Resource Questionnaire/FHIR Server from package tewhatuora.rheumaticfever#current (15 ms)

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{
  "resourceType" : "Questionnaire",
  "id" : "SecondaryProphylaxisHealthAssessmentQuestionnaire",
  "url" : "https://fhir-ig.digital.health.nz/rheumatic-fever/Questionnaire/SecondaryProphylaxisHealthAssessmentQuestionnaire",
  "identifier" : [
    {
      "use" : "official",
      "value" : "SecondaryProphylaxisHealthAssessmentQuestionnaire",
      "period" : {
        "start" : "2023-10-16"
      }
    }
  ],
  "version" : "1.0.0",
  "name" : "SecondaryProphylaxisHealthAssessmentQuestionnaire",
  "title" : "Secondary Prophylaxis Health Assessment Questionnaire",
  "status" : "draft",
  "experimental" : false,
  "subjectType" : [
    "Patient"
  ],
  "date" : "2023-11-10",
  "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 patient health at a secondary prophylaxis medication appointment",
  "purpose" : "Gathers information about patient health at a secondary prophylaxis medication appointment",
  "item" : [
    {
      "linkId" : "page1",
      "prefix" : "page1",
      "text" : "Please complete this questionnaire at the secondary prophylaxis appointment to assess a rheumatic fever patient's health.",
      "type" : "display"
    },
    {
      "linkId" : "ReasonsInjectionOverdue",
      "prefix" : "2)",
      "text" : "Reason(s) injection was give late? (multiple choice)",
      "type" : "choice",
      "required" : true,
      "repeats" : true,
      "answerOption" : [
        {
          "valueString" : "Previously Care On-Hold"
        },
        {
          "valueString" : "Unable to Contact Patient"
        },
        {
          "valueString" : "Patient Not Available on the Day"
        },
        {
          "valueString" : "Patient Declined Treatment"
        },
        {
          "valueString" : "INR Too High"
        },
        {
          "valueString" : "Patient Lost to Follow-Up"
        },
        {
          "valueString" : "Service Delayed To Follow-Up"
        },
        {
          "valueString" : "Service Unavailable on the Day"
        },
        {
          "valueString" : "Service Error"
        },
        {
          "valueString" : "Other"
        }
      ]
    },
    {
      "linkId" : "OverdueInjectionOtherDetail",
      "prefix" : "3)",
      "text" : "Other details for late injection (enter text)",
      "type" : "text",
      "required" : true
    },
    {
      "linkId" : "OtherPainManagementToolsUsed",
      "prefix" : "11)",
      "text" : "Pain management tools used? (multiple choice)",
      "type" : "choice",
      "required" : true,
      "repeats" : true,
      "answerOption" : [
        {
          "valueString" : "Ice pack"
        },
        {
          "valueString" : "Buzzy bee"
        },
        {
          "valueString" : "Numbing cream (Emla)"
        },
        {
          "valueString" : "Numbing spray"
        },
        {
          "valueString" : "Distraction"
        },
        {
          "valueString" : "Very slow injection"
        },
        {
          "valueString" : "Other"
        }
      ]
    },
    {
      "linkId" : "PainManagementOtherDetails",
      "prefix" : "11.1)",
      "text" : "Details of other pain management (enter text)",
      "type" : "text",
      "enableWhen" : [
        {
          "question" : "OtherPainManagementToolsUsed",
          "operator" : "=",
          "answerString" : "Other"
        }
      ],
      "required" : true
    },
    {
      "linkId" : "PostInjectionConcern",
      "prefix" : "12)",
      "text" : "Post injection concern or possible reaction identified?",
      "type" : "boolean",
      "required" : true,
      "initial" : [
        {
          "valueBoolean" : false
        }
      ]
    },
    {
      "linkId" : "PostInjectionConcernDetails",
      "prefix" : "12.1)",
      "text" : "If Yes, Record Details, Symptoms, Actions Taken and Follow-Up Plan (enter text)",
      "type" : "text",
      "enableWhen" : [
        {
          "question" : "PostInjectionConcern",
          "operator" : "=",
          "answerBoolean" : true
        }
      ],
      "required" : true
    },
    {
      "linkId" : "AnyOtherConcerns",
      "prefix" : "13)",
      "text" : "Were There Any Other Concerns or Issues Identified During the Visit?",
      "type" : "boolean",
      "required" : true,
      "initial" : [
        {
          "valueBoolean" : false
        }
      ]
    },
    {
      "linkId" : "OtherConcernsDetail",
      "prefix" : "13.1)",
      "text" : "If yes, describe details, actions taken, and follow-up planned (enter text)",
      "type" : "text",
      "enableWhen" : [
        {
          "question" : "AnyOtherConcerns",
          "operator" : "=",
          "answerBoolean" : true
        }
      ],
      "required" : true
    },
    {
      "linkId" : "HealthEducationTopicsDiscussed",
      "prefix" : "14)",
      "text" : "Health education topics discussed? (multiple choice)",
      "type" : "choice",
      "required" : true,
      "repeats" : true,
      "answerOption" : [
        {
          "valueString" : "Secondary prophylaxis"
        },
        {
          "valueString" : "Sore Throat Management"
        },
        {
          "valueString" : "Skin Infection Management"
        },
        {
          "valueString" : "Dental Health"
        },
        {
          "valueString" : "Endocarditis Prophylaxis"
        },
        {
          "valueString" : "Nutrition"
        },
        {
          "valueString" : "Physical Activity"
        },
        {
          "valueString" : "Healthy Home Environments"
        },
        {
          "valueString" : "Sexual Health"
        },
        {
          "valueString" : "Other"
        }
      ]
    },
    {
      "linkId" : "HealthEducationOtherDetail",
      "prefix" : "14.1)",
      "text" : "Enter details of other health education topic discussed (enter text)",
      "type" : "text",
      "enableWhen" : [
        {
          "question" : "HealthEducationTopicsDiscussed",
          "operator" : "=",
          "answerString" : "Other"
        }
      ],
      "required" : true
    },
    {
      "linkId" : "RecentOrUpcomingAppointments",
      "prefix" : "15)",
      "text" : "Any recent or upcoming follow-up appointments?",
      "type" : "boolean",
      "required" : true
    },
    {
      "linkId" : "RecentOrUpcomingAppointmentsDetails",
      "prefix" : "15.1)",
      "text" : "Enter details and dates of any recent or upcoming follow-up appointments (enter text)",
      "type" : "text",
      "enableWhen" : [
        {
          "question" : "RecentOrUpcomingAppointments",
          "operator" : "=",
          "answerBoolean" : true
        }
      ],
      "required" : true
    },
    {
      "linkId" : "PlanForNextMedicationAppointment",
      "prefix" : "16)",
      "text" : "Comments for the next appointment (enter text)",
      "type" : "text",
      "required" : true
    }
  ],
  "text" : {
  }
}

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