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presentations/2023-05 Tutorials/Health-Status-Questionnaire.R4.json
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| { | ||
| "subjectType": [ | ||
| "Patient" | ||
| ], | ||
| "status": "draft", | ||
| "experimental": true, | ||
| "url": "http://example.org/sample", | ||
| "title": "Health Status Questionnaire", | ||
| "resourceType": "Questionnaire", | ||
| "meta": { | ||
| "profile": [ | ||
| "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire|2.7" | ||
| ], | ||
| "tag": [ | ||
| { | ||
| "code": "lformsVersion: 29.2.1" | ||
| } | ||
| ] | ||
| }, | ||
| "item": [ | ||
| { | ||
| "type": "display", | ||
| "text": "This questionnaire identifies adults for whom physical activity might be inappropriate or adults who should seek physician consultation before beginning a regular physical activity program." | ||
| }, | ||
| { | ||
| "type": "group", | ||
| "required": false, | ||
| "text": "Personal and Emergency Contact Information", | ||
| "prefix": "Section 1", | ||
| "item": [ | ||
| { | ||
| "type": "string", | ||
| "required": false, | ||
| "text": "Name" | ||
| }, | ||
| { | ||
| "type": "date", | ||
| "required": false, | ||
| "text": "Birth date" | ||
| }, | ||
| { | ||
| "type": "string", | ||
| "required": false, | ||
| "text": "Address" | ||
| }, | ||
| { | ||
| "type": "string", | ||
| "required": false, | ||
| "text": "Phone" | ||
| }, | ||
| { | ||
| "type": "string", | ||
| "required": false, | ||
| "text": "Physician's name" | ||
| }, | ||
| { | ||
| "type": "quantity", | ||
| "code": [ | ||
| { | ||
| "code": "8302-2", | ||
| "display": "Height", | ||
| "system": "http://loinc.org" | ||
| } | ||
| ], | ||
| "required": false, | ||
| "text": "Height" | ||
| }, | ||
| { | ||
| "type": "quantity", | ||
| "code": [ | ||
| { | ||
| "code": "29463-7", | ||
| "display": "Weight", | ||
| "system": "http://loinc.org" | ||
| } | ||
| ], | ||
| "required": false, | ||
| "text": "Weight" | ||
| }, | ||
| { | ||
| "type": "group", | ||
| "required": false, | ||
| "text": "General Medical History", | ||
| "prefix": "Section 2", | ||
| "item": [ | ||
| { | ||
| "type": "choice", | ||
| "extension": [ | ||
| { | ||
| "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", | ||
| "valueCodeableConcept": { | ||
| "coding": [ | ||
| { | ||
| "system": "http://hl7.org/fhir/questionnaire-item-control", | ||
| "code": "drop-down", | ||
| "display": "Drop down" | ||
| } | ||
| ], | ||
| "text": "Drop down" | ||
| } | ||
| } | ||
| ], | ||
| "required": false, | ||
| "repeats": true, | ||
| "text": "Heart history", | ||
| "answerOption": [ | ||
| { | ||
| "valueCoding": { | ||
| "code": "22298006", | ||
| "display": "Heart Attack", | ||
| "system": "http://snomed.info/sct" | ||
| } | ||
| }, | ||
| { | ||
| "valueCoding": { | ||
| "code": "64915003", | ||
| "display": "Heart surgery", | ||
| "system": "http://snomed.info/sct" | ||
| } | ||
| }, | ||
| { | ||
| "valueCoding": { | ||
| "code": "41976001", | ||
| "display": "Cardiac catheterization", | ||
| "system": "http://snomed.info/sct" | ||
| } | ||
| }, | ||
| { | ||
| "valueCoding": { | ||
| "code": "41339005", | ||
| "display": "Coronary angioplasty (PTCA)", | ||
| "system": "http://snomed.info/sct" | ||
| } | ||
| }, | ||
| { | ||
| "valueCoding": { | ||
| "code": "441509002", | ||
| "display": "Cardiac pacemaker", | ||
| "system": "http://snomed.info/sct" | ||
