<Questionnaire xmlns="http://hl7.org/fhir"> <id value="questionnaire-Respect-3-R4" /> <url value="http://openehr.org.uk/fhir/questionnaire-respect-3-R4" /> <version value="0" /> <name value="Respect-3" /> <status value="draft" /> <date value="2020-12-02" /> <publisher value="openEHR" /> <contact> <telecom> <system value="url" /> <value value="http://www.veratech.es" /> </telecom> </contact> <description value="Document to communicate information to others, commonly in response to a request from another party." /> <item> <linkId value="openEHR-EHR-COMPOSITION.report.v1:at0000" /> <text value="ReSPECT-3" /> <type value="group" /> <item> <linkId value="openEHR-EHR-SECTION.respect_headings.v0:at0000" /> <text value="ReSPECT headings" /> <type value="group" /> <item> <linkId value="openEHR-EHR-SECTION.respect_headings.v0:at0001" /> <text value="2. Shared understanding" /> <type value="group" /> <item> <linkId value="openEHR-EHR-EVALUATION.clinical_synopsis.v1:at0000" /> <text value="ReSPECT Summary" /> <type value="group" /> </item> <item> <linkId value="openEHR-EHR-SECTION.adhoc.v1:at0000" /> <text value="Details of other relevant care planning documents and where to find them" /> <type value="group" /> <item> <linkId value="openEHR-EHR-EVALUATION.advance_care_directive.v1:at0000" /> <text value="Advance planning document" /> <type value="group" /> <repeats value="true" /> </item> </item> <item> <linkId value="openEHR-EHR-SECTION.ehr_reference.v0:at0000" /> <text value="Legal welfare proxies" /> <type value="group" /> <item> <linkId value="openEHR-EHR-ADMIN_ENTRY.legal_authority.v0:at0000" /> <text value="Legal welfare proxy in place" /> <type value="group" /> <repeats value="true" /> <item> <linkId value="openEHR-EHR-ADMIN_ENTRY.legal_authority.v0:at0002" /> <text value="Type" /> <type value="text" /> </item> <item> <linkId value="openEHR-EHR-ADMIN_ENTRY.legal_authority.v0:at0004" /> <text value="Status" /> <type value="choice" /> <answerValueSet value="http://openehr.org.uk/fhir/ValueSet-report-v1-status-R4" /> </item> </item> </item> </item> <item> <linkId value="openEHR-EHR-SECTION.respect_headings.v0:at0006" /> <text value="3. What matters to me" /> <type value="group" /> <item> <linkId value="openEHR-EHR-EVALUATION.about_me.v0:at0000" /> <text value="What matters to me" /> <type value="group" /> </item> </item> <item> <linkId value="openEHR-EHR-SECTION.respect_headings.v0:at0007" /> <text value="4. Clinical recommendations" /> <type value="group" /> <item> <linkId value="openEHR-EHR-EVALUATION.recommendation.v1:at0000" /> <text value="Recommendation" /> <type value="group" /> </item> <item> <linkId value="openEHR-EHR-EVALUATION.cpr_decision_uk.v0:at0000" /> <text value="CPR decision" /> <type value="group" /> </item> </item> <item> <linkId value="openEHR-EHR-SECTION.respect_headings.v0:at0008" /> <text value="5. Capacity for involvement" /> <type value="group" /> <item> <linkId value="openEHR-EHR-EVALUATION.mental_capacity.v0:at0000" /> <text value="Mental capacity" /> <type value="group" /> </item> </item> <item> <linkId value="openEHR-EHR-SECTION.respect_headings.v0:at0009" /> <text value="6. Involvement in making plan" /> <type value="group" /> <item> <linkId value="openEHR-EHR-ADMIN_ENTRY.respect_involvement.v0:at0000" /> <text value="ReSPECT involvement" /> <type value="group" /> <item> <linkId value="openEHR-EHR-ADMIN_ENTRY.respect_involvement.v0:at0012" /> <text value="Involvement in recommendations" /> <type value="group" /> <item> <linkId value="openEHR-EHR-ADMIN_ENTRY.respect_involvement.v0:at0002" /> <text value="Involvement" /> <type value="choice" /> <repeats value="true" /> <answerValueSet value="http://openehr.org.uk/fhir/ValueSet-report-v1-involvement-R4" /> </item> <item> <linkId value="openEHR-EHR-ADMIN_ENTRY.respect_involvement.v0:at0007" /> <text value="Option D" /> <type value="text" /> </item> </item> </item> </item> <item> <linkId value="openEHR-EHR-SECTION.respect_headings.v0:at0010" /> <text value="7. Clinician signatures" /> <type value="group" /> <item> <linkId value="openEHR-EHR-ACTION.service.v0:at0000" /> <text value="Clinician signature" /> <type value="group" /> <repeats value="true" /> </item> </item> <item> <linkId value="openEHR-EHR-SECTION.respect_headings.v0:at0011" /> <text value="8. Emergency contacts" /> <type value="group" /> <item> <linkId value="openEHR-EHR-ADMIN_ENTRY.care_team.v0:at0000" /> <text value="Emergency contacts" /> <type value="group" /> <item> <linkId value="openEHR-EHR-CLUSTER.care_team.v0:at0018" /> <text value="Name" /> <type value="text" /> </item> <item> <linkId value="openEHR-EHR-CLUSTER.care_team.v0:at0021" /> <text value="Participant" /> <type value="group" /> <repeats value="true" /> <item> <linkId value="openEHR-EHR-CLUSTER.care_team.v0:at0022" /> <text value="Role and Relationship" /> <type value="text" /> <repeats value="true" /> </item> <item> <linkId value="openEHR-EHR-CLUSTER.contact_cc.v0:at0000" /> <text value="Member" /> <type value="group" /> <item> <linkId value="openEHR-EHR-CLUSTER.name_cc.v0:at0000" /> <text value="Name" /> <type value="group" /> <repeats value="true" /> <item> <linkId value="openEHR-EHR-CLUSTER.name_cc.v0:at0001" /> <text value="Use" /> <type value="choice" /> <answerValueSet value="http://openehr.org.uk/fhir/ValueSet-report-v1-use-R4" /> </item> <item> <linkId value="openEHR-EHR-CLUSTER.name_cc.v0:at0009" /> <text value="Contact name" /> <type value="text" /> </item> </item> <item> <linkId value="openEHR-EHR-CLUSTER.telecom_cc.v0:at0000" /> <text value="Telephone" /> <type value="group" /> <repeats value="true" /> <item> <linkId value="openEHR-EHR-CLUSTER.telecom_cc.v0:at0001" /> <text value="System" /> <type value="choice" /> <answerValueSet value="http://openehr.org.uk/fhir/ValueSet-report-v1-system-R4" /> </item> <item> <linkId value="openEHR-EHR-CLUSTER.telecom_cc.v0:at0002" /> <text value="Telephone number" /> <type value="text" /> </item> </item> </item> <item> <linkId value="openEHR-EHR-CLUSTER.care_team.v0:at0030" /> <text value="Other details about contact" /> <type value="text" /> </item> </item> </item> </item> <item> <linkId value="openEHR-EHR-SECTION.respect_headings.v0:at0012" /> <text value="9. Review of Plan" /> <type value="group" /> <item> <linkId value="openEHR-EHR-ACTION.service.v0:at0000_1" /> <text value="Review of plan" /> <type value="group" /> <repeats value="true" /> </item> </item> </item> </item> </Questionnaire>