PregnancyAssessmentSurveyQuestionnaire
type: Questionnaire
node role: treeRoot
id:
  v: PregnancyAssessmentSurveyQuestionnaire
text:
  status:
    v: extensions
  div: Generated Narrative: Questionnaire PregnancyAssessmentSurveyQuestionnaire Structure LinkID Text Cardinality Type Description & Constraints<img src="[binary]" alt="doco" style="background-color: inherit"/> PregnancyAssessmentSurveyQuestionnaire Te Whatu Ora pregnancy assessment survey. Questionnaire https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/Questionnaire/PregnancyAssessmentSurveyQuestionnaire#0.4.3 #xD; p01 page 1. Pregnancy Context 0..1 group #xD; p01-q01-PregnancyStatus page 1 question 1. Are you currently pregnant or postpartum? 1..1 choice Options: 2 options #xD; p01-q01-1-PregnancyStatus.Gestation page 1 question 1.1. Gestation 1..1 integer Enable When: p01-q01-PregnancyStatus = #xD; p01-q01-2-PregnancyStatus.DeliveryDate page 1 question 1.2. Expected Delivery Date (EDD) 1..1 date Enable When: p01-q01-PregnancyStatus = #xD; p01-q01-3-PregnancyStatus.Postpartum page 1 question 1.3. Postpartum 1..1 integer Enable When: p01-q01-PregnancyStatus = #xD; p01-q02-Parity page 1 question 2. Para 1..1 integer #xD; p01-q02-Partiy.HelpText How many live births of viable gestation has the patient had? 0..1 display #xD; p01-q03-Gravida page 1 question 3. Gravida 1..1 integer #xD; p02 page 2. Midwife Information 0..1 group #xD; p02-q01-MidwifeName page 2 question 1. Midwife Name 1..1 text #xD; p02-q02-MidwifeContact page 2 question 2. Midwife Contact 1..1 text #xD; p03 page 3. Findings 0..1 group #xD; p03-q01-Ultrasound page 3 question 1. Ultrasound Findings 0..1 text #xD; p03-q02-BloodTest page 3 question 2. Blood Tests 0..1 text #xD; p04 page 4. Complications and Symptoms 0..1 group #xD; p04-q01-CurrentComplications page 4 question 1. Any current pregnancy complications? 0..1 boolean #xD; p04-q01-1-CurrentComplications.Details page 4 question 1.1. Please explain your pregnancy complications 1..1 text Enable When: p04-q01-CurrentComplications = #xD; p04-q02-ComplicationsPrevious page 4 question 2. Any previous pregnancy complications? 0..1 boolean #xD; p04-q02-1-Compli…
url:
  v: https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/Questionnaire/PregnancyAssessmentSurveyQuestionnaire
identifier:
  use:
    v: official
  value:
    v: PregnancyAssessmentSurveyQuestionnaire
  period:
    start:
      v: 2023-08-16
identifier:
  use:
    v: temp
  value:
    v: Questionnaire-PregnancyAssessmentSurveyQuestionnaire
  period:
    start:
      v: 2023-03-07
    end:
      v: 2023-07-26
version:
  v: 0.4.3
name:
  v: PregnancyAssessmentSurveyQuestionnaire
title:
  v: Pregnancy Assessment Survey
status:
  v: draft
date:
  v: 2025-11-25T02:00:55+00:00
publisher:
  v: Te Whatu Ora
contact:
  name:
    v: Te Whatu Ora
  telecom:
    system:
      v: url
    value:
      v: https://www.tewhatuora.govt.nz/
contact:
  name:
    v: Te Whatu Ora Integration Team
  telecom:
    system:
      v: email
    use:
      v: work
description:
  v: Te Whatu Ora pregnancy assessment survey.
jurisdiction:
  coding:
    system:
      v: urn:iso:std:iso:3166
    code:
      v: NZ
    display:
      v: New Zealand
item:
  link id:
    v: p01
  prefix:
    v: page 1
  text:
    v: Pregnancy Context
  type:
    v: group
  item:
    link id:
      v: p01-q01-PregnancyStatus
    prefix:
      v: page 1 question 1
    text:
      v: Are you currently pregnant or postpartum?
    type:
      v: choice
    required:
      v: true
    repeats:
      v: false
    answer option:
      value: Coding
    answer option:
      value: Coding
  item:
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/questionnaire-unit
      value: Coding
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/maxValue
      value: integer
        v: 40
    link id:
      v: p01-q01-1-PregnancyStatus.Gestation
    prefix:
      v: page 1 question 1.1
    text:
      v: Gestation
    type:
      v: integer
    enable when:
      question:
        v: p01-q01-PregnancyStatus
      operator:
        v: =
      answer: Coding
    enable behavior:
      v: all
    required:
      v: true
    repeats:
      v: false
  item:
    link id:
      v: p01-q01-2-PregnancyStatus.DeliveryDate
    prefix:
      v: page 1 question 1.2
    text:
      v: Expected Delivery Date (EDD)
    type:
      v: date
    enable when:
      question:
        v: p01-q01-PregnancyStatus
      operator:
        v: =
      answer: Coding
    enable behavior:
      v: all
    required:
      v: true
    repeats:
      v: false
  item:
    link id:
      v: p01-q01-3-PregnancyStatus.Postpartum
    prefix:
      v: page 1 question 1.3
    text:
      v: Postpartum
    type:
      v: integer
    enable when:
      question:
        v: p01-q01-PregnancyStatus
      operator:
        v: =
      answer: Coding
    enable behavior:
      v: all
    required:
      v: true
    repeats:
      v: false
  item:
    link id:
      v: p01-q02-Parity
    code: http://snomed.info/id/364325004
      system:
        v: http://snomed.info/sct
      code:
        v: 364325004
      display:
        v: Parity
    prefix:
      v: page 1 question 2
    text:
      v: Para
    type:
      v: integer
    required:
      v: true
    repeats:
      v: false
    item:
      extension:
        value: CodeableConcept
      link id:
        v: p01-q02-Partiy.HelpText
      text:
        v: How many live births of viable gestation has the patient had?
      type:
        v: display
  item:
    link id:
      v: p01-q03-Gravida
    code: http://snomed.info/id/161732006
      system:
        v: http://snomed.info/sct
      code:
        v: 161732006
      display:
        v: Gravida

