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Packageiknl.fhir.stu3.pzp
Resource TypeQuestionnaire
IdQuestionnaire-ACP-zib2017.json
FHIR VersionR3
Sourcehttps://api.iknl.nl/docs/pzp/stu3/1.0.0-rc1/Questionnaire-ACP-zib2017.html
URLhttps://api.iknl.nl/docs/pzp/stu3/Questionnaire/ACP-zib2017
Version1.0.0-rc1
Statusdraft
Date2025-10-30T14:17:52+01:00
NameACPzib2017
TitleUniform vastleggen proactieve zorgpanning advance care planning (ACP) o.b.v. zibs2017 - Beta3 28-08-2025
Realmuv
DescriptionThis 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 proactive 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.
PurposeThis form was developed to clearly document agreements resulting from the advance care planning (ACP) process.
CopyrightThis 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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Narrative

Note: links and images are rebased to the (stated) source

Generated Narrative: Questionnaire ACP-zib2017

Structure
LinkIDTextCardinalityTypeFlagsDescription & Constraintsdoco
.. ACPzib2017This 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 proactive 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.Questionnairehttps://api.iknl.nl/docs/pzp/stu3/Questionnaire/ACP-zib2017#1.0.0-rc1
... 385Datum van invullen0..1dateTime
... 7Naam patiënt0..1group
.... 386Voornamen0..1string
.... 387Voorvoegsels0..1string
.... 388Achternaam0..1string
... 6Geboortedatum patiënt0..1dateTime
... 8Gesprek gevoerd door:0..1group
.... 16Naam zorgverlener0..1group
..... 389Voornamen0..1string
..... 390Voorvoegsels0..1string
..... 391Achternaam0..1string
.... 786Functie (Specialisme)0..1choiceOptions: 6 options
... 261.. Wilsbekwaamheid & Wettelijke vertegenwoordiging0..1group
.... 787Is de patiënt op dit moment wilsbekwaam m.b.t. medische behandelbeslissingen?0..1choiceOptions: 2 options
..... 788Toelichting0..1string
.... 29Bij wilsonbekwaamheid m.b.t. medische behandelbeslissingen is/wordt de wettelijke vertegenwoordiger:0..1group
..... 30a). Naam wettelijk vertegenwoordiger0..1group
...... 392Voornamen0..1string
...... 393Voorvoegsels0..1string
...... 394Achternaam0..1string
..... 39b). Contactgegevens wettelijk vertegenwoordiger0..1group
...... 40Telefoonnummers0..*group
....... 398Telefoonnummer0..1string
....... 399TelecomType0..1choiceOptions: 4 options
....... 400NummerSoort0..1choiceOptions: 3 options
...... 41EmailAdressen0..*group
....... 401EmailAdres0..1string
....... 402EmailSoort0..1choiceOptions: 2 options
..... 410c). Relatie tot patiënt (1)0..*choiceOptions: 6 options
...... 411Anders, namelijk:0..1stringEnable When: 410 =
..... 51c). Relatie tot patiënt (2)0..1choiceOptions: 10 options
...... 408Anders, namelijk:0..1stringEnable When: 51 =
..... 52d). Is de wettelijk vertegenwoordiger ook de eerste contactpersoon?0..1choiceOptions: 2 options
..... 53e). Naam eerste contactpersoon0..1groupEnable When: 52 =
...... 395Voornamen0..1string
...... 396Voorvoegsels0..1string
...... 397Achternaam0..1string
..... 61f). Contactgegevens eerste contactpersoon0..1groupEnable When: 52 =
...... 62Telefoonnummers0..*group
....... 403Telefoonnummer0..1string
....... 404TelecomType0..1choiceOptions: 4 options
....... 405NummerSoort0..1choiceOptions: 3 options
...... 66EmailAdressen0..*group
....... 406EmailAdres0..1string
....... 407EmailSoort0..1choiceOptions: 2 options
..... 77g). Relatie tot patiënt0..1choiceEnable When: 52 =
Options: 10 options
...... 412Anders, namelijk:0..1stringEnable When: 77 =
... 782. Gesprek gevoerd in bijzijn van0..1group
.... 82Patiënt0..1choiceOptions: 1 option
.... 415Rol0..*choiceOptions: 4 options
..... 414Anders, namelijk:0..1stringEnable When: 415 =
.... 80Relatie tot patiënt0..*choiceOptions: 10 options
..... 413Anders, namelijk:0..1stringEnable When: 80 =
... 5863.. Belangrijkste overeengekomen doel van medisch beleid0..1group
.... 790MetingNaam voor Belangrijkste doel van behandeling0..1choiceiconiconOptions: 1 option
Initial Value: Coding = SNOMED CT#180771000146100 "Focus van behandeling (waarneembare entiteit)"
.... 784Doel (UitslagWaarde)0..1choiceOptions: 4 options
... 834.. Behandelgrenzen0..1group
.... 792a). Reanimatie0..1group
..... 791Behandeling0..1choiceiconiconOptions: 1 option
Initial Value: Coding = SNOMED CT#89666000 "Cardiopulmonale resuscitatie (verrichting)"
..... 587BehandelingToegestaan0..1choiceOptions: 4 options
...... 122Beperkingen0..1stringEnable When: 587 =
...... 86Toelichting0..1string
.... 793b). Kunstmatige invasieve beademing0..1group
..... 794Behandeling0..1choiceiconiconOptions: 1 option
Initial Value: Coding = SNOMED CT#40617009 "Kunstmatige beademing (verrichting)"
..... 588BehandelingToegestaan0..1choiceOptions: 4 options
...... 123Beperkingen0..1stringEnable When: 588 =
...... 92Toelichting0..1string
.... 796c). Opname op intensive care0..1group
..... 795Behandeling0..1choiceOptions: 1 option
Initial Value: Coding = SNOMED CT#305351004 "Opname op intensive care (verrichting)"
..... 589BehandelingToegestaan0..1choiceOptions: 4 options
...... 124Beperkingen0..1stringEnable When: 589 =
...... 88Toelichting0..1string
.... 798d). Opname in ziekenhuis0..1group
..... 799Behandeling0..1choiceiconiconOptions: 1 option
Initial Value: Coding = SNOMED CT#32485007 "Opname in ziekenhuis (verrichting)"
..... 590BehandelingToegestaan0..1choiceOptions: 4 options
...... 125Beperkingen0..1stringEnable When: 590 =
...... 94Toelichting0..1string
.... 800e). Behandeling met antibiotica0..1group
..... 801Behandeling0..1choiceiconiconOptions: 1 option
Initial Value: Coding = SNOMED CT#281789004 "Antibiotische therapie (verrichting)"
..... 591BehandelingToegestaan0..1choiceOptions: 4 options
...... 126Beperkingen0..1stringEnable When: 591 =
...... 96Toelichting0..1string
.... 802f). Toediening van een bloedproduct0..1group
..... 803Behandeling0..1choiceiconiconOptions: 1 option
Initial Value: Coding = SNOMED CT#116762002 "Toediening van bloedproduct (verrichting)"
..... 592BehandelingToegestaan0..1choiceOptions: 4 options
...... 127Beperkingen0..1stringEnable When: 592 =
...... 98Toelichting0..1string
.... 804g). Overige behandelgrenzen0..1group
..... 805Behandeling0..1choiceiconiconOptions: 1 option
Initial Value: Coding = NullFlavor#OTH "Overige behandelingen"
..... 593BehandelingToegestaan0..1choiceOptions: 3 options
...... 100Toelichting0..1string
.... 249h). Heeft de patiënt een ICD?0..1choiceOptions: 3 options
..... 600ProductType van ICD0..1choiceEnable When: 249 =
Options: 1 option
..... 599Toelichting0..1stringEnable When: 249 =
.... 808i). Is er een afspraak over het moment van uitzetten ICD?0..1groupEnable When: 249 =
..... 809Behandeling van uitzetten ICD0..1choiceiconiconOptions: 1 option
Initial Value: Coding = SNOMED CT#400231000146108 "uitzetten van cardioverter-defibrillator in laatste levensfase (verrichting)"
..... 595Afspraak uitzetten ICD (BehandelingToegestaan)0..1choiceEnable When: 249 =
Options: 3 options
...... 596Toelichting gemaakte afspraken0..1string
... 1075.. Behandelwensen0..1group
.... 810a). 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..1group
..... 811Wens en verwachting patient (MetingNaam)0..1choiceiconiconOptions: 1 option
Initial Value: Coding = SNOMED CT#153851000146100 "Wensen en verwachtingen met betrekking tot uitkomst van behandeling"
..... 382Wens en verwachting patient (UitslagWaarde)0..1string
.... 812b). Gewenste plek van overlijden0..1group
..... 815MetingNaam voor Gewenste plek van overlijden0..1choiceiconiconOptions: 1 option
Initial Value: Coding = SNOMED CT#395091006 "Gewenste plek van overlijden"
..... 604Voorkeursplek (UitslagWaarde)0..1choiceOptions: 6 options
...... 110Toelichting0..1string
.... 813c). Euthanasie standpunt0..1group
..... 816MetingNaam voor Euthanasie standpunt0..1choiceiconiconOptions: 1 option
Initial Value: Coding = SNOMED CT#340171000146104 "Standpunt ten opzichte van euthanasie (waarneembare entiteit)"
..... 785Standpunt (UitslagWaarde)0..1choiceOptions: 4 options
...... 112Toelichting0..1string
.... 814d). Keuze orgaandonatie vastgelegd in donorregister?0..1group
..... 817MetingNaam voor Keuze orgaandonatie vastgelegd in donorregister?0..1choiceiconiconOptions: 1 option
Initial Value: Coding = SNOMED CT#570801000146104 "Geregistreerd in orgaan donorregister (bevinding)"
..... 789Keuze orgaandonatie in donorregister (UitslagWaarde)0..1choiceOptions: 3 options
... 5986.. Wat verder nog belangrijk is0..1group
.... 818MetingNaam voor Wat verder nog belangrijk is0..1choiceiconiconOptions: 1 option
Initial Value: Coding = SNOMED CT#247751003 "Gevoel van zingeving (waarneembare entiteit)"
.... 383Wat verder nog belangrijk is (UitslagWaarde)0..1string
... 1157.. Eerder vastgelegde behandelwensen0..1group
.... 253a). Heeft de patiënt eerder behandelafspraken vastgelegd?0..1choiceOptions: 3 options
..... 254Toelichting0..1string
.... 255b). Staan in eerder vastgelegde behandelafspraken andere wensen dan nu in deze verklaring?0..1choiceEnable When: 253 =
Options: 3 options
... 1198.. Informatie delen0..1group
.... 256a). Heeft u patient geïnformeerd over eigen verantwoordelijkheid om deze behandelafspraken met naasten te bespreken?0..1choiceOptions: 2 options
.... 257b). Patiënt gaat akkoord met het delen van deze behandelafspraken met andere betrokken hulpverleners0..1choiceOptions: 2 options

