COVIDInitialHealthAssessmentQuestionnaire
type: Questionnaire
node role: treeRoot
id:
  v: COVIDInitialHealthAssessmentQuestionnaire
text:
  status:
    v: extensions
  div: Generated Narrative: Questionnaire COVIDInitialHealthAssessmentQuestionnaire Structure LinkID Text Cardinality Type Description & Constraints<img src="[binary]" alt="doco" style="background-color: inherit"/> 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 = fal…
url:
  v: https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/Questionnaire/COVIDInitialHealthAssessmentQuestionnaire
identifier:
  use:
    v: official
  value:
    v: COVIDInitialHealthAssessmentQuestionnaire
  period:
    start:
      v: 2023-07-19
identifier:
  use:
    v: temp
  value:
    v: QuestionTemplate-CitC-COVID19-InitialAssessment
  period:
    end:
      v: 2023-07-19
version:
  v: 0.4.5
name:
  v: COVIDInitialHealthAssessmentQuestionnaire
title:
  v: COVID19 Initial Health Assessment Questionnaire
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: An initial assessment for a patient who has tested positive for COVID-19
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 Initial Health Assessment
jurisdiction:
  coding:
    system:
      v: urn:iso:std:iso:3166
    code:
      v: NZ
    display:
      v: New Zealand
purpose:
  v: Gather status and conditions for a patient who is self-isolating.
item:
  link id:
    v: 1
  prefix:
    v: 1.
  text:
    v: Past Health and Wellbeing History - ask questions to find out about:
  type:
    v: group
  item:
    link id:
      v: 1.1
    prefix:
      v: 1.1.
    text:
      v: Hypertension?
    type:
      v: boolean
    required:
      v: true
    initial:
      value: boolean
        v: false
  item:
    link id:
      v: 1.2
    prefix:
      v: 1.2.
    text:
      v: Diabetes?
    type:
      v: boolean
    required:
      v: true
    initial:
      value: boolean
        v: false
  item:
    link id:
      v: 1.2.1
    prefix:
      v: 1.2.1
    text:
      v: If using insulin please provide details?
    type:
      v: string
    enable when:
      question:
        v: 1.2
      operator:
        v: =
      answer: boolean
        v: true
    required:
      v: false
  item:
    link id:
      v: 1.3
    prefix:
      v: 1.3.
    text:
      v: Asthma?
    type:
      v: boolean
    required:
      v: true
    initial:
      value: boolean
        v: false
  item:
    link id:
      v: 1.4
    prefix:
      v: 1.4.
    text:
      v: Previous stroke?
    type:
      v: boolean
    required:
      v: true
    initial:
      value: boolean
        v: false
  item:
    link id:
      v: 1.5
    prefix:
      v: 1.5.
    text:
      v: Cancer?
    type:
      v: boolean
    required:
      v: true
    initial:
      value: boolean
        v: false
  item:
    link id:
      v: 1.5.1
    prefix:
      v: 1.5.1
    text:
      v: Please provide cancer details
    type:
      v: text
    enable when:
      question:
        v: 1.5
      operator:
        v: =
      answer: boolean
        v: true
    required:
      v: false
  item:
    link id:
      v: 1.6
    prefix:
      v: 1.6.
    text:
      v: Current/recent pregnancy?

v: boolean

v: true

value: boolean
  v: false

link id:
  v: 1.6.a
prefix:
  v: 1.6.a.
text:
  v: Pregnancy assessment
type:
  v: group
enable when:
  question:
    v: 1.6
  operator:
    v: =
  answer: boolean
    v: true
required:
  v: false
item:
  link id:
    v: 1.6.1
  prefix:
    v: 1.6.1
  text:
    v: Gestation (number of weeks)
  type:
    v: string
  required:
    v: false
item:
  link id:
    v: 1.6.2
  prefix:
    v: 1.6.2
  text:
    v: Postpartum (number of weeks)
  type:
    v: string
  required:
    v: false

