COVIDRegularHealthCheckQuestionnaire
type: Questionnaire
node role: treeRoot
id:
  v: COVIDRegularHealthCheckQuestionnaire
text:
  status:
    v: extensions
  div: Generated Narrative: Questionnaire COVIDRegularHealthCheckQuestionnaire Structure LinkID Text Cardinality Type Description & Constraints<img src="[binary]" alt="doco" style="background-color: inherit"/> COVIDRegularHealthCheckQuestionnaire Gather the status of a patient who is self isolating Questionnaire https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/Questionnaire/COVIDRegularHealthCheckQuestionnaire#0.4.4 #xD; 1 1.. Symptoms - Pay attention to the signs of talking with single words or short sentences, pausing to catch their breath, noisy breathing, persistent coughing, etc. 0..1 group #xD; 1.1 1.1.. Fever chills (feeling hot and cold) 1..1 boolean Initial Value: boolean = false #xD; 1.2 1.2.. Cough 1..1 boolean Initial Value: boolean = false #xD; 1.3 1.3.. Runny nose 1..1 boolean Initial Value: boolean = false #xD; 1.4 1.4.. Headache 1..1 boolean Initial Value: boolean = false #xD; 1.5 1.5.. Joint pain 1..1 boolean Initial Value: boolean = false #xD; 1.6 1.6.. Diarrhoea 1..1 boolean Initial Value: boolean = false #xD; 1.7 1.7.. Nausea / Vomiting 1..1 boolean Initial Value: boolean = false #xD; 1.8 1.8.. Shortness of breath 1..1 boolean Initial Value: boolean = false #xD; 1.8.1 1.8.1.. While at rest? 1..1 boolean Enable When: 1.8 = Initial Value: boolean = false #xD; 1.8.2 1.8.2.. New SOB on exertion? 1..1 boolean Enable When: 1.8 = Initial Value: boolean = false #xD; 1.8.3 1.8.3.. Sudden onset of SOB? (with or without chest pain) 1..1 boolean Enable When: 1.8 = Initial Value: boolean = false #xD; 1.8.4 1.8.4.. Able to speak in full sentences? 1..1 boolean Enable When: 1.8 = Initial Value: boolean = false #xD; 1.8.5 1.8.5.. Assessment? 1..1 choice Enable When: 1.8 = Options: 3 options #xD; 1.8.6 1.8.6.. Further details/what could you do yesterday that you can't do today? 0..1 string Enable When: 1.8 = #xD; 1.9 1.9.. Sore throat 1..1 boolean Initial Value: boolean = false #xD; 1.10 1.10.. Loss of sense of smell / taste 1..1 boolean Initial Value: boolean = false …
url:
  v: https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/Questionnaire/COVIDRegularHealthCheckQuestionnaire
identifier:
  use:
    v: official
  value:
    v: COVIDRegularHealthCheckQuestionnaire
  period:
    start:
      v: 2023-07-19
identifier:
  use:
    v: temp
  value:
    v: QuestionTemplate-CitC-COVID19-RegularHealthCheck
  period:
    start:
      v: 2022-09-12
    end:
      v: 2023-07-19
version:
  v: 0.4.4
name:
  v: COVIDRegularHealthCheckQuestionnaire
title:
  v: Question Template for COVID-19 Regular Health Check
status:
  v: draft
experimental:
  v: false
subject type:
  v: Patient
date:
  v: 2023-07-19
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: Gather the status of a patient who is self isolating
use context:
  code:
    system:
      v: http://terminology.hl7.org/CodeSystem/usage-context-type
    code:
      v: workflow
    display:
      v: Workflow Setting
  value: CodeableConcept
    text:
      v: COVID-19 Regular Health Check
jurisdiction:
  coding:
    system:
      v: urn:iso:std:iso:3166
    code:
      v: NZ
    display:
      v: New Zealand
purpose:
  v: Template for the description of a phone or online video health check to gather the status of a set of conditions for a patient who is self isolating.
item:
  link id:
    v: 1
  prefix:
    v: 1.
  text:
    v: Symptoms - Pay attention to the signs of talking with single words or short sentences, pausing to catch their breath, noisy breathing, persistent coughing, etc.
  type:
    v: group
  item:
    link id:
      v: 1.1
    prefix:
      v: 1.1.
    text:
      v: Fever chills (feeling hot and cold)
    type:
      v: boolean
    required:
      v: true
    initial:
      value: boolean
        v: false
  item:
    link id:
      v: 1.2
    prefix:
      v: 1.2.
    text:
      v: Cough
    type:
      v: boolean
    required:
      v: true
    initial:
      value: boolean
        v: false
  item:
    link id:
      v: 1.3
    prefix:
      v: 1.3.
    text:
      v: Runny nose
    type:
      v: boolean
    required:
      v: true
    initial:
      value: boolean
        v: false
  item:
    link id:
      v: 1.4
    prefix:
      v: 1.4.
    text:
      v: Headache
    type:
      v: boolean
    required:
      v: true
    initial:
      value: boolean
        v: false
  item:
    link id:
      v: 1.5
    prefix:
      v: 1.5.
    text:
      v: Joint pain
    type:
      v: boolean
    required:
      v: true
    initial:
      value: boolean
        v: false
  item:
    link id:
      v: 1.6
    prefix:
      v: 1.6.
    text:
      v: Diarrhoea
    type:
      v: boolean
    required:
      v: true
    initial:
      value: boolean
        v: false
  item:
    link id:
      v: 1.7
    prefix:
      v: 1.7.
    text:
      v: Nausea / Vomiting
    type:
      v: boolean
    required:
      v: true
    initial:
      value: boolean
        v: false
  item:
    link id:
      v: 1.8
    prefix:
      v: 1.8.
    text:
      v: Shortness of breath
    type:
      v: boolean
    required:
      v: true
    initial:
      value: boolean
        v: false

