Generated Narrative: Questionnaire DHOPreoperativeQuestionnaireDaySurgeryDunedinHospital LinkID Text Cardinality Type Flags Description & Constraints DHOPreoperativeQuestionnaireDaySurgeryDunedinHospital Pre-operative assessment questionnaire for day surgery patients at Dunedin Hospital. Questionnaire https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/Questionnaire/DHOPreoperativeQuestionnaireDaySurgeryDunedinHospital#1.0 #xD; patientInfo Patient Information 0..1 group #xD; surname_01 Surname 0..1 string #xD; nhi_02 NHI 0..1 string #xD; othernames_03 Other Names 0..1 string #xD; dob_04 DOB 0..1 date #xD; age_05 Age 0..1 integer #xD; ward_06 Ward 0..1 string #xD; consultant_07 Consultant 0..1 string #xD; adreess_08 Address 0..1 string #xD; phonenumber_09 Phone Number 0..1 string #xD; sectioone_01 Section One 0..1 group #xD; operation_10 Have you ever had an operation and/or anaesthetic? 1..1 boolean #xD; closerelative Have you or a close relative ever had problems with an anaesthetic? 1..1 boolean #xD; problemdescribe If YES, describe the problem: 1..1 string Enable When: closerelative = #xD; medicationsallergy Are you allergic to any medications or other substances? 1..1 boolean #xD; answerallergy If YES, please list: 1..1 string Enable When: medicationsallergy = #xD; anymedications Are you taking or have you taken any medications in the last 6 months? 1..1 boolean #xD; allmedications If YES, please list all medications: 0..1 string Enable When: anymedications = #xD; hadmdro Have you ever had MDRO? (Superbug infection) 0..1 boolean #xD; workedorpatient Have you worked or been a patient in a hospital in NZ or overseas in the last 6 months? 0..1 boolean #xD; answerwhen If YES, state when and where: 0..1 string Enable When: workedorpatient = #xD; artificialjoint Do you have an artificial joint, heart valve or a pacemaker? 0..1 boolean #xD; looseteeth Do you have dentures, partial plate, loose teeth? 0..1 boolean #xD; smoke Do you smoke? 0..1 boolean #xD; howmanysmoke If YES, how many per day? 0..1 string Enable When: smoke = #xD; sufferingcold Are you suffering from or recovering from a cold, sore throat, flu or covid19? 0..1 boolean #xD; pregnant Are you or could you be pregnant? 0..1 boolean #xD; sectiontwo Section Two 0..1 group #xD; symptoms Have you suffered from any of these symptoms or medical conditions? 0..1 display #xD; heartcondition Heart condition 1..1 boolean #xD; angina Chest pain/angina 1..1 boolean #xD; bloodpressure High blood pressure 1..1 boolean #xD; ankleswelling Ankle swelling 1..1 boolean #xD; shortnessbreath Abnormal shortness of breath 1..1 boolean #xD; bloodclots Blood clots in legs/lungs 1..1 boolean #xD; rheumaticfever Rheumatic fever 1..1 boolean #xD; pcough Persistent cough 1..1 boolean #xD; asthma Asthma 1..1 boolean #xD; lungproblem Other lung problems 1..1 boolean #xD; reflux Heartburn/reflux 1..1 boolean #xD; sulcer Stomach ulcer 1..1 boolean #xD; bleedingdisorder Bleeding disorders 1..1 boolean #xD; anaemia Anaemia 1..1 boolean #xD; stroke Stroke/blackouts 1..1 boolean #xD; kidneydisorder Kidney disorders 1..1 boolean #xD; jaundice Hepatitis/jaundice 1..1 boolean #xD; efits Epilepsy/fits 1..1 boolean #xD; migraine_01 Migraine 1..1 boolean #xD; diabetestype Diabetes type 1 / 2 1..1 boolean #xD; depressionnerves Depression/nerves 1..1 boolean #xD; arthritis Arthritis 1..1 boolean #xD; alcoholrelated Alcohol related problems 1..1 boolean #xD; motionsickness Motion sickness 1..1 boolean #xD; other Other 1..1 string #xD; sectionthree Section Three 0..1 group #xD; adultdrive Following surgery I will have a responsible adult drive me home and stay with me for 24hrs. 0..1 display #xD; supportpersonname Support Person Name: 1..1 string #xD; contactphone Contact Phone: 1..1 string #xD; patientsignature Patient Signature: 1..1 string #xD; date Date 1..1 date #xD; smokingcessation ABC for Smoking Cessation 0..1 display #xD; eversmoked Has the patient ever smoked? 1..1 boolean #xD; lastsmoke When did they last smoke? 1..1 string #xD; quitadvise Advised to quit? 1..1 boolean #xD; vape Does the patient vape? 1..1 boolean #xD; withnicotine with nicotine? 1..1 boolean #xD; quitsupport Supported to quit (tick all that apply) 0..1 display #xD; quitcard NRT or Quitcard provided 1..1 boolean #xD; referraltossss Referral to SSSS 1..1 boolean #xD; supportdeclined Support declined 1..1 boolean #xD; cessationprogramme Already on cessation programme 1..1 boolean #xD; date_11 Date 1..1 date #xD; sign_12 Sign 1..1 string #xD; fallsriskassessment Falls Risk Assessment 0..1 display #xD; fallsriskalert If “yes” to the last question, write ‘falls risk’ in orange alert box on the front of the Day Surgery Clinical Pathway & place a red bracelet on pt. 0..1 display #xD; agemore55 >55yrs & Maori or Pacific Islander 1..1 boolean #xD; agemore75 >75yrs (Other Ethnicity) 1..1 boolean #xD; ptfallenpast Pt has fallen in past year 1..1 boolean #xD; assessordeemspt Assessor deems pt requires a full assessment 1..1 boolean #xD; date_21 Date 1..1 date #xD; sign_22 Sign: 0..1 string #xD; Documentation for this format
Preoperative Questionnaire Day Surgery Dunedin Hospital
Pre-operative assessment questionnaire for day surgery patients at Dunedin Hospital.
To collect pre-operative clinical and risk information prior to day surgery.
Have you ever had an operation and/or anaesthetic?
Have you or a close relative ever had problems with an anaesthetic?
Are you allergic to any medications or other substances?
Are you taking or have you taken any medications in the last 6 months?
Have you ever had MDRO? (Superbug infection)
Have you worked or been a patient in a hospital in NZ or overseas in the last 6 months?
Do you have an artificial joint, heart valve or a pacemaker?
Do you have dentures, partial plate, loose teeth?
Are you suffering from or recovering from a cold, sore throat, flu or covid19?
Have you suffered from any of these symptoms or medical conditions?
Following surgery I will have a responsible adult drive me home and stay with me for 24hrs.
If “yes” to the last question, write ‘falls risk’ in orange alert box on the front of the Day Surgery Clinical Pathway & place a red bracelet on pt.
Assessor deems pt requires a full assessment