{
  "resourceType": "Questionnaire",
  "id": "KBV-PR-AW-Questionnaire-M39-2021-01",
  "url": "https://fhir.kbv.de/StructureDefinition/KBV_PR_AW_Questionnaire_M39_2021_01",
  "title": "KBV Muster 39",
  "status": "draft",
  "experimental": false,
  "subjectType": [
    "Patient"
  ],
  "date": "2021-01",
  "publisher": "Kassenärztliche Bundesvereinigung",
  "description": "Vorläufige Abbildung des KBV Muster 39 Version 2021-01",
  "item": [
    {
      "linkId": "1",
      "text": "Personalienfeld",
      "type": "group",
      "item": [
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceProfile",
              "valueCanonical": "https://fhir.kbv.de/StructureDefinition/KBV_PR_AW_Patient|1.3.0"
            }
          ],
          "linkId": "1.1",
          "text": "Referenz Patient inkl. Geschlecht",
          "type": "reference"
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceProfile",
              "valueCanonical": "https://fhir.kbv.de/StructureDefinition/KBV_PR_AW_BehandelnderFunktion|1.3.0"
            }
          ],
          "linkId": "1.2",
          "text": "Referenz BehandelnderFunktion",
          "type": "reference"
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceProfile",
              "valueCanonical": "https://fhir.kbv.de/StructureDefinition/KBV_PR_AW_Krankenversicherungsverhaeltnis|1.3.0"
            }
          ],
          "linkId": "1.3",
          "text": "Referenz Krankenversicherungsverhältnis",
          "type": "reference"
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceProfile",
              "valueCanonical": "https://fhir.kbv.de/StructureDefinition/KBV_PR_AW_Begegnung|1.3.0"
            }
          ],
          "linkId": "1.4",
          "text": "Referenz Begegnung",
          "type": "reference"
        },
        {
          "linkId": "1.5",
          "text": "Datum",
          "type": "date"
        }
      ]
    },
    {
      "linkId": "2",
      "text": "Administrative Daten",
      "type": "group",
      "item": [
        {
          "linkId": "2.1",
          "text": "Auftragsnummer des Labors",
          "type": "string"
        },
        {
          "linkId": "2.2",
          "text": "Alterskategorie",
          "type": "group",
          "item": [
            {
              "linkId": "2.2.1",
              "text": "20-29 Jahre",
              "type": "boolean"
            },
            {
              "linkId": "2.2.2",
              "text": "30-34 Jahre",
              "type": "boolean"
            },
            {
              "linkId": "2.2.3",
              "text": "ab 35 Jahre",
              "type": "boolean"
            }
          ]
        }
      ]
    },
    {
      "linkId": "3",
      "text": "Auftrag",
      "type": "group",
      "item": [
        {
          "linkId": "3.1",
          "text": "Primärscreening",
          "type": "boolean"
        },
        {
          "linkId": "3.2",
          "text": "Abklärungsdiagnostik",
          "type": "boolean"
        },
        {
          "linkId": "3.3",
          "text": "Zytologie",
          "type": "boolean"
        },
        {
          "linkId": "3.4",
          "text": "HPV-Test",
          "type": "boolean"
        },
        {
          "linkId": "3.5",
          "text": "Ko-Testung (Zyt.+HPV)",
          "type": "boolean"
        }
      ]
    },
    {
      "linkId": "4",
      "text": "Anamnese",
      "type": "group",
      "item": [
        {
          "linkId": "4.1",
          "text": "Wurde bereits eine Krebsfrüherkennungsuntersuchung durchgeführt?",
          "type": "group",
          "item": [
            {
              "linkId": "4.1.1",
              "text": "nein",
              "type": "boolean"
            },
            {
              "linkId": "4.1.2",
              "text": "ja",
              "type": "boolean"
            },
            {
              "linkId": "4.1.3",
              "text": "ja, zuletzt",
              "type": "date"
            }
          ]
        },
        {
          "linkId": "4.3",
          "text": "Gruppe",
          "type": "string"
        },
        {
          "linkId": "4.4",
          "text": "HPV-Impfung",
          "type": "group",
          "item": [
            {
              "linkId": "4.4.1",
              "text": "vollständig",
              "type": "boolean"
            },
