| Package | smart.who.int.immunizations |
| Resource Type | Questionnaire |
| Id | QIMMZC4 |
| FHIR Version | R4 |
| Source | http://smart.who.int/immunizations/https://build.fhir.org/ig/WorldHealthOrganization/smart-immunizations/Questionnaire-QIMMZC4.html |
| URL | http://smart.who.int/immunizations/Questionnaire/QIMMZC4 |
| Version | 0.2.0 |
| Status | draft |
| Date | 2025-07-25T21:56:21+00:00 |
| Title | IMMZ.C4.Create client record |
| Authority | who |
| Description | Questionnaire for IMMZ.C4.Create client record |
No resources found
No resources found
Note: links and images are rebased to the (stated) source
Generated Narrative: Questionnaire QIMMZC4
Language: en
| LinkID | Text | Cardinality | Type | Description & Constraints |
|---|---|---|---|---|
  | Questionnaire for IMMZ.C4.Create client record | Questionnaire | http://smart.who.int/immunizations/Questionnaire/QIMMZC4#0.2.0 | |
  uniqueIdentifier | Unique identifier | 1..1 | string | |
| name | Name | 1..1 | string | |
| firstName | First name | 0..1 | string | |
| familyName | Family name | 0..1 | string | |
 sex | Sex | 1..1 | choice | Value Set: IMMZ.C.DE5 ValueSet for Sex |
 dateOfBirth | Date of birth | 1..1 | date | |
| age | Age | 0..1 | string | |
 caregiversMultiple | Caregivers (multiple) | 0..* | group | |
 caregiversFullName | Caregiver's full name | 0..1 | string | |
| caregiversFirstName | Caregiver's first name | 0..1 | string | |
 caregiversFamilyName | Caregiver's family name | 0..1 | string | |
| contactPhoneNumber | Contact phone number | 1..1 | string | |
| address | Address | 1..1 | string | |
| Documentation for this format | ||||
ValueSet #IMMZ.C.DE5
This value set expansion contains 4 concepts.
| Code | System | Display | Definition |
| DE6 | http://smart.who.int/immunizations/CodeSystem/IMMZ.C | Male | Client's biological sex is male |
| DE7 | http://smart.who.int/immunizations/CodeSystem/IMMZ.C | Female | Client's biological sex is female |
| DE8 | http://smart.who.int/immunizations/CodeSystem/IMMZ.C | Biological sex not specified | Client's biological sex is not specified |
| DE9 | http://smart.who.int/immunizations/CodeSystem/IMMZ.C | Intersex | Client's biological sex is intersex |
FHIR{
"resourceType": "Questionnaire",
"id": "QIMMZC4",
"meta": {
"profile": [
"http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-extr-smap"
]
},
"language": "en",
"text": {
"status": "extensions",
"div": "<!-- snip (see above) -->"
},
"contained": [
{
"resourceType": "ValueSet",
"id": "IMMZ.C.DE5",
"url": "http://smart.who.int/immunizations/ValueSet/IMMZ.C.DE5",
"name": "IMMZ_C_DE5",
"title": "IMMZ.C.DE5 ValueSet for Sex",
"status": "active",
"description": "ValueSet for Sex for IMMZ.C.DE5",
"compose": {
"include": [
{
"system": "http://smart.who.int/immunizations/CodeSystem/IMMZ.C",
"concept": [
{
"code": "DE6",
"display": "Male"
},
{
"code": "DE7",
"display": "Female"
},
{
"code": "DE8",
"display": "Biological sex not specified"
},
{
"code": "DE9",
"display": "Intersex"
}
]
}
]
},
"expansion": {
"timestamp": "2025-06-25T16:39:07.092Z",
"contains": [
{
"system": "http://smart.who.int/immunizations/CodeSystem/IMMZ.C",
"code": "DE6",
"display": "Male"
},
{
"system": "http://smart.who.int/immunizations/CodeSystem/IMMZ.C",
"code": "DE7",
"display": "Female"
},
{
"system": "http://smart.who.int/immunizations/CodeSystem/IMMZ.C",
"code": "DE8",
"display": "Biological sex not specified"
},
{
"system": "http://smart.who.int/immunizations/CodeSystem/IMMZ.C",
"code": "DE9",
"display": "Intersex"
}
]
}
}
],
"extension": [
{
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-targetStructureMap",
"valueCanonical": "http://smart.who.int/immunizations/StructureMap/IMMZ.C4.QRToPatient"
}
],
"url": "http://smart.who.int/immunizations/Questionnaire/QIMMZC4",
"version": "0.2.0",
"title": "IMMZ.C4.Create client record",
"status": "draft",
"subjectType": [
"Patient"
],
"date": "2025-07-25T21:56:21+00:00",
"publisher": "WHO",
"contact": [
{
"name": "WHO",
"telecom": [
{
"system": "url",
"value": "http://who.int"
}
]
}
],
"description": "Questionnaire for IMMZ.C4.Create client record",
"item": [
{
"linkId": "uniqueIdentifier",
"code": [
{
"system": "http://smart.who.int/immunizations/CodeSystem/IMMZ.C",
"code": "DE1"
}
],
"text": "Unique identifier",
"type": "string",
"required": true,
"repeats": false
