<status value="active"/> <date value="2026-04-16T21:32:31+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="This form collects information about how a health condition affects different aspects of a person’s sleep, daily functioning, and overall quality of life."/> <jurisdiction> <coding> <system value="urn:iso:std:iso:3166"/> <code value="NZ"/> <display value="New Zealand"/> </coding> </jurisdiction> <item> <linkId value="patientdetails"/> <text value="Patient details"/> <type value="group"/> <item> <linkId value="prefferdname"/> <text value="Preferred name"/> <type value="string"/> <required value="true"/> </item> <item> <linkId value="fullname"/> <text value="Full name"/> <type value="string"/> <required value="true"/> </item> <item> <linkId value="nhinumber"/> <text value="NHI number"/> <type value="string"/> <required value="true"/> </item> <item> <linkId value="dob_01"/> <text value="DOB"/> <type value="date"/> <required value="true"/> </item> <item> <linkId value="address_02"/> <text value="Address"/> <type value="string"/> <required value="true"/> </item> <item> <linkId value="telephonenumber"/> <text value="Telephone Number"/> <type value="string"/> <required value="true"/> </item> <item> <linkId value="date_03"/> <text value="Date"/> <type value="date"/> <required value="true"/> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="help"/> <display value="Help-Button"/> </coding> <text value="Help-Button"/> </valueCodeableConcept> </extension> <linkId value="patientlabel"/> <text value="Stick patient label here (or fill in the details below if no label is available)"/> <type value="display"/> </item> </item> <item> <linkId value="introduction_04"/> <text value="Introduction"/> <type value="group"/> </item> <item> <linkId value="formheading"/> <text value="How does your condition affect your life?"/> <type value="group"/> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="drop-down"/> <display value="Drop down"/> </coding> </valueCodeableConcept> </extension> <linkId value="socialinteractions"/> <text value="How much does your condition affect your social interactions? (Examples: meeting friends, going out, joining in groups, going shopping, everyday activities outside the home)"/> <type value="choice"/> <required value="true"/> <readOnly value="false"/> <answerValueSet value="#difficulty-scale"/> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="drop-down"/> <display value="Drop down"/> </coding> </valueCodeableConcept> </extension> <linkId value="personalrelationships_05"/> <text value="How much does your condition affect your personal relationships? (Examples: personal relations with partner, family members, close personal friends)"/> <type value="choice"/> <required value="true"/> <readOnly value="false"/> <answerValueSet value="#difficulty-scale"/> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="drop-down"/> <display value="Drop down"/> </coding> </valueCodeableConcept> </extension> <linkId value="responsibilitiestoothers"/> <text value="How much does your condition affect your ability to meet your responsibilities to others? (Examples: doing meaningful things for yourself or others, including caring for children, grandchildren or partner, work (paid and unpaid), including how having to rely on others may have an impact on you))"/> <type value="choice"/> <required value="true"/> <readOnly value="false"/> <answerValueSet value="#difficulty-scale"/> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="drop-down"/> <display value="Drop down"/> </coding> </valueCodeableConcept> </extension> <linkId value="personalcare_06"/> <text value="How much does your condition affect your personal care? (Examples: looking after yourself, your health, personal hygiene, need for aids or special clothing)"/> <type value="choice"/> <required value="true"/> <readOnly value="false"/> <answerValueSet value="#difficulty-scale"/> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="drop-down"/> <display value="Drop down"/> </coding> </valueCodeableConcept> </extension> <linkId value="personalsafety_07"/> <text value="How much does your condition affect your personal safety? (Examples: being safe from injury and harm, from yourself or others and in your surroundings)"/> <type value="choice"/> <required value="true"/> <readOnly value="false"/> <answerValueSet value="#difficulty-scale"/> </item> <item> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl"> <valueCodeableConcept> <coding> <system value="http://hl7.org/fhir/questionnaire-item-control"/> <code value="drop-down"/> <display value="Drop down"/> </coding> </valueCodeableConcept> </extension> <linkId value="leisureactivities_08"/> <text value="How much does your condition affect your leisure activities? (Examples: getting exercise, hobbies, sporting activities, gardening, do-it-yourself activities, crafts and travel)"/> <type value="choice"/> <required value="true"/> <readOnly value="false"/> <answerValueSet value="#difficulty-scale"/> </item> </item> </Questionnaire>

Generated Narrative: Questionnaire DHOHowDoesYourConditionAffectYourLife

Contained Resources

ValueSet #difficulty-scale

This value set expansion contains 6 concepts.