New Zealand ICP Implementation Guide
1.1.0 - draft

New Zealand ICP Implementation Guide, published by Accident Compensation Corporation. This guide is not an authorized publication; it is the continuous build for version 1.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/acc-fhir-publisher/icp/ and changes regularly. See the Directory of published versions

Questionnaire: ACC BIST

Official URL: http://hl7.org.nz/fhir/Questionnaire/acc-bist Version: 1.1.0
Draft as of 2026-03-26 Computable Name: ACC BIST - 20202

Usage:Module form: Module form, MCF form: MCF form

Represents the Brain Injury Screening Tool (BIST) for ACC.

Tags: 13.2.1 (Details: formbuilder-runtime-version code 13.2.1), NZ test 1 release 17/04/24 (Details: form-tags code NZ test 1 release 17/04/24), 1.30.0 (Details: formbuilder-editor-version code 1.30.0)

Security Label: acc (Details: smartcare-module code acc)

Structure
LinkIDTextCardinalityTypeFlagsDescription & Constraintsdoco
.. ACC BIST - 20202Represents the Brain Injury Screening Tool (BIST) for ACC.Questionnairehttp://hl7.org.nz/fhir/Questionnaire/acc-bist#1.1.0
... 604b88f5-d404-6683-7680-744941147a9aClaim number0..1groupValue Set:
.... cfdcec28-1325-a279-2604-4fc29e477d36ACC Claim numbers0..1groupValue Set:
..... 875f04a8-2c11-00f7-989a-d2295da80cefnull0..1displayValue Set:
...... 1d4765db-8626-cc6d-06d7-e157dd6428db**Select claim number:** Select an existing claim number for this injury, or start a new claim0..1displayValue Set:
..... e503f5df-88fa-aa3f-6e6a-3a3c0b663b7cACC Claim Numbers0..1displayValue Set:
... dd54effd-cadb-bbd8-26e5-c375a346ae76Accident details0..1groupValue Set:
.... 477e1544-d220-f793-02b7-ebf79054f367Time of accident0..1groupValue Set:
..... d3813771-921e-0d0f-4ff6-851bc880121dDate of injury1..1dateValue Set:
..... 3c4b9927-4ebf-8207-c8dc-1d4caf8d28fbTime of injury0..1timeValue Set:
..... c1e034ae-39dd-66ec-ca03-5cfee995a009Date of consultation1..1dateValue Set:
..... 81927019-006c-7ae6-fcfa-e3242c8e75c4Injury occurred within past 24 hours1..1choiceValue Set:
Options: 2 options
.... 7c5ad9cf-35c9-791f-ecf8-57471f86fefcAccident details0..1groupValue Set:
..... b5db59e5-43c5-8668-041e-baa0523702acPlease tell me about what happened1..1textValue Set:
..... 2480750a-d6fa-2c6e-7fc7-40d2569e938dAre there high-risk indicators such as suspicion of skull fracture, focal neurological deficit, high speed, focal blunt trauma, or fall from height (e.g., > 5 stairs)1..1choiceValue Set:
Options: 2 options
..... 1099711a-1c5f-cf83-c242-7948add4b7d4Did the incident occur in traumatic circumstances which could result in emotional or psychological reactions (e.g., assault, domestic violence, fatalities in a car accident)1..1choiceValue Set:
Options: 2 options
..... 20acb126-54c3-e63a-68f8-3b0217792e76Did anyone with you at the time of injury say anything else about what happened1..1choiceValue Set:
Options: 2 options
..... ae27dd88-0cc0-d8dc-9897-a0a6ac340950Please give details1..1textEnable When: 20acb126-54c3-e63a-68f8-3b0217792e76 = Yes
Value Set:
..... 07a20c2a-e34b-8d6c-7eb9-cbadaa74aff9Were you sick or did you vomit1..1choiceValue Set:
Options: 2 options
..... 3d561610-f162-ecfb-00e7-56357f4ac2c1How many times1..1quantityEnable When: 07a20c2a-e34b-8d6c-7eb9-cbadaa74aff9 = Yes
Value Set:
..... 998b3d51-eba5-5101-c3f3-7537a2826580Were you knocked out (or did you lose consciousness)1..1choiceValue Set:
Options: 3 options
..... 06cd326d-1ba8-ea02-d4e3-0f8d724fb5faDid you have a fit or seizure straight afterwards (i.e., go stiff or shake violently)1..1choiceValue Set:
Options: 3 options
..... 8d87deb7-8818-f790-d3ce-4902b0b8d95bAre you feeling better, worse, or about the same since the injury1..1choiceValue Set:
Options: 3 options
..... cfd82297-8071-f469-2e79-15191f7554a1Have you had a concussion or brain injury before1..1choiceValue Set:
Options: 2 options
..... 39bcf1e3-8743-53b8-3d5c-b5830a414943How many times1..1quantityEnable When: cfd82297-8071-f469-2e79-15191f7554a1 = Yes
Value Set:
..... 34d85b59-da5d-e40a-0072-4be01c5e2955When was the last injury1..1dateEnable When: cfd82297-8071-f469-2e79-15191f7554a1 = Yes
Value Set:
..... 93ffbeb6-acde-7883-b13c-b861139e2a01Was it a prolonged recovery (> 3 months to recover)1..1choiceEnable When: cfd82297-8071-f469-2e79-15191f7554a1 = Yes
Value Set:
Options: 2 options
..... 6ec00706-8935-5b2c-e776-71a7abeab973Are you currently taking any medications that thin the blood e.g., anticoagulants1..1choiceValue Set:
Options: 2 options
..... def327f0-e8b7-c090-36e1-5c2f4f3b01f6Have you ever experienced difficulties with your mental health1..1choiceValue Set:
Options: 2 options
..... 24786db5-a459-371a-8e91-078c125d1356Do you have a history of migraine (severe headache with vomiting or extreme sensitivity to light and sound)1..1choiceValue Set:
Options: 2 options
... 1aeefdd3-210f-3edc-fc10-0c488f054611Symptom scale0..1groupValue Set:
.... 132c4769-39c9-16f2-32c6-47f580c02ecaSymptom scale0..1groupValue Set:
..... fbdc70b5-65e9-551f-eac9-ea17e917fc7fnull0..1displayValue Set:
...... 9ef37f8a-0eff-68bc-5fcc-2204acd4fa8dPlease ask your patient the following questions:0..1displayValue Set:
..... 8eba2434-1564-4584-6971-1bcbbcb0e97aSymptom scale header0..1displayValue Set:
..... ad0d0923-8c59-64a4-4353-f866b7568c0bnull0..1displayValue Set:
...... fbdd4438-9826-36df-1cd6-212b2556351a**Physical:**0..1displayValue Set:
..... 4439ab02-769d-d7c9-04cd-16da25b8d155Headache (my head hurts)0..1groupValue Set:
...... 649ee4dd-5c2c-80a5-75ad-576a27d24d8cHeadache (my head hurts)1..1choice​​iconiconValue Set:
Options: 11 options
...... 3dc85f1f-5c49-b7aa-f1da-b3a36fb932d2Score0..1decimalValue Set:
Initial Value: decimal = 0
..... adcc4190-a80e-03be-7dc1-80eb4d6a3abaMy neck hurts0..1groupValue Set:
...... fb296612-8718-7ebf-ceb2-c88fe247d0aeMy neck hurts1..1choice​​iconiconValue Set:
Options: 11 options
...... a52fbffc-6c8d-ec0f-78d0-fed570941c47Score0..1decimalValue Set:
Initial Value: decimal = 0
..... a37f8af0-b6a6-2672-0e50-7fdc442c3818I don't like bright lights0..1groupValue Set:
...... fd7a2fb1-057d-a3c6-81ad-46e813a33edaI don't like bright lights1..1choice​​iconiconValue Set:
Options: 11 options
...... 6441b3a7-4394-7a82-ed23-8b21d2a4c90fScore0..1decimalValue Set:
Initial Value: decimal = 0
..... 567f262f-6b77-91cc-bc08-9b699ff792c7I don't like loud noises0..1groupValue Set:
...... 98315a2c-010c-a3fb-404d-1ef46f1b76f6I don't like loud noises1..1choice​​iconiconValue Set:
Options: 11 options
...... a21220ee-f70a-ad57-4c4b-aeeb69aeeb25Score0..1decimalValue Set:
Initial Value: decimal = 0
..... 52dc63e5-cd45-a3b0-ad32-9e141a83d1cbTotal physical score (out of 40)0..1decimalValue Set:
Initial Value: decimal = 0
..... ac00575b-b239-702e-839c-a0ca36a1cbeenull0..1displayValue Set:
...... 4df3a643-9264-8325-c544-33124256d0ba**Vestibular-ocular:**0..1displayValue Set:
..... b9e4da41-6665-5f79-a804-560d0f02c47bI feel dizzy or like I could be sick0..1groupValue Set:
...... e4aecd4f-f3f2-c4c5-b73a-91978353c51eI feel dizzy or like I could be sick1..1choice​​iconiconValue Set:
Options: 11 options
...... 9f096e62-7069-b061-32b0-813b125abf70Score0..1decimalValue Set:
Initial Value: decimal = 0
..... 4713c995-deaf-66b9-56fa-becae450f445If I close my eyes, I feel like I am at sea0..1groupValue Set:
...... d60a3770-4327-8ace-acb7-f682ff573dc5If I close my eyes, I feel like I am at sea1..1choice​​iconiconValue Set:
Options: 11 options
...... eccfd6b5-3b34-51c5-9652-66dc9a7a308aScore0..1decimalValue Set:
Initial Value: decimal = 0
..... 8e86f368-cf1a-e6c9-0651-7dc61931a8fdI have trouble with my eyesight (vision)0..1groupValue Set:
...... a405f89b-aee6-76c3-3274-00a6a64412c9I have trouble with my eyesight (vision)1..1choice​​iconiconValue Set:
Options: 11 options
...... c8c04df4-58ed-dbd6-4bf7-5434da6b6d9aScore0..1decimalValue Set:
Initial Value: decimal = 0
..... 2957b123-e6be-ef67-6142-643dd5115d42I feel clumsy (bumping into or dropping things)0..1groupValue Set:
...... e990a88e-d6a2-3340-9b60-831eb7647bfdI feel clumsy (bumping into or dropping things)1..1choice​​iconiconValue Set:
Options: 11 options
...... 6b83c98e-eb9e-17ba-35ab-ca4d8353fc3fScore0..1decimalValue Set:
Initial Value: decimal = 0
..... 227e8a8e-83d9-28ac-ce45-f4d8e2b33c8aTotal vestibular score (out of 40)0..1decimalValue Set:
Initial Value: decimal = 0
..... 8163f6e7-b45b-bf70-25d5-6a272e54e84dnull0..1displayValue Set:
...... 0b219e69-d2c4-30a2-12d3-65663d3b186f**Cognitive:**0..1displayValue Set:
..... 037d5a09-5803-8191-527f-00d2dc1fc073It takes me longer to think0..1groupValue Set:
...... 271beefa-219f-56dc-d065-dc7f9c40b4b0It takes me longer to think1..1choice​​iconiconValue Set:
Options: 11 options
...... 9499e9b1-e021-f327-3bdc-4498fc9c38b9Score0..1decimalValue Set:
Initial Value: decimal = 0
..... 5ee18372-f4d4-29c5-fc08-65c8a4f28124I forget things0..1groupValue Set:
...... 4cd53427-0913-ffb8-09bf-8a85c156169fI forget things1..1choice​​iconiconValue Set:
Options: 11 options
...... 0c1e6c65-1407-1628-28bc-3b9ac5b0c2d1Score0..1decimalValue Set:
Initial Value: decimal = 0
..... 49b8014a-eb00-61f9-97ef-0ef47f182368I get confused easily0..1groupValue Set:
...... 24a62b83-3d45-1dc0-660e-4f3559b271b8I get confused easily1..1choice​​iconiconValue Set:
Options: 11 options
...... b48f29d8-83ba-d8c9-09ab-b4725c7f339aScore0..1decimalValue Set:
Initial Value: decimal = 0
..... 0a303380-670d-9606-fa9f-0b94f045373bI have trouble concentrating0..1groupValue Set:
...... 1600c5f8-b5a7-3806-172e-5c79ad3d15dfI have trouble concentrating1..1choice​​iconiconValue Set:
Options: 11 options
...... b46b9bbc-b834-5a26-75df-c36cfd3386efScore0..1decimalValue Set:
Initial Value: decimal = 0
..... 110b56eb-3567-b53f-11bd-fcc17197719dTotal cognitive score (out of 40)0..1decimalValue Set:
Initial Value: decimal = 0
..... f09e82f6-5aad-3d70-8ddf-c0a791c83b03null0..1displayEnable When: 81927019-006c-7ae6-fcfa-e3242c8e75c4 = No
Value Set:
...... 89ccdd50-bacc-e3fa-0d54-b98461cb0ec5**If more than 24 hours post-injury, please also rate these physical symptoms:**0..1displayValue Set:
..... c8a2f7a2-7282-de64-5756-3cfbaa848300I get angry or irritated easily0..1groupEnable When: 81927019-006c-7ae6-fcfa-e3242c8e75c4 = No
Value Set:
...... a82eb15e-afdc-7037-8201-5d88d50c3f7dI get angry or irritated easily1..1choice​​iconiconValue Set:
Options: 11 options
...... b0324526-62f2-7490-b8d1-328f82f41b98Score0..1decimalValue Set:
Initial Value: decimal = 0
..... c98564a6-4e8f-957f-9f3b-8de4a9acfff2I feel restless0..1groupEnable When: 81927019-006c-7ae6-fcfa-e3242c8e75c4 = No
Value Set:
...... 0af296ab-f09e-48d6-85f4-62e230ad8cf0I feel restless1..1choice​​iconiconValue Set:
Options: 11 options
...... ade568fd-9ae0-6681-e1eb-08d1ede38742Score0..1decimalValue Set:
Initial Value: decimal = 0
..... 93477887-a79c-1c45-cd67-25cda52d5099I feel tired during the day0..1groupEnable When: 81927019-006c-7ae6-fcfa-e3242c8e75c4 = No
Value Set:
...... 99e2f0a4-ea93-c2df-96f9-a9c3834655baI feel tired during the day1..1choice​​iconiconValue Set:
Options: 11 options
...... 6e668680-6fc5-3b69-ca29-6df82198e151Score0..1decimalValue Set:
Initial Value: decimal = 0
..... 2102c7b6-0490-ba51-2757-7f61f0046d4bI need to sleep a lot more or find it hard to sleep at night0..1groupEnable When: 81927019-006c-7ae6-fcfa-e3242c8e75c4 = No
Value Set:
...... d86bdf62-5e16-584b-be3f-0f19956f0a4fI need to sleep a lot more or find it hard to sleep at night1..1choice​​iconiconValue Set:
Options: 11 options
...... 9033a3d5-f7d6-7262-99da-d9d9c98a4919Score0..1decimalValue Set:
Initial Value: decimal = 0
..... 80b44067-3ade-b428-fded-ed36667a47faTotal 24 hour post-injury physical score (out of 40)0..1decimalEnable When: 81927019-006c-7ae6-fcfa-e3242c8e75c4 = No
Value Set:
Initial Value: decimal = 0
..... 6636e6fd-3c79-e6ca-fdd9-023ce1389831Total symptom severity score (out of 120)0..1decimalEnable When: 81927019-006c-7ae6-fcfa-e3242c8e75c4 = Yes
Value Set:
Initial Value: decimal = 0
..... 0597f621-3855-fcaf-d7fb-bf42a65f3d2bTotal symptom severity score (out of 160)0..1decimalEnable When: 81927019-006c-7ae6-fcfa-e3242c8e75c4 = No
Value Set:
Initial Value: decimal = 0
..... 9e494968-dbeb-b5ae-3241-957617a40770Endorsed (out of 12)0..1choiceEnable When: 81927019-006c-7ae6-fcfa-e3242c8e75c4 = Yes
Value Set:
..... 2df943f9-307c-5b05-d7a2-cd619fd016bfEndorsed (out of 16)0..1choiceEnable When: 81927019-006c-7ae6-fcfa-e3242c8e75c4 = No
Value Set:
..... 33b59517-b4e4-f5f0-3c4a-af379c1edc50Dominant group description0..1choiceValue Set:
... 4d60e31a-0a1b-6e98-b839-a6be125f2102Impact score0..1groupValue Set:
.... b09fab7d-e83b-daa4-d54d-2bc5c3ed5323Impact score0..1groupValue Set:
..... a526292e-c1fa-519e-cdbc-e4baa70300b1null0..1displayValue Set:
...... 466b8272-2890-517b-fcf6-fafe1ee701b0**Injuries to the brain can affect how a person feels, behaves, thinks, and how able they are to do everyday tasks** On a scale of 0 to 10, where 0 means that you do not feel the injury has had any impact on you at all, and 10 means you feel that the injury stops you from doing anything, how much do you feel your injury is impacting on you at this point in time:0..1displayValue Set:
..... 8d17b21e-00c0-33d2-ea4e-a0c9647ae75cImpact of injury1..1choice​​iconiconValue Set:
Options: 11 options
