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

Questionnaire: Recurrence Diagnosis Questionnaire

Official URL: https://fhir-ig.digital.health.nz/rheumatic-fever/Questionnaire/RecurrenceDiagnosisQuestionnaire Version: 1.0.0
Draft as of 2024-01-01 Computable Name: RecurrenceDiagnosisQuestionnaire
Other Identifiers: RecurrenceDiagnosisQuestionnaire (use: official, period: 1/1/24 --> (ongoing))

Gathers information about prophylaxis and recurrence details for acute rheumatic fever diagnosis

Gathers information about prophylaxis and recurrence details for acute rheumatic fever diagnosis

Structure

LinkIDTextCardinalityTypeDescription & Constraintsdoco
.. RecurrenceDiagnosisQuestionnaireGathers information about prophylaxis and recurrence details for acute rheumatic fever diagnosisQuestionnairehttps://fhir-ig.digital.health.nz/rheumatic-fever/Questionnaire/RecurrenceDiagnosisQuestionnaire#1.0.0
... page1page1. Please complete this questionnaire to assess recurrence and prophylaxis details for rheumatic fever diagnosis.0..1display
... ReceivingAntibioticProphylaxis1). Was the patient receiving antibiotic prophylaxis?1..1choiceOptions: 5 options
... TypeOfProphylaxis2). Type of Prophylaxis1..1choiceOptions: 8 options
... MedicationRoute4). Medication Route1..1choiceOptions: 3 options
... PrescribedFrequency5). Prescribed Frequency1..1choiceOptions: 6 options
... OtherPrescribedFrequency6). Other Prescribed Frequency1..1textEnable When: PrescribedFrequency =
... ProphylaxisAdherence7). What was the patient's adherence to prophylaxis in the last 12 months?1..1text
... ProphylaxisProvider8). Who was providing the prophylaxis at the time?1..1text
... LastDocumentedDose9). Date of last documented secondary prophylaxis benzathine dose?1..1date
... RiskFactorsRecurrence10). Risk Factors for Recurrence?1..1text

doco Documentation for this format

Options Sets

Answer options for ReceivingAntibioticProphylaxis

  • Yes
  • No - Completed Treatment
  • No - Discontinued Prematurely
  • No - Other
  • Unknown

Answer options for TypeOfProphylaxis

  • Benzathine Penicillin
  • Amoxicillin
  • Penicillin V
  • Erythromycin
  • Roxithromycin
  • Other
  • Unknown
  • None

Answer options for MedicationRoute

  • Intramuscular Injection
  • Subcutaneous Injection
  • Oral

Answer options for PrescribedFrequency

  • 28 Days
  • 21 Days
  • Daily
  • 10 Weeks
  • 13 Weeks
  • Other