doco Documentation for this format

Options Sets

Answer options for 786

  • http://fhir.nl/fhir/NamingSystem/uzi-rolcode#01.000 ("Arts")
  • http://fhir.nl/fhir/NamingSystem/uzi-rolcode#01.015 ("Huisarts")
  • http://fhir.nl/fhir/NamingSystem/uzi-rolcode#01.047 ("Specialist ouderengeneeskunde")
  • http://fhir.nl/fhir/NamingSystem/uzi-rolcode#30.000 ("Verpleegkundige")
  • http://fhir.nl/fhir/NamingSystem/uzi-rolcode#81.000 ("Physician assistant")
  • http://fhir.nl/fhir/NamingSystem/uzi-rolcode#99.000 ("Zorgverlener andere zorg")

Answer options for 787

  • null#1 ("Ja")
  • null#0 ("Nee")

Answer options for 399

  • urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.22.1#LL ("Vast telefoonnummer")
  • urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.22.1#FAX ("Fax")
  • http://terminology.hl7.org/CodeSystem/v3-AddressUse#MC ("Mobiel telefoonnummer")
  • http://terminology.hl7.org/CodeSystem/v3-AddressUse#PG ("Pieper")

Answer options for 400

  • http://terminology.hl7.org/CodeSystem/v3-AddressUse#HP ("Telefoonnummer thuis")
  • http://terminology.hl7.org/CodeSystem/v3-AddressUse#TMP ("Tijdelijk telefoonnummer")
  • http://terminology.hl7.org/CodeSystem/v3-AddressUse#WP ("Zakelijk telefoonnummer")

Answer options for 402

  • http://terminology.hl7.org/CodeSystem/v3-AddressUse#HP ("Privé e-mailadres")
  • http://terminology.hl7.org/CodeSystem/v3-AddressUse#WP ("Zakelijk e-mailadres")

Answer options for 410

  • urn:oid:2.16.840.1.113883.2.4.3.11.22.472#24 ("Wettelijke vertegenwoordiger")
  • urn:oid:2.16.840.1.113883.2.4.3.11.22.472#1 ("Eerste relatie/contactpersoon")
  • http://snomed.info/sct#310141000146103 ("Schriftelijk gemachtigde")
  • urn:oid:2.16.840.1.113883.2.4.3.11.22.472#3 ("Curator (juridisch)")
  • urn:oid:2.16.840.1.113883.2.4.3.11.22.472#15 ("Mentor")
  • urn:oid:2.16.840.1.113883.2.4.3.11.22.472#9 ("Anders")

Answer options for 51

  • http://terminology.hl7.org/CodeSystem/v3-RoleCode#DOMPART ("Partner")
  • http://terminology.hl7.org/CodeSystem/v3-RoleCode#HUSB ("Echtgenoot")
  • http://terminology.hl7.org/CodeSystem/v3-RoleCode#WIFE ("Echtgenote")
  • http://terminology.hl7.org/CodeSystem/v3-RoleCode#FTH ("Vader")
  • http://terminology.hl7.org/CodeSystem/v3-RoleCode#MTH ("Moeder")
  • http://terminology.hl7.org/CodeSystem/v3-RoleCode#SONC ("Zoon")
  • http://terminology.hl7.org/CodeSystem/v3-RoleCode#DAUC ("Dochter")
  • http://terminology.hl7.org/CodeSystem/v3-RoleCode#BRO ("Broer")
  • http://terminology.hl7.org/CodeSystem/v3-RoleCode#SIS ("Zuster")
  • http://terminology.hl7.org/CodeSystem/v3-NullFlavor#OTH ("Anders")

