FHIR IG analytics| Package | tw.iii.ltc |
| Resource Type | Questionnaire |
| Id | Questionnaire-questionnaire-aa01-example.json |
| FHIR Version | R4 |
| Source | https://build.fhir.org/ig/Lorex/TWLongTermCare_IG_Build/Questionnaire-questionnaire-aa01-example.html |
| URL | http://ltc-ig.fhir.tw/Questionnaire/questionnaire-aa01-example |
| Version | 1.0.0 |
| Status | active |
| Date | 2026-04-03T13:32:05+00:00 |
| Name | AA01 |
| Title | 照顧計畫擬訂與服務連結問卷 (AA01) |
| Realm | tw |
| Description | AA01照顧計畫擬訂與服務連結問卷，用於個案管理師擬定個人化照顧計畫 |
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Note: links and images are rebased to the (stated) source
Generated Narrative: Questionnaire questionnaire-aa01-example
Profile: 長期照顧－問卷
| LinkID | Text | Cardinality | Type | Description & Constraints |
|---|---|---|---|---|
  AA01 | AA01照顧計畫擬訂與服務連結問卷，用於個案管理師擬定個人化照顧計畫 | Questionnaire | http://ltc-ig.fhir.tw/Questionnaire/questionnaire-aa01-example#1.0.0 | |
  planTarget | 計畫目標 | 1..1 | group | |
  phoneContactDate | 電聯日期 | 1..1 | dateTime | |
| homeVisitDate | 家訪日期 | 1..1 | dateTime | |
| dischargeDate | 出院日期 | 0..1 | dateTime | |
 coVisitors | 偕同訪視者 | 0..* | string | |
| caseOverview | 個案概況 | 1..1 | group | |
 physicalMentalCondition | 身心概況 | 1..1 | text | |
| economicIncome | 經濟收入 | 1..1 | text | |
| livingEnvironment | 居住環境 | 1..1 | text | |
| socialSupport | 社會支持 | 1..1 | text | |
| other | 其他 | 0..1 | text | |
 reassessmentValue | 複評評值 | 1..1 | text | |
| careGoals | 照顧目標 | 1..1 | text | |
| discrepancyExplanation | 與照專建議服務項目、問題清單不一致原因說明及未來規劃、後續追蹤計劃等 | 0..1 | text | |
| executionPlan | 計畫執行規劃 | 1..1 | group | |
| approvedServices | 長照服務核定項目、頻率 | 1..1 | group | |
| bCodeServices | B碼(輪派/指定○○○單位) | 0..* | text | |
| cCodeServices | C碼:(輪派/指定○○○單位) | 0..* | text | |
| dCodeServices | D碼 | 0..* | text | |
| eFCodeServices | E.F碼 | 0..* | text | |
| gCodeServices | G碼 | 0..* | text | |
| scCodeServices | SC碼 | 0..* | text | |
| mealServices | 營養餐飲服務: 1日核定○○餐(午/晚餐) | 0..1 | string | |
| emergencyServices | 緊急救援服務 | 0..* | text | |
| otherServices | 轉介其他服務資源 | 0..* | text | |
| otherNotes | 其他備註 | 0..1 | text | |
| Documentation for this format | ||||
FHIR
FHIRsmith{
"resourceType": "Questionnaire",
"id": "questionnaire-aa01-example",
"meta": {
"profile": [
"http://ltc-ig.fhir.tw/StructureDefinition/LTCQuestionnaire"
]
},
"text": {
"status": "extensions",
"div": "<!-- snip (see above) -->"
},
"url": "http://ltc-ig.fhir.tw/Questionnaire/questionnaire-aa01-example",
"identifier": [
{
"system": "http://ltc-ig.fhir.tw/questionnaire-id",
"value": "AA01"
}
],
"version": "1.0.0",
"name": "AA01",
"title": "照顧計畫擬訂與服務連結問卷 (AA01)",
"status": "active",
"date": "2026-04-03T13:32:05+00:00",
"publisher": "經濟部產業發展署",
"contact": [
{
"name": "經濟部產業發展署",
"telecom": [
{
"system": "url",
"value": "https://www.ida.gov.tw/"
}
]
}
],
"description": "AA01照顧計畫擬訂與服務連結問卷，用於個案管理師擬定個人化照顧計畫",
"item": [
{
"linkId": "planTarget",
"text": "計畫目標",
"type": "group",
"required": true,
"item": [
{
"linkId": "phoneContactDate",
"text": "電聯日期",
"type": "dateTime",
"required": true
},
{
"linkId": "homeVisitDate",
"text": "家訪日期",
"type": "dateTime",
"required": true
},
{
"linkId": "dischargeDate",
"text": "出院日期",
"type": "dateTime",
"required": false
},
{
"linkId": "coVisitors",
"text": "偕同訪視者",
"type": "string",
"repeats": true
},
{
"linkId": "caseOverview",
"text": "個案概況",
"type": "group",
"required": true,
"item": [
{
"linkId": "physicalMentalCondition",
"text": "身心概況",
"type": "text",
"required": true
},
{
"linkId": "economicIncome",
"text": "經濟收入",
"type": "text",
"required": true
},
{
"linkId": "livingEnvironment",
"text": "居住環境",
"type": "text",
"required": true
},
{
"linkId": "socialSupport",
"text": "社會支持",
"type": "text",
"required": true
},
{
"linkId": "other",
"text": "其他",
"type": "text",
"required": false
},
{
"linkId": "reassessmentValue",
"text": "複評評值",
"type": "text",
"required": true
}
]
},
{
"linkId": "careGoals",
"text": "照顧目標",
"type": "text",
"required": true
},
{
"linkId": "discrepancyExplanation",
"text": "與照專建議服務項目、問題清單不一致原因說明及未來規劃、後續追蹤計劃等",
"type": "text",
"required": false
}
]
},
{
"linkId": "executionPlan",
"text": "計畫執行規劃",
"type": "group",
"required": true,
"item": [
{
"linkId": "approvedServices",
"text": "長照服務核定項目、頻率",
"type": "group",
"required": true,
"item": [
{
"linkId": "bCodeServices",
"text": "B碼(輪派/指定○○○單位)",
"type": "text",
"required": false,
"repeats": true
},
{
"linkId": "cCodeServices",
"text": "C碼:(輪派/指定○○○單位)",
"type": "text",
"required": false,
"repeats": true
},
{
"linkId": "dCodeServices",
"text": "D碼",
"type": "text",
"required": false,
"repeats": true
},
{
"linkId": "eFCodeServices",
"text": "E.F碼",
"type": "text",
"required": false,
"repeats": true
},
{
"linkId": "gCodeServices",
"text": "G碼",
"type": "text",
"required": false,
"repeats": true
},
{
"linkId": "scCodeServices",
"text": "SC碼",
"type": "text",
"required": false,
"repeats": true
},
{
"linkId": "mealServices",
"text": "營養餐飲服務: 1日核定○○餐(午/晚餐)",
"type": "string",
"required": false
},
{
"linkId": "emergencyServices",
"text": "緊急救援服務",
"type": "text",
"required": false,
"repeats": true
}
]
},
{
"linkId": "otherServices",
"text": "轉介其他服務資源",
"type": "text",
"required": false,
"repeats": true
}
]
},
{
"linkId": "otherNotes",
"text": "其他備註",
"type": "text",
"required": false
}
]
}