New Zealand Rheumatic Fever FHIR Implementation Guide
0.4.6 - draft
New Zealand Rheumatic Fever FHIR Implementation Guide
0.4.6 - draft
New Zealand Rheumatic Fever FHIR Implementation Guide - Local Development build (v0.4.6) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
| Draft as of 2023-11-10 |
{
"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/"
}
]
},
{
"name" : "David Grainger",
"telecom" : [
{
"system" : "email",
"value" : "david.grainger@middleware.co.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
}
]
}