Answer options for 52

  • null#1 ("Ja")
  • null#0 ("Nee")

Answer options for 404

  • urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.22.1#LL ("Vast telefoonnummer")
  • urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.22.1#FAX ("Fax")
  • http://terminology.hl7.org/CodeSystem/v3-AddressUse#MC ("Mobiel telefoonnummer")
  • http://terminology.hl7.org/CodeSystem/v3-AddressUse#PG ("Pieper")

Answer options for 405

  • http://terminology.hl7.org/CodeSystem/v3-AddressUse#HP ("Telefoonnummer thuis")
  • http://terminology.hl7.org/CodeSystem/v3-AddressUse#TMP ("Tijdelijk telefoonnummer")
  • http://terminology.hl7.org/CodeSystem/v3-AddressUse#WP ("Zakelijk telefoonnummer")

Answer options for 407

  • http://terminology.hl7.org/CodeSystem/v3-AddressUse#HP ("Privé e-mailadres")
  • http://terminology.hl7.org/CodeSystem/v3-AddressUse#WP ("Zakelijk e-mailadres")

Answer options for 77

  • http://terminology.hl7.org/CodeSystem/v3-RoleCode#DOMPART ("Partner")
  • http://terminology.hl7.org/CodeSystem/v3-RoleCode#HUSB ("Echtgenoot")
  • http://terminology.hl7.org/CodeSystem/v3-RoleCode#WIFE ("Echtgenote")
  • http://terminology.hl7.org/CodeSystem/v3-RoleCode#FTH ("Vader")
  • http://terminology.hl7.org/CodeSystem/v3-RoleCode#MTH ("Moeder")
  • http://terminology.hl7.org/CodeSystem/v3-RoleCode#SONC ("Zoon")
  • http://terminology.hl7.org/CodeSystem/v3-RoleCode#DAUC ("Dochter")
  • http://terminology.hl7.org/CodeSystem/v3-RoleCode#BRO ("Broer")
  • http://terminology.hl7.org/CodeSystem/v3-RoleCode#SIS ("Zuster")
  • http://terminology.hl7.org/CodeSystem/v3-NullFlavor#OTH ("Anders")

Answer options for 82

  • null#Patiënt ("Patiënt")

Answer options for 415

  • urn:oid:2.16.840.1.113883.2.4.3.11.22.472#3 ("Curator (juridisch)")
  • urn:oid:2.16.840.1.113883.2.4.3.11.22.472#15 ("Mentor")
  • http://snomed.info/sct#310141000146103 ("Schriftelijk gemachtigde")
  • urn:oid:2.16.840.1.113883.2.4.3.11.22.472#9 ("Anders")

Answer options for 80

  • http://terminology.hl7.org/CodeSystem/v3-RoleCode#DOMPART ("Partner")
  • http://terminology.hl7.org/CodeSystem/v3-RoleCode#HUSB ("Echtgenoot")
  • http://terminology.hl7.org/CodeSystem/v3-RoleCode#WIFE ("Echtgenote")
  • http://terminology.hl7.org/CodeSystem/v3-RoleCode#FTH ("Vader")
  • http://terminology.hl7.org/CodeSystem/v3-RoleCode#MTH ("Moeder")
  • http://terminology.hl7.org/CodeSystem/v3-RoleCode#SONC ("Zoon")
  • http://terminology.hl7.org/CodeSystem/v3-RoleCode#DAUC ("Dochter")
  • http://terminology.hl7.org/CodeSystem/v3-RoleCode#BRO ("Broer")
  • http://terminology.hl7.org/CodeSystem/v3-RoleCode#SIS ("Zuster")
  • http://terminology.hl7.org/CodeSystem/v3-NullFlavor#OTH ("Anders")

Answer options for 790

  • http://snomed.info/sct#180771000146100 ("Focus van behandeling (waarneembare entiteit)")

Answer options for 784

  • http://snomed.info/sct#385987000 ("Curatief / actief ziektebeleid")
  • http://snomed.info/sct#1351964001 ("Palliatief met als doel levensverlenging én symptoomverlichting")
  • http://snomed.info/sct#713148004 ("Palliatief met als doel symptoomverlichting, waarbij levensverlenging niet gewenst is")
  • http://terminology.hl7.org/CodeSystem/v3-NullFlavor#UNK ("Nog onbekend")

Answer options for 791

  • http://snomed.info/sct#89666000 ("Cardiopulmonale resuscitatie (verrichting)")

Answer options for 587

  • urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4#JA ("Ja")
  • urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4#JA_MAAR ("Ja, maar met beperkingen")
  • urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4#NEE ("Nee")
  • http://terminology.hl7.org/CodeSystem/v3-NullFlavor#UNK ("Onbekend")

Answer options for 794

  • http://snomed.info/sct#40617009 ("Kunstmatige beademing (verrichting)")

Answer options for 588

  • urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4#JA ("Ja")
  • urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4#JA_MAAR ("Ja, maar met beperkingen")
  • urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4#NEE ("Nee")
  • http://terminology.hl7.org/CodeSystem/v3-NullFlavor#UNK ("Onbekend")

Answer options for 795

  • http://snomed.info/sct#305351004 ("Opname op intensive care (verrichting)")

Answer options for 589

  • urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4#JA ("Ja")
  • urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4#JA_MAAR ("Ja, maar met beperkingen")
  • urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4#NEE ("Nee")
  • http://terminology.hl7.org/CodeSystem/v3-NullFlavor#UNK ("Onbekend")

Answer options for 799

  • http://snomed.info/sct#32485007 ("Opname in ziekenhuis (verrichting)")

Answer options for 590

  • urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4#JA ("Ja")
  • urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4#JA_MAAR ("Ja, maar met beperkingen")
  • urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4#NEE ("Nee")
  • http://terminology.hl7.org/CodeSystem/v3-NullFlavor#UNK ("Onbekend")

Answer options for 801

  • http://snomed.info/sct#281789004 ("Antibiotische therapie (verrichting)")

Answer options for 591

  • urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4#JA ("Ja")
  • urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4#JA_MAAR ("Ja, maar met beperkingen")
  • urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4#NEE ("Nee")
  • http://terminology.hl7.org/CodeSystem/v3-NullFlavor#UNK ("Onbekend")

Answer options for 803

  • http://snomed.info/sct#116762002 ("Toediening van bloedproduct (verrichting)")

Answer options for 592

  • urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4#JA ("Ja")
  • urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4#JA_MAAR ("Ja, maar met beperkingen")
  • urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4#NEE ("Nee")
  • http://terminology.hl7.org/CodeSystem/v3-NullFlavor#UNK ("Onbekend")

Answer options for 805

  • http://terminology.hl7.org/CodeSystem/v3-NullFlavor#OTH ("Overige behandelingen")

Answer options for 593

  • urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4#JA ("Ja")
  • urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4#NEE ("Nee")
  • http://terminology.hl7.org/CodeSystem/v3-NullFlavor#UNK ("Onbekend")

