SHD-QuestionnaireResponse-CHCChecklist
This is the StructureDefinition overview for the SHD-QuestionnaireResponse-CHCChecklist
The official URL for this profile is: https
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CHCChecklist Data Mapping
The table below provides the generic business context data mappings for the 'Mandatory' and 'Must Support' elements in the SHD-QuestionnaireResponse-CHCChecklist profile. However, please see the individual use case guidance for specifc constraints and context.
| FHIR Element | Card. | Type | Description/Business Context |
|---|---|---|---|
| QuestionnaireResponse.basedOn | 0..1 | Reference (CareConnect-SHD-ReferralRequest-1) | Reference to the ReferralRequest the CHC Checklist relates to SHALL be provided if sent after the ReferralRequest |
| QuestionnaireResponse.questionnaire.reference | 1..1 | string | Fixed Value: 'http |
| QuestionnaireResponse.status | 1..1 | code | See use case guidance for any specific business context constriants. |
| QuestionnaireResponse.authored | 1..1 | DateTime | The date/time the CHC Checklist was completed/amended by the assessor |
| QuestionnaireResponse.item | 27..32 | BackboneElement | MUST SUPPORT the items in the table below |
SHD-Questionnaire-CHCChecklist Table
| Questionnaire.url[0] | https://fhir.nottinghamshire.gov.uk/STU3/Questionnaire/SHD-Questionnaire-CHCChecklist |
| Questionnaire.version[0] | 0.0.1 |
| Questionnaire.name[0] | NHS Continuing Healthcare Checklist |
| Questionnaire.title[0] | NHS Continuing Healthcare Checklist |
| Questionnaire.status[0] | active |
| Questionnaire.description[0] | NHS Continuing Healthcare Checklist |
| Questionnaire.item[0].linkId[0] | 1.1 |
| Questionnaire.item[0].text[0] | Name of the assessor(s) who completed the CHC Checklist |
| Questionnaire.item[0].type[0] | string |
| Questionnaire.item[0].required[0] | True |
| Questionnaire.item[1].linkId[0] | 1.2 |
| Questionnaire.item[1].text[0] | Contact details of assessors (name, role, organisation, telephone number, email address) |
| Questionnaire.item[1].type[0] | string |
| Questionnaire.item[1].required[0] | False |
| Questionnaire.item[2].linkId[0] | 1.3 |
| Questionnaire.item[2].text[0] | Was the individual involved in the completion of the Checklist? |
| Questionnaire.item[2].type[0] | boolean |
| Questionnaire.item[2].required[0] | True |
| Questionnaire.item[3].linkId[0] | 1.4 |
| Questionnaire.item[3].text[0] | Was the individual offered the opportunity to have a representative such as a family member or other advocate present when the checklist was completed? |
| Questionnaire.item[3].type[0] | boolean |
| Questionnaire.item[3].required[0] | True |
| Questionnaire.item[4].linkId[0] | 1.5 |
| Questionnaire.item[4].text[0] | If yes, did the representative attend the completion of the Checklist? |
| Questionnaire.item[4].type[0] | boolean |
| Questionnaire.item[4].enableWhen[0].question[0] | 1.4 |
| Questionnaire.item[4].enableWhen[0].answer[0] | True |
| Questionnaire.item[4].required[0] | True |
| Questionnaire.item[5].linkId[0] | 1.6 |
| Questionnaire.item[5].text[0] | Please give the contact details of the representative (name, address and telephone number) |
| Questionnaire.item[5].type[0] | string |
| Questionnaire.item[5].enableWhen[0].question[0] | 1.5 |
| Questionnaire.item[5].enableWhen[0].answer[0] | True |
| Questionnaire.item[5].required[0] | True |
| Questionnaire.item[6].linkId[0] | 1.7 |
