Smart Forms
0.1.0 - ci-build

Smart Forms, published by AEHRC CSIRO. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/aehrc/smart-forms-ig/ and changes regularly. See the Directory of published versions

Questionnaire: Aboriginal and Torres Strait Islander Health Check - Patient Details

Official URL: http://www.health.gov.au/assessments/mbs/715/PatientDetails Version: 0.1.0
Draft as of 2024-04-02 Realm: Australia flag Computable Name: PatientDetails

Copyright/Legal: Copyright © 2022+ Australian Government Department of Health and Aged Care - All rights reserved. This content is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License. See https://creativecommons.org/licenses/by-sa/4.0/.

Patient Details sub-questionnaire for Aboriginal and Torres Strait Islander Health Check.

LinkIDTextCardinalityTypeFlagsDescription & Constraintsdoco
.. PatientDetailsPatient Details sub-questionnaire for Aboriginal and Torres Strait Islander Health Check.Questionnairehttp://www.health.gov.au/assessments/mbs/715/PatientDetails#0.1.0
... 5b224753-9365-44e3-823b-9c17e7394005Patient Details0..1group
.... CD-in-progress-32In progress0..1displayEnable When: MarkComplete-32 != true
.... CD-complete-32Complete0..1displayEnable When: MarkComplete-32 = true
.... RecordUpdate-PatientImportant: The patient record may not be updated with information entered here. Information intended for the patient record should be entered there first.0..1display
.... 17596726-34cf-4133-9960-7081e1d63558Name0..1stringiconiconExpressions:
  • Initial Values: (%patient.name.where(use='official').select((family | (given | prefix).join(' ')).join(', ').where($this != '') | text) | %patient.name.select((family | (given | prefix).join(' ')).join(', ').where($this != '') | text)).first()
.... 57093a06-62f7-4b8b-8cb4-2c9f451ac851Preferred name0..1stringiconiconExpressions:
  • Initial Values: (%patient.name.where(use='usual').select((family | (given | prefix).join(' ')).join(', ').where($this != '') | text)).first()
.... 540b1034-7c9a-4aba-a9ef-afb77d445a58Preferred pronouns0..1choiceiconiconValue Set: Australian Pronouns
Expressions:
  • Initial Values: %patient.extension.where(exists(url='http://hl7.org/fhir/StructureDefinition/individual-pronouns') and extension.where(url='period').value.end.empty()).extension.where(url='value').value.coding
.... f669a4fe-4818-429a-8847-d20da88d2bb3Gender identity0..1choiceiconiconValue Set: Gender Identity Response
Expressions:
  • Initial Values: %patient.extension.where(exists(url='http://hl7.org/fhir/StructureDefinition/individual-genderIdentity') and extension.where(url='period').value.end.empty()).extension.where(url='value').value.coding
.... 418e4a02-de77-48a0-a92a-fe8fcc52b1aaAdministrative gender0..1choiceiconiconValue Set: AdministrativeGender
Expressions:
.... 56ef44bb-3d1d-4972-aad1-834b69185d61Sex assigned at birth0..1choiceiconiconValue Set: Biological Sex
Expressions:
  • Initial Values: %patient.extension.where(exists(url='http://hl7.org/fhir/StructureDefinition/individual-recordedSexOrGender' and extension.where(exists(url='type' and value.coding.code='1515311000168102')) and extension.where(url='effectivePeriod').value.end.empty())).extension.where(url='value').value.coding
.... 90ad8f16-16e4-4438-a7aa-b3189f510da2Date of birth0..1dateiconiconExpressions:
.... e2a16e4d-2765-4b61-b286-82cfc6356b30Age0..1integericoniconExpressions:
  • Initial Values: iif(today().toString().select(substring(5,2) & substring(8,2)).toInteger() > %patient.birthDate.toString().select(substring(5,2) & substring(8,2)).toInteger(), today().toString().substring(0,4).toInteger() - %patient.birthDate.toString().substring(0,4).toInteger(), today().toString().substring(0,4).toInteger() - %patient.birthDate.toString().substring(0,4).toInteger() - 1)
