSelected": true
},
{
"valueCoding": {
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.22.472",
"code": "01",
"display": "Eerste relatie/contactpersoon"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "310141000146103",
"display": "Schriftelijk gemachtigde"
}
},
{
"valueCoding": {
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.22.472",
"code": "03",
"display": "Curator (juridisch)"
}
},
{
"valueCoding": {
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.22.472",
"code": "15",
"display": "Mentor"
}
},
{
"valueCoding": {
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.22.472",
"code": "09",
"display": "Anders"
}
}
],
"item": [
{
"linkId": "411",
"text": "Anders, namelijk:",
"type": "string",
"enableWhen": [
{
"question": "982",
"operator": "=",
"answerCoding": {
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.22.472",
"code": "09",
"display": "Anders"
}
}
],
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]
},
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"text": "Relatie tot patiënt (2)",
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"valueCoding": {
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},
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"valueCoding": {
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}
},
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},
{
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},
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},
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},
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},
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},
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"code": "0",
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},
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"display": "Nee"
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],
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"item": [
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"linkId": "985",
"text": "Voornamen",
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},
{
"linkId": "986",
"text": "Voorvoegsels",
"type": "string",
"required": false,
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},
{
"linkId": "987",
"text": "Achternaam",
"type": "string",
"required": false,
"repeats": false
}
]
},
{
"linkId": "61",
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"text": "Contactgegevens eerste contactpersoon",
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"question": "984",
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"code": "0",
"display": "Nee"
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}
],
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"repeats": false,
"item": [
{
"linkId": "62",
"text": "Telefoonnummers",
"type": "group",
"repeats": true,
"item": [
{
"linkId": "988",
"text": "Telefoonnummer",
"type": "string",
"required": false,
"repeats": false
},
{
"linkId": "989",
"text": "TelecomType",
"type": "choice",
"required": false,
"repeats": false,
"answerOption": [
{
"valueCoding": {
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"display": "Land Line"
}
},
{
"valueCoding": {
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"display": "Fax"
}
},
{
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"code": "MC",
"display": "Mobiel telefoonnummer"
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},
{
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"system": "http://terminology.hl7.org/CodeSystem/v3-AddressUse",
"code": "PG",
"display": "Pieper"
}
}
]
},
{
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"required": false,
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},
{
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},
{
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}
]
},
{
"linkId": "991",
"text": "Toelichting",
"type": "string",
"required": false,
"repeats": false
}
]
},
{
"linkId": "66",
"text": "EmailAdressen",
"type": "group",
"repeats": true,
"item": [
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"linkId": "992",
"text": "EmailAdres",
"type": "string",
"required": false,
"repeats": false
},
{
"linkId": "993",
"text": "EmailSoort",
"type": "choice",
"required": false,
"repeats": false,
"answerOption": [
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"system": "http://terminology.hl7.org/CodeSystem/v3-AddressUse",
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"display": "Privé e-mailadres"
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},
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-AddressUse",
"code": "WP",
"display": "Zakelijk e-mailadres"
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}
]
}
]
}
]
},
{
"linkId": "1644",
"text": "Rol",
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"display": "Nee"
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"repeats": false,
"readOnly": true,
"answerOption": [
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"valueCoding": {
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"initialSelected": true
}
]
},
{
"linkId": "995",
"prefix": "g)",
"text": "Relatie tot patiënt",
"type": "choice",
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"answerCoding": {
"code": "0",
"display": "Nee"
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],
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"required": false,
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}
},
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
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"display": "Echtgenoot"
}
},
{
"valueCoding": {
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}
},
{
"valueCoding": {
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"display": "Vader"
