Questionnaire
Composition Form
Download Composition Form Questionnaire
Download Composition Form QuestionnaireResponse Sample
| No | Title | JSON |
|---|---|---|
| 1. | Dengue Assessment Checklist |
Questionnaire
{ "resourceType": "Questionnaire", "id": "q-dengue-checklist", "url": "http://fhir.hie.moh.gov.my/Questionnaire/q-dengue-checklist", "version": "1.0.0", "name": "QDengueChecklist", "title": "Dengue Assessment Checklist", "status": "active", "date": "2024-02-12T04:04:09.5621857+00:00", "item": [ { "linkId": "dengue-cl.1", "text": "Recognition", "type": "group", "item": [ { "linkId": "dengue-cl.1.1", "text": "Fever", "type": "boolean" }, { "linkId": "dengue-cl.1.2", "text": "Aches and Pain", "type": "boolean" }, { "linkId": "dengue-cl.1.3", "text": "Nausea and / or Vomitting", "type": "boolean" }, { "linkId": "dengue-cl.1.4", "text": "Rash", "type": "boolean" }, { "linkId": "dengue-cl.1.5", "text": "Leucopenia", "type": "boolean" }, { "linkId": "dengue-cl.1.6", "text": "Any Warning Signs", "type": "boolean" }, { "linkId": "dengue-cl.1.7", "text": "Remarks", "type": "text" } ] }, { "linkId": "dengue-cl.2", "text": "Warning signs", "type": "group", "item": [ { "linkId": "dengue-cl.2.1", "text": "Persistent Vomiting (3 or more than 3 times over the last 24 hours)", "type": "boolean" }, { "linkId": "dengue-cl.2.2", "text": "Persistent Diarrhea (3 or more than 3 times over the last 24 hours)", "type": "boolean" }, { "linkId": "dengue-cl.2.3", "text": "Any Abdominal Pain / Tenderness", "type": "boolean" }, { "linkId": "dengue-cl.2.4", "text": "Lethargy / Restlessness / Confusion", "type": "boolean" }, { "linkId": "dengue-cl.2.5", "text": "Tender Liver", "type": "boolean" }, { "linkId": "dengue-cl.2.6", "text": "Third Space Fluid Accumulation", "type": "boolean" }, { "linkId": "dengue-cl.2.7", "text": "Spontaneous Bleeding Tendencies", "type": "boolean" }, { "linkId": "dengue-cl.2.8", "text": "Raised HCT With Rapid Drop in Platelet. \nMale Age ≤ 60 : HCT >46 \nMale Age >60 : HCT > 42 \nFemale All Ages : >40", "type": "boolean" }, { "linkId": "dengue-cl.2.9", "text": "Remarks", "type": "text" } ] }, { "linkId": "dengue-cl.3", "text": "Other criteria", "type": "group", "item": [ { "linkId": "dengue-cl.3.1", "text": "Syncope", "type": "boolean" }, { "linkId": "dengue-cl.3.2", "text": "Social factor", "type": "boolean" }, { "linkId": "dengue-cl.3.3", "text": "Remarks", "type": "text" } ] }, { "linkId": "dengue-cl.4", "text": "Special Group", "type": "group", "item": [ { "linkId": "dengue-cl.4.1", "text": "Obese", "type": "boolean" }, { "linkId": "dengue-cl.4.2", "text": "Pregnant", "type": "boolean" }, { "linkId": "dengue-cl.4.3", "text": "Heart failure / CKD / CLD", "type": "boolean" }, { "linkId": "dengue-cl.4.4", "text": "Diabetes Mellitus", "type": "boolean" }, { "linkId": "dengue-cl.4.5", "text": "Hypertension", "type": "boolean" }, { "linkId": "dengue-cl.4.6", "text": "IHD", "type": "boolean" }, { "linkId": "dengue-cl.4.7", "text": "COPD", "type": "boolean" }, { "linkId": "dengue-cl.4.8", "text": "Age > 65", "type": "boolean" }, { "linkId": "dengue-cl.4.9", "text": "Remarks", "type": "text" } ] }, { "linkId": "dengue-cl.5", "text": "Physical Examination and Vital Signs", "type": "group", "item": [ { "linkId": "dengue-cl.5.1", "text": "Physical Examination Findings", "type": "text" }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/minValue", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/maxValue", "valueInteger": 300 } ], "linkId": "dengue-cl.5.2", "code": [ { "system": "http://loinc.org", "code": "8480-6", "display": "Systolic Blood Pressure" } ], "text": "Systolic Blood Pressure (mmHg)", "type": "quantity", "initial": [ { "valueQuantity": { "unit": "mmHg", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/minValue", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/maxValue", "valueInteger": 250 } ], "linkId": "dengue-cl.5.3", "code": [ { "system": "http://loinc.org", "code": "8462-4", "display": "Diastolic Blood Pressure" } ], "text": "Diastolic Blood Pressure (mmHg)", "type": "quantity", "enableWhen": [ { "question": "dengue-cl.5.2", "operator": "exists", "answerBoolean": true } ], "initial": [ { "valueQuantity": { "unit": "mmHg", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/minValue-my-core", "valueInteger": 0 }, { "url": "http://hl7.org/fhir/StructureDefinition/maxValue-my-core", "valueInteger": 400 } ], "linkId": "dengue-cl.5.4", "text": "Heart Rate (/min)", "type": "quantity", "initial": [ { "valueQuantity": { "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/minValue-my-core", "valueInteger": 0 }, { "url": "http://hl7.org/fhir/StructureDefinition/maxValue-my-core", "valueInteger": 100 } ], "linkId": "dengue-cl.5.5", "text": "Body Temperature (°C)", "type": "quantity", "initial": [ { "valueQuantity": { "unit": "°C", "system": "http://unitsofmeasure.org", "code": "Cel" } } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/minValue-my-core", "valueInteger": 0 }, { "url": "http://hl7.org/fhir/StructureDefinition/maxValue-my-core", "valueInteger": 100 } ], "linkId": "dengue-cl.5.6", "text": "Oxygen Saturation (%)", "type": "quantity", "initial": [ { "valueQuantity": { "unit": "%", "system": "http://unitsofmeasure.org", "code": "%" } } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/minValue-my-core", "valueInteger": 0 }, { "url": "http://hl7.org/fhir/StructureDefinition/maxValue-my-core", "valueInteger": 80 } ], "linkId": "dengue-cl.5.7", "text": "Respiratory Rate (/min)", "type": "quantity", "initial": [ { "valueQuantity": { "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/minValue", "valueInteger": 0 }, { "url": "http://hl7.org/fhir/StructureDefinition/maxValue", "valueInteger": 10 } ], "linkId": "dengue-cl.5.8", "text": "Pain Score", "type": "quantity" } ] }, { "linkId": "dengue-cl.6", "text": "Blood Investigation", "type": "group", "item": [ { "linkId": "dengue-cl.6.1", "text": "White Cell Counts", "type": "quantity" }, { "linkId": "dengue-cl.6.2", "text": "Hb", "type": "quantity" }, { "linkId": "dengue-cl.6.3", "text": "HCT", "type": "quantity" }, { "linkId": "dengue-cl.6.4", "text": "Platelet", "type": "quantity" }, { "linkId": "dengue-cl.6.5", "text": "Dengue Point of Care Checklist (Combo / Rapid Checklist)", "type": "quantity" } ] }, { "linkId": "dengue-cl.7", "text": "Severe Dengue", "type": "group", "item": [ { "linkId": "dengue-cl.7.1", "text": "Hypotension SBP <90 or MAP <60 or SBP Drop > 40mmHg From Known Baseline", "type": "boolean" }, { "linkId": "dengue-cl.7.2", "text": "Shock Index: HR > SBP or Abnormal CCTVR", "type": "boolean" }, { "linkId": "dengue-cl.7.3", "text": "Third Space Fluid Accumulation With Respiratory Distress", "type": "boolean" }, { "linkId": "dengue-cl.7.4", "text": "Altered Concious Level", "type": "boolean" }, { "linkId": "dengue-cl.7.5", "text": "Any bleed GI / Non Mucosal And Non Cutaneous / Non Physiological", "type": "boolean" }, { "linkId": "dengue-cl.7.6", "text": "Specific Organ Dysfunction", "type": "boolean" }, { "linkId": "dengue-cl.7.7", "text": "Remarks", "type": "text" } ] }, { "linkId": "dengue-cl.8", "text": "Onset of Illness", "type": "group", "item": [ { "linkId": "dengue-cl.8,1", "text": "Fever Onset", "type": "dateTime" }, { "linkId": "dengue-cl.8.2", "text": "Critical Phase Onset", "type": "dateTime" } ] }, { "linkId": "dengue-cl.9", "text": "Phase of Illness", "type": "choice", "answerOption": [ { "valueCoding": { "code": "01", "display": "Febrile" } }, { "valueCoding": { "code": "02", "display": "Critical" } }, { "valueCoding": { "code": "03", "display": "Recovery" } } ] }, { "linkId": "dengue-cl.10", "text": "Diagnosis", "type": "choice", "answerOption": [ { "valueCoding": { "code": "01", "display": "Dengue Fever Without Warning Signs" } }, { "valueCoding": { "code": "02", "display": "Dengue Fever With Warning Signs" } }, { "valueCoding": { "code": "03", "display": "Severe Dengue" } } ] }, { "linkId": "dengue-cl.11", "text": "Management", "type": "group", "item": [ { "linkId": "dengue-cl.11.1", "text": "Management / Plans", "type": "text" } ] } ] } QuestionnaireResponse
{ "resourceType": "QuestionnaireResponse", "id": "qr-dengue-checklist", "meta": { "source": "http://provider.hie.moh.gov.my", "profile": [ "http://fhir.hie.moh.gov.my/StructureDefinition/QuestionnaireResponse-my-core" ] }, "identifier": { "system": "http://fhir.hie.moh.gov.my/sid/template-section", "value": "qr-dengue-checklist" }, "questionnaire": "http://fhir.hie.moh.gov.my/Questionnaire/q-dengue-checklist", "status": "completed", "subject": { "reference": "Patient/93fd2974-8652-489e-a75e-e5a489796f77" }, "authored": "2023-04-27T00:20:14.414Z", "item": [ { "linkId": "dengue-cl.1", "text": "Recognition", "item": [ { "linkId": "dengue-cl.1.1", "text": "Fever", "answer": [ { "valueBoolean": true } ] }, { "linkId": "dengue-cl.1.2", "text": "Aches and pain", "answer": [ { "valueBoolean": true } ] }, { "linkId": "dengue-cl.1.3", "text": "Nausea and / or vomitting", "answer": [ { "valueBoolean": true } ] }, { "linkId": "dengue-cl.1.4", "text": "Rash", "answer": [ { "valueBoolean": true } ] }, { "linkId": "dengue-cl.1.5", "text": "Leucopenia", "answer": [ { "valueBoolean": true } ] }, { "linkId": "dengue-cl.1.6", "text": "Any warning signs", "answer": [ { "valueBoolean": true } ] }, { "linkId": "dengue-cl.1.7", "text": "Remarks", "answer": [ { "valueString": "insert string here" } ] } ] }, { "linkId": "dengue-cl.2", "text": "Warning signs", "item": [ { "linkId": "dengue-cl.2.1", "text": "Persistent vomiting (3 or more than 3 times over the last 24 hours)", "answer": [ { "valueBoolean": true } ] }, { "linkId": "dengue-cl.2.2", "text": "Persistent diarrhea (3 or more than 3 times over the last 24 hours)", "answer": [ { "valueBoolean": true } ] }, { "linkId": "dengue-cl.2.3", "text": "Any abdominal pain / tenderness", "answer": [ { "valueBoolean": true } ] }, { "linkId": "dengue-cl.2.4", "text": "Lethargy / Restlessness / Confusion", "answer": [ { "valueBoolean": true } ] }, { "linkId": "dengue-cl.2.5", "text": "Tender liver", "answer": [ { "valueBoolean": true } ] }, { "linkId": "dengue-cl.2.6", "text": "Third space fluid accumulation", "answer": [ { "valueBoolean": true } ] }, { "linkId": "dengue-cl.2.7", "text": "Spontaneous bleeding tendencies", "answer": [ { "valueBoolean": true } ] }, { "linkId": "dengue-cl.2.8", "text": "Raised HCT with rapid drop in platelet. \nMale age ≤ 60 : HCT >46 \nMale age >60 : HCT > 42 \nFemale all ages : >40", "answer": [ { "valueBoolean": true } ] }, { "linkId": "dengue-cl.2.9", "text": "Remarks", "answer": [ { "valueString": "insert string here" } ] } ] }, { "linkId": "dengue-cl.3", "text": "Other criteria", "item": [ { "linkId": "dengue-cl.3.1", "text": "Syncope", "answer": [ { "valueBoolean": true } ] }, { "linkId": "dengue-cl.3.2", "text": "Social factor", "answer": [ { "valueBoolean": true } ] }, { "linkId": "dengue-cl.3.3", "text": "Remarks", "answer": [ { "valueString": "insert string here" } ] } ] }, { "linkId": "dengue-cl.4", "text": "Special Group", "item": [ { "linkId": "dengue-cl.4.1", "text": "Obese", "answer": [ { "valueBoolean": true } ] }, { "linkId": "dengue-cl.4.2", "text": "Pregnant", "answer": [ { "valueBoolean": true } ] }, { "linkId": "dengue-cl.4.3", "text": "Heart failure /CKD / CLD", "answer": [ { "valueBoolean": true } ] }, { "linkId": "dengue-cl.4.4", "text": "Diabetes Mellitus", "answer": [ { "valueBoolean": true } ] }, { "linkId": "dengue-cl.4.5", "text": "Hypertension", "answer": [ { "valueBoolean": true } ] }, { "linkId": "dengue-cl.4.6", "text": "IHD", "answer": [ { "valueBoolean": true } ] }, { "linkId": "dengue-cl.4.7", "text": "COPD", "answer": [ { "valueBoolean": true } ] }, { "linkId": "dengue-cl.4.8", "text": "Age > 65", "answer": [ { "valueBoolean": true } ] }, { "linkId": "dengue-cl.4.9", "text": "Remarks", "answer": [ { "valueString": "insert string here" } ] } ] }, { "linkId": "dengue-cl.5", "text": "Physical Examination and Vital signs", "item": [ { "linkId": "dengue-cl.5.1", "text": "Physical Examination findings", "answer": [ { "valueString": "insert string here" } ] }, { "linkId": "dengue-cl.5.2", "text": "Systolic Blood Pressure (mmHg)", "answer": [ { "valueQuantity": { "value": 12, "unit": "mmHg", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } } ] }, { "linkId": "dengue-cl.5.3", "text": "Diastolic Blood Pressure (mmHg)", "answer": [ { "valueQuantity": { "value": 12, "unit": "mmHg", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } } ] }, { "linkId": "dengue-cl.5.4", "text": "Heart Rate (/min)", "answer": [ { "valueQuantity": { "value": 12, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } } ] }, { "linkId": "dengue-cl.5.5", "text": "Body Temperature (°C)", "answer": [ { "valueQuantity": { "value": 12, "unit": "°C", "system": "http://unitsofmeasure.org", "code": "Cel" } } ] }, { "linkId": "dengue-cl.5.6", "text": "Oxygen Saturation (%)", "answer": [ { "valueQuantity": { "value": 12, "unit": "%", "system": "http://unitsofmeasure.org", "code": "%" } } ] }, { "linkId": "dengue-cl.5.7", "text": "Respiratory Rate (/min)", "answer": [ { "valueQuantity": { "value": 12, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } } ] }, { "linkId": "dengue-cl.5.8", "text": "Pain score" } ] }, { "linkId": "dengue-cl.6", "text": "Blood investigation", "item": [ { "linkId": "dengue-cl.6.1", "text": "White cell counts", "answer": [ { "valueString": "insert string here" } ] }, { "linkId": "dengue-cl.6.2", "text": "Hb", "answer": [ { "valueString": "insert string here" } ] }, { "linkId": "dengue-cl.6.3", "text": "HCT", "answer": [ { "valueString": "inseinsert string herert string here" } ] }, { "linkId": "dengue-cl.6.4", "text": "Platelet", "answer": [ { "valueString": "insert string here" } ] }, { "linkId": "dengue-cl.6.5", "text": "Dengue Point of Care checklist (Combo/Rapid checklist)", "answer": [ { "valueString": "insert string here" } ] } ] }, { "linkId": "dengue-cl.7", "text": "Severe Dengue", "item": [ { "linkId": "dengue-cl.7.1", "text": "Hypotension SBP <90 or MAP <60 or SBP drop > 40mmHg from known baseline", "answer": [ { "valueBoolean": true } ] }, { "linkId": "dengue-cl.7.2", "text": "Shock Index: HR > SBP or abnormal CCTVR", "answer": [ { "valueBoolean": true } ] }, { "linkId": "dengue-cl.7.3", "text": "Third Space fluid accumulation with respiratory distress", "answer": [ { "valueBoolean": true } ] }, { "linkId": "dengue-cl.7.4", "text": "Altered concious level", "answer": [ { "valueBoolean": true } ] }, { "linkId": "dengue-cl.7.5", "text": "Any bleed GI / non mucosal and non cutaneous / non physiological", "answer": [ { "valueBoolean": true } ] }, { "linkId": "dengue-cl.7.6", "text": "Specific organ dysfunction", "answer": [ { "valueBoolean": true } ] }, { "linkId": "dengue-cl.7.7", "text": "Remarks", "answer": [ { "valueString": "insert string here" } ] } ] }, { "linkId": "dengue-cl.8", "text": "Onset of illness", "item": [ { "linkId": "dengue-cl.8,1", "text": "Fever onset", "answer": [ { "valueDateTime": "2023-06-26T02:23:10.392Z" } ] }, { "linkId": "dengue-cl.8.2", "text": "Critical phase onset", "answer": [ { "valueDateTime": "2023-06-12T02:23:11.621Z" } ] } ] }, { "linkId": "dengue-cl.9", "text": "Phase of illness", "answer": [ { "valueCoding": { "code": "02", "display": "Critical" } } ] }, { "linkId": "dengue-cl.10", "text": "Diagnosis", "answer": [ { "valueCoding": { "code": "01", "display": "Dengue fever without warning signs" } } ] }, { "linkId": "dengue-cl.11", "text": "Management", "item": [ { "linkId": "dengue-cl.11.1", "text": "Management/Plans", "answer": [ { "valueString": "insert string here" } ] } ] } ] } |
| 2. | Hypertension Clerking Note |
Questionnaire
{ "resourceType": "Questionnaire", "id": "q-hpt-note", "url": "http://fhir.hie.moh.gov.my/Questionnaire/q-hpt-note", "version": "1.0.0", "name": "QHptNoteA", "title": "Hypertension Clerking Note", "status": "active", "date": "2024-02-12T04:04:09.5621857+00:00", "description": "Hypertension Clerking Note", "item": [ { "linkId": "hpt-note.1", "text": "Concomitant Disease", "type": "group", "item": [ { "linkId": "hpt-note.1.1", "text": "Diabetes Mellitus", "type": "boolean" }, { "linkId": "hpt-note.1.2", "text": "Renal Disease", "type": "boolean" }, { "linkId": "hpt-note.1.3", "text": "Heart Failure", "type": "boolean" }, { "linkId": "hpt-note.1.4", "text": "Gout", "type": "boolean" }, { "linkId": "hpt-note.1.5", "text": "Concomitant Disease Remarks", "type": "text" } ] }, { "linkId": "hpt-note.2", "text": "Past Medical Admissions for Hypertension", "type": "group", "item": [ { "linkId": "hpt-note.2.1", "text": "Any Ward Admissions For Hypertension Emergencies", "type": "boolean" }, { "linkId": "hpt-note.2.2", "text": "Any Emergency Department Encounters", "type": "boolean" }, { "linkId": "hpt-note.2.3", "text": "Past Medical Admissions Remarks", "type": "text" } ] }, { "linkId": "hpt-note.3", "text": "Medication Summary", "type": "group", "item": [ { "linkId": "hpt-note.3.1", "text": "Findings", "type": "text" } ] }, { "linkId": "hpt-note.4", "text": "Smoking History", "type": "group", "item": [ { "linkId": "hpt-note.4.1", "text": "Starting Date of Smoking", "type": "date" }, { "linkId": "hpt-note.4.2", "text": "How Many Cigarettes Per Day", "type": "integer" }, { "linkId": "hpt-note.4.3", "text": "Pack Years of Smoking (years)", "type": "integer" } ] }, { "linkId": "hpt-note.5", "text": "Social History", "type": "group", "item": [ { "linkId": "hpt-note.5.1", "text": "Findings", "type": "text" } ] }, { "linkId": "hpt-note.6", "text": "Family History", "type": "group", "item": [ { "linkId": "hpt-note.6.1", "text": "Findings", "type": "text" } ] }, { "linkId": "hpt-note.7", "text": "Symptoms", "type": "group", "item": [ { "linkId": "hpt-note.7.1", "text": "Visual Disturbances", "type": "boolean" }, { "linkId": "hpt-note.7.2", "text": "Chest Pain", "type": "boolean" }, { "linkId": "hpt-note.7.3", "text": "Lower Limb Swellings", "type": "boolean" }, { "linkId": "hpt-note.7.4", "text": "Headache", "type": "boolean" }, { "linkId": "hpt-note.7.5", "text": "Vomiting", "type": "boolean" }, { "linkId": "hpt-note.7.6", "text": "Limb Weakness", "type": "boolean" }, { "linkId": "hpt-note.7.7", "text": "Shortness of Breath", "type": "boolean" }, { "linkId": "hpt-note.7.8", "text": "Symptoms Remarks", "type": "text" } ] }, { "linkId": "hpt-note.8", "text": "History of Presenting Illness Summary", "type": "group", "item": [ { "linkId": "hpt-note.8.1", "text": "Findings", "type": "text" } ] }, { "linkId": "hpt-note.9", "text": "Initial Vital Signs", "type": "group", "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/minValue-my-core", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/maxValue-my-core", "valueInteger": 300 } ], "linkId": "hpt-note.9.1", "code": [ { "system": "http://loinc.org", "code": "8480-6", "display": "Systolic Blood Pressure" } ], "text": "Systolic Blood Pressure (mmHg)", "type": "quantity", "initial": [ { "valueQuantity": { "unit": "mmHg", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/minValue-my-core", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/maxValue-my-core", "valueInteger": 250 } ], "linkId": "hpt-note.9.2", "code": [ { "system": "http://loinc.org", "code": "8462-4", "display": "Diastolic Blood Pressure" } ], "text": "Diastolic Blood Pressure (mmHg)", "type": "quantity", "enableWhen": [ { "question": "hpt-note.9.1", "operator": "exists", "answerBoolean": true } ], "initial": [ { "valueQuantity": { "unit": "mmHg", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/minValue-my-core", "valueInteger": 0 }, { "url": "http://hl7.org/fhir/StructureDefinition/maxValue-my-core", "valueInteger": 400 } ], "linkId": "hpt-note.9.9", "text": "Heart Rate (/min)", "type": "quantity", "initial": [ { "valueQuantity": { "unit": "per minute", "system": "http://unitsofmeasure.org", "code": "/min" } } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/minValue-my-core", "valueInteger": 0 }, { "url": "http://hl7.org/fhir/StructureDefinition/maxValue-my-core", "valueInteger": 100 } ], "linkId": "hpt-note.9.10", "text": "Oxygen Saturation (%)", "type": "quantity", "initial": [ { "valueQuantity": { "unit": "%", "system": "http://unitsofmeasure.org", "code": "%" } } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/minValue-my-core", "valueInteger": 0 }, { "url": "http://hl7.org/fhir/StructureDefinition/maxValue-my-core", "valueInteger": 100 } ], "linkId": "hpt-note.9.11", "code": [ { "system": "http://loinc.org", "code": "8310-5", "display": "Body Temperature" } ], "text": "Body Temperature (°C)", "type": "quantity", "initial": [ { "valueQuantity": { "unit": "°C", "system": "http://unitsofmeasure.org", "code": "Cel" } } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/minValue-my-core", "valueInteger": 0 }, { "url": "http://hl7.org/fhir/StructureDefinition/maxValue-my-core", "valueInteger": 10 } ], "linkId": "hpt-note.9.12", "text": "Pain score", "type": "quantity" }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/minValue-my-core", "valueInteger": 0 }, { "url": "http://hl7.org/fhir/StructureDefinition/maxValue-my-core", "valueInteger": 80 } ], "linkId": "hpt-note.9.13", "text": "Respiratory Rate (/min)", "type": "quantity", "initial": [ { "valueQuantity": { "unit": "per minute", "system": "http://unitsofmeasure.org", "code": "/min" } } ] } ] }, { "linkId": "hpt-note.10", "text": "Blood Pressure Second