New Zealand ICP Implementation Guide
1.1.0 - draft
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
| Official URL: http://hl7.org.nz/fhir/Questionnaire/acc-bist | Version: 1.1.0 | |||
| Draft as of 2025-07-17 | 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)
| LinkID | Text | Cardinality | Type | Flags | Description & Constraints |
|---|---|---|---|---|---|
  ACC BIST - 20202 | Represents the Brain Injury Screening Tool (BIST) for ACC. | Questionnaire | http://hl7.org.nz/fhir/Questionnaire/acc-bist#1.1.0 | ||
  604b88f5-d404-6683-7680-744941147a9a | Claim number | 0..1 | group | ||
  cfdcec28-1325-a279-2604-4fc29e477d36 | ACC Claim numbers | 0..1 | group | ||
  875f04a8-2c11-00f7-989a-d2295da80cef | null | 0..1 | display | ||
| 1d4765db-8626-cc6d-06d7-e157dd6428db | **Select claim number:** Select an existing claim number for this injury, or start a new claim | 0..1 | display | ||
| e503f5df-88fa-aa3f-6e6a-3a3c0b663b7c | ACC Claim Numbers | 0..1 | display | ||
| dd54effd-cadb-bbd8-26e5-c375a346ae76 | Accident details | 0..1 | group | ||
| 477e1544-d220-f793-02b7-ebf79054f367 | Time of accident | 0..1 | group | ||
 d3813771-921e-0d0f-4ff6-851bc880121d | Date of injury | 1..1 | date | ||
 3c4b9927-4ebf-8207-c8dc-1d4caf8d28fb | Time of injury | 0..1 | time | ||
| c1e034ae-39dd-66ec-ca03-5cfee995a009 | Date of consultation | 1..1 | date | ||
 81927019-006c-7ae6-fcfa-e3242c8e75c4 | Injury occurred within past 24 hours | 1..1 | choice | Options: 2 options | |
| 7c5ad9cf-35c9-791f-ecf8-57471f86fefc | Accident details | 0..1 | group | ||
 b5db59e5-43c5-8668-041e-baa0523702ac | Please tell me about what happened | 1..1 | text | ||
| 2480750a-d6fa-2c6e-7fc7-40d2569e938d | Are 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..1 | choice | Options: 2 options | |
| 1099711a-1c5f-cf83-c242-7948add4b7d4 | Did 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..1 | choice | Options: 2 options | |
| 20acb126-54c3-e63a-68f8-3b0217792e76 | Did anyone with you at the time of injury say anything else about what happened | 1..1 | choice | Options: 2 options | |
| ae27dd88-0cc0-d8dc-9897-a0a6ac340950 | Please give details | 1..1 | text | Enable When: 20acb126-54c3-e63a-68f8-3b0217792e76 = | |
| 07a20c2a-e34b-8d6c-7eb9-cbadaa74aff9 | Were you sick or did you vomit | 1..1 | choice | Options: 2 options | |
 3d561610-f162-ecfb-00e7-56357f4ac2c1 | How many times | 1..1 | quantity | Enable When: 07a20c2a-e34b-8d6c-7eb9-cbadaa74aff9 = | |
| 998b3d51-eba5-5101-c3f3-7537a2826580 | Were you knocked out (or did you lose consciousness) | 1..1 | choice | Options: 3 options | |
| 06cd326d-1ba8-ea02-d4e3-0f8d724fb5fa | Did you have a fit or seizure straight afterwards (i.e., go stiff or shake violently) | 1..1 | choice | Options: 3 options | |
| 8d87deb7-8818-f790-d3ce-4902b0b8d95b | Are you feeling better, worse, or about the same since the injury | 1..1 | choice | Options: 3 options | |
| cfd82297-8071-f469-2e79-15191f7554a1 | Have you had a concussion or brain injury before | 1..1 | choice | Options: 2 options | |
| 39bcf1e3-8743-53b8-3d5c-b5830a414943 | How many times | 1..1 | quantity | Enable When: cfd82297-8071-f469-2e79-15191f7554a1 = | |
| 34d85b59-da5d-e40a-0072-4be01c5e2955 | When was the last injury | 1..1 | date | Enable When: cfd82297-8071-f469-2e79-15191f7554a1 = | |
| 93ffbeb6-acde-7883-b13c-b861139e2a01 | Was it a prolonged recovery (> 3 months to recover) | 1..1 | choice | Enable When: cfd82297-8071-f469-2e79-15191f7554a1 = Options: 2 options | |
| 6ec00706-8935-5b2c-e776-71a7abeab973 | Are you currently taking any medications that thin the blood e.g., anticoagulants | 1..1 | choice | Options: 2 options | |