| Questionnaire.item[6].text[0] | Did you explain to the individual how their personal information will be shared with the different organisations involved in their care, and did they consent to this information sharing? |
| Questionnaire.item[6].type[0] | boolean |
| Questionnaire.item[6].required[0] | False |
| Questionnaire.item[7].linkId[0] | 2.1 |
| Questionnaire.item[7].text[0] | 'Behaviour' Domain Level Score |
| Questionnaire.item[7].type[0] | choice |
| Questionnaire.item[7].required[0] | True |
| Questionnaire.item[7].options[0].reference[0] | https://fhir.nottinghamshire.gov.uk/STU3/valueset/CHC-DomainLevelScore |
| Questionnaire.item[8].linkId[0] | 2.2 |
| Questionnaire.item[8].text[0] | Evidence to support 'Behaviour' Domain Level |
| Questionnaire.item[8].type[0] | string |
| Questionnaire.item[8].required[0] | True |
| Questionnaire.item[9].linkId[0] | 2.3 |
| Questionnaire.item[9].text[0] | 'Cognition' Domain Level Score |
| Questionnaire.item[9].type[0] | choice |
| Questionnaire.item[9].required[0] | True |
| Questionnaire.item[9].options[0].reference[0] | https://fhir.nottinghamshire.gov.uk/STU3/valueset/CHC-DomainLevelScore |
| Questionnaire.item[10].linkId[0] | 2.4 |
| Questionnaire.item[10].text[0] | Evidence to support 'Cognition' Domain Level |
| Questionnaire.item[10].type[0] | string |
| Questionnaire.item[10].required[0] | True |
| Questionnaire.item[11].linkId[0] | 2.5 |
| Questionnaire.item[11].text[0] | 'Psychological/Emotional' Domain Level Score |
| Questionnaire.item[11].type[0] | choice |
| Questionnaire.item[11].required[0] | True |
| Questionnaire.item[11].options[0].reference[0] | https://fhir.nottinghamshire.gov.uk/STU3/valueset/CHC-DomainLevelScore |
| Questionnaire.item[12].linkId[0] | 2.6 |
| Questionnaire.item[12].text[0] | Evidence to support 'Psychological/Emotional' Domain Level |
| Questionnaire.item[12].type[0] | string |
| Questionnaire.item[12].required[0] | True |
| Questionnaire.item[13].linkId[0] | 2.7 |
| Questionnaire.item[13].text[0] | 'Communication' Domain Level Score |
| Questionnaire.item[13].type[0] | choice |
| Questionnaire.item[13].required[0] | True |
| Questionnaire.item[13].options[0].reference[0] | https://fhir.nottinghamshire.gov.uk/STU3/valueset/CHC-DomainLevelScore |
| Questionnaire.item[14].linkId[0] | 2.8 |
| Questionnaire.item[14].text[0] | Evidence to support 'Communication' Domain Level |
| Questionnaire.item[14].type[0] | string |
| Questionnaire.item[14].required[0] | True |
| Questionnaire.item[15].linkId[0] | 2.9 |
| Questionnaire.item[15].text[0] | 'Mobility' Domain Level Score |
| Questionnaire.item[15].type[0] | choice |
| Questionnaire.item[15].required[0] | True |
| Questionnaire.item[15].options[0].reference[0] | https://fhir.nottinghamshire.gov.uk/STU3/valueset/CHC-DomainLevelScore |
| Questionnaire.item[16].linkId[0] | 2.10 |
| Questionnaire.item[16].text[0] | Evidence to support 'Mobility' Domain Level |
| Questionnaire.item[16].type[0] | string |
| Questionnaire.item[16].required[0] | True |
| Questionnaire.item[17].linkId[0] | 2.11 |
| Questionnaire.item[17].text[0] | 'Nutrition' Domain Level Score |
| Questionnaire.item[17].type[0] | choice |
| Questionnaire.item[17].required[0] | True |
| Questionnaire.item[17].options[0].reference[0] | https://fhir.nottinghamshire.gov.uk/STU3/valueset/CHC-DomainLevelScore |
| Questionnaire.item[18].linkId[0] | 2.12 |
| Questionnaire.item[18].text[0] | Evidence to support 'Nutrition' Domain Level |
| Questionnaire.item[18].type[0] | string |
| Questionnaire.item[18].required[0] | True |
| Questionnaire.item[19].linkId[0] | 2.13 |
