Smart Forms, 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
| Official URL: http://www.health.gov.au/assessments/mbs/715 | Version: 0.3.0 | |||
| Draft as of 2025-03-14 | Computable Name: AboriginalTorresStraitIslanderHealthCheck | |||
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/. |
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Aboriginal and Torres Strait Islander Health Check assessment form.
Generated Narrative: Questionnaire AssemblyInstructions
Profiles: Advanced Rendering Questionnaire, SDC Modular Questionnaire, Populatable Questionnaire - Expression
| LinkID | Text | Cardinality | Type | Description & Constraints |
|---|---|---|---|---|
  AboriginalTorresStraitIslanderHealthCheck | Aboriginal and Torres Strait Islander Health Check assessment form. | Questionnaire | http://www.health.gov.au/assessments/mbs/715#0.3.0 | |
  fd5af92e-c248-497a-8007-ee0952ccd4d9 | null | 0..1 | group | |
   cd3303a6-e3b6-4732-80e8-54d2bd740beb | Sub-questionnaire [http://www.health.gov.au/assessments/mbs/715/AboutTheHealthCheck|0.2.0] not available. Unable to display all questions. | 0..1 | display | |
| fab52f87-22a6-4a54-9797-0bb6b0f5d2a2 | Sub-questionnaire [http://www.health.gov.au/assessments/mbs/715/Consent|0.2.0] not available. Unable to display all questions. | 0..1 | display | |
| 1d10910d-c195-4964-bdc6-98310a44719e | Sub-questionnaire [http://www.health.gov.au/assessments/mbs/715/PatientDetails|0.2.0] not available. Unable to display all questions. | 0..1 | display | |
| 7692f28c-7c0a-48ea-b27d-a8489974377d | Sub-questionnaire [http://www.health.gov.au/assessments/mbs/715/CurrentPriorities|0.2.0] not available. Unable to display all questions. | 0..1 | display | |
| 15f83d80-f49a-4852-a20f-18db9b951e53 | Sub-questionnaire [http://www.health.gov.au/assessments/mbs/715/MedicalHistory|0.2.0] not available. Unable to display all questions. | 0..1 | display | |
| 3a7151ef-d63b-4818-8367-03d394383a61 | Sub-questionnaire [http://www.health.gov.au/assessments/mbs/715/RegularMedications|0.2.0] not available. Unable to display all questions. | 0..1 | display | |
| 334853dc-88d4-4cb1-a119-bb0ff6ea0516 | Sub-questionnaire [http://www.health.gov.au/assessments/mbs/715/AllergiesAdverseReactions|0.2.0] not available. Unable to display all questions. | 0..1 | display | |
| 1ab9b519-85ce-48ee-a408-8f0b9b74d112 | Sub-questionnaire [http://www.health.gov.au/assessments/mbs/715/FamilyHistory|0.2.0] not available. Unable to display all questions. | 0..1 | display | |
| 228b8d31-21e3-49a6-b802-984135908dca | Sub-questionnaire [http://www.health.gov.au/assessments/mbs/715/SocialAndEmotionalWellbeing|0.2.0] not available. Unable to display all questions. | 0..1 | display | |
| a43517f9-538e-4a4d-8789-b6c3d44206ba | Sub-questionnaire [http://www.health.gov.au/assessments/mbs/715/SocialHistoryChild|0.2.0] not available. Unable to display all questions. | 0..1 | display | |
| 8decf7bf-e24c-4d3d-815c-c53e269f004b | Sub-questionnaire [http://www.health.gov.au/assessments/mbs/715/HomeAndFamily|0.2.0] not available. Unable to display all questions. | 0..1 | display | |
| 3f554c37-7d0e-4b14-8f7f-a9ec665cc0a6 | Sub-questionnaire [http://www.health.gov.au/assessments/mbs/715/LearningAndDevelopment|0.2.0] not available. Unable to display all questions. | 0..1 | display | |
| 362bf381-23e5-4eee-963a-3de73e584da5 | Sub-questionnaire [http://www.health.gov.au/assessments/mbs/715/LearningAndWork|0.2.0] not available. Unable to display all questions. | 0..1 | display | |
| 51a545fa-907f-40f0-9304-36bcab5a16b8 | Sub-questionnaire [http://www.health.gov.au/assessments/mbs/715/Mood|0.2.0] not available. Unable to display all questions. | 0..1 | display | |
