Pre-training questionnaire
Resource status: Draft
Canonical URL: http://fhir.smart4health.eu/Questionnaire/pre-training-questionnaire
Questionnaire resource representing the questionnaires used for assessment at the beginning of a the back pain training.
Link to raw resource: Smart4Health pre-training questionnaire
| Questionnaire |
| url : http://fhir.smart4health.eu/Questionnaire/pre-training-questionnaire |
| version : 1.0.0 |
| title : Smart4Health pre-training questionnaire |
| status : draft |
| subjectType : Patient |
| date : 2021-04-13 |
| publisher : D4L data4life gGmbH |
| contact |
| name : ITTM Solutions |
| telecom |
| system : url |
| value : https://www.ittm-solutions.com/ |
| contact |
| name : D4L data4life gGmbH |
| telecom |
| system : url |
| value : https://www.data4life.care |
| item |
| linkId : training_no |
| text : Training Number |
| type : integer |
| required : True |
| item |
| linkId : back_pain_level_before |
| code |
| system : http://loinc.org |
| code : 72514-3 |
| text : Lower back pain level before training |
| type : choice |
| required : True |
| answerValueSet : http://loinc.org/vs/LL2335-9 |
| item |
| linkId : back_pain_level_before.explanation |
| text : In the following, please provide your pain level (Visual Analog Scale for Pain - VAS Pain). Please select how you experience your pain (under your usual medication dose) from the given scale (0-10). The VAS pain level describes the scale between '0' ('no pain') and '10' ('worst imaginable pain'). |
| type : display |
| enableBehavior : any |
| extension |
| url : http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl |
| value |
| coding |
| system : http://fhir.smart4health.eu/CodeSystem/questionnaire-ui-codes |
| code : painscalewithlabels |
| item |
| linkId : well_being |
| text : Well being |
| type : choice |
| required : True |
| answerValueSet : http://loinc.org/vs/LL2335-9 |
| item |
| linkId : well_being.explanation |
| text : 0: All well, 10: All bad |
| type : display |
| extension |
| url : http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl |
| value |
| coding |
| system : http://fhir.smart4health.eu/CodeSystem/questionnaire-ui-codes |
| code : wellbeingscalewithlabels |
| item |
| linkId : well-being_summary |
| text : Summary of your health, general well-being and activities in the last days/weeks |
| type : choice |
| required : True |
| answerValueSet : http://fhir.smart4health.eu/ValueSet/s4h-pre-training-well-being-summary |
| item |
| linkId : extraordinary_circumstances |
| text : Extraordinary circumstances |
| type : choice |
| enableWhen |
| question : well-being_summary |
| operator : = |
| answer |
| system : http://fhir.smart4health.eu/CodeSystem/s4h-pre-training-well-being-summary |
| code : extraordinary |
| required : True |
| repeats : True |
| answerValueSet : http://fhir.smart4health.eu/ValueSet/s4h-backpain-extraordinary-circumstances |
Example questionnaire response
Example QuestionnaireResponse matching the pre-training back pain assessment questionnaire.
Link to raw resource: Response for questionnaire pre-training-questionnaire|1.0.0: s4h-pre-training-response-example-en
| QuestionnaireResponse |
| id : s4h-pre-training-response-example |
| language : en |
| questionnaire : http://fhir.smart4health.eu/Questionnaire/pre-training-questionnaire|1.0.0 |
| status : completed |
| authored : 2020-05-04T14:15:00-05:00 |
| subject |
| display : Marie Lux-Brennard |
| item |
| linkId : training_no |
| text : Training Number |
| answer |
| value : 2 |
| item |
| linkId : back_pain_level_before |
| text : Lower back pain level before training |
| answer |
| value |
| system : http://loinc.org |
| code : LA6115-5 |
| item |
| linkId : well_being |
| text : Well being |
| answer |
| value |
| system : http://loinc.org |
| code : LA10137-0 |
| item |
| linkId : well-being_summary |
| text : Summary of your health, general well-being and activities in the last days/weeks |
| answer |
| value |
| system : http://fhir.smart4health.eu/CodeSystem/s4h-pre-training-well-being-summary |
| code : extraordinary |
| item |
| linkId : extraordinary_circumstances |
| text : Extraordinary circumstances |
| answer |
| value |
| system : http://fhir.smart4health.eu/CodeSystem/s4h-backpain-extraordinary-circumstances |
| code : muscle-ache |
| answer |
| value |
| system : http://fhir.smart4health.eu/CodeSystem/s4h-backpain-extraordinary-circumstances |
| code : gardening |
| answer |
| value |
| system : http://fhir.smart4health.eu/CodeSystem/s4h-backpain-extraordinary-circumstances |
| code : busy-day |