FHIR IG analytics| Package | tewhatuora.rheumaticfever |
| Resource Type | Questionnaire |
| Id | Questionnaire-PatientWhanauGoalsPreferencesQuestionnaire.json |
| FHIR Version | R4 |
| Source | https://build.fhir.org/ig/tewhatuora/fhir-rheumatic-fever/Questionnaire-PatientWhanauGoalsPreferencesQuestionnaire.html |
| URL | https://fhir-ig.digital.health.nz/rheumatic-fever/Questionnaire/PatientWhanauGoalsPreferencesQuestionnaire |
| Version | 1.0.0 |
| Status | draft |
| Date | 2023-10-16 |
| Name | PatientWhanauGoalsPreferencesQuestionnaire |
| Title | Patient & whanau goals and preferences questionnaire |
| Authority | national |
| Description | Gathers patient and whanau preferences and goals for rheumatic fever care |
| Purpose | Gathers patient and whanau preferences and goals for rheumatic fever care |
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FHIR
FHIRsmith{
"resourceType": "Questionnaire",
"id": "PatientWhanauGoalsPreferencesQuestionnaire",
"url": "https://fhir-ig.digital.health.nz/rheumatic-fever/Questionnaire/PatientWhanauGoalsPreferencesQuestionnaire",
"identifier": [
{
"use": "official",
"value": "PatientWhanauGoalsPreferencesQuestionnaire",
"period": {
"start": "2023-10-16"
}
}
],
"version": "1.0.0",
"name": "PatientWhanauGoalsPreferencesQuestionnaire",
"title": "Patient & whanau goals and preferences questionnaire",
"status": "draft",
"experimental": false,
"subjectType": [
"Patient"
],
"date": "2023-10-16",
"publisher": "Te Whatu Ora",
"contact": [
{
"name": "Te Whatu Ora",
"telecom": [
{
"system": "url",
"value": "https://www.tewhatuora.govt.nz/"
},
{
"system": "email",
"value": "integration@tewhatuora.govt.nz"
}
]
},
{
"name": "HNZ Integration Team",
"telecom": [
{
"system": "email",
"value": "integration@tewhatuora.govt.nz",
"use": "work"
}
]
}
],
"description": "Gathers patient and whanau preferences and goals for rheumatic fever care",
"purpose": "Gathers patient and whanau preferences and goals for rheumatic fever care",
"item": [
{
"linkId": "page1",
"prefix": "page1",
"text": "Please complete this questionnaire to record goals and preferences of a patient or their whanau in relation to rheumatic fever prevention treatment.",
"type": "display"
},
{
"linkId": "ImportantToMe",
"prefix": "1)",
"text": "What things that are important to me and my family that support my health and wellbeing? (enter text)",
"type": "text",
"required": true
},
{
"linkId": "WhanauInvolvement",
"prefix": "2)",
"text": "How would I like my whanau and support persons to be involved? (enter text)",
"type": "text",
"required": true
},
{
"linkId": "BestWayToCommunicate",
"prefix": "3)",
"text": "The best way to communicate with me is…? (choose one)",
"type": "choice",
"required": true,
"repeats": false,
"answerOption": [
{
"valueString": "phone call"
},
{
"valueString": "text message"
},
{
"valueString": "email"
}
]
},
{
"linkId": "AppointmentsContact",
"prefix": "4)",
"text": "I know who to contact about my appointments? (choose one)",
"type": "boolean",
"required": false,
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "help",
"display": "Help-Button"
}
],
"text": "Help-Button"
}
}
],
"linkId": "AppointmentsContactHelp",
"text": "I understand who I should phone or text if I need to change my appointments, OR if I am going to be away, OR if I have questions.",
"type": "display"
}
]
},
{
"linkId": "PreferredAppointmentsLocation",
"prefix": "5)",
"text": "What location do I prefer to receive injected antibiotics at? (choose one)",
"type": "choice",
"required": true,
"repeats": false,
"answerOption": [
{
"valueString": "School"
},
{
"valueString": "Home"
},
{
"valueString": "Work"
},
{
"valueString": "Clinic"
},
{
"valueString": "Other"
}
]
},
{
"linkId": "InjectionLocationDetail",
