Smart Health Checks
0.3.0 - ci-build

Smart Health Checks, published by AEHRC CSIRO. This guide is not an authorized publication; it is the continuous build for version 0.3.0 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: 0.3.0
Draft as of 2025-03-14 | 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/.

Profiles: Advanced Rendering Questionnaire, SDC Modular Questionnaire, Populatable Questionnaire - Expression

LinkID | Text | Cardinality | Type | Flags | Description & Constraints
--- | --- | --- | --- | --- | ---
PatientDetails |  |  | Questionnaire |  | http://www.health.gov.au/assessments/mbs/715/PatientDetails#0.3.0
5b224753-9365-44e3-823b-9c17e7394005 | Patient Details | 0..1 | group |  |
CD-in-progress-32 | In progress | 0..1 | display |  | Enable When: MarkComplete-32 !=
CD-complete-32 | Complete | 0..1 | display |  | Enable When: MarkComplete-32 =
patientdetails-writebackinstruction | This section contains several read only, non-editable items. Updates to these items will need to be done in the patient record. The form can be repopulated to include any updates. | 0..1 | display |  |
17596726-34cf-4133-9960-7081e1d63558 | Name | 0..1 | string |  |
57093a06-62f7-4b8b-8cb4-2c9f451ac851 | Preferred name | 0..1 | string |  |
540b1034-7c9a-4aba-a9ef-afb77d445a58 | Preferred pronouns | 0..1 | choice |  | Value Set: Australian Pronouns
f669a4fe-4818-429a-8847-d20da88d2bb3 | Gender identity | 0..1 | choice |  | Value Set: Gender Identity Response
418e4a02-de77-48a0-a92a-fe8fcc52b1aa | Administrative gender | 0..1 | choice |  | Value Set: AdministrativeGender
56ef44bb-3d1d-4972-aad1-834b69185d61 | Sex assigned at birth | 0..1 | choice |  | Value Set: Biological Sex
90ad8f16-16e4-4438-a7aa-b3189f510da2 | Date of birth | 0..1 | date |  |
e2a16e4d-2765-4b61-b286-82cfc6356b30 | Age | 0..1 | integer |  |
8acde9f8-7a91-4f0c-9216-38531ec984ef | Aboriginal and/or Torres Strait Islander status | 0..1 | choice |  | Value Set: Aboriginal and/or Torres Strait Islander
c8852db9-efe9-4102-96db-cef3a8be0a5f | Parents/primary carer/s | 0..* | choice |  | Value Set: Primary Carer Of Parent Or Grandparent
7089c48e-4216-4089-a548-034cd585e4da | Other family | 0..* | string |  |
42b1f5e0-bf4a-47d9-86a4-f2fe946ac01f | Other | 0..* | string |  |
06737e46-e880-4037-9a2c-bcd278cd70ba | Parents/primary carer/s details | 0..* | group |  |
cc20ce96-af06-4cd7-aa9b-c2601a6169ad | Name of parent/primary carer | 0..1 | string |  |
372d79bb-9d0b-42d2-a98c-cbe332bd3745 | Relationship to child | 0..1 | string |  |
f1262ade-843c-4eba-a86d-51a9c97d134b | Home address | 0..1 | group |  |
311d83bb-f22e-4f60-9b50-b6e38dd2059b | No fixed address | 0..1 | boolean |  | Definition: Address.extension:noFixedAddress
4e0dc185-f83e-4027-b7a8-ecb543d42c6d | Home address | 0..* | group |  | Enable When: 311d83bb-f22e-4f60-9b50-b6e38dd2059b !=
2fee2d51-7828-4178-b8c1-35edd32ba338 | Street address | 0..1 | string |  | Definition: Address.line
ddb65ed1-f4b2-4730-af2a-2f98bc73c76f | City | 0..1 | string |  | Definition: Address.city
d9a1236c-8d6e-4f20-a12a-9d5de5a1d0f6 | State | 0..1 | choice |  | Definition: Address.state Value Set: Australian States and Territories
3f61a1ea-1c74-4f52-8519-432ce861a74f | Postcode | 0..1 | string |  | Definition: Address.postalCode
edc081ea-b5ba-4234-9234-8ee598c2f95f | Postal address | 0..* | group |  |
622970f1-3cf1-4f0a-bf05-b00a08046eba | Purpose of use | 0..1 | string |  | Definition: Address.use
2e8437cd-5ea0-4d44-8ab2-d2aa9ef18ba7 | Street address | 0..1 | string |  | Definition: Address.line
2bde25e5-2c4c-4c0c-b6f3-c6859535a764 | City | 0..1 | string |  | Definition: Address.city
b41a8b11-8dbf-4999-9d0a-71d39240fed1 | State | 0..1 | choice |  | Definition: Address.state Value Set: Australian States and Territories
28b58e50-2a04-4192-9655-efc8d72f32fa | Postcode | 0..1 | string |  | Definition: Address.postalCode