v: Pregnant

v: Pregnant

v: Postpartum

v: Postpartum

v: Weeks

v: Weeks

v: Pregnant

v: Pregnant

v: Postpartum

CodeableConcept
coding:
  system:
    v: http://hl7.org/fhir/questionnaire-item-control
  code:
    v: help
  display:
    v: Help-Button
text:
  v: Help-Button

v: page 1 question 3

v: Gravida

v: integer

v: true

v: false

link id:
  v: p02
prefix:
  v: page 2
text:
  v: Midwife Information
type:
  v: group
item:
  link id:
    v: p02-q01-MidwifeName
  prefix:
    v: page 2 question 1
  text:
    v: Midwife Name
  type:
    v: text
  required:
    v: true
item:
  link id:
    v: p02-q02-MidwifeContact
  prefix:
    v: page 2 question 2
  text:
    v: Midwife Contact
  type:
    v: text
  required:
    v: true

link id:
  v: p03
prefix:
  v: page 3
text:
  v: Findings
type:
  v: group
item:
  link id:
    v: p03-q01-Ultrasound
  code: http://snomed.info/id/370380004
    system:
      v: http://snomed.info/sct
    code:
      v: 370380004
  prefix:
    v: page 3 question 1
  text:
    v: Ultrasound Findings
  type:
    v: text
item:
  link id:
    v: p03-q02-BloodTest
  code: http://snomed.info/id/106200001
    system:
      v: http://snomed.info/sct
    code:
      v: 106200001
  prefix:
    v: page 3 question 2
  text:
    v: Blood Tests
  type:
    v: text

