New Zealand Rheumatic Fever FHIR Implementation Guide - Local Development build (v0.5.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

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: Oral Secondary Prophylaxis Health Assessment Questionnaire - XML Representation

Draft as of 2024-06-17

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<Questionnaire xmlns="http://hl7.org/fhir">
  <id value="OralSecondaryProphylaxisHealthAssessmentQuestionnaire"/>
  <url
       value="https://fhir-ig.digital.health.nz/rheumatic-fever/Questionnaire/OralSecondaryProphylaxisHealthAssessmentQuestionnaire"/>
  <identifier>
    <use value="official"/>
    <value value="OralSecondaryProphylaxisHealthAssessmentQuestionnaire"/>
    <period>
      <start value="2024-06-17"/>
    </period>
  </identifier>
  <version value="1.0.0"/>
  <name value="OralSecondaryProphylaxisHealthAssessmentQuestionnaire"/>
  <title value="Oral Secondary Prophylaxis Health Assessment Questionnaire"/>
  <status value="draft"/>
  <experimental value="false"/>
  <subjectType value="Patient"/>
  <date value="2024-06-17"/>
  <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 information about patient health at an oral secondary prophylaxis medication appointment"/>
  <purpose
           value="Gathers information about patient health at an appointemnt for oral secondary prophylaxis medication"/>
  <item>
    <linkId value="page1"/>
    <prefix value="page1"/>
    <text
          value="Please complete this questionnaire at the oral secondary prophylaxis appointment to assess a rheumatic fever patient's health."/>
    <type value="display"/>
  </item>
  <item>
    <linkId value="MedicationIssues"/>
    <prefix value="1"/>
    <text value="Has the patient had any issues taking their medications?"/>
    <type value="boolean"/>
    <required value="true"/>
  </item>
  <item>
    <linkId value="DelaysObtainingMedication"/>
    <prefix value="2)"/>
    <text
          value="Were there delays in obtaining medications that interrupted the patient’s treatment?"/>
    <type value="boolean"/>
    <required value="true"/>
  </item>
  <item>
    <linkId value="DelaysObtainingMedicationDetail"/>
    <prefix value="2.1)"/>
    <text
          value="Enter details of delays in obtaining medication that interrupted patient's treatment (enter text)"/>
    <type value="text"/>
    <enableWhen>
      <question value="DelaysObtainingMedication"/>
      <operator value="="/>
      <answerBoolean value="true"/>
    </enableWhen>
    <required value="true"/>
  </item>
  <item>
    <linkId value="SufficientMedication"/>
    <prefix value="3)"/>
    <text
          value="Does the patient have enough medication to last until their next check-in?"/>
    <type value="boolean"/>
    <required value="true"/>
  </item>
  <item>
    <linkId value="PlanForObtainingMedications"/>
    <prefix value="4)"/>
    <text
          value="Plan for obtaining medications to last until next check-in (enter text)"/>
    <type value="text"/>
    <required value="true"/>
  </item>
  <item>
    <linkId value="AnyOtherConcerns"/>
    <prefix value="5)"/>
    <text
          value="Were There Any Other Concerns or Issues Identified During the Visit?"/>
    <type value="boolean"/>
    <required value="true"/>
    <initial>
      <valueBoolean value="false"/>
    </initial>
  </item>
  <item>
    <linkId value="OtherConcernsDetail"/>
    <prefix value="5.1)"/>
    <text
          value="If yes, describe details, actions taken, and follow-up planned (enter text)"/>
    <type value="text"/>
    <enableWhen>
      <question value="AnyOtherConcerns"/>
      <operator value="="/>
      <answerBoolean value="true"/>
    </enableWhen>
    <required value="true"/>
  </item>
  <item>
    <linkId value="HealthEducationTopicsDiscussed"/>
    <prefix value="6)"/>
    <text value="Health education topics discussed? (multiple choice)"/>
    <type value="choice"/>
    <required value="true"/>
    <repeats value="true"/>
    <answerOption>
      <valueString value="Secondary prophylaxis"/>
    </answerOption>
    <answerOption>
      <valueString value="Sore Throat Management"/>
    </answerOption>
    <answerOption>
      <valueString value="Skin Infection Management"/>
    </answerOption>
    <answerOption>
      <valueString value="Dental Health"/>
    </answerOption>
    <answerOption>
      <valueString value="Endocarditis Prophylaxis"/>
    </answerOption>
    <answerOption>
      <valueString value="Nutrition"/>
    </answerOption>
    <answerOption>
      <valueString value="Physical Activity"/>
    </answerOption>
    <answerOption>
      <valueString value="Healthy Home Environments"/>
    </answerOption>
    <answerOption>
      <valueString value="Sexual Health"/>
    </answerOption>
    <answerOption>
      <valueString value="Other"/>
    </answerOption>
  </item>
  <item>
    <linkId value="HealthEducationOtherDetail"/>
    <prefix value="6.1)"/>
    <text
          value="Enter details of other health education topic discussed (enter text)"/>
    <type value="text"/>
    <enableWhen>
      <question value="HealthEducationTopicsDiscussed"/>
      <operator value="="/>
      <answerString value="Other"/>
    </enableWhen>
    <required value="true"/>
  </item>
  <item>
    <linkId value="RecentOrUpcomingAppointments"/>
    <prefix value="7)"/>
    <text value="Any recent or upcoming follow-up appointments?"/>
    <type value="boolean"/>
    <required value="true"/>
  </item>
  <item>
    <linkId value="RecentOrUpcomingAppointmentsDetails"/>
    <prefix value="7.1)"/>
    <text
          value="Enter details and dates of any recent or upcoming follow-up appointments (enter text)"/>
    <type value="text"/>
    <enableWhen>
      <question value="RecentOrUpcomingAppointments"/>
      <operator value="="/>
      <answerBoolean value="true"/>
    </enableWhen>
    <required value="true"/>
  </item>
  <item>
    <linkId value="PlanForNextMedicationAppointment"/>
    <prefix value="8)"/>
    <text value="Comments for the next appointment (enter text)"/>
    <type value="text"/>
    <required value="true"/>
  </item>
</Questionnaire>