DHOPreoperativeQuestionnaireDaySurgeryDunedinHospital
type: Questionnaire
node role: treeRoot
id:
  v: DHOPreoperativeQuestionnaireDaySurgeryDunedinHospital
text:
  status:
    v: extensions
  div: Generated Narrative: Questionnaire DHOPreoperativeQuestionnaireDaySurgeryDunedinHospital LinkID Text Cardinality Type Flags Description & Constraints<img src="[binary]" alt="doco" style="background-color: inherit"/> DHOPreoperativeQuestionnaireDaySurgeryDunedinHospital Pre-operative assessment questionnaire for day surgery patients at Dunedin Hospital. Questionnaire https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/Questionnaire/DHOPreoperativeQuestionnaireDaySurgeryDunedinHospital#1.0 #xD; patientInfo Patient Information 0..1 group #xD; surname_01 Surname 0..1 string #xD; nhi_02 NHI 0..1 string #xD; othernames_03 Other Names 0..1 string #xD; dob_04 DOB 0..1 date #xD; age_05 Age 0..1 integer #xD; ward_06 Ward 0..1 string #xD; consultant_07 Consultant 0..1 string #xD; adreess_08 Address 0..1 string #xD; phonenumber_09 Phone Number 0..1 string #xD; sectioone_01 Section One 0..1 group #xD; operation_10 Have you ever had an operation and/or anaesthetic? 1..1 boolean #xD; closerelative Have you or a close relative ever had problems with an anaesthetic? 1..1 boolean #xD; problemdescribe If YES, describe the problem: 1..1 string Enable When: closerelative = #xD; medicationsallergy Are you allergic to any medications or other substances? 1..1 boolean #xD; answerallergy If YES, please list: 1..1 string Enable When: medicationsallergy = #xD; anymedications Are you taking or have you taken any medications in the last 6 months? 1..1 boolean #xD; allmedications If YES, please list all medications: 0..1 string Enable When: anymedications = #xD; hadmdro Have you ever had MDRO? (Superbug infection) 0..1 boolean #xD; workedorpatient Have you worked or been a patient in a hospital in NZ or overseas in the last 6 months? 0..1 boolean #xD; answerwhen If YES, state when and where: 0..1 string Enable When: workedorpatient = #xD; artificialjoint Do you have an artificial joint, heart valve or a pacemaker? 0..1 boolean #xD; looseteeth Do you have dentures, partial plate, loose teeth? 0..1 …
url:
  v: https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/Questionnaire/DHOPreoperativeQuestionnaireDaySurgeryDunedinHospital
version:
  v: 1.0
name:
  v: DHOPreoperativeQuestionnaireDaySurgeryDunedinHospital
title:
  v: Preoperative Questionnaire Day Surgery Dunedin Hospital
status:
  v: active
date:
  v: 2026-04-16T21:32:31+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: Pre-operative assessment questionnaire for day surgery patients at Dunedin Hospital.
jurisdiction:
  coding:
    system:
      v: urn:iso:std:iso:3166
    code:
      v: NZ
    display:
      v: New Zealand
purpose:
  v: To collect pre-operative clinical and risk information prior to day surgery.
item:
  link id:
    v: patientInfo
  text:
    v: Patient Information
  type:
    v: group
  item:
    link id:
      v: surname_01
    text:
      v: Surname
    type:
      v: string
  item:
    link id:
      v: nhi_02
    text:
      v: NHI
    type:
      v: string
  item:
    link id:
      v: othernames_03
    text:
      v: Other Names
    type:
      v: string
  item:
    link id:
      v: dob_04
    text:
      v: DOB
    type:
      v: date
  item:
    link id:
      v: age_05
    text:
      v: Age
    type:
      v: integer
  item:
    link id:
      v: ward_06
    text:
      v: Ward
    type:
      v: string
  item:
    link id:
      v: consultant_07
    text:
      v: Consultant
    type:
      v: string
  item:
    link id:
      v: adreess_08
    text:
      v: Address
    type:
      v: string
  item:
    link id:
      v: phonenumber_09
    text:
      v: Phone Number
    type:
      v: string
item:
  link id:
    v: sectioone_01
  text:
    v: Section One
  type:
    v: group
  read only:
    v: false
  item:
    link id:
      v: operation_10
    text:
      v: Have you ever had an operation and/or anaesthetic?
    type:
      v: boolean
    required:
      v: true
    repeats:
      v: false
  item:
    link id:
      v: closerelative
    text:
      v: Have you or a close relative ever had problems with an anaesthetic?
    type:
      v: boolean
    required:
      v: true
    repeats:
      v: false
  item:
    link id:
      v: problemdescribe
    text:
      v: If YES, describe the problem:
    type:
      v: string
    enable when:
      question:
        v: closerelative
      operator:
        v: =
      answer: boolean
        v: true
    enable behavior:
      v: any
    required:
      v: true
    repeats:
      v: false
  item:
    link id:
      v: medicationsallergy
    text:
      v: Are you allergic to any medications or other substances?
    type:
      v: boolean
    required:
      v: true
    repeats:
      v: false
  item:
    link id:
      v: answerallergy
    text:
      v: If YES, please list:
    type:
      v: string
    enable when:
      question:
        v: medicationsallergy
      operator:
        v: =
      answer: boolean
        v: true
    enable behavior:
      v: all
    required:
      v: true
    repeats:
      v: false