| def327f0-e8b7-c090-36e1-5c2f4f3b01f6 | Have you ever experienced difficulties with your mental health | 1..1 | choice | Options: 2 options | |
| 24786db5-a459-371a-8e91-078c125d1356 | Do you have a history of migraine (severe headache with vomiting or extreme sensitivity to light and sound) | 1..1 | choice | Options: 2 options | |
| 1aeefdd3-210f-3edc-fc10-0c488f054611 | Symptom scale | 0..1 | group | ||
| 132c4769-39c9-16f2-32c6-47f580c02eca | Symptom scale | 0..1 | group | ||
| fbdc70b5-65e9-551f-eac9-ea17e917fc7f | null | 0..1 | display | ||
| 9ef37f8a-0eff-68bc-5fcc-2204acd4fa8d | Please ask your patient the following questions: | 0..1 | display | ||
| 8eba2434-1564-4584-6971-1bcbbcb0e97a | Symptom scale header | 0..1 | display | ||
| ad0d0923-8c59-64a4-4353-f866b7568c0b | null | 0..1 | display | ||
| fbdd4438-9826-36df-1cd6-212b2556351a | **Physical:** | 0..1 | display | ||
| 4439ab02-769d-d7c9-04cd-16da25b8d155 | Headache (my head hurts) | 0..1 | group | ||
| 649ee4dd-5c2c-80a5-75ad-576a27d24d8c | Headache (my head hurts) | 1..1 | choice |  | Options: 11 options |
 3dc85f1f-5c49-b7aa-f1da-b3a36fb932d2 | Score | 0..1 | decimal | Initial Value: decimal = 0 | |
| adcc4190-a80e-03be-7dc1-80eb4d6a3aba | My neck hurts | 0..1 | group | ||
| fb296612-8718-7ebf-ceb2-c88fe247d0ae | My neck hurts | 1..1 | choice | | Options: 11 options |
| a52fbffc-6c8d-ec0f-78d0-fed570941c47 | Score | 0..1 | decimal | Initial Value: decimal = 0 | |
| a37f8af0-b6a6-2672-0e50-7fdc442c3818 | I don't like bright lights | 0..1 | group | ||
| fd7a2fb1-057d-a3c6-81ad-46e813a33eda | I don't like bright lights | 1..1 | choice | | Options: 11 options |
| 6441b3a7-4394-7a82-ed23-8b21d2a4c90f | Score | 0..1 | decimal | Initial Value: decimal = 0 | |
| 567f262f-6b77-91cc-bc08-9b699ff792c7 | I don't like loud noises | 0..1 | group | ||
| 98315a2c-010c-a3fb-404d-1ef46f1b76f6 | I don't like loud noises | 1..1 | choice | | Options: 11 options |
| a21220ee-f70a-ad57-4c4b-aeeb69aeeb25 | Score | 0..1 | decimal | Initial Value: decimal = 0 | |
| 52dc63e5-cd45-a3b0-ad32-9e141a83d1cb | Total physical score (out of 40) | 0..1 | decimal | Initial Value: decimal = 0 | |
| ac00575b-b239-702e-839c-a0ca36a1cbee | null | 0..1 | display | ||
| 4df3a643-9264-8325-c544-33124256d0ba | **Vestibular-ocular:** | 0..1 | display | ||
| b9e4da41-6665-5f79-a804-560d0f02c47b | I feel dizzy or like I could be sick | 0..1 | group | ||
| e4aecd4f-f3f2-c4c5-b73a-91978353c51e | I feel dizzy or like I could be sick | 1..1 | choice | | Options: 11 options |
| 9f096e62-7069-b061-32b0-813b125abf70 | Score | 0..1 | decimal | Initial Value: decimal = 0 | |
| 4713c995-deaf-66b9-56fa-becae450f445 | If I close my eyes, I feel like I am at sea | 0..1 | group | ||
| d60a3770-4327-8ace-acb7-f682ff573dc5 | If I close my eyes, I feel like I am at sea | 1..1 | choice | | Options: 11 options |
| eccfd6b5-3b34-51c5-9652-66dc9a7a308a | Score | 0..1 | decimal | Initial Value: decimal = 0 | |
| 8e86f368-cf1a-e6c9-0651-7dc61931a8fd | I have trouble with my eyesight (vision) | 0..1 | group | ||
| a405f89b-aee6-76c3-3274-00a6a64412c9 | I have trouble with my eyesight (vision) | 1..1 | choice | | Options: 11 options |
| c8c04df4-58ed-dbd6-4bf7-5434da6b6d9a | Score | 0..1 | decimal | Initial Value: decimal = 0 | |
| 2957b123-e6be-ef67-6142-643dd5115d42 | I feel clumsy (bumping into or dropping things) | 0..1 | group | ||
| e990a88e-d6a2-3340-9b60-831eb7647bfd | I feel clumsy (bumping into or dropping things) | 1..1 | choice | | Options: 11 options |
