Generated Narrative: Questionnaire AfpCaseReport Profile: http://hl7.org/fhir/4.0/StructureDefinition/Questionnaire Structure LinkID Text Cardinality Type Flags Description & Constraints AFP Surveillance questionnaire for disease surveillance Questionnaire http://example.org/Questionnaire/AfpCaseReport#0.1.0 #xD; 151479012557 Reporting Site 0..1 group #xD; user_role User Role 0..1 string #xD; user_facility User Facility 0..1 string #xD; user_ward User Ward 0..1 string #xD; user_sub_county User Sub County 0..1 string #xD; user_county User County 0..1 string #xD; facility_level null 0..1 group Enable When: user_role = VACCINATOR #xD; 294367770999 County 1..1 reference #xD; 819946803642 Sub County 1..1 reference #xD; 819943434 Ward 1..1 reference #xD; 819946803677 Health Facility 1..1 reference #xD; 438862163919 Type of health facility 1..1 choice Options: 3 options #xD; sub_county_level null 0..1 group Enable When: user_role = SUBCOUNTY_DISEASE_SURVEILLANCE_OFFICER #xD; 294367770999_sub_county County 1..1 reference #xD; 819946803642_sub_county Sub County 1..1 reference #xD; 819943434_sub_county Ward 1..1 reference #xD; 819946803677_sub_county Health Facility 1..1 reference #xD; 438862163919_sub_county Type of health facility 1..1 choice Options: 3 options #xD; county_level null 0..1 group Enable When: user_role = COUNTY_DISEASE_SURVEILLANCE_OFFICER #xD; 294367770999_county County 1..1 reference #xD; 819946803642_county Sub County 1..1 reference #xD; 819943434_county Ward 1..1 reference #xD; 819946803677_county Health Facility 1..1 reference #xD; 438862163919_county Type of health facility 1..1 choice Options: 3 options #xD; national_level null 0..1 group Enable When: user_role = ADMINISTRATOR #xD; 294367770999_national County 1..1 reference #xD; 819946803642_national Sub County 1..1 reference #xD; 819943434_national Ward 1..1 reference #xD; 819946803677_national Health Facility 1..1 reference #xD; 438862163919_national Type of health facility 1..1 choice Options: 3 options #xD; 992818778559 EPID No 0..1 string #xD; 359809652429 Case Demographics 0..1 group #xD; 873240407472 First name 1..1 string #xD; 246751846436 Middle name 0..1 string #xD; 486402457213 Surname/Family name 1..1 string #xD; 929966324957 Sex 1..1 choice Options: 2 options #xD; 262588607153_helpText What is the sex of the patient? 0..1 display #xD; 442636360588 Date of Birth known or unknown? 1..1 choice Options: 2 options #xD; 258271896621_helpText Date of birth of the patient (DD/MM/YYYY) 0..1 display #xD; 257830485990 Date of Birth. 1..1 date Enable When: 442636360588 = Known (known) #xD; age-at-onset Age at Onset 0..1 string Initial Value: string = 0 #xD; 492731638700 Age in Years 1..1 integer Enable When: 442636360588 = Unknown (unknown) #xD; 185726989867 Age in Months 0..1 integer Enable When: 442636360588 = Unknown (unknown) #xD; 828303331247 Age in Days 0..1 integer Enable When: 442636360588 = Unknown (unknown) #xD; 856448027666 Name of Parent/Guardian. 1..1 string #xD; 576318206363 Telephone no. of parent/guardian. 1..1 string #xD; telephone-hint 07xxxxxxxx 0..1 display #xD; a4-county County 1..1 reference #xD; a3-sub-county Sub County 1..1 reference #xD; a2-ward Ward 1..1 reference #xD; residence-details Residence (Village/Estate/Hse No). 1..1 string #xD; 946232932304 Neighborhood major landmark. 1..1 string #xD; 487686858194 Name Nearest Health Facility. 1..1 string #xD; 110761799063 Town/City/Location. 1..1 string #xD; 509826995484_helpText The specific town, city, or geographical location of residence. 0..1 display #xD; 451840456960 Case Information 0..1 group #xD; 502488184403 Date of Investigation. 1..1 date #xD; 502488184403_helpText The date when the affected individual first sought medical care. 0..1 display #xD; 426321975477 Date of Notification. 1..1 date #xD; 426321975477_helpText The date when the health facility reported the case to the sub-county and national health authorities. 0..1 display #xD; 171292274939 Notified by? 1..1 choice Options: 4 options #xD; 336643888536 Was the patient admitted? 