New Zealand Rheumatic Fever FHIR Implementation Guide
0.4.8 - draft

New Zealand Rheumatic Fever FHIR Implementation Guide - Local Development build (v0.4.8) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

: Patient & whanau goals and preferences questionnaire - XML Representation

Draft as of 2023-10-16

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<Questionnaire xmlns="http://hl7.org/fhir">
  <id value="PatientWhanauGoalsPreferencesQuestionnaire"/>
  <url
       value="https://fhir-ig.digital.health.nz/rheumatic-fever/Questionnaire/PatientWhanauGoalsPreferencesQuestionnaire"/>
  <identifier>
    <use value="official"/>
    <value value="PatientWhanauGoalsPreferencesQuestionnaire"/>
    <period>
      <start value="2023-10-16"/>
    </period>
  </identifier>
  <version value="1.0.0"/>
  <name value="PatientWhanauGoalsPreferencesQuestionnaire"/>
  <title value="Patient &amp; whanau goals and preferences questionnaire"/>
  <status value="draft"/>
  <experimental value="false"/>
  <subjectType value="Patient"/>
  <date value="2023-10-16"/>
  <publisher value="Te Whatu Ora"/>
  <contact>
    <name value="Te Whatu Ora"/>
    <telecom>
      <system value="url"/>
      <value value="https://www.tewhatuora.govt.nz/"/>
    </telecom>
  </contact>
  <contact>
    <name value="David Grainger"/>
    <telecom>
      <system value="email"/>
      <value value="david.grainger@middleware.co.nz"/>
      <use value="work"/>
    </telecom>
  </contact>
  <description
               value="Gathers patient and whanau preferences and goals for rheumatic fever care"/>
  <purpose
           value="Gathers patient and whanau preferences and goals for rheumatic fever care"/>
  <item>
    <linkId value="page1"/>
    <prefix value="page1"/>
    <text
          value="Please complete this questionnaire to record goals and preferences of a patient or their whanau in relation to rheumatic fever prevention treatment."/>
    <type value="display"/>
  </item>
  <item>
    <linkId value="ImportantToMe"/>
    <prefix value="1)"/>
    <text
          value="What things that are important to me and my family that support my health and wellbeing? (enter text)"/>
    <type value="text"/>
    <required value="true"/>
  </item>
  <item>
    <linkId value="WhanauInvolvement"/>
    <prefix value="2)"/>
    <text
          value="How would I like my whanau and support persons to be involved? (enter text)"/>
    <type value="text"/>
    <required value="true"/>
  </item>
  <item>
    <linkId value="BestWayToCommunicate"/>
    <prefix value="3)"/>
    <text value="The best way to communicate with me is…? (choose one)"/>
    <type value="choice"/>
    <required value="true"/>
    <repeats value="false"/>
    <answerOption>
      <valueString value="phone call"/>
    </answerOption>
    <answerOption>
      <valueString value="text message"/>
    </answerOption>
    <answerOption>
      <valueString value="email"/>
    </answerOption>
  </item>
  <item>
    <linkId value="AppointmentsContact"/>
    <prefix value="4)"/>
    <text value="I know who to contact about my appointments? (choose one)"/>
    <type value="boolean"/>
    <required value="false"/>
    <item>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
        <valueCodeableConcept>
          <coding>
            <system value="http://hl7.org/fhir/questionnaire-item-control"/>
            <code value="help"/>
            <display value="Help-Button"/>
          </coding>
          <text value="Help-Button"/>
        </valueCodeableConcept>
      </extension>
      <linkId value="AppointmentsContactHelp"/>
      <text
            value="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 value="display"/>
    </item>
  </item>
  <item>
    <linkId value="PreferredAppointmentsLocation"/>
    <prefix value="5)"/>
    <text
          value="What location do I prefer to receive injected antibiotics at? (choose one)"/>
    <type value="choice"/>
    <required value="true"/>
    <repeats value="false"/>
    <answerOption>
      <valueString value="School"/>
    </answerOption>
    <answerOption>
      <valueString value="Home"/>
    </answerOption>
    <answerOption>
      <valueString value="Work"/>
    </answerOption>
    <answerOption>
      <valueString value="Clinic"/>
    </answerOption>
    <answerOption>
      <valueString value="Other"/>
    </answerOption>
  </item>
  <item>
    <linkId value="InjectionLocationDetail"/>
    <prefix value="6)"/>
    <text
          value="More detail about this location (eg. at school during term time, but at home with Dad if out of term time)? (enter text)"/>
    <type value="text"/>
    <required value="true"/>
  </item>
  <item>
    <linkId value="ImportantDuringInjectionVisits"/>
    <prefix value="7)"/>
    <text
          value="What things that are important to me during my injection visits eg. karakia, kaiawhina support? (enter text)"/>
    <type value="text"/>
    <required value="true"/>
  </item>
  <item>
    <linkId value="InjectionVisitsNoNos"/>
    <prefix value="8)"/>
    <text
          value="What things don't work well for me during my injection visits? (enter text)"/>
    <type value="text"/>