| 6b83c98e-eb9e-17ba-35ab-ca4d8353fc3f | Score | 0..1 | decimal | Initial Value: decimal = 0 | |
| 227e8a8e-83d9-28ac-ce45-f4d8e2b33c8a | Total vestibular score (out of 40) | 0..1 | decimal | Initial Value: decimal = 0 | |
| 8163f6e7-b45b-bf70-25d5-6a272e54e84d | null | 0..1 | display | ||
| 0b219e69-d2c4-30a2-12d3-65663d3b186f | **Cognitive:** | 0..1 | display | ||
| 037d5a09-5803-8191-527f-00d2dc1fc073 | It takes me longer to think | 0..1 | group | ||
| 271beefa-219f-56dc-d065-dc7f9c40b4b0 | It takes me longer to think | 1..1 | choice | | Options: 11 options |
| 9499e9b1-e021-f327-3bdc-4498fc9c38b9 | Score | 0..1 | decimal | Initial Value: decimal = 0 | |
| 5ee18372-f4d4-29c5-fc08-65c8a4f28124 | I forget things | 0..1 | group | ||
| 4cd53427-0913-ffb8-09bf-8a85c156169f | I forget things | 1..1 | choice | | Options: 11 options |
| 0c1e6c65-1407-1628-28bc-3b9ac5b0c2d1 | Score | 0..1 | decimal | Initial Value: decimal = 0 | |
| 49b8014a-eb00-61f9-97ef-0ef47f182368 | I get confused easily | 0..1 | group | ||
| 24a62b83-3d45-1dc0-660e-4f3559b271b8 | I get confused easily | 1..1 | choice | | Options: 11 options |
| b48f29d8-83ba-d8c9-09ab-b4725c7f339a | Score | 0..1 | decimal | Initial Value: decimal = 0 | |
| 0a303380-670d-9606-fa9f-0b94f045373b | I have trouble concentrating | 0..1 | group | ||
| 1600c5f8-b5a7-3806-172e-5c79ad3d15df | I have trouble concentrating | 1..1 | choice | | Options: 11 options |
| b46b9bbc-b834-5a26-75df-c36cfd3386ef | Score | 0..1 | decimal | Initial Value: decimal = 0 | |
| 110b56eb-3567-b53f-11bd-fcc17197719d | Total cognitive score (out of 40) | 0..1 | decimal | Initial Value: decimal = 0 | |
| f09e82f6-5aad-3d70-8ddf-c0a791c83b03 | null | 0..1 | display | Enable When: 81927019-006c-7ae6-fcfa-e3242c8e75c4 = | |
| 89ccdd50-bacc-e3fa-0d54-b98461cb0ec5 | **If more than 24 hours post-injury, please also rate these physical symptoms:** | 0..1 | display | ||
| c8a2f7a2-7282-de64-5756-3cfbaa848300 | I get angry or irritated easily | 0..1 | group | Enable When: 81927019-006c-7ae6-fcfa-e3242c8e75c4 = | |
| a82eb15e-afdc-7037-8201-5d88d50c3f7d | I get angry or irritated easily | 1..1 | choice | | Options: 11 options |
| b0324526-62f2-7490-b8d1-328f82f41b98 | Score | 0..1 | decimal | Initial Value: decimal = 0 | |
| c98564a6-4e8f-957f-9f3b-8de4a9acfff2 | I feel restless | 0..1 | group | Enable When: 81927019-006c-7ae6-fcfa-e3242c8e75c4 = | |
| 0af296ab-f09e-48d6-85f4-62e230ad8cf0 | I feel restless | 1..1 | choice | | Options: 11 options |
| ade568fd-9ae0-6681-e1eb-08d1ede38742 | Score | 0..1 | decimal | Initial Value: decimal = 0 | |
| 93477887-a79c-1c45-cd67-25cda52d5099 | I feel tired during the day | 0..1 | group | Enable When: 81927019-006c-7ae6-fcfa-e3242c8e75c4 = | |
| 99e2f0a4-ea93-c2df-96f9-a9c3834655ba | I feel tired during the day | 1..1 | choice | | Options: 11 options |
| 6e668680-6fc5-3b69-ca29-6df82198e151 | Score | 0..1 | decimal | Initial Value: decimal = 0 | |
| 2102c7b6-0490-ba51-2757-7f61f0046d4b | I need to sleep a lot more or find it hard to sleep at night | 0..1 | group | Enable When: 81927019-006c-7ae6-fcfa-e3242c8e75c4 = | |
| d86bdf62-5e16-584b-be3f-0f19956f0a4f | I need to sleep a lot more or find it hard to sleep at night | 1..1 | choice | | Options: 11 options |
| 9033a3d5-f7d6-7262-99da-d9d9c98a4919 | Score | 0..1 | decimal | Initial Value: decimal = 0 | |
| 80b44067-3ade-b428-fded-ed36667a47fa | Total 24 hour post-injury physical score (out of 40) | 0..1 | decimal | Enable When: 81927019-006c-7ae6-fcfa-e3242c8e75c4 = Initial Value: decimal = 0 | |