Reading", "type": "group", "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/minValue-my-core", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/maxValue-my-core", "valueInteger": 300 } ], "linkId": "hpt-note.10.1", "code": [ { "system": "http://loinc.org", "code": "8480-6", "display": "Systolic Blood Pressure" } ], "text": "Systolic Blood Pressure Second Reading (mmHg)", "type": "quantity", "initial": [ { "valueQuantity": { "unit": "mmHg", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/minValue-my-core", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/maxValue-my-core", "valueInteger": 250 } ], "linkId": "hpt-note.10.2", "code": [ { "system": "http://loinc.org", "code": "8462-4", "display": "Diastolic Blood Pressure" } ], "text": "Diastolic Blood Pressure Second Reading (mmHg)", "type": "quantity", "enableWhen": [ { "question": "hpt-note.10.1", "operator": "exists", "answerBoolean": true } ], "initial": [ { "valueQuantity": { "unit": "mmHg", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } } ] }, { "linkId": "hpt-note.10.3", "text": "Recorded Time", "type": "dateTime" } ] }, { "linkId": "hpt-note.11", "text": "Blood Pressure Standing", "type": "group", "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/minValue-my-core", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/maxValue-my-core", "valueInteger": 300 } ], "linkId": "hpt-note.11.1", "code": [ { "system": "http://loinc.org", "code": "8480-6", "display": "Systolic Blood Pressure" } ], "text": "Systolic Blood Pressure Standing (mmHg)", "type": "quantity", "initial": [ { "valueQuantity": { "unit": "mmHg", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/minValue-my-core", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/maxValue-my-core", "valueInteger": 250 } ], "linkId": "hpt-note.11.2", "code": [ { "system": "http://loinc.org", "code": "8462-4", "display": "Diastolic Blood Pressure" } ], "text": "Diastolic Blood Pressure Standing (mmHg)", "type": "quantity", "enableWhen": [ { "question": "hpt-note.11.1", "operator": "exists", "answerBoolean": true } ], "initial": [ { "valueQuantity": { "unit": "mmHg", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } } ] }, { "linkId": "hpt-note.11.3", "text": "Recorded Time", "type": "dateTime" } ] }, { "linkId": "hpt-note.12", "text": "Blood Pressure Seated", "type": "group", "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/minValue-my-core", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/maxValue-my-core", "valueInteger": 300 } ], "linkId": "hpt-note.12.1", "text": "Systolic Blood Pressure Seated (mmHg)", "type": "quantity", "initial": [ { "valueQuantity": { "unit": "mmHg", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/minValue-my-core", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/maxValue-my-core", "valueInteger": 250 } ], "linkId": "hpt-note.12.2", "code": [ { "system": "http://loinc.org", "code": "8462-4", "display": "Diastolic Blood Pressure" } ], "text": "Diastolic Blood Pressure Seated (mmHg)", "type": "quantity", "enableWhen": [ { "question": "hpt-note.12.1", "operator": "exists", "answerBoolean": true } ], "initial": [ { "valueQuantity": { "unit": "mmHg", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } } ] }, { "linkId": "hpt-note.12.3", "text": "Recorded Time", "type": "dateTime" } ] }, { "linkId": "hpt-note.13", "text": "Central Nervous System Examinations", "type": "group", "item": [ { "linkId": "hpt-note.13.1", "text": "Findings", "type": "text" } ] }, { "linkId": "hpt-note.14", "text": "Eye Examination", "type": "group", "item": [ { "linkId": "hpt-note.14.1", "text": "Findings", "type": "text" } ] }, { "linkId": "hpt-note.15", "text": "Cranial Nerves Examination", "type": "group", "item": [ { "linkId": "hpt-note.15.1", "text": "Findings", "type": "text" } ] }, { "linkId": "hpt-note.16", "text": "Cardiac Examination", "type": "group", "item": [ { "linkId": "hpt-note.16.1", "text": "Findings", "type": "text" } ] }, { "linkId": "hpt-note.17", "text": "General Endocrine Examination", "type": "group", "item": [ { "linkId": "hpt-note.17.1", "text": "Findings", "type": "text" } ] }, { "linkId": "hpt-note.18", "text": "Abdominal Examination", "type": "group", "item": [ { "linkId": "hpt-note.18.1", "text": "Findings", "type": "text" } ] }, { "linkId": "hpt-note.19", "text": "Respiratory Examination", "type": "group", "item": [ { "linkId": "hpt-note.19.1", "text": "Findings", "type": "text" } ] }, { "linkId": "hpt-note.20", "text": "General Examination Findings Summary", "type": "group", "item": [ { "linkId": "hpt-note.20.1", "text": "Findings", "type": "text" } ] }, { "linkId": "hpt-note.21", "text": "Investigations / Special Test", "type": "group", "item": [ { "linkId": "hpt-note.21.1", "text": "Fundoscopy", "type": "text" }, { "linkId": "hpt-note.21.2", "text": "US KUB Findings", "type": "text" }, { "linkId": "hpt-note.21.3", "text": "CT Scan Findings", "type": "text" }, { "linkId": "hpt-note.21.4", "text": "Xray Findings", "type": "text" }, { "linkId": "hpt-note.21.5", "text": "General Investigations / Summary", "type": "text" } ] }, { "linkId": "hpt-note.22", "text": "Diagnosis", "type": "group", "item": [ { "linkId": "hpt-note.22.1", "text": "Diagnosis", "type": "text" } ] }, { "linkId": "hpt-note.23", "text": "Management / Treatment", "type": "group", "item": [ { "linkId": "hpt-note.23.1", "text": "Management Summary", "type": "text" } ] }, { "linkId": "hpt-note.24", "text": "TCA Date", "type": "group", "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/dateRule-my-core", "valueString": "futureDate" } ], "linkId": "hpt-note.24.1", "text": "Date", "type": "dateTime" } ] }, { "linkId": "hpt-note.25", "text": "Referral", "type": "group", "item": [ { "linkId": "hpt-note.25.1", "text": "Reason for Referral", "type": "text" }, { "linkId": "hpt-note.25.2", "text": "Spoken To", "type": "string" }, { "linkId": "hpt-note.25.3", "text": "Time of Referral made", "type": "dateTime" } ] } ] } QuestionnaireResponse
{ "resourceType": "QuestionnaireResponse", "id": "qr-hpt-note", "meta": { "source": "http://provider.hie.moh.gov.my", "profile": [ "http://fhir.hie.moh.gov.my/StructureDefinition/QuestionnaireResponse-my-core" ] }, "identifier": { "system": "http://fhir.hie.moh.gov.my/sid/template-section", "value": "qr-hpt-note" }, "questionnaire": "http://fhir.hie.moh.gov.my/Questionnaire/q-hpt-note", "status": "completed", "subject": { "reference": "Patient/3a1fe467-cad5-4ec9-83f8-fd6dfb46470c" }, "authored": "2023-04-27T00:20:14.414Z", "item": [ { "linkId": "hpt-note.1", "text": "Concomitant Disease", "item": [ { "linkId": "hpt-note.1.1", "text": "Diabetes Mellitus", "answer": [ { "valueBoolean": true } ] }, { "linkId": "hpt-note.1.2", "text": "Renal Disease", "answer": [ { "valueBoolean": true } ] }, { "linkId": "hpt-note.1.3", "text": "Heart Failure", "answer": [ { "valueBoolean": true } ] }, { "linkId": "hpt-note.1.4", "text": "Gout", "answer": [ { "valueBoolean": true } ] }, { "linkId": "hpt-note.1.5", "text": "Concomitant Disease Remarks", "answer": [ { "valueString": "enter string here" } ] } ] }, { "linkId": "hpt-note.2", "text": "Past Medical Admissions for Hypertension", "item": [ { "linkId": "hpt-note.2.1", "text": "Any ward admissions for Hypertension Emergencies", "answer": [ { "valueBoolean": true } ] }, { "linkId": "hpt-note.2.3", "text": "Past Medical Admissions Remarks", "answer": [ { "valueString": "enter string here" } ] } ] }, { "linkId": "hpt-note.3", "text": "Medication History", "answer": [ { "valueString": "enter string here" } ] }, { "linkId": "hpt-note.4", "text": "Smoking History", "answer": [ { "valueBoolean": true, "item": [ { "linkId": "hpt-note.4.1", "text": "Starting Date of Smoking", "answer": [ { "valueDateTime": "2023-05-28T08:24:00.500Z" } ] }, { "linkId": "hpt-note.4.2", "text": "How many ciggarates per day", "answer": [ { "valueInteger": 12 } ] }, { "linkId": "hpt-note.4.3", "text": "Pack years of smoking (years)", "answer": [ { "valueInteger": 12 } ] } ] } ] }, { "linkId": "hpt-note.5", "text": "Social History", "answer": [ { "valueString": "enter string here" } ] }, { "linkId": "hpt-note.6", "text": "Family History", "answer": [ { "valueString": "enter string here" } ] }, { "linkId": "hpt-note.7", "text": "Symptoms", "item": [ { "linkId": "hpt-note.7.1", "text": "Visual Disturbances", "answer": [ { "valueBoolean": true } ] }, { "linkId": "hpt-note.7.2", "text": "Chest pain", "answer": [ { "valueBoolean": true } ] }, { "linkId": "hpt-note.7.3", "text": "Lower limb swellings", "answer": [ { "valueBoolean": true } ] }, { "linkId": "hpt-note.7.4", "text": "Headache", "answer": [ { "valueBoolean": true } ] }, { "linkId": "hpt-note.7.5", "text": "Vomiting", "answer": [ { "valueBoolean": true } ] }, { "linkId": "hpt-note.7.6", "text": "Limb weakness", "answer": [ { "valueBoolean": true } ] }, { "linkId": "hpt-note.7.7", "text": "Shortness of breath", "answer": [ { "valueBoolean": true } ] }, { "linkId": "hpt-note.7.8", "text": "Symptoms Remarks", "answer": [ { "valueString": "enter string here" } ] } ] }, { "linkId": "hpt-note.8", "text": "History of Presenting Illness Summary", "answer": [ { "valueString": "enter string here" } ] }, { "linkId": "hpt-note.9", "text": "Vital Signs", "item": [ { "linkId": "hpt-note.9.1", "text": "BP on arrival systolic (mmHg)", "answer": [ { "valueInteger": 120 } ] }, { "linkId": "hpt-note.9.2", "text": "BP on arrival diastolic (mmHg)", "answer": [ { "valueInteger": 70 } ] }, { "linkId": "hpt-note.9.3", "text": "BP second reading systolic (mmHg)", "answer": [ { "valueInteger": 120 } ] }, { "linkId": "hpt-note.9.4", "text": "BP second reading diastolic (mmHg)", "answer": [ { "valueInteger": 70 } ] }, { "linkId": "hpt-note.9.5", "text": "BP systolic standing (mmHg)", "answer": [ { "valueInteger": 120 } ] }, { "linkId": "hpt-note.9.6", "text": "BP diastolic standing (mmHg)", "answer": [ { "valueInteger": 70 } ] }, { "linkId": "hpt-note.9.7", "text": "BP systolic seated (mmHg)", "answer": [ { "valueInteger": 120 } ] }, { "linkId": "hpt-note.9.8", "text": "BP diastolic seated (mmHg)", "answer": [ { "valueInteger": 70 } ] }, { "linkId": "hpt-note.9.9", "text": "Heart Rate (bpm)", "answer": [ { "valueInteger": 99 } ] }, { "linkId": "hpt-note.9.10", "text": "SPo2 (%)", "answer": [ { "valueInteger": 99 } ] }, { "linkId": "hpt-note.9.11", "text": "Temperature (Degrees Celcius)", "answer": [ { "valueDecimal": 36.87 } ] }, { "linkId": "hpt-note.9.12", "text": "Pain score", "answer": [ { "valueInteger": 2 } ] }, { "linkId": "hpt-note.9.13", "text": "CCTVR", "answer": [ { "valueString": "enter string here" } ] } ] }, { "linkId": "hpt-note.10", "text": "Central Nervous System Examinations (Normal Findings)", "answer": [ { "valueBoolean": true, "item": [ { "linkId": "hpt-note.10.1", "text": "Findings", "answer": [ { "valueString": "enter string here" } ] } ] } ] }, { "linkId": "hpt-note.11", "text": "Eye Examination (Normal Findings)", "answer": [ { "valueBoolean": true, "item": [ { "linkId": "hpt-note.11.1", "text": "Findings", "answer": [ { "valueString": "enter string here" } ] } ] } ] }, { "linkId": "hpt-note.12", "text": "Cranial Nerves Examination (Normal findings)", "answer": [ { "valueBoolean": true, "item": [ { "linkId": "hpt-note.12.1", "text": "Findings", "answer": [ { "valueString": "enter string here" } ] } ] } ] }, { "linkId": "hpt-note.13", "text": "Cardiac Examination (Normal Findings)", "answer": [ { "valueBoolean": true, "item": [ { "linkId": "hpt-note.13.1", "text": "Findings", "answer": [ { "valueString": "enter string here" } ] } ] } ] }, { "linkId": "hpt-note.14", "text": "General Endocrine Examination (Normal Findings)", "answer": [ { "valueBoolean": true, "item": [ { "linkId": "hpt-note.14.1", "text": "Findings", "answer": [ { "valueString": "enter string here" } ] } ] } ] }, { "linkId": "hpt-note.15", "text": "Abdominal Examination (Normal Findings)", "answer": [ { "valueBoolean": true, "item": [ { "linkId": "hpt-note.15.1", "text": "Findings", "answer": [ { "valueString": "enter string here" } ] } ] } ] }, { "linkId": "hpt-note.16", "text": "Respiratory Examination ( Normal Findings)", "answer": [ { "valueBoolean": true, "item": [ { "linkId": "hpt-note.16.1", "text": "Findings", "answer": [ { "valueString": "enter string here" } ] } ] } ] }, { "linkId": "hpt-note.17", "text": "General Examination Findings Summary", "answer": [ { "valueString": "enter string here" } ] }, { "linkId": "hpt-note.18", "text": "Investigations / Special Test", "answer": [ { "valueString": "enter string here", "item": [ { "linkId": "hpt-note.18.1", "text": "Fundoscopy", "answer": [ { "valueString": "enter string here" } ] }, { "linkId": "hpt-note.18.2", "text": "US KUB Findings", "answer": [ { "valueString": "enter string here" } ] }, { "linkId": "hpt-note.18.3", "text": "CT Scan Findings", "answer": [ { "valueString": "enter string here" } ] }, { "linkId": "hpt-note.18.4", "text": "Xray Findings", "answer": [ { "valueString": "enter string here" } ] } ] } ] }, { "linkId": "hpt-note.19", "text": "Diagnosis", "answer": [ { "valueString": "enter string here" } ] }, { "linkId": "hpt-note.20", "text": "Management/Treatment Summary", "answer": [ { "valueString": "enter string here" } ] }, { "linkId": "hpt-note.21", "text": "TCA Date", "answer": [ { "valueDateTime": "2023-05-28T08:24:52.474Z" } ] }, { "linkId": "hpt-note.22", "text": "Referral", "answer": [ { "valueBoolean": true, "item": [ { "linkId": "hpt-note.22.1", "text": "Reason for Referral", "answer": [ { "valueString": "enter string here" } ] }, { "linkId": "hpt-note.22.2", "text": "Spoken To:", "answer": [ { "valueString": "enter string here" } ] }, { "linkId": "hpt-note.22.3", "text": "Time of Referral made", "answer": [ { "valueDateTime": "2023-05-07T08:24:55.409Z" } ] } ] } ] } ] } |
| 3. | TB Clerking Template |
Questionnaire
{ "resourceType": "Questionnaire", "id": "q-tb-note", "url": "http://fhir.hie.moh.gov.my/Questionnaire/q-tb-note", "version": "1.0.0", "name": "QTbNote", "title": "TB Clerking Template", "status": "active", "date": "2024-02-12T04:04:09.5621857+00:00", "item": [ { "linkId": "tb-note.1", "text": "Special Group", "type": "group", "item": [ { "linkId": "tb-note.1.1", "text": "TB Contact", "type": "boolean" }, { "linkId": "tb-note.1.2", "text": "Pregnancy", "type": "boolean" }, { "linkId": "tb-note.1.3", "text": "Other Comorbids (e.g Diabetes Mellitus or Hypertension)", "type": "boolean" }, { "linkId": "tb-note.1.4", "text": "Immunocompromised (e.g. on Immunosupressants / HIV)", "type": "boolean" }, { "linkId": "tb-note.1.5", "text": "Special Group Remarks", "type": "text" } ] }, { "linkId": "tb-note.2", "text": "Past Medical / Surgical History", "type": "group", "item": [ { "linkId": "tb-note.2.1", "text": "Past Medical History", "type": "text" }, { "linkId": "tb-note.2.2", "text": "Past Surgical History", "type": "text" } ] }, { "linkId": "tb-note.3", "text": "Medication History", "type": "group", "item": [ { "linkId": "tb-note.3.1", "text": "Medication Details", "type": "text" } ] }, { "linkId": "tb-note.4", "text": "Social and Family History", "type": "group", "item": [ { "linkId": "tb-note.4.2", "text": "Social History", "type": "text" }, { "linkId": "tb-note.4.1", "text": "Family History", "type": "text" } ] }, { "linkId": "tb-note.5", "text": "Symptoms", "type": "group", "item": [ { "linkId": "tb-note.5.1", "text": "Cough", "type": "boolean" }, { "linkId": "tb-note.5.2", "text": "Fever", "type": "boolean" }, { "linkId": "tb-note.5.3", "text": "Night Sweats", "type": "boolean" }, { "linkId": "tb-note.5.4", "text": "Haemoptysis", "type": "boolean" }, { "linkId": "tb-note.5.5", "text": "Weight Loss", "type": "boolean" }, { "linkId": "tb-note.5.6", "text": "Chest Pain", "type": "boolean" }, { "linkId": "tb-note.5.7", "text": "Shortness of Breath", "type": "boolean" }, { "linkId": "tb-note.5.8", "text": "Lethargy", "type": "boolean" }, { "linkId": "tb-note.5.9", "text": "Symptoms Remark", "type": "text" } ] }, { "linkId": "tb-note.6", "text": "History of Presenting Illness Summary", "type": "group", "item": [ { "linkId": "tb-note.6.1", "text": "Findings", "type": "text" } ] }, { "linkId": "tb-note.7", "text": "Vital Signs", "type": "group", "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/minValue-my-core", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/maxValue-my-core", "valueInteger": 300 } ], "linkId": "tb-note.7.1", "code": [ { "system": "http://loinc.org", "code": "8480-6", "display": "Systolic Blood Pressure" } ], "text": "Systolic Blood Pressure (mmHg)", "type": "quantity", "initial": [ { "valueQuantity": { "unit": "mmHg", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/minValue-my-core", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/maxValue-my-core", "valueInteger": 250 } ], "linkId": "tb-note.7.2", "code": [ { "system": "http://loinc.org", "code": "8462-4", "display": "Diastolic Blood Pressure" } ], "text": "Diastolic Blood Pressure (mmHg)", "type": "quantity", "enableWhen": [ { "question": "tb-note.7.1", "operator": "exists", "answerBoolean": true } ], "initial": [ { "valueQuantity": { "unit": "mmHg", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/minValue-my-core", "valueInteger": 0 }, { "url": "http://hl7.org/fhir/StructureDefinition/maxValue-my-core", "valueInteger": 400 } ], "linkId": "tb-note.7.3", "text": "Heart Rate (/min)", "type": "quantity", "initial": [ { "valueQuantity": { "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/minValue-my-core", "valueInteger": 0 }, { "url": "http://hl7.org/fhir/StructureDefinition/maxValue-my-core", "valueInteger": 100 } ], "linkId": "tb-note.7.4", "code": [ { "system": "http://loinc.org", "code": "8310-5", "display": "Body Temperature" } ], "text": "Body Temperature (°C)", "type": "quantity", "initial": [ { "valueQuantity": { "unit": "°C", "system": "http://unitsofmeasure.org", "code": "Cel" } } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/minValue-my-core", "valueInteger": 0 }, { "url": "http://hl7.org/fhir/StructureDefinition/maxValue-my-core", "valueInteger": 100 } ], "linkId": "tb-note.7.5", "text": "Oxygen Saturation (%)", "type": "quantity", "initial": [ { "valueQuantity": { "unit": "%", "system": "http://unitsofmeasure.org", "code": "%" } } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/minValue-my-core", "valueInteger": 0 }, { "url": "http://hl7.org/fhir/StructureDefinition/maxValue-my-core", "valueInteger": 80 } ], "linkId": "tb-note.7.6", "text": "Respiratory Rate (/min)", "type": "quantity", "initial": [ { "valueQuantity": { "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } } ] }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/minValue-my-core", "valueInteger": 1 }, { "url": "http://hl7.org/fhir/StructureDefinition/maxValue-my-core", "valueInteger": 10 } ], "linkId": "tb-note.7.7", "text": "Pain score", "type": "quantity" } ] }, { "linkId": "tb-note.8", "text": "Physical Examination", "type": "group", "item": [ { "linkId": "tb-note.8.1", "text": "Findings", "type": "text" } ] }, { "linkId": "tb-note.9", "text": "Investigations / Special Test", "type": "group", "item": [ { "linkId": "tb-note.9.1", "text": "Findings", "type": "text" } ] }, { "linkId": "tb-note.10", "text": "Imaging", "type": "group", "item": [ { "linkId": "tb-note.10.1", "text": "Chest X ray Intepretation", "type": "text" } ] }, { "linkId": "tb-note.11", "text": "Diagnosis", "type": "group", "item": [ { "linkId": "tb-note.11.1", "text": "Diagnosis", "type": "text" } ] }, { "linkId": "tb-note.12", "text": "Management / Treatment", "type": "group", "item": [ { "linkId": "tb-note.12.1", "text": "Management Summary", "type": "text" } ] }, { "linkId": "tb-note.13", "text": "Notification of Infectious Disease", "type": "group", "item": [ { "linkId": "tb-note.13.1", "text": "Spoken To", "type": "text" }, { "linkId": "tb-note.13.2", "text": "Time of Notification", "type": "dateTime" } ] }, { "linkId": "tb-note.14", "text": "TCA Date", "type": "group", "item": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/dateRule-my-core", "valueString": "futureDate" } ], "linkId": "tb-note.14.1", "text": "Date", "type": "dateTime" } ] }, { "linkId": "tb-note.15", "text": "Referral", "type": "group", "item": [ { "linkId": "tb-note.15.1", "text": "Reason for Referral", "type": "text" }, { "linkId": "tb-note.15.2", "text": "Spoken To", "type": "string" }, { "linkId": "tb-note.15.3", "text": "Time of Referral", "type": "dateTime" } ] } ] } QuestionnaireResponse