Answer options for 249

  • http://snomed.info/sct#373066001 ("Ja")
  • http://snomed.info/sct#373067005 ("Nee")
  • http://terminology.hl7.org/CodeSystem/v3-NullFlavor#UNK ("Nog onbekend")

Answer options for 600

  • null#ICD ("ICD")

Answer options for 809

  • http://snomed.info/sct#400231000146108 ("uitzetten van cardioverter-defibrillator in laatste levensfase (verrichting)")

Answer options for 595

  • urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4#JA ("Ja")
  • http://terminology.hl7.org/CodeSystem/v3-NullFlavor#ASKU ("Nee, nog geen besluit genomen")
  • http://terminology.hl7.org/CodeSystem/v3-NullFlavor#NASK ("Niet besproken")

Answer options for 811

  • http://snomed.info/sct#153851000146100 ("Wensen en verwachtingen met betrekking tot uitkomst van behandeling")

Answer options for 815

  • http://snomed.info/sct#395091006 ("Gewenste plek van overlijden")

Answer options for 604

  • http://snomed.info/sct#264362003 ("Thuis")
  • http://snomed.info/sct#22232009 ("Ziekenhuis")
  • http://snomed.info/sct#108344006 ("Verpleeghuis")
  • http://snomed.info/sct#284546000 ("Hospice")
  • http://terminology.hl7.org/CodeSystem/v3-NullFlavor#OTH ("Anders")
  • http://terminology.hl7.org/CodeSystem/v3-NullFlavor#UNK ("Nog onbekend")

Answer options for 816

  • http://snomed.info/sct#340171000146104 ("Standpunt ten opzichte van euthanasie (waarneembare entiteit)")

Answer options for 785

  • http://snomed.info/sct#340181000146102 ("Heeft euthanasieverklaring")
  • http://snomed.info/sct#340201000146103 ("Wenst geen euthanasie")
  • http://snomed.info/sct#340191000146100 ("Geen euthanasieverklaring, zou wel verzoek kunnen doen in bepaalde situaties")
  • http://terminology.hl7.org/CodeSystem/v3-NullFlavor#UNK ("Nog onbekend")

Answer options for 817

  • http://snomed.info/sct#570801000146104 ("Geregistreerd in orgaan donorregister (bevinding)")

Answer options for 789

  • http://snomed.info/sct#373066001 ("Ja")
  • http://snomed.info/sct#373067005 ("Nee")
  • http://terminology.hl7.org/CodeSystem/v3-NullFlavor#UNK ("Nog onbekend")

Answer options for 818

  • http://snomed.info/sct#247751003 ("Gevoel van zingeving (waarneembare entiteit)")

Answer options for 253

  • http://snomed.info/sct#373066001 ("Ja")
  • http://snomed.info/sct#373067005 ("Nee")
  • http://terminology.hl7.org/CodeSystem/v3-NullFlavor#UNK ("Nog onbekend")

Answer options for 255

  • http://snomed.info/sct#373066001 ("Ja")
  • http://snomed.info/sct#373067005 ("Nee")
  • http://terminology.hl7.org/CodeSystem/v3-NullFlavor#UNK ("Nog onbekend")

Answer options for 256

  • null#1 ("Ja")
  • null#0 ("Nee")

Answer options for 257

  • http://snomed.info/sct#441898007 ("Akkoord")
  • http://terminology.hl7.org/CodeSystem/v3-NullFlavor#UNK ("Nog onbekend")

