AzacitidineV1
type: Questionnaire
node role: treeRoot
id:
  v: AzacitidineV1
meta:
  profile:
    v: http://hl7belgium.org/fhir/patient-monitoring/StructureDefinition/homehosp-onco-azacitidine
    l: homehosp-onco-azacitidine
language:
  v: en
text:
  status:
    v: extensions
  div:
    v: Generated Narrative: Questionnaire AzacitidineV1 Profile: ONCO Azacitidine Nursing Questionnaire Structure LinkID Text Cardinality Type Description & Constraints<img src="[binary]" alt="doco" style="background-color: inherit"/> AzacitidineV1 Questionnaire http://hl7belgium.org/fhir/patient-monitoring/Questionnaire/AzacitidineV1#0.1.0 #xD; Verpleegkundigassessment Verpleegkundig assessment 0..1 group #xD; Bewaring Bewaring 0..1 group #xD; A1_Bewaring Zijn er opmerkingen of bezorgdheden omtrent de (correcte) thuisbewaring van de medicatie? 1..1 choice Options: 2 options #xD; A2_BewaringSpecifieer > Indien opmerkingen of bezorgdheid: specifieer 0..1 string Enable When: A1_Bewaring = Improper storage of medication (SNOMED CT#424363005) #xD; Observatieparameters Observatie parameters 0..1 group #xD; B1_Temperatuur Lichaamstemperatuur: 1..1 decimal #xD; B2_Pols Pols: 1..1 decimal #xD; B3_BloeddrukSystolisch Bloeddruk systolisch: 1..1 decimal #xD; B4_BloeddrukDiastolisch Bloeddruk diastolisch: 1..1 decimal #xD; B5_Zuurstofsaturatie Zuurstofsaturatie (enkel uitvoeren bij hoest en kortademigheid) 0..1 decimal #xD; Tegenindicaties Tegenindicaties 0..1 group #xD; C1_Tegenindicatie Zijn er tegenindicaties voor toediening? 1..1 choice Options: 2 options #xD; C2_SpecifieerTegenindicatie > Indien 'ja': specifieer 0..1 display Enable When: C1_Tegenindicatie = Yes (SNOMED CT#373066001) #xD; C3_KoortsRillingen Koorts , koude rillingen, zich ziek voelen 1..1 choice Options: 2 options #xD; C4_OraleIntake Geen orale intake (tgv verminderde eetlust of smaakverandering) 1..1 choice Options: 2 options #xD; C5_MisselijkheidErnstig Ernstige misselijkheid (dwz misselijkheid met onvoldoende orale intake) 1..1 choice Options: 2 options #xD; C6_KortademigheidErnstig Toegenomen kortademigheid en/of ernstige kortademigheid (dwz kortademigheid in rust/zonder inspanning en/of kortademigheid die hindert bij de dagelijkse activiteiten) (Trastuzumab, Azacitidine) 1..1 choice Options: 2 options #xD; C7_…
url:
  v: http://hl7belgium.org/fhir/patient-monitoring/Questionnaire/AzacitidineV1
  l: AzacitidineV1
identifier:
  system:
    v: urn:ietf:rfc:3986
    l: 3986
  value:
    v: urn:oid:2.16.840.1.113883.4.642.40.54.35.1
version:
  v: 0.1.0
name:
  v: AzacitidineV1
title:
  v: Azacitidine
status:
  v: active
subject type:
  v: Patient
date:
  v: 2026-05-18T17:09:55+00:00
publisher:
  v: HL7 Belgium
contact:
  name:
    v: HL7 Belgium
  telecom:
    system:
      v: url
    value:
      v: http://example.com/committees
  telecom:
    system:
      v: email
contact:
  name:
    v: Bob Smith
  telecom:
    system:
      v: email
    use:
      v: work
jurisdiction:
  coding:
    system:
      v: urn:iso:std:iso:3166
      l: 3166
    code:
      v: BE
    display:
      v: Belgium
item:
  link id:
    v: Verpleegkundigassessment
  text:
    v: Verpleegkundig assessment
  type:
    v: group
  item:
    link id:
      v: Bewaring
    text:
      v: Bewaring
    type:
      v: group
    item:
      link id:
        v: A1_Bewaring
      code: http://snomed.info/id/422413002
      text:
        v: Zijn er opmerkingen of bezorgdheden omtrent de (correcte) thuisbewaring van de medicatie?
      type:
        v: choice
      required:
        v: true
      answer option:
        value: Coding
      answer option:
        value: Coding
    item:
      link id:
        v: A2_BewaringSpecifieer
      text:
        v: > Indien opmerkingen of bezorgdheid: specifieer
      type:
        v: string
      enable when:
        answer: Coding
  item:
    link id:
      v: Observatieparameters
    text:
      v: Observatie parameters
    type:
      v: group
    item:
      extension:
        value: Coding
      link id:
        v: B1_Temperatuur
      code: https://loinc.org/rdf/8310-5
      text:
        v: Lichaamstemperatuur:
      type:
        v: decimal
      required:
        v: true
    item:
      extension:
        value: Coding
      link id:
        v: B2_Pols
      code: http://snomed.info/id/364075005
      text:
        v: Pols:
      type:
        v: decimal
      required:
        v: true
    item:
      extension:
        value: Coding
      link id:
        v: B3_BloeddrukSystolisch
      code: https://loinc.org/rdf/8480-6
      text:
        v: Bloeddruk systolisch:
      type:
        v: decimal
      required:
        v: true
    item:
      extension:
        value: Coding
      link id:
        v: B4_BloeddrukDiastolisch
      code: https://loinc.org/rdf/8462-4
      text:
        v: Bloeddruk diastolisch:
      type:
        v: decimal
      required:
        v: true
    item:
      extension:
        value: Coding
      link id:
        v: B5_Zuurstofsaturatie
      code: https://loinc.org/rdf/2708-6
      text:
        v: Zuurstofsaturatie (enkel uitvoeren bij hoest en kortademigheid)
      type:
        v: decimal
  item:
    link id:
      v: Tegenindicaties
    text:
      v: Tegenindicaties
    type:
      v: group
    item:
      link id:
        v: C1_Tegenindicatie
      code: http://snomed.info/id/395008009
      text:
        v: Zijn er tegenindicaties voor toediening?
      type:
        v: choice
      required:
        v: true
      answer option:
        value: Coding
      answer option:
        value: Coding
    item:
      link id:
        v: C2_SpecifieerTegenindicatie
      text:
        v: > Indien 'ja': specifieer
      type:
        v: display
      enable when:
        answer: Coding
    item:
      link id:
        v: C3_KoortsRillingen
      code: http://snomed.info/id/39104002
      text:
        v: Koorts , koude rillingen, zich ziek voelen