... 1b1463e7-8f79-b112-78b5-63562c718543Physical examination0..1groupValue Set:
.... 405a02b2-09bd-ac7b-1bbf-973bcbffd5fePhysical examination0..1groupValue Set:
..... 55a9d3e3-5d84-dd47-8002-e46fc831b2c6Evidence of skull fracture0..1choiceValue Set:
Options: 2 options
..... 27586f48-90c5-8b80-f957-79d34b4651c6Please give details0..1textEnable When: 55a9d3e3-5d84-dd47-8002-e46fc831b2c6 = Yes
Value Set:
..... cf456c31-0550-718f-7e96-66d1baada245Other significant injuries0..1choiceValue Set:
Options: 2 options
..... 115d0341-637a-684e-c05e-d72b51451970Please give details0..1textEnable When: cf456c31-0550-718f-7e96-66d1baada245 = Yes
Value Set:
..... 7a8f25dd-04eb-f4b4-b2fb-98dba3fb1fbbnull0..1displayValue Set:
...... 1bfe283c-c3e7-45dd-7ccf-fbf53db6838d**Neurological examination:**0..1displayValue Set:
..... 33352cf0-53bf-13ac-5268-954008b0be2eAbnormality of gait0..1choiceValue Set:
Options: 2 options
..... 1f31017d-f306-4554-7e07-040f1bfa4b32Please give details0..1textEnable When: 33352cf0-53bf-13ac-5268-954008b0be2e = Yes
Value Set:
..... f2511f67-e620-368b-3352-64336c7e404fnull0..1displayValue Set:
...... b14e105b-b005-6e34-7d8e-0bb9f8cd76b1**Upper limb:**0..1displayValue Set:
..... 6eb239a3-b5ea-f46b-939b-165004089b4aUpper limb tone0..1choice​​iconiconValue Set:
Options: 3 options
..... 035c6086-4399-9f86-9f30-acb5ed4400faSide0..1choice​​iconiconEnable When:
Value Set:
Options: 3 options
..... 58f714e9-0c9c-79ef-0a49-2b624172ad89Upper limb power0..1choice​​iconiconValue Set:
Options: 2 options
..... fd4ba90f-0c51-f38f-8408-994ecc62f87bSide0..1choice​​iconiconEnable When: 58f714e9-0c9c-79ef-0a49-2b624172ad89 = Reduced
Value Set:
Options: 3 options
..... 913bfe12-4ff4-8dd7-4c8b-ad28f81e1ea5Upper limb sensation0..1choice​​iconiconValue Set:
Options: 3 options
..... 0375054b-7126-ea8b-13df-86c8317b6291Side0..1choice​​iconiconEnable When:
Value Set:
Options: 3 options
..... 20804cc5-8e38-e8d5-3215-435d7ba8ed1eUpper limb reflexes normal0..1choiceValue Set:
Options: 2 options
..... fbe5d8c4-8d88-62bc-7cdd-ace891a76597Reflexes tested0..1choice​​iconiconEnable When: 20804cc5-8e38-e8d5-3215-435d7ba8ed1e = No
Value Set:
Options: 6 options
..... 3357cbda-4506-68b4-8cc1-ee9bd6b952c1Please state abnormality0..1stringEnable When: 20804cc5-8e38-e8d5-3215-435d7ba8ed1e = No
Value Set:
..... 5a9b42b6-a12d-7baf-dc05-04a300b21aacUpper limb vibration sense0..1choiceValue Set:
Options: 2 options
..... 88114e19-a1b2-0485-8a24-9ced2a78a032Side0..1choice​​iconiconEnable When: 5a9b42b6-a12d-7baf-dc05-04a300b21aac = Abnormal (reduced)
Value Set:
Options: 3 options
..... 85c86289-5170-f4bf-c8ac-2e92e93bd5f3Upper limb joint position sense0..1choiceValue Set:
Options: 2 options
..... 01313e25-2aa6-a3e2-4c8e-96cbe949da0bSide0..1choice​​iconiconEnable When: 85c86289-5170-f4bf-c8ac-2e92e93bd5f3 = Abnormal (reduced)
Value Set:
Options: 3 options
..... 501ad295-81cf-aef5-3c14-b128feb04a4anull0..1displayValue Set:
...... d9874ede-7361-deff-baf5-869fb6d1411b**Lower limb:**0..1displayValue Set:
..... 172fc4f0-9e70-a5e8-8e2b-287a57c75f7eLower limb tone0..1choice​​iconiconValue Set:
Options: 3 options
..... 4d1e47cc-5720-f4f2-d4d2-83e50e522896Side0..1choice​​iconiconEnable When:
Value Set:
Options: 3 options
..... 7ab9f7ed-5903-3a55-cdc8-a9240afffa27Lower limb power0..1choice​​iconiconValue Set:
Options: 2 options
..... 7582cbd7-4c5c-58f1-4a60-ed34895a5375Side0..1choice​​iconiconEnable When: 7ab9f7ed-5903-3a55-cdc8-a9240afffa27 = Reduced
Value Set:
Options: 3 options
..... f266288d-32e3-a594-c721-58e35df6a501Lower limb sensation0..1choice​​iconiconValue Set:
Options: 3 options
..... bb401fd2-e8fd-cebb-6592-4e6ad6d6f16aSide0..1choice​​iconiconEnable When:
Value Set:
Options: 3 options
..... 67c8a150-a80d-cafc-c8f2-ef6577e6ed7dLower limb reflexes normal0..1choiceValue Set:
Options: 2 options
..... 548d723c-dc92-af49-1900-ff0d913511b4Reflexes tested0..1choice​​iconiconEnable When: 67c8a150-a80d-cafc-c8f2-ef6577e6ed7d = No
Value Set:
Options: 6 options
..... 21ae8e6e-52b7-057a-f42d-136320d08140Please state abnormality0..1stringEnable When: 67c8a150-a80d-cafc-c8f2-ef6577e6ed7d = No
Value Set:
..... dd9edad2-21a4-e031-d083-ea775a298eb4Lower limb vibration sense0..1choiceValue Set:
Options: 2 options
..... 39cb1de0-493c-5b69-eeed-b30e32a08715Side0..1choice​​iconiconEnable When: dd9edad2-21a4-e031-d083-ea775a298eb4 = Abnormal (reduced)
Value Set:
Options: 3 options