    <required value="true"/>
  </item>
  <item>
    <linkId value="MakingInjectionsComfortable"/>
    <prefix value="9)"/>
    <text
          value="What things do I like to have with my injections to make them more comfortable? (multiple choice)"/>
    <type value="choice"/>
    <required value="true"/>
    <repeats value="true"/>
    <answerOption>
      <valueString value="Lignocaine"/>
    </answerOption>
    <answerOption>
      <valueString value="Ice pack"/>
    </answerOption>
    <answerOption>
      <valueString value="Buzzy bee"/>
    </answerOption>
    <answerOption>
      <valueString value="Numbing cream (Emla)"/>
    </answerOption>
    <answerOption>
      <valueString value="Numbing spray"/>
    </answerOption>
    <answerOption>
      <valueString value="Distraction"/>
    </answerOption>
    <answerOption>
      <valueString value="Very slow injection"/>
    </answerOption>
  </item>
  <item>
    <linkId value="InjectionOtherComfort"/>
    <prefix value="10)"/>
    <text
          value="What other things make my injections more comfortable? (enter text)"/>
    <type value="text"/>
    <required value="true"/>
  </item>
  <item>
    <linkId value="MedsPreferredSupplyMethod"/>
    <prefix value="11)"/>
    <text
          value="I would prefer to get my oral antibiotic medicines from? (choose one)"/>
    <type value="choice"/>
    <required value="true"/>
    <repeats value="false"/>
    <answerOption>
      <valueString value="GP prescription"/>
    </answerOption>
    <answerOption>
      <valueString value="Monthly visit from a nurse"/>
    </answerOption>
    <answerOption>
      <valueString value="3 monthly visit from a nurse"/>
    </answerOption>
    <answerOption>
      <valueString value="Pick-up from a pharmacy"/>
    </answerOption>
    <answerOption>
      <valueString value="Other"/>
    </answerOption>
  </item>
  <item>
    <linkId value="MedsSupplyOtherDetail"/>
    <prefix value="11.1)"/>
    <text value="If other, enter details"/>
    <type value="text"/>
    <enableWhen>
      <question value="MedsPreferredSupplyMethod"/>
      <operator value="="/>
      <answerString value="Other"/>
    </enableWhen>
    <required value="true"/>
  </item>
  <item>
    <linkId value="EasierToGetToAppointments"/>
    <prefix value="12)"/>
    <text
          value="What things make it easier for me to get to hospital appointments? (multiple choice)"/>
    <type value="choice"/>
    <required value="true"/>
    <repeats value="true"/>
    <answerOption>
      <valueString value="Support with transport"/>
    </answerOption>
    <answerOption>
      <valueString value="Morning appointments"/>
    </answerOption>
    <answerOption>
      <valueString value="Afternoon appointments"/>
    </answerOption>
    <answerOption>
      <valueString value="Choice of clinic days"/>
    </answerOption>
    <answerOption>
      <valueString value="Cultural support"/>
    </answerOption>
    <answerOption>
      <valueString value="Other"/>
    </answerOption>
  </item>
  <item>
    <linkId value="HospitalAppointmentsImportant"/>
    <prefix value="13)"/>
    <text
          value="More detail about the things that are important to me about hospital appointments (enter text)"/>
    <type value="text"/>
    <required value="true"/>
  </item>
  <item>
    <linkId value="HospitalAppointmentsNoNos"/>
    <prefix value="14)"/>
    <text
          value="Things that don't work well for me about hospital appointments (enter text)"/>
    <type value="text"/>
    <required value="true"/>
  </item>
  <item>
    <linkId value="SupportGettingToHospitalAppointments"/>
    <prefix value="15)"/>
    <text
          value="Do I need support getting to and from hospital appointment? (choose one)"/>
    <type value="choice"/>
    <required value="true"/>
    <repeats value="false"/>
    <answerOption>
      <valueString value="Yes - always"/>
    </answerOption>
    <answerOption>
      <valueString value="Yes - sometimes, please check each time"/>
    </answerOption>
    <answerOption>
      <valueString value="No"/>
    </answerOption>
    <answerOption>
      <valueString value="Not sure"/>
    </answerOption>
    <answerOption>
      <valueString value="Other"/>
    </answerOption>
  </item>
  <item>
    <linkId value="HospitalAppointmentsTransportSupport"/>
    <prefix value="question 16"/>
    <text value="Which transport support option do I need? (choose one)"/>
    <type value="choice"/>
    <required value="true"/>
    <repeats value="false"/>
    <answerOption>
      <valueString value="Taxi vouchers"/>
    </answerOption>
    <answerOption>
      <valueString value="Top up on public transport card"/>
    </answerOption>
    <answerOption>
      <valueString value="Hospital to provide transport"/>
    </answerOption>
    <answerOption>
      <valueString value="Other"/>
    </answerOption>
  </item>
  <item>
    <linkId value="HospitalAppointmentsTransportOtherDetail"/>
    <prefix value="question 17"/>
    <text
          value="What other details are there about getting to hospital appointments? (enter text)"/>
    <type value="text"/>
    <required value="true"/>
  </item>
</Questionnaire>