Health New Zealand Te Whatu Ora Shared Care FHIR API
0.4.8 - release
Health New Zealand Te Whatu Ora Shared Care FHIR API - Local Development build (v0.4.8) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
| Official URL: https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/Questionnaire/RespiratoryAdultHealthQuestionnaire | Version: 1.0.0 | |||
| Active as of 2026-10-19 | Computable Name: RespiratoryAdultHealthQuestionnaire | |||
| Other Identifiers: RespiratoryAdultHealthQuestionnaire (use: official) | ||||
Usage:Clinical Focus: M65 Respiratory Medicine |
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Questions about respiratory procedure health assessment
Respiratory procedure health assessment
| LinkID | Text | Cardinality | Type | Flags | Description & Constraints![]() |
|---|---|---|---|---|---|
![]() | Questions about respiratory procedure health assessment | Questionnaire | https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/Questionnaire/RespiratoryAdultHealthQuestionnaire#1.0.0 | ||
![]() ![]() | Specialty Code | 0..1 | string | Value Set: Initial Value: string = M65 | |
![]() ![]() | Specialty Name | 0..1 | string | Value Set: Initial Value: string = Respiratory Medicine | |
![]() ![]() | Patient ID | 0..1 | group | Value Set: | |
![]() ![]() ![]() | Surname | 0..1 | string | Value Set: | |
![]() ![]() ![]() | First Names | 0..1 | string | Value Set: | |
![]() ![]() ![]() | NHI | 0..1 | string | Value Set: | |
![]() ![]() ![]() | Date of Birth | 0..1 | date | Value Set: | |
![]() ![]() ![]() | Sex | 0..1 | string | Value Set: | |
![]() ![]() | Section 1 – Patient details | 0..1 | group | Value Set: | |
![]() ![]() ![]() | Today's date | 0..1 | date | Value Set: | |
![]() ![]() ![]() | Your height (cm) | 0..1 | decimal | Value Set: | |
![]() ![]() ![]() | Your weight (kg) | 0..1 | decimal | Value Set: | |
![]() ![]() ![]() | BMI | 0..1 | decimal | Value Set: | |
![]() ![]() ![]() | Proposed surgery / procedure | 0..1 | string | Value Set: Initial Value: string = Endobronchial Ultrasound (EBUS) | |
![]() ![]() ![]() | If a phone call is required for further information relating to this questionnaire, please provide details on how we can contact you. | 0..1 | group | Value Set: | |
![]() ![]() ![]() ![]() | Home phone | 0..1 | string | Value Set: | |
![]() ![]() ![]() ![]() | Work phone | 0..1 | string | Value Set: | |
![]() ![]() ![]() ![]() | Mobile phone | 0..1 | string | Value Set: | |
![]() ![]() ![]() ![]() | 0..1 | string | Value Set: | ||
![]() ![]() ![]() | Are you happy for us to leave a message? | 0..1 | choice | Value Set: Options: 2 options | |
![]() ![]() ![]() | With a person? | 0..1 | choice | Enable When: HappyToLeaveMessage = Yes (yes) Value Set: Options: 2 options | |
![]() ![]() ![]() | If yes, please give person's name | 0..1 | string | Enable When:
Value Set: | |
![]() ![]() ![]() | On answer phone? | 0..1 | choice | Enable When: HappyToLeaveMessage = Yes (yes) Value Set: Options: 2 options | |
![]() ![]() ![]() | When is the best time for you to receive telephone calls from staff? | 0..1 | string | Value Set: | |
![]() ![]() | Section 2 – Capital and Coast DHB use only | 0..1 | group | Value Set: | |
![]() ![]() ![]() | Name | 0..1 | string | Value Set: | |
![]() ![]() ![]() | Position | 0..1 | string | Value Set: | |
![]() ![]() ![]() | Date | 0..1 | date | Value Set: | |
![]() ![]() ![]() | Pre-anaesthesia Requirements | 0..* | choice | Value Set: Options: 5 options | |
![]() ![]() | Section 3 – Medical conditions | 0..1 | group | Value Set: | |
