| Package | myhie.v4 |
| Resource Type | Questionnaire |
| Id | q-death-certificate |
| FHIR Version | R4 |
| Source | https://simplifier.net/resolve?scope=myhie.v4@1.0.0&canonical=http://fhir.hie.moh.gov.my/Questionnaire/q-death-certificate |
| URL | http://fhir.hie.moh.gov.my/Questionnaire/q-death-certificate |
| Status | active |
| Date | 2024-03-01T02:25:07.0445554+00:00 |
| Title | Death Certificate |
No resources found
No resources found
No narrative content found in resource
FHIR{
"resourceType": "Questionnaire",
"id": "q-death-certificate",
"url": "http://fhir.hie.moh.gov.my/Questionnaire/q-death-certificate",
"title": "Death Certificate",
"status": "active",
"date": "2024-03-01T02:25:07.0445554+00:00",
"item": [
{
"linkId": "death-date",
"text": "Date of death",
"type": "dateTime"
},
{
"linkId": "medical",
"text": "Frame A: Medical data:Part 1 and 2",
"type": "group",
"item": [
{
"linkId": "terminal-cod",
"text": "Terminal Cause of Death",
"type": "reference"
},
{
"linkId": "underlying-cod",
"text": "Underlying Cause of Death",
"type": "reference",
"repeats": true
},
{
"linkId": "underlying-condition",
"text": "Underlying Condition",
"type": "reference"
}
]
},
{
"linkId": "medical-other",
"text": "Frame B: Other medical data",
"type": "group",
"item": [
{
"linkId": "surgery",
"text": "Was surgery performed within the last 4 weeks?",
"type": "choice",
"answerOption": [
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "52101004",
"display": "Yes"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "2667000",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "373068000",
"display": "Unknown"
}
}
],
"item": [
{
"linkId": "surgery-date",
"text": "If yes please specify date of surgery",
"type": "date",
"enableWhen": [
{
"question": "surgery",
"operator": "=",
"answerCoding": {
"system": "http://snomed.info/sct",
"code": "52101004",
"display": "Yes"
}
}
]
},
{
"linkId": "surgery-reason",
"text": "If yes please specify reason for surgery (disease or condition)",
"type": "text",
"enableWhen": [
{
"question": "surgery",
"operator": "=",
"answerCoding": {
"system": "http://snomed.info/sct",
"code": "52101004",
"display": "Yes"
}
}
]
},
{
"linkId": "surgery-autopsy-request",
"text": "Was an autopsy request",
"type": "choice",
"answerOption": [
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "52101004",
"display": "Yes"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "2667000",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "373068000",
"display": "Unknown"
}
}
]
},
{
"linkId": "surgery-findings-used",
"text": "If yes, were the findings used in the certifcation?",
"type": "choice",
"enableWhen": [
{
"question": "surgery-autopsy-request",
"operator": "=",
"answerCoding": {
"system": "http://snomed.info/sct",
"code": "52101004",
"display": "Yes"
}
}
],
"answerOption": [
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "52101004",
"display": "Yes"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "2667000",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "373068000",
"display": "Unknown"
}
}
]
}
]
},
{
"linkId": "manner",
"text": "Manner of death:",
"type": "choice",
"answerOption": [
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "64572001",
"display": "Disease"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "55566008",
"display": "Accident"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "418420002",
"display": "Intentional self harm"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "52684005",
"display": "Assault"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "418635006",
"display": "Legal intervention"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "418781000",
"display": "War"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "65037004",
"display": "Could not be determined"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "716348004",
"display": "Pending investigation"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "373068000",
"display": "Unknown"
}
}
],
"item": [
{
"linkId": "manner-external",
"text": "If external cause or poisoning:",
"type": "group",
"item": [
{
"linkId": "manner-external-injury-date",
"text": "Date of injury",
"type": "date"
},
{
"linkId": "manner-external-description",
"text": "Please describe how external cause occured (If poisoning please specify poisoning agent)",
"type": "text"
}
]
}
]
},
{
"linkId": "location",
"text": "Place of occurrence of the external cause:",
"type": "choice",
"answerOption": [
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "876879006",
"display": "At home"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "105530003",
"display": "Residential institution"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "257698009",
"display": "School, other institution, public administrative area"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "257704009",
"display": "Sports and athletics area"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "257710009",
"display": "Street and highway"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "284443006",
"display": "Trade and service area"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "75414001",
"display": "Industrial and construction area"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "257609008",
"display": "Farm"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "74964007",
"display": "Other"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "373068000",
"display": "Unknown"
}
}
],
"item": [
{
"linkId": "location-other",
"text": "Other place (please specify)",
"type": "text",
"enableWhen": [
{
"question": "location",
"operator": "=",
"answerCoding": {
"system": "http://snomed.info/sct",
"code": "74964007",
"display": "Other"
}
}
]
}
]
},
{
"linkId": "child",
"text": "Fetal or infant Death",
"type": "group",
"item": [
{
"linkId": "child-multiple",
"text": "Multiple pregnancy",
"type": "choice",
"answerOption": [
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "52101004",
"display": "Yes"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "2667000",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "373068000",
"display": "Unknown"
}
}
]
},
{
"linkId": "child-stillborn",
"text": "Stillborn?",
"type": "choice",
"answerOption": [
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "52101004",
"display": "Yes"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "2667000",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "373068000",
"display": "Unknown"
}
}
]
},
{
"linkId": "child-hours-survived",
"text": "If death within 24h specify number of hours survived",
"type": "time"
},
{
"linkId": "child-birth-weight",
"text": "Birth weight (in grams)",
"type": "decimal"
},
{
"linkId": "child-gestation",
"text": "Number of completed weeks of pregnancy",
"type": "integer"
},
{
"linkId": "child-mother-age",
"text": "Age of mother (years)",
"type": "integer"
},
{
"linkId": "child-mother-condition",
"text": "If death was perinatal, please state conditions of mother that affected the fetus and newborn",
"type": "text"
}
]
},
{
"linkId": "pregnancy",
"text": "For women, was the deceased pregnant?",
"type": "choice",
"answerOption": [
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "52101004",
"display": "Yes"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "2667000",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "373068000",
"display": "Unknown"
}
}
],
"item": [
{
"linkId": "pregnancy-time",
"text": "If yes specifically up to when was patient in pregnancy prior to death?",
"type": "choice",
"enableWhen": [
{
"question": "pregnancy",
"operator": "=",
"answerCoding": {
"system": "http://snomed.info/sct",
"code": "52101004",
"display": "Yes"
}
}
],
"answerOption": [
{
"valueCoding": {
"code": "1",
"display": "At time of death"
}
},
{
"valueCoding": {
"code": "2",
"display": "Within 42 days before the death"
}
},
{
"valueCoding": {
"code": "3",
"display": "Between 42 days up to 1 year before death"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "373068000",
"display": "Unknown"
}
}
]
},
{
"linkId": "pregnancy-reason-death",
"text": "did the pregnancy contribute to the death",
"type": "choice",
"enableWhen": [
{
"question": "pregnancy",
"operator": "=",
"answerCoding": {
"system": "http://snomed.info/sct",
"code": "52101004",
"display": "Yes"
}
}
],
"answerOption": [
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "52101004",
"display": "Yes"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "2667000",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "373068000",
"display": "Unknown"
}
}
]
}
]
}
]
}
]
}