.... 8acde9f8-7a91-4f0c-9216-38531ec984efAboriginal and/or Torres Strait Islander status0..1choiceiconiconValue Set: Aboriginal and/or Torres Strait Islander
Expressions:
  • Initial Values: %patient.extension.where(url='http://hl7.org.au/fhir/StructureDefinition/indigenous-status').value
.... c8852db9-efe9-4102-96db-cef3a8be0a5fParents/primary carer/s0..*choiceValue Set: Primary Carer Of Parent Or Grandparent
Expressions:
.... 7089c48e-4216-4089-a548-034cd585e4daOther family0..*stringExpressions:
..... 70c45932-99dc-42a3-9650-4683892a0892details0..1display
.... 42b1f5e0-bf4a-47d9-86a4-f2fe946ac01fOther0..*stringExpressions:
..... dcbd3a54-9b68-4486-bf30-f6f1723bc39cdetails0..1display
.... 06737e46-e880-4037-9a2c-bcd278cd70baParents/primary carer/s details0..*groupExpressions:
..... cc20ce96-af06-4cd7-aa9b-c2601a6169adName of parent/primary carer0..1string
..... 372d79bb-9d0b-42d2-a98c-cbe332bd3745Relationship to child0..1string
.... f1262ade-843c-4eba-a86d-51a9c97d134bHome address0..1group
..... 311d83bb-f22e-4f60-9b50-b6e38dd2059bNo fixed address0..1booleanDefinition: Address.extension:noFixedAddress
Expressions:
  • Initial Values: %HomeAddressRepeat.extension('http://hl7.org.au/fhir/StructureDefinition/no-fixed-address').value
..... 4e0dc185-f83e-4027-b7a8-ecb543d42c6dnull0..*groupEnable When: 311d83bb-f22e-4f60-9b50-b6e38dd2059b != true
...... 2fee2d51-7828-4178-b8c1-35edd32ba338Street address0..1stringDefinition: Address.line
Expressions:
...... ddb65ed1-f4b2-4730-af2a-2f98bc73c76fCity0..1stringDefinition: Address.city
Expressions:
...... d9a1236c-8d6e-4f20-a12a-9d5de5a1d0f6State0..1choiceDefinition: Address.state
Value Set: Australian States and Territories
Expressions:
...... 3f61a1ea-1c74-4f52-8519-432ce861a74fPostcode0..1stringDefinition: Address.postalCode
Expressions:
.... edc081ea-b5ba-4234-9234-8ee598c2f95fPostal address0..*groupiconiconExpressions:
..... 622970f1-3cf1-4f0a-bf05-b00a08046ebaPurpose of use0..1stringDefinition: Address.use
Expressions:
..... 2e8437cd-5ea0-4d44-8ab2-d2aa9ef18ba7Address0..1stringDefinition: Address.line
Expressions:
..... 2bde25e5-2c4c-4c0c-b6f3-c6859535a764City0..1stringDefinition: Address.city
Expressions:
..... b41a8b11-8dbf-4999-9d0a-71d39240fed1State0..1choiceDefinition: Address.state
Value Set: Australian States and Territories
Expressions:
..... 28b58e50-2a04-4192-9655-efc8d72f32faPostcode0..1stringDefinition: Address.postalCode
Expressions:
.... 9541f0b0-f5ba-4fe7-a8e9-ad003cef897bHome phone0..*stringExpressions:
  • Initial Values: %patient.telecom.where(system = 'phone' and use = 'home').value
.... 4037a02b-4a85-40e0-9be6-5b17df1aac56Mobile phone0..*stringExpressions:
  • Initial Values: %patient.telecom.where(system = 'phone' and use = 'mobile').value
.... c22390d3-1be6-4fd1-b775-6443b7239a6bEmergency contact0..*group
..... d7f2dd75-20c8-480f-8c22-71d604ebee8dName0..1stringExpressions:
  • Initial Values: %EmergencyContactRepeat.name.select((family | (given | prefix).join(' ')).join(', ').where($this != '') | text)
..... aa35d559-f45b-4d35-9453-dd02e4a790f3Relationship to child0..1stringExpressions:
..... 27099697-d6d1-42c0-bb0a-5e9ff7372a96Relationship to patient0..1stringExpressions:
..... 626e3723-6310-4b99-81c1-525676b027c8Phone0..*stringExpressions:
.... df1475ea-bf7e-4bf0-a69f-7f9608c3ed3cMedicare number0..1group
..... eb2a59ed-9632-4df1-b5b1-1e85c3b4b7cfNumber0..1stringExpressions:
  • Initial Values: %patient.identifier.where(type.coding.exists(system='http://terminology.hl7.org/CodeSystem/v2-0203' and code='MC')).value.substring(0,10)
..... d6253253-a124-494e-a1d8-7ce02c69ec11Reference number0..1stringExpressions:
  • Initial Values: %patient.identifier.where(type.coding.exists(system='http://terminology.hl7.org/CodeSystem/v2-0203' and code='MC')).value.substring(10,1)
