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Packagemyhie.v4
Resource TypeQuestionnaire
Idq-dietetic-care-notes-new.json
FHIR VersionR4

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Source1

{
  "resourceType": "Questionnaire",
  "id": "q-dietetic-care-notes-new",
  "url": "http://fhir.hie.moh.gov.my/Questionnaire/q-dietetic-care-notes-new",
  "name": "DieteticCareNotes",
  "title": "Dietetic Care Notes",
  "status": "active",
  "date": "2024-04-16T01:09:35.2239695+00:00",
  "item": [
    {
      "linkId": "anthropometry-measurement",
      "text": "Anthropometry Measurement",
      "type": "group",
      "item": [
        {
          "linkId": "anthropometry-adult",
          "text": "Adult",
          "type": "group",
          "item": [
            {
              "linkId": "wt-adult",
              "text": "Weight (kg)",
              "type": "decimal"
            },
            {
              "linkId": "ht-adult",
              "text": "Height (m)",
              "type": "decimal"
            },
            {
              "linkId": "bmi-adult",
              "text": "BMI (kg/m2)",
              "type": "decimal"
            },
            {
              "linkId": "ibw",
              "text": "IBW (kg)",
              "type": "text"
            }
          ]
        },
        {
          "linkId": "anthropometry-child",
          "text": "Child",
          "type": "group",
          "item": [
            {
              "linkId": "wt-child",
              "text": "Weight (kg) at 50th centile",
              "type": "decimal"
            },
            {
              "linkId": "ht-child",
              "text": "Height (m) at 50th centile",
              "type": "decimal"
            },
            {
              "linkId": "bmi-child",
              "text": "BMI (kg/m2)",
              "type": "decimal"
            }
          ]
        },
        {
          "linkId": "anthropometry-others",
          "text": "Entry Others (WC/ HC/ KH/ MUAC/ Wt Changes/ fat%)",
          "type": "text"
        }
      ]
    },
    {
      "linkId": "nutrition-related-hx",
      "text": "Nutrition Related History",
      "type": "group",
      "item": [
        {
          "linkId": "nutrition-related-choice",
          "text": "Underlying Issues",
          "type": "choice",
          "repeats": true,
          "answerOption": [
            {
              "valueCoding": {
                "code": "1",
                "display": "Diabetes Mellitus (DM)"
              }
            },
            {
              "valueCoding": {
                "code": "2",
                "display": "Hypertension (HPT)"
              }
            },
            {
              "valueCoding": {
                "code": "3",
                "display": "Cardiovascular Disease (CVD)"
              }
            },
            {
              "valueCoding": {
                "code": "4",
                "display": "Failure To Thrive (FTT)"
              }
            },
            {
              "valueCoding": {
                "code": "5",
                "display": "Gout"
              }
            },
            {
              "valueCoding": {
                "code": "6",
                "display": "Gestitional Diabetes Mellitus (GDM)"
              }
            },
            {
              "valueCoding": {
                "code": "7",
                "display": "Human Placental Lactogen (HPL)"
              }
            },
            {
              "valueCoding": {
                "code": "8",
                "display": "Chronic Kidney Disease (CKD)"
              }
            },
            {
              "valueCoding": {
                "code": "9",
                "display": "Obesity"
              }
            },
            {
              "valueCoding": {
                "code": "10",
                "display": "Others"
              }
            }
          ]
        },
        {
          "linkId": "nutrition-related-hx-entry",
          "text": "Entry (Clinical Diagnosis/ Medical History/ Social History/ Family History/ Medication/ Physical Activity/ Food Allergy or intolerance/ Supllement used/ Food Belief/ Alcohol)",
          "type": "text"
        }
      ]
    },
    {
      "linkId": "nutrition-related-biochemstry",
      "text": "Nutrition Related Biochemistry",
      "type": "group",
      "item": [
        {
          "linkId": "nutrition-related-biochemstry-entry",
          "text": "Entry (Biochemical Data, Medical Test and Procedure)",
          "type": "text"
        }
      ]
    },
    {
      "linkId": "nutrition-focused-pe",
      "text": "Nutrition Focused Physical Findings",
      "type": "group",
      "item": [
        {
          "linkId": "nutrition-focused-pe-choice",
          "text": "BP/ HR/ BP/ Stool Pattern/ etc",
          "type": "choice",
          "repeats": true,
          "answerOption": [
            {
              "valueCoding": {
                "code": "1",
                "display": "Abdominal Distension"
              }
            },
            {
              "valueCoding": {
                "code": "2",
                "display": "Ascites"
              }
            },
            {
              "valueCoding": {
                "code": "3",
                "display": "Assisted feeding"
              }
            },
            {
              "valueCoding": {
                "code": "4",
                "display": "Constipation"
              }
            },
            {
              "valueCoding": {
                "code": "5",
                "display": "Diarrhoea"
              }