}
},
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
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"display": "Moeder"
}
},
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"code": "SONC",
"display": "Zoon"
}
},
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"code": "DAUC",
"display": "Dochter"
}
},
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"code": "BRO",
"display": "Broer"
}
},
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"code": "SIS",
"display": "Zuster"
}
},
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
"code": "OTH",
"display": "Anders"
}
}
],
"item": [
{
"linkId": "412",
"text": "Anders, namelijk:",
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"question": "995",
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}
}
],
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"repeats": false
}
]
}
]
}
]
},
{
"linkId": "78",
"prefix": "2",
"text": "Gesprek gevoerd in bijzijn van",
"type": "group",
"repeats": false,
"item": [
{
"linkId": "82",
"text": "Patiënt",
"type": "choice",
"required": false,
"repeats": false,
"answerOption": [
{
"valueCoding": {
"code": "Patiënt",
"display": "Patiënt"
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}
]
},
{
"linkId": "997",
"text": "Rol",
"type": "choice",
"required": false,
"repeats": true,
"answerOption": [
{
"valueCoding": {
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"display": "Curator (juridisch)"
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},
{
"valueCoding": {
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"code": "15",
"display": "Mentor"
}
},
{
"valueCoding": {
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"code": "310141000146103",
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},
{
"valueCoding": {
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"code": "09",
"display": "Anders"
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}
],
"item": [
{
"linkId": "414",
"text": "Anders, namelijk:",
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"required": false,
"repeats": false
}
]
},
{
"linkId": "998",
"text": "Relatie tot patiënt",
"type": "choice",
"required": false,
"repeats": true,
"answerOption": [
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"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
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"display": "Partner"
}
},
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"code": "HUSB",
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}
},
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
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}
},
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"code": "FTH",
"display": "Vader"
}
},
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"code": "MTH",
"display": "Moeder"
}
},
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"code": "SONC",
"display": "Zoon"
}
},
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"code": "DAUC",
"display": "Dochter"
}
},
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"code": "BRO",
"display": "Broer"
}
},
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"code": "SIS",
"display": "Zuster"
}
},
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
"code": "OTH",
"display": "Anders"
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}
],
"item": [
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}
],
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}
]
}
]
},
{
"linkId": "586",
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"text": "Belangrijkste overeengekomen doel van medisch beleid",
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"repeats": false,
"item": [
{
"linkId": "1408",
"text": "Belangrijkste doel van behandeling ([MetingNaam])",
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"required": false,
"repeats": false,
"readOnly": true,
"answerOption": [
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]
},
{
"linkId": "999",
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"answerOption": [
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"valueCoding": {
"system": "http://snomed.info/sct",
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},
{
"valueCoding": {
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},
{
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},
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]
}
]
},
{
"linkId": "83",
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"text": "Behandelgrenzen",
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"linkId": "1409",
"prefix": "a)",
"text": "Reanimatie",
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"item": [
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"linkId": "1410",
"text": "Behandeling",
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"repeats": false,
"readOnly": true,
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]
},
{
"linkId": "1386",
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},
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},
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},
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}
],
"item": [
{
"linkId": "1001",
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}
],
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},
{
"linkId": "1002",
"text": "Toelichting",
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"required": false,
"repeats": false
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]
}
]
},
{
"linkId": "1411",
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"readOnly": true,
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]
},
{
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},