| 4217646d-e8e4-4ac5-baa7-fae28937cda7 | Sub-questionnaire [http://www.health.gov.au/assessments/mbs/715/MemoryAndThinking|0.2.0] not available. Unable to display all questions. | 0..1 | display | |
| 070eadcf-9e93-499e-8615-61991ab35b32 | Sub-questionnaire [http://www.health.gov.au/assessments/mbs/715/ChronicDiseaseAgeing|0.2.0] not available. Unable to display all questions. | 0..1 | display | |
| 56d4bc0b-3bf1-4d47-ac34-5a1de0902de1 | Sub-questionnaire [http://www.health.gov.au/assessments/mbs/715/ScreeningPrograms|0.2.0] not available. Unable to display all questions. | 0..1 | display | |
| e0962739-c506-41d4-afd7-ab1b90db9cb4 | Sub-questionnaire [http://www.health.gov.au/assessments/mbs/715/HealthyEating|0.2.0] not available. Unable to display all questions. | 0..1 | display | |
| 63cfb279-cd7d-41ed-a54b-0c17b6efe609 | Sub-questionnaire [http://www.health.gov.au/assessments/mbs/715/PhysicalActivityAndScreenTime|0.2.0] not available. Unable to display all questions. | 0..1 | display | |
| db70690e-2199-495a-9919-53697efaf913 | Sub-questionnaire [http://www.health.gov.au/assessments/mbs/715/RedFlagsEarlyIdentificationGuide|0.2.0] not available. Unable to display all questions. | 0..1 | display | |
| d1f66f56-75fa-4498-9c51-eb98e1644243 | Sub-questionnaire [http://www.health.gov.au/assessments/mbs/715/SubstanceUse|0.2.0] not available. Unable to display all questions. | 0..1 | display | |
| ea748251-bf77-4085-b912-e9002dfa02ca | Sub-questionnaire [http://www.health.gov.au/assessments/mbs/715/Gambling|0.2.0] not available. Unable to display all questions. | 0..1 | display | |
| 84bd802b-b3e1-4098-aa2c-2133f0e252f4 | Sub-questionnaire [http://www.health.gov.au/assessments/mbs/715/SexualHealth|0.2.0] not available. Unable to display all questions. | 0..1 | display | |
| 56ad8128-0e12-4779-8ff4-47dcff6b29b5 | Sub-questionnaire [http://www.health.gov.au/assessments/mbs/715/EyeHealth|0.2.0] not available. Unable to display all questions. | 0..1 | display | |
| a8161e91-7cff-403f-85e6-982a9bc8fca6 | Sub-questionnaire [http://www.health.gov.au/assessments/mbs/715/EarHealthAndHearing|0.2.0] not available. Unable to display all questions. | 0..1 | display | |
| fe05d868-aaed-4921-9d49-4e7746bbe143 | Sub-questionnaire [http://www.health.gov.au/assessments/mbs/715/OralAndDentalHealth|0.2.0] not available. Unable to display all questions. | 0..1 | display | |
| 64ec4c1c-0824-4b84-8d3f-40f6e066cb80 | Sub-questionnaire [http://www.health.gov.au/assessments/mbs/715/Skin|0.2.0] not available. Unable to display all questions. | 0..1 | display | |
| 595737cd-3a94-442b-8be6-ab461c3181d2 | Sub-questionnaire [http://www.health.gov.au/assessments/mbs/715/Immunisation|0.2.0] not available. Unable to display all questions. | 0..1 | display | |
| 3263611d-5813-4393-a660-d10166acd728 | Sub-questionnaire [http://www.health.gov.au/assessments/mbs/715/Examination|0.2.0] not available. Unable to display all questions. | 0..1 | display | |
| 3a3b0810-e091-48ad-af50-913b0deaf663 | Sub-questionnaire [http://www.health.gov.au/assessments/mbs/715/AbsoluteCVDRiskCalculation|0.2.0] not available. Unable to display all questions. | 0..1 | display | |
| 302d9437-25b9-41e3-9d66-138c352d32a8 | Sub-questionnaire [http://www.health.gov.au/assessments/mbs/715/Investigations|0.2.0] not available. Unable to display all questions. | 0..1 | display | |
| ada45623-5e86-49ea-a00b-be0699364281 | Sub-questionnaire [http://www.health.gov.au/assessments/mbs/715/HealthPrioritiesSummary|0.2.0] not available. Unable to display all questions. | 0..1 | display | |
| a6395946-872a-4f2e-b697-c74aa1ab9b8d | Sub-questionnaire [http://www.health.gov.au/assessments/mbs/715/FinalisingHealthCheck|0.2.0] not available. Unable to display all questions. | 0..1 | display | |
