{ "resourceType" : "Questionnaire", "id" : "VlCaseHospitalization", "meta" : { "profile" : ["http://hl7.org/fhir/4.0/StructureDefinition/Questionnaire"] }, "text" : { "status" : "extensions", "div" : "

Generated Narrative: Questionnaire VlCaseHospitalization

Profile: http://hl7.org/fhir/4.0/StructureDefinition/Questionnaire

Structure\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
LinkIDTextCardinalityTypeFlagsDescription & Constraints\"doco\"
\".\"\".\" Hospitalization and treatment information for Visceral Leishmaniasis casesQuestionnairehttp://example.org/Questionnaire/VlCaseHospitalization#0.1.0
\".\"\".\"\".\" 782742635664Treatment/Hospitilazation0..1group
\".\"\".\"\".\"\".\" 428237064956IP No1..1string
\".\"\".\"\".\"\".\" 272556667885Hospital Ward1..1string
\".\"\".\"\".\"\".\" 885705999856Date of Admission1..1date
\".\"\".\"\".\"\".\" 150613899880Date Leishmaniasis Treatment Started1..1date
\".\"\".\"\".\"\".\" 733604782646Treatment Regimen1..1choiceOptions: 5 options
\".\"\".\"\".\"\".\" 498949031326Other Treatment Regimen ( Specify)1..1stringEnable When: 733604782646 = Other (Specify). (reg-005)
\".\"\".\"\".\"\".\" regimen-dosageTreatment Regimen Dosage1..1decimal
\".\"\".\"\".\"\".\" 175945763878Number of Treatment Days1..1choiceOptions: 4 options
\".\"\".\"\".\"\".\" 686824046139Number of treatment days (Specify)1..1integerEnable When: 175945763878 = Other (Specify) (trtemnt-004)
\".\"\".\"\".\"\".\" 723427815459Was Treatment Completed?0..1choice\"icon\"/\"icon\"/Options: 2 options
\".\"\".\"\".\"\".\" 342763225855Reason for Incomplete Treatment1..1stringEnable When: 723427815459 = No (no)
\".\"\".\"\".\"\".\" 708058904265Initial Treatment Outcome1..1choiceOptions: 5 options
\".\"\".\"\".\"\".\" 131738268669Cause of Death1..1choiceEnable When: 708058904265 = Death (outcome-005)
Options: 6 options
\".\"\".\"\".\"\".\" 884379481934Was there any reported severe adverse event of drug(s) used?1..1choice\"icon\"/\"icon\"/Options: 2 options
\".\"\".\"\".\"\".\" 560909523868Input Name(s) of Drug Causing Adverse Event1..1stringEnable When: 884379481934 = Yes (yes)
\".\"\".\"\".\"\".\" 396444399071Indicate Description of Severe Adverse Event1..1stringEnable When: 884379481934 = Yes (yes)
\".\"\".\"\".\"\".\" 904748389038Any other condition(s) treated during Initial VL treatment?1..1choice\"icon\"/\"icon\"/Options: 2 options
\".\"\".\"\".\"\".\" 922498480736Name of Other Condition1..1stringEnable When: 904748389038 = Yes (yes)