..... c520e213-5313-42c3-860a-d30206620290Expiry0..1stringExpressions:
  • Initial Values: %patient.identifier.where(type.coding.exists(system='http://terminology.hl7.org/CodeSystem/v2-0203' and code='MC')).period.end.toString()
.... c1e4e967-c0aa-4280-b5d4-ab1f375ed9acPensioner Card Number0..1stringMax Length: 10
Expressions:
  • Initial Values: %patient.identifier.where(type.coding.exists(system='http://terminology.hl7.org/CodeSystem/v2-0203' and code='PEN')).value
.... a7e97574-3cea-4dfa-bef2-2665e7748364Health Care Card Number0..1stringMax Length: 10
Expressions:
  • Initial Values: %patient.identifier.where(type.coding.exists(system='http://terminology.hl7.org/CodeSystem/v2-0203' and code='HC')).value
.... 83814495-3a81-43f4-88df-42186cce516aRegistered for Closing the Gap PBS Co-payment Measure (CTG)0..1choiceiconiconValue Set: Yes/No/NA
.... e63547c6-1623-412f-963f-5f1ebf23563fChild has a birth certificate0..1choiceiconiconValue Set: Yes/No/NA
Expressions:
.... a8143230-b30d-4b85-9805-5f2f73f2dffaMy Aged Care0..1groupExpressions:
..... 7165c072-e3d8-4564-9d1d-d17f6807787cRegistered for My Aged Care0..1choiceiconiconValue Set: Yes/No/NA
..... 04e50521-dc85-4744-b7ab-6f8682aacb11My Aged Care Number0..1stringEnable When: 7165c072-e3d8-4564-9d1d-d17f6807787c = Yes (v2 Y/N Indicator#Y)
.... 2bfe50cb-7913-4f31-bce2-763c17ff8b1aNational Disability Insurance Scheme0..1group
..... 924b4500-53ac-4c4e-831b-7ab5569ff981Registered for NDIS0..1choiceiconiconValue Set: Yes/No/NA
..... 7379a0fd-d95b-4ecb-a781-9f43d1394f10NDIS Number0..1stringEnable When: 924b4500-53ac-4c4e-831b-7ab5569ff981 = Yes (v2 Y/N Indicator#Y)
.... 9bc882bc-e989-4600-9587-8089fb757641Children0..1groupExpressions:
..... e90b436b-2751-4e07-a40c-adfe951b6528Do you have children?0..1choiceiconiconValue Set: Yes/No/NA
..... 241f5fca-f61a-49bd-8972-52613c0e6d15Number of children0..1integerEnable When: e90b436b-2751-4e07-a40c-adfe951b6528 = Yes (v2 Y/N Indicator#Y)
..... 74ce4c60-31d6-4e78-9056-579937379451Number of children in your care0..1integerEnable When: e90b436b-2751-4e07-a40c-adfe951b6528 = Yes (v2 Y/N Indicator#Y)
.... 2b5ae784-4341-4172-875d-1698cc8069f0Someone's carer0..1groupExpressions:
..... a08271f1-194b-4fe9-91f9-4f3398858eb0Are you responsible for caring for someone else?0..1choiceiconiconValue Set: Yes/No/NA
..... 4c14b158-3ae4-4994-8446-76e02640702cDetails0..1textEnable When: a08271f1-194b-4fe9-91f9-4f3398858eb0 = Yes (v2 Y/N Indicator#Y)
.... 6c80c675-1320-4ca3-ae3f-51ad173da741Your carer0..1groupExpressions:
..... d05558fb-a3cc-4bd6-b803-b672b36b9c51Do you have a carer?0..1choiceiconiconValue Set: Yes/No/NA
..... b9991e7e-ce03-465d-b4b0-5a1725b24e02Details0..1textEnable When: d05558fb-a3cc-4bd6-b803-b672b36b9c51 = Yes (v2 Y/N Indicator#Y)
.... 3494631c-6b56-46dc-abf7-a17bfc1d025fProviders0..1group
..... 41210be5-d441-4c44-b9c2-8dd94a44cbb4Are name and contact details of other key providers (eg case workers, support services) up to date?0..1choiceiconiconValue Set: Yes/No/NA
..... 6733d6ec-5b6b-4ee2-a21e-0e9474c2b22bDetails0..1text
.... 38f81a73-447f-4ecd-a8eb-6eccd9dee050Advance care planning0..1groupExpressions:
..... c023ef16-b554-4ed9-8993-1331e5f5a3b4Enduring Power of Attorney0..1group
...... 036eace9-ea83-46ec-9d01-f2093f710816Enduring Power of Attorney0..1choiceiconiconValue Set: Yes/No/NA
...... 83518215-7151-4365-b745-d7464bbb9528Discussed today0..1text
..... c4f68251-26af-462f-879a-a69b449066ffAdvance Health Directive0..1group
...... b0632039-c12b-4748-9e94-52073590c0baAdvance Health Directive0..1choiceiconiconValue Set: Yes/No/NA
...... c4bc2d84-e411-488d-9c0d-761f0377a026Discussed today0..1text
.... MarkComplete-32Mark section as complete0..1boolean

doco Documentation for this format