v: 422413002

v: Ability to store medications

Coding
type: http://snomed.info/id/710977001
system:
  v: http://snomed.info/sct
  l: sct
code:
  v: 710977001
display:
  v: Safe storage and management of medication

Coding
type: http://snomed.info/id/424363005
system:
  v: http://snomed.info/sct
  l: sct
code:
  v: 424363005
display:
  v: Improper storage of medication

v: A1_Bewaring

v: =

Coding
type: http://snomed.info/id/424363005
system:
  v: http://snomed.info/sct
  l: sct
code:
  v: 424363005
display:
  v: Improper storage of medication

Coding
system:
  v: http://unitsofmeasure.org
  l: unitsofmeasure.org
code:
  v: Cel
display:
  v: Cel

v: 8310-5

v: Body temperature

Coding
system:
  v: http://unitsofmeasure.org
  l: unitsofmeasure.org
code:
  v: {beats}/min
display:
  v: {beats}/min

v: 364075005

v: Heart rate

Coding
system:
  v: http://unitsofmeasure.org
  l: unitsofmeasure.org
code:
  v: mm[Hg]
display:
  v: mm[Hg]

v: 8480-6

v: Systolic blood pressure

Coding
system:
  v: http://unitsofmeasure.org
  l: unitsofmeasure.org
code:
  v: mm[Hg]
display:
  v: mm[Hg]

v: 8462-4

v: Diastolic blood pressure

Coding
system:
  v: http://unitsofmeasure.org
  l: unitsofmeasure.org
code:
  v: %
display:
  v: %

v: 2708-6

v: Oxygen saturation in Arterial blood

v: 395008009

v: Medication stopped - contra-indication

Coding
type: http://snomed.info/id/373066001
system:
  v: http://snomed.info/sct
  l: sct
code:
  v: 373066001
display:
  v: Yes