{ "resourceType": "QuestionnaireResponse", "id": "qr-tb-note", "meta": { "source": "http://provider.hie.moh.gov.my", "profile": [ "http://fhir.hie.moh.gov.my/StructureDefinition/QuestionnaireResponse-my-core" ] }, "identifier": { "system": "http://fhir.hie.moh.gov.my/sid/template-section", "value": "qr-tb-note" }, "questionnaire": "http://fhir.hie.moh.gov.my/Questionnaire/q-tb-note", "status": "completed", "subject": { "reference": "Patient/3a1fe467-cad5-4ec9-83f8-fd6dfb46470c" }, "authored": "2023-04-27T00:20:14.414Z", "item": [ { "linkId": "tb-note.1", "text": "Special Group", "item": [ { "linkId": "tb-note.1.1", "text": "TB Contact", "answer": [ { "valueBoolean": true } ] }, { "linkId": "tb-note.1.2", "text": "Pregnancy", "answer": [ { "valueBoolean": true } ] }, { "linkId": "tb-note.1.3", "text": "Other comorbids (e.g Diabetes Mellitus or Hypertension)", "answer": [ { "valueBoolean": true } ] }, { "linkId": "tb-note.1.4", "text": "Immunocompromised (e.g. on immunosupressants / HIV)", "answer": [ { "valueBoolean": true } ] }, { "linkId": "tb-note.1.5", "text": "Special Group Remarks", "answer": [ { "valueString": "insert string here" } ] } ] }, { "linkId": "tb-note.2", "text": "Past Medical / Surgical History", "item": [ { "linkId": "tb-note.2.1", "text": "Past Medical History", "answer": [ { "valueString": "insert string here" } ] }, { "linkId": "tb-note.2.2", "text": "Past Surgical History", "answer": [ { "valueString": "insert string here" } ] } ] }, { "linkId": "tb-note.3", "text": "Medication History", "item": [ { "linkId": "tb-note.3.1", "text": "Medication Details", "answer": [ { "valueString": "insert string here" } ] } ] }, { "linkId": "tb-note.4", "text": "Social and Family History", "item": [ { "linkId": "tb-note.4.2", "text": "Social History", "answer": [ { "valueString": "insert string here" } ] }, { "linkId": "tb-note.4.1", "text": "Family History", "answer": [ { "valueString": "insert string here" } ] } ] }, { "linkId": "tb-note.5", "text": "Symptoms", "item": [ { "linkId": "tb-note.5.1", "text": "Cough", "answer": [ { "valueBoolean": true } ] }, { "linkId": "tb-note.5.2", "text": "Fever", "answer": [ { "valueBoolean": true } ] }, { "linkId": "tb-note.5.3", "text": "Night Sweats", "answer": [ { "valueBoolean": true } ] }, { "linkId": "tb-note.5.4", "text": "Haemoptysis", "answer": [ { "valueBoolean": true } ] }, { "linkId": "tb-note.5.5", "text": "Weight loss", "answer": [ { "valueBoolean": true } ] }, { "linkId": "tb-note.5.6", "text": "Chest pain", "answer": [ { "valueBoolean": true } ] }, { "linkId": "tb-note.5.7", "text": "Shortness of breath", "answer": [ { "valueBoolean": true } ] }, { "linkId": "tb-note.5.8", "text": "Lethargy", "answer": [ { "valueBoolean": true } ] }, { "linkId": "tb-note.5.9", "text": "Symptoms Remark", "answer": [ { "valueString": "insert string here" } ] } ] }, { "linkId": "tb-note.6", "text": "History of Presenting Illness Summary", "item": [ { "linkId": "tb-note.6.1", "text": "Findings", "answer": [ { "valueString": "insert string here" } ] } ] }, { "linkId": "tb-note.7", "text": "Vital Signs", "item": [ { "linkId": "tb-note.7.1", "text": "Systolic Blood Pressure (mmHg)", "answer": [ { "valueQuantity": { "value": 120, "unit": "mmHg", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } } ] }, { "linkId": "tb-note.7.2", "text": "Diastolic Blood Pressure (mmHg)", "answer": [ { "valueQuantity": { "value": 70, "unit": "mmHg", "system": "http://unitsofmeasure.org", "code": "mm[Hg]" } } ] }, { "linkId": "tb-note.7.3", "text": "Heart Rate (/min)", "answer": [ { "valueQuantity": { "value": 66, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } } ] }, { "linkId": "tb-note.7.4", "text": "Body Temperature (°C)", "answer": [ { "valueQuantity": { "value": 36.7, "unit": "°C", "system": "http://unitsofmeasure.org", "code": "Cel" } } ] }, { "linkId": "tb-note.7.5", "text": "Oxygen Saturation (%)", "answer": [ { "valueQuantity": { "value": 99, "unit": "%", "system": "http://unitsofmeasure.org", "code": "%" } } ] }, { "linkId": "tb-note.7.6", "text": "Respiratory Rate (/min)", "answer": [ { "valueQuantity": { "value": 66, "unit": "/min", "system": "http://unitsofmeasure.org", "code": "/min" } } ] }, { "linkId": "tb-note.7.7", "text": "Pain score", "answer": [ { "valueInteger": 2 } ] } ] }, { "linkId": "tb-note.8", "text": "Physical Examination", "item": [ { "linkId": "tb-note.8.1", "text": "Findings", "answer": [ { "valueString": "insert string here" } ] } ] }, { "linkId": "tb-note.9", "text": "Investigations / Special Test", "item": [ { "linkId": "tb-note.9.1", "text": "Findings", "answer": [ { "valueString": "insert string here" } ] } ] }, { "linkId": "tb-note.10", "text": "Imaging", "item": [ { "linkId": "tb-note.10.1", "text": "Chest X ray Intepretation", "answer": [ { "valueString": "insert string here" } ] } ] }, { "linkId": "tb-note.11", "text": "Diagnosis", "item": [ { "linkId": "tb-note.11.1", "text": "Diagnosis", "answer": [ { "valueString": "insert string here" } ] } ] }, { "linkId": "tb-note.12", "text": "Management / Treatment", "item": [ { "linkId": "tb-note.12.1", "text": "Management Summary", "answer": [ { "valueString": "insert string here" } ] } ] }, { "linkId": "tb-note.13", "text": "Notification of Infectious Disease", "item": [ { "linkId": "tb-note.13.1", "text": "Spoken To", "answer": [ { "valueString": "insert string here" } ] }, { "linkId": "tb-note.13.2", "text": "Time of Notification", "answer": [ { "valueDateTime": "2023-06-13T08:37:27.230Z" } ] } ] }, { "linkId": "tb-note.14", "text": "TCA Date", "item": [ { "linkId": "tb-note.14.1", "text": "Date", "answer": [ { "valueDateTime": "2023-06-26T08:37:29.780Z" } ] } ] }, { "linkId": "tb-note.15", "text": "Referral", "item": [ { "linkId": "tb-note.15.1", "text": "Reason for Referral", "answer": [ { "valueString": "insert string here" } ] }, { "linkId": "tb-note.15.2", "text": "Spoken To", "answer": [ { "valueString": "insert string here" } ] }, { "linkId": "tb-note.15.3", "text": "Time of Referral", "answer": [ { "valueDateTime": "2023-06-12T08:37:33.806Z" } ] } ] } ] } |
Self/Risk Assessment
Download Self/Risk Assessment Questionnaire
Download Self/Risk Assessment QuestionnaireResponse Sample
| No | Title | JSON |
|---|---|---|
| 1. | AUDIT-C |
Questionnaire
{ "resourceType": "Questionnaire", "id": "q-audit-c", "url": "http://fhir.hie.moh.gov.my/Questionnaire/q-audit-c", "title": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]", "status": "active", "date": "2024-02-12T04:04:09.5621857+00:00", "description": "The AUDIT-C is scored on a scale of 0-12 (scores of 0 reflect no alcohol use). In men, a score of 4 or more is considered positive; in women, a score of 3 or more is considered positive. Generally, the higher the AUDIT-C score, the more likely it is that the person's drinking is affecting his/her health and safety.", "useContext": [ { "code": { "system": "http://hl7.org/fhir/CodeSystem/usage-context-type", "code": "workflow", "display": "Workflow Setting" }, "valueCodeableConcept": { "coding": [ { "code": "self-assessment", "display": "Self-Assessment" } ] } } ], "purpose": "The AUDIT questionnaire is designed to help in the self-assessment of alcohol consumption and to identify any implications for the person's health and wellbeing, now and in the future.", "code": [ { "system": "http://loinc.org", "code": "72109-2", "display": "Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]" } ], "item": [ { "linkId": "01", "code": [ { "system": "http://loinc.org", "code": "68518-0", "display": "How often do you have a drink containing alcohol" } ], "prefix": "1", "text": "How often did you have a drink containing alcohol in the past year?", "type": "choice", "required": true, "answerOption": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 0.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA6270-8", "display": "Never" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 1.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA18926-8", "display": "Monthly or less" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 2.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA18927-6", "display": "Two to four times a month" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 3.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA18928-4", "display": "Two to three times per week" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 4.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA18929-2", "display": "Four or more times a week" } } ] }, { "linkId": "02", "code": [ { "system": "http://loinc.org", "code": "68519-8", "display": "How many standard drinks containing alcohol do you have on a typical day" } ], "prefix": "2", "text": "How many drinks containing alcohol did you have on a typical day when you were drinking in the past year?", "type": "choice", "required": true, "answerOption": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 0.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA6270-8", "display": "1 or 2 drinks" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 1.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA18926-8", "display": "3 or 4" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 2.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA18927-6", "display": "5 to 6" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 3.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA18928-4", "display": "7 to 9" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 4.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA18929-2", "display": "10 or more" } } ] }, { "linkId": "03", "code": [ { "system": "http://loinc.org", "code": "68520-6", "display": "How often do you have 6 or more drinks on 1 occasion" } ], "prefix": "3", "text": "How often did you have six or more drinks on one occasion in the past year?", "type": "choice", "required": true, "answerOption": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 0.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA6270-8", "display": "Never" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 1.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA18926-8", "display": "Less than monthly" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 2.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA18927-6", "display": "monthly" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 3.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA18928-4", "display": "weekly" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 4.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA18929-2", "display": "daily or almost daily" } } ] }, { "id": "score", "linkId": "04", "code": [ { "system": "http://loinc.org", "code": "75626-2", "display": "Total score [AUDIT-C]" } ], "prefix": "4", "text": "Total score [AUDIT-C]", "type": "integer", "required": true, "readOnly": true }, { "id": "outcome", "linkId": "05", "code": [ { "code": "outcome" } ], "prefix": "5", "text": "Outcome Summary [AUDIT]", "type": "choice", "required": true, "readOnly": true, "answerOption": [ { "valueCoding": { "system": "http://fhir.hie.moh.gov.my/CodeSystem/outcome-audit-c-my-core", "code": "a1", "display": "Low-Risk Consumption" } }, { "valueCoding": { "system": "http://fhir.hie.moh.gov.my/CodeSystem/outcome-audit-c-my-core", "code": "a2", "display": "Alcohol misuse" } }, { "valueCoding": { "system": "http://fhir.hie.moh.gov.my/CodeSystem/outcome-audit-c-my-core", "code": "a3", "display": "Alcohol misuse and possible health effected" } } ] } ] } QuestionnaireResponse