1..1 choice Options: 2 options #xD; 336643888536_helpText Was the patient hospitalized? 0..1 display #xD; 507199621281 Date of admission. 1..1 date Enable When: 336643888536 = Yes (yes) #xD; 507199621281_helpText The date when the patient was admitted to a healthcare facility. 0..1 display #xD; 525996604810 IP/OP No. 1..1 string #xD; 525996604810_helpText Inpatient (IP) or Outpatient (OP) number assigned by the health facility. 0..1 display #xD; 735342695013 Clinical Information 0..1 group #xD; 728034137219 Date of onset of paralysis. 1..1 date #xD; 932108244312 Fever at onset of paralysis? 1..1 choice Options: 2 options #xD; 396371836778 Is paralysis of sudden onset? 1..1 choice Options: 2 options #xD; 917680711879 Progressive Paralysis < 3 days? 1..1 choice Options: 2 options #xD; 917680711879_helpText Was the progression of paralysis less than 3 days? 0..1 display #xD; 776980947995 Is paralysiss flaccid(floppy)? 1..1 choice Options: 2 options #xD; 679475123276 Is the paralysis asymmetric? 1..1 choice Options: 2 options #xD; 828001350323 Site of paralysis (check all that apply) 1..* choice Options: 5 options #xD; 815911574910 Specify other site of Paralysis 1..1 string Enable When: 828001350323 = Other (Specify) (othersite) #xD; 249388449455 Paralyzed limb sensitive to pain? 1..1 choice Options: 2 options #xD; 638592165160 Was there any injection just before onset of paralysis? 1..1 choice Options: 2 options #xD; 701518392602 Site of injection ( check all that applies). 0..* choice Enable When: 638592165160 = Yes (yes) Options: 10 options #xD; 564450145870 After Investigation, was this a true AFP? 0..1 choice Options: 2 options #xD; 212304573462 Outcome 0..1 choice Options: 3 options #xD; 446305443608 Vaccination History for disease under investigation 0..1 group #xD; 970455623029 Was the patient vaccinated against illness (including campaign)? 1..1 choice Options: 3 options #xD; 970455623029_helpText Was the patient vaccinated against illness (including campaign)? 0..1 display #xD; 886125589225 Number of doses administered(Excluding birth OPV Dose) 1..1 integer Enable When: 970455623029 = Yes (yes) #xD; 886125589225_helpText The total number of polio vaccines administered (excluding birth OPV) 0..1 display #xD; 413372430071 Date of OPV dose at birth. 1..1 date Enable When: 970455623029 = Yes (yes) #xD; 671158128551 Date of 1st dose. 1..1 date Enable When: 970455623029 = Yes (yes) #xD; 286826008175 Date of 2nd dose. 0..1 date Enable When: 886125589225 > 1 #xD; 705067672267 Date of 3rd Dose. 0..1 date Enable When: 886125589225 > 2 #xD; 974686716540 Date of 4th Dose. 0..1 date Enable When: 886125589225 > 3 #xD; 597572769623 If more than 4 doses, date of last dose. 0..1 date Enable When: 886125589225 > 4 #xD; 597572769623_helpText If more than 4 doses, date of last dose. 0..1 display #xD; 610048088023 Were there any vaccines given in last 30 days? 0..1 choice Enable When: 970455623029 = Yes (yes) Options: 3 options #xD; 610048088023_helpText Were there any vaccines given in the last 30 days? 0..1 display #xD; 960020813971 if yes, confirm number of days/interval 1..1 integer Enable When: 610048088023 = Yes (yes) #xD; 910678978959 Date of last OPV dose received through SIA. 1..1 date Enable When: 970455623029 = Yes (yes) #xD; 910678978959_helpText Date of last OPV dose administered during Supplementary Immunization Activity (SIA) e.g. vaccination campaigns. 0..1 display #xD; 774679982525 Total OPV (bOPV/mOPV2) doses received through SIA. 1..1 integer Enable When: 970455623029 = Yes (yes) #xD; 774679982525_helpText Total number of OPV doses administered during Supplementary Immunization Activity (SIA) e.g. vaccination campaigns. 0..1 display #xD; 440401067645 Total OPV (bOPV/mOPV2/) doses received through RI. 1..1 integer Enable When: 970455623029 = Yes (yes) #xD; 440401067645_helpText Total number of OPV doses administered during Routine Immunization (RI). 