},
{
"linkId": "name",
"code": [
{
"system": "http://smart.who.int/immunizations/CodeSystem/IMMZ.C",
"code": "DE2"
},
{
"system": "http://loinc.org",
"code": "54125-0",
"display": "Patient name"
},
{
"system": "http://snomed.info/sct",
"code": "371484003",
"display": "Patient name (observable entity)"
}
],
"text": "Name",
"type": "string",
"required": true,
"repeats": false
},
{
"linkId": "firstName",
"code": [
{
"system": "http://smart.who.int/immunizations/CodeSystem/IMMZ.C",
"code": "DE3"
},
{
"system": "http://loinc.org",
"code": "45392-8",
"display": "First name"
},
{
"system": "http://snomed.info/sct",
"code": "184095009",
"display": "Patient forename (observable entity)"
}
],
"text": "First name",
"type": "string",
"required": false,
"repeats": false
},
{
"linkId": "familyName",
"code": [
{
"system": "http://smart.who.int/immunizations/CodeSystem/IMMZ.C",
"code": "DE4"
},
{
"system": "http://loinc.org",
"code": "45394-4",
"display": "Last name"
},
{
"system": "http://snomed.info/sct",
"code": "184096005",
"display": "Patient surname (observable entity)"
}
],
"text": "Family name",
"type": "string",
"required": false,
"repeats": false
},
{
"linkId": "sex",
"code": [
{
"system": "http://smart.who.int/immunizations/CodeSystem/IMMZ.C",
"code": "DE5"
},
{
"system": "http://loinc.org",
"code": "46098-0",
"display": "Sex"
},
{
"system": "http://snomed.info/sct",
"code": "184100006",
"display": "Patient sex (observable entity)"
}
],
"text": "Sex",
"type": "choice",
"required": true,
"repeats": false,
"answerValueSet": "#IMMZ.C.DE5"
},
{
"linkId": "dateOfBirth",
"code": [
{
"system": "http://smart.who.int/immunizations/CodeSystem/IMMZ.C",
"code": "DE10"
},
{
"system": "http://loinc.org",
"code": "21112-8",
"display": "Birth date"
},
{
"system": "http://snomed.info/sct",
"code": "184099003",
"display": "Date of birth (observable entity)"
}
],
"text": "Date of birth",
"type": "date",
"required": true,
"repeats": false
},
{
"linkId": "age",
"code": [
{
"system": "http://smart.who.int/immunizations/CodeSystem/IMMZ.C",
"code": "DE13"
},
{
"system": "http://loinc.org",
"code": "63900-5",
"display": "Current age or age at death"
}
],
"text": "Age",
"type": "string",
"required": false,
"repeats": false
},
{
"linkId": "caregiversMultiple",
"code": [
{
"system": "http://smart.who.int/immunizations/CodeSystem/IMMZ.C",
"code": "DE14"
},
{
"system": "http://snomed.info/sct",
"code": "184140000",
"display": "Caregiver details (observable entity)"
}
],
"text": "Caregivers (multiple)",
"type": "group",
"required": false,
"repeats": true,
"item": [
{
"linkId": "caregiversFullName",
"code": [
{
"system": "http://smart.who.int/immunizations/CodeSystem/IMMZ.C",
"code": "DE15"
},
{
"system": "http://snomed.info/sct",
"code": "184140000",
"display": "Caregiver details (observable entity)"
}
],
"text": "Caregiver's full name",
"type": "string",
"required": false,
"repeats": false
},
{
"linkId": "caregiversFirstName",
"code": [
{
"system": "http://smart.who.int/immunizations/CodeSystem/IMMZ.C",
"code": "DE16"
},
{
"system": "http://loinc.org",
"code": "45392-8",
"display": "First name"
}
],
"text": "Caregiver's first name",
"type": "string",
"required": false,
"repeats": false
},
{
"linkId": "caregiversFamilyName",
"code": [
{
"system": "http://smart.who.int/immunizations/CodeSystem/IMMZ.C",
"code": "DE17"
},
{
"system": "http://loinc.org",
"code": "45394-4",
"display": "Last name"
}
],
"text": "Caregiver's family name",
"type": "string",
"required": false,
"repeats": false
}
]
},
{
"linkId": "contactPhoneNumber",
"code": [
{
"system": "http://smart.who.int/immunizations/CodeSystem/IMMZ.C",
"code": "DE18"
},
{
"system": "http://loinc.org",
"code": "42077-8",
"display": "Patient Phone number"
},
{
"system": "http://snomed.info/sct",
"code": "184103008",
"display": "Patient telephone number (observable entity)"
}
],
"text": "Contact phone number",
"type": "string",
"required": true,
"repeats": false
},
{
"linkId": "address",
"code": [
{
"system": "http://smart.who.int/immunizations/CodeSystem/IMMZ.C",
"code": "DE19"
},
{
"system": "http://loinc.org",
"code": "56799-0",
"display": "Address"
},
{
"system": "http://snomed.info/sct",
"code": "184097001",
"display": "Patient address (observable entity)"
}
],
"text": "Address",
"type": "string",
"required": true,
"repeats": false
}
]
}