![]() ![]() ![]() | 1. High blood pressure? | 0..1 | choice | Value Set: Options: 2 options | |
![]() ![]() ![]() | BP at clinic | 0..1 | string | Enable When: HighBloodPressure = Yes (yes) Value Set: | |
![]() ![]() ![]() | 2. Heart conditions (e.g. heart murmur, valve disease, chest pain or discomfort, angina, palpitations or irregular heart beat)? | 0..1 | choice | Value Set: Options: 2 options | |
![]() ![]() ![]() | If yes, or not certain, please comment | 0..1 | text | Enable When: HeartConditions = Yes (yes) Value Set: | |
![]() ![]() ![]() | 3. Heart/Lung surgery? | 0..1 | choice | Value Set: Options: 2 options | |
![]() ![]() ![]() | If yes, or not certain, please comment | 0..1 | string | Enable When: HeartLungSurgery = Yes (yes) Value Set: | |
![]() ![]() ![]() | 4. Implanted cardiac defibrillator (ICD) or Pacemaker? | 0..1 | choice | Value Set: Options: 2 options | |
![]() ![]() ![]() | When was it last checked? | 0..1 | string | Enable When: ICDorPacemaker = Yes (yes) Value Set: | |
![]() ![]() ![]() | 5. Shortness of breath at night? | 0..1 | choice | Value Set: Options: 2 options | |
![]() ![]() ![]() | If yes, or not certain, please comment | 0..1 | string | Enable When: ShortnessOfBreathAtNight = Yes (yes) Value Set: | |
![]() ![]() ![]() | 6. Blackouts or fainting? | 0..1 | choice | Value Set: Options: 2 options | |
![]() ![]() ![]() | Under what circumstances? | 0..1 | string | Enable When: BlackoutsOrFainting = Yes (yes) Value Set: | |
![]() ![]() ![]() | 7. Swollen ankles? | 0..1 | choice | Value Set: Options: 2 options | |
![]() ![]() ![]() | If yes, or not certain, please comment | 0..1 | string | Enable When: SwollenAnkles = Yes (yes) Value Set: | |
![]() ![]() ![]() | 8. Breathing difficulties (e.g. asthma, emphysema, C.O.R.D., bronchitis)? | 0..1 | choice | Value Set: Options: 2 options | |
![]() ![]() ![]() | (Please bring peak flow recordings with you if available) | 0..1 | string | Enable When: BreathingDifficulties = Yes (yes) Value Set: | |
![]() ![]() ![]() | 9. Have you taken steroids for your breathing difficulty in the past 5 years? | 0..1 | choice | Value Set: Options: 2 options | |
![]() ![]() ![]() | When was the last course? | 0..1 | string | Enable When: SteroidsForBreathing = Yes (yes) Value Set: | |
![]() ![]() ![]() | 10. Sleep apnoea (or have you been told you stop breathing while asleep)? | 0..1 | choice | Value Set: Options: 2 options | |
![]() ![]() ![]() | If yes, or not certain, please comment | 0..1 | text | Enable When: SleepApnoea = Yes (yes) Value Set: | |
![]() ![]() ![]() | 11. Kidney (Renal) condition? | 0..1 | choice | Value Set: Options: 2 options | |
![]() ![]() ![]() | If yes, or not certain, please comment | 0..1 | string | Enable When: KidneyCondition = Yes (yes) Value Set: | |
![]() ![]() ![]() | 12. Diabetes? | 0..1 | choice | Value Set: Options: 2 options | |
![]() ![]() ![]() | Please tick which type | 0..1 | choice | Enable When: Diabetes = Yes (yes) Value Set: Options: 2 options | |
![]() ![]() ![]() | Do you currently use (please tick): | 0..* | choice | Enable When: Diabetes = Yes (yes) Value Set: Options: 3 options | |
![]() ![]() ![]() | 13. Stroke (Cerebrovascular accident or CVA)? | 0..1 | choice | Value Set: Options: 2 options | |
![]() ![]() ![]() | If yes, or not certain, please comment | 0..1 | text | Enable When: Stroke = Yes (yes) Value Set: | |
![]() ![]() ![]() | 14. Sudden loss of vision, speech or movement? | 0..1 | choice | Value Set: Options: 2 options | |
![]() ![]() ![]() | If yes, or not certain, please comment | 0..1 | string | Enable When: SuddenLossVisionSpeechMovement = Yes (yes) Value Set: | |