| 6636e6fd-3c79-e6ca-fdd9-023ce1389831 | Total symptom severity score (out of 120) | 0..1 | decimal | Enable When: 81927019-006c-7ae6-fcfa-e3242c8e75c4 = Initial Value: decimal = 0 | |
| 0597f621-3855-fcaf-d7fb-bf42a65f3d2b | Total symptom severity score (out of 160) | 0..1 | decimal | Enable When: 81927019-006c-7ae6-fcfa-e3242c8e75c4 = Initial Value: decimal = 0 | |
| 9e494968-dbeb-b5ae-3241-957617a40770 | Endorsed (out of 12) | 0..1 | choice | Enable When: 81927019-006c-7ae6-fcfa-e3242c8e75c4 = | |
| 2df943f9-307c-5b05-d7a2-cd619fd016bf | Endorsed (out of 16) | 0..1 | choice | Enable When: 81927019-006c-7ae6-fcfa-e3242c8e75c4 = | |
| 33b59517-b4e4-f5f0-3c4a-af379c1edc50 | Dominant group description | 0..1 | choice | ||
 74d94b9d-400f-9db9-e402-81b12e4e232b | Age | 0..1 | string |  | |
| 4d60e31a-0a1b-6e98-b839-a6be125f2102 | Impact score | 0..1 | group | ||
| b09fab7d-e83b-daa4-d54d-2bc5c3ed5323 | Impact score | 0..1 | group | ||
| a526292e-c1fa-519e-cdbc-e4baa70300b1 | null | 0..1 | display | ||
| 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..1 | display | ||
| 8d17b21e-00c0-33d2-ea4e-a0c9647ae75c | Impact of injury | 1..1 | choice | | Options: 11 options |
| 1b1463e7-8f79-b112-78b5-63562c718543 | Physical examination | 0..1 | group | ||
| 405a02b2-09bd-ac7b-1bbf-973bcbffd5fe | Physical examination | 0..1 | group | ||
| 55a9d3e3-5d84-dd47-8002-e46fc831b2c6 | Evidence of skull fracture | 0..1 | choice | Options: 2 options | |
| 27586f48-90c5-8b80-f957-79d34b4651c6 | Please give details | 0..1 | text | Enable When: 55a9d3e3-5d84-dd47-8002-e46fc831b2c6 = | |
| cf456c31-0550-718f-7e96-66d1baada245 | Other significant injuries | 0..1 | choice | Options: 2 options | |
| 115d0341-637a-684e-c05e-d72b51451970 | Please give details | 0..1 | text | Enable When: cf456c31-0550-718f-7e96-66d1baada245 = | |
| 7a8f25dd-04eb-f4b4-b2fb-98dba3fb1fbb | null | 0..1 | display | ||
| 1bfe283c-c3e7-45dd-7ccf-fbf53db6838d | **Neurological examination:** | 0..1 | display | ||
| 33352cf0-53bf-13ac-5268-954008b0be2e | Abnormality of gait | 0..1 | choice | Options: 2 options | |
| 1f31017d-f306-4554-7e07-040f1bfa4b32 | Please give details | 0..1 | text | Enable When: 33352cf0-53bf-13ac-5268-954008b0be2e = | |
| f2511f67-e620-368b-3352-64336c7e404f | null | 0..1 | display | ||
| b14e105b-b005-6e34-7d8e-0bb9f8cd76b1 | **Upper limb:** | 0..1 | display | ||
| 6eb239a3-b5ea-f46b-939b-165004089b4a | Upper limb tone | 0..1 | choice | | Options: 3 options |
| 035c6086-4399-9f86-9f30-acb5ed4400fa | Side | 0..1 | choice | | Enable When: Options: 3 options |
| 58f714e9-0c9c-79ef-0a49-2b624172ad89 | Upper limb power | 0..1 | choice | | Options: 2 options |
| fd4ba90f-0c51-f38f-8408-994ecc62f87b | Side | 0..1 | choice | | Enable When: 58f714e9-0c9c-79ef-0a49-2b624172ad89 = Options: 3 options |
| 913bfe12-4ff4-8dd7-4c8b-ad28f81e1ea5 | Upper limb sensation | 0..1 | choice | | Options: 3 options |
| 0375054b-7126-ea8b-13df-86c8317b6291 | Side | 0..1 | choice | | Enable When: Options: 3 options |
| 20804cc5-8e38-e8d5-3215-435d7ba8ed1e | Upper limb reflexes normal | 0..1 | choice | Options: 2 options | |
| fbe5d8c4-8d88-62bc-7cdd-ace891a76597 | Reflexes tested | 0..1 | choice | | Enable When: 20804cc5-8e38-e8d5-3215-435d7ba8ed1e = Options: 6 options |
| 3357cbda-4506-68b4-8cc1-ee9bd6b952c1 | Please state abnormality | 0..1 | string | Enable When: 20804cc5-8e38-e8d5-3215-435d7ba8ed1e = | |
| 5a9b42b6-a12d-7baf-dc05-04a300b21aac | Upper limb vibration sense | 0..1 | choice | Options: 2 options | |
| 88114e19-a1b2-0485-8a24-9ced2a78a032 | Side | 0..1 | choice | | Enable When: 5a9b42b6-a12d-7baf-dc05-04a300b21aac = Options: 3 options |
