Smart Health Checks
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Smart Health Checks, published by AEHRC CSIRO. This guide is not an authorized publication; it is the continuous build for version 0.4.0 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 - Ear Health And Hearing

Official URL: http://www.health.gov.au/assessments/mbs/715/EarHealthAndHearing Version: 0.4.0
Draft as of 2025-03-14 Computable Name: EarHealthAndHearing

Copyright/Legal: Copyright © 2022+ Australian Government Department of Health, Disability and Ageing - 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/.

Structure
LinkIDTextCardinalityTypeFlagsDescription & Constraintsdoco
.. EarHealthAndHearing Questionnaire http://www.health.gov.au/assessments/mbs/715/EarHealthAndHearing#0.4.0
... de71bbd0-178c-4974-9c75-55d5a48c66f7 Ear health and hearing 0..1 group Value Set:
.... CD-in-progress-6 In progress 0..1 display Value Set:
.... CD-complete-6 Complete 0..1 display Value Set:
.... CD-attention-6 Attention required 0..1 display Value Set:
.... f3473e82-4336-4858-96de-3a61eff5abfb Child listening concerns 0..1 group Value Set:
..... f982c374-f023-4e68-8968-1f1f5d3969ae Is there anything that you are worried about with your child's listening? 0..1 choice iconicon Value Set: Yes/No
..... 297114f4-8c3f-4916-b840-c38ea14d37b1 Details 0..1 text Enable When: f982c374-f023-4e68-8968-1f1f5d3969ae = Yes (v2 Y/N Indicator#Y)
Value Set:
.... d2a3a346-7b20-4634-beb4-f2bdc7252fe5 Child language concerns 0..1 group Value Set:
..... 06c150f8-4d54-4d10-aeff-2ef7567b6812 Is there anything you are worried about with your child's language/talking? 0..1 choice iconicon Value Set: Yes/No
..... 30dc1581-f6b7-49f0-be09-3902178a495f Details 0..1 text Enable When: 06c150f8-4d54-4d10-aeff-2ef7567b6812 = Yes (v2 Y/N Indicator#Y)
Value Set:
.... 6662bc91-fd05-4ea0-a96b-1cc124a9769a Child snoring 0..1 group Value Set:
..... b326271b-e9b1-45a0-b899-125364833702 Do you notice snoring/noisy breathing at night/while your child is sleeping? 0..1 choice iconicon Value Set: Yes/No
..... 36a3967c-e79a-49a7-8022-ac9561c4e656 Details 0..1 text Enable When: b326271b-e9b1-45a0-b899-125364833702 = Yes (v2 Y/N Indicator#Y)
Value Set:
.... ec7b6e93-e1f0-41f5-b2c2-43c7ddff8aed Hearing concerns 0..1 group Value Set:
..... 3e53edc7-c90e-4681-a006-b7a05b91a02c Is there anything that you are worried about with your hearing? 0..1 choice iconicon Value Set: Yes/No
..... d72dacb8-a9b3-483b-ae24-8b062873b2cb Details 0..1 text Enable When: 3e53edc7-c90e-4681-a006-b7a05b91a02c = Yes (v2 Y/N Indicator#Y)
Value Set:
.... 11aa62ca-5a52-428b-952b-cfbcd2c75824 Last hearing test (audiology) 0..1 date Value Set:
.... 31452c47-30b2-4590-95f4-b2b75aad2fb6 Ear examination 0..1 group Value Set:
..... 44c3434d-ea52-43bd-b635-34184e5f037d Otoscopy 0..1 group Value Set:
...... fe96046a-a202-4c22-ad3e-00419e717185 Video otoscopy procedure recommended where possible as it allows for parental education and for images to be saved for tracking over time. 0..1 display iconicon Value Set:
...... 2841915f-c8d2-4edb-8bc7-39b63385a2fb Otoscopy findings 0..1 group Value Set:
....... dedfc83e-7451-404d-bd24-97b1254304eb Left ear 0..* open-choice Value Set:
Options: 10 options
....... 23daa784-4476-447f-8aa2-42933b4490d9 Right ear 0..* open-choice Value Set:
Options: 10 options
...... 361b3c80-375b-423e-bb61-5732826bc2f0 Otoscopy findings 0..1 group Value Set:
....... 079df9c5-234c-4129-8769-800dab47a59a Left ear 0..* open-choice Value Set:
Options: 6 options
....... ce1fc869-a412-4aea-aa53-36e794a14519 Right ear 0..* open-choice Value Set:
Options: 6 options
..... 972afa06-9649-43d9-b8ce-c802f7f27e39 Tympanometry 0..1 group Value Set:
...... a0d1413f-31e5-4b29-a00b-235f50f91cf7 Left ear 0..1 text Value Set:
...... 6423348a-943f-41e5-b4f2-ef5a34e56414 Right ear 0..1 text Value Set:
.... ac87b23a-b022-4d62-9e82-1c56583bca34 Health priorities, actions and follow-up 0..1 text Value Set:
.... earhealthandhearing-section-end-divider null 0..1 display Value Set:
.... MarkComplete-6 Section completion status 0..1 choice Value Set:
Options: 3 options

