Smart Forms
0.2.0 - ci-build

Smart Forms, published by AEHRC CSIRO. This guide is not an authorized publication; it is the continuous build for version 0.2.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/aehrc/smart-forms-ig/ and changes regularly. See the Directory of published versions

Questionnaire: Aboriginal and Torres Strait Islander Health Check - Patient Details

Official URL: http://www.health.gov.au/assessments/mbs/715/PatientDetails Version: 0.2.0
Draft as of 2024-04-02 Computable Name: PatientDetails

Copyright/Legal: Copyright © 2022+ Australian Government Department of Health and Aged Care - All rights reserved. This content is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License. See https://creativecommons.org/licenses/by-sa/4.0/.

Patient Details sub-questionnaire for Aboriginal and Torres Strait Islander Health Check.

Generated Narrative: Questionnaire PatientDetails

LinkIDTextCardinalityTypeFlagsDescription & Constraintsdoco
.. PatientDetailsPatient Details sub-questionnaire for Aboriginal and Torres Strait Islander Health Check.Questionnairehttp://www.health.gov.au/assessments/mbs/715/PatientDetails#0.2.0
... 5b224753-9365-44e3-823b-9c17e7394005Patient Details0..1group
.... CD-in-progress-32In progress0..1displayEnable When: MarkComplete-32 !=
.... CD-complete-32Complete0..1displayEnable When: MarkComplete-32 =
.... RecordUpdate-PatientImportant: The patient record may not be updated with information entered here. Information intended for the patient record should be entered there first.0..1display
.... 17596726-34cf-4133-9960-7081e1d63558Name0..1stringiconicon
.... 57093a06-62f7-4b8b-8cb4-2c9f451ac851Preferred name0..1stringiconicon
.... 540b1034-7c9a-4aba-a9ef-afb77d445a58Preferred pronouns0..1choiceiconiconValue Set: Australian Pronouns
.... f669a4fe-4818-429a-8847-d20da88d2bb3Gender identity0..1choiceiconiconValue Set: Gender Identity Response
.... 418e4a02-de77-48a0-a92a-fe8fcc52b1aaAdministrative gender0..1choiceiconiconValue Set: AdministrativeGender
.... 56ef44bb-3d1d-4972-aad1-834b69185d61Sex assigned at birth0..1choiceiconiconValue Set: Biological Sex
.... 90ad8f16-16e4-4438-a7aa-b3189f510da2Date of birth0..1dateiconicon
.... e2a16e4d-2765-4b61-b286-82cfc6356b30Age0..1integericonicon
.... 8acde9f8-7a91-4f0c-9216-38531ec984efAboriginal and/or Torres Strait Islander status0..1choiceiconiconValue Set: Aboriginal and/or Torres Strait Islander
.... c8852db9-efe9-4102-96db-cef3a8be0a5fParents/primary carer/s0..*choiceValue Set: Primary Carer Of Parent Or Grandparent
.... 7089c48e-4216-4089-a548-034cd585e4daOther family0..*string
..... 70c45932-99dc-42a3-9650-4683892a0892details0..1display
.... 42b1f5e0-bf4a-47d9-86a4-f2fe946ac01fOther0..*string
..... dcbd3a54-9b68-4486-bf30-f6f1723bc39cdetails0..1display
.... 06737e46-e880-4037-9a2c-bcd278cd70baParents/primary carer/s details0..*group
..... cc20ce96-af06-4cd7-aa9b-c2601a6169adName of parent/primary carer0..1string
..... 372d79bb-9d0b-42d2-a98c-cbe332bd3745Relationship to child0..1string
.... f1262ade-843c-4eba-a86d-51a9c97d134bHome address0..1group
..... 311d83bb-f22e-4f60-9b50-b6e38dd2059bNo fixed address0..1booleanDefinition: Address.extension:noFixedAddress
..... 4e0dc185-f83e-4027-b7a8-ecb543d42c6dnull0..*groupEnable When: 311d83bb-f22e-4f60-9b50-b6e38dd2059b !=
...... 2fee2d51-7828-4178-b8c1-35edd32ba338Street address0..1stringDefinition: Address.line
...... ddb65ed1-f4b2-4730-af2a-2f98bc73c76fCity0..1stringDefinition: Address.city
...... d9a1236c-8d6e-4f20-a12a-9d5de5a1d0f6State0..1choiceDefinition: Address.state
Value Set: Australian States and Territories
...... 3f61a1ea-1c74-4f52-8519-432ce861a74fPostcode0..1stringDefinition: Address.postalCode
.... edc081ea-b5ba-4234-9234-8ee598c2f95fPostal address0..*groupiconicon
..... 622970f1-3cf1-4f0a-bf05-b00a08046ebaPurpose of use0..1stringDefinition: Address.use
..... 2e8437cd-5ea0-4d44-8ab2-d2aa9ef18ba7Address0..1stringDefinition: Address.line