| 85c86289-5170-f4bf-c8ac-2e92e93bd5f3 | Upper limb joint position sense | 0..1 | choice | Options: 2 options | |
| 01313e25-2aa6-a3e2-4c8e-96cbe949da0b | Side | 0..1 | choice | | Enable When: 85c86289-5170-f4bf-c8ac-2e92e93bd5f3 = Options: 3 options |
| 501ad295-81cf-aef5-3c14-b128feb04a4a | null | 0..1 | display | ||
| d9874ede-7361-deff-baf5-869fb6d1411b | **Lower limb:** | 0..1 | display | ||
| 172fc4f0-9e70-a5e8-8e2b-287a57c75f7e | Lower limb tone | 0..1 | choice | | Options: 3 options |
| 4d1e47cc-5720-f4f2-d4d2-83e50e522896 | Side | 0..1 | choice | | Enable When: Options: 3 options |
| 7ab9f7ed-5903-3a55-cdc8-a9240afffa27 | Lower limb power | 0..1 | choice | | Options: 2 options |
| 7582cbd7-4c5c-58f1-4a60-ed34895a5375 | Side | 0..1 | choice | | Enable When: 7ab9f7ed-5903-3a55-cdc8-a9240afffa27 = Options: 3 options |
| f266288d-32e3-a594-c721-58e35df6a501 | Lower limb sensation | 0..1 | choice | | Options: 3 options |
| bb401fd2-e8fd-cebb-6592-4e6ad6d6f16a | Side | 0..1 | choice | | Enable When: Options: 3 options |
| 67c8a150-a80d-cafc-c8f2-ef6577e6ed7d | Lower limb reflexes normal | 0..1 | choice | Options: 2 options | |
| 548d723c-dc92-af49-1900-ff0d913511b4 | Reflexes tested | 0..1 | choice | | Enable When: 67c8a150-a80d-cafc-c8f2-ef6577e6ed7d = Options: 6 options |
| 21ae8e6e-52b7-057a-f42d-136320d08140 | Please state abnormality | 0..1 | string | Enable When: 67c8a150-a80d-cafc-c8f2-ef6577e6ed7d = | |
| dd9edad2-21a4-e031-d083-ea775a298eb4 | Lower limb vibration sense | 0..1 | choice | Options: 2 options | |
| 39cb1de0-493c-5b69-eeed-b30e32a08715 | Side | 0..1 | choice | | Enable When: dd9edad2-21a4-e031-d083-ea775a298eb4 = Options: 3 options |
| c4ec6154-56a0-d915-be83-0bf3a2e1370e | Lower limb joint position sense | 0..1 | choice | Options: 2 options | |
| 1e4af20b-6767-6d0e-690f-6c81ec8816ac | Side | 0..1 | choice | | Enable When: c4ec6154-56a0-d915-be83-0bf3a2e1370e = Options: 3 options |
| 32c17d53-f413-0a0a-9806-cfb00724a782 | null | 0..1 | display | ||
| 89ea47d6-eaa5-4b34-97c8-ce9fdb2e1c1f | **Coordination:** | 0..1 | display | ||
| 99d5df32-a4ac-9a4a-c4a4-85071a26b450 | Coordination normal | 0..1 | choice | Options: 2 options | |
| b106bc52-d1b7-09b4-bc32-5b7eb9ba1506 | Coordination deficit | 0..1 | choice | | Enable When: 99d5df32-a4ac-9a4a-c4a4-85071a26b450 = Options: 3 options |
| fdd9c39b-6de2-9416-b453-2b0d7488f1da | Side | 0..1 | choice | | Enable When: 99d5df32-a4ac-9a4a-c4a4-85071a26b450 = Options: 3 options |
| dc09fdb2-5546-b3d7-c528-158b0a3482ab | Please give details | 0..1 | text | Enable When: 99d5df32-a4ac-9a4a-c4a4-85071a26b450 = | |
| da44c1da-25e3-3768-2dba-f67543461e9d | null | 0..1 | display | ||
| c8399e97-4394-32cb-cc7d-f0a6230d78da | **Cranial nerves:** | 0..1 | display | ||
| c2859a5e-6057-5ac4-55d7-124340313f1a | Cranial nerves tested | 0..1 | choice | Options: 2 options | |
| 7784e363-b9b3-c164-119d-9e5b6c67928f | Cranial nerve deficit | 0..1 | choice | Enable When: c2859a5e-6057-5ac4-55d7-124340313f1a = Options: 2 options | |
| 842189ca-f322-497e-25c6-334bedd6a765 | Cranial nerve deficit(s) | 0..1 | choice | | Enable When: 7784e363-b9b3-c164-119d-9e5b6c67928f = Options: 8 options |
| 9b2cebd4-7066-a1d8-21a9-697769b57e7e | CN I deficit | 0..1 | text | Enable When: 842189ca-f322-497e-25c6-334bedd6a765 = | |
| 6afe1fc8-f152-6b4c-db60-17160fc4c66f | CN II deficit | 0..1 | text | Enable When: 842189ca-f322-497e-25c6-334bedd6a765 = | |
| 13e87fed-4eb7-b703-27da-373126691be4 | CN III, IV, VI deficit | 0..1 | text | Enable When: 842189ca-f322-497e-25c6-334bedd6a765 = | |