link id:
  v: 1.7
prefix:
  v: 1.7.
text:
  v: Immunocompromised?
type:
  v: boolean
required:
  v: true
initial:
  value: boolean
    v: false

link id:
  v: 1.7.1
prefix:
  v: 1.7.1
text:
  v: Specify immunocompromised further details
type:
  v: text
enable when:
  question:
    v: 1.7
  operator:
    v: =
  answer: boolean
    v: true
required:
  v: false

link id:
  v: 1.8
prefix:
  v: 1.8.
text:
  v: Previous heart attack or heart failure?
type:
  v: boolean
required:
  v: true
initial:
  value: boolean
    v: false

link id:
  v: 1.9
prefix:
  v: 1.9.
text:
  v: Epilepsy?
type:
  v: boolean
required:
  v: true
initial:
  value: boolean
    v: false

link id:
  v: 1.10
prefix:
  v: 1.10.
text:
  v: Other respiratory disease?
type:
  v: boolean
required:
  v: true
initial:
  value: boolean
    v: false

link id:
  v: 1.11
prefix:
  v: 1.11.
text:
  v: Mental health and/or addiction?
type:
  v: boolean
required:
  v: true
initial:
  value: boolean
    v: false

link id:
  v: 1.12
prefix:
  v: 1.12.
text:
  v: Kidney disease?
type:
  v: boolean
required:
  v: true
initial:
  value: boolean
    v: false

link id:
  v: 1.13
prefix:
  v: 1.13.
text:
  v: CPAP device used?
type:
  v: boolean
required:
  v: true
initial:
  value: boolean
    v: false

link id:
  v: 1.14
prefix:
  v: 1.14.
text:
  v: Weight?
type:
  v: choice
required:
  v: true
answer option:
  value: string
    v: Under
answer option:
  value: string
    v: Average
answer option:
  value: string
    v: Over
answer option:
  value: string
    v: Obese

link id:
  v: 1.15
prefix:
  v: 1.15.
text:
  v: Other
type:
  v: string
required:
  v: false

link id:
  v: 2
prefix:
  v: 2.
text:
  v: Medication and Allergies
type:
  v: group
item:
  link id:
    v: 2.1
  prefix:
    v: 2.1.
  text:
    v: Smoking?
  type:
    v: boolean
  required:
    v: true
  initial:
    value: boolean
      v: false
item:
  link id:
    v: 2.1b
  prefix:
    v: 2.1b.
  text:
    v: Would you like NRT?
  type:
    v: boolean
  enable when:
    question:
      v: 2.1
    operator:
      v: =
    answer: boolean
      v: true
  required:
    v: false
item:
  link id:
    v: 2.2
  prefix:
    v: 2.2.
  text:
    v: Alcohol?
  type:
    v: boolean
  required:
    v: true
  initial:
    value: boolean
      v: false
item:
  link id:
    v: 2.2.1
  prefix:
    v: 2.2.1.
  text:
    v: Drinks per week?
  type:
    v: choice
  enable when:
    question:
      v: 2.2
    operator:
      v: =
    answer: boolean
      v: true
  required:
    v: false
  answer option:
    value: string
      v: <10
  answer option:
    value: string
      v: 10-16
  answer option:
    value: string
      v: >16
item:
  link id:
    v: 2.3
  prefix:
    v: 2.3.
  text:
    v: Recreational drugs?
  type:
    v: boolean
  initial:
    value: boolean
      v: false
item:
  link id:
    v: 2.4
  prefix:
    v: 2.4.
  text:
    v: Allergies?
  type:
    v: boolean
  required:
    v: true
  initial:
    value: boolean
      v: false
item:
  link id:
    v: 2.4.1
  prefix:
    v: 2.4.1.
  text:
    v: Medication Allergies
  type:
    v: boolean
  enable when:
    question:
      v: 2.4
    operator:
      v: =
    answer: boolean
      v: true
  required:
    v: true
  initial:
    value: boolean
      v: false
item:
  link id:
    v: 2.4.1.1
  prefix:
    v: 2.4.1.1.
  text:
    v: Medicine
  type:
    v: string
  enable when:
    question:
      v: 2.4.1
    operator:
      v: =
    answer: boolean
      v: true
item:
  link id:
    v: 2.4.1.2
  prefix:
    v: 2.4.1.2.
  text:
    v: Category (select)
  type:
    v: choice
  enable when:
    question:
      v: 2.4.1
    operator:
      v: =
    answer: boolean
      v: true
  answer option:
    value: string
      v: Allergy
  answer option:
    value: string
      v: Patient Complaint
  answer option:
    value: string
      v: Side Effect
item:
  link id:
    v: 2.4.1.3
  prefix:
    v: 2.4.1.3.
  text:
    v: Reaction (select)
  type:
    v: choice
  enable when:
    question:
      v: 2.4.1
    operator:
      v: =
    answer: boolean
      v: true
  answer option:
    value: string
      v: Mild
  answer option:
    value: string
      v: Moderate
  answer option:
    value: string
      v: Severe
  answer option:
    value: string
      v: Anaphylaxis
item:
  link id:
    v: 2.4.1.4
  prefix:
    v: 2.4.1.4.