| } | ||
| }, | ||
| { | ||
| "valueCoding": { | ||
| "code": "361135004", | ||
| "display": "Cardiac rhythm disturbance", | ||
| "system": "http://snomed.info/sct" | ||
| } | ||
| }, | ||
| { | ||
| "valueCoding": { | ||
| "code": "368009", | ||
| "display": "Heart valve disease", | ||
| "system": "http://snomed.info/sct" | ||
| } | ||
| }, | ||
| { | ||
| "valueCoding": { | ||
| "code": "84114007", | ||
| "display": "Heart failure", | ||
| "system": "http://snomed.info/sct" | ||
| } | ||
| }, | ||
| { | ||
| "valueCoding": { | ||
| "code": "32413006", | ||
| "display": "Heart transplantation", | ||
| "system": "http://snomed.info/sct" | ||
| } | ||
| }, | ||
| { | ||
| "valueCoding": { | ||
| "code": "3213009", | ||
| "display": "Congenital heart disease", | ||
| "system": "http://snomed.info/sct" | ||
| } | ||
| } | ||
| ] | ||
| }, | ||
| { | ||
| "type": "choice", | ||
| "extension": [ | ||
| { | ||
| "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", | ||
| "valueCodeableConcept": { | ||
| "coding": [ | ||
| { | ||
| "system": "http://hl7.org/fhir/questionnaire-item-control", | ||
| "code": "drop-down", | ||
| "display": "Drop down" | ||
| } | ||
| ], | ||
| "text": "Drop down" | ||
| } | ||
| } | ||
| ], | ||
| "required": false, | ||
| "repeats": true, | ||
| "text": "Symptoms", | ||
| "answerOption": [ | ||
| { | ||
| "valueCoding": { | ||
| "code": "279084009|408729009=255214003", | ||
| "display": "You experience chest discomfort with exertion", | ||
| "system": "http://snomed.info/sct" | ||
| } | ||
| }, | ||
| { | ||
| "valueCoding": { | ||
| "code": "267036007", | ||
| "display": "You experience unreasonable shortness of breath at any time", | ||
| "system": "http://snomed.info/sct" | ||
| } | ||
| }, | ||
| { | ||
| "valueCoding": { | ||
| "display": "You experience dizziness, fainting, or blackouts" | ||
| } | ||
| }, | ||
| { | ||
| "valueCoding": { | ||
| "display": "You take heart medications" | ||
| } | ||
| } | ||
| ] | ||
| }, | ||
| { | ||
| "type": "choice", | ||
| "extension": [ | ||
| { | ||
| "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", | ||
| "valueCodeableConcept": { | ||
| "coding": [ | ||
| { | ||
| "system": "http://hl7.org/fhir/questionnaire-item-control", | ||
| "code": "drop-down", | ||
| "display": "Drop down" | ||
| } | ||
| ], | ||
| "text": "Drop down" | ||
| } | ||
| } | ||
| ], | ||
| "required": false, | ||
| "repeats": true, | ||
| "text": "Additional Health Issues", | ||
| "answerOption": [ | ||
| { | ||
| "valueCoding": { | ||
| "code": "50043002", | ||
| "display": "You have asthma or other lung disease (e.g., emphysema)", | ||
| "system": "http://snomed.info/sct" | ||
| } | ||
| }, | ||
| { | ||
| "valueCoding": { | ||
| "display": "You have burning or cramping sensations in your lower legs with minimal physical activity" | ||
| } | ||
| } | ||
| ] | ||
| }, | ||
| { | ||
| "text": "Please check the following conditions you have experienced", | ||
| "type": "display", | ||
| "linkId": "undefined-help", | ||
| "extension": [ | ||
| { | ||
| "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", | ||
| "valueCodeableConcept": { | ||
| "text": "Help-Button", | ||
| "coding": [ | ||
| { | ||
| "code": "help", | ||
| "display": "Help-Button", | ||
| "system": "http://hl7.org/fhir/questionnaire-item-control" | ||
| } | ||
| ] | ||
| } | ||
| } | ||
| ] | ||
| } | ||
| ] | ||
| } | ||
| ] | ||
| } | ||
| ] | ||
| } |