Te Whatu Ora Shared Care FHIR API
0.3.9 - release
Te Whatu Ora Shared Care FHIR API
0.3.9 - release
Te Whatu Ora Shared Care FHIR API - Local Development build (v0.3.9) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
| Draft as of 2023-08-23 |
<Questionnaire xmlns="http://hl7.org/fhir">
<id value="ActiveMonitoringDay42Survey"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><b>Structure</b><table border="1" cellpadding="0" cellspacing="0" style="border: 1px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;"><tr style="border: 2px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top"><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="The linkID for the item">LinkID</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Text for the item">Text</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Minimum and Maximum # of times the item can appear in the instance">Cardinality</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="The type of the item">Type</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Other attributes of the item">Flags</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Additional information about the item">Description & Constraints</a><span style="float: right"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="data:image/png;base64,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" alt="doco" style="background-color: inherit"/></a></span></th></tr><tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_q_root.gif" alt="." style="background-color: white; background-color: inherit" title="QuestionnaireRoot" class="hierarchy"/> ActiveMonitoringDay42Survey</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Te Whatu Ora 42-day post Influenza/Covid-19 booster vaccination survey.</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Questionnaire</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/Questionnaire/ActiveMonitoringDay42Survey#0.2.2</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.p00-q01" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="String" class="hierarchy"/> p00-q01</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">null</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string">string</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/extension-questionnaire-hidden.html" title="Is a hidden item"><img src="icon-qi-hidden.png" alt="icon"/></a><img src="icon-qi-hidden.png" alt="icon"/></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.p01-Intro" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-display.png" alt="." style="background-color: white; background-color: inherit" title="Display" class="hierarchy"/> p01-Intro</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">page 01. Kia ora This is second of two surveys about your vaccination experience. This survey will take approximately two minutes to complete. You will be asked about any symptoms you had after your vaccination. There is also a section at the end for you to comment on any other parts of the vaccine experience. Your responses are important and will help contribute to the safety monitoring of vaccines in New Zealand. The information you provide is confidential and is protected by the Privacy Act 2020 and data security safeguards. Please remember this is a survey only, your answers will not result in a medical response to your situation. If you have any concerns about your health after your vaccination, call Healthline at 0800 611 116 or speak to your healthcare professional. If you experience any of the following symptoms, you should seek medical help urgently and tell them about your vaccination: tightness, heaviness, discomfort, pressure or pain in your chest or neck difficulty breathing or catching your breath feeling faint, dizzy, or light-headed fluttering, racing, or pounding heart, or feeling like it’s ‘skipping beats’</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-display">display</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)" id="item.p02-Advice" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Group" class="hierarchy"/> p02-Advice</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">page 02. Seeking advice</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group">group</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)" id="item.p02-q01-MedicalAdviceSought" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="Coding" class="hierarchy"/> p02-q01-MedicalAdviceSought</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">page 02 question 1. Since the day 3 survey have you or your dependent sought medical help/ advice related to your vaccination? Choose all that apply</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..*</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.p02-q01-MedicalAdviceSought">9 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)" id="item.p03-Diagnoses" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Group" class="hierarchy"/> p03-Diagnoses</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">page 03. Medical diagnoses</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group">group</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" id="item.p03-q01-ConditionsDiagnosed" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="Coding" class="hierarchy"/> p03-q01-ConditionsDiagnosed</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">page 03 question 1. Since the day 3 survey, have you/they been diagnosed with any medical conditions that a medical professional has attributed to your/their vaccination?