Source1

{
  "resourceType": "Questionnaire",
  "id": "ACP-zib2017",
  "text": {
    "status": "extensions",
    "div": "<!-- snip (see above) -->"
  },
  "url": "https://api.iknl.nl/docs/pzp/stu3/Questionnaire/ACP-zib2017",
  "version": "1.0.0-rc1",
  "name": "ACPzib2017",
  "title": "Uniform vastleggen proactieve zorgpanning advance care planning (ACP) o.b.v. zibs2017 - Beta3 28-08-2025",
  "status": "draft",
  "experimental": false,
  "date": "2025-10-30T14:17:52+01:00",
  "publisher": "IKNL",
  "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 proactive 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.",
  "jurisdiction": [
    {
      "coding": [
        {
          "system": "http://unstats.un.org/unsd/methods/m49/m49.htm",
          "code": "001"
        }
      ]
    }
  ],
  "contact": [
    {
      "telecom": [
        {
          "system": "url",
          "value": "https://www.iknl.nl"
        }
      ]
    }
  ],
  "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.",
  "item": [
    {
      "linkId": "385",
      "code": [
        {
          "system": "http://snomed.info/sct",
          "code": "439771001"
        }
      ],
      "text": "Datum van invullen",
      "type": "dateTime",
      "required": false,
      "repeats": false
    },
    {
      "linkId": "7",
      "text": "Naam patiënt",
      "type": "group",
      "repeats": false,
      "item": [
        {
          "linkId": "386",
          "text": "Voornamen",
          "type": "string",
          "required": false,
          "repeats": false
        },
        {
          "linkId": "387",
          "text": "Voorvoegsels",
          "type": "string",
          "required": false,
          "repeats": false
        },
        {
          "linkId": "388",
          "text": "Achternaam",
          "type": "string",
          "required": false,
          "repeats": false
        }
      ]
    },
    {
      "linkId": "6",
      "code": [
        {
          "code": "21112-8"
        }
      ],
      "text": "Geboortedatum patiënt",
      "type": "dateTime",
      "required": false,
      "repeats": false
    },
    {
      "linkId": "8",
      "text": "Gesprek gevoerd door:",
      "type": "group",
      "repeats": false,
      "item": [
        {
          "linkId": "16",
          "text": "Naam zorgverlener",
          "type": "group",
          "repeats": false,
          "item": [
            {
              "linkId": "389",
              "text": "Voornamen",
              "type": "string",
              "required": false,
              "repeats": false
            },
            {
              "linkId": "390",
              "text": "Voorvoegsels",
              "type": "string",
              "required": false,
              "repeats": false
            },
            {
              "linkId": "391",
              "text": "Achternaam",
              "type": "string",
              "required": false,
              "repeats": false
            }
          ]
        },
        {
          "linkId": "786",
          "code": [
            {
              "system": "http://snomed.info/sct",
              "code": "394658006"
            }
          ],
          "text": "Functie (Specialisme)",
          "type": "choice",
          "required": false,
          "repeats": false,
          "option": [
            {
              "valueCoding": {
                "system": "http://fhir.nl/fhir/NamingSystem/uzi-rolcode",
                "code": "01.000",
                "display": "Arts"
              }
            },
            {
              "valueCoding": {
                "system": "http://fhir.nl/fhir/NamingSystem/uzi-rolcode",
                "code": "01.015",
                "display": "Huisarts"
              }
            },
            {
              "valueCoding": {
                "system": "http://fhir.nl/fhir/NamingSystem/uzi-rolcode",
                "code": "01.047",
                "display": "Specialist ouderengeneeskunde"
              }
            },
            {
              "valueCoding": {
                "system": "http://fhir.nl/fhir/NamingSystem/uzi-rolcode",
                "code": "30.000",
                "display": "Verpleegkundige"
              }
            },
            {
              "valueCoding": {
                "system": "http://fhir.nl/fhir/NamingSystem/uzi-rolcode",
                "code": "81.000",
                "display": "Physician assistant"
              }
            },
            {
              "valueCoding": {
                "system": "http://fhir.nl/fhir/NamingSystem/uzi-rolcode",
                "code": "99.000",
                "display": "Zorgverlener andere zorg"
              }
            }
          ]
        }
      ]
    },
    {
      "linkId": "26",
      "prefix": "1.",
      "text": "Wilsbekwaamheid & Wettelijke vertegenwoordiging",
      "type": "group",
      "repeats": false,
      "item": [
        {
          "linkId": "787",
          "text": "Is de patiënt op dit moment wilsbekwaam m.b.t. medische behandelbeslissingen?",
          "type": "choice",
          "required": false,
          "repeats": false,
          "option": [
            {
              "valueCoding": {
                "code": "1",
                "display": "Ja"
              }
            },
            {
              "valueCoding": {
                "code": "0",
                "display": "Nee"
              }
            }
          ],
          "item": [
            {
              "linkId": "788",
              "code": [
                {
                  "code": "48767-8"
                }
              ],
              "text": "Toelichting",
              "type": "string",
              "required": false,
              "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",
              "repeats": false,
              "item": [
                {
                  "linkId": "392",
                  "text": "Voornamen",
                  "type": "string",
                  "required": false,
                  "repeats": false
                },
                {
                  "linkId": "393",
                  "text": "Voorvoegsels",
                  "type": "string",
                  "required": false,
                  "repeats": false
                },
                {
                  "linkId": "394",
                  "text": "Achternaam",
                  "type": "string",
                  "required": false,
                  "repeats": false
                }
              ]
            },
            {
              "linkId": "39",
              "prefix": "b)",
              "text": "Contactgegevens wettelijk vertegenwoordiger",
              "type": "group",
              "repeats": false,
              "item": [
                {
                  "linkId": "40",
                  "text": "Telefoonnummers",
                  "type": "group",
                  "repeats": true,
                  "item": [
                    {
                      "linkId": "398",
                      "text": "Telefoonnummer",
                      "type": "string",
                      "required": false,
                      "repeats": false
                    },
                    {
                      "linkId": "399",
                      "text": "TelecomType",
                      "type": "choice",
                      "required": false,
                      "repeats": false,
                      "option": [
                        {
                          "valueCoding": {
                            "system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.22.1",
                            "code": "LL",
                            "display": "Vast telefoonnummer"
                          }
                        },
                        {
                          "valueCoding": {
                            "system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.22.1",
                            "code": "FAX",
                            "display": "Fax"
                          }
                        },
                        {
                          "valueCoding": {
                            "system": "http://terminology.hl7.org/CodeSystem/v3-AddressUse",
                            "code": "MC",
                            "display": "Mobiel telefoonnummer"
                          }
                        },
                        {
                          "valueCoding": {
                            "system": "http://terminology.hl7.org/CodeSystem/v3-AddressUse",
                            "code": "PG",
                            "display": "Pieper"
                          }
                        }
                      ]
                    },
                    {
                      "linkId": "400",
                      "text": "NummerSoort",
                      "type": "choice",
                      "required": false,
                      "repeats": false,
                      "option": [
                        {
                          "valueCoding": {
                            "system": "http://terminology.hl7.org/CodeSystem/v3-AddressUse",
                            "code": "HP",
                            "display": "Telefoonnummer thuis"
                          }
                        },
                        {
                          "valueCoding": {
                            "system": "http://terminology.hl7.org/CodeSystem/v3-AddressUse",
                            "code": "TMP",
                            "display": "Tijdelijk telefoonnummer"
                          }
                        },
                        {
                          "valueCoding": {
                            "system": "http://terminology.hl7.org/CodeSystem/v3-AddressUse",
                            "code": "WP",
                            "display": "Zakelijk telefoonnummer"
                          }
                        }
                      ]
                    }
                  ]
                },
                {
                  "linkId": "41",
                  "text": "EmailAdressen",
                  "type": "group",
                  "repeats": true,
                  "item": [
                    {
                      "linkId": "401",
                      "text": "EmailAdres",
                      "type": "string",
                      "required": false,
                      "repeats": false
                    },
                    {
                      "linkId": "402",
                      "text": "EmailSoort",
                      "type": "choice",
                      "required": false,
                      "repeats": false,
                      "option": [
                        {
                          "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": "410",
              "code": [
                {
                  "code": "24"
                },
                {
                  "code": "1"
                },
                {
                  "code": "3"
                },
                {
                  "code": "15"
                },
                {
                  "system": "http://snomed.info/sct",
                  "code": "310141000146103"
                },
                {
                  "code": "9"
                }
              ],
              "prefix": "c)",
              "text": "Relatie tot patiënt (1)",
              "type": "choice",
              "required": false,
              "repeats": true,
              "option": [
                {
                  "valueCoding": {
                    "system": "urn:oid:2.16.840.1.113883.2.4.3.11.22.472",
                    "code": "24",
                    "display": "Wettelijke vertegenwoordiger"
                  }
                },
                {
                  "valueCoding": {
                    "system": "urn:oid:2.16.840.1.113883.2.4.3.11.22.472",
                    "code": "1",
                    "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": "3",
                    "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": "9",
                    "display": "Anders"
                  }
                }
              ],
              "item": [
                {
                  "linkId": "411",
                  "text": "Anders, namelijk:",
