FHIR IG analytics| Package | myhie.v4 |
| Resource Type | QuestionnaireResponse |
| Id | qr-initial-gl.json |
| FHIR Version | R4 |
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No resources found
No narrative content found in resource
FHIR
FHIRsmith{
"resourceType": "QuestionnaireResponse",
"id": "qr-gl-initial",
"meta": {
"source": "http://provider.hie.moh.gov.my",
"profile": [
"http://fhir.hie.moh.gov.my/StructureDefinition/QuestionnaireResponse-my-core"
]
},
"questionnaire": "http://fhir.hie.moh.gov.my/Questionnaire/q-gl-initial",
"status": "completed",
"subject": {
"reference": "Patient/74c778d4-19a4-442e-8918-620733047fce"
},
"authored": "2024-01-22T12:02:00+08:00",
"author": {
"reference": "PractitionerRole/b9797173-7e15-4fc3-8f85-d58627935956/_history/19"
},
"extension": [
{
"url": "http://fhir.hie.moh.gov.my/StructureDefinition/service-provider-my-core",
"valueReference": {
"reference": "Organization/11-05060009"
}
}
],
"item": [
{
"linkId": "HEADER",
"text": "Header",
"item": [
{
"answer": [
{
"valueString": "20"
}
],
"linkId": "GE HOSP_CODE",
"text": "GE PROVIDER CODE"
},
{
"answer": [
{
"valueCoding": {
"code": "PA",
"display": "Pre-Authorization Form /Initial GL request"
}
}
],
"linkId": "REQ_TYPE",
"text": "Request type"
},
{
"answer": [
{
"valueDateTime": "2024-03-04T04:01:58.677Z"
}
],
"linkId": "REQ_DATE",
"text": "Current date & time stamp"
},
{
"answer": [
{
"valueString": "123456"
}
],
"linkId": "HOSP_CASENO",
"text": "Hospital admission case no"
}
]
},
{
"linkId": "D1",
"text": "Details",
"item": [
{
"answer": [
{
"valueString": "12345"
}
],
"linkId": "REC-ID",
"text": "REC-ID"
},
{
"answer": [
{
"valueString": "Saifuldaulah"
}
],
"linkId": "PATIENT",
"text": "Patient Name"
},
{
"answer": [
{
"valueString": "921005146671"
}
],
"linkId": "NEWIC",
"text": "IC (new)"
},
{
"answer": [
{
"valueCoding": {
"system": "http://hl7.org/fhir/administrative-gender",
"code": "male",
"display": "Male"
}
}
],
"linkId": "CLTSEX",
"text": "Sex"
},
{
"answer": [
{
"valueString": "32"
}
],
"linkId": "CLTAGE",
"text": "Age of Patient"
},
{
"answer": [
{
"valueString": "123456"
}
],
"linkId": "POLICY_NO",
"text": "Policy No"
},
{
"answer": [
{
"valueString": "01156404217"
}
],
"linkId": "HOSP_CONTACT",
"text": "Hospital contact number"
},
{
"answer": [
{
"valueString": "123456"
}
],
"linkId": "HOSP_FAX",
"text": "Hospital Fax number"
},
{
"answer": [
{
"valueDateTime": "2024-03-04T04:02:36.549Z"
}
],
"linkId": "ADMISSION_DATE",
"text": "Admission /Planned Admission Date & Time"
},
{
"answer": [
{
"valueString": "5"
}
],
"linkId": "EXP_LOS",
"text": "Expected days of stay / Discharge date"
},
{
"answer": [
{
"valueString": "This is a text field"
}
],
"linkId": "SYMPTOMS",
"text": "Symtoms /Conditions requiring admission"
},
{
"answer": [
{
"valueString": "120.3"
}
],
"linkId": "BP_PULSE",
"text": "Patient's BP/Temp/Pulse"
},
{
"answer": [
{
"valueDateTime": "2024-01-22T12:02:00+08:00"
}
],
"linkId": "CLT_AWARE",
"text": "How long is patient aware of the condition"
},
{
"answer": [
{
"valueDateTime": "2024-01-22T12:02:00+08:00"
}
],
"linkId": "SYMPTOMS_DATE",
"text": "Date symptoms first appeared"
},
{
"answer": [
{
"valueDateTime": "2024-01-22T12:02:00+08:00"
}
],
"linkId": "DATE_CONSULTED",
"text": "Date first consulted"
},
{
"answer": [
{
"valueBoolean": true
}
],
"linkId": "PREV_CONSULT",
"text": "Any previous consultation/treatment/hospitalization for this symptoms/illness or related conditions whether in this hospital or any other facilities"
},
{
"answer": [
{
"valueBoolean": true
}
],
"linkId": "REFERRED",
"text": "Was the patient referred?"
