New Zealand Rheumatic Fever FHIR Implementation Guide
1.0.0 - draft
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
| Draft as of 2024-01-01 |
{
"resourceType" : "Questionnaire",
"id" : "RecurrenceDiagnosisQuestionnaire",
"url" : "https://fhir-ig.digital.health.nz/rheumatic-fever/Questionnaire/RecurrenceDiagnosisQuestionnaire",
"identifier" : [
{
"use" : "official",
"value" : "RecurrenceDiagnosisQuestionnaire",
"period" : {
"start" : "2024-01-01"
}
}
],
"version" : "1.0.0",
"name" : "RecurrenceDiagnosisQuestionnaire",
"title" : "Recurrence Diagnosis Questionnaire",
"status" : "draft",
"experimental" : false,
"subjectType" : [
"Patient"
],
"date" : "2024-01-01",
"publisher" : "Te Whatu Ora",
"contact" : [
{
"name" : "Te Whatu Ora",
"telecom" : [
{
"system" : "url",
"value" : "https://www.tewhatuora.govt.nz/"
},
{
"system" : "email",
"value" : "integration@tewhatuora.govt.nz"
}
]
},
{
"name" : "HNZ Integration Team",
"telecom" : [
{
"system" : "email",
"value" : "integration@tewhatuora.govt.nz",
"use" : "work"
}
]
}
],
"description" : "Gathers information about prophylaxis and recurrence details for acute rheumatic fever diagnosis",
"purpose" : "Gathers information about prophylaxis and recurrence details for acute rheumatic fever diagnosis",
"item" : [
{
"linkId" : "page1",
"prefix" : "page1",
"text" : "Please complete this questionnaire to assess recurrence and prophylaxis details for rheumatic fever diagnosis.",
"type" : "display"
},
{
"linkId" : "ReceivingAntibioticProphylaxis",
"prefix" : "1)",
"text" : "Was the patient receiving antibiotic prophylaxis?",
"type" : "choice",
"required" : true,
"repeats" : false,
"answerOption" : [
{
"valueString" : "Yes"
},
{
"valueString" : "No - Completed Treatment"
},
{
"valueString" : "No - Discontinued Prematurely"
},
{
"valueString" : "No - Other"
},
{
"valueString" : "Unknown"
}
]
},
{
"linkId" : "TypeOfProphylaxis",
"prefix" : "2)",
"text" : "Type of Prophylaxis",
"type" : "choice",
"required" : true,
"repeats" : false,
"answerOption" : [
{
"valueString" : "Benzathine Penicillin"
},
{
"valueString" : "Amoxicillin"
},
{
"valueString" : "Penicillin V"
},
{
"valueString" : "Erythromycin"
},
{
"valueString" : "Roxithromycin"
},
{
"valueString" : "Other"
},
{
"valueString" : "Unknown"
},
{
"valueString" : "None"
}
]
},
{
"linkId" : "OtherProphylaxis",
"prefix" : "3)",
"text" : "Other Prophylaxis",
"type" : "text",
"enableWhen" : [
{
"question" : "TypeOfProphylaxis",
"operator" : "=",
"answerString" : "Other"
}
],
"required" : true
},
{
"linkId" : "MedicationRoute",
"prefix" : "4)",
"text" : "Medication Route",
"type" : "choice",
"required" : true,
"repeats" : false,
"answerOption" : [
{
"valueString" : "Intramuscular Injection"
},
{
"valueString" : "Subcutaneous Injection"
},
{
"valueString" : "Oral"
}
]
},
{
"linkId" : "PrescribedFrequency",
"prefix" : "5)",
"text" : "Prescribed Frequency",
"type" : "choice",
"required" : true,
"repeats" : false,
"answerOption" : [
{
"valueString" : "28 Days"
},
{
"valueString" : "21 Days"
},
{
"valueString" : "Daily"
},
{
"valueString" : "10 Weeks"
},
{
"valueString" : "13 Weeks"
},
{
"valueString" : "Other"
}
]
},
{
"linkId" : "OtherPrescribedFrequency",
"prefix" : "6)",
"text" : "Other Prescribed Frequency",
"type" : "text",
"enableWhen" : [
{
"question" : "PrescribedFrequency",
"operator" : "=",
"answerString" : "Other"
}
],
"required" : true
},
{
"linkId" : "ProphylaxisAdherence",
"prefix" : "7)",
"text" : "What was the patient's adherence to prophylaxis in the last 12 months?",
"type" : "text",
"required" : true
},
{
"linkId" : "ProphylaxisProvider",
"prefix" : "8)",
"text" : "Who was providing the prophylaxis at the time?",
"type" : "text",
"required" : true
},
{
"linkId" : "LastDocumentedDose",
"prefix" : "9)",
"text" : "Date of last documented secondary prophylaxis benzathine dose?",
"type" : "date",
"required" : true
},
{
"linkId" : "RiskFactorsRecurrence",
"prefix" : "10)",
"text" : "Risk Factors for Recurrence?",
"type" : "text",
"required" : true
}
]
}