| Documentation for this format | ||||
Contained Resources
ValueSet #YesNo
Expansion based on system expandedYes-NoIndicator v2.1.0 (CodeSystem)
This value set contains 2 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 |
ValueSet #YesNoNA
Expansion based on system expandedYes-NoIndicator v2.1.0 (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 |
ValueSet #YesNoNotAskedDeclined
Expansion based on:
- system DataAbsentReason version5.0.0-ballot
- system expandedYes-NoIndicator v2.1.0 (CodeSystem)
This value set contains 4 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 |
| NASK | http://terminology.hl7.org/CodeSystem/v2-0532 | Not Asked | not asked |
| asked-declined | http://terminology.hl7.org/CodeSystem/data-absent-reason | Asked But Declined | The source was asked but declined to answer. |
ValueSet #clinical-condition-1
Profiles: Shareable ValueSet, https://healthterminologies.gov.au/fhir/StructureDefinition/composed-value-set-4
- Include codes from
http://snomed.info/sctwhere concept in 32570581000036105 (Problem/Diagnosis reference set)
ValueSet #administrative-gender
Profile: Shareable ValueSet
Expansion based on system AdministrativeGender v4.0.1 (CodeSystem)
This value set contains 4 concepts
| Code | System | Display | Definition | v2 map for AdministrativeGender | v3 map for AdministrativeGender |
| female | http://hl7.org/fhir/administrative-gender | Female | Female. | ~http://terminology.hl7.org/5.0.0/ValueSet-v2-0001.html | ~http://terminology.hl7.org/6.2.0/ValueSet-v3-AdministrativeGender.html |
| male | http://hl7.org/fhir/administrative-gender | Male | Male. | ~http://terminology.hl7.org/5.0.0/ValueSet-v2-0001.html | ~http://terminology.hl7.org/6.2.0/ValueSet-v3-AdministrativeGender.html |
| other | http://hl7.org/fhir/administrative-gender | Other | 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/6.2.0/ValueSet-v3-AdministrativeGender.html |
| unknown | http://hl7.org/fhir/administrative-gender | Unknown | Unknown. | ~http://terminology.hl7.org/5.0.0/ValueSet-v2-0001.html | ~http://terminology.hl7.org/6.2.0/ValueSet-v3-AdministrativeGender.html |
ValueSet #condition-clinical
Expansion based on system Condition Clinical Status Codes version4.0.1
This value set contains 6 concepts
| Code | System | Display | Definition |
| active | http://terminology.hl7.org/CodeSystem/condition-clinical | Active | The subject is currently experiencing the condition or situation, there is evidence of the condition or situation, or considered to be a significant risk. |
| inactive | http://terminology.hl7.org/CodeSystem/condition-clinical | Inactive | The subject is no longer experiencing the condition or situation and there is no longer evidence or appreciable risk of the condition or situation. |
| recurrence | http://terminology.hl7.org/CodeSystem/condition-clinical | Recurrence | The subject is experiencing a reoccurence or repeating of a previously resolved condition or situation, e.g. urinary tract infection, food insecurity. |
| relapse | http://terminology.hl7.org/CodeSystem/condition-clinical | Relapse | The subject is experiencing a return of a condition or situation after a period of improvement or remission, e.g. relapse of cancer, alcoholism. |
| remission | http://terminology.hl7.org/CodeSystem/condition-clinical | Remission | The subject is not presently experiencing the condition or situation, but there is a risk of the condition or situation returning. |
| resolved | http://terminology.hl7.org/CodeSystem/condition-clinical | Resolved | The subject is not presently experiencing the condition or situation and there is a negligible perceived risk of the condition or situation returning. |