doco Documentation for this format

Options Sets

Answer options for dedfc83e-7451-404d-bd24-97b1254304eb

  • Clear and intact
  • Dull and intact
  • Discharge
  • Retracted
  • Unable to view eardrum
  • Wax
  • Grommet in canal
  • Grommet in eardrum
  • Perforation
  • Red/bulging

Answer options for 23daa784-4476-447f-8aa2-42933b4490d9

  • Clear and intact
  • Dull and intact
  • Discharge
  • Retracted
  • Unable to view eardrum
  • Wax
  • Grommet in canal
  • Grommet in eardrum
  • Perforation
  • Red/bulging

Answer options for 079df9c5-234c-4129-8769-800dab47a59a

  • Clear and intact
  • Dull and intact
  • Discharge
  • Retracted
  • Unable to view eardrum
  • Wax

Answer options for ce1fc869-a412-4aea-aa53-36e794a14519

  • Clear and intact
  • Dull and intact
  • Discharge
  • Retracted
  • Unable to view eardrum
  • Wax

Answer options for MarkComplete-6

  • Complete
  • In progress
  • Attention required

Ear health and hearing

  • linkId: de71bbd0-178c-4974-9c75-55d5a48c66f7
  • Answers:

In progress

  • linkId: CD-in-progress-6
  • Answers:

Complete

  • linkId: CD-complete-6
  • Answers:

Attention required

  • linkId: CD-attention-6
  • Answers:

Child listening concerns

  • linkId: f3473e82-4336-4858-96de-3a61eff5abfb
  • Answers:

Is there anything that you are worried about with your child's listening?

  • linkId: f982c374-f023-4e68-8968-1f1f5d3969ae
  • Answers: Yes/No

Details

  • linkId: 297114f4-8c3f-4916-b840-c38ea14d37b1
  • Enable When: todo
  • Answers:

Child language concerns

  • linkId: d2a3a346-7b20-4634-beb4-f2bdc7252fe5
  • Answers:

Is there anything you are worried about with your child's language/talking?

  • linkId: 06c150f8-4d54-4d10-aeff-2ef7567b6812
  • Answers: Yes/No

Details

  • linkId: 30dc1581-f6b7-49f0-be09-3902178a495f
  • Enable When: todo
  • Answers:

Child snoring

  • linkId: 6662bc91-fd05-4ea0-a96b-1cc124a9769a
  • Answers:

Do you notice snoring/noisy breathing at night/while your child is sleeping?

  • linkId: b326271b-e9b1-45a0-b899-125364833702
  • Answers: Yes/No

Details

  • linkId: 36a3967c-e79a-49a7-8022-ac9561c4e656
  • Enable When: todo
  • Answers:

Hearing concerns

  • linkId: ec7b6e93-e1f0-41f5-b2c2-43c7ddff8aed
  • Answers:

Is there anything that you are worried about with your hearing?

  • linkId: 3e53edc7-c90e-4681-a006-b7a05b91a02c
  • Answers: Yes/No

Details

  • linkId: d72dacb8-a9b3-483b-ae24-8b062873b2cb
  • Enable When: todo
  • Answers:

Last hearing test (audiology)

  • linkId: 11aa62ca-5a52-428b-952b-cfbcd2c75824
  • Answers:

Ear examination

  • linkId: 31452c47-30b2-4590-95f4-b2b75aad2fb6
  • Answers:

Otoscopy

  • linkId: 44c3434d-ea52-43bd-b635-34184e5f037d
  • Answers:

Video otoscopy procedure recommended where possible as it allows for parental education and for images to be saved for tracking over time.