..... c4ec6154-56a0-d915-be83-0bf3a2e1370eLower limb joint position sense0..1choiceValue Set:
Options: 2 options
..... 1e4af20b-6767-6d0e-690f-6c81ec8816acSide0..1choice​​iconiconEnable When: c4ec6154-56a0-d915-be83-0bf3a2e1370e = Abnormal (reduced)
Value Set:
Options: 3 options
..... 32c17d53-f413-0a0a-9806-cfb00724a782null0..1displayValue Set:
...... 89ea47d6-eaa5-4b34-97c8-ce9fdb2e1c1f**Coordination:**0..1displayValue Set:
..... 99d5df32-a4ac-9a4a-c4a4-85071a26b450Coordination normal0..1choiceValue Set:
Options: 2 options
..... b106bc52-d1b7-09b4-bc32-5b7eb9ba1506Coordination deficit0..1choice​​iconiconEnable When: 99d5df32-a4ac-9a4a-c4a4-85071a26b450 = No
Value Set:
Options: 3 options
..... fdd9c39b-6de2-9416-b453-2b0d7488f1daSide0..1choice​​iconiconEnable When: 99d5df32-a4ac-9a4a-c4a4-85071a26b450 = No
Value Set:
Options: 3 options
..... dc09fdb2-5546-b3d7-c528-158b0a3482abPlease give details0..1textEnable When: 99d5df32-a4ac-9a4a-c4a4-85071a26b450 = No
Value Set:
..... da44c1da-25e3-3768-2dba-f67543461e9dnull0..1displayValue Set:
...... c8399e97-4394-32cb-cc7d-f0a6230d78da**Cranial nerves:**0..1displayValue Set:
..... c2859a5e-6057-5ac4-55d7-124340313f1aCranial nerves tested0..1choiceValue Set:
Options: 2 options
..... 7784e363-b9b3-c164-119d-9e5b6c67928fCranial nerve deficit0..1choiceEnable When: c2859a5e-6057-5ac4-55d7-124340313f1a = Yes
Value Set:
Options: 2 options
..... 842189ca-f322-497e-25c6-334bedd6a765Cranial nerve deficit(s)0..1choice​​iconiconEnable When: 7784e363-b9b3-c164-119d-9e5b6c67928f = Yes
Value Set:
Options: 8 options
..... 9b2cebd4-7066-a1d8-21a9-697769b57e7eCN I deficit0..1textEnable When: 842189ca-f322-497e-25c6-334bedd6a765 = CN I (olfactory)
Value Set:
..... 6afe1fc8-f152-6b4c-db60-17160fc4c66fCN II deficit0..1textEnable When: 842189ca-f322-497e-25c6-334bedd6a765 = CN II (optic)
Value Set:
..... 13e87fed-4eb7-b703-27da-373126691be4CN III, IV, VI deficit0..1textEnable When: 842189ca-f322-497e-25c6-334bedd6a765 = CN III, IV, VI (oculomotor, trochlear, abducens)
Value Set:
..... e4b7bd2e-18c5-bc59-db1e-14f188cba0a0CN V deficit0..1textEnable When: 842189ca-f322-497e-25c6-334bedd6a765 = CN V (trigeminal)
Value Set:
..... a97e8d83-afcd-d99f-3aac-50c0363ce087CN VII deficit0..1textEnable When: 842189ca-f322-497e-25c6-334bedd6a765 = CN VII (facial)
Value Set:
..... 1c0d69f1-316c-d2d6-34fa-34c6fbede8f8CN VIII deficit0..1textEnable When: 842189ca-f322-497e-25c6-334bedd6a765 = CN VIII (vestibulocochlear)
Value Set:
..... 6fc6f331-69d8-fc06-27d0-c081061e021eCN IX, X, XII deficit0..1textEnable When: 842189ca-f322-497e-25c6-334bedd6a765 = CN IX, X, XII (glossopharyngeal, vagus, hypoglossal
Value Set:
..... 7240730c-1fd5-622b-dd8b-351240806889CN XI0..1textEnable When: 842189ca-f322-497e-25c6-334bedd6a765 = CN XI (spinal accessory)
Value Set:
..... 04139f55-b235-2441-76e6-bab2040eb888Other comments on physical examination0..1textValue Set:
... 29fac8b1-960d-86c0-1037-9a0e18668b32Decision0..1groupValue Set:
.... 77742a37-f115-f6a5-f351-9072e3c76084Diagnosis0..1groupValue Set:
..... 709fe161-2597-35bf-1056-eb57c06e3a09Do you consider this patient to have a diagnosis of concussion1..1choiceValue Set:
Options: 3 options
..... 722337cb-b4a5-76a6-271a-a0a74b641befHas this patient recovered from the concussion1..1choiceEnable When: 709fe161-2597-35bf-1056-eb57c06e3a09 = Yes
Value Set:
Options: 2 options
.... c40f9751-737e-66e7-b7aa-033762edd32eDecision to refer0..1groupValue Set:
..... 76485f80-eaf4-85d2-a8a5-7cd5fb84001aDo you feel a referral to the emergency department is appropriate1..1choiceEnable When: a51231eb-4df8-790b-c972-07f38c904098 = true
Value Set:
Options: 2 options
..... 0b5fbd16-bc77-7b01-6808-f4ec6dfaa868Do you intend to create a referral based on this assessment1..1choice​​iconiconValue Set:
Options: 5 options
..... c2e2a26e-5fb9-ff78-aac6-36f03ed16accPlease state other referral1..1stringEnable When: 0b5fbd16-bc77-7b01-6808-f4ec6dfaa868 = Other
Value Set:
.... 61750ed9-71a7-74a4-e705-ae70b73f2523Comments0..1groupValue Set:
..... bd14c97d-4241-a996-dcef-e2404225b5e2Additional comments from the current appointment0..1textValue Set:
... a620be23-57c7-3c2e-4e89-98bd94b4e8efBIST progress0..1groupValue Set:
.... 97fb5b6c-b9c4-3469-9b18-f62da19796d6Assessment progress0..1groupValue Set:
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... 667e2cac-32f4-6899-1d30-174a695257b4Education0..1groupValue Set:
.... ab7a1936-260b-45f3-c860-981808a17100Education content0..1groupValue Set:
..... 2984c8bc-5620-e8f9-4025-6bbba0920d37Send educational content to:1..1choice​​iconiconValue Set:
Options: 4 options
..... 9af0aecb-e6ec-5dfd-6629-877fdfedf2a1Education content has been provided. You can select an option below to resend0..1displayValue Set:
..... a4a6c194-69b2-0195-659f-2bb554941d81Send educational content to:0..1choice​​iconiconValue Set:
Options: 2 options
..... 048ed550-b543-49af-d925-d852f41e3adcEmail1..1stringEnable When:
Value Set:
..... bd3dcaae-13f2-b6e4-7b39-feec105a5367Mobile1..1quantityEnable When:
Value Set:
... 2dc32449-f70e-4c46-f576-a09faebda094Patient details0..1groupValue Set:
.... 263e0594-c466-5c7b-a584-f7af1a289142Patient details0..1groupValue Set:
..... 03e36387-b872-1a4e-eb0c-48a53a979f9eFirst name1..1stringValue Set:
..... c8d94679-3937-c736-70a0-b9c6fb0439aeLast name1..1stringValue Set:
..... 176e27b8-1489-985f-6d2a-4d9ccbe1ce6cDate of birth1..1dateValue Set:
..... fcb35de7-5396-c1f0-62d7-bd31f896522eNHI1..1stringValue Set:
..... fd056bcc-6b26-fb3b-1cf3-9df1d03b0581Gender1..1choice​​iconiconValue Set:
Options: 3 options
..... 45cebce6-3226-bb75-a5c3-d8f237bb22b5Other gender1..1stringEnable When: fd056bcc-6b26-fb3b-1cf3-9df1d03b0581 = Other
Value Set:
..... 1bf0400e-9a61-9120-6ae9-5fd08ccdfbe5Birth sex1..1choice​​iconiconValue Set:
Options: 3 options
..... bd7c4c1d-5efb-5602-4dfd-9286be1d69f8Other birth sex1..1stringEnable When: 1bf0400e-9a61-9120-6ae9-5fd08ccdfbe5 = Other
Value Set:
..... 5e7a8712-6899-cd9d-b44d-a87533acff68Ethnicity1..1choiceValue Set:
Options: 187 options
.... affc1a44-c7c9-fc8b-bad6-9b0ba5cf89acPatient address0..1groupValue Set:
..... 29e6f6be-ce14-e490-8f90-5dd1bb88e981Street1..1stringValue Set:
..... 616527e1-3934-d716-f129-87e1f59ab45cSuburb1..1stringValue Set:
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..... 192f3985-82e0-ca5c-e574-a5b3f5626921Postcode0..1stringValue Set:
.... 463cad26-ccb6-1782-b166-84f35b8176ebPatient contact details0..1groupValue Set:
..... 7fa49ad6-1929-11e4-2386-f0c5013054efMobile0..1stringValue Set:
..... 7ea584dd-7623-dc35-a333-274d621cdac9Email0..1stringValue Set:
... 280906d6-ec92-ba82-abc8-e9c2a28ebb50Provider details0..1groupValue Set:
.... 9492fc6a-55f2-e2bd-fa84-9c80e300e174Clinician details0..1groupValue Set:
..... 57ee43af-edf5-1b98-cc1c-b77a0c7cd610Name1..1stringValue Set:
..... e0ecb802-a804-c196-91c3-85bc7da2a8c2ACC provider ID1..1stringValue Set:
..... 1fe7a18c-dda4-b5b7-d81c-2f21988b1024Practice name1..1stringValue Set:
..... 6619a29e-6904-770e-b6e1-caa7c0690a0aACC facility ID1..1stringValue Set:
.... c565a411-e138-8a71-e4e3-c028127be576Provider address0..1groupValue Set:
..... 651f9e22-80e7-6ad1-5306-ef782c09745dStreet1..1stringValue Set:
..... 5c386c17-3d45-99ca-748e-23d8159e4f9cSuburb1..1stringValue Set:
..... fb0f00aa-5b5d-579f-1b95-273716525d9cCity1..1stringValue Set:
..... de0635ff-4bde-54c4-c01b-e8915d945591Postcode0..1stringValue Set:
.... 50e5749b-17e6-3075-76f4-3ba1eb276b7cProvider contact details0..1groupValue Set:
..... c4f62f2a-00bf-3174-d6dc-2f36dab2ed03Mobile0..1stringValue Set:
..... fa1d5d88-b8aa-691f-088d-e223705bd331Email0..1stringValue Set:
... a51231eb-4df8-790b-c972-07f38c904098Outcome ED referral0..1choiceiconiconValue Set:
... aedd11d2-0814-e723-3247-1f36911576e2Age weight0..1choiceiconiconValue Set:
... caef507e-0d08-2e25-a2aa-bd484cb59526Trauma weight0..1choiceiconiconValue Set:
... b51f80fd-dd63-71b3-e488-c946fdcb9c26Vomit weight0..1choiceiconiconValue Set:
... 42a05af8-ad84-7e66-572b-8605f6b8477dLOC weight0..1choiceiconiconValue Set:
... 47df88f0-d5b0-9b06-0a31-777040912294Symptoms experience weight0..1choiceiconiconValue Set:
... 25a82bc7-1b04-3fe8-2f30-082076a5b75cPrior TBI weighting0..1choiceiconiconValue Set:
... 676f937c-574e-4c28-dd24-65ee9b7d93d3Prolonged recovery weighting0..1choiceiconiconValue Set:
... 6fae9e39-9797-66c4-7236-6fec867df7cbMH disorder weighting0..1choiceiconiconValue Set:
... 834484c0-3ef6-9e35-cb3f-04f046f29888Dom VO weighting0..1choiceiconiconValue Set:
... b2c33d75-9008-1941-e0bf-759456a4ff0dMigraine weighting0..1choiceiconiconValue Set:
... 33ca4de1-1d93-d13b-e726-c72b39c72ea2Symptoms score 160 weighting0..1choiceiconiconValue Set:
... edda66c2-d94c-0629-efac-4dcf815f27bbImpact weighting0..1choiceiconiconValue Set:
... f300185f-01a7-6785-7370-cd92ad07c334Weightings total0..1choiceiconiconValue Set:

