New Zealand Rheumatic Fever FHIR Implementation Guide
1.0.0 - draft

New Zealand Rheumatic Fever FHIR Implementation Guide - Local Development build (v1.0.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

: Diagnosis Risk Factors Questionnaire - XML Representation

Draft as of 2024-01-01

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<Questionnaire xmlns="http://hl7.org/fhir">
  <id value="DiagnosisRiskFactorsQuestionnaire"/>
  <url
       value="https://fhir-ig.digital.health.nz/rheumatic-fever/Questionnaire/DiagnosisRiskFactorsQuestionnaire"/>
  <identifier>
    <use value="official"/>
    <value value="DiagnosisRiskFactorsQuestionnaire"/>
    <period>
      <start value="2024-01-01"/>
    </period>
  </identifier>
  <version value="1.0.0"/>
  <name value="DiagnosisRiskFactorsQuestionnaire"/>
  <title value="Diagnosis Risk Factors Questionnaire"/>
  <status value="draft"/>
  <experimental value="false"/>
  <subjectType value="Patient"/>
  <date value="2024-01-01"/>
  <publisher value="Te Whatu Ora"/>
  <contact>
    <name value="Te Whatu Ora"/>
    <telecom>
      <system value="url"/>
      <value value="https://www.tewhatuora.govt.nz/"/>
    </telecom>
    <telecom>
      <system value="email"/>
      <value value="integration@tewhatuora.govt.nz"/>
    </telecom>
  </contact>
  <contact>
    <name value="HNZ Integration Team"/>
    <telecom>
      <system value="email"/>
      <value value="integration@tewhatuora.govt.nz"/>
      <use value="work"/>
    </telecom>
  </contact>
  <description
               value="Gathers risk factor information during rheumatic fever diagnosis assessment"/>
  <purpose
           value="Gathers risk factor information during rheumatic fever diagnosis assessment"/>
  <item>
    <linkId value="page1"/>
    <prefix value="page1"/>
    <text
          value="Please complete this questionnaire to assess risk factors for rheumatic fever diagnosis."/>
    <type value="display"/>
  </item>
  <item>
    <linkId value="SoreThroat4Weeks"/>
    <prefix value="1)"/>
    <text
          value="Did the patient have a sore throat in the four weeks prior to onset?"/>
    <type value="choice"/>
    <required value="true"/>
    <repeats value="false"/>
    <answerValueSet
                    value="https://fhir-ig.digital.health.nz/rheumatic-fever/ValueSet/nz-questionnaireresponse-qualifiedyesno-code"/>
  </item>
  <item>
    <linkId value="AntibioticsSoreThroat"/>
    <prefix value="2)"/>
    <text value="Did the patient receive antibiotics for a sore throat?"/>
    <type value="choice"/>
    <required value="true"/>
    <repeats value="false"/>
    <answerValueSet
                    value="https://fhir-ig.digital.health.nz/rheumatic-fever/ValueSet/nz-questionnaireresponse-qualifiedyesno-code"/>
  </item>
  <item>
    <linkId value="AntibioticsDetails"/>
    <prefix value="3)"/>
    <text value="Antibiotics used for sore throat / Strep A treatment"/>
    <type value="text"/>
    <enableWhen>
      <question value="AntibioticsSoreThroat"/>
      <operator value="="/>
      <answerCoding>
        <system value="http://snomed.info/sct"/>
        <code value="373066001"/>
        <display value="Yes (qualifier value)"/>
      </answerCoding>
    </enableWhen>
    <required value="true"/>
  </item>
  <item>
    <linkId value="SoreThroatTreatedProperly"/>
    <prefix value="4)"/>
    <text value="Was the patient's sore throat appropriately treated?"/>
    <type value="choice"/>
    <required value="true"/>
    <repeats value="false"/>
    <answerValueSet
                    value="https://fhir-ig.digital.health.nz/rheumatic-fever/ValueSet/nz-questionnaireresponse-qualifiedyesno-code"/>
  </item>
  <item>
    <linkId value="FamilyHistoryARFRHD"/>
    <prefix value="5)"/>
    <text value="Family History of ARF / RHD?"/>
    <type value="choice"/>
    <required value="true"/>
    <repeats value="false"/>
    <answerValueSet
