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Source1

{
  "resourceType": "Questionnaire",
  "id": "RecurrenceDiagnosisQuestionnaire",
  "url": "https://fhir-ig.digital.health.nz/rheumatic-fever/Questionnaire/RecurrenceDiagnosisQuestionnaire",
  "identifier": [
    {
      "use": "official",
      "value": "RecurrenceDiagnosisQuestionnaire",
      "period": {
        "start": "2024-01-01"
      }
    }
  ],
  "version": "1.0.0",
  "name": "RecurrenceDiagnosisQuestionnaire",
  "title": "Recurrence Diagnosis Questionnaire",
  "status": "draft",
  "experimental": false,
  "subjectType": [
    "Patient"
  ],
  "date": "2024-01-01",
  "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 information about prophylaxis and recurrence details for acute rheumatic fever diagnosis",
  "purpose": "Gathers information about prophylaxis and recurrence details for acute rheumatic fever diagnosis",
  "item": [
    {
      "linkId": "page1",
      "prefix": "page1",
      "text": "Please complete this questionnaire to assess recurrence and prophylaxis details for rheumatic fever diagnosis.",
      "type": "display"
    },
    {
      "linkId": "ReceivingAntibioticProphylaxis",
      "prefix": "1)",
      "text": "Was the patient receiving antibiotic prophylaxis?",
      "type": "choice",
      "required": true,
      "repeats": false,
      "answerOption": [
        {
          "valueString": "Yes"
        },
        {
          "valueString": "No - Completed Treatment"
        },
        {
          "valueString": "No - Discontinued Prematurely"
        },
        {
          "valueString": "No - Other"
        },
        {
          "valueString": "Unknown"
        }
      ]
    },
    {
      "linkId": "TypeOfProphylaxis",
      "prefix": "2)",
      "text": "Type of Prophylaxis",
      "type": "choice",
      "required": true,
      "repeats": false,
      "answerOption": [
        {
          "valueString": "Benzathine Penicillin"
        },
        {
          "valueString": "Amoxicillin"
        },
        {
          "valueString": "Penicillin V"
        },
        {
          "valueString": "Erythromycin"
        },
        {
          "valueString": "Roxithromycin"
        },
        {
          "valueString": "Other"
        },
        {
          "valueString": "Unknown"
        },
        {
          "valueString": "None"
        }
      ]
    },
    {
      "linkId": "OtherProphylaxis",
      "prefix": "3)",
      "text": "Other Prophylaxis",
      "type": "text",
      "enableWhen": [
        {
          "question": "TypeOfProphylaxis",
          "operator": "=",
          "answerString": "Other"
        }
      ],
      "required": true
    },
    {
      "linkId": "MedicationRoute",
      "prefix": "4)",
      "text": "Medication Route",
      "type": "choice",
      "required": true,
      "repeats": false,
      "answerOption": [
        {
          "valueString": "Intramuscular Injection"
        },
        {
          "valueString": "Subcutaneous Injection"
        },
        {
          "valueString": "Oral"
        }
      ]
    },
    {
      "linkId": "PrescribedFrequency",
      "prefix": "5)",
      "text": "Prescribed Frequency",
      "type": "choice",
      "required": true,
      "repeats": false,
      "answerOption": [
        {
          "valueString": "28 Days"
        },
        {
          "valueString": "21 Days"
        },
        {
          "valueString": "Daily"
        },
        {
          "valueString": "10 Weeks"
        },
        {
          "valueString": "13 Weeks"
        },
        {
          "valueString": "Other"
        }
      ]
    },
    {
      "linkId": "OtherPrescribedFrequency",
      "prefix": "6)",
      "text": "Other Prescribed Frequency",
      "type": "text",
      "enableWhen": [
        {
          "question": "PrescribedFrequency",
          "operator": "=",
          "answerString": "Other"
        }
      ],
      "required": true
    },
    {
      "linkId": "ProphylaxisAdherence",
      "prefix": "7)",
      "text": "What was the patient's adherence to prophylaxis in the last 12 months?",
      "type": "text",
      "required": true
    },
    {
      "linkId": "ProphylaxisProvider",
      "prefix": "8)",
      "text": "Who was providing the prophylaxis at the time?",
      "type": "text",
      "required": true
    },
    {
      "linkId": "LastDocumentedDose",
      "prefix": "9)",
      "text": "Date of last documented secondary prophylaxis benzathine dose?",
      "type": "date",
      "required": true
    },
    {
      "linkId": "RiskFactorsRecurrence",
      "prefix": "10)",
      "text": "Risk Factors for Recurrence?",
      "type": "text",
      "required": true
    }
  ]
}