Generated Narrative: Questionnaire VlCase Profile: http://hl7.org/fhir/4.0/StructureDefinition/Questionnaire Structure LinkID Text Cardinality Type Flags Description & Constraints Visceral Leishmaniasis surveillance case questionnaire Questionnaire http://example.org/Questionnaire/VlCase#0.1.0 #xD; 151479012557 PRESENTATION PHASE 0..1 group #xD; 546255966914 Hospital/Facility Location 0..1 display #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; 185890957847 Date of Diagnosis 1..1 date #xD; 565301843046 Case Information 0..1 group #xD; 123103147447 IP/OP Number 1..1 string #xD; 817903655885 Patient First Name 1..1 string #xD; 164840483828 Patient Middle Name 0..1 string #xD; 606848143908 Patient Family Name 1..1 string #xD; 760016167922 Patient Mobile Contact 0..1 string #xD; 123456678 07xxxxxxxx 0..1 display #xD; 442636360588 Date of Birth known or unknown? 0..1 choice Options: 2 options #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; 543806612685 Gender 1..1 choice Options: 2 options #xD; 743522593349 Pregnancy Status 1..1 choice Enable When: 543806612685 = Female (female) Options: 3 options #xD; 832804021140 Weight (Kg) 1..1 decimal #xD; 856786488810 Height (cm) 1..1 decimal #xD; 361227700960 Temperature (°C) 1..1 decimal #xD; 350480749254 Patient Location 0..1 display #xD; a4-county County 1..1 reference #xD; a3-sub-county Sub County 1..1 reference #xD; 754362784943 Ward 1..1 reference #xD; 116279465819 Village 1..1 string #xD; 845666899224 Nearest Health Facility 1..1 string #xD; 999881476256 Occupation 1..1 choice Options: 6 options #xD; 673073919688 Other Occupation(Specify) 1..1 string Enable When: 999881476256 = Other (Specify) (occ-006) #xD; 899673957595 Education Level 1..1 choice Options: 5 options #xD; 261509225024 Other Education ( Specify) 1..1 string Enable When: 899673957595 = Other (Specify) (edu-005) #xD; 657999955440 Name of Contact Person 1..1 string #xD; 354738003178 Mobile Contact (of Contact Person) 1..1 string #xD; 984586235 07xxxxxxxx 0..1 display #xD; 682361027621 History of the disease 0..1 group #xD; 728034137219 Date of Onset of Symptoms 1..1 date #xD; 920645761660 Days Since Onset of Symptoms 0..1 string Initial Value: string = 0 #xD; 997694179371 Name of Village Where Patient Probably Got Infected 1..1 string #xD; 648643802331 Is It an Imported Case (from outside the country)? 1..1 choice Options: 2 options #xD; 405254523776 If Yes, Indicate Name of Country 1..1 string Enable When: 648643802331 = Yes (yes) #xD; 241783748776 Did Patient Travel to Endemic Area in Last 6 Months? (In country) 1..1 choice Options: 2 options #xD; 240876879827 If yes, indicate the place(s) visited: 0..1 display Enable When: 241783748776 = Yes (yes) #xD; 751649865991 County 1..1 reference Enable When: 241783748776 = Yes (yes) #xD; 751649866545 Sub-county 1..1 reference Enable When: 241783748776 = Yes (yes) #xD; 683913433621 Ward 0..1 reference Enable When: 241783748776 = Yes (yes) #xD; 304570397907 Village 1..1 string Enable When: 241783748776 = Yes (yes) #xD; 201707720724 Location 1..1 string Enable When: 241783748776 = Yes (yes) #xD; 742577347417 Did Patient Visit Traditional Healer before visiting Health Facility? 1..1 choice Options: 2 options #xD; 291919290357 Previous Admission Due to Visceral Leishmaniasis? 1..1 choice Options: 2 options #xD; 653200828098 If Yes, When Admitted? 1..1 choice Enable When: 291919290357 = Yes (yes) Options: 4 options #xD; 119408288668 Physical Examination 0..1 group #xD; 699010843343 Has Patient Had Fever for Last 2 Weeks? 1..1 choice Options: 2 options #xD; clinician-action Clinician should perform spleen and liver palpation 0..1 display Enable When: 699010843343 = Yes (yes) #xD; 458194698702 Abdominal Distension Present? 1..1 choice Options: 2 options #xD; 788908031336 Organ Enlargement 0..1 display #xD; 594158306957 Liver Enlarged? 1..1 choice Options: 2 options #xD; 754134389540 Liver Measurement below Costal Margin (cm) 1..1 decimal Enable When: 594158306957 = Yes (yes) #xD; 433410405758 Spleen Enlarged? 1..1 choice Options: 2 options #xD; 808046746150 Spleen Measurement below Costal Margin (cm) 1..1 decimal Enable When: 433410405758 = Yes (yes) #xD; 496596553090 Presence of Concomitant Infections at presentation? 1..1 choice Options: 2 options #xD; 968034282530 Name(s) of Concomitant Infections 1..1 string Enable When: 496596553090 = Yes (yes) #xD; 332723314026 Clinician's Name 1..1 string #xD; 493012943787 Clinician's Signature 1..1 string #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 442636360588 null#known ("Known") null#unknown ("Unknown") Answer options for 543806612685 null#male ("Male") null#female ("Female") Answer options for 743522593349 null#notknown ("Not Known") null#positive ("Positive") null#negative ("Negative") Answer options for 999881476256 null#occ-001 ("None") null#occ-002 ("Student") null#occ-003 ("Animal Herder") null#occ-004 ("Self Employed") null#occ-005 ("Homemaker") null#occ-006 ("Other (Specify)") Answer options for 899673957595 null#edu-001 ("None") null#edu-002 ("Primary") null#edu-003 ("Secondary") null#edu-004 ("Post–Secondary") null#edu-005 ("Other (Specify)") Answer options for 648643802331 null#yes ("Yes") null#no ("No") Answer options for 241783748776 null#yes ("Yes") null#no ("No") Answer options for 742577347417 null#yes ("Yes") null#no ("No") Answer options for 291919290357 null#yes ("Yes") null#no ("No") Answer options for 653200828098 null#admin-001 ("3 months ago") null#admin-002 ("6 months ago") null#admin-003 ("1 year ago") null#admin-004 ("More than 1 year ago") Answer options for 699010843343 null#yes ("Yes") null#no ("No") Answer options for 458194698702 null#yes ("Yes") null#no ("No") Answer options for 594158306957 null#yes ("Yes") null#no ("No") Answer options for 433410405758 null#yes ("Yes") null#no ("No") Answer options for 496596553090 null#yes ("Yes") null#no ("No")
Visceral Leishmaniasis surveillance case questionnaire
Enter a valid mobile number. Strings and special characters aren't allowed
Name of Village Where Patient Probably Got Infected
Is It an Imported Case (from outside the country)?
Did Patient Travel to Endemic Area in Last 6 Months? (In country)
Did Patient Visit Traditional Healer before visiting Health Facility?
Previous Admission Due to Visceral Leishmaniasis?
Clinician should perform spleen and liver palpation
Liver Measurement below Costal Margin (cm)
Spleen Measurement below Costal Margin (cm)
Presence of Concomitant Infections at presentation?