Generated Narrative: Questionnaire DunedinFormConditionAffectQuestionnaire Profile: Questionnaire Structure LinkID Text Cardinality Type Flags Description & Constraints Patient‑reported assessment of the impact of a health condition on daily life. Questionnaire https://fhir-ig.digital.health.nz/shared-care/Questionnaire/DunedinFormConditionAffectQuestionnaire#0.4.5 #xD; 765911107151 How does your condition affect your life? 0..1 group #xD; 765911107151_helpText Please tell us about how much difficulty your condition causes in different areas of your life, which may limit the things you can do. Each question below includes examples to illustrate some of the things this area of life covers. It is okay if some of these examples don't apply to you. Please just think about whatever this area of life means for you. Please circle the number that most represents how much your condition affects each area of your life. 0..1 display #xD; 624356696038 How much does your condition affect your social interactions? 1..1 choice Options: 6 options #xD; 624356696038_helpText (Examples: meeting friends, going out, joining in groups, going shopping, everyday activities outside the home) 0..1 display #xD; 601664488659 How much does your condition affect your personal relationships? 1..1 choice Options: 6 options #xD; 938604546200 (Examples: personal relations with partner, family members, close personal friends) 0..1 display #xD; 863443735387 How much does your condition affect your ability to meet your responsibilities to others? 1..1 choice Options: 6 options #xD; 624618506381 (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)) 0..1 display #xD; 161471334792 How much does your condition affect your personal care? 1..1 choice Options: 6 options #xD; 220304359852 (Examples: looking after yourself, your health, personal hygiene, need for aids or special clothing) 0..1 display #xD; 159129288879 How much does your condition affect your personal safety? 1..1 choice Options: 6 options #xD; 324353862698 (Examples: being safe from injury and harm, from yourself or others and in your surroundings) 0..1 display #xD; 104877718606 How much does your condition affect your leisure activities? 1..1 choice Options: 6 options #xD; 738991042018 (Examples: getting exercise, hobbies, sporting activities, gardening, do-it-yourself activities, crafts and travel) 0..1 display #xD; 502868396322 Patient details 0..1 group #xD; 995364900981 Stick patient label here (or fill in the details below if no label is available) 0..1 display #xD; 140426997110 Preferred name 0..1 string #xD; 961244077884 Full name 0..1 string #xD; 392686174684 NHI number 0..1 string #xD; 220094605396 DOB 0..1 date #xD; 348937414067 Address 0..1 string #xD; 917247769414 Telephone Number 0..1 string #xD; 717341772298 Date 0..1 date #xD; Documentation for this format Options Sets Answer options for 624356696038 null#1 ("No difficulty") null#2 ("Little difficulty") null#3 ("Some difficulty") null#4 ("Quite difficult") null#5 ("Very difficult") null#6 ("Extremely difficult") Answer options for 601664488659 null#1 ("No difficulty") null#2 ("Little difficulty") null#3 ("Some difficulty") null#4 ("Quite difficult") null#5 ("Very difficult") null#6 ("Extremely difficult") Answer options for 863443735387 null#1 ("No difficulty") null#2 ("Little difficulty") null#3 ("Some difficulty") null#4 ("Quite difficult") null#5 ("Very difficult") null#6 ("Extremely difficult") Answer options for 161471334792 null#1 ("No difficulty") null#2 ("Little difficulty") null#3 ("Some difficulty") null#4 ("Quite difficult") null#5 ("Very difficult") null#6 ("Extremely difficult") Answer options for 159129288879 null#1 ("No difficulty") null#2 ("Little difficulty") null#3 ("Some difficulty") null#4 ("Quite difficult") null#5 ("Very difficult") null#6 ("Extremely difficult") Answer options for 104877718606 null#1 ("No difficulty") null#2 ("Little difficulty") null#3 ("Some difficulty") null#4 ("Quite difficult") null#5 ("Very difficult") null#6 ("Extremely difficult")
Patient‑reported assessment of the impact of a health condition on daily life.
How does your condition affect your life?
Please tell us about how much difficulty your condition causes in different areas of your life, which may limit the things you can do. Each question below includes examples to illustrate some of the things this area of life covers. It is okay if some of these examples don't apply to you. Please just think about whatever this area of life means for you. Please circle the number that most represents how much your condition affects each area of your life.
How much does your condition affect your social interactions?
(Examples: meeting friends, going out, joining in groups, going shopping, everyday activities outside the home)
How much does your condition affect your personal relationships?
(Examples: personal relations with partner, family members, close personal friends)
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))
How much does your condition affect your personal care?
(Examples: looking after yourself, your health, personal hygiene, need for aids or special clothing)
How much does your condition affect your personal safety?
(Examples: being safe from injury and harm, from yourself or others and in your surroundings)
How much does your condition affect your leisure activities?
(Examples: getting exercise, hobbies, sporting activities, gardening, do-it-yourself activities, crafts and travel)
Stick patient label here (or fill in the details below if no label is available)