                    value="https://fhir-ig.digital.health.nz/rheumatic-fever/ValueSet/nz-questionnaireresponse-qualifiedyesno-code"/>
  </item>
  <item>
    <linkId value="FamilyHistoryDetails"/>
    <prefix value="5.1)"/>
    <text value="Details of Family History"/>
    <type value="text"/>
    <enableWhen>
      <question value="FamilyHistoryARFRHD"/>
      <operator value="="/>
      <answerCoding>
        <system value="http://snomed.info/sct"/>
        <code value="373066001"/>
        <display value="Yes (qualifier value)"/>
      </answerCoding>
    </enableWhen>
    <required value="true"/>
  </item>
  <item>
    <linkId value="FamilyHistoryRelationship"/>
    <prefix value="6)"/>
    <text value="Family History Relationship to Patient"/>
    <type value="choice"/>
    <enableWhen>
      <question value="FamilyHistoryARFRHD"/>
      <operator value="="/>
      <answerCoding>
        <system value="http://snomed.info/sct"/>
        <code value="373066001"/>
        <display value="Yes (qualifier value)"/>
      </answerCoding>
    </enableWhen>
    <required value="true"/>
    <repeats value="true"/>
    <answerOption>
      <valueCoding>
        <system value="http://snomed.info/sct"/>
        <code value="375005"/>
        <display value="Sibling (person)"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system value="http://snomed.info/sct"/>
        <code value="40683002"/>
        <display value="Parent (person)"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system value="http://snomed.info/sct"/>
        <code value="38312007"/>
        <display value="Grandparent (person)"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system value="http://snomed.info/sct"/>
        <code value="25211005"/>
        <display value="Aunt (person)"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system value="http://snomed.info/sct"/>
        <code value="38048003"/>
        <display value="Uncle (person)"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system value="http://snomed.info/sct"/>
        <code value="55538000"/>
        <display value="Cousin (person)"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system value="http://snomed.info/sct"/>
        <code value="125677006"/>
        <display value="Other relative (person)"/>
      </valueCoding>
    </answerOption>
  </item>
  <item>
    <linkId value="PastMedicalHistoryARF"/>
    <prefix value="7)"/>
    <text value="Any past medical history that may have been ARF?"/>
    <type value="choice"/>
    <required value="true"/>
    <repeats value="false"/>
    <answerValueSet
                    value="https://fhir-ig.digital.health.nz/rheumatic-fever/ValueSet/nz-questionnaireresponse-qualifiedyesno-code"/>
  </item>
  <item>
    <linkId value="EvidencePreviousRHD"/>
    <prefix value="8)"/>
    <text value="Any evidence of previous RHD?"/>
    <type value="choice"/>
    <required value="true"/>
    <repeats value="false"/>
    <answerValueSet
                    value="https://fhir-ig.digital.health.nz/rheumatic-fever/ValueSet/nz-questionnaireresponse-qualifiedyesno-code"/>
  </item>
  <item>
    <linkId value="PMHXDetailsARFRHD"/>
    <prefix value="9)"/>
    <text value="Details of PMHX of possible ARF / RHD"/>
    <type value="text"/>
    <enableWhen>
      <question value="PastMedicalHistoryARF"/>
      <operator value="="/>
      <answerCoding>
        <system value="http://snomed.info/sct"/>
        <code value="373066001"/>
        <display value="Yes (qualifier value)"/>
      </answerCoding>
    </enableWhen>
    <enableWhen>
      <question value="EvidencePreviousRHD"/>
      <operator value="="/>
      <answerCoding>
        <system value="http://snomed.info/sct"/>
        <code value="373066001"/>
        <display value="Yes (qualifier value)"/>
      </answerCoding>
    </enableWhen>
    <enableBehavior value="any"/>
    <required value="true"/>
  </item>
</Questionnaire>