link id:
  v: 1.8.1
prefix:
  v: 1.8.1.
text:
  v: While at rest?
type:
  v: boolean
enable when:
  question:
    v: 1.8
  operator:
    v: =
  answer: boolean
    v: true
required:
  v: true
initial:
  value: boolean
    v: false

link id:
  v: 1.8.2
prefix:
  v: 1.8.2.
text:
  v: New SOB on exertion?
type:
  v: boolean
enable when:
  question:
    v: 1.8
  operator:
    v: =
  answer: boolean
    v: true
required:
  v: true
initial:
  value: boolean
    v: false

link id:
  v: 1.8.3
prefix:
  v: 1.8.3.
text:
  v: Sudden onset of SOB? (with or without chest pain)
type:
  v: boolean
enable when:
  question:
    v: 1.8
  operator:
    v: =
  answer: boolean
    v: true
required:
  v: true
initial:
  value: boolean
    v: false

link id:
  v: 1.8.4
prefix:
  v: 1.8.4.
text:
  v: Able to speak in full sentences?
type:
  v: boolean
enable when:
  question:
    v: 1.8
  operator:
    v: =
  answer: boolean
    v: true
required:
  v: true
initial:
  value: boolean
    v: false

link id:
  v: 1.8.5
prefix:
  v: 1.8.5.
text:
  v: Assessment?
type:
  v: choice
enable when:
  question:
    v: 1.8
  operator:
    v: =
  answer: boolean
    v: true
required:
  v: true
answer option:
  value: string
    v: Same
answer option:
  value: string
    v: Better
answer option:
  value: string
    v: Worse

link id:
  v: 1.8.6
prefix:
  v: 1.8.6.
text:
  v: Further details/what could you do yesterday that you can't do today?
type:
  v: string
enable when:
  question:
    v: 1.8
  operator:
    v: =
  answer: boolean
    v: true
required:
  v: false

link id:
  v: 1.9
prefix:
  v: 1.9.
text:
  v: Sore throat
type:
  v: boolean
required:
  v: true
initial:
  value: boolean
    v: false

link id:
  v: 1.10
prefix:
  v: 1.10.
text:
  v: Loss of sense of smell / taste
type:
  v: boolean
required:
  v: true
initial:
  value: boolean
    v: false

link id:
  v: 1.11
prefix:
  v: 1.11.
text:
  v: Chest pain
type:
  v: boolean
required:
  v: true
initial:
  value: boolean
    v: false

link id:
  v: 1.12
prefix:
  v: 1.12.
text:
  v: Muscular pain (Myalgia)
type:
  v: boolean
required:
  v: true
initial:
  value: boolean
    v: false

link id:
  v: 1.13
prefix:
  v: 1.13.
text:
  v: Abdominal pain
type:
  v: boolean
required:
  v: true
initial:
  value: boolean
    v: false

link id:
  v: 1.14
prefix:
  v: 1.14.
text:
  v: Any light headedness on standing?
type:
  v: boolean
required:
  v: true
initial:
  value: boolean
    v: false

link id:
  v: 1.15
prefix:
  v: 1.15.
text:
  v: Concentrated urine?
type:
  v: boolean
required:
  v: true
initial:
  value: boolean
    v: false

link id:
  v: 1.16
prefix:
  v: 1.16.
text:
  v: Other COVID related symptoms
type:
  v: string
required:
  v: false