![]() ![]() ![]() | 15. Blood clots in lungs or legs or a bleeding disorder (PE, DVT, thrombosis)? | 0..1 | choice | Value Set: Options: 2 options | |
![]() ![]() ![]() | If yes, or not certain, please comment | 0..1 | text | Enable When: BloodClotsOrBleedingDisorder = Yes (yes) Value Set: | |
![]() ![]() ![]() | 16. Heartburn/reflux of acid/hiatus hernia? | 0..1 | choice | Value Set: Options: 2 options | |
![]() ![]() ![]() | If yes, or not certain, please comment | 0..1 | string | Enable When: HeartburnRefluxHiatusHernia = Yes (yes) Value Set: | |
![]() ![]() ![]() | 17. Thyroid problems? | 0..1 | choice | Value Set: Options: 2 options | |
![]() ![]() ![]() | If yes, or not certain, please comment | 0..1 | string | Enable When: ThyroidProblems = Yes (yes) Value Set: | |
![]() ![]() ![]() | 18. Dementia? (e.g. Alzheimer's, forgetfulness) | 0..1 | choice | Value Set: Options: 2 options | |
![]() ![]() ![]() | If yes, or not certain, please comment | 0..1 | text | Enable When: Dementia = Yes (yes) Value Set: | |
![]() ![]() ![]() | 19. Epilepsy? | 0..1 | choice | Value Set: Options: 2 options | |
![]() ![]() ![]() | How often do you have seizures? | 0..1 | string | Enable When: Epilepsy = Yes (yes) Value Set: | |
![]() ![]() ![]() | When was your last seizure? | 0..1 | string | Enable When: Epilepsy = Yes (yes) Value Set: | |
![]() ![]() ![]() | 20. Arthritis? | 0..1 | choice | Value Set: Options: 2 options | |
![]() ![]() ![]() | If yes, or not certain, please comment | 0..1 | string | Enable When: Arthritis = Yes (yes) Value Set: | |
![]() ![]() ![]() | 21. Joint replacement or orthopaedic metalware? | 0..1 | choice | Value Set: Options: 2 options | |
![]() ![]() ![]() | What type? | 0..1 | string | Enable When: JointReplacementOrMetalware = Yes (yes) Value Set: | |
![]() ![]() ![]() | 22. Muscle or Neurological disease (e.g. MS, Parkinson's, Muscular dystrophy)? | 0..1 | choice | Value Set: Options: 2 options | |
![]() ![]() ![]() | If yes, or not certain, please comment | 0..1 | text | Enable When: MuscleOrNeurologicalDisease = Yes (yes) Value Set: | |
![]() ![]() ![]() | 23. Jaw or neck problems? | 0..1 | choice | Value Set: Options: 2 options | |
![]() ![]() ![]() | If yes, or not certain, please comment | 0..1 | string | Enable When: JawOrNeckProblems = Yes (yes) Value Set: | |
![]() ![]() ![]() | 24. Hepatitis A, B, C, jaundice or liver condition? | 0..1 | choice | Value Set: Options: 2 options | |
![]() ![]() ![]() | If yes, or not certain, please comment | 0..1 | string | Enable When: HepatitisOrLiverCondition = Yes (yes) Value Set: | |
![]() ![]() ![]() | 25. Transmittable disease (such as MRSA, 'golden staph', boils, skin or other infection, septicaemia, HIV, VRSA)? | 0..1 | choice | Value Set: Options: 2 options | |
![]() ![]() ![]() | If yes, or not certain, please comment | 0..1 | text | Enable When: TransmittableDisease = Yes (yes) Value Set: | |
![]() ![]() ![]() | 26. Tuberculosis (TB)? | 0..1 | choice | Value Set: Options: 2 options | |
![]() ![]() ![]() | Have you had or are you on treatment for this? | 0..1 | string | Enable When: Tuberculosis = Yes (yes) Value Set: | |
![]() ![]() ![]() | 27. Are there any conditions that run in your family? (e.g. malignant hyperthermia, thalassaemia, muscular dystrophy)? | 0..1 | choice | Value Set: Options: 2 options | |
![]() ![]() ![]() | If yes, or not certain, please comment | 0..1 | text | Enable When: FamilyConditions = Yes (yes) Value Set: | |
![]() ![]() ![]() | 28. Anaemia? | 0..1 | choice | Value Set: Options: 2 options | |