                  "type": "string",
                  "enableWhen": [
                    {
                      "question": "410",
                      "answerCoding": {
                        "system": "urn:oid:2.16.840.1.113883.2.4.3.11.22.472",
                        "code": "9"
                      }
                    }
                  ],
                  "required": false,
                  "repeats": false
                }
              ]
            },
            {
              "linkId": "51",
              "code": [
                {
                  "code": "HUSB"
                },
                {
                  "code": "MTH"
                },
                {
                  "code": "FTH"
                },
                {
                  "code": "DOMPART"
                },
                {
                  "code": "WIFE"
                },
                {
                  "code": "DAUC"
                },
                {
                  "code": "SONC"
                },
                {
                  "code": "SIS"
                },
                {
                  "code": "BRO"
                },
                {
                  "system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
                  "code": "OTH"
                }
              ],
              "prefix": "c)",
              "text": "Relatie tot patiënt (2)",
              "type": "choice",
              "required": false,
              "repeats": false,
              "option": [
                {
                  "valueCoding": {
                    "system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
                    "code": "DOMPART",
                    "display": "Partner"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
                    "code": "HUSB",
                    "display": "Echtgenoot"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
                    "code": "WIFE",
                    "display": "Echtgenote"
                  }
                },
                {
                  "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"
                  }
                }
              ],
              "item": [
                {
                  "linkId": "408",
                  "text": "Anders, namelijk:",
                  "type": "string",
                  "enableWhen": [
                    {
                      "question": "51",
                      "answerCoding": {
                        "system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
                        "code": "OTH"
                      }
                    }
                  ],
                  "required": false,
                  "repeats": false
                }
              ]
            },
            {
              "linkId": "52",
              "prefix": "d)",
              "text": "Is de wettelijk vertegenwoordiger ook de eerste contactpersoon?",
              "type": "choice",
              "required": false,
              "repeats": false,
              "option": [
                {
                  "valueCoding": {
                    "code": "1",
                    "display": "Ja"
                  }
                },
                {
                  "valueCoding": {
                    "code": "0",
                    "display": "Nee"
                  }
                }
              ]
            },
            {
              "linkId": "53",
              "prefix": "e)",
              "text": "Naam eerste contactpersoon",
              "type": "group",
              "enableWhen": [
                {
                  "question": "52",
                  "answerCoding": {
                    "code": "0",
                    "display": "Nee"
                  }
                }
              ],
              "repeats": false,
              "item": [
                {
                  "linkId": "395",
                  "text": "Voornamen",
                  "type": "string",
                  "required": false,
                  "repeats": false
                },
                {
                  "linkId": "396",
                  "text": "Voorvoegsels",
                  "type": "string",
                  "required": false,
                  "repeats": false
                },
                {
                  "linkId": "397",
                  "text": "Achternaam",
                  "type": "string",
                  "required": false,
                  "repeats": false
                }
              ]
            },
            {
              "linkId": "61",
              "prefix": "f)",
              "text": "Contactgegevens eerste contactpersoon",
              "type": "group",
              "enableWhen": [
                {
                  "question": "52",
                  "answerCoding": {
                    "code": "0",
                    "display": "Nee"
                  }
                }
              ],
              "repeats": false,
              "item": [
                {
                  "linkId": "62",
                  "text": "Telefoonnummers",
                  "type": "group",
                  "repeats": true,
                  "item": [
                    {
                      "linkId": "403",
                      "text": "Telefoonnummer",
                      "type": "string",
                      "required": false,
                      "repeats": false
                    },
                    {
                      "linkId": "404",
                      "text": "TelecomType",
                      "type": "choice",
                      "required": false,
                      "repeats": false,
                      "option": [
                        {
                          "valueCoding": {
                            "system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.22.1",
                            "code": "LL",
                            "display": "Vast telefoonnummer"
                          }
                        },
                        {
                          "valueCoding": {
                            "system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.22.1",
                            "code": "FAX",
                            "display": "Fax"
                          }
                        },
                        {
                          "valueCoding": {
                            "system": "http://terminology.hl7.org/CodeSystem/v3-AddressUse",
                            "code": "MC",
                            "display": "Mobiel telefoonnummer"
                          }
                        },
                        {
                          "valueCoding": {
                            "system": "http://terminology.hl7.org/CodeSystem/v3-AddressUse",
                            "code": "PG",
                            "display": "Pieper"
                          }
                        }
                      ]
                    },
                    {
                      "linkId": "405",
                      "text": "NummerSoort",
                      "type": "choice",
                      "required": false,
                      "repeats": false,
                      "option": [
                        {
                          "valueCoding": {
                            "system": "http://terminology.hl7.org/CodeSystem/v3-AddressUse",
                            "code": "HP",
                            "display": "Telefoonnummer thuis"
                          }
                        },
                        {
                          "valueCoding": {
                            "system": "http://terminology.hl7.org/CodeSystem/v3-AddressUse",
                            "code": "TMP",
                            "display": "Tijdelijk telefoonnummer"
                          }
                        },
                        {
                          "valueCoding": {
                            "system": "http://terminology.hl7.org/CodeSystem/v3-AddressUse",
                            "code": "WP",
                            "display": "Zakelijk telefoonnummer"
                          }
                        }
                      ]
                    }
                  ]
                },
                {
                  "linkId": "66",
                  "text": "EmailAdressen",
                  "type": "group",
                  "repeats": true,
                  "item": [
                    {
                      "linkId": "406",
                      "text": "EmailAdres",
                      "type": "string",
                      "required": false,
                      "repeats": false
                    },
                    {
                      "linkId": "407",
                      "text": "EmailSoort",
                      "type": "choice",
                      "required": false,
                      "repeats": false,
                      "option": [
                        {
                          "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": "77",
              "code": [
                {
                  "system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
                  "code": "HUSB"
                },
                {
                  "system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
                  "code": "OTH"
                },
                {
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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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                {
                  "system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
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              ],
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                {
                  "question": "52",
                  "answerCoding": {
                    "code": "0",
                    "display": "Nee"
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              ],
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                },
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                  }
                },
                {
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                    "system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
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                    "display": "Moeder"
                  }
                },
                {
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                  }
                },
                {
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                    "display": "Dochter"
                  }
                },
                {
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                },
                {
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                    "display": "Zuster"
                  }
                },
                {
                  "valueCoding": {
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                    "display": "Anders"
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                }
              ],
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      ]
    },
    {
      "linkId": "78",
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      "text": "Gesprek gevoerd in bijzijn van",
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      "repeats": false,
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        {
          "linkId": "82",
          "text": "Patiënt",
          "type": "choice",
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          "repeats": false,
          "option": [
            {
              "valueCoding": {
                "code": "Patiënt",
                "display": "Patiënt"
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            }
          ]
        },
        {
          "linkId": "415",
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            {
              "system": "urn:oid:2.16.840.1.113883.2.4.3.11.22.472",
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          ],
          "text": "Rol",
          "type": "choice",
          "required": false,
          "repeats": true,
          "option": [