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},
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},
{
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}
],
"item": [
{
"linkId": "1388",
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],
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},
{
"linkId": "1389",
"text": "Toelichting",
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"required": false,
"repeats": false
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]
}
]
},
{
"linkId": "1413",
"prefix": "c)",
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"repeats": false,
"item": [
{
"linkId": "1414",
"text": "Behandeling",
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"repeats": false,
"readOnly": true,
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},
{
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"repeats": false,
"answerOption": [
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"valueCoding": {
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},
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},
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},
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}
],
"item": [
{
"linkId": "1391",
"text": "SpecificatieAnders",
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"question": "1390",
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}
],
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"repeats": false
},
{
"linkId": "1392",
"text": "Toelichting",
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"required": false,
"repeats": false
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]
}
]
},
{
"linkId": "1415",
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"repeats": false,
"item": [
{
"linkId": "1416",
"text": "Behandeling",
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"readOnly": true,
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]
},
{
"linkId": "1393",
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"repeats": false,
"answerOption": [
{
"valueCoding": {
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"display": "Wel uitvoeren"
}
},
{
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"system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.25.1",
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}
},
{
"valueCoding": {
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.25.1",
"code": "2",
"display": "Niet uitvoeren"
}
},
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
"code": "UNK",
"display": "Onbekend"
}
}
],
"item": [
{
"linkId": "1394",
"text": "SpecificatieAnders",
"type": "string",
"enableWhen": [
{
"question": "1393",
"operator": "=",
"answerCoding": {
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"display": "Anders"
}
}
],
"enableBehavior": "any",
"required": false,
"repeats": false
},
{
"linkId": "1395",
"text": "Toelichting",
"type": "string",
"required": false,
"repeats": false
}
]
}
]
},
{
"linkId": "1417",
"prefix": "e)",
"text": "Behandeling met antibiotica",
"type": "group",
"repeats": false,
"item": [
{
"linkId": "1418",
"text": "Behandeling",
"type": "choice",
"required": false,
"repeats": false,
"readOnly": true,
"answerOption": [
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"valueCoding": {
"system": "http://snomed.info/sct",
"code": "281789004",
"display": "antibiotische therapie"
},
"initialSelected": true
}
]
},
{
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"required": false,
"repeats": false,
"answerOption": [
{
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}
},
{
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}
},
{
"valueCoding": {
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.25.1",
"code": "2",
"display": "Niet uitvoeren"
}
},
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
"code": "UNK",
"display": "Onbekend"
}
}
],
"item": [
{
"linkId": "1397",
"text": "SpecificatieAnders",
"type": "string",
"enableWhen": [
{
"question": "1396",
"operator": "=",
"answerCoding": {
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.25.1",
"code": "1",
"display": "Anders"
}
}
],
"enableBehavior": "any",
"required": false,
"repeats": false
},
{
"linkId": "1398",
"text": "Toelichting",
"type": "string",
"required": false,
"repeats": false
}
]
}
]
},
{
"linkId": "1419",
"prefix": "f)",
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"type": "group",
"repeats": false,
"item": [
{
"linkId": "1420",
"text": "Behandeling",
"type": "choice",
"required": false,
"repeats": false,
"readOnly": true,
"answerOption": [
{
"valueCoding": {
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"code": "116762002",
"display": "toediening van bloedproduct"
},
"initialSelected": true
}
]
},
{
"linkId": "1399",
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"type": "choice",
"required": false,
"repeats": false,
"answerOption": [
{
"valueCoding": {
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.25.1",
"code": "0",
"display": "Wel uitvoeren"
}
},
{
"valueCoding": {
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.25.1",
"code": "1",
"display": "Anders"
}
},
{
"valueCoding": {
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.25.1",
"code": "2",
"display": "Niet uitvoeren"
}
},
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
"code": "UNK",
"display": "Onbekend"
}
}
],
"item": [
{
"linkId": "1400",
"text": "SpecificatieAnders",
"type": "string",
"enableWhen": [
{
"question": "1399",
"operator": "=",
"answerCoding": {
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.25.1",
"code": "1",
"display": "Anders"
}
}
],
"enableBehavior": "any",
"required": false,
"repeats": false
},
{
"linkId": "1401",
"text": "Toelichting",
"type": "string",
"required": false,
"repeats": false