| Questionnaire.item[19].text[0] | 'Continence' Domain Level Score |
| Questionnaire.item[19].type[0] | choice |
| Questionnaire.item[19].required[0] | True |
| Questionnaire.item[19].options[0].reference[0] | https://fhir.nottinghamshire.gov.uk/STU3/valueset/CHC-DomainLevelScore |
| Questionnaire.item[20].linkId[0] | 2.14 |
| Questionnaire.item[20].text[0] | Evidence to support 'Continence' Domain Level |
| Questionnaire.item[20].type[0] | string |
| Questionnaire.item[20].required[0] | True |
| Questionnaire.item[21].linkId[0] | 2.15 |
| Questionnaire.item[21].text[0] | 'Skin integrity' Domain Level Score |
| Questionnaire.item[21].type[0] | choice |
| Questionnaire.item[21].required[0] | True |
| Questionnaire.item[21].options[0].reference[0] | https://fhir.nottinghamshire.gov.uk/STU3/valueset/CHC-DomainLevelScore |
| Questionnaire.item[22].linkId[0] | 2.16 |
| Questionnaire.item[22].text[0] | Evidence to support 'Skin integrity' Domain Level |
| Questionnaire.item[22].type[0] | string |
| Questionnaire.item[22].required[0] | True |
| Questionnaire.item[23].linkId[0] | 2.17 |
| Questionnaire.item[23].text[0] | 'Breathing' Domain Level Score |
| Questionnaire.item[23].type[0] | choice |
| Questionnaire.item[23].required[0] | True |
| Questionnaire.item[23].options[0].reference[0] | https://fhir.nottinghamshire.gov.uk/STU3/valueset/CHC-DomainLevelScore |
| Questionnaire.item[24].linkId[0] | 2.18 |
| Questionnaire.item[24].text[0] | Evidence to support 'Breathing' Domain Level |
| Questionnaire.item[24].type[0] | string |
| Questionnaire.item[24].required[0] | True |
| Questionnaire.item[25].linkId[0] | 2.19 |
| Questionnaire.item[25].text[0] | 'Drug therapies and medication: symptom control' Domain Level Score |
| Questionnaire.item[25].type[0] | choice |
| Questionnaire.item[25].required[0] | True |
| Questionnaire.item[25].options[0].reference[0] | https://fhir.nottinghamshire.gov.uk/STU3/valueset/CHC-DomainLevelScore |
| Questionnaire.item[26].linkId[0] | 2.20 |
| Questionnaire.item[26].text[0] | Evidence to support 'Drug therapies and medication: symptom control' Domain Level |
| Questionnaire.item[26].type[0] | string |
| Questionnaire.item[26].required[0] | True |
| Questionnaire.item[27].linkId[0] | 2.21 |
| Questionnaire.item[27].text[0] | 'Altered states of consciousness' Domain Level Score |
| Questionnaire.item[27].type[0] | choice |
| Questionnaire.item[27].required[0] | True |
| Questionnaire.item[27].options[0].reference[0] | https://fhir.nottinghamshire.gov.uk/STU3/valueset/CHC-DomainLevelScore |
| Questionnaire.item[28].linkId[0] | 2.22 |
| Questionnaire.item[28].text[0] | Evidence to support 'Altered states of consciousness' Domain Level |
| Questionnaire.item[28].type[0] | string |
| Questionnaire.item[28].required[0] | True |
| Questionnaire.item[29].linkId[0] | 2.23 |
| Questionnaire.item[29].text[0] | Total Score from Checklist |
| Questionnaire.item[29].type[0] | string |
| Questionnaire.item[29].required[0] | True |
| Questionnaire.item[30].linkId[0] | 2.24 |
| Questionnaire.item[30].text[0] | Outcome indicated by the Checklist |
| Questionnaire.item[30].type[0] | choice |
| Questionnaire.item[30].required[0] | True |
| Questionnaire.item[30].options[0].reference[0] | https://fhir.nottinghamshire.gov.uk/STU3/valueset/CHC-Outcome |
| Questionnaire.item[31].linkId[0] | 2.25 |
| Questionnaire.item[31].text[0] | Rationale for decision |
| Questionnaire.item[31].type[0] | string |
| Questionnaire.item[31].required[0] | False |