![]() ![]() ![]() | If yes, or not certain, please comment | 0..1 | string | Enable When: Anaemia = Yes (yes) Value Set: | |
![]() ![]() ![]() | 29. Previous blood transfusion? | 0..1 | choice | Value Set: Options: 2 options | |
![]() ![]() ![]() | When was the last? | 0..1 | string | Enable When: PreviousBloodTransfusion = Yes (yes) Value Set: | |
![]() ![]() ![]() | 30. Do you have any reasons which might stop you from accepting a blood transfusion? | 0..1 | choice | Value Set: Options: 2 options | |
![]() ![]() ![]() | What was the reason? | 0..1 | text | Enable When: BloodTransfusionRefusal = Yes (yes) Value Set: | |
![]() ![]() ![]() | 31. Phobias (e.g. claustrophobia, anxiety attacks)? | 0..1 | choice | Value Set: Options: 2 options | |
![]() ![]() ![]() | If yes, or not certain, please comment | 0..1 | text | Enable When: Phobias = Yes (yes) Value Set: | |
![]() ![]() ![]() | 32. Travelled overseas in the last 6 months? | 0..1 | choice | Value Set: Options: 2 options | |
![]() ![]() ![]() | Were you hospitalised? | 0..1 | string | Enable When: TravelledOverseas = Yes (yes) Value Set: | |
![]() ![]() ![]() | 33. A visual or hearing impairment? | 0..1 | choice | Value Set: Options: 2 options | |
![]() ![]() ![]() | If yes, or not certain, please comment | 0..1 | string | Enable When: VisualOrHearingImpairment = Yes (yes) Value Set: | |
![]() ![]() ![]() | 34. Do you have any current pain problems? | 0..1 | choice | Value Set: Options: 2 options | |
![]() ![]() ![]() | What is the location of the pain? | 0..1 | string | Enable When: CurrentPainProblems = Yes (yes) Value Set: | |
![]() ![]() ![]() | 35. Is there any other relevant medical condition that you need to tell us about? | 0..1 | text | Value Set: | |
![]() ![]() | Section 4 – Health professionals | 0..1 | group | Value Set: | |
![]() ![]() ![]() | List the name(s) of the hospital/clinic/doctors/surgeons/nurses you see. | 0..* | group | Value Set: | |
![]() ![]() ![]() ![]() | Doctor's name | 0..1 | string | Value Set: | |
![]() ![]() ![]() ![]() | Reason you see this doctor | 0..1 | string | Value Set: | |
![]() ![]() ![]() ![]() | Date of last visit | 0..1 | date | Value Set: | |
![]() ![]() | Section 5 – Fitness and lifestyle | 0..1 | group | Value Set: | |
![]() ![]() ![]() | 1. What can you do without stopping or getting breathless? | 0..1 | choice | Value Set: Options: 4 options | |
![]() ![]() ![]() | 2. Can you manage around the house? | 0..1 | choice | Value Set: Options: 2 options | |
![]() ![]() ![]() | 3. Has this changed in the last 6 months? | 0..1 | choice | Value Set: Options: 2 options | |
![]() ![]() ![]() | If yes, what could you do without stopping or getting breathless 6 months ago? | 0..1 | choice | Enable When: ChangedInLast6Months = Yes (yes) Value Set: Options: 4 options | |
![]() ![]() ![]() | 4. What stops or restricts you from walking now? (e.g. getting breathless, pain in joints, pain in calf muscles) | 0..1 | text | Value Set: | |
![]() ![]() ![]() | 5. Do you smoke? | 0..1 | choice | Value Set: Options: 2 options | |
![]() ![]() ![]() | How many per day? | 0..1 | integer | Enable When: DoYouSmoke = Yes (yes) Value Set: | |
![]() ![]() ![]() | 6. Have you ever smoked? | 0..1 | choice | Value Set: Options: 2 options | |
![]() ![]() ![]() | If so, when did you stop? | 0..1 | string | Enable When: EverSmoked = Yes (yes) Value Set: | |
![]() ![]() ![]() | 7. Do you drink alcohol regularly? | 0..1 | choice | Value Set: Options: 2 options | |
![]() ![]() ![]() | How much per week? | 0..1 | string | Enable When: DrinkAlcoholRegularly = Yes (yes) Value Set: | |