| e4b7bd2e-18c5-bc59-db1e-14f188cba0a0 | CN V deficit | 0..1 | text | Enable When: 842189ca-f322-497e-25c6-334bedd6a765 = | |
| a97e8d83-afcd-d99f-3aac-50c0363ce087 | CN VII deficit | 0..1 | text | Enable When: 842189ca-f322-497e-25c6-334bedd6a765 = | |
| 1c0d69f1-316c-d2d6-34fa-34c6fbede8f8 | CN VIII deficit | 0..1 | text | Enable When: 842189ca-f322-497e-25c6-334bedd6a765 = | |
| 6fc6f331-69d8-fc06-27d0-c081061e021e | CN IX, X, XII deficit | 0..1 | text | Enable When: 842189ca-f322-497e-25c6-334bedd6a765 = | |
| 7240730c-1fd5-622b-dd8b-351240806889 | CN XI | 0..1 | text | Enable When: 842189ca-f322-497e-25c6-334bedd6a765 = | |
| 04139f55-b235-2441-76e6-bab2040eb888 | Other comments on physical examination | 0..1 | text | ||
| 29fac8b1-960d-86c0-1037-9a0e18668b32 | Decision | 0..1 | group | ||
| 77742a37-f115-f6a5-f351-9072e3c76084 | Diagnosis | 0..1 | group | ||
| 709fe161-2597-35bf-1056-eb57c06e3a09 | Do you consider this patient to have a diagnosis of concussion | 1..1 | choice | Options: 3 options | |
| 722337cb-b4a5-76a6-271a-a0a74b641bef | Has this patient recovered from the concussion | 1..1 | choice | Enable When: 709fe161-2597-35bf-1056-eb57c06e3a09 = Options: 2 options | |
| c40f9751-737e-66e7-b7aa-033762edd32e | Decision to refer | 0..1 | group | ||
| 76485f80-eaf4-85d2-a8a5-7cd5fb84001a | Do you feel a referral to the emergency department is appropriate | 1..1 | choice | Enable When: a51231eb-4df8-790b-c972-07f38c904098 = Options: 2 options | |
| 0b5fbd16-bc77-7b01-6808-f4ec6dfaa868 | Do you intend to create a referral based on this assessment | 1..1 | choice | | Options: 5 options |
| c2e2a26e-5fb9-ff78-aac6-36f03ed16acc | Please state other referral | 1..1 | string | Enable When: 0b5fbd16-bc77-7b01-6808-f4ec6dfaa868 = | |
| 61750ed9-71a7-74a4-e705-ae70b73f2523 | Comments | 0..1 | group | ||
| bd14c97d-4241-a996-dcef-e2404225b5e2 | Additional comments from the current appointment | 0..1 | text | ||
| a620be23-57c7-3c2e-4e89-98bd94b4e8ef | BIST progress | 0..1 | group | ||
| 97fb5b6c-b9c4-3469-9b18-f62da19796d6 | Assessment progress | 0..1 | group | ||
| c788967c-7847-1508-a526-81a55a48e3b5 | BIST progress tab view | 0..1 | display | ||
| 3028723c-8190-7832-d227-1f455404b348 | Comments | 0..1 | group | ||
| b6126f1b-33b8-c374-6213-8f7c9b1b5f64 | BIST comments table | 0..1 | display | ||
| 667e2cac-32f4-6899-1d30-174a695257b4 | Education | 0..1 | group | ||
| ab7a1936-260b-45f3-c860-981808a17100 | Education content | 0..1 | group | ||
| 2984c8bc-5620-e8f9-4025-6bbba0920d37 | Send educational content to: | 1..1 | choice | | Options: 4 options |
| 9af0aecb-e6ec-5dfd-6629-877fdfedf2a1 | Education content has been provided. You can select an option below to resend | 0..1 | display | ||
| a4a6c194-69b2-0195-659f-2bb554941d81 | Send educational content to: | 0..1 | choice | | Options: 2 options |
| 048ed550-b543-49af-d925-d852f41e3adc | 1..1 | string | Enable When: | ||
| bd3dcaae-13f2-b6e4-7b39-feec105a5367 | Mobile | 1..1 | quantity | Enable When: | |
| 2dc32449-f70e-4c46-f576-a09faebda094 | Patient details | 0..1 | group | ||
| 263e0594-c466-5c7b-a584-f7af1a289142 | Patient details | 0..1 | group | ||
| 03e36387-b872-1a4e-eb0c-48a53a979f9e | First name | 1..1 | string | ||
| c8d94679-3937-c736-70a0-b9c6fb0439ae | Last name | 1..1 | string | ||
| 176e27b8-1489-985f-6d2a-4d9ccbe1ce6c | Date of birth | 1..1 | date | ||
| fcb35de7-5396-c1f0-62d7-bd31f896522e | NHI | 1..1 | string | ||
| fd056bcc-6b26-fb3b-1cf3-9df1d03b0581 | Gender | 1..1 | choice | | Options: 3 options |
| 45cebce6-3226-bb75-a5c3-d8f237bb22b5 | Other gender | 1..1 | string | Enable When: fd056bcc-6b26-fb3b-1cf3-9df1d03b0581 = | |
