Generated Narrative: Questionnaire COVIDVaccinationSurveyQuestionnaire

Structure
LinkIDTextCardinalityTypeDescription & Constraintsdoco
COVIDVaccinationSurveyQuestionnaireTe Whatu Ora post COVID-19 vaccination survey.Questionnairehttps://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/Questionnaire/COVIDVaccinationSurveyQuestionnaire#1.4.8
COVIDVaccinationSurveyQuestionnaire / p01page 1. Thanks for taking part in our survey to understand the side effects you experienced after your Pfizer COVID-19 vaccination. Please note this is a survey only and your answers will not result in a medical response to your situation. If you have concerns about your health since your vaccination, particularly if you have had chest pain, racing heartbeat, or trouble breathing, please seek medical attention. You may ring the Healthline at 0800 358 5453 or speak to your healthcare professional. This survey is optional and will take approximately 5 minutes to complete. Your responses will help us to monitor the safety of the Pfizer COVID-19 vaccine in Aotearoa New Zealand. For more information about this survey, visit http://medsafe.govt.nz/covid-safety-reporting/.0..1display
COVIDVaccinationSurveyQuestionnaire / p02page 2. Side Effects0..1group
COVIDVaccinationSurveyQuestionnaire / p02 / p02-q01-SideEffectspage 2 question 1. Select all the side effects you experienced after your recent COVID-19 vaccination0..*choiceOptions: 11 options
COVIDVaccinationSurveyQuestionnaire / p02 / p02-q02-SideEffects.Rashpage 2 question 2. Rash not near injection site1..1boolean
COVIDVaccinationSurveyQuestionnaire / p02 / p02-q02-1-SideEffects.Rash.WhenStartedpage 2 question 2.1. When did the rash appear?1..1choiceEnable When: p02-q02-SideEffects.Rash = true
Options: 3 options
COVIDVaccinationSurveyQuestionnaire / p02 / p02-q02-2-SideEffects.Rash.HowLongpage 2 question 2.2. How long did the rash last?1..1choiceEnable When: p02-q02-SideEffects.Rash = true
Options: 3 options
COVIDVaccinationSurveyQuestionnaire / p02 / p02-q03-SideEffects.Otherpage 2 question 3. Other or not listed side effect?1..1boolean
COVIDVaccinationSurveyQuestionnaire / p02 / p02-q03-1-SideEffects.Other.Descriptionpage 2 question 3.1. What other side effects did you experience?0..1textEnable When: p02-q03-SideEffects.Other = true
COVIDVaccinationSurveyQuestionnaire / p03page 3. Symptom Relief0..1group
COVIDVaccinationSurveyQuestionnaire / p03 / p03-q01-SymptomRelief.Medicinespage 3 question 1. Did you take any medicines to ease your symptoms for example paracetamol or ibuprofen?1..1boolean
COVIDVaccinationSurveyQuestionnaire / p03 / p03-q01-1-Medicines.ReducedSymptomspage 3 question 1.1. Did the medicines help ease your symptoms?1..1booleanEnable When: p03-q01-SymptomRelief.Medicines = true
COVIDVaccinationSurveyQuestionnaire / p03 / p03-q02-Medicines.SawDoctorpage 3 question 2. Did you see a healthcare provider for your symptoms?1..1boolean
COVIDVaccinationSurveyQuestionnaire / p03 / p03-q03-MissedActivitiespage 3 question 3. Did your symptoms cause you to miss any normal daily or normal daily activities? For example, work, school, exercise or other activities.1..1boolean
COVIDVaccinationSurveyQuestionnaire / p03 / p03-q03-1-MissedActivities.Periodpage 3 question 3.1. How many days did you miss?1..1choiceEnable When: p03-q03-MissedActivities = true
Options: 4 options
COVIDVaccinationSurveyQuestionnaire / p04page 4. Health Conditions0..1group
COVIDVaccinationSurveyQuestionnaire / p04 / p04-q01-Pregnantpage 4 question 1. Are you pregnant or have you given birth in the last 6 weeks?1..1boolean
COVIDVaccinationSurveyQuestionnaire / p04 / p04-q02-LongTermConditionspage 4 question 2. Do you have any of the following conditions?0..*choiceOptions: 11 options
COVIDVaccinationSurveyQuestionnaire / p04 / p04-q02-1-LongTermConditions.Otherpage 4 question 2.1. Other or not listed long term condition?1..1boolean
COVIDVaccinationSurveyQuestionnaire / p04 / p04-q02-2-LongTermConditions.Other.Descriptionpage 4 question 2.2. Please list any other long term condition(s) you have0..1textEnable When: p04-q02-1-LongTermConditions.Other = true
COVIDVaccinationSurveyQuestionnaire / p05page 5. Thank you for taking part in this survey. The information you provide is confidential and is protected by the Privacy Act 2020 and by the safeguards we have put in place. Remember this is a survey only and your answers will not result in a medical response to your situation. If you have concerns about your health since your vaccination, particularly if you have had chest pain, racing heartbeat, or trouble breathing, please seek medical attention. You may ring the Healthline at 0800 358 5453 or speak to your healthcare professional. Results from the survey will be published on the Medsafe website at http://medsafe.govt.nz/covid-safety-reporting/as the survey progresses.0..1display