![]() ![]() ![]() | 8. Are you or do you think you may be pregnant? | 0..1 | choice | Value Set: Options: 2 options | |
![]() ![]() ![]() | If yes – how many weeks? | 0..1 | integer | Enable When: PregnantOrMayBePregnant = Yes (yes) Value Set: | |
![]() ![]() | Section 6 – Allergies | 0..1 | group | Value Set: | |
![]() ![]() ![]() | 1. Allergies or reactions to medicines (sticking plasters, food, paint, latex / rubber products or x-ray dye)? | 0..1 | choice | Value Set: Options: 2 options | |
![]() ![]() ![]() | Please describe what happens to you: | 0..1 | text | Enable When: AllergiesOrReactions = Yes (yes) Value Set: | |
![]() ![]() | Section 7 – Medications | 0..1 | group | Value Set: | |
![]() ![]() ![]() | Medication / Therapy | 0..* | group | Value Set: | |
![]() ![]() ![]() ![]() | Name of Medication/Therapy | 0..1 | string | Value Set: | |
![]() ![]() ![]() ![]() | How much? | 0..1 | string | Value Set: | |
![]() ![]() ![]() ![]() | How often each day? (Breakfast, lunch, tea) | 0..1 | string | Value Set: | |
![]() ![]() | Section 8 – Previous surgery / anaesthesia | 0..1 | group | Value Set: | |
![]() ![]() ![]() | 1. Have you ever had surgery or been admitted to hospital before? (Including day surgery) | 0..1 | choice | Value Set: Options: 2 options | |
![]() ![]() ![]() | If yes, when, what for and what hospital was that in? | 0..* | group | Enable When: PreviousSurgeryOrAdmission = Yes (yes) Value Set: | |
![]() ![]() ![]() ![]() | Operation / Illness | 0..1 | string | Value Set: | |
![]() ![]() ![]() ![]() | Year | 0..1 | string | Value Set: | |
![]() ![]() ![]() ![]() | Hospital | 0..1 | string | Value Set: | |
![]() ![]() | Section 9 – Anaesthesia related issues | 0..1 | group | Value Set: | |
![]() ![]() ![]() | 1. Have you had any problems while under an anaesthetic? | 0..1 | choice | Value Set: Options: 2 options | |
![]() ![]() ![]() | (e.g. slow to wake, nausea and vomiting, post surgery confusion, agitation) | 0..1 | string | Enable When: ProblemsUnderAnaesthetic = Yes (yes) Value Set: | |
![]() ![]() ![]() | 2. Has any blood relative had problems while under an anaesthetic? | 0..1 | choice | Value Set: Options: 2 options | |
![]() ![]() ![]() | If yes, or not certain, please comment | 0..1 | string | Enable When: RelativeProblemsUnderAnaesthetic = Yes (yes) Value Set: | |
![]() ![]() ![]() | 3. Have you attended a pre-anaesthesia assessment before? | 0..1 | choice | Value Set: Options: 2 options | |
![]() ![]() ![]() | When was the last time? | 0..1 | string | Enable When: AttendedPreAnaesthesiaAssessment = Yes (yes) Value Set: | |
![]() ![]() | Section 10 – Discharge planning | 0..1 | group | Value Set: | |
![]() ![]() ![]() | 1. Do you require any physical support or aids? | 0..1 | choice | Value Set: Options: 2 options | |
![]() ![]() ![]() | If so what? | 0..1 | string | Enable When: RequirePhysicalSupportOrAids = Yes (yes) Value Set: | |
![]() ![]() ![]() | 2. Do you live alone? | 0..1 | choice | Value Set: Options: 2 options | |
![]() ![]() ![]() | If yes, or not certain, please comment | 0..1 | string | Enable When: LiveAlone = Yes (yes) Value Set: | |
![]() ![]() ![]() | 3. Do you have any problems with daily activities? | 0..1 | choice | Value Set: Options: 2 options | |
![]() ![]() ![]() | (e.g. showering, bathing, dressing) | 0..1 | string | Enable When: ProblemsWithDailyActivities = Yes (yes) Value Set: | |
![]() ![]() ![]() | 4. Who will be taking you home? | 0..1 | choice | Value Set: Options: 2 options | |
![]() ![]() ![]() | If yes, or not certain, please comment | 0..1 | string | Enable When: WhoWillTakeYouHome = Yes (yes) Value Set: | |
