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

Health New Zealand Te Whatu Ora Shared Care FHIR API - Local Development build (v0.4.5) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

## Questionnaire: COVID19 Initial Health Assessment Questionnaire

Official URL: https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/Questionnaire/COVIDInitialHealthAssessmentQuestionnaire | Version: 0.4.5
Draft as of 2023-07-19 | Computable Name: COVIDInitialHealthAssessmentQuestionnaire
Other Identifiers: COVIDInitialHealthAssessmentQuestionnaire (use: official, period: 7/19/23 --> (ongoing)), QuestionTemplate-CitC-COVID19-InitialAssessment (use: temp, period: (?) --> 7/19/23)
Usage:Workflow Setting:

An initial assessment for a patient who has tested positive for COVID-19

Gather status and conditions for a patient who is self-isolating.

Structure

LinkID | Text | Cardinality | Type | Description & Constraints
--- | --- | --- | --- | ---
COVIDInitialHealthAssessmentQuestionnaire | An initial assessment for a patient who has tested positive for COVID-19 |  | Questionnaire | https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/Questionnaire/COVIDInitialHealthAssessmentQuestionnaire#0.4.5
1 | 1.. Past Health and Wellbeing History - ask questions to find out about: | 0..1 | group |
1.1 | 1.1.. Hypertension? | 1..1 | boolean | Initial Value: boolean = false
1.2 | 1.2.. Diabetes? | 1..1 | boolean | Initial Value: boolean = false
1.2.1 | 1.2.1. If using insulin please provide details? | 0..1 | string | Enable When: 1.2 =
1.3 | 1.3.. Asthma? | 1..1 | boolean | Initial Value: boolean = false
1.4 | 1.4.. Previous stroke? | 1..1 | boolean | Initial Value: boolean = false
1.5 | 1.5.. Cancer? | 1..1 | boolean | Initial Value: boolean = false
1.5.1 | 1.5.1. Please provide cancer details | 0..1 | text | Enable When: 1.5 =
1.6 | 1.6.. Current/recent pregnancy? | 1..1 | boolean | Initial Value: boolean = false
1.6.a | 1.6.a.. Pregnancy assessment | 0..1 | group | Enable When: 1.6 =
1.6.1 | 1.6.1. Gestation (number of weeks) | 0..1 | string |
1.6.2 | 1.6.2. Postpartum (number of weeks) | 0..1 | string |
1.7 | 1.7.. Immunocompromised? | 1..1 | boolean | Initial Value: boolean = false
1.7.1 | 1.7.1. Specify immunocompromised further details | 0..1 | text | Enable When: 1.7 =
1.8 | 1.8.. Previous heart attack or heart failure? | 1..1 | boolean | Initial Value: boolean = false
1.9 | 1.9.. Epilepsy? | 1..1 | boolean | Initial Value: boolean = false
1.10 | 1.10.. Other respiratory disease? | 1..1 | boolean | Initial Value: boolean = false
1.11 | 1.11.. Mental health and/or addiction? | 1..1 | boolean | Initial Value: boolean = false
1.12 | 1.12.. Kidney disease? | 1..1 | boolean | Initial Value: boolean = false
1.13 | 1.13.. CPAP device used? | 1..1 | boolean | Initial Value: boolean = false
1.14 | 1.14.. Weight? | 1..1 | choice | Options: 4 options
1.15 | 1.15.. Other | 0..1 | string |
2 | 2.. Medication and Allergies | 0..1 | group |
2.1 | 2.1.. Smoking? | 1..1 | boolean | Initial Value: boolean = false
2.1b | 2.1b.. Would you like NRT? | 0..1 | boolean | Enable When: 2.1 =
2.2 | 2.2.. Alcohol? | 1..1 | boolean | Initial Value: boolean = false
2.2.1 | 2.2.1.. Drinks per week? | 0..1 | choice | Enable When: 2.2 = Options: 3 options
2.3 | 2.3.. Recreational drugs? | 0..1 | boolean | Initial Value: boolean = false
2.4 | 2.4.. Allergies? | 1..1 | boolean | Initial Value: boolean = false
2.4.1 | 2.4.1.. Medication Allergies | 1..1 | boolean | Enable When: 2.4 = Initial Value: boolean = false
2.4.1.1 | 2.4.1.1.. Medicine | 0..1 | string | Enable When: 2.4.1 =
2.4.1.2 | 2.4.1.2.. Category (select) | 0..1 | choice | Enable When: 2.4.1 = Options: 3 options
2.4.1.3 | 2.4.1.3.. Reaction (select) | 0..1 | choice | Enable When: 2.4.1 = Options: 4 options
2.4.1.4 | 2.4.1.4.. Onset Date | 0..1 | date | Enable When: 2.4.1 =
2.4.1.5 | 2.4.1.5.. Date of Entry | 0..1 | date | Enable When: 2.4.1 =
2.4.1.6 | 2.4.1.6.. Active? | 1..1 | boolean | Enable When: 2.4.1 = Initial Value: boolean = true
2.4.1.6.1 | 2.4.1.6.1.. Specify Reason for deactivation | 0..1 | string | Enable When: 2.4.1.6 =
2.4.1.7 | 2.4.1.7.. Comments | 0..1 | text | Enable When: 2.4.1 =
2.4.2 | 2.4.2.. Other allergies | 1..1 | text | Enable When: 2.4 =
2.5 | 2.5.. Prescription medication or medical devices (eg. CPAP, nebuliser, blood glucose meter)? | 1..1 | boolean | Initial Value: boolean = false
2.6 | 2.6.. Details of medications, medical devices, recreational drugs here | 0..1 | text |
2.7 | 2.7.. Able to manage meds independently? | 0..1 | boolean | Initial Value: boolean = false
2.8 | 2.8.. Sufficient supply for 14 days? | 0..1 | boolean |
2.9 | 2.9.. Taking immunosuppressant? | 0..1 | boolean |
3 | 3.. Individual assessment plan/guideline | 0..1 | group |
3.1 | 3.1.. Individual assessment plan / guideline | 0..1 | text |
Documentation for this format

Options Sets

Answer options for 1.14

- Under
- Average
- Over
- Obese

Answer options for 2.2.1

- <10
- 10-16
- >16

Answer options for 2.4.1.2

- Allergy
- Patient Complaint
- Side Effect

Answer options for 2.4.1.3

- Mild
- Moderate
- Severe
- Anaphylaxis