| 1bf0400e-9a61-9120-6ae9-5fd08ccdfbe5 | Birth sex | 1..1 | choice | | Options: 3 options |
| bd7c4c1d-5efb-5602-4dfd-9286be1d69f8 | Other birth sex | 1..1 | string | Enable When: 1bf0400e-9a61-9120-6ae9-5fd08ccdfbe5 = | |
| 5e7a8712-6899-cd9d-b44d-a87533acff68 | Ethnicity | 1..1 | choice | Options: 187 options | |
| affc1a44-c7c9-fc8b-bad6-9b0ba5cf89ac | Patient address | 0..1 | group | ||
| 29e6f6be-ce14-e490-8f90-5dd1bb88e981 | Street | 1..1 | string | ||
| 616527e1-3934-d716-f129-87e1f59ab45c | Suburb | 1..1 | string | ||
| 78aaa9e7-39f8-97a0-23a1-328727b70abb | City | 1..1 | string | ||
| 192f3985-82e0-ca5c-e574-a5b3f5626921 | Postcode | 0..1 | string | ||
| 463cad26-ccb6-1782-b166-84f35b8176eb | Patient contact details | 0..1 | group | ||
| 7fa49ad6-1929-11e4-2386-f0c5013054ef | Mobile | 0..1 | string | ||
| 7ea584dd-7623-dc35-a333-274d621cdac9 | 0..1 | string | |||
| 280906d6-ec92-ba82-abc8-e9c2a28ebb50 | Provider details | 0..1 | group | ||
| 9492fc6a-55f2-e2bd-fa84-9c80e300e174 | Clinician details | 0..1 | group | ||
| 57ee43af-edf5-1b98-cc1c-b77a0c7cd610 | Name | 1..1 | string | ||
| e0ecb802-a804-c196-91c3-85bc7da2a8c2 | ACC provider ID | 1..1 | string | ||
| 1fe7a18c-dda4-b5b7-d81c-2f21988b1024 | Practice name | 1..1 | string | ||
| 6619a29e-6904-770e-b6e1-caa7c0690a0a | ACC facility ID | 1..1 | string | ||
| c565a411-e138-8a71-e4e3-c028127be576 | Provider address | 0..1 | group | ||
| 651f9e22-80e7-6ad1-5306-ef782c09745d | Street | 1..1 | string | ||
| 5c386c17-3d45-99ca-748e-23d8159e4f9c | Suburb | 1..1 | string | ||
| fb0f00aa-5b5d-579f-1b95-273716525d9c | City | 1..1 | string | ||
| de0635ff-4bde-54c4-c01b-e8915d945591 | Postcode | 0..1 | string | ||
| 50e5749b-17e6-3075-76f4-3ba1eb276b7c | Provider contact details | 0..1 | group | ||
| c4f62f2a-00bf-3174-d6dc-2f36dab2ed03 | Mobile | 0..1 | string | ||
| fa1d5d88-b8aa-691f-088d-e223705bd331 | 0..1 | string | |||
| a51231eb-4df8-790b-c972-07f38c904098 | Outcome ED referral | 0..1 | choice | | |
| aedd11d2-0814-e723-3247-1f36911576e2 | Age weight | 0..1 | choice | | |
| caef507e-0d08-2e25-a2aa-bd484cb59526 | Trauma weight | 0..1 | choice | | |
| b51f80fd-dd63-71b3-e488-c946fdcb9c26 | Vomit weight | 0..1 | choice | | |
| 42a05af8-ad84-7e66-572b-8605f6b8477d | LOC weight | 0..1 | choice | | |
| 47df88f0-d5b0-9b06-0a31-777040912294 | Symptoms experience weight | 0..1 | choice | | |
| 25a82bc7-1b04-3fe8-2f30-082076a5b75c | Prior TBI weighting | 0..1 | choice | | |
| 676f937c-574e-4c28-dd24-65ee9b7d93d3 | Prolonged recovery weighting | 0..1 | choice | | |
| 6fae9e39-9797-66c4-7236-6fec867df7cb | MH disorder weighting | 0..1 | choice | | |
| 834484c0-3ef6-9e35-cb3f-04f046f29888 | Dom VO weighting | 0..1 | choice | | |
| b2c33d75-9008-1941-e0bf-759456a4ff0d | Migraine weighting | 0..1 | choice | | |
| 33ca4de1-1d93-d13b-e726-c72b39c72ea2 | Symptoms score 160 weighting | 0..1 | choice | | |
| edda66c2-d94c-0629-efac-4dcf815f27bb | Impact weighting | 0..1 | choice | | |
| f300185f-01a7-6785-7370-cd92ad07c334 | Weightings total | 0..1 | choice | | |
| Documentation for this format | |||||
Options Sets
Answer options for 81927019-006c-7ae6-fcfa-e3242c8e75c4
Answer options for 2480750a-d6fa-2c6e-7fc7-40d2569e938d
Answer options for 1099711a-1c5f-cf83-c242-7948add4b7d4
Answer options for 20acb126-54c3-e63a-68f8-3b0217792e76
Answer options for 07a20c2a-e34b-8d6c-7eb9-cbadaa74aff9
Answer options for 998b3d51-eba5-5101-c3f3-7537a2826580
Answer options for 06cd326d-1ba8-ea02-d4e3-0f8d724fb5fa
Answer options for 8d87deb7-8818-f790-d3ce-4902b0b8d95b