..... 2bde25e5-2c4c-4c0c-b6f3-c6859535a764City0..1stringDefinition: Address.city
..... b41a8b11-8dbf-4999-9d0a-71d39240fed1State0..1choiceDefinition: Address.state
Value Set: Australian States and Territories
..... 28b58e50-2a04-4192-9655-efc8d72f32faPostcode0..1stringDefinition: Address.postalCode
.... 9541f0b0-f5ba-4fe7-a8e9-ad003cef897bHome phone0..*string
.... 4037a02b-4a85-40e0-9be6-5b17df1aac56Mobile phone0..*string
.... c22390d3-1be6-4fd1-b775-6443b7239a6bEmergency contact0..*group
..... d7f2dd75-20c8-480f-8c22-71d604ebee8dName0..1string
..... aa35d559-f45b-4d35-9453-dd02e4a790f3Relationship to child0..1string
..... 27099697-d6d1-42c0-bb0a-5e9ff7372a96Relationship to patient0..1string
..... 626e3723-6310-4b99-81c1-525676b027c8Phone0..*string
.... df1475ea-bf7e-4bf0-a69f-7f9608c3ed3cMedicare number0..1group
..... eb2a59ed-9632-4df1-b5b1-1e85c3b4b7cfNumber0..1string
..... d6253253-a124-494e-a1d8-7ce02c69ec11Reference number0..1string
..... c520e213-5313-42c3-860a-d30206620290Expiry0..1string
.... c1e4e967-c0aa-4280-b5d4-ab1f375ed9acPensioner Card Number0..1stringMax Length: 10
.... a7e97574-3cea-4dfa-bef2-2665e7748364Health Care Card Number0..1stringMax Length: 10
.... 83814495-3a81-43f4-88df-42186cce516aRegistered for Closing the Gap PBS Co-payment Measure (CTG)0..1choiceiconiconValue Set: Yes/No/NA
.... e63547c6-1623-412f-963f-5f1ebf23563fChild has a birth certificate0..1choiceiconiconValue Set: Yes/No/NA
.... a8143230-b30d-4b85-9805-5f2f73f2dffaMy Aged Care0..1group
..... 7165c072-e3d8-4564-9d1d-d17f6807787cRegistered for My Aged Care0..1choiceiconiconValue Set: Yes/No/NA
..... 04e50521-dc85-4744-b7ab-6f8682aacb11My Aged Care Number0..1stringEnable When: 7165c072-e3d8-4564-9d1d-d17f6807787c =
.... 2bfe50cb-7913-4f31-bce2-763c17ff8b1aNational Disability Insurance Scheme0..1group
..... 924b4500-53ac-4c4e-831b-7ab5569ff981Registered for NDIS0..1choiceiconiconValue Set: Yes/No/NA
..... 7379a0fd-d95b-4ecb-a781-9f43d1394f10NDIS Number0..1stringEnable When: 924b4500-53ac-4c4e-831b-7ab5569ff981 =
.... 9bc882bc-e989-4600-9587-8089fb757641Children0..1group
..... e90b436b-2751-4e07-a40c-adfe951b6528Do you have children?0..1choiceiconiconValue Set: Yes/No/NA
..... 241f5fca-f61a-49bd-8972-52613c0e6d15Number of children0..1integerEnable When: e90b436b-2751-4e07-a40c-adfe951b6528 =
..... 74ce4c60-31d6-4e78-9056-579937379451Number of children in your care0..1integerEnable When: e90b436b-2751-4e07-a40c-adfe951b6528 =
.... 2b5ae784-4341-4172-875d-1698cc8069f0Someone's carer0..1group
..... a08271f1-194b-4fe9-91f9-4f3398858eb0Are you responsible for caring for someone else?0..1choiceiconiconValue Set: Yes/No/NA
..... 4c14b158-3ae4-4994-8446-76e02640702cDetails0..1textEnable When: a08271f1-194b-4fe9-91f9-4f3398858eb0 =
.... 6c80c675-1320-4ca3-ae3f-51ad173da741Your carer0..1group
..... d05558fb-a3cc-4bd6-b803-b672b36b9c51Do you have a carer?0..1choiceiconiconValue Set: Yes/No/NA
..... b9991e7e-ce03-465d-b4b0-5a1725b24e02Details0..1textEnable When: d05558fb-a3cc-4bd6-b803-b672b36b9c51 =
.... 3494631c-6b56-46dc-abf7-a17bfc1d025fProviders0..1group
..... 41210be5-d441-4c44-b9c2-8dd94a44cbb4Are name and contact details of other key providers (eg case workers, support services) up to date?0..1choiceiconiconValue Set: Yes/No/NA
..... 6733d6ec-5b6b-4ee2-a21e-0e9474c2b22bDetails0..1text
.... 38f81a73-447f-4ecd-a8eb-6eccd9dee050Advance care planning0..1group
..... c023ef16-b554-4ed9-8993-1331e5f5a3b4Enduring Power of Attorney0..1group
...... 036eace9-ea83-46ec-9d01-f2093f710816Enduring Power of Attorney0..1choiceiconiconValue Set: Yes/No/NA
...... 83518215-7151-4365-b745-d7464bbb9528Discussed today0..1text
..... c4f68251-26af-462f-879a-a69b449066ffAdvance Health Directive0..1group
...... b0632039-c12b-4748-9e94-52073590c0baAdvance Health Directive0..1choiceiconiconValue Set: Yes/No/NA
...... c4bc2d84-e411-488d-9c0d-761f0377a026Discussed today0..1text
.... MarkComplete-32Mark section as complete0..1boolean