</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.p03-q01-ConditionsDiagnosed">2 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" id="item.p03-q02-ConditionNames" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="String" class="hierarchy"/> p03-q02-ConditionNames</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">page 03 question 2. Please answer ONLY with the name of the condition(s).</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string">string</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Enable When: <span><a href="#item.p03-q01-ConditionsDiagnosed">p03-q01-ConditionsDiagnosed</a> = Yes, You/they have been diagnosed with a medical condition attributed to vaccination</span></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" id="item.p03-q03-CARMSubmitted" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="Coding" class="hierarchy"/> p03-q03-CARMSubmitted</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">page 03 question 3. Have you/ they had a Centre for Adverse Reactions Monitoring (CARM) report submitted for your/their diagnosis</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Enable When: <span><a href="#item.p03-q01-ConditionsDiagnosed">p03-q01-ConditionsDiagnosed</a> = Yes, You/they have been diagnosed with a medical condition attributed to vaccination</span><br/>Options: <a href="#opt-item.p03-q03-CARMSubmitted">4 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)" id="item.p03-q04-ACCClaim" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Coding" class="hierarchy"/> p03-q04-ACCClaim</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">page 03 question 4. Has an ACC claim been made for your/their diagnosis</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Enable When: <span><a href="#item.p03-q01-ConditionsDiagnosed">p03-q01-ConditionsDiagnosed</a> = Yes, You/they have been diagnosed with a medical condition attributed to vaccination</span><br/>Options: <a href="#opt-item.p03-q04-ACCClaim">4 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck00.png)" id="item.p04-Thanks" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-display.png" alt="." style="background-color: white; background-color: inherit" title="Display" class="hierarchy"/> p04-Thanks</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">page 04. Thank you for completing the Day 42 post vaccine survey, your answers have been submitted. This is your final survey for your COVID-19 and flu vaccines. Your responses help Health New Zealand monitor the safety of the COVID-19 and flu vaccines. The information you provided is protected by the Privacy Act 2020 and by the safeguards we have in place. The data collected by these surveys will be made available online on the Health NZ website. Survey data provided online are not identifiable and individual responses are confidential. Ngā mihi, Health New Zealand</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-display">display</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr><td colspan="6" class="hierarchy"><br/><a href="http://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="data:image/png;base64,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" alt="doco" style="background-color: inherit"/> Documentation for this format</a></td></tr></table><hr/><p><b>Options Sets</b></p><a name="opt-item.p02-q01-MedicalAdviceSought"> </a><p><b>Answer options for p02-q01-MedicalAdviceSought </b></p><ul><li style="font-size: 11px">null#null ("Phone advice from a helpline (e.g., Healthline)")</li><li style="font-size: 11px">null#null ("Care from a GP clinic (including the clinic nurse, a doctor, or a phone call with a person at the GP clinic).")</li><li style="font-size: 11px">null#null ("Visit to a hospital emergency department")</li><li style="font-size: 11px">null#null ("Rongoā clinic")</li><li style="font-size: 11px">null#null ("Whānau Ora navigator")</li><li style="font-size: 11px">null#null ("Māori Health Provider")</li><li style="font-size: 11px">null#null ("Pharmacy")</li><li style="font-size: 11px">null#null ("Other")</li><li style="font-size: 11px">null#null ("Did not seek any medical advice")</li></ul><a name="opt-item.p03-q01-ConditionsDiagnosed"> </a><p><b>Answer options for p03-q01-ConditionsDiagnosed </b></p><ul><li style="font-size: 11px">null#null ("No, you/they have not been diagnosed with a medical condition attributed to vaccination")</li><li style="font-size: 11px">null#null ("Yes, You/they have been diagnosed with a medical condition attributed to vaccination")</li></ul><a name="opt-item.p03-q03-CARMSubmitted"> </a><p><b>Answer options for p03-q03-CARMSubmitted </b></p><ul><li style="font-size: 11px">null#null ("Yes")</li><li style="font-size: 11px">null#null ("No")</li><li style="font-size: 11px">null#null ("No - I did not know about reporting")</li><li style="font-size: 11px">null#null ("Unsure")</li></ul><a name="opt-item.p03-q04-ACCClaim"> </a><p><b>Answer options for p03-q04-ACCClaim </b></p><ul><li style="font-size: 11px">null#null ("Yes")</li><li style="font-size: 11px">null#null ("No")</li><li style="font-size: 11px">null#null ("No - I did not know about making an ACC claim")</li><li style="font-size: 11px">null#null ("Unsure")</li></ul></div>