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              "valueCoding": {
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                "display": "Curator (juridisch)"
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            },
            {
              "valueCoding": {
                "system": "urn:oid:2.16.840.1.113883.2.4.3.11.22.472",
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          ],
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          ]
        },
        {
          "linkId": "80",
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            {
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          ],
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          "repeats": true,
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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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          ],
          "item": [
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                }
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      ]
    },
    {
      "linkId": "586",
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        {
          "linkId": "790",
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          "linkId": "784",
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            },
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              "valueCoding": {
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    },
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      "linkId": "83",
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        {
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              "linkId": "791",
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              "initialCoding": {
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        },
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          "text": "Opname in ziekenhuis",
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          "item": [
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              ],
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            },
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              ]
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          ]
        },
        {
          "linkId": "800",
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          "repeats": false,
          "item": [
            {
              "linkId": "801",
              "code": [
                {
                  "system": "http://snomed.info/sct",
                  "code": "50731006"
                }
              ],
              "text": "Behandeling",
              "type": "choice",
              "required": false,
              "repeats": false,
              "readOnly": true,
              "option": [
                {
                  "valueCoding": {
                    "system": "http://snomed.info/sct",
                    "code": "281789004",
                    "display": "Antibiotische therapie (verrichting)"
                  }
                }
              ],
              "initialCoding": {
                "system": "http://snomed.info/sct",
                "code": "281789004",
                "display": "Antibiotische therapie (verrichting)"
              }
            },
            {
              "linkId": "591",
              "text": "BehandelingToegestaan",
              "type": "choice",
              "required": false,
              "repeats": false,
              "option": [
                {
                  "valueCoding": {
                    "system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4",
                    "code": "JA",
                    "display": "Ja"
                  }
                },
                {
                  "valueCoding": {
                    "system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4",
                    "code": "JA_MAAR",
                    "display": "Ja, maar met beperkingen"
                  }
                },
                {
                  "valueCoding": {
                    "system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4",
                    "code": "NEE",
                    "display": "Nee"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
                    "code": "UNK",
                    "display": "Onbekend"
                  }
                }
              ],
              "item": [
                {
                  "linkId": "126",
                  "text": "Beperkingen",
                  "type": "string",
                  "enableWhen": [
                    {
                      "question": "591",
                      "answerCoding": {
                        "system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4",
                        "code": "JA_MAAR"
                      }
                    }
                  ],
                  "required": false,
                  "repeats": false
                },
                {
                  "linkId": "96",
                  "code": [
                    {
                      "code": "48767-8"
                    }
                  ],
                  "text": "Toelichting",
                  "type": "string",
                  "required": false,
                  "repeats": false
                }
              ]
            }
          ]
        },
        {
          "linkId": "802",
          "prefix": "f)",
          "text": "Toediening van een bloedproduct",
          "type": "group",
          "repeats": false,
          "item": [
            {
              "linkId": "803",
              "code": [
                {
                  "system": "http://snomed.info/sct",
                  "code": "50731006"
                }
              ],
              "text": "Behandeling",
              "type": "choice",
              "required": false,
              "repeats": false,
              "readOnly": true,
              "option": [
                {
                  "valueCoding": {
                    "system": "http://snomed.info/sct",
                    "code": "116762002",
                    "display": "Toediening van bloedproduct (verrichting)"
                  }
                }
              ],
              "initialCoding": {
                "system": "http://snomed.info/sct",
                "code": "116762002",
                "display": "Toediening van bloedproduct (verrichting)"
              }
            },
            {
              "linkId": "592",
              "text": "BehandelingToegestaan",
              "type": "choice",
              "required": false,
              "repeats": false,
              "option": [
                {
                  "valueCoding": {
                    "system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4",
                    "code": "JA",
                    "display": "Ja"
                  }
                },
                {
                  "valueCoding": {
                    "system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4",
                    "code": "JA_MAAR",
                    "display": "Ja, maar met beperkingen"
                  }
                },
                {
                  "valueCoding": {
                    "system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4",
                    "code": "NEE",
                    "display": "Nee"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
                    "code": "UNK",
                    "display": "Onbekend"
                  }
                }
              ],
              "item": [
                {
                  "linkId": "127",
                  "text": "Beperkingen",
                  "type": "string",
                  "enableWhen": [
                    {
                      "question": "592",
                      "answerCoding": {
                        "system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4",
                        "code": "JA_MAAR"
                      }
                    }
                  ],
                  "required": false,
                  "repeats": false
                },
                {
                  "linkId": "98",
                  "code": [
                    {
                      "code": "48767-8"
                    }
                  ],
                  "text": "Toelichting",
                  "type": "string",
                  "required": false,
                  "repeats": false
                }
              ]
            }
          ]
        },
        {
          "linkId": "804",
          "prefix": "g)",
          "text": "Overige behandelgrenzen",
          "type": "group",
          "repeats": false,
          "item": [
            {
              "linkId": "805",
              "code": [
                {
                  "system": "http://snomed.info/sct",
                  "code": "50731006"
                }
              ],
              "text": "Behandeling",
              "type": "choice",
              "required": false,
              "repeats": false,
              "readOnly": true,
              "option": [
                {
                  "valueCoding": {
                    "system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
                    "code": "OTH",
                    "display": "Overige behandelingen"
                  }
                }
              ],
              "initialCoding": {
                "system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
                "code": "OTH",
                "display": "Overige behandelingen"
              }
            },
            {
              "linkId": "593",
              "text": "BehandelingToegestaan",
              "type": "choice",
              "required": false,
              "repeats": false,
              "option": [
                {
                  "valueCoding": {
                    "system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4",
                    "code": "JA",
                    "display": "Ja"
                  }
                },
                {
                  "valueCoding": {
                    "system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4",
                    "code": "NEE",
                    "display": "Nee"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
                    "code": "UNK",
                    "display": "Onbekend"
                  }
                }
              ],
              "item": [
                {
                  "linkId": "100",
                  "code": [
                    {
                      "code": "48767-8"
                    }
                  ],
                  "text": "Toelichting",
                  "type": "string",
                  "required": false,
                  "repeats": false
                }
              ]
            }
          ]
        },
        {
          "linkId": "249",
          "prefix": "h)",
          "text": "Heeft de patiënt een ICD?",
          "type": "choice",
          "required": false,
          "repeats": false,
          "option": [
            {
              "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": "600",
              "text": "ProductType van ICD",
              "type": "choice",
              "enableWhen": [
                {
                  "question": "249",
                  "answerCoding": {
                    "system": "http://snomed.info/sct",
                    "code": "373066001"
                  }
                }
              ],
              "required": false,
              "repeats": false,
              "option": [
                {
                  "valueCoding": {
                    "code": "ICD",
                    "display": "ICD"
                  }
                }
              ]
            },
            {
              "linkId": "599",
              "code": [
                {
                  "code": "48767-8"
                }
              ],
              "text": "Toelichting",
              "type": "string",
              "enableWhen": [
                {
                  "question": "249",
                  "answerCoding": {
                    "system": "http://snomed.info/sct",
                    "code": "373066001"