doco Documentation for this format

Options Sets

Answer options for 81927019-006c-7ae6-fcfa-e3242c8e75c4

  • Yes
  • No

Answer options for 2480750a-d6fa-2c6e-7fc7-40d2569e938d

  • Yes
  • No

Answer options for 1099711a-1c5f-cf83-c242-7948add4b7d4

  • Yes
  • No

Answer options for 20acb126-54c3-e63a-68f8-3b0217792e76

  • Yes
  • No

Answer options for 07a20c2a-e34b-8d6c-7eb9-cbadaa74aff9

  • Yes
  • No

Answer options for 998b3d51-eba5-5101-c3f3-7537a2826580

  • Yes
  • No
  • Unknown

Answer options for 06cd326d-1ba8-ea02-d4e3-0f8d724fb5fa

  • Yes
  • No
  • Unknown

Answer options for 8d87deb7-8818-f790-d3ce-4902b0b8d95b

  • Better
  • Worse
  • About the same

Answer options for cfd82297-8071-f469-2e79-15191f7554a1

  • Yes
  • No

Answer options for 93ffbeb6-acde-7883-b13c-b861139e2a01

  • Yes
  • No

Answer options for 6ec00706-8935-5b2c-e776-71a7abeab973

  • Yes
  • No

Answer options for def327f0-e8b7-c090-36e1-5c2f4f3b01f6

  • Yes
  • No

Answer options for 24786db5-a459-371a-8e91-078c125d1356

  • Yes
  • No

Answer options for 649ee4dd-5c2c-80a5-75ad-576a27d24d8c

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10

Answer options for fb296612-8718-7ebf-ceb2-c88fe247d0ae

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10

Answer options for fd7a2fb1-057d-a3c6-81ad-46e813a33eda

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10

Answer options for 98315a2c-010c-a3fb-404d-1ef46f1b76f6

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
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  • 10

Answer options for e4aecd4f-f3f2-c4c5-b73a-91978353c51e

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10

Answer options for d60a3770-4327-8ace-acb7-f682ff573dc5

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10

Answer options for a405f89b-aee6-76c3-3274-00a6a64412c9

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10

Answer options for e990a88e-d6a2-3340-9b60-831eb7647bfd

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10

Answer options for 271beefa-219f-56dc-d065-dc7f9c40b4b0

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
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  • 10

Answer options for 4cd53427-0913-ffb8-09bf-8a85c156169f

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10

Answer options for 24a62b83-3d45-1dc0-660e-4f3559b271b8

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10

Answer options for 1600c5f8-b5a7-3806-172e-5c79ad3d15df

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10

Answer options for a82eb15e-afdc-7037-8201-5d88d50c3f7d

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10

Answer options for 0af296ab-f09e-48d6-85f4-62e230ad8cf0

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10

Answer options for 99e2f0a4-ea93-c2df-96f9-a9c3834655ba

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10

Answer options for d86bdf62-5e16-584b-be3f-0f19956f0a4f

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10

Answer options for 8d17b21e-00c0-33d2-ea4e-a0c9647ae75c

  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10

Answer options for 55a9d3e3-5d84-dd47-8002-e46fc831b2c6

  • Yes
  • No

Answer options for cf456c31-0550-718f-7e96-66d1baada245

  • Yes
  • No

Answer options for 33352cf0-53bf-13ac-5268-954008b0be2e

  • Yes
  • No

Answer options for 6eb239a3-b5ea-f46b-939b-165004089b4a

  • Hypotonia
  • Hypertonia
  • Normal tone

Answer options for 035c6086-4399-9f86-9f30-acb5ed4400fa

  • Left
  • Right
  • Bilateral

Answer options for 58f714e9-0c9c-79ef-0a49-2b624172ad89

  • Reduced
  • Normal power

Answer options for fd4ba90f-0c51-f38f-8408-994ecc62f87b

  • Left
  • Right
  • Bilateral

Answer options for 913bfe12-4ff4-8dd7-4c8b-ad28f81e1ea5

  • Altered fine touch
  • Altered pain/sharp sensation
  • Normal sensation

Answer options for 0375054b-7126-ea8b-13df-86c8317b6291

  • Left
  • Right
  • Bilateral

Answer options for 20804cc5-8e38-e8d5-3215-435d7ba8ed1e

  • Yes
  • No

Answer options for fbe5d8c4-8d88-62bc-7cdd-ace891a76597

  • L. Brachioradialis
  • L. Deltoid
  • L. Biceps
  • R. Brachioradialis
  • R. Deltoid
  • R. Biceps

Answer options for 5a9b42b6-a12d-7baf-dc05-04a300b21aac

  • Intact
  • Abnormal (reduced)

Answer options for 88114e19-a1b2-0485-8a24-9ced2a78a032

  • Left
  • Right
  • Bilateral

Answer options for 85c86289-5170-f4bf-c8ac-2e92e93bd5f3

  • Intact
  • Abnormal (reduced)

Answer options for 01313e25-2aa6-a3e2-4c8e-96cbe949da0b

  • Left
  • Right
  • Bilateral

Answer options for 172fc4f0-9e70-a5e8-8e2b-287a57c75f7e

  • Hypotonia
  • Hypertonia
  • Normal tone

Answer options for 4d1e47cc-5720-f4f2-d4d2-83e50e522896

  • Left
  • Right
  • Bilateral

Answer options for 7ab9f7ed-5903-3a55-cdc8-a9240afffa27

  • Reduced
  • Normal

Answer options for 7582cbd7-4c5c-58f1-4a60-ed34895a5375

  • Left
  • Right
  • Bilateral

Answer options for f266288d-32e3-a594-c721-58e35df6a501

  • Altered fine touch
  • Altered pain/sharp sensation
  • Normal sensation

Answer options for bb401fd2-e8fd-cebb-6592-4e6ad6d6f16a

  • Left
  • Right
  • Bilateral

Answer options for 67c8a150-a80d-cafc-c8f2-ef6577e6ed7d

  • Yes
  • No

Answer options for 548d723c-dc92-af49-1900-ff0d913511b4

  • L. Knee
  • L. Ankle
  • L. Plantar
  • R. Knee
  • R. Ankle
  • R. Plantar

Answer options for dd9edad2-21a4-e031-d083-ea775a298eb4

  • Intact
  • Abnormal (reduced)

Answer options for 39cb1de0-493c-5b69-eeed-b30e32a08715

  • Left
  • Right
  • Bilateral

Answer options for c4ec6154-56a0-d915-be83-0bf3a2e1370e

  • Intact
  • Abnormal (reduced)