Coding
type: http://snomed.info/id/373067005
system:
  v: http://snomed.info/sct
  l: sct
code:
  v: 373067005
display:
  v: No

v: C1_Tegenindicatie

v: =

Coding
type: http://snomed.info/id/373066001
system:
  v: http://snomed.info/sct
  l: sct
code:
  v: 373066001
display:
  v: Yes

v: 39104002

v: Illness

v: choice

v: true

value: Coding
  type: http://snomed.info/id/373066001
  system:
    v: http://snomed.info/sct
    l: sct
  code:
    v: 373066001
  display:
    v: Yes

value: Coding
  type: http://snomed.info/id/373067005
  system:
    v: http://snomed.info/sct
    l: sct
  code:
    v: 373067005
  display:
    v: No

link id:
  v: C4_OraleIntake
code: http://snomed.info/id/247318005
  system:
    v: http://snomed.info/sct
    l: sct
  code:
    v: 247318005
  display:
    v: Abnormal taste in mouth
text:
  v: Geen orale intake (tgv verminderde eetlust of smaakverandering)
type:
  v: choice
required:
  v: true
answer option:
  value: Coding
    type: http://snomed.info/id/373066001
    system:
      v: http://snomed.info/sct
      l: sct
    code:
      v: 373066001
    display:
      v: Yes
answer option:
  value: Coding
    type: http://snomed.info/id/373067005
    system:
      v: http://snomed.info/sct
      l: sct
    code:
      v: 373067005
    display:
      v: No

link id:
  v: C5_MisselijkheidErnstig
code: http://snomed.info/id/73335002
  system:
    v: http://snomed.info/sct
    l: sct
  code:
    v: 73335002
  display:
    v: Increased nausea and vomiting
text:
  v: Ernstige misselijkheid (dwz misselijkheid met onvoldoende orale intake)
type:
  v: choice
required:
  v: true
answer option:
  value: Coding
    type: http://snomed.info/id/373066001
    system:
      v: http://snomed.info/sct
      l: sct
    code:
      v: 373066001
    display:
      v: Yes
answer option:
  value: Coding
    type: http://snomed.info/id/373067005
    system:
      v: http://snomed.info/sct
      l: sct
    code:
      v: 373067005
    display:
      v: No

link id:
  v: C6_KortademigheidErnstig
code: http://snomed.info/id/297216006
  system:
    v: http://snomed.info/sct
    l: sct
  code:
    v: 297216006
  display:
    v: Increasing breathlessness
text:
  v: Toegenomen kortademigheid en/of ernstige kortademigheid (dwz kortademigheid in rust/zonder inspanning en/of kortademigheid die hindert bij de dagelijkse activiteiten) (Trastuzumab, Azacitidine)
type:
  v: choice
required:
  v: true
answer option:
  value: Coding
    type: http://snomed.info/id/373066001
    system:
      v: http://snomed.info/sct
      l: sct
    code:
      v: 373066001
    display:
      v: Yes
answer option:
  value: Coding
    type: http://snomed.info/id/373067005
    system:
      v: http://snomed.info/sct
      l: sct
    code:
      v: 373067005
    display:
      v: No

link id:
  v: C7_HoestDyspnoe
code: http://snomed.info/id/11833005
  system:
    v: http://snomed.info/sct
    l: sct
  code:
    v: 11833005
  display:
    v: Dry cough
text:
  v: Nieuwe of toegenomen productieve of droge hoest, met of zonder dyspnoe
type:
  v: choice
required:
  v: true
answer option:
  value: Coding
    type: http://snomed.info/id/373066001
    system:
      v: http://snomed.info/sct
      l: sct
    code:
      v: 373066001
    display:
      v: Yes
answer option:
  value: Coding
    type: http://snomed.info/id/373067005
    system:
      v: http://snomed.info/sct
      l: sct
    code:
      v: 373067005
    display:
      v: No

link id:
  v: C8_Achteruitgang
code: http://snomed.info/id/154091000119106
  system:
    v: http://snomed.info/sct
    l: sct
  code:
    v: 154091000119106
  display:
    v: Decline in functional status
text:
  v: Algemene achteruitgang
type:
  v: choice
required:
  v: true
answer option:
  value: Coding
    type: http://snomed.info/id/373066001
    system:
      v: http://snomed.info/sct
      l: sct
    code:
      v: 373066001
    display:
      v: Yes
answer option:
  value: Coding
    type: http://snomed.info/id/373067005
    system:
      v: http://snomed.info/sct
      l: sct
    code:
      v: 373067005
    display:
      v: No