link id:
  v: p04
prefix:
  v: page 4
text:
  v: Complications and Symptoms
type:
  v: group
item:
  link id:
    v: p04-q01-CurrentComplications
  prefix:
    v: page 4 question 1
  text:
    v: Any current pregnancy complications?
  type:
    v: boolean
item:
  link id:
    v: p04-q01-1-CurrentComplications.Details
  prefix:
    v: page 4 question 1.1
  text:
    v: Please explain your pregnancy complications
  type:
    v: text
  enable when:
    question:
      v: p04-q01-CurrentComplications
    operator:
      v: =
    answer: boolean
      v: true
  enable behavior:
    v: all
  required:
    v: true
  repeats:
    v: false
item:
  link id:
    v: p04-q02-ComplicationsPrevious
  prefix:
    v: page 4 question 2
  text:
    v: Any previous pregnancy complications?
  type:
    v: boolean
item:
  link id:
    v: p04-q02-1-ComplicationsPrevious.Details
  prefix:
    v: page 4 question 2.1
  text:
    v: Please explain any complications from previous pregnancies
  type:
    v: text
  enable when:
    question:
      v: p04-q02-ComplicationsPrevious
    operator:
      v: =
    answer: boolean
      v: true
  enable behavior:
    v: all
  required:
    v: true
  repeats:
    v: false
item:
  link id:
    v: p04-q03-PreEclampsia
  code: http://snomed.info/id/398254007
    system:
      v: http://snomed.info/sct
    code:
      v: 398254007
    display:
      v: Pre-eclampsia
  prefix:
    v: page 4 question 3
  text:
    v: Any signs of pre-eclampsia?
  type:
    v: boolean
  item:
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
      value: CodeableConcept
    link id:
      v: p04-q03-p04-q03-PreEclampsia.HelpText
    text:
      v: Headache, Epigastric pain, flashing lights.
    type:
      v: display
item:
  link id:
    v: p04-q03-1-PreEclampsia.Details
  prefix:
    v: page 4 question 3.1
  text:
    v: Please explain any symptoms suggestive of pre-eclampsia?
  type:
    v: text
  enable when:
    question:
      v: p04-q03-PreEclampsia
    operator:
      v: =
    answer: boolean
      v: true
  enable behavior:
    v: all
  required:
    v: true
  repeats:
    v: false
item:
  link id:
    v: p04-q04-DVT
  code: http://snomed.info/id/128053003
    system:
      v: http://snomed.info/sct
    code:
      v: 128053003
    display:
      v: Deep venous thrombosis
  prefix:
    v: page 4 question 4
  text:
    v: Any signs suggestive of a DVT?
  type:
    v: boolean
  required:
    v: true
  item:
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
      value: CodeableConcept
    link id:
      v: p04-q04-DVT.HelpText
    text:
      v: lateral swelling, redness or calf-tenderness
    type:
      v: display
item:
  link id:
    v: p04-q04-1-DVT.Details
  prefix:
    v: page 4 question 4.1
  text:
    v: Please explain any symptoms suggestive of a DVT
  type:
    v: text
  enable when:
    question:
      v: p04-q04-DVT
    operator:
      v: =
    answer: boolean
      v: true
  enable behavior:
    v: all
  required:
    v: true
  repeats:
    v: false
item:
  link id:
    v: p04-q05-Dysuria
  code: http://snomed.info/id/49650001
    system:
      v: http://snomed.info/sct
    code:
      v: 49650001
    display:
      v: Dysuria
  prefix:
    v: page 4 question 5
  text:
    v: Any signs of Dysuria?
  type:
    v: boolean
  required:
    v: true
  repeats:
    v: false
item:
  link id:
    v: p04-q05-1-Dysuria.Details
  prefix:
    v: page 4 question 5.1
  text:
    v: Please explain any details of your Dysuria
  type:
    v: text
  enable when:
    question:
      v: p04-q05-Dysuria
    answer: boolean