{ "resourceType": "QuestionnaireResponse", "id": "qr-audit-c", "meta": { "source": "http://provider.hie.moh.gov.my", "profile": [ "http://fhir.hie.moh.gov.my/StructureDefinition/QuestionnaireResponse-my-core" ] }, "extension": [ { "url": "http://fhir.hie.moh.gov.my/StructureDefinition/questionnaire-reference-my-core", "valueReference": { "reference": "Questionnaire/q-audit-c" } } ], "questionnaire": "http://fhir.hie.moh.gov.my/Questionnaire/q-audit-c", "status": "completed", "subject": { "reference": "Patient/bfb81ffe-637d-4b3f-befa-f7a1546ed9f8" }, "authored": "2023-01-30T04:22:00.113Z", "author": { "reference": "Patient/bfb81ffe-637d-4b3f-befa-f7a1546ed9f8" }, "item": [ { "linkId": "01", "text": "How often do you have a drink containing alcohol?", "answer": [ { "valueCoding": { "system": "http://loinc.org", "code": "LA6270-8", "display": "Never" } } ] }, { "linkId": "02", "text": "How many standard drinks containing alcohol do you have on a typical day when drinking?", "answer": [ { "valueCoding": { "system": "http://loinc.org", "code": "LA6270-8", "display": "Never" } } ] }, { "linkId": "03", "text": "How often do you have six or more drinks on one occasion?", "answer": [ { "valueCoding": { "system": "http://loinc.org", "code": "LA6270-8", "display": "Never" } } ] }, { "linkId": "04", "text": "Total score [AUDIT-C]", "answer": [ { "valueInteger": 0 } ] }, { "linkId": "05", "text": "Outcome Summary [AUDIT]", "answer": [ { "valueCoding": { "system": "http://fhir.hie.moh.gov.my/CodeSystem/outcome-audit-c-my-core", "code": "a1", "display": "Low-Risk Consumption" } } ] } ] } |
| 2. | AUDIT-10 |
Questionnaire
{ "resourceType": "Questionnaire", "id": "q-audit-10", "url": "http://fhir.hie.moh.gov.my/Questionnaire/q-audit-10", "title": "Alcohol Use Disorder Identification Test 10 [AUDIT-10]", "status": "active", "date": "2024-02-12T04:04:09.5621857+00:00", "description": "The AUDIT-10 has 10 questions and the range of possible scores is from 0 to 40 where 0 indicates an abstainer who has never had any problems from alcohol, 1 to 7 suggests low risk consumption, 8 to 14 suggest harmful alcohol consumption and ≥15 Likelihood of alcohol dependence (moderate-severe alcohol use disorder)", "useContext": [ { "code": { "system": "http://hl7.org/fhir/CodeSystem/usage-context-type", "code": "workflow", "display": "Workflow Setting" }, "valueCodeableConcept": { "coding": [ { "code": "self-assessment", "display": "Self-Assessment" } ] } } ], "purpose": "The AUDIT questionnaire is designed to help in the self-assessment of alcohol consumption and to identify any implications for the person's health and wellbeing, now and in the future.", "code": [ { "system": "http://loinc.org", "code": "72110-0", "display": "Alcohol Use Disorder Identification Test [AUDIT]" } ], "item": [ { "linkId": "00", "code": [ { "system": "http://loinc.org", "code": "46098-0", "display": "Sex" } ], "prefix": "1", "text": "Please select your gender", "type": "choice", "required": false, "answerOption": [ { "valueCoding": { "system": "http://hl7.org/fhir/administrative-gender", "code": "male", "display": "Male" } }, { "valueCoding": { "system": "http://hl7.org/fhir/administrative-gender", "code": "female", "display": "Female" } } ] }, { "linkId": "01", "code": [ { "system": "http://loinc.org", "code": "68518-0", "display": "How often do you have a drink containing alcohol" } ], "prefix": "2", "text": "How often do you have a drink containing alcohol?", "type": "choice", "required": true, "answerOption": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 0.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA6270-8", "display": "Never" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 1.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA18933-4", "display": "Monthly or less" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 2.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA18876-5", "display": "2-4 times a month" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 3.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA18891-4", "display": "2-3 times a week" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 4.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA18934-2", "display": "4 or more times a week" } } ] }, { "linkId": "02", "code": [ { "system": "http://loinc.org", "code": "68519-8", "display": "How many standard drinks containing alcohol do you have on a typical day" } ], "prefix": "3", "text": "How many standard drinks containing alcohol do you have on a typical day when drinking?", "type": "choice", "required": true, "answerOption": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 0.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA6270-8", "display": "1 or 2" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 1.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA18926-8", "display": "3 or 4" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 2.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA18927-6", "display": "5 or 6" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 3.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA18928-4", "display": "7 to 9" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 4.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA18929-2", "display": "10 or more" } } ] }, { "linkId": "03", "code": [ { "system": "http://loinc.org", "code": "68520-6", "display": "How often do you have 6 or more drinks on 1 occasion" } ], "prefix": "4", "text": "How often do you have six or more drinks on one occasion?", "type": "choice", "required": true, "answerOption": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 0.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA6270-8", "display": "Never" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 1.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA18926-8", "display": "Less than monthly" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 2.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA18927-6", "display": "Monthly" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 3.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA18928-4", "display": "Weekly" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 4.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA18929-2", "display": "Daily or almost daily" } } ] }, { "linkId": "04", "code": [ { "system": "http://loinc.org", "code": "97734-8", "display": "Inability to stop drinking once started" } ], "prefix": "5", "text": "During the past year, how often have you found that you were not able to stop drinking once you had started?", "type": "choice", "required": true, "answerOption": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 0.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA6270-8", "display": "Never" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 1.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA18933-4", "display": "Less than monthly" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 2.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA18876-5", "display": "Monthly" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 3.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA18891-4", "display": "Weekly" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 4.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA18934-2", "display": "Daily or almost daily" } } ] }, { "linkId": "05", "code": [ { "system": "http://loinc.org", "code": "97735-5", "display": "Failed expectations due to drinking" } ], "prefix": "6", "text": "During the past year, how often have you failed to do what was normally expected of you because of drinking?", "type": "choice", "required": true, "answerOption": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 0.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA6270-8", "display": "Never" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 1.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA18933-4", "display": "Less than monthly" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 2.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA18876-5", "display": "Monthly" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 3.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA18891-4", "display": "Weekly" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 4.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA18934-2", "display": "Daily or almost daily" } } ] }, { "linkId": "06", "code": [ { "system": "http://loinc.org", "code": "97736-3", "display": "Drink needed in morning to begin activities after drinking session" } ], "prefix": "7", "text": "During the past year, how often have you needed a drink in the morning to get yourself going after a heavy drinking session?", "type": "choice", "required": true, "answerOption": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 0.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA6270-8", "display": "Never" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 1.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA18933-4", "display": "Less than monthly" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 2.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA18876-5", "display": "Monthly" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 3.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA18891-4", "display": "Weekly" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 4.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA18934-2", "display": "Daily or almost daily" } } ] }, { "linkId": "07", "code": [ { "system": "http://loinc.org", "code": "97737-1", "display": "Guilt or remorse after drinking" } ], "prefix": "8", "text": "During the past year, how often have you had a feeling of guilt or remorse after drinking?", "type": "choice", "required": true, "answerOption": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 0.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA6270-8", "display": "Never" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 1.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA18933-4", "display": "Less than monthly" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 2.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA18876-5", "display": "Monthly" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 3.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA18891-4", "display": "Weekly" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 4.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA18934-2", "display": "Daily or almost daily" } } ] }, { "linkId": "08", "code": [ { "system": "http://loinc.org", "code": "97738-9", "display": "Inability to recall events from night before due to drinking" } ], "prefix": "9", "text": "During the past year, how often have you been unable to remember what happened the night before because you had been drinking?", "type": "choice", "required": true, "answerOption": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 0.