ValueSet #AboriginalTorresStraitIslander
Expansion based on system australian-indigenous-status-1 version1.0.3
This value set contains 3 concepts
ValueSet #PrimaryCarerParentGrandparent
Expansion based on:
- system NullFlavor version2018-08-12
- system RoleCode version2018-08-12
This value set contains 4 concepts
| Code | System | Display | 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). |
ValueSet #australian-pronouns-1
Expansion based on:
- Loinc v2.77
- system DataAbsentReason version5.0.0-ballot
This value set contains 7 concepts
| Code | System | Display | 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 | |
| asked-declined | http://terminology.hl7.org/CodeSystem/data-absent-reason | Asked But Declined | The source was asked but declined to answer. |
| asked-unknown | http://terminology.hl7.org/CodeSystem/data-absent-reason | Asked But Unknown | The source was asked but does not know the value. |
| not-asked | http://terminology.hl7.org/CodeSystem/data-absent-reason | Not Asked | The workflow didn't lead to this value being known. |
| unknown | http://terminology.hl7.org/CodeSystem/data-absent-reason | Unknown | The value is expected to exist but is not known. |
ValueSet #australian-states-territories-2
Profiles: Shareable ValueSet, https://healthterminologies.gov.au/fhir/StructureDefinition/composed-value-set-4
Expansion based on system australian-states-territories-1 version1.1.3
This value set contains 9 concepts
ValueSet #gender-identity-response-1
Expansion based on:
- SNOMED CT 32506021000036107 edition 31-Mar 2024
- system DataAbsentReason version5.0.0-ballot
This value set contains 6 concepts
| Code | System | Display | 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. |
ValueSet #biological-sex-1
Profiles: Shareable ValueSet, https://healthterminologies.gov.au/fhir/StructureDefinition/composed-value-set-4
Expansion based on SNOMED CT 32506021000036107 edition 31-Aug 2023
This value set contains 4 concepts
| Code | System | Display |
| 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 |
ValueSet #SmokingQuitStatus-1
This ValueSet requires the Code system Supplement SNOMED CT Supplement for Aboriginal and Torres Strait Islander Health Check.
Expansion based on SNOMED CT 32506021000036107 edition 31-Mar 2024
This value set contains 2 concepts
| Code | System | Display |
| 48031000119106 | http://snomed.info/sct | Quit >12 months |
| 735128000 | http://snomed.info/sct | Quit <12 months |
ValueSet #TobaccoUseStatus-1
This ValueSet requires the Code system Supplement SNOMED CT Supplement for Aboriginal and Torres Strait Islander Health Check.
Expansion based on SNOMED CT 32506021000036107 edition 30-Nov 2024
This value set expansion contains 6 concepts.
| Code | System | Display |
| 266919005 | http://snomed.info/sct | Never smoked |
| 77176002 | http://snomed.info/sct | Current smoker |
| 8517006 | http://snomed.info/sct | Ex-smoker |
| 16090371000119103 | http://snomed.info/sct | Exposure to second hand tobacco smoke |
| 394872000 | http://snomed.info/sct | Wants to quit |
| 713914004 | http://snomed.info/sct | Other tobacco use |
ValueSet #CervicalScreeningStatus-1
This ValueSet requires the Code system Supplement SNOMED CT Supplement for Aboriginal and Torres Strait Islander Health Check.
Expansion based on SNOMED CT 32506021000036107 edition 31-Mar 2024
This value set contains 4 concepts
| Code | System | Display |
| 736595007 | http://snomed.info/sct | Declined |
| 410527000 | http://snomed.info/sct | Offered |
| 171154002 | http://snomed.info/sct | Not required |
| 171155001 | http://snomed.info/sct | Up to date |