doco Documentation for this format

Contained Resources

Generated Narrative: ValueSet #YesNoNA

Expansion based on system expandedYes-NoIndicator v2.1.0 (CodeSystem)

This value set contains 3 concepts

CodeSystemDisplayDefinition
  Yhttp://terminology.hl7.org/CodeSystem/v2-0532Yes

Yes

  Nhttp://terminology.hl7.org/CodeSystem/v2-0532No

No

  NAhttp://terminology.hl7.org/CodeSystem/v2-0532N/A

not applicable

Generated Narrative: ValueSet #AboriginalTorresStraitIslander

Expansion based on system australian-indigenous-status-1 version1.0.3

This value set contains 3 concepts

CodeSystemDisplay
  1https://healthterminologies.gov.au/fhir/CodeSystem/australian-indigenous-status-1Aboriginal but not Torres Strait Islander origin
  2https://healthterminologies.gov.au/fhir/CodeSystem/australian-indigenous-status-1Torres Strait Islander but not Aboriginal origin
  3https://healthterminologies.gov.au/fhir/CodeSystem/australian-indigenous-status-1Both Aboriginal and Torres Strait Islander origin

Generated Narrative: ValueSet #PrimaryCarerParentGrandparent

Expansion based on:

  • system NullFlavor version2018-08-12
  • system RoleCode version2018-08-12

This value set contains 4 concepts

CodeSystemDisplayDefinition
  MTHhttp://terminology.hl7.org/CodeSystem/v3-RoleCodemother

The player of the role is a female who conceives, gives birth to, or raises and nurtures the scoping entity (child).

  FTHhttp://terminology.hl7.org/CodeSystem/v3-RoleCodefather

The player of the role is a male who begets or raises or nurtures the scoping entity (child).

  GRPRNhttp://terminology.hl7.org/CodeSystem/v3-RoleCodegrandparent

The player of the role is a parent of the scoping person's mother or father.

  NAhttp://terminology.hl7.org/CodeSystem/v3-NullFlavornot applicable

Known to have no proper value (e.g., last menstrual period for a male).

Generated Narrative: ValueSet #administrative-gender

Expansion based on system AdministrativeGender v4.0.1 (CodeSystem)

This value set contains 4 concepts

CodeSystemDisplayDefinitionv2 map for AdministrativeGenderv3 map for AdministrativeGender
  femalehttp://hl7.org/fhir/administrative-genderFemale

Female.

~http://terminology.hl7.org/5.0.0/ValueSet-v2-0001.html~http://terminology.hl7.org/6.1.0/ValueSet-v3-AdministrativeGender.html
  malehttp://hl7.org/fhir/administrative-genderMale

Male.