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA6270-8", "display": "Never" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 1.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA18933-4", "display": "Less than monthly" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 2.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA18876-5", "display": "Monthly" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 3.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA18891-4", "display": "Weekly" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 4.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA18934-2", "display": "Daily or almost daily" } } ] }, { "linkId": "09", "code": [ { "system": "http://loinc.org", "code": "97739-7", "display": "Injury to you or someone else resulting from drinking" } ], "prefix": "10", "text": "Have you or someone else been injured as a result of your drinking?", "type": "choice", "required": true, "answerOption": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 0.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 2.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA32279-4", "display": "Yes, but not in the past year" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 4.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA32280-2", "display": "Yes, during the past year" } } ] }, { "linkId": "10", "code": [ { "system": "http://loinc.org", "code": "97740-5", "display": "Has anyone expressed concern about your drinking or suggested you cut down" } ], "prefix": "11", "text": "Has a relative or friend, doctor or other health worker been concerned about your drinking or suggested you cut down?", "type": "choice", "required": true, "answerOption": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 0.0 } ], "valueCoding": { "code": "LA32-8", "display": "No" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 2.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA32279-4", "display": "Yes, but not in the past year" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 4.0 } ], "valueCoding": { "system": "http://loinc.org", "code": "LA32280-2", "display": "Yes, during the past year" } } ] }, { "id": "score", "linkId": "11", "code": [ { "system": "http://loinc.org", "code": "75624-7", "display": "Total score [AUDIT]" } ], "prefix": "12", "text": "Total score [AUDIT]", "type": "integer", "required": true, "readOnly": true }, { "id": "outcome", "linkId": "12", "code": [ { "code": "outcome" } ], "prefix": "13", "text": "Outcome Summary [AUDIT]", "type": "choice", "required": true, "readOnly": true, "answerOption": [ { "valueCoding": { "system": "http://fhir.hie.moh.gov.my/CodeSystem/outcome-audit-10-my-core", "code": "a0", "display": "Indicates an abstainer who has never had any problems from alcohol" } }, { "valueCoding": { "system": "http://fhir.hie.moh.gov.my/CodeSystem/outcome-audit-10-my-core", "code": "a1", "display": "Suggests low risk consumption" } }, { "valueCoding": { "system": "http://fhir.hie.moh.gov.my/CodeSystem/outcome-audit-10-my-core", "code": "a2", "display": "Suggest harmful alcohol consumption" } }, { "valueCoding": { "system": "http://fhir.hie.moh.gov.my/CodeSystem/outcome-audit-10-my-core", "code": "a3", "display": "Likelihood of alcohol dependence (moderate-severe alcohol use disorder)" } } ] } ] } QuestionnaireResponse
{ "resourceType": "QuestionnaireResponse", "id": "qr-audit-10", "meta": { "source": "http://provider.hie.moh.gov.my", "profile": [ "http://fhir.hie.moh.gov.my/StructureDefinition/QuestionnaireResponse-my-core" ] }, "questionnaire": "http://fhir.hie.moh.gov.my/Questionnaire/q-audit-10", "status": "completed", "subject": { "reference": "Patient/bfb81ffe-637d-4b3f-befa-f7a1546ed9f8" }, "authored": "2022-08-03T04:22:00.113Z", "author": { "reference": "Patient/bfb81ffe-637d-4b3f-befa-f7a1546ed9f8" }, "item": [ { "linkId": "00", "text": "Please select your gender", "answer": [ { "valueCoding": { "system": "http://hl7.org/fhir/administrative-gender", "code": "male", "display": "Male" } } ] }, { "linkId": "01", "text": "How often do you have a drink containing alcohol?", "answer": [ { "valueCoding": { "system": "http://loinc.org", "code": "LA18926-8", "display": "Monthly or less" } } ] }, { "linkId": "02", "text": "How many standard drinks containing alcohol do you have on a typical day when drinking?", "answer": [ { "valueCoding": { "system": "http://loinc.org", "code": "LA18926-8", "display": "Monthly or less" } } ] }, { "linkId": "03", "text": "How often do you have six or more drinks on one occasion?", "answer": [ { "valueCoding": { "system": "http://loinc.org", "code": "LA18926-8", "display": "Monthly or less" } } ] }, { "linkId": "04", "text": "During the past year, how often have you found that you were not able to stop drinking once you had started?", "answer": [ { "valueCoding": { "system": "http://loinc.org", "code": "LA18933-4", "display": "Less than monthly" } } ] }, { "linkId": "05", "text": "During the past year, how often have you failed to do what was normally expected of you because of drinking?", "answer": [ { "valueCoding": { "system": "http://loinc.org", "code": "LA18933-4", "display": "Less than monthly" } } ] }, { "linkId": "06", "text": "During the past year, how often have you needed a drink in the morning to get yourself going after a heavy drinking session?", "answer": [ { "valueCoding": { "system": "http://loinc.org", "code": "LA6270-8", "display": "Never" } } ] }, { "linkId": "07", "text": "During the past year, how often have you had a feeling of guilt or remorse after drinking?", "answer": [ { "valueCoding": { "system": "http://loinc.org", "code": "LA6270-8", "display": "Never" } } ] }, { "linkId": "08", "text": "During the past year, how often have you been unable to remember what happened the night before because you had been drinking?", "answer": [ { "valueCoding": { "system": "http://loinc.org", "code": "LA6270-8", "display": "Never" } } ] }, { "linkId": "09", "text": "Have you or someone else been injured as a result of your drinking?", "answer": [ { "valueCoding": { "system": "http://loinc.org", "code": "LA32-8", "display": "No" } } ] }, { "linkId": "10", "text": "Has a relative or friend, doctor or other health worker been concerned about your drinking or suggested you cut down?", "answer": [ { "valueCoding": { "code": "LA32-8", "display": "No" } } ] }, { "linkId": "11", "text": "Total score [AUDIT]", "answer": [ { "valueInteger": 7 } ] }, { "linkId": "12", "text": "Outcome Summary [AUDIT]", "answer": [ { "valueCoding": { "system": "http://fhir.hie.moh.gov.my/CodeSystem/outcome-audit-10-my-core", "code": "a1", "display": "Low-risk consumption" } } ] } ] } |
| 3. | DASS-21 |
Questionnaire
{ "resourceType": "Questionnaire", "id": "q-dass-21", "meta": { "versionId": "4", "lastUpdated": "2024-02-06T11:39:55.765+08:00", "source": "#gvQEyVe526qP1u0y", "profile": [ "http://hl7.org/fhir/StructureDefinition/Questionnaire" ] }, "url": "http://fhir.hie.moh.gov.my/Questionnaire/dass-21", "title": "Depression Anxiety and Stress Scale 21 (DASS-21)", "status": "active", "date": "2023-08-30T01:44:59.0418083+00:00", "description": "Please read each statement and choose the answer that indicates how much the statement applied to you over the past week. There are no right or wrong answers. Do not spend too much time on any statement", "useContext": [ { "code": { "system": "http://terminology.hl7.org/CodeSystem/usage-context-type", "code": "workflow", "display": "Workflow Setting" }, "valueCodeableConcept": { "coding": [ { "code": "self-assessment", "display": "Self-Assessment" } ] } } ], "purpose": "The DASS-21 is the short form of the DASS-42, a self-report scale designed to measure the negative emotional states of depression, anxiety and stress.", "code": [ { "code": "dass-21" } ], "item": [ { "linkId": "01", "code": [ { "code": "stress" } ], "prefix": "1", "text": "I found it hard to wind down", "type": "choice", "required": true, "answerOption": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 0.0 } ], "valueCoding": { "code": "0", "display": "Never" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 1.0 } ], "valueCoding": { "code": "1", "display": "Sometimes" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 2.0 } ], "valueCoding": { "code": "2", "display": "Often" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 3.0 } ], "valueCoding": { "code": "3", "display": "Almost Always" } } ] }, { "linkId": "02", "code": [ { "code": "anxiety" } ], "prefix": "2", "text": "I was aware of dryness of my mouth", "type": "choice", "required": true, "answerOption": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 0.0 } ], "valueCoding": { "code": "0", "display": "Never" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 1.0 } ], "valueCoding": { "code": "1", "display": "Sometimes" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 2.0 } ], "valueCoding": { "code": "2", "display": "Often" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 3.0 } ], "valueCoding": { "code": "3", "display": "Almost Always" } } ] }, { "linkId": "03", "code": [ { "code": "depression" } ], "prefix": "3", "text": "I couldn’t seem to experience any positive feeling at all", "type": "choice", "required": true, "answerOption": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 0.0 } ], "valueCoding": { "code": "0", "display": "Never" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 1.0 } ], "valueCoding": { "code": "1", "display": "Sometimes" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 2.0 } ], "valueCoding": { "code": "2", "display": "Often" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 3.0 } ], "valueCoding": { "code": "3", "display": "Almost Always" } } ] }, { "linkId": "04", "code": [ { "code": "anxiety" } ], "prefix": "4", "text": "I experienced breathing difficulty", "type": "choice", "required": true, "answerOption": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 0.0 } ], "valueCoding": { "code": "0", "display": "Never" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 1.0 } ], "valueCoding": { "code": "1", "display": "Sometimes" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 2.0 } ], "valueCoding": { "code": "2", "display": "Often" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 3.0 } ], "valueCoding": { "code": "3", "display": "Almost Always" } } ] }, { "linkId": "05", "code": [ { "code": "depression" } ], "prefix": "5", "text": "I found it difficult to work up the initiative to do things", "type": "choice", "required": true, "answerOption": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 0.0 } ], "valueCoding": { "code": "0", "display": "Never" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 1.0 } ], "valueCoding": { "code": "1", "display": "Sometimes" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 