link id:
  v: 2
prefix:
  v: 2.
text:
  v: Further Details
type:
  v: group
item:
  link id:
    v: 2.1
  prefix:
    v: 2.1.
  text:
    v: How are you feeling today compared to yesterday?
  type:
    v: choice
  required:
    v: true
  answer option:
    value: string
      v: Same
  answer option:
    value: string
      v: Better
  answer option:
    value: string
      v: Worse
item:
  link id:
    v: 2.2
  prefix:
    v: 2.2.
  text:
    v: Do you have any health concerns?
  type:
    v: boolean
  required:
    v: true
  initial:
    value: boolean
      v: false
item:
  link id:
    v: 2.3
  prefix:
    v: 2.3.
  text:
    v: Have you been eating / sleeping well?
  type:
    v: boolean
  required:
    v: true
  initial:
    value: boolean
      v: true
item:
  link id:
    v: 2.4
  prefix:
    v: 2.4.
  text:
    v: Please provide further eating / sleeping details
  type:
    v: string
  required:
    v: false
item:
  link id:
    v: 2.5
  prefix:
    v: 2.5.
  text:
    v: Have you left the room without your mask or has anyone outside your bubble visited your room?
  type:
    v: boolean
  required:
    v: true
  initial:
    value: boolean
      v: false
item:
  link id:
    v: 2.6
  prefix:
    v: 2.6.
  text:
    v: Please provide further details regarding whether you had visitors in your room / bubble
  type:
    v: string
  required:
    v: false

link id:
  v: 3
prefix:
  v: 3.
text:
  v: Vital Signs
type:
  v: group
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/maxValue
    value: decimal
      v: 60
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/minValue
    value: decimal
      v: 20
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-unit
    value: Coding
      system:
        v: http://unitsofmeasure.org
      code:
        v: Cel
      display:
        v: Cel
  link id:
    v: 3.1
  prefix:
    v: 3.1.
  text:
    v: Temperature (°C)
  type:
    v: decimal
  required:
    v: true
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-unit
    value: Coding
      system:
        v: http://unitsofmeasure.org
      code:
        v: {beats}/min
      display:
        v: {beats}/min
  link id:
    v: 3.2
  prefix:
    v: 3.2.
  text:
    v: Heart Rate (BPM)
  type:
    v: integer
  required:
    v: true
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-unit
    value: Coding
      system:
        v: http://unitsofmeasure.org
      code:
        v: mm[Hg]
      display:
        v: mm[Hg]
  link id:
    v: 3.3
  prefix:
    v: 3.3.
  text:
    v: BP (Systolic) (mmHg)
  type:
    v: integer
  required:
    v: true
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-unit
    value: Coding
      system:
        v: http://unitsofmeasure.org
      code:
        v: mm[Hg]
      display:
        v: mm[Hg]
  link id:
    v: 3.4
  prefix:
    v: 3.4.
  text:
    v: BP (Diastolic) (mmHg)
  type:
    v: integer
  required:
    v: true
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/maxValue
    value: integer
      v: 100
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/minValue
    value: integer
      v: 0
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-unit
    value: Coding
      system:
        v: http://unitsofmeasure.org
      code:
        v: %
      display:
        v: %
  link id:
    v: 3.5
  prefix:
    v: 3.5.
  text:
    v: Oxygen Saturation, SpO2 (%)
  type:
    v: integer
  required:
    v: false
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-unit
    value: Coding
      system:
        v: http://unitsofmeasure.org
      code:
        v: {Breaths}/min
      display:
        v: {Breaths}/min
  link id:
    v: 3.6
  prefix:
    v: 3.6.
  text:
    v: Respiration (RPM)
  type:
    v: integer
  required:
    v: false
item:
  link id:
    v: 3.7
  prefix:
    v: 3.7.
  text:
    v: Other vital signs
  type:
    v: string
  required:
    v: false
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/maxValue
    value: integer
      v: 10
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/minValue
    value: integer
      v: 0
  link id:
    v: 3.8
  prefix:
    v: 3.8.
  text:
    v: Mood (/10)
  type:
    v: integer
  required:
    v: false

link id:
  v: 4
prefix:
  v: 4.
text:
  v: Health check note
type:
  v: group
item:
  link id:
    v: 4.1
  prefix:
    v: 4.1.
  text:
    v: Acuity Rating
  type:
    v: choice
  required:
    v: true
  answer option:
    value: integer
      v: 1
  answer option:
    value: integer
      v: 2
  answer option:
    value: integer
      v: 3
  answer option:
    value: integer
      v: 4
  answer option:
    value: integer
      v: 5
  answer option:
    value: integer
      v: 6
item:
  link id:
    v: 4.2
  prefix:
    v: 4.2.
  text:
    v: Regular health check note
  type:
    v: string
  required:
    v: false
item:
  link id:
    v: 4.3
  prefix:
    v: 4.3.
  text:
    v: Care Management Plan
  type:
    v: choice
  required:
    v: true
  answer option:
    value: string
      v: Self Management
  answer option:
    value: string
      v: Active Management