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

Health New Zealand Te Whatu Ora Shared Care FHIR API - Local Development build (v0.4.4) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

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

Draft as of 2025-12-11

Raw xml | Download

    <Questionnaire xmlns="http://hl7.org/fhir">
      <id value="RemoteMonitoringHeartFailureSymptomSurveyQuestionnaire"/>
      <text>
        <status value="extensions"/>
        <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,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" 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#0.4.4</td></tr>
    <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>
    <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>
    <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>
    <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,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" 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>
      </text>
      <url
           value="https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/Questionnaire/RemoteMonitoringHeartFailureSymptomSurveyQuestionnaire"/>
      <identifier>
        <use value="official"/>
        <value value="RemoteMonitoringHeartFailureSymptomSurveyQuestionnaire"/>
        <period>
          <start value="2023-08-16"/>
        </period>
      </identifier>
      <identifier>
        <use value="temp"/>
        <value
               value="Questionnaire-RemoteMonitoringHeartFailureSymptomSurveyQuestionnaire"/>
        <period>
          <start value="2023-03-07"/>
          <end value="2023-07-26"/>
        </period>
      </identifier>
      <version value="0.4.4"/>
      <title
             value="Remote Monitoring Heart Failure Symptom Survey Questionnaire"/>
      <status value="draft"/>
      <subjectType value="Patient"/>
      <date value="2025-12-11T23:52:07+00:00"/>
      <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="Te Whatu Ora Integration Team"/>
        <telecom>
          <system value="email"/>
          <value value="integration@tewhatuora.govt.nz"/>
          <use value="work"/>
        </telecom>
      </contact>
      <description
                   value="A questionnaire for a daily symptom surveying for Heart Failure patients"/>
      <jurisdiction>
        <coding>
          <system value="urn:iso:std:iso:3166"/>
          <code value="NZ"/>
          <display value="New Zealand"/>
        </coding>
      </jurisdiction>
      <item>
        <linkId value="p01"/>
        <prefix value="page 1"/>
        <text
              value="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 value="group"/>
        <item>
          <linkId value="p01-q01-Symptoms"/>
          <prefix value="page 1 question 1"/>
          <text
                value="Think about what symptoms you have had in the last 24 hours?"/>
          <type value="choice"/>
          <required value="false"/>
          <repeats value="true"/>
          <answerOption>
            <valueCoding>
              <system value="http://snomed.info/sct"/>
              <code value="267036007"/>
              <display value="Shortness of Breath"/>
            </valueCoding>
          </answerOption>
          <answerOption>
            <valueCoding>
              <system value="http://snomed.info/sct"/>
              <code value="84229001"/>
              <display value="Tiredness or Weakness"/>
            </valueCoding>
          </answerOption>
          <answerOption>
            <valueCoding>
              <system value="http://snomed.info/sct"/>
              <code value="26237000"/>
              <display value="Ankle Swelling"/>
            </valueCoding>
          </answerOption>
          <answerOption>
            <valueCoding>
              <system value="http://snomed.info/sct"/>
              <code value="49436004"/>
              <display value="Rapid or Irregular Heartbeat"/>
            </valueCoding>
          </answerOption>
          <answerOption>
            <valueCoding>
              <system value="http://snomed.info/sct"/>
              <code value="56018004"/>
              <display value="Wheezing"/>
            </valueCoding>
          </answerOption>
          <answerOption>
            <valueCoding>
              <system value="http://snomed.info/sct"/>
              <code value="49727002"/>
              <display value="Cough"/>
            </valueCoding>
          </answerOption>
          <answerOption>
            <valueCoding>
              <system value="http://snomed.info/sct"/>
              <code value="29857009"/>
              <display value="Chest Pain"/>
            </valueCoding>
          </answerOption>
          <answerOption>
            <valueCoding>
              <system value="http://snomed.info/sct"/>
              <code value="314938000"/>
              <display value="Poor Sleep"/>
            </valueCoding>
          </answerOption>
          <answerOption>
            <valueCoding>
              <system value="http://snomed.info/sct"/>
              <code value="8943002"/>
              <display value="Weight Gain"/>
            </valueCoding>
          </answerOption>
        </item>
        <item>
          <linkId value="p01-q01-OtherInfo"/>
          <prefix value="page 1 question 2"/>
          <text
                value="Is there anything else you want to tell us about the last 24 hours?"/>
          <type value="text"/>
          <required value="false"/>
          <repeats value="false"/>
        </item>
      </item>
    </Questionnaire>