}
]
}
]
},
{
"linkId": "1421",
"prefix": "g)",
"text": "Overige behandelgrenzen",
"type": "group",
"repeats": false,
"item": [
{
"linkId": "1422",
"text": "Behandeling",
"type": "choice",
"required": false,
"repeats": false,
"readOnly": true,
"answerOption": [
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
"code": "OTH",
"display": "Other"
},
"initialSelected": true
}
]
},
{
"linkId": "1402",
"text": "BehandelBesluit",
"type": "choice",
"required": false,
"repeats": false,
"answerOption": [
{
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"system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.25.1",
"code": "0",
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}
},
{
"valueCoding": {
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.25.1",
"code": "2",
"display": "Niet uitvoeren"
}
},
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
"code": "UNK",
"display": "Onbekend"
}
}
],
"item": [
{
"linkId": "1404",
"text": "Toelichting",
"type": "string",
"required": false,
"repeats": false
}
]
}
]
},
{
"linkId": "1006",
"prefix": "h)",
"text": "Heeft de patiënt een ICD?",
"type": "choice",
"required": false,
"repeats": false,
"answerOption": [
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "373066001",
"display": "Ja"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "373067005",
"display": "Nee"
}
},
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
"code": "UNK",
"display": "Nog onbekend"
}
}
],
"item": [
{
"linkId": "1008",
"text": "ProductType van ICD",
"type": "choice",
"enableWhen": [
{
"question": "1006",
"operator": "=",
"answerCoding": {
"system": "http://snomed.info/sct",
"code": "373066001",
"display": "Ja"
}
}
],
"enableBehavior": "any",
"required": false,
"repeats": false,
"answerOption": [
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "72506001",
"display": "implanteerbare cardioverter-defibrillator"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "465460004",
"display": "univentriculaire implanteerbare cardioverter-defibrillator"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "468542000",
"display": "implanteerbare tweekamercardioverter-defibrillator"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "704707009",
"display": "implanteerbare biventriculaire cardioverter-defibrillator"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "1263462004",
"display": "pulsgenerator van defibrillator voor cardiale resynchronisatietherapie"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "1236894001",
"display": "subcutane implanteerbare cardioverter-defibrillator"
}
}
]
},
{
"linkId": "1009",
"text": "Toelichting",
"type": "string",
"enableWhen": [
{
"question": "1006",
"operator": "=",
"answerCoding": {
"system": "http://snomed.info/sct",
"code": "373066001",
"display": "Ja"
}
}
],
"enableBehavior": "any",
"required": false,
"repeats": false
}
]
},
{
"linkId": "1425",
"prefix": "i)",
"text": "Is er een afspraak over het moment van uitzetten ICD?",
"type": "group",
"enableWhen": [
{
"question": "1006",
"operator": "=",
"answerCoding": {
"system": "http://snomed.info/sct",
"code": "373066001",
"display": "Ja"
}
}
],
"enableBehavior": "any",
"repeats": false,
"item": [
{
"linkId": "1426",
"text": "Behandeling van uitzetten ICD (Behandeling)",
"type": "choice",
"required": false,
"repeats": false,
"readOnly": true,
"answerOption": [
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "400231000146108",
"display": "uitzetten van cardioverter-defibrillator in laatste levensfase (verrichting)"
},
"initialSelected": true
}
]
},
{
"linkId": "1005",
"text": "Afspraak uitzetten ICD (BehandelBesluit)",
"type": "choice",
"enableWhen": [
{
"question": "1006",
"operator": "=",
"answerCoding": {
"system": "http://snomed.info/sct",
"code": "373066001",
"display": "Ja"
}
}
],
"enableBehavior": "any",
"required": false,
"repeats": false,
"answerOption": [
{
"valueCoding": {
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.25.1",
"code": "0",
"display": "Wel uitvoeren"
}
},
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
"code": "ASKU",
"display": "Nee, nog geen besluit genomen"
}
},
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
"code": "NASK",
"display": "Niet besproken"
}
}
],
"item": [
{
"linkId": "1010",
"text": "Toelichting gemaakte afspraken",
"type": "string",
"required": false,
"repeats": false
}
]
}
]
}
]
},
{
"linkId": "107",
"prefix": "5",
"text": "Behandelwensen",
"type": "group",
"repeats": false,
"item": [
{
"linkId": "1427",
"prefix": "a)",
"text": "Wat zouden zorgverleners, volgens de patiënt, moeten weten om goede zorg te kunnen verlenen? Heeft deze patiënt specifieke wensen met betrekking tot zijn zorg? (incl. culturele/religieuze/sociale/spirituele aspecten)",
"type": "group",
"repeats": false,
"item": [
{
"linkId": "1428",
"text": "Wens en verwachting patient ([MetingNaam])",
"type": "choice",
"required": false,
"repeats": false,
"readOnly": true,
"answerOption": [
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "153851000146100",
"display": "Wensen en verwachtingen met betrekking tot uitkomst van behandeling"
},
"initialSelected": true
}
]
},
{
"linkId": "1190",
"text": "Wens en verwachting patient ([MetingWaarde])",
"type": "string",
"required": false,
"repeats": false
}
]
},
{
"linkId": "1429",
"prefix": "b)",
"text": "Gewenste plek van overlijden",
"type": "group",
"repeats": false,
"item": [
{
"linkId": "1430",
"text": "Gewenste plek van overlijden ([MetingNaam])",
"type": "choice",
"required": false,
"repeats": false,
"readOnly": true,
"answerOption": [
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "395091006",
"display": "Gewenste plek van overlijden"
},
"initialSelected": true
}
]
},
{
"linkId": "1191",