            {
              "linkId": "4.4.2",
              "text": "unvollständig",
              "type": "boolean"
            },
            {
              "linkId": "4.4.3",
              "text": "keine",
              "type": "boolean"
            },
            {
              "linkId": "4.4.4",
              "text": "unklar",
              "type": "boolean"
            }
          ]
        },
        {
          "linkId": "4.5",
          "text": "HPV-HR-Testergebnis",
          "type": "group",
          "item": [
            {
              "linkId": "4.5.1",
              "text": "liegt nicht vor",
              "type": "boolean"
            },
            {
              "linkId": "4.5.2",
              "text": "liegt vor",
              "type": "boolean"
            },
            {
              "linkId": "4.5.3",
              "text": "positiv",
              "type": "boolean"
            },
            {
              "linkId": "4.5.4",
              "text": "negativ",
              "type": "boolean"
            },
            {
              "linkId": "4.5.5",
              "text": "nicht verwertbar",
              "type": "boolean"
            }
          ]
        },
        {
          "linkId": "4.6",
          "text": "Gynäkologische OP, Strahlen- oder Chemotherapie des Genitales",
          "type": "group",
          "item": [
            {
              "linkId": "4.6.1",
              "text": "nein",
              "type": "boolean"
            },
            {
              "linkId": "4.6.2",
              "text": "ja",
              "type": "boolean"
            },
            {
              "linkId": "4.6.3",
              "text": "welche?",
              "type": "string"
            },
            {
              "linkId": "4.6.4",
              "text": "wann?",
              "type": "string"
            }
          ]
        }
      ]
    },
    {
      "linkId": "4.7",
      "text": "letzte Periode",
      "type": "date"
    },
    {
      "linkId": "4.8",
      "text": "Gravidität",
      "type": "group",
      "item": [
        {
          "linkId": "4.8.1",
          "text": "nein",
          "type": "boolean"
        },
        {
          "linkId": "4.8.2",
          "text": "ja",
          "type": "boolean"
        }
      ]
    },
    {
      "linkId": "4.30",
      "text": "Ausfluss/ pathologische Blutung",
      "type": "group",
      "item": [
        {
          "linkId": "4.30.1",
          "text": "nein",
          "type": "boolean"
        },
        {
          "linkId": "4.30.2",
          "text": "ja",
          "type": "boolean"
        }
      ]
    },
    {
      "linkId": "4.11",
      "text": "IUP",
      "type": "group",
      "item": [
        {
          "linkId": "4.11.1",
          "text": "nein",
          "type": "boolean"
        },
        {
          "linkId": "4.11.2",
          "text": "ja",
          "type": "boolean"
        }
      ]
    },
    {
      "linkId": "4.31",
      "text": "Einnahme von Ovulationshemmer/sonstige Hormonanwendung(ggf. bitte in Anmerkungen erläutern)",
      "type": "group",
      "item": [
        {
          "linkId": "4.31.1",
          "text": "nein",
          "type": "boolean"
        },
        {
          "linkId": "4.31.2",
          "text": "ja",
          "type": "boolean"
        }
      ]
    },
    {
      "linkId": "4.32",
      "text": "Klinischer Befund",
      "type": "group",
      "item": [
        {
          "linkId": "4.32.1",
          "text": "unauffällig",
          "type": "boolean"
        },
        {
          "linkId": "4.32.2",
          "text": "auffällig",
          "type": "boolean"
        }
      ]
    },
    {
      "linkId": "5",
      "text": "Erläuterungen",
      "type": "group",
      "item": [
        {
          "linkId": "5.1",
          "text": "Erläuterungen ggf. gyn. Befunde {Vulva, Vagina, Portio); Diagnosen; sonstige Anmerkungen",
          "type": "text"
        },
        {
          "extension": [
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceProfile",
              "valueCanonical": "https://fhir.kbv.de/StructureDefinition/KBV_PR_AW_Observation_Befund|1.3.0"
            },
            {
              "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-referenceProfile",