</text>
<url
value="https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/Questionnaire/ActiveMonitoringDay42Survey"/>
<identifier>
<use value="official"/>
<value value="ActiveMonitoringDay42Survey"/>
<period>
<start value="2023-07-19"/>
</period>
</identifier>
<identifier>
<use value="temp"/>
<value value="Questionnaire-ActiveMonitoring-Day42SurveyQuestionnaire"/>
<period>
<end value="2023-07-19"/>
</period>
</identifier>
<version value="0.2.2"/>
<name value="ActiveMonitoringDay42Survey"/>
<title value="Post Vaccine Symptom Check day 42 survey"/>
<status value="draft"/>
<subjectType value="Patient"/>
<date value="2023-08-23T22:13:19+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="David Grainger"/>
<telecom>
<system value="email"/>
<value value="david.grainger@middleware.co.nz"/>
<use value="work"/>
</telecom>
</contact>
<description
value="Te Whatu Ora 42-day post Influenza/Covid-19 booster vaccination survey."/>
<useContext>
<code>
<system
value="http://terminology.hl7.org/CodeSystem/usage-context-type"/>
<code value="workflow"/>
<display value="Workflow Setting"/>
</code>
<valueCodeableConcept>
<text value="Vaccination Side Effect Questionnaire"/>
</valueCodeableConcept>
</useContext>
<jurisdiction>
<coding>
<system value="urn:iso:std:iso:3166"/>
<code value="NZ"/>
<display value="New Zealand"/>
</coding>
</jurisdiction>
<purpose
value="Survey of side effects and overall experience of Influenza/COVID-19 Booster vaccination after 42 days."/>
<code>
<system value="http://snomed.info/sct"/>
<code value="293104008"/>
<display value="Vaccine adverse reaction"/>
</code>
<item>
<extension
url="http://hl7.org/fhir/StructureDefinition/questionnaire-hidden">
<valueBoolean value="true"/>
</extension>
<linkId value="p00-q01"/>
<type value="string"/>
<required value="false"/>
</item>
<item>
<linkId value="p01-Intro"/>
<prefix value="page 01"/>
<text
value="Kia ora This is second of two surveys about your vaccination experience. This survey will take approximately two minutes to complete. You will be asked about any symptoms you had after your vaccination. There is also a section at the end for you to comment on any other parts of the vaccine experience. Your responses are important and will help contribute to the safety monitoring of vaccines in New Zealand. The information you provide is confidential and is protected by the Privacy Act 2020 and data security safeguards. Please remember this is a survey only, your answers will not result in a medical response to your situation. If you have any concerns about your health after your vaccination, call Healthline at 0800 611 116 or speak to your healthcare professional. If you experience any of the following symptoms, you should seek medical help urgently and tell them about your vaccination: tightness, heaviness, discomfort, pressure or pain in your chest or neck difficulty breathing or catching your breath feeling faint, dizzy, or light-headed fluttering, racing, or pounding heart, or feeling like it’s ‘skipping beats’">
<extension
url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
<valueString
value="<p>Kia ora</p><p>This is the second of two surveys about your vaccination experience. This survey will take approximately two minutes to complete. You will be asked about any reactions you had after your vaccination. There is also a section at the end for you to comment on any other parts of the vaccine experience. Your responses are important and will help contribute to the safety monitoring of vaccines in Aotearoa New Zealand. The information you provide is confidential and is protected by the Privacy Act 2020 and data security safeguards.</p><p>Please remember this is a survey only, your answers will not result in a medical response to your situation. If you have any concerns about your health after your vaccination, call Healthline at 0800 611 116 or speak to your healthcare professional.<p>If you experience any of the following symptoms, <u>you should seek medical help urgently</u> and tell them about your vaccinations: <ul><li>tightness, heaviness, discomfort, pressure or pain in your chest or neck</li><li>difficulty breathing or catching your breath</li><li>feeling faint, dizzy, or light-headed</li><li>fluttering, racing, or pounding heart, or feeling like it’s ‘skipping beats’</li></ul></p><p>If you need any help completing your survey you can call 0800 855 066 for assistance.</p>"/>
</extension>
</text>
<type value="display"/>
</item>
<item>
<linkId value="p02-Advice"/>
<prefix value="page 02"/>
<text value="Seeking advice"/>
<type value="group"/>
<item>
<linkId value="p02-q01-MedicalAdviceSought"/>
<prefix value="page 02 question 1"/>
<text
value="Since the day 3 survey have you or your dependent sought medical help/ advice related to your vaccination? Choose all that apply"/>
<type value="choice"/>
<required value="true"/>
<repeats value="true"/>
<answerOption>
<valueCoding>
<display value="Phone advice from a helpline (e.g., Healthline)"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<display