"text": "Voorkeursplek ([MetingWaarde])",
"type": "choice",
"required": false,
"repeats": false,
"answerOption": [
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "264362003",
"display": "Thuis"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "22232009",
"display": "Ziekenhuis"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "108344006",
"display": "Verpleeghuis"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "284546000",
"display": "Hospice"
}
},
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
"code": "OTH",
"display": "Anders"
}
},
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
"code": "UNK",
"display": "Nog onbekend"
}
}
],
"item": [
{
"linkId": "1192",
"text": "Toelichting",
"type": "string",
"required": false,
"repeats": false
}
]
}
]
},
{
"linkId": "1431",
"prefix": "c)",
"text": "Euthanasie standpunt",
"type": "group",
"repeats": false,
"item": [
{
"linkId": "1432",
"text": "Euthanasie standpunt ([MetingNaam])",
"type": "choice",
"required": false,
"repeats": false,
"readOnly": true,
"answerOption": [
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "340171000146104",
"display": "Standpunt ten opzichte van euthanasie (waarneembare entiteit)"
},
"initialSelected": true
}
]
},
{
"linkId": "1193",
"text": "Euthanasie standpunt ([MetingWaarde])",
"type": "choice",
"required": false,
"repeats": false,
"answerOption": [
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "340181000146102",
"display": "Heeft euthanasieverklaring"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "340201000146103",
"display": "Wenst geen euthanasie"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "340191000146100",
"display": "Geen euthanasieverklaring, zou wel verzoek kunnen doen in bepaalde situaties"
}
},
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
"code": "UNK",
"display": "Nog onbekend"
}
}
],
"item": [
{
"linkId": "1194",
"text": "Toelichting",
"type": "string",
"required": false,
"repeats": false
}
]
}
]
},
{
"linkId": "1433",
"prefix": "d)",
"text": "Keuze orgaandonatie vastgelegd in donorregister?",
"type": "group",
"repeats": false,
"item": [
{
"linkId": "1434",
"text": "Keuze orgaandonatie vastgelegd in donorregister? ([MetingNaam])",
"type": "choice",
"required": false,
"repeats": false,
"readOnly": true,
"answerOption": [
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "570801000146104",
"display": "Geregistreerd in orgaan donorregister (bevinding)"
},
"initialSelected": true
}
]
},
{
"linkId": "1435",
"text": "Keuze orgaandonatie in donorregister ([MetingWaarde])",
"type": "choice",
"required": false,
"repeats": false,
"answerOption": [
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "373066001",
"display": "Ja"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "373067005",
"display": "Nee"
}
},
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
"code": "UNK",
"display": "Nog onbekend"
}
}
]
}
]
}
]
},
{
"linkId": "598",
"prefix": "6",
"text": "Wat verder nog belangrijk is",
"type": "group",
"repeats": false,
"item": [
{
"linkId": "1436",
"text": "Wat verder nog belangrijk is ([MetingNaam])",
"type": "choice",
"required": false,
"repeats": false,
"readOnly": true,
"answerOption": [
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "247751003",
"display": "Gevoel van zingeving (waarneembare entiteit)"
},
"initialSelected": true
}
]
},
{
"linkId": "1196",
"text": "Wat verder nog belangrijk is ([MetingWaarde])",
"type": "string",
"required": false,
"repeats": false
}
]
},
{
"linkId": "115",
"prefix": "7",
"text": "Eerder vastgelegde behandelwensen",
"type": "group",
"repeats": false,
"item": [
{
"linkId": "1197",
"prefix": "a)",
"text": "Heeft de patiënt eerder behandelafspraken vastgelegd?",
"type": "choice",
"required": false,
"repeats": false,
"answerOption": [
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "373066001",
"display": "Ja"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "373067005",
"display": "Nee"
}
},
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
"code": "UNK",
"display": "Nog onbekend"
}
}
],
"item": [
{
"linkId": "1198",
"text": "Toelichting",
"type": "string",
"required": false,
"repeats": false
}
]
},
{
"linkId": "1199",
"prefix": "b)",
"text": "Staan in eerder vastgelegde behandelafspraken andere wensen dan nu in deze verklaring?",
"type": "choice",
"enableWhen": [
{
"question": "1197",
"operator": "=",
"answerCoding": {
"system": "http://snomed.info/sct",
"code": "373066001",
"display": "Ja"
}
}
],
"enableBehavior": "any",
"required": false,
"repeats": false,
"answerOption": [
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "373066001",
"display": "Ja"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "373067005",
"display": "Nee"
}
},
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
"code": "UNK",
"display": "Nog onbekend"
}
}
]
}
]
},
{
"linkId": "119",
"prefix": "8",
"text": "Informatie delen",
"type": "group",
"repeats": false,
"item": [
{
"linkId": "1200",
"prefix": "a)",
"text": "Heeft u patient geïnformeerd over eigen verantwoordelijkheid om deze behandelafspraken met naasten te bespreken?",
"type": "choice",
"required": false,
"repeats": false,
"answerOption": [
{
"valueCoding": {
"code": "1",
"display": "Ja"
}
},
{
"valueCoding": {
"code": "0",
"display": "Nee"
}
}
]
},
{
"linkId": "1201",
"prefix": "b)",
"text": "Patiënt gaat akkoord met het delen van deze behandelafspraken met andere betrokken hulpverleners",
"type": "choice",
"required": false,
"repeats": false,
"answerOption": [
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "441898007",
"display": "Akkoord"
}
},
{
"valueCoding": {
"system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
"code": "UNK",
"display": "Nog onbekend"
}
}
]
}
]
}
]
}