# Konsulta Health Screening/FPE Form - NHDR Implementation Guide Release 1.0 v0.1.0

* [**Table of Contents**](toc.md)
* **Konsulta Health Screening/FPE Form**

## Konsulta Health Screening/FPE Form

This is a sample representation of the **Use Case** implementation guide for **Konsulta Health Screening/FPE Form**

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### Implementation Rules

* name.given is an array that captures the first name and middle name. 
1. name.`given[0]`is used to capture a person's**first name**.
1. name.`given[1]`is used to capture a person's**middle name**.
 

**Questionnaire**

```
   {
        "resourceType": "Questionnaire",
        "id": "K5-Questionnaire",
        "meta": {
          "profile": [
            "https://nhdr.gov.ph/fhir/StructureDefinition/PH-Questionnaire"
          ]
        },
        "status": "active",
        "item": [
          {
            "linkId": "K5-Q1",
            "text": "Do you experience any of the following: fever, cough, colds, or headache?",
            "type": "boolean"
          },
          {
            "linkId": "K5-Q2",
            "text": "If yes, please explain",
            "type": "string",
            "enableWhen": [
              {
                "question": "K5-Q1",
                "operator": "=",
                "answerBoolean": true
              }
            ]
          },
          {
            "linkId": "K5-Q3",
            "text": "Do you experience any of the following: unexplained change in weight, loss of appetite, change in bowel movement, or abdominal pain?",
            "type": "boolean"
          },
          {
            "linkId": "K5-Q4",
            "text": "If yes, please explain",
            "type": "string",
            "enableWhen": [
              {
                "question": "K5-Q3",
                "operator": "=",
                "answerBoolean": true
              }
            ]
          },
          {
            "linkId": "K5-Q5",
            "text": "Do you experience any of the following: chest pain or difficulty in breathing?",
            "type": "boolean"
          },
          {
            "linkId": "K5-Q6",
            "text": "If yes, please explain",
            "type": "string",
            "enableWhen": [
              {
                "question": "K5-Q5",
                "operator": "=",
                "answerBoolean": true
              }
            ]
          },
          {
            "linkId": "K5-Q7",
            "text": "Do you experience any of the following: frequent urination, frequent eating, frequent intake of fluids, smoking, and drinking alcohol?",
            "type": "boolean"
          },
          {
            "linkId": "K5-Q8",
            "text": "If yes, please explain",
            "type": "string",
            "enableWhen": [
              {
                "question": "K5-Q7",
                "operator": "=",
                "answerBoolean": true
              }
            ]
          },
          {
            "linkId": "K5-Q9",
            "text": "For male and female, do you experience any of the following: pain or discomfort on urination or frequency of urination?",
            "type": "boolean"
          },
          {
            "linkId": "K5-Q10",
            "text": "If yes, please explain",
            "type": "string",
            "enableWhen": [
              {
                "question": "K5-Q9",
                "operator": "=",
                "answerBoolean": true
              }
            ]
          }
        ]
    }
    

```

**Questionnaire Response**

```
    {
        "resourceType": "QuestionnaireResponse",
        "id": "K5-QuestionnaireResponse",
        "meta": {
          "profile": [
            "https://nhdr.gov.ph/fhir/StructureDefinition/PH-QuestionnaireResponse"
          ]
        },
        "status": "completed",
        "questionnaire": "urn:uuid:questionnaire-k5",
        "item": [
          {
            "linkId": "K5-Q1",
            "answer": [
              {
                "valueBoolean": true
              }
            ]
          },
          {
            "linkId": "K5-Q2",
            "answer": [
              {
                "valueString": "Fever and headache for 2 days"
              }
            ]
          },
          {
            "linkId": "K5-Q3",
            "answer": [
              {
                "valueBoolean": false
              }
            ]
          },
          {
            "linkId": "K5-Q4"
          },
          {
            "linkId": "K5-Q5",
            "answer": [
              {
                "valueBoolean": false
              }
            ]
          },
          {
            "linkId": "K5-Q6"
          },
          {
            "linkId": "K5-Q7",
            "answer": [
              {
                "valueBoolean": true
              }
            ]
          },
          {
            "linkId": "K5-Q8",
            "answer": [
              {
                "valueString": "Occasional drinking alcohol"
              }
            ]
          },
          {
            "linkId": "K5-Q9",
            "answer": [
              {
                "valueBoolean": false
              }
            ]
          },
          {
            "linkId": "K5-Q10"
          }
        ]
    },


```