doco Documentation for this format

Options Sets

Answer options for p02-q01-SideEffects

  • http://snomed.info/sct#95376002 ("Pain, redness, swelling, itching at or near the injection site")
  • http://snomed.info/sct#386661006 ("Fever")
  • http://snomed.info/sct#25064002 ("Headache")
  • http://snomed.info/sct#68962001 ("Muscle pain")
  • http://snomed.info/sct#57676002 ("Joint pain")
  • http://snomed.info/sct#274640006 ("Chills and fever")
  • http://snomed.info/sct#422587007 ("Nausea")
  • http://snomed.info/sct#422400008 ("Vomiting")
  • http://snomed.info/sct#62315008 ("Diarrhoea")
  • http://snomed.info/sct#271681002 ("Stomach pain")
  • http://snomed.info/sct#84229001 ("Fatigue")

Answer options for p02-q02-1-SideEffects.Rash.WhenStarted

  • null#Within 1 hour after vaccination ("Within 1 hour after vaccination")
  • null#Within a day after vaccination ("Within a day after vaccination")
  • null#More than a day after vaccination ("More than a day after vaccination")

Answer options for p02-q02-2-SideEffects.Rash.HowLong

  • null#Less than 30 minutes ("Less than 30 minutes")
  • null#30 minutes to 24 hours ("30 minutes to 24 hours")
  • null#More than 24 hours ("More than 24 hours")

Answer options for p03-q03-1-MissedActivities.Period

  • null#Less than 1 day ("Less than 1 day")
  • null#1 day ("1 day")
  • null#2 days ("2 days")
  • null#3 days or more ("3 days or more")

