FHIR IG Statistics: Questionnaire/SHD-Questionnaire-CHCChecklist

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{
  "resourceType": "Questionnaire",
  "url": "https://fhir.nottinghamshire.gov.uk/STU3/Questionnaire/SHD-Questionnaire-CHCChecklist",
  "version": "0.0.1",
  "name": "NHS Continuing Healthcare Checklist",
  "title": "NHS Continuing Healthcare Checklist",
  "status": "active",
  "description": "NHS Continuing Healthcare Checklist",
  "item": [
    {
      "linkId": "1.1",
      "text": "Name of the assessor(s) who completed the CHC Checklist",
      "type": "string",
      "required": true
    },
    {
      "linkId": "1.2",
      "text": "Contact details of assessors (name, role, organisation, telephone number, email address)",
      "type": "string",
      "required": false
    },
    {
      "linkId": "1.3",
      "text": "Was the individual involved in the completion of the Checklist?",
      "type": "boolean",
      "required": true
    },
    {
      "linkId": "1.4",
      "text": "Was the individual offered the opportunity to have a representative such as a family member or other advocate present when the checklist was completed?",
      "type": "boolean",
      "required": true
    },
    {
      "linkId": "1.5",
      "text": "If yes, did the representative attend the completion of the Checklist?",
      "type": "boolean",
      "enableWhen": [
        {
          "question": "1.4",
          "answerBoolean": true
        }
      ],
      "required": true
    },
    {
      "linkId": "1.6",
      "text": "Please give the contact details of the representative (name, address and telephone number)",
      "type": "string",
      "enableWhen": [
        {
          "question": "1.5",
          "answerBoolean": true
        }
      ],
      "required": true
    },
    {
      "linkId": "1.7",
      "text": "Did you explain to the individual how their personal information will be shared with the different organisations involved in their care, and did they consent to this information sharing?",
      "type": "boolean",
      "required": false
    },
    {
      "linkId": "2.1",
      "text": "'Behaviour' Domain Level Score",
      "type": "choice",
      "required": true,
      "options": {
        "reference": "https://fhir.nottinghamshire.gov.uk/STU3/valueset/CHC-DomainLevelScore"
      }
    },
    {
      "linkId": "2.2",
      "text": "Evidence to support 'Behaviour' Domain Level",
      "type": "string",
      "required": true
    },
    {
      "linkId": "2.3",
      "text": "'Cognition' Domain Level Score",
      "type": "choice",
      "required": true,
      "options": {
        "reference": "https://fhir.nottinghamshire.gov.uk/STU3/valueset/CHC-DomainLevelScore"
      }
    },
    {
      "linkId": "2.4",
      "text": "Evidence to support 'Cognition' Domain Level",
      "type": "string",
      "required": true
    },
    {
      "linkId": "2.5",
      "text": "'Psychological/Emotional' Domain Level Score",
      "type": "choice",
      "required": true,
      "options": {
        "reference": "https://fhir.nottinghamshire.gov.uk/STU3/valueset/CHC-DomainLevelScore"
      }
    },
    {
      "linkId": "2.6",
      "text": "Evidence to support 'Psychological/Emotional' Domain Level",
      "type": "string",
      "required": true
    },
    {
      "linkId": "2.7",
      "text": "'Communication' Domain Level Score",
      "type": "choice",
      "required": true,
      "options": {
        "reference": "https://fhir.nottinghamshire.gov.uk/STU3/valueset/CHC-DomainLevelScore"
      }
    },
    {
      "linkId": "2.8",
      "text": "Evidence to support 'Communication' Domain Level",
      "type": "string",
      "required": true
    },
    {
      "linkId": "2.9",
      "text": "'Mobility' Domain Level Score",
      "type": "choice",
      "required": true,
      "options": {
        "reference": "https://fhir.nottinghamshire.gov.uk/STU3/valueset/CHC-DomainLevelScore"
      }
    },
    {
      "linkId": "2.10",
      "text": "Evidence to support 'Mobility' Domain Level",
      "type": "string",
      "required": true
    },
    {
      "linkId": "2.11",
      "text": "'Nutrition' Domain Level Score",
      "type": "choice",
      "required": true,
      "options": {
        "reference": "https://fhir.nottinghamshire.gov.uk/STU3/valueset/CHC-DomainLevelScore"
      }
    },
    {
      "linkId": "2.12",
      "text": "Evidence to support 'Nutrition' Domain Level",
      "type": "string",
      "required": true
    },
    {
      "linkId": "2.13",
      "text": "'Continence' Domain Level Score",
      "type": "choice",
      "required": true,
      "options": {
        "reference": "https://fhir.nottinghamshire.gov.uk/STU3/valueset/CHC-DomainLevelScore"
      }
    },
    {
      "linkId": "2.14",
      "text": "Evidence to support 'Continence' Domain Level",
      "type": "string",
      "required": true
    },
    {
      "linkId": "2.15",
      "text": "'Skin integrity' Domain Level Score",
      "type": "choice",
      "required": true,
      "options": {
        "reference": "https://fhir.nottinghamshire.gov.uk/STU3/valueset/CHC-DomainLevelScore"
      }
    },
    {
      "linkId": "2.16",
      "text": "Evidence to support 'Skin integrity' Domain Level",
      "type": "string",
      "required": true
    },
    {
      "linkId": "2.17",
      "text": "'Breathing' Domain Level Score",
      "type": "choice",
      "required": true,
      "options": {
        "reference": "https://fhir.nottinghamshire.gov.uk/STU3/valueset/CHC-DomainLevelScore"
      }
    },
    {
      "linkId": "2.18",
      "text": "Evidence to support 'Breathing' Domain Level",
      "type": "string",
      "required": true
    },
    {
      "linkId": "2.19",
      "text": "'Drug therapies and medication: symptom control' Domain Level Score",
      "type": "choice",
      "required": true,
      "options": {
        "reference": "https://fhir.nottinghamshire.gov.uk/STU3/valueset/CHC-DomainLevelScore"
      }
    },
    {
      "linkId": "2.20",
      "text": "Evidence to support 'Drug therapies and medication: symptom control' Domain Level",
      "type": "string",
      "required": true
    },
    {
      "linkId": "2.21",
      "text": "'Altered states of consciousness' Domain Level Score",
      "type": "choice",
      "required": true,
      "options": {
        "reference": "https://fhir.nottinghamshire.gov.uk/STU3/valueset/CHC-DomainLevelScore"
      }
    },
    {
      "linkId": "2.22",
      "text": "Evidence to support 'Altered states of consciousness' Domain Level",
      "type": "string",
      "required": true
    },
    {
      "linkId": "2.23",
      "text": "Total Score from Checklist",
      "type": "string",
      "required": true
    },
    {
      "linkId": "2.24",
      "text": "Outcome indicated by the Checklist",
      "type": "choice",
      "required": true,
      "options": {
        "reference": "https://fhir.nottinghamshire.gov.uk/STU3/valueset/CHC-Outcome"
      }
    },
    {
      "linkId": "2.25",
      "text": "Rationale for decision",
      "type": "string",
      "required": false
    }
  ]
}