\"doco\" Documentation for this format

Options Sets

Answer options for 733604782646

Answer options for 175945763878

Answer options for 723427815459

Answer options for 708058904265

Answer options for 131738268669

Answer options for 884379481934

Answer options for 904748389038

" }, "url" : "http://example.org/Questionnaire/VlCaseHospitalization", "version" : "0.1.0", "title" : "VL Case Lab Information", "status" : "draft", "date" : "2026-05-04T06:19:40+00:00", "publisher" : "Kenya National Public Health Institute", "contact" : [{ "name" : "Kenya National Public Health Institute", "telecom" : [{ "system" : "url", "value" : "https://www.nphi.go.ke/" }] }, { "name" : "Kenya National Public Health Institute", "telecom" : [{ "system" : "url", "value" : "https://www.nphi.go.ke/", "use" : "work" }] }], "description" : "Hospitalization and treatment information for Visceral Leishmaniasis cases", "jurisdiction" : [{ "coding" : [{ "system" : "urn:iso:std:iso:3166", "code" : "KE", "display" : "Kenya" }] }], "item" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept" : { "coding" : [{ "system" : "http://hl7.org/fhir/questionnaire-item-control", "code" : "page", "display" : "Page" }] } }], "linkId" : "782742635664", "text" : "Treatment/Hospitilazation", "type" : "group", "item" : [{ "linkId" : "428237064956", "text" : "IP No", "type" : "string", "required" : true }, { "linkId" : "272556667885", "text" : "Hospital Ward", "type" : "string", "required" : true }, { "extension" : [{ "url" : "http://ehelse.no/fhir/StructureDefinition/validationtext", "valueString" : "Cannot be a date in the future" }, { "url" : "http://hl7.org/fhir/StructureDefinition/maxValue", "_valueDate" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/cqf-calculatedValue", "valueExpression" : { "language" : "text/fhirpath", "expression" : "today()" } }] } }], "linkId" : "885705999856", "text" : "Date of Admission", "type" : "date", "required" : true }, { "extension" : [{ "url" : "http://ehelse.no/fhir/StructureDefinition/validationtext", "valueString" : "Cannot be a date in the future" }, { "url" : "http://hl7.org/fhir/StructureDefinition/maxValue", "_valueDate" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/cqf-calculatedValue", "valueExpression" : { "language" : "text/fhirpath", "expression" : "today()" } }] } }], "linkId" : "150613899880", "text" : "Date Leishmaniasis Treatment Started", "type" : "date", "required" : true }, { "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" }] } }], "linkId" : "733604782646", "text" : "Treatment Regimen", "type" : "choice", "required" : true, "answerOption" : [{ "valueCoding" : { "code" : "reg-001", "display" : "Combination (SSG + Paramomycin)(17 days)" } }, { "valueCoding" : { "code" : "reg-002", "display" : "Pentostam (SSG) (30 days)" } }, { "valueCoding" : { "code" : "reg-003", "display" : "Glucantime" } }, { "valueCoding" : { "code" : "reg-004", "display" : "Liposomal Amphotericin B (6-10 days)" } }, { "valueCoding" : { "code" : "reg-005", "display" : "Other (Specify)." } }] }, { "linkId" : "498949031326", "text" : "Other Treatment Regimen ( Specify)", "type" : "string", "enableWhen" : [{ "question" : "733604782646", "operator" : "=", "answerCoding" : { "code" : "reg-005", "display" : "Other (Specify)." } }], "required" : true }, { "linkId" : "regimen-dosage", "text" : "Treatment Regimen Dosage", "type" : "decimal", "required" : true }, { "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" }] } }], "linkId" : "175945763878", "text" : "Number of Treatment Days", "type" : "choice", "required" : true, "answerOption" : [{ "valueCoding" : { "code" : "trtemnt-001", "display" : "6-10 Days" } }, { "valueCoding" : { "code" : "trtemnt-002", "display" : "17 Days" } }, { "valueCoding" : { "code" : "trtemnt-003", "display" : "30 Days" } }, { "valueCoding" : { "code" : "trtemnt-004", "display" : "Other (Specify)" } }] }, { "linkId" : "686824046139", "text" : "Number of treatment days (Specify)", "type" : "integer", "enableWhen" : [{ "question" : "175945763878", "operator" : "=", "answerCoding" : { "code" : "trtemnt-004", "display" : "Other (Specify)" } }], "required" : true }, { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept" : { "coding" : [{ "system" : "http://hl7.org/fhir/questionnaire-item-control", "code" : "radio-button", "display" : "Radio Button" }] } }, { "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation", "valueCode" : "horizontal" }], "linkId" : "723427815459", "text" : "Was Treatment Completed?", "type" : "choice", "answerOption" : [{ "valueCoding" : { "code" : "yes", "display" : "Yes" } }, { "valueCoding" : { "code" : "no", "display" : "No" } }] }, { "linkId" : "342763225855", "text" : "Reason for Incomplete Treatment", "type" : "string", "enableWhen" : [{ "question" : "723427815459", "operator" : "=", "answerCoding" : { "code" : "no", "display" : "No" } }], "required" : true }, { "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" }] } }], "linkId" : "708058904265", "text" : "Initial Treatment Outcome", "type" : "choice", "required" : true, "answerOption" : [{ "valueCoding" : { "code" : "outcome-001", "display" : "Initial cure" } }, { "valueCoding" : { "code" : "outcome-002", "display" : "Probable non-response" } }, { "valueCoding" : { "code" : "outcome-003", "display" : "Confirmed non-response" } }, { "valueCoding" : { "code" : "outcome-004", "display" : "Default" } }, { "valueCoding" : { "code" : "outcome-005", "display" : "Death" } }] }, { "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" }] } }], "linkId" : "131738268669", "text" : "Cause of Death", "type" : "choice", "enableWhen" : [{ "question" : "708058904265", "operator" : "=", "answerCoding" : { "code" : "outcome-005", "display" : "Death" } }], "required" : true, "answerOption" : [{ "valueCoding" : { "code" : "death-cause-001", "display" : "Unknown" } }, { "valueCoding" : { "code" : "death-cause-002", "display" : "VL" } }, { "valueCoding" : { "code" : "death-cause-003", "display" : "HIV" } }, { "valueCoding" : { "code" : "death-cause-004", "display" : "Other disease" } }, { "valueCoding" : { "code" : "death-cause-005", "display" : "SAE" } }, { "valueCoding" : { "code" : "death-cause-006", "display" : "Non-medical condition" } }] }, { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept" : { "coding" : [{ "system" : "http://hl7.org/fhir/questionnaire-item-control", "code" : "radio-button", "display" : "Radio Button" }] } }, { "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation", "valueCode" : "horizontal" }], "linkId" : "884379481934", "text" : "Was there any reported severe adverse event of drug(s) used?", "type" : "choice", "required" : true, "answerOption" : [{ "valueCoding" : { "code" : "yes", "display" : "Yes" } }, { "valueCoding" : { "code" : "no", "display" : "No" } }] }, { "linkId" : "560909523868", "text" : "Input Name(s) of Drug Causing Adverse Event", "type" : "string", "enableWhen" : [{ "question" : "884379481934", "operator" : "=", "answerCoding" : { "code" : "yes", "display" : "Yes" } }], "required" : true }, { "linkId" : "396444399071", "text" : "Indicate Description of Severe Adverse Event", "type" : "string", "enableWhen" : [{ "question" : "884379481934", "operator" : "=", "answerCoding" : { "code" : "yes", "display" : "Yes" } }], "required" : true }, { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept" : { "coding" : [{ "system" : "http://hl7.org/fhir/questionnaire-item-control", "code" : "radio-button", "display" : "Radio Button" }] } }, { "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-choiceOrientation", "valueCode" : "horizontal" }], "linkId" : "904748389038", "text" : "Any other condition(s) treated during Initial VL treatment?", "type" : "choice", "required" : true, "answerOption" : [{ "valueCoding" : { "code" : "yes", "display" : "Yes" } }, { "valueCoding" : { "code" : "no", "display" : "No" } }] }, { "linkId" : "922498480736", "text" : "Name of Other Condition", "type" : "string", "enableWhen" : [{ "question" : "904748389038", "operator" : "=", "answerCoding" : { "code" : "yes", "display" : "Yes" } }], "required" : true }] }] }