value="Care from a GP clinic (including the clinic nurse, a doctor, or a phone call with a person at the GP clinic)."/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<display value="Visit to a hospital emergency department"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<display value="Rongoā clinic"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<display value="Whānau Ora navigator"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<display value="Māori Health Provider"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<display value="Pharmacy"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<display value="Other"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<display value="Did not seek any medical advice"/>
</valueCoding>
</answerOption>
</item>
</item>
<item>
<linkId value="p03-Diagnoses"/>
<prefix value="page 03"/>
<text value="Medical diagnoses"/>
<type value="group"/>
<required value="true"/>
<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="p03-q01-ConditionsDiagnosed"/>
<prefix value="page 03 question 1"/>
<text
value="Since the day 3 survey, have you/they been diagnosed with any medical conditions that a medical professional has attributed to your/their vaccination?"/>
<type value="choice"/>
<required value="true"/>
<answerOption>
<valueCoding>
<display
value="No, you/they have not been diagnosed with a medical condition attributed to vaccination"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<display
value="Yes, You/they have been diagnosed with a medical condition attributed to vaccination"/>
</valueCoding>
</answerOption>
</item>
<item>
<linkId value="p03-q02-ConditionNames"/>
<prefix value="page 03 question 2"/>
<text value="Please answer ONLY with the name of the condition(s)."/>
<type value="string"/>
<enableWhen>
<question value="p03-q01-ConditionsDiagnosed"/>
<operator value="="/>
<answerCoding>
<display
value="Yes, You/they have been diagnosed with a medical condition attributed to vaccination"/>
</answerCoding>
</enableWhen>
<enableBehavior value="all"/>
<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="drop-down"/>
<display value="Drop down"/>
</coding>
</valueCodeableConcept>
</extension>
<linkId value="p03-q03-CARMSubmitted"/>
<prefix value="page 03 question 3"/>
<text
value="Have you/ they had a Centre for Adverse Reactions Monitoring (CARM) report submitted for your/their diagnosis"/>
<type value="choice"/>
<enableWhen>
<question value="p03-q01-ConditionsDiagnosed"/>
<operator value="="/>
<answerCoding>
<display
value="Yes, You/they have been diagnosed with a medical condition attributed to vaccination"/>
</answerCoding>
</enableWhen>
<enableBehavior value="all"/>
<required value="true"/>
<answerOption>
<valueCoding>
<display value="Yes"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<display value="No"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<display value="No - I did not know about reporting"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<display value="Unsure"/>
</valueCoding>
</answerOption>
</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="p03-q04-ACCClaim"/>
<prefix value="page 03 question 4"/>
<text value="Has an ACC claim been made for your/their diagnosis"/>
<type value="choice"/>
<enableWhen>
<question value="p03-q01-ConditionsDiagnosed"/>
<operator value="="/>
<answerCoding>
<display
value="Yes, You/they have been diagnosed with a medical condition attributed to vaccination"/>
</answerCoding>
</enableWhen>
<enableBehavior value="all"/>
<required value="true"/>
<answerOption>
<valueCoding>
<display value="Yes"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<display value="No"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<display value="No - I did not know about making an ACC claim"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<display value="Unsure"/>
</valueCoding>
</answerOption>
</item>
</item>
<item>
<extension
url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
<valueCodeableConcept>
<coding>
<code value="post-submit"/>
</coding>
</valueCodeableConcept>
</extension>
<linkId value="p04-Thanks"/>
<prefix value="page 04"/>
<text
value="Thank you for completing the Day 42 post vaccine survey, your answers have been submitted. This is your final survey for your COVID-19 and flu vaccines. Your responses help Health New Zealand monitor the safety of the COVID-19 and flu vaccines. The information you provided is protected by the Privacy Act 2020 and by the safeguards we have in place. The data collected by these surveys will be made available online on the Health NZ website. Survey data provided online are not identifiable and individual responses are confidential. Ngā mihi, Health New Zealand">
<extension
url="http://hl7.org/fhir/StructureDefinition/rendering-xhtml">
<valueString
value="<p>Thank you for completing the Day 42 post vaccine survey, your answers have been submitted. This is your final survey for your COVID-19 and flu vaccines. Your responses help Health New Zealand monitor the safety of the COVID-19 and flu vaccines. The information you provided is protected by the Privacy Act 2020 and by the safeguards we have in place. The data collected by these surveys will be made available online on the Health NZ website. Survey data provided online are not identifiable and individual responses are confidential.</p><p>Ngā mihi</p><p>Health New Zealand</p>"/>
</extension>
</text>
<type value="display"/>
</item>
</Questionnaire>