0..1 display #xD; 799376740588 Total IPV doses received through SIA 1..1 integer Enable When: 970455623029 = Yes (yes) #xD; 799376740588_helpText Total number of IPV doses administered during Supplementary Immunization Activity (SIA) e.g. vaccination campaigns. 0..1 display #xD; 999346763880 Total IPV doses received through RI. 1..1 integer Enable When: 970455623029 = Yes (yes) #xD; 999346763880_helpText Total number of IPV doses administered during Routine Immunization (RI). 0..1 display #xD; 766122504504 Date of last IPV dose received through RI or SIA. 1..1 date Enable When: 970455623029 = Yes (yes) #xD; 766122504504_helpText Date of last IPV dose administered during Routine Immunization (RI) OR Supplementary Immunization Activity (SIA) e.g. vaccination campaigns. 0..1 display #xD; 650080600932 Source of RI vaccination Information. 1..1 choice Enable When: 970455623029 = Yes (yes) Options: 3 options #xD; 650080600932_helpText What is the source of Routine Vaccination Information. 0..1 display #xD; 511517897367 Immunocompromised status suspected? 0..1 choice Options: 3 options #xD; 350784256533 Stool Specimen Collection Information 0..1 group #xD; 737703942433 Date 1st specimen collected. 1..1 date #xD; 737703942433_helpText Collect the first date when the case is investigated. 0..1 display #xD; 711388438654 Date 2nd specimen collected. 1..1 date #xD; 808177332790 Date Specimen sent to the national level 1..1 date #xD; Documentation for this format Options Sets Answer options for 438862163919 null#Private ("Private") null#Public ("Public") null#Faith Based ("Faith Based") Answer options for 438862163919_sub_county null#Private ("Private") null#Public ("Public") null#Faith Based ("Faith Based") Answer options for 438862163919_county null#Private ("Private") null#Public ("Public") null#Faith Based ("Faith Based") Answer options for 438862163919_national null#Private ("Private") null#Public ("Public") null#Faith Based ("Faith Based") Answer options for 929966324957 null#male ("Male") null#female ("Female") Answer options for 442636360588 null#known ("Known") null#unknown ("Unknown") Answer options for 171292274939 null#null ("Health Worker/focal person in reporting site") null#null ("Community Health Volunteer") null#null ("Community Informant") null#null ("Alternative Health Care Provider(traditionalhealer, herbalist, etc))") Answer options for 336643888536 null#yes ("Yes") null#no ("No") Answer options for 932108244312 null#yes ("Yes") null#no ("No") Answer options for 396371836778 null#yes ("Yes") null#no ("No") Answer options for 917680711879 null#yes ("Yes") null#no ("No") Answer options for 776980947995 null#yes ("Yes") null#no ("No") Answer options for 679475123276 null#yes ("Yes") null#no ("No") Answer options for 828001350323 null#la ("LA") null#ll ("LL") null#ra ("RA") null#rl ("RL") null#othersite ("Other (Specify)") Answer options for 249388449455 null#yes ("Yes") null#no ("No") Answer options for 638592165160 null#yes ("Yes") null#no ("No") Answer options for 701518392602 null#arm ("Left Arm") null#forearm ("Left Forearm") null#thigh ("Left Buttock") null#leg ("Left Thigh") null#null ("Left Leg") null#null ("Right Arm") null#null ("Right Forearm") null#null ("Right Buttock") null#null ("Right Thigh") null#null ("Right Leg") Answer options for 564450145870 null#yes ("Yes") null#no ("No") Answer options for 212304573462 null#hospitilized ("Still Hospitized") null#dead ("Dead") null#alive ("Alive") Answer options for 970455623029 null#yes ("Yes") null#no ("No") null#unknown ("Unknown") Answer options for 610048088023 null#yes ("Yes") null#no ("No") null#unknown ("Unknown") Answer options for 650080600932 null#immunization-card ("Immunization Card") null#recall ("Recall") null#unknown ("Unknown") Answer options for 511517897367 null#yes ("Yes") null#no ("No") null#unknown ("Unknown")
AFP Surveillance questionnaire for disease surveillance
Date of birth of the patient (DD/MM/YYYY)
Enter a valid mobile number. Strings and special characters aren't allowed
The specific town, city, or geographical location of residence.