              "valueCanonical": "https://fhir.kbv.de/StructureDefinition/KBV_PR_AW_Diagnose|1.3.0"
            }
          ],
          "linkId": "5.2",
          "text": "Befunde, Diagnosen",
          "type": "reference"
        }
      ]
    },
    {
      "linkId": "7",
      "text": "Zytologischer Befund / Kombinationsbefund",
      "type": "group",
      "item": [
        {
          "linkId": "7.1",
          "text": "Eingangsdatum",
          "type": "date"
        },
        {
          "linkId": "7.3",
          "text": "Endozervikale Zellen",
          "type": "group",
          "item": [
            {
              "linkId": "7.3.1",
              "text": "vorhanden",
              "type": "boolean"
            },
            {
              "linkId": "7.3.2",
              "text": "nicht vorhanden",
              "type": "boolean"
            }
          ]
        },
        {
          "linkId": "7.4",
          "text": "Proliferationsgrad",
          "type": "string"
        },
        {
          "linkId": "7.5",
          "text": "Döderleinflora",
          "type": "boolean"
        },
        {
          "linkId": "7.6",
          "text": "Mischflora",
          "type": "boolean"
        },
        {
          "linkId": "7.7",
          "text": "Kokkenflora",
          "type": "boolean"
        },
        {
          "linkId": "7.8",
          "text": "Trichomonaden",
          "type": "boolean"
        },
        {
          "linkId": "7.9",
          "text": "Candida",
          "type": "boolean"
        },
        {
          "linkId": "7.10",
          "text": "Gardnerella",
          "type": "boolean"
        },
        {
          "linkId": "7.11",
          "text": "Gruppe",
          "type": "string"
        },
        {
          "linkId": "7.12",
          "text": "HPV-HR-Testergebnis",
          "type": "group",
          "item": [
            {
              "linkId": "7.12.30",
              "text": "positiv, wenn ja: Liegt HPV-Typ 16 oder HPV-Typ 18 vor?",
              "type": "boolean"
            },
            {
              "linkId": "7.12.31",
              "text": "ja",
              "type": "boolean"
            },
            {
              "linkId": "7.12.32",
              "text": "nein",
              "type": "boolean"
            },
            {
              "linkId": "7.12.33",
              "text": "nicht differenzierbar",
              "type": "boolean"
            },
            {
              "linkId": "7.12.5",
              "text": "negativ",
              "type": "boolean"
            },
            {
              "linkId": "7.12.7",
              "text": "nicht verwertbar",
              "type": "boolean"
            }
          ]
        },
        {
          "linkId": "7.13",
          "text": "Bemerkungen",
          "type": "text"
        },
        {
          "linkId": "7.14",
          "text": "Zusammenfassende Empfehlung",
          "type": "group",
          "item": [
            {
              "linkId": "7.14.1",
              "text": "zytologische Kontrolle",
              "type": "boolean"
            },
            {
              "linkId": "7.14.2",
              "text": "nach Entzündungsbehandlung",
              "type": "boolean"
            },
            {
              "linkId": "7.14.3",
              "text": "nach Ostrogenbehandlung",
              "type": "boolean"
            },
            {
              "linkId": "7.14.4",
              "text": "HPV-Test",
              "type": "boolean"
            },
            {
              "linkId": "7.14.5",
              "text": "Ko-Test",
              "type": "boolean"
            },
            {
              "linkId": "7.14.6",
              "text": "Abklärungskolposkopie",
              "type": "boolean"
            }
          ]
        },
        {
          "linkId": "7.15",
          "text": "Zeitraum",
          "type": "group",
          "item": [
            {
              "linkId": "7.15.1",
              "text": "in Monaten",
              "type": "boolean"
            },
            {
              "linkId": "7.15.2",
              "text": "in Monaten",
              "type": "integer"
            },
            {
              "linkId": "7.15.3",
              "text": "sofort",
              "type": "boolean"
            }
          ]
        }
      ]
    }
  ]
}