Answer options for cfd82297-8071-f469-2e79-15191f7554a1
Answer options for 93ffbeb6-acde-7883-b13c-b861139e2a01
Answer options for 6ec00706-8935-5b2c-e776-71a7abeab973
Answer options for def327f0-e8b7-c090-36e1-5c2f4f3b01f6
Answer options for 24786db5-a459-371a-8e91-078c125d1356
Answer options for 649ee4dd-5c2c-80a5-75ad-576a27d24d8c
Answer options for fb296612-8718-7ebf-ceb2-c88fe247d0ae
Answer options for fd7a2fb1-057d-a3c6-81ad-46e813a33eda
Answer options for 98315a2c-010c-a3fb-404d-1ef46f1b76f6
Answer options for e4aecd4f-f3f2-c4c5-b73a-91978353c51e
Answer options for d60a3770-4327-8ace-acb7-f682ff573dc5
Answer options for a405f89b-aee6-76c3-3274-00a6a64412c9
Answer options for e990a88e-d6a2-3340-9b60-831eb7647bfd
Answer options for 271beefa-219f-56dc-d065-dc7f9c40b4b0
Answer options for 4cd53427-0913-ffb8-09bf-8a85c156169f
Answer options for 24a62b83-3d45-1dc0-660e-4f3559b271b8
Answer options for 1600c5f8-b5a7-3806-172e-5c79ad3d15df
Answer options for a82eb15e-afdc-7037-8201-5d88d50c3f7d
Answer options for 0af296ab-f09e-48d6-85f4-62e230ad8cf0
Answer options for 99e2f0a4-ea93-c2df-96f9-a9c3834655ba
Answer options for d86bdf62-5e16-584b-be3f-0f19956f0a4f
Answer options for 8d17b21e-00c0-33d2-ea4e-a0c9647ae75c
Answer options for 55a9d3e3-5d84-dd47-8002-e46fc831b2c6
Answer options for cf456c31-0550-718f-7e96-66d1baada245
Answer options for 33352cf0-53bf-13ac-5268-954008b0be2e
Answer options for 6eb239a3-b5ea-f46b-939b-165004089b4a
Answer options for 035c6086-4399-9f86-9f30-acb5ed4400fa
Answer options for 58f714e9-0c9c-79ef-0a49-2b624172ad89
Answer options for fd4ba90f-0c51-f38f-8408-994ecc62f87b
Answer options for 913bfe12-4ff4-8dd7-4c8b-ad28f81e1ea5
Answer options for 0375054b-7126-ea8b-13df-86c8317b6291
Answer options for 20804cc5-8e38-e8d5-3215-435d7ba8ed1e
Answer options for fbe5d8c4-8d88-62bc-7cdd-ace891a76597
Answer options for 5a9b42b6-a12d-7baf-dc05-04a300b21aac
Answer options for 88114e19-a1b2-0485-8a24-9ced2a78a032
Answer options for 85c86289-5170-f4bf-c8ac-2e92e93bd5f3
Answer options for 01313e25-2aa6-a3e2-4c8e-96cbe949da0b
Answer options for 172fc4f0-9e70-a5e8-8e2b-287a57c75f7e
Answer options for 4d1e47cc-5720-f4f2-d4d2-83e50e522896
Answer options for 7ab9f7ed-5903-3a55-cdc8-a9240afffa27
Answer options for 7582cbd7-4c5c-58f1-4a60-ed34895a5375
Answer options for f266288d-32e3-a594-c721-58e35df6a501
Answer options for bb401fd2-e8fd-cebb-6592-4e6ad6d6f16a
Answer options for 67c8a150-a80d-cafc-c8f2-ef6577e6ed7d
Answer options for 548d723c-dc92-af49-1900-ff0d913511b4
Answer options for dd9edad2-21a4-e031-d083-ea775a298eb4
Answer options for 39cb1de0-493c-5b69-eeed-b30e32a08715
Answer options for c4ec6154-56a0-d915-be83-0bf3a2e1370e
Answer options for 1e4af20b-6767-6d0e-690f-6c81ec8816ac
Answer options for 99d5df32-a4ac-9a4a-c4a4-85071a26b450
Answer options for b106bc52-d1b7-09b4-bc32-5b7eb9ba1506
Answer options for fdd9c39b-6de2-9416-b453-2b0d7488f1da
Answer options for c2859a5e-6057-5ac4-55d7-124340313f1a
Answer options for 7784e363-b9b3-c164-119d-9e5b6c67928f
Answer options for 842189ca-f322-497e-25c6-334bedd6a765
Answer options for 709fe161-2597-35bf-1056-eb57c06e3a09
Answer options for 722337cb-b4a5-76a6-271a-a0a74b641bef
Answer options for 76485f80-eaf4-85d2-a8a5-7cd5fb84001a
Answer options for 0b5fbd16-bc77-7b01-6808-f4ec6dfaa868
Answer options for 2984c8bc-5620-e8f9-4025-6bbba0920d37
Answer options for a4a6c194-69b2-0195-659f-2bb554941d81
Answer options for fd056bcc-6b26-fb3b-1cf3-9df1d03b0581
Answer options for 1bf0400e-9a61-9120-6ae9-5fd08ccdfbe5
Answer options for 5e7a8712-6899-cd9d-b44d-a87533acff68