            },
            {
              "valueCoding": {
                "code": "6",
                "display": "Dysphagia"
              }
            },
            {
              "valueCoding": {
                "code": "7",
                "display": "Early satiety"
              }
            },
            {
              "valueCoding": {
                "code": "8",
                "display": "Edema"
              }
            },
            {
              "valueCoding": {
                "code": "9",
                "display": "High aspiration"
              }
            },
            {
              "valueCoding": {
                "code": "10",
                "display": "Lethargy"
              }
            },
            {
              "valueCoding": {
                "code": "11",
                "display": "Nausea"
              }
            },
            {
              "valueCoding": {
                "code": "12",
                "display": "Poor appetite"
              }
            },
            {
              "valueCoding": {
                "code": "13",
                "display": "Poor dentition"
              }
            },
            {
              "valueCoding": {
                "code": "14",
                "display": "Vomiting"
              }
            }
          ]
        }
      ]
    },
    {
      "linkId": "dietary-assessment",
      "text": "Dietary Assessment",
      "type": "group",
      "item": [
        {
          "linkId": "dietary-assessment-entry",
          "text": "Entry (diet recall such as history/ Food checklist/ Summary of Nutrient Intake/ Enteral Feeding",
          "type": "text"
        }
      ]
    },
    {
      "linkId": "nutrition-dx",
      "text": "Nutrition Diagnosis",
      "type": "group",
      "item": [
        {
          "linkId": "nutrition-dx-entry",
          "text": "Entry (Problem, Etiology, Sign & Symptoms)",
          "type": "text"
        }
      ]
    },
    {
      "linkId": "nutrition-tx",
      "text": "Nutrition Intervention Plan",
      "type": "group",
      "item": [
        {
          "linkId": "nutrition-tx-educate",
          "text": "Educate on",
          "type": "choice",
          "repeats": true,
          "answerOption": [
            {
              "valueCoding": {
                "code": "1",
                "display": "Healthy Plate Model"
              }
            },
            {
              "valueCoding": {
                "code": "2",
                "display": "Meals and snacks"
              }
            },
            {
              "valueCoding": {
                "code": "3",
                "display": "Meal timing"
              }
            },
            {
              "valueCoding": {
                "code": "4",
                "display": "Calorie modification"
              }
            },
            {
              "valueCoding": {
                "code": "5",
                "display": "Carbohydrate counring and distribution"
              }
            },
            {
              "valueCoding": {
                "code": "6",
                "display": "Type of fat and fat recommendation"
              }
            },
            {
              "valueCoding": {
                "code": "7",
                "display": "Recommendation of Fiber intake"
              }
            },
            {
              "valueCoding": {
                "code": "8",
                "display": "Low Sodium"
              }
            },
            {
              "valueCoding": {
                "code": "9",
                "display": "Low Purine"
              }
            },
            {
              "valueCoding": {
                "code": "10",
                "display": "High / Low Protein"
              }
            },
            {
              "valueCoding": {
                "code": "11",
                "display": "High / Low Phosphate"
              }
            },
            {
              "valueCoding": {
                "code": "12",
                "display": "High / Low Potassium"
              }
            },
            {
              "valueCoding": {
                "code": "13",
                "display": "Functional foods"
              }
            },
            {
              "valueCoding": {
                "code": "14",
                "display": "Food choices when eating out"
              }
            },
            {
              "valueCoding": {
                "code": "15",
                "display": "Medical food supplements"
              }
            },
            {
              "valueCoding": {
                "code": "16",
                "display": "Food label"
              }
            },
            {
              "valueCoding": {
                "code": "17",
                "display": "Helthy cooking method"
              }
            },
            {
              "valueCoding": {
                "code": "18",
                "display": "Mindful eating"
              }
            },
            {
              "valueCoding": {
                "code": "19",
                "display": "Meal planning and modifications"
              }
            },
            {
              "valueCoding": {
                "code": "20",
                "display": "Physical activity"
              }
            }
          ]
        },
        {
          "linkId": "nutrition-tx-other",
          "text": "Other Intervention Entry (Energy requirement, diet prescription, meal plan, enteral feeding, prescription, regime)",
          "type": "text"
        }
      ]
    }
  ]
}