9541f0b0-f5ba-4fe7-a8e9-ad003cef897b | Home phone | 0..* | string |  |
4037a02b-4a85-40e0-9be6-5b17df1aac56 | Mobile phone | 0..* | string |  |
c22390d3-1be6-4fd1-b775-6443b7239a6b | Emergency contact | 0..* | group |  |
d7f2dd75-20c8-480f-8c22-71d604ebee8d | Name | 0..1 | string |  |
aa35d559-f45b-4d35-9453-dd02e4a790f3 | Relationship to child | 0..1 | string |  |
27099697-d6d1-42c0-bb0a-5e9ff7372a96 | Relationship to patient | 0..1 | string |  |
626e3723-6310-4b99-81c1-525676b027c8 | Phone | 0..* | string |  |
df1475ea-bf7e-4bf0-a69f-7f9608c3ed3c | Medicare number | 0..* | group |  |
eb2a59ed-9632-4df1-b5b1-1e85c3b4b7cf | Number | 0..1 | string |  |
d6253253-a124-494e-a1d8-7ce02c69ec11 | Reference number | 0..1 | string |  |
c520e213-5313-42c3-860a-d30206620290 | Expiry | 0..1 | string |  |
c1e4e967-c0aa-4280-b5d4-ab1f375ed9ac | Pensioner Card Number | 0..1 | string |  | Max Length: 10
a7e97574-3cea-4dfa-bef2-2665e7748364 | Health Care Card Number | 0..1 | string |  | Max Length: 10
83814495-3a81-43f4-88df-42186cce516a | Registered for Closing the Gap PBS Co-payment Measure (CTG) | 0..1 | boolean |  |
e63547c6-1623-412f-963f-5f1ebf23563f | Child has a birth certificate | 0..1 | choice |  | Value Set: Yes/No/NA
a8143230-b30d-4b85-9805-5f2f73f2dffa | My Aged Care | 0..1 | group |  |
7165c072-e3d8-4564-9d1d-d17f6807787c | Registered for My Aged Care | 0..1 | choice |  | Value Set: Yes/No/NA
04e50521-dc85-4744-b7ab-6f8682aacb11 | My Aged Care Number | 0..1 | string |  | Enable When: 7165c072-e3d8-4564-9d1d-d17f6807787c =
2bfe50cb-7913-4f31-bce2-763c17ff8b1a | National Disability Insurance Scheme | 0..1 | group |  |
924b4500-53ac-4c4e-831b-7ab5569ff981 | Registered for NDIS | 0..1 | choice |  | Value Set: Yes/No/NA
7379a0fd-d95b-4ecb-a781-9f43d1394f10 | NDIS Number | 0..1 | string |  | Enable When: 924b4500-53ac-4c4e-831b-7ab5569ff981 =
9bc882bc-e989-4600-9587-8089fb757641 | Children | 0..1 | group |  |
e90b436b-2751-4e07-a40c-adfe951b6528 | Do you have children? | 0..1 | choice |  | Value Set: Yes/No/NA
241f5fca-f61a-49bd-8972-52613c0e6d15 | Number of children | 0..1 | integer |  | Enable When: e90b436b-2751-4e07-a40c-adfe951b6528 =
74ce4c60-31d6-4e78-9056-579937379451 | Number of children in your care | 0..1 | integer |  | Enable When: e90b436b-2751-4e07-a40c-adfe951b6528 =
2b5ae784-4341-4172-875d-1698cc8069f0 | Someone's carer | 0..1 | group |  |
a08271f1-194b-4fe9-91f9-4f3398858eb0 | Are you responsible for caring for someone else? | 0..1 | choice |  | Value Set: Yes/No/NA
4c14b158-3ae4-4994-8446-76e02640702c | Details | 0..1 | text |  | Enable When: a08271f1-194b-4fe9-91f9-4f3398858eb0 =
6c80c675-1320-4ca3-ae3f-51ad173da741 | Your carer | 0..1 | group |  |
d05558fb-a3cc-4bd6-b803-b672b36b9c51 | Do you have a carer? | 0..1 | choice |  | Value Set: Yes/No/NA
b9991e7e-ce03-465d-b4b0-5a1725b24e02 | Details | 0..1 | text |  | Enable When: d05558fb-a3cc-4bd6-b803-b672b36b9c51 =
3494631c-6b56-46dc-abf7-a17bfc1d025f | Providers | 0..1 | group |  |
41210be5-d441-4c44-b9c2-8dd94a44cbb4 | Are name and contact details of other key providers (eg case workers, support services) up to date? | 0..1 | choice |  | Value Set: Yes/No/NA
6733d6ec-5b6b-4ee2-a21e-0e9474c2b22b | Details | 0..1 | text |  |
38f81a73-447f-4ecd-a8eb-6eccd9dee050 | Advance care planning | 0..1 | group |  |
c023ef16-b554-4ed9-8993-1331e5f5a3b4 | Enduring Power of Attorney | 0..1 | group |  |
036eace9-ea83-46ec-9d01-f2093f710816 | Enduring Power of Attorney | 0..1 | choice |  | Value Set: Yes/No/NA
83518215-7151-4365-b745-d7464bbb9528 | Discussed today | 0..1 | text |  |
c4f68251-26af-462f-879a-a69b449066ff | Advance Health Directive | 0..1 | group |  |
b0632039-c12b-4748-9e94-52073590c0ba | Advance Health Directive | 0..1 | choice |  | Value Set: Yes/No/NA
c4bc2d84-e411-488d-9c0d-761f0377a026 | Discussed today | 0..1 | text |  |
MarkComplete-32 | Mark section as complete | 0..1 | boolean |  |
Documentation for this format