link id:
  v: anymedications
text:
  v: Are you taking or have you taken any medications in the last 6 months?
type:
  v: boolean
required:
  v: true
repeats:
  v: false

link id:
  v: allmedications
text:
  v: If YES, please list all medications:
type:
  v: string
enable when:
  question:
    v: anymedications
  operator:
    v: =
  answer: boolean
    v: true
enable behavior:
  v: all
repeats:
  v: false

link id:
  v: hadmdro
text:
  v: Have you ever had MDRO? (Superbug infection)
type:
  v: boolean
repeats:
  v: false

link id:
  v: workedorpatient
text:
  v: Have you worked or been a patient in a hospital in NZ or overseas in the last 6 months?
type:
  v: boolean
repeats:
  v: false

link id:
  v: answerwhen
text:
  v: If YES, state when and where:
type:
  v: string
enable when:
  question:
    v: workedorpatient
  operator:
    v: =
  answer: boolean
    v: true
enable behavior:
  v: all
repeats:
  v: false

link id:
  v: artificialjoint
text:
  v: Do you have an artificial joint, heart valve or a pacemaker?
type:
  v: boolean
repeats:
  v: false

link id:
  v: looseteeth
text:
  v: Do you have dentures, partial plate, loose teeth?
type:
  v: boolean
repeats:
  v: false

link id:
  v: smoke
text:
  v: Do you smoke?
type:
  v: boolean
repeats:
  v: false

link id:
  v: howmanysmoke
text:
  v: If YES, how many per day?
type:
  v: string
enable when:
  question:
    v: smoke
  operator:
    v: =
  answer: boolean
    v: true
enable behavior:
  v: all
repeats:
  v: false

link id:
  v: sufferingcold
text:
  v: Are you suffering from or recovering from a cold, sore throat, flu or covid19?
type:
  v: boolean
repeats:
  v: false

link id:
  v: pregnant
text:
  v: Are you or could you be pregnant?
type:
  v: boolean
repeats:
  v: false

link id:
  v: sectiontwo
text:
  v: Section Two
type:
  v: group
required:
  v: false
repeats:
  v: false
item:
  link id:
    v: symptoms
  text:
    v: Have you suffered from any of these symptoms or medical conditions?
  type:
    v: display
item:
  link id:
    v: heartcondition
  text:
    v: Heart condition
  type:
    v: boolean
  required:
    v: true
item:
  link id:
    v: angina
  text:
    v: Chest pain/angina
  type:
    v: boolean
  required:
    v: true
item:
  link id:
    v: bloodpressure
  text:
    v: High blood pressure
  type:
    v: boolean
  required:
    v: true
item:
  link id:
    v: ankleswelling
  text:
    v: Ankle swelling
  type:
    v: boolean
  required:
    v: true
item:
  link id:
    v: shortnessbreath
  text:
    v: Abnormal shortness of breath
  type:
    v: boolean
  required:
    v: true
item:
  link id:
    v: bloodclots
  text:
    v: Blood clots in legs/lungs
  type:
    v: boolean
  required:
    v: true
item:
  link id:
    v: rheumaticfever
  text:
    v: Rheumatic fever
  type:
    v: boolean
  required:
    v: true
item:
  link id:
    v: pcough
  text:
    v: Persistent cough
  type:
    v: boolean
  required:
    v: true
  repeats:
    v: false
item:
  link id:
    v: asthma
  text:
    v: Asthma
  type:
    v: boolean
  required:
    v: true
  repeats:
    v: false
item:
  link id:
    v: lungproblem
  text:
    v: Other lung problems
  type:
    v: boolean
  required:
    v: true
  repeats:
    v: false
item:
  link id:
    v: reflux
  text:
    v: Heartburn/reflux
  type:
    v: boolean
  required:
    v: true
  repeats:
    v: false
item:
  link id:
    v: sulcer
  text:
    v: Stomach ulcer
  type:
    v: boolean
  required:
    v: true
  repeats:
    v: false
item:
  link id:
    v: bleedingdisorder
  text:
    v: Bleeding disorders
  type:
    v: boolean
  required:
    v: true
  repeats:
    v: false
item:
  link id:
    v: anaemia
  text:
    v: Anaemia
  type:
    v: boolean
  required:
    v: true
item:
  link id:
    v: stroke
  text:
    v: Stroke/blackouts
  type:
    v: boolean
  required:
    v: true
item:
  link id:
    v: kidneydisorder
  text:
    v: Kidney disorders
  type:
    v: boolean
  required:
    v: true
item:
  link id:
    v: jaundice
  text:
    v: Hepatitis/jaundice
  type:
    v: boolean
  required:
    v: true
item:
  link id:
    v: efits
  text:
    v: Epilepsy/fits
  type:
    v: boolean
  required:
    v: true
item:
  link id:
    v: migraine_01
  text:
    v: Migraine
  type:
    v: boolean
  required:
    v: true

