DunedinFormConditionAffectQuestionnaire
type: Questionnaire
node role: treeRoot
id:
  v: DunedinFormConditionAffectQuestionnaire
meta:
  profile:
    v: http://hl7.org/fhir/StructureDefinition/Questionnaire
    link: http://hl7.org/fhir/StructureDefinition/Questionnaire
text:
  status:
    v: extensions
  div: Generated Narrative: Questionnaire DunedinFormConditionAffectQuestionnaire Profile: Questionnaire Structure LinkID Text Cardinality Type Flags Description & Constraints<img src="[binary]" alt="doco" style="background-color: inherit"/> Patient‑reported assessment of the impact of a health condition on daily life. Questionnaire https://fhir-ig.digital.health.nz/shared-care/Questionnaire/DunedinFormConditionAffectQuestionnaire#0.4.5 #xD; 765911107151 How does your condition affect your life? 0..1 group #xD; 765911107151_helpText Please tell us about how much difficulty your condition causes in different areas of your life, which may limit the things you can do. Each question below includes examples to illustrate some of the things this area of life covers. It is okay if some of these examples don't apply to you. Please just think about whatever this area of life means for you. Please circle the number that most represents how much your condition affects each area of your life. 0..1 display #xD; 624356696038 How much does your condition affect your social interactions? 1..1 choice Options: 6 options #xD; 624356696038_helpText (Examples: meeting friends, going out, joining in groups, going shopping, everyday activities outside the home) 0..1 display #xD; 601664488659 How much does your condition affect your personal relationships? 1..1 choice Options: 6 options #xD; 938604546200 (Examples: personal relations with partner, family members, close personal friends) 0..1 display #xD; 863443735387 How much does your condition affect your ability to meet your responsibilities to others? 1..1 choice Options: 6 options #xD; 624618506381 (Examples: doing meaningful things for yourself or others, including caring for children, grandchildren or partner, work (paid and unpaid), including how having to rely on others may have an impact on you)) 0..1 display #xD; 161471334792 How much does your condition affect your personal care? 1..1 choice Options: 6 options #xD; 220304359852 (Examp…
url:
  v: https://fhir-ig.digital.health.nz/shared-care/Questionnaire/DunedinFormConditionAffectQuestionnaire
version:
  v: 0.4.5
title:
  v: How does condition affect your life
status:
  v: draft
date:
  v: 2026-04-02T02:35:25+00:00
publisher:
  v: Te Whatu Ora
contact:
  name:
    v: Te Whatu Ora
  telecom:
    system:
      v: url
    value:
      v: https://www.tewhatuora.govt.nz/
contact:
  name:
    v: Te Whatu Ora Integration Team
  telecom:
    system:
      v: email
    use:
      v: work
description:
  v: Patient‑reported assessment of the impact of a health condition on daily life.
jurisdiction:
  coding:
    system:
      v: urn:iso:std:iso:3166
    code:
      v: NZ
    display:
      v: New Zealand
item:
  link id:
    v: 765911107151
  text:
    v: How does your condition affect your life?
  type:
    v: group
  item:
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
      value: CodeableConcept
    link id:
      v: 765911107151_helpText
    text:
      v: Please tell us about how much difficulty your condition causes in different areas of your life, which may limit the things you can do. Each question below includes examples to illustrate some of the things this area of life covers. It is okay if some of these examples don't apply to you. Please just think about whatever this area of life means for you. Please circle the number that most represents how much your condition affects each area of your life.
    type:
      v: display
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
    value: CodeableConcept
  link id:
    v: 624356696038
  text:
    v: How much does your condition affect your social interactions?
  type:
    v: choice
  required:
    v: true
  read only:
    v: false
  answer option:
    value: Coding
      code:
        v: 1
      display:
        v: No difficulty
  answer option:
    value: Coding
      code:
        v: 2
      display:
        v: Little difficulty
  answer option:
    value: Coding
      code:
        v: 3
      display:
        v: Some difficulty
  answer option:
    value: Coding
      code:
        v: 4
      display:
        v: Quite difficult
  answer option:
    value: Coding
      code:
        v: 5
      display:
        v: Very difficult
  answer option:
    value: Coding
      code:
        v: 6
      display:
        v: Extremely difficult
  item:
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
      value: CodeableConcept
    link id:
      v: 624356696038_helpText
    text:
      v: (Examples: meeting friends, going out, joining in groups, going shopping, everyday activities outside the home)
    type:
      v: display
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
    value: CodeableConcept
  link id:
    v: 601664488659
  text:
    v: How much does your condition affect your personal relationships?
  type:
    v: choice
  required:
    v: true
  read only:
    v: false
  answer option:
    value: Coding
      code:
        v: 1
      display:
        v: No difficulty
  answer option:
    value: Coding
      code:
        v: 2
      display:
        v: Little difficulty
  answer option:
    value: Coding
      code:
        v: 3
      display:
        v: Some difficulty
  answer option:
    value: Coding
      code:
        v: 4
      display:
        v: Quite difficult
  answer option:
    value: Coding
      code:
        v: 5
      display:
        v: Very difficult
  answer option:
    value: Coding
      code:
        v: 6
      display:
        v: Extremely difficult
  item:
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
      value: CodeableConcept
    link id:
      v: 938604546200
    text:
      v: (Examples: personal relations with partner, family members, close personal friends)
    type:
      v: display
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
    value: CodeableConcept
  link id:
    v: 863443735387
  text:
    v: How much does your condition affect your ability to meet your responsibilities to others?