## Contained Resources

Expansion based on codesystem expandedYes-NoIndicator v2.0.0 (CodeSystem)

This value set contains 3 concepts

Code | System | Display | Definition
Y | http://terminology.hl7.org/CodeSystem/v2-0532 | Yes | Yes
N | http://terminology.hl7.org/CodeSystem/v2-0532 | No | No
NA | http://terminology.hl7.org/CodeSystem/v2-0532 | N/A | not applicable

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

This value set contains 3 concepts

Code | System | Display (en-US)
1 | https://healthterminologies.gov.au/fhir/CodeSystem/australian-indigenous-status-1 | Aboriginal
2 | https://healthterminologies.gov.au/fhir/CodeSystem/australian-indigenous-status-1 | Torres Strait Islander
3 | https://healthterminologies.gov.au/fhir/CodeSystem/australian-indigenous-status-1 | Aboriginal and Torres Strait Islander

Expansion based on:

- codesystem NullFlavor v3.0.0 (CodeSystem)
- codesystem RoleCode v3.0.0 (CodeSystem)

This value set contains 4 concepts

Code | System | Display (en-US) | Definition
MTH | http://terminology.hl7.org/CodeSystem/v3-RoleCode | mother | The player of the role is a female who conceives, gives birth to, or raises and nurtures the scoping entity (child).
FTH | http://terminology.hl7.org/CodeSystem/v3-RoleCode | father | The player of the role is a male who begets or raises or nurtures the scoping entity (child).
GRPRN | http://terminology.hl7.org/CodeSystem/v3-RoleCode | grandparent | The player of the role is a parent of the scoping person's mother or father.
NA | http://terminology.hl7.org/CodeSystem/v3-NullFlavor | not applicable | Known to have no proper value (e.g., last menstrual period for a male).