Answer options for 1e4af20b-6767-6d0e-690f-6c81ec8816ac

  • Left
  • Right
  • Bilateral

Answer options for 99d5df32-a4ac-9a4a-c4a4-85071a26b450

  • Yes
  • No

Answer options for b106bc52-d1b7-09b4-bc32-5b7eb9ba1506

  • Upper limbs
  • Lower limbs
  • Upper and lower limbs

Answer options for fdd9c39b-6de2-9416-b453-2b0d7488f1da

  • Left
  • Right
  • Bilateral

Answer options for c2859a5e-6057-5ac4-55d7-124340313f1a

  • Yes
  • No

Answer options for 7784e363-b9b3-c164-119d-9e5b6c67928f

  • Yes
  • No

Answer options for 842189ca-f322-497e-25c6-334bedd6a765

  • CN I (olfactory)
  • CN II (optic)
  • CN III, IV, VI (oculomotor, trochlear, abducens)
  • CN V (trigeminal)
  • CN VII (facial)
  • CN VIII (vestibulocochlear)
  • CN IX, X, XII (glossopharyngeal, vagus, hypoglossal
  • CN XI (spinal accessory)

Answer options for 709fe161-2597-35bf-1056-eb57c06e3a09

  • Yes
  • No
  • Unsure

Answer options for 722337cb-b4a5-76a6-271a-a0a74b641bef

  • Yes
  • No

Answer options for 76485f80-eaf4-85d2-a8a5-7cd5fb84001a

  • Yes
  • No

Answer options for 0b5fbd16-bc77-7b01-6808-f4ec6dfaa868

  • Emergency department
  • Concussion services
  • Vestibular physiotherapist
  • Other
  • No referral

Answer options for 2984c8bc-5620-e8f9-4025-6bbba0920d37

  • Email
  • Mobile
  • Hard copy provided
  • Not supplied

Answer options for a4a6c194-69b2-0195-659f-2bb554941d81

  • Email
  • Mobile

Answer options for fd056bcc-6b26-fb3b-1cf3-9df1d03b0581

  • Female
  • Male
  • Other

Answer options for 1bf0400e-9a61-9120-6ae9-5fd08ccdfbe5

  • Female
  • Male
  • Other

Answer options for 5e7a8712-6899-cd9d-b44d-a87533acff68

  • European nfd
  • NZ European
  • British nfd
  • Celtic nfd
  • Channel Islander
  • Cornish
  • English
  • Irish
  • Manx
  • Scottish
  • Welsh
  • British nec
  • Dutch
  • Greek
  • Polish
  • South Slav nfd
  • Croatian
  • Dalmatian
  • Macedonian
  • Serbian
  • Slovenian
  • Bosnian
  • South Slav nec
  • Italian
  • German
  • Australian
  • Albanian
  • Armenian
  • Austrian
  • Belgian
  • Bulgarian
  • Belorussian
  • Cypriot nfd
  • Czech
  • Danish
  • Estonian
  • Finnish
  • Flemish
  • French
  • Hungarian
  • Icelandic
  • Latvian
  • Lithuanian
  • Maltese
  • Norwegian
  • Portuguese
  • Romanian
  • Gypsy
  • Russian
  • Slavic
  • Slovak
  • Spanish
  • Swedish
  • Swiss
  • Ukrainian
  • American
  • Canadian
  • New Caledonian
  • South African European
  • Afrikaner
  • Zimbabwean European
  • European nec
  • Māori
  • Pacific Peoples nfd
  • Samoan
  • Cook Islands Māori
  • Tongan
  • Niuean
  • Tokelauan
  • Fijian
  • Indigenous Australian
  • Hawaiian
  • Kiribati
  • Nauruan
  • Papua New Guinean
  • Pitcairn Islander
  • Rotuman
  • Tahitian
  • Solomon Islander
  • Tuvaluan
  • Ni Vanuatu
  • Pacific Peoples nec
  • Asian nfd
  • Southeast Asian nfd
  • Filipino
  • Cambodian
  • Vietnamese
  • Burmese
  • Indonesian
  • Lao
  • Malay
  • Thai
  • Karen
  • Chin
  • Southeast Asian nec
  • Chinese nfd
  • Hong Kong Chinese
  • Cambodian Chinese
  • Malaysian Chinese
  • Singaporean Chinese
  • Vietnamese Chinese
  • Taiwanese
  • Chinese nec
  • Indian nfd
  • Bengali
  • Fijian Indian
  • Indian Tamil
  • Punjabi
  • Sikh
  • Anglo Indian
  • Malaysian Indian
  • South African Indian
  • Indian nec
  • Sri Lankan nfd
  • Sinhalese
  • Sri Lankan Tamil
  • Sri Lankan nec
  • Japanese
  • Korean
  • Afghani
  • Bangladeshi
  • Nepalese
  • Pakistani
  • Tibetan
  • Eurasian
  • Bhutanese
  • Maldivian
  • Mongolian
  • Asian nec
  • Middle Eastern nfd
  • Algerian
  • Arab
  • Assyrian
  • Egyptian
  • Iranian/Persian
  • Iraqi
  • Israeli/Jewish
  • Jordanian
  • Kurd
  • Lebanese
  • Moroccan
  • Palestinian
  • Syrian
  • Turkish
  • Middle Eastern nec
  • Latin American nfd
  • Argentinian
  • Bolivian
  • Brazilian
  • Chilean
  • Colombian
  • Ecuadorian
  • Mexican
  • Peruvian
  • Puerto Rican
  • Uruguayan
  • Venezuelan
  • Latin American nec
  • Jamaican
  • Kenyan
  • Nigerian
  • African American
  • Caribbean
  • Somali
  • Eritrean
  • Ethiopian
  • Ghanaian
  • Burundian
  • Congolese
  • Sudanese
  • Zambian
  • Other Zimbabwean
  • African nec
  • Indigenous American
  • Mauritian
  • Seychellois
  • Other South African
  • New Zealander
  • Aboriginal Australian
  • Torres Strait Islander
  • Other ethnicity nec
  • Don't know
  • Refused to answer
  • Repeated value
  • Response unidentifiable
  • Response outside scope
  • Not stated