Health New Zealand Te Whatu Ora Shared Care FHIR API
0.4.3 - release

Health New Zealand Te Whatu Ora Shared Care FHIR API - Local Development build (v0.4.3) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

## : Remote Monitoring Heart Failure Symptom Survey Questionnaire - JSON Representation

Draft as of 2025-11-25

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    {
      "resourceType" : "Questionnaire",
      "id" : "RemoteMonitoringHeartFailureSymptomSurveyQuestionnaire",
      "text" : {
        "status" : "extensions",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Questionnaire RemoteMonitoringHeartFailureSymptomSurveyQuestionnaire</b></p><a name=\"RemoteMonitoringHeartFailureSymptomSurveyQuestionnaire\"> </a><a name=\"hcRemoteMonitoringHeartFailureSymptomSurveyQuestionnaire\"> </a><b>Structure</b><table border=\"1\" cellpadding=\"0\" cellspacing=\"0\" style=\"border: 1px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;\"><tr style=\"border: 2px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top\"><th style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"The linkID for the item\">LinkID</a></th><th style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Text for the item\">Text</a></th><th style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Minimum and Maximum # of times the item can appear in the instance\">Cardinality</a></th><th style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"The type of the item\">Type</a></th><th style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Additional information about the item\">Description &amp; Constraints</a><span style=\"float: right\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Legend for this format\"><img src=\"data:image/png;base64, \" alt=\"doco\" style=\"background-color: inherit\"/></a></span></th></tr><tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_q_root.gif\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"QuestionnaireRoot\" class=\"hierarchy\"/> </td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">A questionnaire for a daily symptom surveying for Heart Failure patients</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Questionnaire</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/Questionnaire/RemoteMonitoringHeartFailureSymptomSurveyQuestionnaire#0.4.3</td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck01.png)\" id=\"item.p01\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"group\" class=\"hierarchy\"/> p01</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 1. Welcome to today's survey, this is your chance to tell us about any symptoms you have had with your heart failure in the last 24 hours</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)\" id=\"item.p01-q01-Symptoms\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> p01-q01-Symptoms</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 1 question 1. Think about what symptoms you have had in the last 24 hours?</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.p01-q01-Symptoms\">9 options</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck000.png)\" id=\"item.p01-q01-OtherInfo\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-text.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"text\" class=\"hierarchy\"/> p01-q01-OtherInfo</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 1 question 2. Is there anything else you want to tell us about the last 24 hours?</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-text\">text</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr><td colspan=\"5\" class=\"hierarchy\"><br/><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Legend for this format\"><img src=\"data:image/png;base64, \" alt=\"doco\" style=\"background-color: inherit\"/> Documentation for this format</a></td></tr></table><hr/><p><b>Options Sets</b></p><a name=\"opt-item.p01-q01-Symptoms\"> </a><p><b>Answer options for p01-q01-Symptoms </b></p><ul><li style=\"font-size: 11px\">http://snomed.info/sct#267036007 (&quot;Shortness of Breath&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#84229001 (&quot;Tiredness or Weakness&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#26237000 (&quot;Ankle Swelling&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#49436004 (&quot;Rapid or Irregular Heartbeat&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#56018004 (&quot;Wheezing&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#49727002 (&quot;Cough&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#29857009 (&quot;Chest Pain&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#314938000 (&quot;Poor Sleep&quot;)</li><li style=\"font-size: 11px\">http://snomed.info/sct#8943002 (&quot;Weight Gain&quot;)</li></ul></div>"
      },
      "url" : "https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/Questionnaire/RemoteMonitoringHeartFailureSymptomSurveyQuestionnaire",
      "identifier" : [
        {
          "use" : "official",
          "value" : "RemoteMonitoringHeartFailureSymptomSurveyQuestionnaire",
          "period" : {
            "start" : "2023-08-16"
          }
        },
        {
          "use" : "temp",
          "value" : "Questionnaire-RemoteMonitoringHeartFailureSymptomSurveyQuestionnaire",
          "period" : {
            "start" : "2023-03-07",
            "end" : "2023-07-26"
          }
        }
      ],
      "version" : "0.4.3",
      "title" : "Remote Monitoring Heart Failure Symptom Survey Questionnaire",
      "status" : "draft",
      "subjectType" : [
        "Patient"
      ],
      "date" : "2025-11-25T02:00:55+00:00",
      "publisher" : "Te Whatu Ora",
      "contact" : [
        {
          "name" : "Te Whatu Ora",
          "telecom" : [
            {
              "system" : "url",
              "value" : "https://www.tewhatuora.govt.nz/"
            }
          ]
        },
        {
          "name" : "Te Whatu Ora Integration Team",
          "telecom" : [
            {
              "system" : "email",
              "value" : "integration@tewhatuora.govt.nz",
              "use" : "work"
            }
          ]
        }
      ],
      "description" : "A questionnaire for a daily symptom surveying for Heart Failure patients",
      "jurisdiction" : [
        {
          "coding" : [
            {
              "system" : "urn:iso:std:iso:3166",
              "code" : "NZ",
              "display" : "New Zealand"
            }
          ]
        }
      ],
      "item" : [
        {
          "linkId" : "p01",
          "prefix" : "page 1",
          "text" : "Welcome to today's survey, this is your chance to tell us about any symptoms you have had with your heart failure in the last 24 hours",
          "type" : "group",
          "item" : [
            {
              "linkId" : "p01-q01-Symptoms",
              "prefix" : "page 1 question 1",
              "text" : "Think about what symptoms you have had in the last 24 hours?",
              "type" : "choice",
              "required" : false,
              "repeats" : true,
              "answerOption" : [
                {
                  "valueCoding" : {
                    "system" : "http://snomed.info/sct",
                    "code" : "267036007",
                    "display" : "Shortness of Breath"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://snomed.info/sct",
                    "code" : "84229001",
                    "display" : "Tiredness or Weakness"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://snomed.info/sct",
                    "code" : "26237000",
                    "display" : "Ankle Swelling"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://snomed.info/sct",
                    "code" : "49436004",
                    "display" : "Rapid or Irregular Heartbeat"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://snomed.info/sct",
                    "code" : "56018004",
                    "display" : "Wheezing"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://snomed.info/sct",
                    "code" : "49727002",
                    "display" : "Cough"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://snomed.info/sct",
                    "code" : "29857009",
                    "display" : "Chest Pain"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://snomed.info/sct",
                    "code" : "314938000",
                    "display" : "Poor Sleep"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://snomed.info/sct",
                    "code" : "8943002",
                    "display" : "Weight Gain"
                  }
                }
              ]
            },
            {
              "linkId" : "p01-q01-OtherInfo",
              "prefix" : "page 1 question 2",
              "text" : "Is there anything else you want to tell us about the last 24 hours?",
              "type" : "text",
              "required" : false,
              "repeats" : false
            }
          ]
        }
      ]
    }