![]() ![]() ![]() | 5. Do you have someone to stay overnight with you when you get home? | 0..1 | choice | Value Set: Options: 2 options | |
![]() ![]() ![]() | If yes, or not certain, please comment | 0..1 | text | Enable When: SomeoneToStayOvernight = Yes (yes) Value Set: | |
![]() ![]() ![]() | 6. Are you currently using any community support services? | 0..1 | choice | Value Set: Options: 2 options | |
![]() ![]() ![]() | If so please list: | 0..1 | string | Enable When: UsingCommunitySupportServices = Yes (yes) Value Set: | |
![]() ![]() ![]() | 7. Do you speak and understand English? | 0..1 | choice | Value Set: Options: 2 options | |
![]() ![]() ![]() | If not, what is your first language? | 0..1 | string | Enable When: SpeakUnderstandEnglish = No (no) Value Set: | |
![]() ![]() ![]() | 8. Is there anything in particular you would like to discuss? | 0..1 | text | Value Set: | |
![]() ![]() | Section 11 – Patient declaration | 0..1 | group | Value Set: | |
![]() ![]() ![]() | The above health information is a true and accurate account of my health status. | 0..1 | display | Value Set: | |
![]() ![]() ![]() | Patient's signature | 0..1 | string | Value Set: | |
![]() ![]() ![]() | Date | 0..1 | date | Value Set: | |
Documentation for this format | |||||
Options Sets
Answer options for HappyToLeaveMessage
Answer options for MessageWithPerson
Answer options for MessageOnAnswerPhone
Answer options for PreAnaesthesiaRequirements
Answer options for HighBloodPressure
Answer options for HeartConditions
Answer options for HeartLungSurgery
Answer options for ICDorPacemaker
Answer options for ShortnessOfBreathAtNight
Answer options for BlackoutsOrFainting
Answer options for SwollenAnkles
Answer options for BreathingDifficulties
Answer options for SteroidsForBreathing
Answer options for SleepApnoea
Answer options for KidneyCondition
Answer options for Diabetes
Answer options for DiabetesType
Answer options for DiabetesManagement
Answer options for Stroke
Answer options for SuddenLossVisionSpeechMovement
Answer options for BloodClotsOrBleedingDisorder
Answer options for HeartburnRefluxHiatusHernia
Answer options for ThyroidProblems
Answer options for Dementia
Answer options for Epilepsy
Answer options for Arthritis
Answer options for JointReplacementOrMetalware
Answer options for MuscleOrNeurologicalDisease
Answer options for JawOrNeckProblems
Answer options for HepatitisOrLiverCondition
Answer options for TransmittableDisease
Answer options for Tuberculosis
Answer options for FamilyConditions
Answer options for Anaemia
Answer options for PreviousBloodTransfusion
Answer options for BloodTransfusionRefusal
Answer options for Phobias
Answer options for TravelledOverseas
Answer options for VisualOrHearingImpairment
Answer options for CurrentPainProblems
Answer options for StairsWithoutStoppingNow
Answer options for ManageAroundHouse
Answer options for ChangedInLast6Months
Answer options for StairsWithoutStopping6MonthsAgo
Answer options for DoYouSmoke
Answer options for EverSmoked
Answer options for DrinkAlcoholRegularly
Answer options for PregnantOrMayBePregnant
Answer options for AllergiesOrReactions
Answer options for PreviousSurgeryOrAdmission
Answer options for ProblemsUnderAnaesthetic
Answer options for RelativeProblemsUnderAnaesthetic
Answer options for AttendedPreAnaesthesiaAssessment
Answer options for RequirePhysicalSupportOrAids
Answer options for LiveAlone
Answer options for ProblemsWithDailyActivities
Answer options for WhoWillTakeYouHome
Answer options for SomeoneToStayOvernight
Answer options for UsingCommunitySupportServices
Answer options for SpeakUnderstandEnglish