system:
  v: http://hl7.org/fhir/questionnaire-item-control
code:
  v: help
display:
  v: Help-Button

v: Help-Button

system:
  v: http://hl7.org/fhir/questionnaire-item-control
code:
  v: help
display:
  v: Help-Button

v: Help-Button

v: =

boolean
v: true

v: all

v: true

v: false

link id:
  v: p04-q06-VaginalDischarge
code: http://snomed.info/id/271939006
  system:
    v: http://snomed.info/sct
  code:
    v: 271939006
  display:
    v: Vaginal discharge
prefix:
  v: page 4 question 6
text:
  v: Vaginal Discharge?
type:
  v: boolean
required:
  v: true
repeats:
  v: false
initial:
  value: boolean
    v: false

link id:
  v: p04-q06-1-VaginalDischarge.Details
prefix:
  v: page 4 question 6.1
text:
  v: Please explain any details.
type:
  v: text
enable when:
  question:
    v: p04-q06-VaginalDischarge
  operator:
    v: =
  answer: boolean
    v: true
enable behavior:
  v: all
required:
  v: true
repeats:
  v: false

link id:
  v: p05
prefix:
  v: page 5
text:
  v: Obstetrician Notes
type:
  v: group
item:
  link id:
    v: p05-q01-ObstetricianNotes
  prefix:
    v: page 5 question 1
  text:
    v: Obstetrician Details and Discussion, including any potential clexane requirement?
  type:
    v: text

link id:
  v: p06
prefix:
  v: page 6
text:
  v: Post 23 Week Information
type:
  v: group
enable when:
  question:
    v: p01-q01-1-PregnancyStatus.Gestation
  operator:
    v: >=
  answer: integer
    v: 23
enable behavior:
  v: all
item:
  link id:
    v: p06-q01-FetalMovement
  code: http://snomed.info/id/289431008
    system:
      v: http://snomed.info/sct
    code:
      v: 289431008
    display:
      v: Fetal movements present
  prefix:
    v: page 6 question 1
  text:
    v: Any baby movement felt?
  type:
    v: boolean
  required:
    v: true
item:
  link id:
    v: p06-q01-1-FetalMovement.Details
  prefix:
    v: page 6 question 1.1
  text:
    v: Any details surrounding the baby movement?
  type:
    v: text
  enable when:
    question:
      v: p06-q01-FetalMovement
    operator:
      v: =
    answer: boolean
      v: true
  enable behavior:
    v: all
item:
  link id:
    v: p06-q02-VaginalBleeding
  code: http://snomed.info/id/289530006
    system:
      v: http://snomed.info/sct
    code:
      v: 289530006
    display:
      v: Vaginal bleeding
  prefix:
    v: page 6 question 2
  text:
    v: Any vaginal bleeding?
  type:
    v: boolean
  required:
    v: true
  repeats:
    v: false
item:
  link id:
    v: p06-q02-1-VaginalBleeding.Details
  prefix:
    v: page 6 question 2.1
  text:
    v: Any details surrounding vaginal bleeding?
  type:
    v: string
  enable when:
    question:
      v: p06-q02-VaginalBleeding
    operator:
      v: =
    answer: boolean
      v: true
  enable behavior:
    v: all

link id:
  v: p07
prefix:
  v: page 7
text:
  v: General Practice Information
type:
  v: group
item:
  link id:
    v: p07-q01-PracticeName
  prefix:
    v: page 7 question 1
  text:
    v: GP Practice Name
  type:
    v: string
item:
  link id:
    v: p07-q02-PracticeEDI
  prefix:
    v: page 7 question 2
  text:
    v: Practice EDI
  type:
    v: string
item:
  link id:
    v: p07-q03-GPSend
  prefix:
    v: page 7 question 3
  text:
    v: Send note to GP Inbox?
  type:
    v: boolean
  required:
    v: true