Profile: Shareable ValueSet

Expansion based on codesystem AdministrativeGender v4.0.1 (CodeSystem)

This value set contains 4 concepts

Code | System | Display (en-US) | Definition | v2 map for AdministrativeGender | v3 map for AdministrativeGender
male | http://hl7.org/fhir/administrative-gender | Male | Male. | ~http://terminology.hl7.org/6.5.0/ValueSet-v2-0001.html | ~http://terminology.hl7.org/6.5.0/ValueSet-v3-AdministrativeGender.html
female | http://hl7.org/fhir/administrative-gender | Female | Female. | ~http://terminology.hl7.org/6.5.0/ValueSet-v2-0001.html | ~http://terminology.hl7.org/6.5.0/ValueSet-v3-AdministrativeGender.html
other | http://hl7.org/fhir/administrative-gender | Other | Other. | <http://terminology.hl7.org/6.5.0/ValueSet-v2-0001.html <http://terminology.hl7.org/6.5.0/ValueSet-v2-0001.html | <http://terminology.hl7.org/6.5.0/ValueSet-v3-AdministrativeGender.html
unknown | http://hl7.org/fhir/administrative-gender | Unknown | Unknown. | ~http://terminology.hl7.org/6.5.0/ValueSet-v2-0001.html | ~http://terminology.hl7.org/6.5.0/ValueSet-v3-AdministrativeGender.html

Expansion based on:

- Loinc v2.80
- codesystem DataAbsentReason v1.0.0 (CodeSystem)

This value set contains 7 concepts

Code | System | Display (en-US) | Definition
LA29518-0 | http://loinc.org | he/him/his/his/himself |
LA29519-8 | http://loinc.org | she/her/her/hers/herself |
LA29520-6 | http://loinc.org | they/them/their/theirs/themselves |
unknown | http://terminology.hl7.org/CodeSystem/data-absent-reason | Unknown | The value is expected to exist but is not known.
asked-declined | http://terminology.hl7.org/CodeSystem/data-absent-reason | Asked But Declined | The source was asked but declined to answer.
not-asked | http://terminology.hl7.org/CodeSystem/data-absent-reason | Not Asked | The workflow didn't lead to this value being known.
asked-unknown | http://terminology.hl7.org/CodeSystem/data-absent-reason | Asked But Unknown | The source was asked but does not know the value.

Expansion based on:

- SNOMED CT Australian Edition edition 30-Apr 2025
- codesystem DataAbsentReason v1.0.0 (CodeSystem)

This value set expansion contains 6 concepts.

Code | System | Display (en-US) | Definition
446151000124109 | http://snomed.info/sct | Identifies as male gender |
446141000124107 | http://snomed.info/sct | Identifies as female gender |
33791000087105 | http://snomed.info/sct | Identifies as nonbinary gender |
unknown | http://terminology.hl7.org/CodeSystem/data-absent-reason | Unknown | The value is expected to exist but is not known.
asked-declined | http://terminology.hl7.org/CodeSystem/data-absent-reason | Asked But Declined | The source was asked but declined to answer.
not-asked | http://terminology.hl7.org/CodeSystem/data-absent-reason | Not Asked | The workflow didn't lead to this value being known.

Profiles: Shareable ValueSet, `https://healthterminologies.gov.au/fhir/StructureDefinition/composed-value-set-4`

Expansion based on SNOMED CT Australian Edition edition 30-Apr 2025

This value set expansion contains 4 concepts.

Code | System | Display (en-US)
248152002 | http://snomed.info/sct | Female
32570681000036106 | http://snomed.info/sct | Indeterminate sex
32570691000036108 | http://snomed.info/sct | Intersex
248153007 | http://snomed.info/sct | Male

Profiles: Shareable ValueSet, `https://healthterminologies.gov.au/fhir/StructureDefinition/composed-value-set-4`

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

This value set contains 9 concepts

Code | System | Display (en-US)
ACT | https://healthterminologies.gov.au/fhir/CodeSystem/australian-states-territories-1 | Australian Capital Territory
NSW | https://healthterminologies.gov.au/fhir/CodeSystem/australian-states-territories-1 | New South Wales
NT | https://healthterminologies.gov.au/fhir/CodeSystem/australian-states-territories-1 | Northern Territory
OTHER | https://healthterminologies.gov.au/fhir/CodeSystem/australian-states-territories-1 | Other territories
QLD | https://healthterminologies.gov.au/fhir/CodeSystem/australian-states-territories-1 | Queensland
SA | https://healthterminologies.gov.au/fhir/CodeSystem/australian-states-territories-1 | South Australia
TAS | https://healthterminologies.gov.au/fhir/CodeSystem/australian-states-territories-1 | Tasmania
VIC | https://healthterminologies.gov.au/fhir/CodeSystem/australian-states-territories-1 | Victoria
WA | https://healthterminologies.gov.au/fhir/CodeSystem/australian-states-territories-1 | Western Australia