New Zealand Rheumatic Fever FHIR Implementation Guide
0.4.7 - draft

New Zealand Rheumatic Fever FHIR Implementation Guide - Local Development build (v0.4.7) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

: Patient & whanau goals and preferences questionnaire - JSON Representation

Draft as of 2023-10-16

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{
  "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/"
        }
      ]
    },
    {
      "name" : "David Grainger",
      "telecom" : [
        {
          "system" : "email",
          "value" : "david.grainger@middleware.co.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
    }
  ]
}