Generated Narrative: Questionnaire COVIDInitialHealthAssessmentQuestionnaire Structure LinkID Text Cardinality Type Description & Constraints COVIDInitialHealthAssessmentQuestionnaire An initial assessment for a patient who has tested positive for COVID-19 Questionnaire https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/Questionnaire/COVIDInitialHealthAssessmentQuestionnaire#0.4.5 #xD; 1 1.. Past Health and Wellbeing History - ask questions to find out about: 0..1 group #xD; 1.1 1.1.. Hypertension? 1..1 boolean Initial Value: boolean = false #xD; 1.2 1.2.. Diabetes? 1..1 boolean Initial Value: boolean = false #xD; 1.2.1 1.2.1. If using insulin please provide details? 0..1 string Enable When: 1.2 = #xD; 1.3 1.3.. Asthma? 1..1 boolean Initial Value: boolean = false #xD; 1.4 1.4.. Previous stroke? 1..1 boolean Initial Value: boolean = false #xD; 1.5 1.5.. Cancer? 1..1 boolean Initial Value: boolean = false #xD; 1.5.1 1.5.1. Please provide cancer details 0..1 text Enable When: 1.5 = #xD; 1.6 1.6.. Current/recent pregnancy? 1..1 boolean Initial Value: boolean = false #xD; 1.6.a 1.6.a.. Pregnancy assessment 0..1 group Enable When: 1.6 = #xD; 1.6.1 1.6.1. Gestation (number of weeks) 0..1 string #xD; 1.6.2 1.6.2. Postpartum (number of weeks) 0..1 string #xD; 1.7 1.7.. Immunocompromised? 1..1 boolean Initial Value: boolean = false #xD; 1.7.1 1.7.1. Specify immunocompromised further details 0..1 text Enable When: 1.7 = #xD; 1.8 1.8.. Previous heart attack or heart failure? 1..1 boolean Initial Value: boolean = false #xD; 1.9 1.9.. Epilepsy? 1..1 boolean Initial Value: boolean = false #xD; 1.10 1.10.. Other respiratory disease? 1..1 boolean Initial Value: boolean = false #xD; 1.11 1.11.. Mental health and/or addiction? 1..1 boolean Initial Value: boolean = false #xD; 1.12 1.12.. Kidney disease? 1..1 boolean Initial Value: boolean = false #xD; 1.13 1.13.. CPAP device used? 1..1 boolean Initial Value: boolean = false #xD; 1.14 1.14.. Weight? 1..1 choice Options: 4 options #xD; 1.15 1.15.. Other 0..1 string #xD; 2 2.. Medication and Allergies 0..1 group #xD; 2.1 2.1.. Smoking? 1..1 boolean Initial Value: boolean = false #xD; 2.1b 2.1b.. Would you like NRT? 0..1 boolean Enable When: 2.1 = #xD; 2.2 2.2.. Alcohol? 1..1 boolean Initial Value: boolean = false #xD; 2.2.1 2.2.1.. Drinks per week? 0..1 choice Enable When: 2.2 = Options: 3 options #xD; 2.3 2.3.. Recreational drugs? 0..1 boolean Initial Value: boolean = false #xD; 2.4 2.4.. Allergies? 1..1 boolean Initial Value: boolean = false #xD; 2.4.1 2.4.1.. Medication Allergies 1..1 boolean Enable When: 2.4 = Initial Value: boolean = false #xD; 2.4.1.1 2.4.1.1.. Medicine 0..1 string Enable When: 2.4.1 = #xD; 2.4.1.2 2.4.1.2.. Category (select) 0..1 choice Enable When: 2.4.1 = Options: 3 options #xD; 2.4.1.3 2.4.1.3.. Reaction (select) 0..1 choice Enable When: 2.4.1 = Options: 4 options #xD; 2.4.1.4 2.4.1.4.. Onset Date 0..1 date Enable When: 2.4.1 = #xD; 2.4.1.5 2.4.1.5.. Date of Entry 0..1 date Enable When: 2.4.1 = #xD; 2.4.1.6 2.4.1.6.. Active? 1..1 boolean Enable When: 2.4.1 = Initial Value: boolean = true #xD; 2.4.1.6.1 2.4.1.6.1.. Specify Reason for deactivation 0..1 string Enable When: 2.4.1.6 = #xD; 2.4.1.7 2.4.1.7.. Comments 0..1 text Enable When: 2.4.1 = #xD; 2.4.2 2.4.2.. Other allergies 1..1 text Enable When: 2.4 = #xD; 2.5 2.5.. Prescription medication or medical devices (eg. CPAP, nebuliser, blood glucose meter)? 1..1 boolean Initial Value: boolean = false #xD; 2.6 2.6.. Details of medications, medical devices, recreational drugs here 0..1 text #xD; 2.7 2.7.. Able to manage meds independently? 0..1 boolean Initial Value: boolean = false #xD; 2.8 2.8.. Sufficient supply for 14 days? 0..1 boolean #xD; 2.9 2.9.. Taking immunosuppressant? 0..1 boolean #xD; 3 3.. Individual assessment plan/guideline 0..1 group #xD; 3.1 3.1.. Individual assessment plan / guideline 0..1 text #xD; Documentation for this format Options Sets Answer options for 1.14 Under Average Over Obese Answer options for 2.2.1 <10 10-16 >16 Answer options for 2.4.1.2 Allergy Patient Complaint Side Effect Answer options for 2.4.1.3 Mild Moderate Severe Anaphylaxis
COVID19 Initial Health Assessment Questionnaire
An initial assessment for a patient who has tested positive for COVID-19
Gather status and conditions for a patient who is self-isolating.
Past Health and Wellbeing History - ask questions to find out about:
If using insulin please provide details?
Specify immunocompromised further details
Prescription medication or medical devices (eg. CPAP, nebuliser, blood glucose meter)?
Details of medications, medical devices, recreational drugs here