},
{
"answer": [
{
"valueString": "This is a text field"
}
],
"linkId": "MEDICAL_HIST",
"text": "Referred hospital & details"
},
{
"answer": [
{
"valueBoolean": true
}
],
"linkId": "OUTPATIENT",
"text": "The condition can be managed under outpatient basis"
},
{
"answer": [
{
"valueString": "This is a text field"
}
],
"linkId": "ICD_CODE",
"text": "Diagnosis Description"
},
{
"answer": [
{
"valueString": "This is a text field"
}
],
"linkId": "2nd_ICD",
"text": "Secondary Diagnosis code"
},
{
"answer": [
{
"valueString": "This is a text field"
}
],
"linkId": "ICD_DESC",
"text": "Expected days of stay / Discharge date"
},
{
"answer": [
{
"valueDateTime": "2024-01-22T12:02:00+08:00"
}
],
"linkId": "DIAGNOSIS_DATE",
"text": "Diagnosis confirmed on date"
},
{
"answer": [
{
"valueDateTime": "2024-01-22T12:02:00+08:00"
}
],
"linkId": "ADVISED_DATE",
"text": "Date when doctor first advised the diagnosis to patient"
},
{
"answer": [
{
"valueBoolean": true
}
],
"linkId": "RELAPSE",
"text": "Any possibility of relapse"
},
{
"answer": [
{
"valueDecimal": 5000.43
}
],
"linkId": "EST_COST",
"text": "Estimated Cost"
},
{
"answer": [
{
"valueCoding": {
"code": "IP",
"display": "Hospitalisation"
}
}
],
"linkId": "ADMISSION_TYPE",
"text": "Type of admission"
},
{
"answer": [
{
"valueCoding": {
"code": "e",
"display": "Cosmetic reason / Dental care / refractive errors correction"
}
}
],
"linkId": "ILLNESS_CONDITION",
"text": "selected illness/condition related to the diagnosis"
},
{
"answer": [
{
"valueString": "This is a text field"
}
],
"linkId": "TREATMENT_PLAN",
"text": "Medical treatment, Investigation and Surgical procedure to be performed"
},
{
"answer": [
{
"valueBoolean": true
}
],
"linkId": "DIABETES_MELLITUS",
"text": "Does the patient have any Diabetes Mellitus condition?"
},
{
"answer": [
{
"valueDateTime": "2024-01-22T12:02:00+08:00"
}
],
"linkId": "DIABETES_SINCE_WHEN",
"text": "Date first diagnosed with Diabetes Mellitus"
},
{
"answer": [
{
"valueString": "This is a text field"
}
],
"linkId": "DIABETES_MED_DET",
"text": "1) doctor who first diagnosed (Name & Hosp) \n 2) usual treating doctor \n 3) current medications (name/dosage)"
},
{
"answer": [
{
"valueBoolean": true
}
],
"linkId": "HYPERTENSION",
"text": "Does the patient have any hypertension condition?"
},
{
"answer": [
{
"valueDateTime": "2024-01-22T12:02:00+08:00"
}
],
"linkId": "HYPERTENSION_SINCE_WHEN",
"text": "Date first diagnosed with hypertension"
},
{
"answer": [
{
"valueString": "This is a text field"
}
],
"linkId": "HYPERTENSION_MED_DET",
"text": "1) doctor who first diagnosed (Name & Hosp) \n 2) usual treating doctor \n 3) current medications (name/dosage)"
},
{
"answer": [
{
"valueBoolean": true
}
],
"linkId": "HEART_DISEASE",
"text": "Does the patient have any heart disease condition?"
},
{
"answer": [
{
"valueDateTime": "2024-01-22T12:02:00+08:00"
}
],
"linkId": "HEART_DISEASE_SINCE_WHEN",
"text": "Date first diagnosed with heart disease"
},
{
"answer": [
{
"valueString": "This is a text field"
}
],
"linkId": "HEART_DIASEASE_MED_DET",
"text": "1) doctor who first diagnosed (Name & Hosp) \n 2) usual treating doctor \n 3) current medications (name/dosage)"
},
{
"answer": [
{
"valueBoolean": true
}
],
"linkId": "OTH_MEDICAL",
"text": "Other than above 3 specific illness. Does the patient have any other medical condition"
},
{
"answer": [
{
"valueString": "This is a text field"
}
],
"linkId": "OTH_MEDICAL_DET",
"text": "Other than above 3 specific illness. \n Doctor to provide other medical conditions if exist, if possible to provide medical conditions since date"
},
{
"answer": [
{
"valueBoolean": true
}
],
"linkId": "PREGNANT",
"text": "Was the patient pregnant at the time of hospitalization"
},
{
"answer": [
{
"valueBoolean": true
}
],
"linkId": "ACCIDENTAL",
"text": "Accidental case"
},
{
"answer": [
{
"valueDateTime": "2024-01-22T12:02:00+08:00"
}
],
"linkId": "ACCIDENT_DATE",
"text": "Date & time of Accident"
},
{
"answer": [
{
"valueString": "This is a text field"
}
],
"linkId": "ACCIDENT_DET",
"text": "Details of Accident"
},
{
"answer": [
{
"valueBoolean": true
}
],
"linkId": "SURGICAL",
"text": "Surgery is required"
},
{
"answer": [
{
"valueDateTime": "2024-01-22T12:02:00+08:00"
}
],
"linkId": "SURGICAL_DATE",
"text": "Date of Surgical"
},
{
"answer": [
{
"valueString": "This is a text field"
}
],
"linkId": "INJURY_DESC",
"text": "Injury description"
},
{
"answer": [
{
"valueString": "This is a text field"
}
],
"linkId": "HOSP_DOCTOR_CODE",
"text": "Hospital doctor User Code"
},
{
"answer": [
{
"valueString": "This is a text field"
}
],
"linkId": "PHYSICIAN",
"text": "Name of Admitting / Treating doctor"
},
{
"answer": [
{
"valueString": "This is a text field"
}
],
"linkId": "PHYSICIAN_SPECIALTY",
"text": "Physician Specialty"
},
{
"answer": [
{
"valueString": "This is a text field"
}
],
"linkId": "GL Number",
"text": "GE Guarantee Letter Number"
},
{
"answer": [
{
"valueBoolean": true
}
],
"linkId": "Patient_Consent",
"text": "Checklist - Patient's Consent and witness signature obtained"
}
]
}
]
}