~http://terminology.hl7.org/5.0.0/ValueSet-v2-0001.html~http://terminology.hl7.org/6.1.0/ValueSet-v3-AdministrativeGender.html
  otherhttp://hl7.org/fhir/administrative-genderOther

Other.

<http://terminology.hl7.org/5.0.0/ValueSet-v2-0001.html
<http://terminology.hl7.org/5.0.0/ValueSet-v2-0001.html		<http://terminology.hl7.org/6.1.0/ValueSet-v3-AdministrativeGender.html
  unknownhttp://hl7.org/fhir/administrative-genderUnknown

Unknown.

~http://terminology.hl7.org/5.0.0/ValueSet-v2-0001.html~http://terminology.hl7.org/6.1.0/ValueSet-v3-AdministrativeGender.html

Generated Narrative: ValueSet #australian-pronouns-1

Expansion based on:

  • Loinc v2.77
  • system DataAbsentReason version5.0.0-ballot

This value set contains 7 concepts

CodeSystemDisplayDefinition
  LA29518-0http://loinc.orghe/him/his/his/himself
  LA29519-8http://loinc.orgshe/her/her/hers/herself
  LA29520-6http://loinc.orgthey/them/their/theirs/themselves
  asked-declinedhttp://terminology.hl7.org/CodeSystem/data-absent-reasonAsked But Declined

The source was asked but declined to answer.

  asked-unknownhttp://terminology.hl7.org/CodeSystem/data-absent-reasonAsked But Unknown

The source was asked but does not know the value.

  not-askedhttp://terminology.hl7.org/CodeSystem/data-absent-reasonNot Asked

The workflow didn't lead to this value being known.

  unknownhttp://terminology.hl7.org/CodeSystem/data-absent-reasonUnknown

The value is expected to exist but is not known.

Generated Narrative: ValueSet #gender-identity-response-1

Expansion based on:

  • SNOMED CT Australian edition 31-Mar 2024
  • system DataAbsentReason version5.0.0-ballot

This value set contains 6 concepts

CodeSystemDisplayDefinition
  446151000124109http://snomed.info/sctIdentifies as male gender
  446141000124107http://snomed.info/sctIdentifies as female gender
  33791000087105http://snomed.info/sctIdentifies as nonbinary gender
  unknownhttp://terminology.hl7.org/CodeSystem/data-absent-reasonUnknown

The value is expected to exist but is not known.

  asked-declinedhttp://terminology.hl7.org/CodeSystem/data-absent-reasonAsked But Declined

The source was asked but declined to answer.

  not-askedhttp://terminology.hl7.org/CodeSystem/data-absent-reasonNot Asked

The workflow didn't lead to this value being known.

Generated Narrative: ValueSet #biological-sex-1

Expansion based on SNOMED CT Australian edition 31-Aug 2023

This value set contains 4 concepts

CodeSystemDisplay
  248152002http://snomed.info/sctFemale
  32570681000036106http://snomed.info/sctIndeterminate sex
  32570691000036108http://snomed.info/sctIntersex
  248153007http://snomed.info/sctMale

Generated Narrative: ValueSet #australian-states-territories-2

Expansion based on system australian-states-territories-1 version1.1.3

This value set contains 9 concepts

CodeSystemDisplay
  ACThttps://healthterminologies.gov.au/fhir/CodeSystem/australian-states-territories-1Australian Capital Territory
  NSWhttps://healthterminologies.gov.au/fhir/CodeSystem/australian-states-territories-1New South Wales
  NThttps://healthterminologies.gov.au/fhir/CodeSystem/australian-states-territories-1Northern Territory
  OTHERhttps://healthterminologies.gov.au/fhir/CodeSystem/australian-states-territories-1Other territories
  QLDhttps://healthterminologies.gov.au/fhir/CodeSystem/australian-states-territories-1Queensland
  SAhttps://healthterminologies.gov.au/fhir/CodeSystem/australian-states-territories-1South Australia
  TAShttps://healthterminologies.gov.au/fhir/CodeSystem/australian-states-territories-1Tasmania
  VIChttps://healthterminologies.gov.au/fhir/CodeSystem/australian-states-territories-1Victoria
  WAhttps://healthterminologies.gov.au/fhir/CodeSystem/australian-states-territories-1Western Australia