Generated Narrative: Questionnaire COVIDRATResultQuestionnaire version: 25; Last updated: 2024-01-25 19:54:10+0000; Language: en-NZ Structure LinkID Text Cardinality Type Flags Description & Constraints COVID-19 RAT Result Questionnaire Complete this form to notify Health New Zealand | Te Whatu Ora of COVID-19 rapid antigen test (RAT) results Questionnaire https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/Questionnaire/COVIDRATResultQuestionnaire#1.0.5 #xD; p01-Consent page 1. 1. Consent 0..1 group #xD; p01-Consent-q01 page 1 question 1. Consent to share information 0..1 group #xD; p01-Consent-q01-1 page 1 question 1.1. This report is confidential, and your/the patient's information will be kept safe in accordance with the New Zealand Privacy Act. 0..1 display #xD; p01-Consent-q01-2 page 1 question 1.2. When we collect your/the patient's information, we can only use it for the purposes for which it was collected. For COVID RAT tests, this means we will only use the information to: 0..1 display #xD; p01-Consent-q01-3 page 1 question 1.3. ● Inform you about your/the patient's COVID-19 status 0..1 display #xD; p01-Consent-q01-4 page 1 question 1.4. ● Inform your/the patient's enrolled general practice team and general practitioner (where applicable) 0..1 display #xD; p01-Consent-q01-5 page 1 question 1.5. ● Ensure accurate national reporting of COVID-19 results and informing decisions regarding New Zealand’s response to COVID-19. 0..1 display #xD; p01-Consent-q01-6 page 1 question 1.6. ● Perform anonymous statistical analysis and research purposes in line with usual processes and where permitted by the Privacy Act 2020 and Health Information Privacy Code 2020. 0..1 display #xD; p01-Consent-q01-7 page 1 question 1.7. We may need to share some of your/the patient's personal information with other agencies for health purposes and to ensure we meet our legal obligations. 0..1 display #xD; p01-Consent-q01-8 page 1 question 1.8. If you would like more information about how your/the patient's personal information is managed, please go to the Te Whatu Ora website, and look for our ‘privacy & security’ webpage. 0..1 display #xD; p01-Consent-q01-9 page 1 question 1.9. Do you wish to continue and consent to collection of your/the patient's information? 0..1 display #xD; p02-Test page 2. null 0..1 group #xD; p02-Test-Details page 2 question 1. null 0..1 group #xD; p02-Test-Details-Role page 2 question 1.1. What is your role? 1..1 choice Options: 2 options #xD; p02-Test-Details-Source page 2 question 1.2. Who are you receiving this RAT report from? 1..1 choice Enable When: p02-Test-Details-Role = Options: 2 options #xD; p02-Test-Details-Mobile page 2 question 1.3. Mobile number 1..1 string Definition: https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/StructureDefinition/ManaakiNgaTahiObservation#Observation.valueString Enable When: p02-Test-Details-Role = #xD; p02-Test-Details-MobileCode page 2 question 1.4. null 0..1 choice Definition: https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/StructureDefinition/ManaakiNgaTahiObservation#Observation.code.coding[] Enable When: p02-Test-Details-Role = Initial Value: Coding = [not stated]#8497 "Text patient com" #xD; p02-Test-Details-MobileNote page 2 question 1.5. Enter the mobile number for further communications related to this RAT report 0..1 display Enable When: p02-Test-Details-Role = #xD; p02-Test-Reporter page 2 question 2. Reporter details 0..1 group Enable When: p02-Test-Details-Source = p02-Test-Details-Role = #xD; p02-Test-Reporter-FirstName page 2 question 2.1. First name 1..1 string #xD; p02-Test-Reporter-LastName page 2 question 2.2. Last name 1..1 string #xD; p02-Test-Reporter-Relationship page 2 question 2.3. Relationship to person 1..1 string #xD; p02-Test-Kit page 2 question 3. Covid test kit 0..1 group #xD; p02-Test-Kit-Batch page 2 question 3.1. Lot number 0..1 string Definition: https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/StructureDefinition/ManaakiNgaTahiObservation#Observation.valueString Enable When: p02-Test-Details-Role = #xD; p02-Test-Details-BatchCode page 2 question 3.2. null 0..1 choice Definition: https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/StructureDefinition/ManaakiNgaTahiObservation#Observation.code.coding[] Enable When: p02-Test-Kit-Batch exists Initial Value: Coding = [not stated]#8499 "Lot Number" #xD; p02-Test-Kit-Result page 2 question 3.3. Enter result 1..1 choice Options: 2 options #xD; p02-Test-Kit-Result-Positive page 2 question 3.4. Extract - test result positive 0..1 string Definition: https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/StructureDefinition/ManaakiNgaTahiObservation#Observation.valueString Enable When: p02-Test-Kit-Result = Initial Value: string = DETECTED #xD; p02-Test-Kit-Result-Negative page 2 question 3.5. Extract - test result negative 0..1 string Definition: https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/StructureDefinition/ManaakiNgaTahiObservation#Observation.valueString Enable When: p02-Test-Kit-Result = Initial Value: string = NOT DETECTED #xD; p02-Test-Kit-Result-Code-Unsupervised page 2 question 3.6. null 0..1 choice Definition: https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/StructureDefinition/ManaakiNgaTahiObservation#Observation.code.coding[] Enable When: p02-Test-Details-Role = Initial Value: Coding = [not stated]#XNZ5530 "SARS-CoV-2 RAT Self" #xD; p02-Test-Kit-Result-Code-Supervised page 2 question 3.7. null 0..1 choice Definition: https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/StructureDefinition/ManaakiNgaTahiObservation#Observation.code.coding[] Enable When: p02-Test-Details-Role = Initial Value: Coding = [not stated]#97097-0 "Supervised RAT SARS-CoV-2" #xD; p02-Test-Kit-Result-PositiveNote page 2 question 3.8. The COVID-19 antigen was detected, which indicates the patient might be positive for COVID-19. 0..1 display Enable When: p02-Test-Kit-Result = #xD; p02-Test-Kit-Result-NegativeNote page 2 question 3.9. The COVID-19 antigen was not detected which indicates the patient is likely to be negative for COVID-19. 0..1 display Enable When: p02-Test-Kit-Result = #xD; p02-Test-Kit-Result-Symptomatic page 2 question 3.10. Is the patient presenting symptoms? 1..1 boolean Enable When: p02-Test-Details-Role != #xD; p02-Test-Kit-Result-SymptomaticFalse page 2 question 3.11. Extract - asymptomatic positive 0..1 boolean Definition: https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/StructureDefinition/ManaakiNgaTahiObservation#Observation.valueBoolean Enable When: p02-Test-Kit-Result-Symptomatic = Initial Value: boolean = true #xD; p02-Test-Kit-Result-SymptomaticTrue page 2 question 3.12. Extract - asymptomatic negative 0..1 boolean Definition: https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/StructureDefinition/ManaakiNgaTahiObservation#Observation.valueBoolean Enable When: p02-Test-Kit-Result-Symptomatic = p02-Test-Details-Role = Initial Value: boolean = false #xD; p02-Test-Kit-Result-SymptomaticCoding page 2 question 3.13. null 0..1 choice Definition: https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/StructureDefinition/ManaakiNgaTahiObservation#Observation.code.coding[] Initial Value: Coding = [not stated]#84387000 "Asymptomatic" #xD; p02-Test-Date page 2 question 4. null 0..1 group #xD; p02-Test-Date-Entry page 2 question 4.1. Day test was taken 1..1 date #xD; p03-ExtractResources page 3 question 1. null 0..1 group #xD; p03-ExtractResources-DiagnosticReport-code-supervised page 3 question 1.1.1. null 0..1 choice Definition: DiagnosticReport.code.coding[] Enable When: p02-Test-Details-Role = Initial Value: Coding = [not stated]#97097-0 "Supervised RAT SARS-CoV-2" #xD; p03-ExtractResources-DiagnosticReport-code-self page 3 question 1.1.2. null 0..1 choice Definition: DiagnosticReport.code.coding[] Enable When: p02-Test-Details-Role = Initial Value: Coding = [not stated]#XNZ5530 "SARS-CoV-2 RAT Self" #xD; p03-ExtractResources-DiagnosticReport-identifierSystem page 3 question 1.2. null 0..1 choice Definition: DiagnosticReport.identifier[0].system Initial Value: string = https://standards.digital.health.nz/ns/SendingApplication #xD; p03-ExtractResources-DiagnosticReport-identifierValue-RAT page 3 question 1.3. null 0..1 choice Definition: DiagnosticReport.identifier[0].value Enable When: p02-Test-Details-Role = Initial Value: string = RAT Catcher #xD; p03-ExtractResources-DiagnosticReport-identifierValue-CICS page 3 question 1.4. null 0..1 choice Definition: DiagnosticReport.identifier[0].value Enable When: p02-Test-Details-Role = Initial Value: string = CICS #xD; p03-ExtractResources-DiagnosticReport-result page 3 question 1.5. null 0..1 choice Definition: DiagnosticReport.result[] Initial Value: Reference = urn:uuid:observation-result: SARS-CoV-2 RAT Self #xD; p03-ExtractResources-DiagnosticReport-phone page 3 question 1.6. null 0..1 choice Definition: DiagnosticReport.result[] Enable When: p02-Test-Details-Role = Initial Value: Reference = urn:uuid:observation-phone: Text patient com #xD; p03-ExtractResources-DiagnosticReport-batch page 3 question 1.7. null 0..1 choice Definition: DiagnosticReport.result[] Enable When: p02-Test-Kit-Batch exists Initial Value: Reference = urn:uuid:observation-batch: Lot Number #xD; p03-ExtractResources-DiagnosticReport-asymptomatic page 3 question 1.8. null 0..1 choice Definition: DiagnosticReport.result[] Initial Value: Reference = urn:uuid:observation-asymptomatic: Asymptomatic #xD; p03-ExtractResources-DiagnosticReport-authoriser page 3 question 1.9. null 0..1 choice Definition: DiagnosticReport.result[] Initial Value: Reference = urn:uuid:observation-authoriser: Authoriser #xD; p03-ExtractResources-DiagnosticReport-site page 3 question 1.10. null 0..1 choice Definition: DiagnosticReport.result[] Initial Value: Reference = urn:uuid:observation-site: Specimen site #xD; p03-ExtractResources-DiagnosticReport-subject page 3 question 1.11. null 0..1 boolean Initial Value: boolean = true #xD; p03-ExtractResources-DiagnosticReport-performer page 3 question 1.12. null 0..1 boolean Initial Value: boolean = true #xD; p03-ExtractResources-Observation-site page 3 question 1.13. null 0..1 string Definition: https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/StructureDefinition/ManaakiNgaTahiObservation#Observation.valueString Initial Value: string = Nasal #xD; p03-ExtractResources-Observation-SiteCoding page 3 question 1.14. null 0..1 choice Definition: https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/StructureDefinition/ManaakiNgaTahiObservation#Observation.code.coding[] Initial Value: Coding = [not stated]#66746-9 "Specimen site" #xD; p03-ExtractResources-Observation-authoriser page 3 question 1.15. null 0..1 boolean Initial Value: boolean = true #xD; p03-ExtractResources-Observation-authoriserCoding page 3 question 1.16. null 0..1 choice Definition: https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/StructureDefinition/ManaakiNgaTahiObservation#Observation.code.coding[] Initial Value: Coding = [not stated]#8495 "RAT Authoriser" #xD; Documentation for this format Options Sets Answer options for p02-Test-Details-Role null#Assisted channel ("Assisted channel") null#Aged residential care ("Aged residential care") Answer options for p02-Test-Details-Source null#Individual ("Individual") null#Someone else ("Someone else") Answer options for p02-Test-Kit-Result null#Detected ("Detected") null#Not detected ("Not detected")
Complete this form to notify Health New Zealand | Te Whatu Ora of COVID-19 rapid antigen test (RAT) results
This report is confidential, and your/the patient's information will be kept safe in accordance with the New Zealand Privacy Act.
When we collect your/the patient's information, we can only use it for the purposes for which it was collected. For COVID RAT tests, this means we will only use the information to:
● Inform you about your/the patient's COVID-19 status
● Inform your/the patient's enrolled general practice team and general practitioner (where applicable)
● Ensure accurate national reporting of COVID-19 results and informing decisions regarding New Zealand’s response to COVID-19.
● Perform anonymous statistical analysis and research purposes in line with usual processes and where permitted by the Privacy Act 2020 and Health Information Privacy Code 2020.
We may need to share some of your/the patient's personal information with other agencies for health purposes and to ensure we meet our legal obligations.
If you would like more information about how your/the patient's personal information is managed, please go to the Te Whatu Ora website, and look for our ‘privacy & security’ webpage.
Do you wish to continue and consent to collection of your/the patient's information?
Who are you receiving this RAT report from?
Enter the mobile number for further communications related to this RAT report
The COVID-19 antigen was detected, which indicates the patient might be positive for COVID-19.
The COVID-19 antigen was not detected which indicates the patient is likely to be negative for COVID-19.