v: Onset Date

v: date

question:
  v: 2.4.1
operator:
  v: =
answer: boolean
  v: true

link id:
  v: 2.4.1.5
prefix:
  v: 2.4.1.5.
text:
  v: Date of Entry
type:
  v: date
enable when:
  question:
    v: 2.4.1
  operator:
    v: =
  answer: boolean
    v: true

link id:
  v: 2.4.1.6
prefix:
  v: 2.4.1.6.
text:
  v: Active?
type:
  v: boolean
enable when:
  question:
    v: 2.4.1
  operator:
    v: =
  answer: boolean
    v: true
required:
  v: true
initial:
  value: boolean
    v: true

link id:
  v: 2.4.1.6.1
prefix:
  v: 2.4.1.6.1.
text:
  v: Specify Reason for deactivation
type:
  v: string
enable when:
  question:
    v: 2.4.1.6
  operator:
    v: =
  answer: boolean
    v: false

link id:
  v: 2.4.1.7
prefix:
  v: 2.4.1.7.
text:
  v: Comments
type:
  v: text
enable when:
  question:
    v: 2.4.1
  operator:
    v: =
  answer: boolean
    v: true

link id:
  v: 2.4.2
prefix:
  v: 2.4.2.
text:
  v: Other allergies
type:
  v: text
enable when:
  question:
    v: 2.4
  operator:
    v: =
  answer: boolean
    v: true
required:
  v: true

link id:
  v: 2.5
prefix:
  v: 2.5.
text:
  v: Prescription medication or medical devices (eg. CPAP, nebuliser, blood glucose meter)?
type:
  v: boolean
required:
  v: true
initial:
  value: boolean
    v: false

link id:
  v: 2.6
prefix:
  v: 2.6.
text:
  v: Details of medications, medical devices, recreational drugs here
type:
  v: text

link id:
  v: 2.7
prefix:
  v: 2.7.
text:
  v: Able to manage meds independently?
type:
  v: boolean
initial:
  value: boolean
    v: false

link id:
  v: 2.8
prefix:
  v: 2.8.
text:
  v: Sufficient supply for 14 days?
type:
  v: boolean

link id:
  v: 2.9
prefix:
  v: 2.9.
text:
  v: Taking immunosuppressant?
type:
  v: boolean

link id:
  v: 3
prefix:
  v: 3.
text:
  v: Individual assessment plan/guideline
type:
  v: group
item:
  link id:
    v: 3.1
  prefix:
    v: 3.1.
  text:
    v: Individual assessment plan / guideline
  type:
    v: text