"prefix": "6)",
"text": "More detail about this location (eg. at school during term time, but at home with Dad if out of term time)? (enter text)",
"type": "text",
"required": true
},
{
"linkId": "ImportantDuringInjectionVisits",
"prefix": "7)",
"text": "What things that are important to me during my injection visits eg. karakia, kaiawhina support? (enter text)",
"type": "text",
"required": true
},
{
"linkId": "InjectionVisitsNoNos",
"prefix": "8)",
"text": "What things don't work well for me during my injection visits? (enter text)",
"type": "text",
"required": true
},
{
"linkId": "MakingInjectionsComfortable",
"prefix": "9)",
"text": "What things do I like to have with my injections to make them more comfortable? (multiple choice)",
"type": "choice",
"required": true,
"repeats": true,
"answerOption": [
{
"valueString": "Lignocaine"
},
{
"valueString": "Ice pack"
},
{
"valueString": "Buzzy bee"
},
{
"valueString": "Numbing cream (Emla)"
},
{
"valueString": "Numbing spray"
},
{
"valueString": "Distraction"
},
{
"valueString": "Very slow injection"
}
]
},
{
"linkId": "InjectionOtherComfort",
"prefix": "10)",
"text": "What other things make my injections more comfortable? (enter text)",
"type": "text",
"required": true
},
{
"linkId": "MedsPreferredSupplyMethod",
"prefix": "11)",
"text": "I would prefer to get my oral antibiotic medicines from? (choose one)",
"type": "choice",
"required": true,
"repeats": false,
"answerOption": [
{
"valueString": "GP prescription"
},
{
"valueString": "Monthly visit from a nurse"
},
{
"valueString": "3 monthly visit from a nurse"
},
{
"valueString": "Pick-up from a pharmacy"
},
{
"valueString": "Other"
}
]
},
{
"linkId": "MedsSupplyOtherDetail",
"prefix": "11.1)",
"text": "If other, enter details",
"type": "text",
"enableWhen": [
{
"question": "MedsPreferredSupplyMethod",
"operator": "=",
"answerString": "Other"
}
],
"required": true
},
{
"linkId": "EasierToGetToAppointments",
"prefix": "12)",
"text": "What things make it easier for me to get to hospital appointments? (multiple choice)",
"type": "choice",
"required": true,
"repeats": true,
"answerOption": [
{
"valueString": "Support with transport"
},
{
"valueString": "Morning appointments"
},
{
"valueString": "Afternoon appointments"
},
{
"valueString": "Choice of clinic days"
},
{
"valueString": "Cultural support"
},
{
"valueString": "Other"
}
]
},
{
"linkId": "HospitalAppointmentsImportant",
"prefix": "13)",
"text": "More detail about the things that are important to me about hospital appointments (enter text)",
"type": "text",
"required": true
},
{
"linkId": "HospitalAppointmentsNoNos",
"prefix": "14)",
"text": "Things that don't work well for me about hospital appointments (enter text)",
"type": "text",
"required": true
},
{
"linkId": "SupportGettingToHospitalAppointments",
"prefix": "15)",
"text": "Do I need support getting to and from hospital appointment? (choose one)",
"type": "choice",
"required": true,
"repeats": false,
"answerOption": [
{
"valueString": "Yes - always"
},
{
"valueString": "Yes - sometimes, please check each time"
},
{
"valueString": "No"
},
{
"valueString": "Not sure"
},
{
"valueString": "Other"
}
]
},
{
"linkId": "HospitalAppointmentsTransportSupport",
"prefix": "question 16",
"text": "Which transport support option do I need? (choose one)",
"type": "choice",
"required": true,
"repeats": false,
"answerOption": [
{
"valueString": "Taxi vouchers"
},
{
"valueString": "Top up on public transport card"
},
{
"valueString": "Hospital to provide transport"
},
{
"valueString": "Other"
}
]
},
{
"linkId": "HospitalAppointmentsTransportOtherDetail",
"prefix": "question 17",
"text": "What other details are there about getting to hospital appointments? (enter text)",
"type": "text",
"required": true
}
]
}