Answer options for p04-q02-LongTermConditions

  • http://snomed.info/sct#4301008 ("Autoimmune conditions (eg. arthritis)")
  • http://snomed.info/sct#32709003 ("Alcohol or other drug addictions")
  • http://snomed.info/sct#195967001 ("Asthma")
  • http://snomed.info/sct#363346000 ("Cancer")
  • http://snomed.info/sct#82423001 ("Chronic pain")
  • http://snomed.info/sct#13645005 ("Chronic obstructive pulmonary disease")
  • http://snomed.info/sct#73211009 ("Diabetes mellitus")
  • http://snomed.info/sct#770924008 ("Acute Gout (disorder)")
  • http://snomed.info/sct#56265001 ("Heart disease")
  • http://snomed.info/sct#74732009 ("Mental health condition")
  • http://snomed.info/sct#414916001 ("Obesity")
 <status value="draft"/> <experimental value="false"/> <subjectType value="Patient"/> <date value="2023-07-19"/> <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="Te Whatu Ora Integration Team"/> <telecom> <system value="email"/> <value value="integration@tewhatuora.govt.nz"/> <use value="work"/> </telecom> </contact> <description value="Te Whatu Ora post COVID-19 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 experienced after COVID-19 vaccination"/> <code> <system value="http://snomed.info/sct"/> <code value="293104008"/> <display value="Vaccine adverse reaction"/> </code> <item> <linkId value="p01"/> <prefix value="page 1"/> <text value="Thanks for taking part in our survey to understand the side effects you experienced after your Pfizer COVID-19 vaccination. Please note this is a survey only and your answers will not result in a medical response to your situation. If you have concerns about your health since your vaccination, particularly if you have had chest pain, racing heartbeat, or trouble breathing, please seek medical attention. You may ring the Healthline at 0800 358 5453 or speak to your healthcare professional. This survey is optional and will take approximately 5 minutes to complete. Your responses will help us to monitor the safety of the Pfizer COVID-19 vaccine in Aotearoa New Zealand. For more information about this survey, visit http://medsafe.govt.nz/covid-safety-reporting/."/> <type value="display"/> </item> <item> <linkId value="p02"/> <prefix value="page 2"/> <text value="Side Effects"/> <type value="group"/> <item> <linkId value="p02-q01-SideEffects"/> <prefix value="page 2 question 1"/> <text value="Select all the side effects you experienced after your recent COVID-19 vaccination"/> <type value="choice"/> <required value="false"/> <repeats value="true"/> <answerOption> <valueCoding> <system value="http://snomed.info/sct"/> <code value="95376002"/> <display value="Pain, redness, swelling, itching at or near the injection site"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="http://snomed.info/sct"/> <code value="386661006"/> <display value="Fever"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="http://snomed.info/sct"/> <code value="25064002"/> <display value="Headache"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="http://snomed.info/sct"/> <code value="68962001"/> <display value="Muscle pain"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="http://snomed.info/sct"/> <code value="57676002"/> <display value="Joint pain"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="http://snomed.info/sct"/> <code value="274640006"/> <display value="Chills and fever"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="http://snomed.info/sct"/> <code value="422587007"/> <display value="Nausea"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="http://snomed.info/sct"/> <code value="422400008"/> <display value="Vomiting"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="http://snomed.info/sct"/> <code value="62315008"/> <display value="Diarrhoea"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="http://snomed.info/sct"/> <code value="271681002"/> <display value="Stomach pain"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="http://snomed.info/sct"/> <code value="84229001"/> <display value="Fatigue"/> </valueCoding> </answerOption> </item> <item> <linkId value="p02-q02-SideEffects.Rash"/> <code> <system value="http://snomed.info/sct"/> <code value="271807003"/> <display value="Rash"/> </code> <prefix value="page 2 question 2"/> <text value="Rash not near injection site"/> <type value="boolean"/> <required value="true"/> </item> <item> <linkId value="p02-q02-1-SideEffects.Rash.WhenStarted"/> <prefix value="page 2 question 2.1"/> <text value="When did the rash appear?"/> <type value="choice"/> <enableWhen> <question value="p02-q02-SideEffects.Rash"/> <operator value="="/> <answerBoolean value="true"/> </enableWhen> <enableBehavior value="all"/> <required value="true"/> <answerOption> <valueCoding> <code value="Within 1 hour after vaccination"/> <display value="Within 1 hour after vaccination"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <code value="Within a day after vaccination"/> <display value="Within a day after vaccination"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <code value="More than a day after vaccination"/> <display value="More than a day after vaccination"/> </valueCoding> </answerOption> </item> <item> <linkId value="p02-q02-2-SideEffects.Rash.HowLong"/> <prefix value="page 2 question 2.2"/> <text value="How long did the rash last?"/> <type value="choice"/> <enableWhen> <question value="p02-q02-SideEffects.Rash"/> <operator value="="/> <answerBoolean value="true"/> </enableWhen> <enableBehavior value="all"/> <required value="true"/> <answerOption> <valueCoding> <code value="Less than 30 minutes"/> <display value="Less than 30 minutes"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <code value="30 minutes to 24 hours"/> <display value="30 minutes to 24 hours"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <code value="More than 24 hours"/> <display value="More than 24 hours"/> </valueCoding> </answerOption> </item> <item> <linkId value="p02-q03-SideEffects.Other"/> <prefix value="page 2 question 3"/> <text value="Other or not listed side effect?"