New Zealand Rheumatic Fever FHIR Implementation Guide - Local Development build (v0.4.8) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

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: Oral Secondary Prophylaxis Health Assessment Questionnaire - JSON Representation

Draft as of 2024-06-17

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{
  "resourceType" : "Questionnaire",
  "id" : "OralSecondaryProphylaxisHealthAssessmentQuestionnaire",
  "url" : "https://fhir-ig.digital.health.nz/rheumatic-fever/Questionnaire/OralSecondaryProphylaxisHealthAssessmentQuestionnaire",
  "identifier" : [
    {
      "use" : "official",
      "value" : "OralSecondaryProphylaxisHealthAssessmentQuestionnaire",
      "period" : {
        "start" : "2024-06-17"
      }
    }
  ],
  "version" : "1.0.0",
  "name" : "OralSecondaryProphylaxisHealthAssessmentQuestionnaire",
  "title" : "Oral Secondary Prophylaxis Health Assessment Questionnaire",
  "status" : "draft",
  "experimental" : false,
  "subjectType" : [
    "Patient"
  ],
  "date" : "2024-06-17",
  "publisher" : "Te Whatu Ora",
  "contact" : [
    {
      "name" : "Te Whatu Ora",
      "telecom" : [
        {
          "system" : "url",
          "value" : "https://www.tewhatuora.govt.nz/"
        }
      ]
    },
    {
      "name" : "David Grainger",
      "telecom" : [
        {
          "system" : "email",
          "value" : "david.grainger@middleware.co.nz",
          "use" : "work"
        }
      ]
    }
  ],
  "description" : "Gathers information about patient health at an oral secondary prophylaxis medication appointment",
  "purpose" : "Gathers information about patient health at an appointemnt for oral secondary prophylaxis medication",
  "item" : [
    {
      "linkId" : "page1",
      "prefix" : "page1",
      "text" : "Please complete this questionnaire at the oral secondary prophylaxis appointment to assess a rheumatic fever patient's health.",
      "type" : "display"
    },
    {
      "linkId" : "MedicationIssues",
      "prefix" : "1",
      "text" : "Has the patient had any issues taking their medications?",
      "type" : "boolean",
      "required" : true
    },
    {
      "linkId" : "DelaysObtainingMedication",
      "prefix" : "2)",
      "text" : "Were there delays in obtaining medications that interrupted the patient’s treatment?",
      "type" : "boolean",
      "required" : true
    },
    {
      "linkId" : "DelaysObtainingMedicationDetail",
      "prefix" : "2.1)",
      "text" : "Enter details of delays in obtaining medication that interrupted patient's treatment (enter text)",
      "type" : "text",
      "enableWhen" : [
        {
          "question" : "DelaysObtainingMedication",
          "operator" : "=",
          "answerBoolean" : true
        }
      ],
      "required" : true
    },
    {
      "linkId" : "SufficientMedication",
      "prefix" : "3)",
      "text" : "Does the patient have enough medication to last until their next check-in?",
      "type" : "boolean",
      "required" : true
    },
    {
      "linkId" : "PlanForObtainingMedications",
      "prefix" : "4)",
      "text" : "Plan for obtaining medications to last until next check-in (enter text)",
      "type" : "text",
      "required" : true
    },
    {
      "linkId" : "AnyOtherConcerns",
      "prefix" : "5)",
      "text" : "Were There Any Other Concerns or Issues Identified During the Visit?",
      "type" : "boolean",
      "required" : true,
      "initial" : [
        {
          "valueBoolean" : false
        }
      ]
    },
    {
      "linkId" : "OtherConcernsDetail",
      "prefix" : "5.1)",
      "text" : "If yes, describe details, actions taken, and follow-up planned (enter text)",
      "type" : "text",
      "enableWhen" : [
        {
          "question" : "AnyOtherConcerns",
          "operator" : "=",
          "answerBoolean" : true
        }
      ],
      "required" : true
    },
    {
      "linkId" : "HealthEducationTopicsDiscussed",
      "prefix" : "6)",
      "text" : "Health education topics discussed? (multiple choice)",
      "type" : "choice",
      "required" : true,
      "repeats" : true,
      "answerOption" : [
        {
          "valueString" : "Secondary prophylaxis"
        },
        {
          "valueString" : "Sore Throat Management"
        },
        {
          "valueString" : "Skin Infection Management"
        },
        {
          "valueString" : "Dental Health"
        },
        {
          "valueString" : "Endocarditis Prophylaxis"
        },
        {
          "valueString" : "Nutrition"
        },
        {
          "valueString" : "Physical Activity"
        },
        {
          "valueString" : "Healthy Home Environments"
        },
        {
          "valueString" : "Sexual Health"
        },
        {
          "valueString" : "Other"
        }
      ]
    },
    {
      "linkId" : "HealthEducationOtherDetail",
      "prefix" : "6.1)",
      "text" : "Enter details of other health education topic discussed (enter text)",
      "type" : "text",
      "enableWhen" : [
        {
          "question" : "HealthEducationTopicsDiscussed",
          "operator" : "=",
          "answerString" : "Other"
        }
      ],
      "required" : true
    },
    {
      "linkId" : "RecentOrUpcomingAppointments",
      "prefix" : "7)",
      "text" : "Any recent or upcoming follow-up appointments?",
      "type" : "boolean",
      "required" : true
    },
    {
      "linkId" : "RecentOrUpcomingAppointmentsDetails",
      "prefix" : "7.1)",
      "text" : "Enter details and dates of any recent or upcoming follow-up appointments (enter text)",
      "type" : "text",
      "enableWhen" : [
        {
          "question" : "RecentOrUpcomingAppointments",
          "operator" : "=",
          "answerBoolean" : true
        }
      ],
      "required" : true
    },
    {
      "linkId" : "PlanForNextMedicationAppointment",
      "prefix" : "8)",
      "text" : "Comments for the next appointment (enter text)",
      "type" : "text",
      "required" : true
    }
  ]
}