system:
  v: http://hl7.org/fhir/questionnaire-item-control
code:
  v: help
display:
  v: Help-Button

v: Help-Button

v: radio-button

v: Radio Button

system:
  v: http://hl7.org/fhir/questionnaire-item-control
code:
  v: help
display:
  v: Help-Button

v: Help-Button

v: radio-button

v: Radio Button

system:
  v: http://hl7.org/fhir/questionnaire-item-control
code:
  v: help
display:
  v: Help-Button

v: Help-Button

v: radio-button

v: Radio Button

v: choice

v: true

v: false

value: Coding
  code:
    v: 1
  display:
    v: No difficulty

value: Coding
  code:
    v: 2
  display:
    v: Little difficulty

value: Coding
  code:
    v: 3
  display:
    v: Some difficulty

value: Coding
  code:
    v: 4
  display:
    v: Quite difficult

value: Coding
  code:
    v: 5
  display:
    v: Very difficult

value: Coding
  code:
    v: 6
  display:
    v: Extremely difficult

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/questionnaire-item-control
      code:
        v: help
      display:
        v: Help-Button
    text:
      v: Help-Button
link id:
  v: 624618506381
text:
  v: (Examples: doing meaningful things for yourself or others, including caring for children, grandchildren or partner, work (paid and unpaid), including how having to rely on others may have an impact on you))
type:
  v: display

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/questionnaire-item-control
      code:
        v: radio-button
      display:
        v: Radio Button
link id:
  v: 161471334792
text:
  v: How much does your condition affect your personal care?
type:
  v: choice
required:
  v: true
read only:
  v: false
answer option:
  value: Coding
    code:
      v: 1
    display:
      v: No difficulty
answer option:
  value: Coding
    code:
      v: 2
    display:
      v: Little difficulty
answer option:
  value: Coding
    code:
      v: 3
    display:
      v: Some difficulty
answer option:
  value: Coding
    code:
      v: 4
    display:
      v: Quite difficult
answer option:
  value: Coding
    code:
      v: 5
    display:
      v: Very difficult
answer option:
  value: Coding
    code:
      v: 6
    display:
      v: Extremely difficult
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
    value: CodeableConcept
      text:
        v: Help-Button
  link id:
    v: 220304359852
  text:
    v: (Examples: looking after yourself, your health, personal hygiene, need for aids or special clothing)
  type:
    v: display

v: help

v: Help-Button

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/questionnaire-item-control
      code:
        v: radio-button
      display:
        v: Radio Button
link id:
  v: 159129288879
text:
  v: How much does your condition affect your personal safety?
type:
  v: choice
required:
  v: true
read only:
  v: false
answer option:
  value: Coding
    code:
      v: 1
    display:
      v: No difficulty
answer option:
  value: Coding
    code:
      v: 2
    display:
      v: Little difficulty
answer option:
  value: Coding
    code:
      v: 3
    display:
      v: Some difficulty
answer option:
  value: Coding
    code:
      v: 4
    display:
      v: Quite difficult
answer option:
  value: Coding
    code:
      v: 5
    display:
      v: Very difficult
answer option:
  value: Coding
    code:
      v: 6
    display:
      v: Extremely difficult
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
    value: CodeableConcept
      text:
        v: Help-Button
  link id:
    v: 324353862698
  text:
    v: (Examples: being safe from injury and harm, from yourself or others and in your surroundings)
  type:
    v: display

v: help

v: Help-Button

extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
  value: CodeableConcept
    coding:
      system:
        v: http://hl7.org/fhir/questionnaire-item-control
      code:
        v: radio-button
      display:
        v: Radio Button
link id:
  v: 104877718606
text:
  v: How much does your condition affect your leisure activities?
type:
  v: choice
required:
  v: true
read only:
  v: false
answer option:
  value: Coding
    code:
      v: 1
    display:
      v: No difficulty
answer option:
  value: Coding
    code:
      v: 2
    display:
      v: Little difficulty
answer option:
  value: Coding
    code:
      v: 3
    display:
      v: Some difficulty
answer option:
  value: Coding
    code:
      v: 4
    display:
      v: Quite difficult
answer option:
  value: Coding
    code:
      v: 5
    display:
      v: Very difficult
answer option:
  value: Coding
    code:
      v: 6
    display:
      v: Extremely difficult
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
    value: CodeableConcept
      text:
        v: Help-Button
  link id:
    v: 738991042018
  text:
    v: (Examples: getting exercise, hobbies, sporting activities, gardening, do-it-yourself activities, crafts and travel)
  type:
    v: display

v: help

v: Help-Button

link id:
  v: 502868396322
text:
  v: Patient details
type:
  v: group
item:
  extension:
    url:
      v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
    value: CodeableConcept
      text:
        v: Help-Button
  link id:
    v: 995364900981
  text:
    v: Stick patient label here (or fill in the details below if no label is available)
  type:
    v: display

v: help

v: Help-Button

link id:
  v: 140426997110
text:
  v: Preferred name
type:
  v: string
required:
  v: false

link id:
  v: 961244077884
text:
  v: Full name
type:
  v: string
required:
  v: false

link id:
  v: 392686174684
text:
  v: NHI number
type:
  v: string
required:
  v: false

link id:
  v: 220094605396
text:
  v: DOB
type:
  v: date
required:
  v: false

link id:
  v: 348937414067
text:
  v: Address
type:
  v: string
required:
  v: false

link id:
  v: 917247769414
text:
  v: Telephone Number
type:
  v: string
required:
  v: false

link id:
  v: 717341772298
text:
  v: Date
type:
  v: date
required:
  v: false