  • Flags: icon
  • linkId: fe96046a-a202-4c22-ad3e-00419e717185
  • Answers:

Otoscopy findings

  • linkId: 2841915f-c8d2-4edb-8bc7-39b63385a2fb
  • Answers:

Left ear

Right ear

Otoscopy findings

  • linkId: 361b3c80-375b-423e-bb61-5732826bc2f0
  • Answers:

Left ear

Right ear

Tympanometry

  • linkId: 972afa06-9649-43d9-b8ce-c802f7f27e39
  • Answers:

Left ear

  • linkId: a0d1413f-31e5-4b29-a00b-235f50f91cf7
  • Answers:

Right ear

  • linkId: 6423348a-943f-41e5-b4f2-ef5a34e56414
  • Answers:

Health priorities, actions and follow-up

  • linkId: ac87b23a-b022-4d62-9e82-1c56583bca34
  • Answers:

  • linkId: earhealthandhearing-section-end-divider
  • Answers:

Section completion status

LinkIDDescription & Constraintsdoco
.. de71bbd0-178c-4974-9c75-55d5a48c66f7 Value Set:
... CD-in-progress-6 Value Set:
... CD-complete-6 Value Set:
... CD-attention-6 Value Set:
.... f982c374-f023-4e68-8968-1f1f5d3969ae Value Set: Yes/No
.... 297114f4-8c3f-4916-b840-c38ea14d37b1 Enable When: Not done yet
Value Set:
... d2a3a346-7b20-4634-beb4-f2bdc7252fe5 Value Set:
.... 06c150f8-4d54-4d10-aeff-2ef7567b6812 Value Set: Yes/No
.... 30dc1581-f6b7-49f0-be09-3902178a495f Enable When: Not done yet
Value Set:
... 6662bc91-fd05-4ea0-a96b-1cc124a9769a Value Set:
.... b326271b-e9b1-45a0-b899-125364833702 Value Set: Yes/No
.... 36a3967c-e79a-49a7-8022-ac9561c4e656 Enable When: Not done yet
Value Set:
... ec7b6e93-e1f0-41f5-b2c2-43c7ddff8aed Value Set:
.... 3e53edc7-c90e-4681-a006-b7a05b91a02c Value Set: Yes/No
.... d72dacb8-a9b3-483b-ae24-8b062873b2cb Enable When: Not done yet
Value Set:
... 11aa62ca-5a52-428b-952b-cfbcd2c75824 Value Set:
... 31452c47-30b2-4590-95f4-b2b75aad2fb6 Value Set:
.... 44c3434d-ea52-43bd-b635-34184e5f037d Value Set:
..... fe96046a-a202-4c22-ad3e-00419e717185 Value Set:
..... 2841915f-c8d2-4edb-8bc7-39b63385a2fb Value Set:
...... dedfc83e-7451-404d-bd24-97b1254304eb Value Set:
Options: 10 options
...... 23daa784-4476-447f-8aa2-42933b4490d9 Value Set:
Options: 10 options
..... 361b3c80-375b-423e-bb61-5732826bc2f0 Value Set:
...... 079df9c5-234c-4129-8769-800dab47a59a Value Set:
Options: 6 options
...... ce1fc869-a412-4aea-aa53-36e794a14519 Value Set:
Options: 6 options
.... 972afa06-9649-43d9-b8ce-c802f7f27e39 Value Set:
..... a0d1413f-31e5-4b29-a00b-235f50f91cf7 Value Set:
..... 6423348a-943f-41e5-b4f2-ef5a34e56414 Value Set:
... ac87b23a-b022-4d62-9e82-1c56583bca34 Value Set:
... earhealthandhearing-section-end-divider Value Set:
... MarkComplete-6 Value Set:
Options: 3 options

doco Documentation for this format

Contained resources

Test this Questionnaire

Try this questionnaire out:

Responses for this Questionnaire

There are currently no QuestionnaireResponse instances for this Questionnaire defined in this IG.