The date when the affected individual first sought medical care.
The date should be before the date of Investigation
%context.answer.value <= %resource.descendants().where(linkId='502488184403').answer.value
The date when the health facility reported the case to the sub-county and national health authorities.
Health Worker/focal person in reporting site
Alternative Health Care Provider(traditionalhealer, herbalist, etc))
The date when the patient was admitted to a healthcare facility.
Inpatient (IP) or Outpatient (OP) number assigned by the health facility.
Was the progression of paralysis less than 3 days?
Site of paralysis (check all that apply)
Was there any injection just before onset of paralysis?
Site of injection ( check all that applies).
After Investigation, was this a true AFP?
Vaccination History for disease under investigation
Was the patient vaccinated against illness (including campaign)?
Number of doses administered(Excluding birth OPV Dose)
The total number of polio vaccines administered (excluding birth OPV)
The date should be after the date of the 1st dose
%context.answer.value >= %resource.descendants().where(linkId='671158128551').answer.value
The date should be after the date of the 2nd dose
%context.answer.value >= %resource.descendants().where(linkId='286826008175').answer.value
The date should be after the date of the 3rd dose
%context.answer.value >= %resource.descendants().where(linkId='705067672267').answer.value
The date should be after the date of the 4th dose
%context.answer.value >= %resource.descendants().where(linkId='974686716540').answer.value
If more than 4 doses, date of last dose.
Were there any vaccines given in last 30 days?
Were there any vaccines given in the last 30 days?
Date of last OPV dose received through SIA.
Date of last OPV dose administered during Supplementary Immunization Activity (SIA) e.g. vaccination campaigns.
Total OPV (bOPV/mOPV2) doses received through SIA.
Total number of OPV doses administered during Supplementary Immunization Activity (SIA) e.g. vaccination campaigns.
Total OPV (bOPV/mOPV2/) doses received through RI.
Total number of OPV doses administered during Routine Immunization (RI).
Total number of IPV doses administered during Supplementary Immunization Activity (SIA) e.g. vaccination campaigns.
Total number of IPV doses administered during Routine Immunization (RI).
Date of last IPV dose received through RI or SIA.
Date of last IPV dose administered during Routine Immunization (RI) OR Supplementary Immunization Activity (SIA) e.g. vaccination campaigns.
What is the source of Routine Vaccination Information.
The date should be on or after the date of Investigation
%context.answer.value >= %resource.descendants().where(linkId='502488184403').answer.value
The date should be one or after the date of Investigation
Collect the first date when the case is investigated.
The date should be on or after the date of 1st specimen collection
%context.answer.value >= %resource.descendants().where(linkId='737703942433').answer.value
The date should be on or after the date of 2nd specimen collection
%context.answer.value >= %resource.descendants().where(linkId='711388438654').answer.value
Date Specimen sent to the national level