2.0 } ], "valueCoding": { "code": "2", "display": "Often" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 3.0 } ], "valueCoding": { "code": "3", "display": "Almost Always" } } ] }, { "linkId": "06", "code": [ { "code": "stress" } ], "prefix": "6", "text": "I tended to over-react to situations", "type": "choice", "required": true, "answerOption": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 0.0 } ], "valueCoding": { "code": "0", "display": "Never" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 1.0 } ], "valueCoding": { "code": "1", "display": "Sometimes" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 2.0 } ], "valueCoding": { "code": "2", "display": "Often" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 3.0 } ], "valueCoding": { "code": "3", "display": "Almost Always" } } ] }, { "linkId": "07", "code": [ { "code": "anxiety" } ], "prefix": "7", "text": "I experienced trembling", "type": "choice", "required": true, "answerOption": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 0.0 } ], "valueCoding": { "code": "0", "display": "Never" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 1.0 } ], "valueCoding": { "code": "1", "display": "Sometimes" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 2.0 } ], "valueCoding": { "code": "2", "display": "Often" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 3.0 } ], "valueCoding": { "code": "3", "display": "Almost Always" } } ] }, { "linkId": "08", "code": [ { "code": "stress" } ], "prefix": "8", "text": "I felt that I was using a lot of nervous energy", "type": "choice", "required": true, "answerOption": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 0.0 } ], "valueCoding": { "code": "0", "display": "Never" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 1.0 } ], "valueCoding": { "code": "1", "display": "Sometimes" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 2.0 } ], "valueCoding": { "code": "2", "display": "Often" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 3.0 } ], "valueCoding": { "code": "3", "display": "Almost Always" } } ] }, { "linkId": "09", "code": [ { "code": "anxiety" } ], "prefix": "9", "text": "I was worried about situations in which I might panic and make a fool of myself", "type": "choice", "required": true, "answerOption": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 0.0 } ], "valueCoding": { "code": "0", "display": "Never" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 1.0 } ], "valueCoding": { "code": "1", "display": "Sometimes" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 2.0 } ], "valueCoding": { "code": "2", "display": "Often" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 3.0 } ], "valueCoding": { "code": "3", "display": "Almost Always" } } ] }, { "linkId": "10", "code": [ { "code": "depression" } ], "prefix": "10", "text": "I felt that I had nothing to look forward to", "type": "choice", "required": true, "answerOption": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 0.0 } ], "valueCoding": { "code": "0", "display": "Never" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 1.0 } ], "valueCoding": { "code": "1", "display": "Sometimes" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 2.0 } ], "valueCoding": { "code": "2", "display": "Often" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 3.0 } ], "valueCoding": { "code": "3", "display": "Almost Always" } } ] }, { "linkId": "11", "code": [ { "code": "stress" } ], "prefix": "11", "text": "I found myself getting agitated", "type": "choice", "required": true, "answerOption": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 0.0 } ], "valueCoding": { "code": "0", "display": "Never" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 1.0 } ], "valueCoding": { "code": "1", "display": "Sometimes" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 2.0 } ], "valueCoding": { "code": "2", "display": "Often" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 3.0 } ], "valueCoding": { "code": "3", "display": "Almost Always" } } ] }, { "linkId": "12", "code": [ { "code": "stress" } ], "prefix": "12", "text": "I found it difficult to relax", "type": "choice", "required": true, "answerOption": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 0.0 } ], "valueCoding": { "code": "0", "display": "Never" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 1.0 } ], "valueCoding": { "code": "1", "display": "Sometimes" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 2.0 } ], "valueCoding": { "code": "2", "display": "Often" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 3.0 } ], "valueCoding": { "code": "3", "display": "Almost Always" } } ] }, { "linkId": "13", "code": [ { "code": "depression" } ], "prefix": "13", "text": "I felt down-hearted and blue", "type": "choice", "required": true, "answerOption": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 0.0 } ], "valueCoding": { "code": "0", "display": "Never" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 1.0 } ], "valueCoding": { "code": "1", "display": "Sometimes" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 2.0 } ], "valueCoding": { "code": "2", "display": "Often" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 3.0 } ], "valueCoding": { "code": "3", "display": "Almost Always" } } ] }, { "linkId": "14", "code": [ { "code": "stress" } ], "prefix": "14", "text": "I was intolerant of anything that kept me from getting on with what I was doing", "type": "choice", "required": true, "answerOption": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 0.0 } ], "valueCoding": { "code": "0", "display": "Never" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 1.0 } ], "valueCoding": { "code": "1", "display": "Sometimes" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 2.0 } ], "valueCoding": { "code": "2", "display": "Often" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 3.0 } ], "valueCoding": { "code": "3", "display": "Almost Always" } } ] }, { "linkId": "15", "code": [ { "code": "anxiety" } ], "prefix": "15", "text": "I felt I was close to panic", "type": "choice", "required": true, "answerOption": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 0.0 } ], "valueCoding": { "code": "0", "display": "Never" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 1.0 } ], "valueCoding": { "code": "1", "display": "Sometimes" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 2.0 } ], "valueCoding": { "code": "2", "display": "Often" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 3.0 } ], "valueCoding": { "code": "3", "display": "Almost Always" } } ] }, { "linkId": "16", "code": [ { "code": "depression" } ], "prefix": "16", "text": "I was unable to become enthusiastic about anything", "type": "choice", "required": true, "answerOption": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 0.0 } ], "valueCoding": { "code": "0", "display": "Never" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 1.0 } ], "valueCoding": { "code": "1", "display": "Sometimes" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 2.0 } ], "valueCoding": { "code": "2", "display": "Often" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 3.0 } ], "valueCoding": { "code": "3", "display": "Almost Always" } } ] }, { "linkId": "17", "code": [ { "code": "depression" } ], "prefix": "17", "text": "I felt I wasn’t worth much as a person", "type": "choice", "required": true, "answerOption": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 0.0 } ], "valueCoding": { "code": "0", "display": "Never" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 1.0 } ], "valueCoding": { "code": "1", "display": "Sometimes" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 2.0 } ], "valueCoding": { "code": "2", "display": "Often" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 3.0 } ], "valueCoding": { "code": "3", "display": "Almost Always" } } ] }, { "linkId": "18", "code": [ { "code": "stress" } ], "prefix": "18", "text": "I felt that I was rather touchy", "type": "choice", "required": true, "answerOption": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 0.0 } ], "valueCoding": { "code": "0", "display": "Never" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 1.0 } ], "valueCoding": { "code": "1", "display": "Sometimes" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 2.0 } ], "valueCoding": { "code": "2", "display": "Often" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 3.0 } ], "valueCoding": { "code": "3", "display": "Almost Always" } } ] }, { "linkId": "19", "code": [ { "code": "anxiety" } ], "prefix": "19", "text": "I was aware of the action of my heart in the absence of physical exertion", "type": "choice", "required": true, "answerOption": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 0.0 } ], "valueCoding": { "code": "0", "display": "Never" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 1.0 } ], "valueCoding": { "code": "1", "display": "Sometimes" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 2.0 } ], "valueCoding": { "code": "2", "display": "Often" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 3.0 } ], "valueCoding": { "code": "3", "display": "Almost Always" } } ] }, { "linkId": "20", "code": [ { "code": "anxiety" } ], "prefix": "20", "text": "I felt scared without any good reason", "type": "choice", "required": true, "answerOption": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 0.0 } ], "valueCoding": { "code": "0", "display": "Never" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 1.0 } ], "valueCoding": { "code": "1", "display": "Sometimes" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 2.0 } ], "valueCoding": { "code": "2", "display": "Often" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 3.0 } ], "valueCoding": { "code": "3", "display": "Almost Always" } } ] }, { "linkId": "21", "code": [ { "code": "depression" } ], "prefix": "21", "text": "I felt that life was meaningless", "type": "choice", "required": true, "answerOption": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 0.0 } ], "valueCoding": { "code": "0", "display": "Never" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 1.0 } ], "valueCoding": { "code": "1", "display": "Sometimes" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 2.0 } ], "valueCoding": { "code": "2", "display": "Often" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue-my-core", "valueDecimal": 3.0 } ], "valueCoding": { "code": "3", "display": "Almost Always" } } ] }, { "id": "score-stress", "linkId": "22", "code": [ { "code": "stress-score" } ], "text": "Stress Score", "type": "integer", "required": true, "readOnly": true }, { "id": "outcome-stress", "linkId": "23", "code": [ { "code": "stress outcome" } ], |