/> <type value="boolean"/> <required value="true"/> </item> <item> <linkId value="p02-q03-1-SideEffects.Other.Description"/> <prefix value="page 2 question 3.1"/> <text value="What other side effects did you experience?"/> <type value="text"/> <enableWhen> <question value="p02-q03-SideEffects.Other"/> <operator value="="/> <answerBoolean value="true"/> </enableWhen> <enableBehavior value="all"/> <required value="false"/> </item> </item> <item> <linkId value="p03"/> <prefix value="page 3"/> <text value="Symptom Relief"/> <type value="group"/> <item> <linkId value="p03-q01-SymptomRelief.Medicines"/> <prefix value="page 3 question 1"/> <text value="Did you take any medicines to ease your symptoms for example paracetamol or ibuprofen?"/> <type value="boolean"/> <required value="true"/> </item> <item> <linkId value="p03-q01-1-Medicines.ReducedSymptoms"/> <prefix value="page 3 question 1.1"/> <text value="Did the medicines help ease your symptoms?"/> <type value="boolean"/> <enableWhen> <question value="p03-q01-SymptomRelief.Medicines"/> <operator value="="/> <answerBoolean value="true"/> </enableWhen> <enableBehavior value="all"/> <required value="true"/> </item> <item> <linkId value="p03-q02-Medicines.SawDoctor"/> <prefix value="page 3 question 2"/> <text value="Did you see a healthcare provider for your symptoms?"/> <type value="boolean"/> <required value="true"/> </item> <item> <linkId value="p03-q03-MissedActivities"/> <prefix value="page 3 question 3"/> <text value="Did your symptoms cause you to miss any normal daily or normal daily activities? For example, work, school, exercise or other activities."/> <type value="boolean"/> <required value="true"/> </item> <item> <linkId value="p03-q03-1-MissedActivities.Period"/> <prefix value="page 3 question 3.1"/> <text value="How many days did you miss?"/> <type value="choice"/> <enableWhen> <question value="p03-q03-MissedActivities"/> <operator value="="/> <answerBoolean value="true"/> </enableWhen> <enableBehavior value="all"/> <required value="true"/> <repeats value="false"/> <answerOption> <valueCoding> <code value="Less than 1 day"/> <display value="Less than 1 day"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <code value="1 day"/> <display value="1 day"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <code value="2 days"/> <display value="2 days"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <code value="3 days or more"/> <display value="3 days or more"/> </valueCoding> </answerOption> </item> </item> <item> <linkId value="p04"/> <prefix value="page 4"/> <text value="Health Conditions"/> <type value="group"/> <item> <linkId value="p04-q01-Pregnant"/> <code> <system value="http://snomed.info/sct"/> <code value="77386006"/> <display value="Pregnancy"/> </code> <prefix value="page 4 question 1"/> <text value="Are you pregnant or have you given birth in the last 6 weeks?"/> <type value="boolean"/> <required value="true"/> </item> <item> <linkId value="p04-q02-LongTermConditions"/> <prefix value="page 4 question 2"/> <text value="Do you have any of the following conditions?"/> <type value="choice"/> <required value="false"/> <repeats value="true"/> <answerOption> <valueCoding> <system value="http://snomed.info/sct"/> <code value="4301008"/> <display value="Autoimmune conditions (eg. arthritis)"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="http://snomed.info/sct"/> <code value="32709003"/> <display value="Alcohol or other drug addictions"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="http://snomed.info/sct"/> <code value="195967001"/> <display value="Asthma"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="http://snomed.info/sct"/> <code value="363346000"/> <display value="Cancer"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="http://snomed.info/sct"/> <code value="82423001"/> <display value="Chronic pain"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="http://snomed.info/sct"/> <code value="13645005"/> <display value="Chronic obstructive pulmonary disease"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="http://snomed.info/sct"/> <code value="73211009"/> <display value="Diabetes mellitus"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="http://snomed.info/sct"/> <code value="770924008"/> <display value="Acute Gout (disorder)"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="http://snomed.info/sct"/> <code value="56265001"/> <display value="Heart disease"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="http://snomed.info/sct"/> <code value="74732009"/> <display value="Mental health condition"/> </valueCoding> </answerOption> <answerOption> <valueCoding> <system value="http://snomed.info/sct"/> <code value="414916001"/> <display value="Obesity"/> </valueCoding> </answerOption> </item> <item> <linkId value="p04-q02-1-LongTermConditions.Other"/> <prefix value="page 4 question 2.1"/> <text value="Other or not listed long term condition?"/> <type value="boolean"/> <required value="true"/> </item> <item> <linkId value="p04-q02-2-LongTermConditions.Other.Description"/> <prefix value="page 4 question 2.2"/> <text value="Please list any other long term condition(s) you have"/> <type value="text"/> <enableWhen> <question value="p04-q02-1-LongTermConditions.Other"/> <operator value="="/> <answerBoolean value="true"/> </enableWhen> <enableBehavior value="all"/> <required value="false"/> </item> </item> <item> <linkId value="p05"/> <prefix value="page 5"/> <text value="Thank you for taking part in this survey. The information you provide is confidential and is protected by the Privacy Act 2020 and by the safeguards we have put in place. Remember this is a survey only and your answers will not result in a medical response to your situation. If you have concerns about your health since your vaccination, particularly if you have had chest pain, racing heartbeat, or trouble breathing, please seek medical attention. You may ring the Healthline at 0800 358 5453 or speak to your healthcare professional. Results from the survey will be published on the Medsafe website at http://medsafe.govt.nz/covid-safety-reporting/as the survey progresses."/> <type value="display"/> </item> </Questionnaire>