link id:
  v: diabetestype
text:
  v: Diabetes type 1 / 2
type:
  v: boolean
required:
  v: true

link id:
  v: depressionnerves
text:
  v: Depression/nerves
type:
  v: boolean
required:
  v: true

link id:
  v: arthritis
text:
  v: Arthritis
type:
  v: boolean
required:
  v: true

link id:
  v: alcoholrelated
text:
  v: Alcohol related problems
type:
  v: boolean
required:
  v: true

link id:
  v: motionsickness
text:
  v: Motion sickness
type:
  v: boolean
required:
  v: true

link id:
  v: other
text:
  v: Other
type:
  v: string
required:
  v: true

link id:
  v: sectionthree
text:
  v: Section Three
type:
  v: group
required:
  v: false
repeats:
  v: false
item:
  link id:
    v: adultdrive
  text:
    v: Following surgery I will have a responsible adult drive me home and stay with me for 24hrs.
  type:
    v: display
item:
  link id:
    v: supportpersonname
  text:
    v: Support Person Name:
  type:
    v: string
  required:
    v: true
item:
  link id:
    v: contactphone
  text:
    v: Contact Phone:
  type:
    v: string
  required:
    v: true
item:
  link id:
    v: patientsignature
  text:
    v: Patient Signature:
  type:
    v: string
  required:
    v: true
item:
  link id:
    v: date
  text:
    v: Date
  type:
    v: date
  required:
    v: true
item:
  link id:
    v: smokingcessation
  text:
    v: ABC for Smoking Cessation
  type:
    v: display
item:
  link id:
    v: eversmoked
  text:
    v: Has the patient ever smoked?
  type:
    v: boolean
  required:
    v: true
item:
  link id:
    v: lastsmoke
  text:
    v: When did they last smoke?
  type:
    v: string
  required:
    v: true
item:
  link id:
    v: quitadvise
  text:
    v: Advised to quit?
  type:
    v: boolean
  required:
    v: true
item:
  link id:
    v: vape
  text:
    v: Does the patient vape?
  type:
    v: boolean
  required:
    v: true
item:
  link id:
    v: withnicotine
  text:
    v: with nicotine?
  type:
    v: boolean
  required:
    v: true
item:
  link id:
    v: quitsupport
  text:
    v: Supported to quit (tick all that apply)
  type:
    v: display
item:
  link id:
    v: quitcard
  text:
    v: NRT or Quitcard provided
  type:
    v: boolean
  required:
    v: true
item:
  link id:
    v: referraltossss
  text:
    v: Referral to SSSS
  type:
    v: boolean
  required:
    v: true
item:
  link id:
    v: supportdeclined
  text:
    v: Support declined
  type:
    v: boolean
  required:
    v: true
item:
  link id:
    v: cessationprogramme
  text:
    v: Already on cessation programme
  type:
    v: boolean
  required:
    v: true
item:
  link id:
    v: date_11
  text:
    v: Date
  type:
    v: date
  required:
    v: true
item:
  link id:
    v: sign_12
  text:
    v: Sign
  type:
    v: string
  required:
    v: true
item:
  link id:
    v: fallsriskassessment
  text:
    v: Falls Risk Assessment
  type:
    v: display
item:
  link id:
    v: fallsriskalert
  text:
    v: If “yes” to the last question, write ‘falls risk’ in orange alert box on the front of the Day Surgery Clinical Pathway & place a red bracelet on pt.
  type:
    v: display
item:
  link id:
    v: agemore55
  text:
    v: >55yrs & Maori or Pacific Islander
  type:
    v: boolean
  required:
    v: true
item:
  link id:
    v: agemore75
  text:
    v: >75yrs (Other Ethnicity)
  type:
    v: boolean
  required:
    v: true
item:
  link id:
    v: ptfallenpast

v: Pt has fallen in past year

v: boolean

v: true

link id:
  v: assessordeemspt
text:
  v: Assessor deems pt requires a full assessment
type:
  v: boolean
required:
  v: true

link id:
  v: date_21
text:
  v: Date
type:
  v: date
required:
  v: true

link id:
  v: sign_22
text:
  v: Sign:
type:
  v: string