                  }
                }
              ],
              "required": false,
              "repeats": false
            }
          ]
        },
        {
          "linkId": "808",
          "prefix": "i)",
          "text": "Is er een afspraak over het moment van uitzetten ICD?",
          "type": "group",
          "enableWhen": [
            {
              "question": "249",
              "answerCoding": {
                "system": "http://snomed.info/sct",
                "code": "373066001",
                "display": "Ja"
              }
            }
          ],
          "repeats": false,
          "item": [
            {
              "linkId": "809",
              "code": [
                {
                  "system": "http://snomed.info/sct",
                  "code": "50731006"
                }
              ],
              "text": "Behandeling van uitzetten ICD",
              "type": "choice",
              "required": false,
              "repeats": false,
              "readOnly": true,
              "option": [
                {
                  "valueCoding": {
                    "system": "http://snomed.info/sct",
                    "code": "400231000146108",
                    "display": "uitzetten van cardioverter-defibrillator in laatste levensfase (verrichting)"
                  }
                }
              ],
              "initialCoding": {
                "system": "http://snomed.info/sct",
                "code": "400231000146108",
                "display": "uitzetten van cardioverter-defibrillator in laatste levensfase (verrichting)"
              }
            },
            {
              "linkId": "595",
              "text": "Afspraak uitzetten ICD (BehandelingToegestaan)",
              "type": "choice",
              "enableWhen": [
                {
                  "question": "249",
                  "answerCoding": {
                    "system": "http://snomed.info/sct",
                    "code": "373066001"
                  }
                }
              ],
              "required": false,
              "repeats": false,
              "option": [
                {
                  "valueCoding": {
                    "system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4",
                    "code": "JA",
                    "display": "Ja"
                  }
                },
                {
                  "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": "596",
                  "code": [
                    {
                      "code": "48767-8"
                    }
                  ],
                  "text": "Toelichting gemaakte afspraken",
                  "type": "string",
                  "required": false,
                  "repeats": false
                }
              ]
            }
          ]
        }
      ]
    },
    {
      "linkId": "107",
      "prefix": "5.",
      "text": "Behandelwensen",
      "type": "group",
      "repeats": false,
      "item": [
        {
          "linkId": "810",
          "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": "811",
              "text": "Wens en verwachting patient (MetingNaam)",
              "type": "choice",
              "required": false,
              "repeats": false,
              "readOnly": true,
              "option": [
                {
                  "valueCoding": {
                    "system": "http://snomed.info/sct",
                    "code": "153851000146100",
                    "display": "Wensen en verwachtingen met betrekking tot uitkomst van behandeling"
                  }
                }
              ],
              "initialCoding": {
                "system": "http://snomed.info/sct",
                "code": "153851000146100",
                "display": "Wensen en verwachtingen met betrekking tot uitkomst van behandeling"
              }
            },
            {
              "linkId": "382",
              "text": "Wens en verwachting patient (UitslagWaarde)",
              "type": "string",
              "required": false,
              "repeats": false
            }
          ]
        },
        {
          "linkId": "812",
          "prefix": "b)",
          "text": "Gewenste plek van overlijden",
          "type": "group",
          "repeats": false,
          "item": [
            {
              "linkId": "815",
              "text": "MetingNaam voor Gewenste plek van overlijden",
              "type": "choice",
              "required": false,
              "repeats": false,
              "readOnly": true,
              "option": [
                {
                  "valueCoding": {
                    "system": "http://snomed.info/sct",
                    "code": "395091006",
                    "display": "Gewenste plek van overlijden"
                  }
                }
              ],
              "initialCoding": {
                "system": "http://snomed.info/sct",
                "code": "395091006",
                "display": "Gewenste plek van overlijden"
              }
            },
            {
              "linkId": "604",
              "text": "Voorkeursplek (UitslagWaarde)",
              "type": "choice",
              "required": false,
              "repeats": false,
              "option": [
                {
                  "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": "110",
                  "code": [
                    {
                      "code": "48767-8"
                    }
                  ],
                  "text": "Toelichting",
                  "type": "string",
                  "required": false,
                  "repeats": false
                }
              ]
            }
          ]
        },
        {
          "linkId": "813",
          "prefix": "c)",
          "text": "Euthanasie standpunt",
          "type": "group",
          "repeats": false,
          "item": [
            {
              "linkId": "816",
              "text": "MetingNaam voor Euthanasie standpunt",
              "type": "choice",
              "required": false,
              "repeats": false,
              "readOnly": true,
              "option": [
                {
                  "valueCoding": {
                    "system": "http://snomed.info/sct",
                    "code": "340171000146104",
                    "display": "Standpunt ten opzichte van euthanasie (waarneembare entiteit)"
                  }
                }
              ],
              "initialCoding": {
                "system": "http://snomed.info/sct",
                "code": "340171000146104",
                "display": "Standpunt ten opzichte van euthanasie (waarneembare entiteit)"
              }
            },
            {
              "linkId": "785",
              "text": "Standpunt (UitslagWaarde)",
              "type": "choice",
              "required": false,
              "repeats": false,
              "option": [
                {
                  "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": "112",
                  "code": [
                    {
                      "code": "48767-8"
                    }
                  ],
                  "text": "Toelichting",
                  "type": "string",
                  "required": false,
                  "repeats": false
                }
              ]
            }
          ]
        },
        {
          "linkId": "814",
          "prefix": "d)",
          "text": "Keuze orgaandonatie vastgelegd in donorregister?",
          "type": "group",
          "repeats": false,
          "item": [
            {
              "linkId": "817",
              "text": "MetingNaam voor Keuze orgaandonatie vastgelegd in donorregister?",
              "type": "choice",
              "required": false,
              "repeats": false,
              "readOnly": true,
              "option": [
                {
                  "valueCoding": {
                    "system": "http://snomed.info/sct",
                    "code": "570801000146104",
                    "display": "Geregistreerd in orgaan donorregister (bevinding)"
                  }
                }
              ],
              "initialCoding": {
                "system": "http://snomed.info/sct",
                "code": "570801000146104",
                "display": "Geregistreerd in orgaan donorregister (bevinding)"
              }
            },
            {
              "linkId": "789",
              "text": "Keuze orgaandonatie in donorregister (UitslagWaarde)",
              "type": "choice",
              "required": false,
              "repeats": false,
              "option": [
                {
                  "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": "818",
          "text": "MetingNaam voor Wat verder nog belangrijk is",
          "type": "choice",
          "required": false,
          "repeats": false,
          "readOnly": true,
          "option": [
            {
              "valueCoding": {
                "system": "http://snomed.info/sct",
                "code": "247751003",
                "display": "Gevoel van zingeving (waarneembare entiteit)"
              }
            }
          ],
          "initialCoding": {
            "system": "http://snomed.info/sct",
            "code": "247751003",
            "display": "Gevoel van zingeving (waarneembare entiteit)"
          }
        },
        {
          "linkId": "383",
          "text": "Wat verder nog belangrijk is (UitslagWaarde)",
          "type": "string",
          "required": false,
          "repeats": false
        }
      ]
    },
    {
      "linkId": "115",
      "prefix": "7.",
      "text": "Eerder vastgelegde behandelwensen",
      "type": "group",
      "repeats": false,
      "item": [
        {
          "linkId": "253",
          "prefix": "a)",
          "text": "Heeft de patiënt eerder behandelafspraken vastgelegd?",
          "type": "choice",
          "required": false,
          "repeats": false,
          "option": [
            {
              "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": "254",
              "text": "Toelichting",
              "type": "string",
              "required": false,
              "repeats": false
            }
          ]
        },
        {
          "linkId": "255",
          "prefix": "b)",
          "text": "Staan in eerder vastgelegde behandelafspraken andere wensen dan nu in deze verklaring?",
          "type": "choice",
          "enableWhen": [
            {
              "question": "253",
              "answerCoding": {
                "system": "http://snomed.info/sct",
                "code": "373066001"
              }
            }
          ],
          "required": false,
          "repeats": false,
          "option": [
            {
              "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": "256",
          "code": [
            {
              "system": "http://snomed.info/sct",
              "code": "223449006"
            }
          ],
          "prefix": "a)",
          "text": "Heeft u patient geïnformeerd over eigen verantwoordelijkheid om deze behandelafspraken met naasten te bespreken?",
          "type": "choice",
          "required": false,
          "repeats": false,
          "option": [
            {
              "valueCoding": {
                "code": "1",
                "display": "Ja"
              }
            },
            {
              "valueCoding": {
                "code": "0",
                "display": "Nee"
              }
            }
          ]
        },
        {
          "linkId": "257",
          "prefix": "b)",
          "text": "Patiënt gaat akkoord met het delen van deze behandelafspraken met andere betrokken hulpverleners",
          "type": "choice",
          "required": false,
          "repeats": false,
          "option": [
            {
              "valueCoding": {
                "system": "http://snomed.info/sct",
                "code": "441898007",
                "display": "Akkoord"
              }
            },
            {
              "valueCoding": {
                "system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
                "code": "UNK",
                "display": "Nog onbekend"
              }
            }
          ]
        }
      ]
    }
  ]
}