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{
  "resourceType": "Questionnaire",
  "id": "q-covid-19-st",
  "url": "http://fhir.hie.moh.gov.my/Questionnaire/q-covid-19-st",
  "version": "1.0.0",
  "name": "QCovid19St",
  "title": "Covid-19 Self Test",
  "status": "active",
  "date": "2024-01-12T07:01:56.2573632+00:00",
  "item": [
    {
      "linkId": "1",
      "text": "Where was the swab test done?",
      "type": "choice",
      "answerOption": [
        {
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "394759007",
            "display": "Independent provider site"
          }
        },
        {
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "309895006",
            "display": "Private hospital (environment)"
          }
        },
        {
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "79993009",
            "display": "Government Hospital (environment)"
          }
        },
        {
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "409978001",
            "display": "Self-examination"
          }
        }
      ]
    },
    {
      "linkId": "2",
      "text": "When was the test taken?",
      "type": "dateTime"
    },
    {
      "linkId": "3",
      "text": "Please select the outcome of your test",
      "type": "choice",
      "answerOption": [
        {
          "valueCoding": {
            "system": "https://loinc.org",
            "code": "LA33552-3",
            "display": "COVID-19 negative"
          }
        },
        {
          "valueCoding": {
            "system": "https://loinc.org",
            "code": "LA33551-5",
            "display": "COVID-19 positive"
          }
        },
        {
          "valueCoding": {
            "system": "https://loinc.org",
            "code": "LA13548-5",
            "display": "Specimen unsatisfactory for evaluation"
          }
        }
      ]
    },
    {
      "linkId": "4",
      "text": "Please upload and snapshot the test result",
      "type": "string"
    },
    {
      "linkId": "5",
      "text": "Are you experiencing any COVID-19 symptoms (for example fever, sore throat, nausea and vomiting, diarrhea, cough etc)?",
      "type": "boolean"
    },
    {
      "linkId": "6",
      "text": "Line Address",
      "type": "text"
    },
    {
      "linkId": "7",
      "text": "District",
      "type": "string"
    },
    {
      "linkId": "8",
      "text": "Please select your state",
      "type": "choice",
      "answerOption": [
        {
          "valueCoding": {
            "system": "http://fhir.hie.moh.gov.my/CodeSystem/state-my-core",
            "code": "00",
            "display": "No Information"
          }
        },
        {
          "valueCoding": {
            "system": "http://fhir.hie.moh.gov.my/CodeSystem/state-my-core",
            "code": "01",
            "display": "Johor"
          }
        },
        {
          "valueCoding": {
            "system": "http://fhir.hie.moh.gov.my/CodeSystem/state-my-core",
            "code": "02",
            "display": "Kedah"
          }
        },
        {
          "valueCoding": {
            "system": "http://fhir.hie.moh.gov.my/CodeSystem/state-my-core",
            "code": "03",
            "display": "Kelantan"
          }
        },
        {
          "valueCoding": {
            "system": "http://fhir.hie.moh.gov.my/CodeSystem/state-my-core",
            "code": "04",
            "display": "Melaka"
          }
        },
        {
          "valueCoding": {
            "system": "http://fhir.hie.moh.gov.my/CodeSystem/state-my-core",
            "code": "05",
            "display": "Negeri Sembilan"
          }
        },
        {
          "valueCoding": {
            "system": "http://fhir.hie.moh.gov.my/CodeSystem/state-my-core",
            "code": "06",
            "display": "Pahang"
          }
        },
        {
          "valueCoding": {
            "system": "http://fhir.hie.moh.gov.my/CodeSystem/state-my-core",
            "code": "07",
            "display": "Pulau Pinang"
          }
        },
        {
          "valueCoding": {
            "system": "http://fhir.hie.moh.gov.my/CodeSystem/state-my-core",
            "code": "08",
            "display": "Perak"
          }
        },
        {
          "valueCoding": {
            "system": "http://fhir.hie.moh.gov.my/CodeSystem/state-my-core",
            "code": "09",
            "display": "Perlis"
          }
        },
        {
          "valueCoding": {
            "system": "http://fhir.hie.moh.gov.my/CodeSystem/state-my-core",
            "code": "10",
            "display": "Selangor"
          }
        },
        {
          "valueCoding": {
            "system": "http://fhir.hie.moh.gov.my/CodeSystem/state-my-core",
            "code": "11",
            "display": "Terengganu"
          }
        },
        {
          "valueCoding": {
            "system": "http://fhir.hie.moh.gov.my/CodeSystem/state-my-core",
            "code": "12",
            "display": "Sabah"
          }
        },
        {
          "valueCoding": {
            "system": "http://fhir.hie.moh.gov.my/CodeSystem/state-my-core",
            "code": "13",
            "display": "Sarawak"
          }
        },
        {
          "valueCoding": {
            "system": "http://fhir.hie.moh.gov.my/CodeSystem/state-my-core",
            "code": "14",
            "display": "Wilayah Persekutuan Kuala Lumpur"
          }
        },
        {
          "valueCoding": {
            "system": "http://fhir.hie.moh.gov.my/CodeSystem/state-my-core",
            "code": "15",
            "display": "Wilayah Persekutuan Labuan"
          }
        },
        {
          "valueCoding": {
            "system": "http://fhir.hie.moh.gov.my/CodeSystem/state-my-core",
            "code": "16",
            "display": "Wilayah Persekutuan Putrajaya"
          }
        },
        {
          "valueCoding": {
            "system": "http://fhir.hie.moh.gov.my/CodeSystem/state-my-core",
            "code": "98",
            "display": "Luar Negeri"
          }
        },
        {
          "valueCoding": {
            "system": "http://fhir.hie.moh.gov.my/CodeSystem/state-my-core",
            "code": "99",
            "display": "Others"
          }
        }
      ]
    },
    {
      "linkId": "9",
      "text": "Please enter your current postcode",
      "type": "string"
    }
  ]
}

name : QCovid19St

{

}