link id:
  v: C9_Andere
code: http://snomed.info/id/438833006
  system:
    v: http://snomed.info/sct
    l: sct
  code:
    v: 438833006
  display:
    v: Administration of drug or medicament contraindicated
text:
  v: Andere: (indien van toepassing)
type:
  v: string

link id:
  v: C10_ContactZorgteam
text:
  v: > Indien tegenindicatie(s): gelieve contact op te nemen met het zorgteam in het ziekenhuis
type:
  v: display
enable when:
  question:
    v: C1_Tegenindicatie
  operator:
    v: =
  answer: Coding
    type: http://snomed.info/id/373066001
    system:
      v: http://snomed.info/sct
      l: sct
    code:
      v: 373066001
    display:
      v: Yes

link id:
  v: C11_Beslissing
code: http://snomed.info/id/182836005
  system:
    v: http://snomed.info/sct
    l: sct
  code:
    v: 182836005
  display:
    v: Medication review
text:
  v: Beslissing na overleg ziekenhuis
type:
  v: choice
answer option:
  value: String
    v: toediening
answer option:
  value: String
    v: geen toediening
answer option:
  value: String
    v: andere

link id:
  v: C12_BeslissingSpecifieer
code: http://snomed.info/id/1156698007
  system:
    v: http://snomed.info/sct
    l: sct
  code:
    v: 1156698007
  display:
    v: Review of current supply of medication
text:
  v: > Indien andere: specifieer
type:
  v: string
enable when:
  question:
    v: C11_Beslissing
  operator:
    v: =
  answer: String
    v: andere

link id:
  v: Symptoomlast
text:
  v: Symptoomlast
type:
  v: group
item:
  link id:
    v: D1_Misselijkheid
  code: http://snomed.info/id/422587007
    system:
      v: http://snomed.info/sct
      l: sct
    code:
      v: 422587007
    display:
      v: Nausea
  text:
    v: Misselijkheid
  type:
    v: choice
  answer option:
    value: Coding
      type: http://snomed.info/id/444431007
      system:
        v: http://snomed.info/sct
        l: sct
      code:
        v: 444431007
      display:
        v: Grade 0 on a scale of 0 to 3
  answer option:
    value: Coding
      type: http://snomed.info/id/444456001
      system:
        v: http://snomed.info/sct
        l: sct
      code:
        v: 444456001
      display:
        v: Grade 1 on a scale of 0 to 3
  answer option:
    value: Coding
      type: http://snomed.info/id/444457005
      system:
        v: http://snomed.info/sct
        l: sct
      code:
        v: 444457005
      display:
        v: Grade 2 on a scale of 0 to 3
  answer option:
    value: Coding
      type: http://snomed.info/id/444447009
      system:
        v: http://snomed.info/sct
        l: sct
      code:
        v: 444447009
      display:
        v: Grade 3 on a scale of 0 to 3
item:
  link id:
    v: D2_Braken
  code: http://snomed.info/id/249497008
    system:
      v: http://snomed.info/sct
      l: sct
    code:
      v: 249497008
    display:
      v: Vomiting symptom
  text:
    v: Braken
  type:
    v: choice
  answer option:
    value: Coding
      type: http://snomed.info/id/444431007
      system:
        v: http://snomed.info/sct
        l: sct
      code:
        v: 444431007
      display:
        v: Grade 0 on a scale of 0 to 3
  answer option:
    value: Coding
      type: http://snomed.info/id/444456001
      system:
        v: http://snomed.info/sct
        l: sct
      code:
        v: 444456001
      display:
        v: Grade 1 on a scale of 0 to 3
  answer option:
    value: Coding
      type: http://snomed.info/id/444457005
      system:
        v: http://snomed.info/sct
        l: sct
      code:
        v: 444457005
      display:
        v: Grade 2 on a scale of 0 to 3
  answer option:
    value: Coding
      type: http://snomed.info/id/444447009
      system:
        v: http://snomed.info/sct
        l: sct
      code:
        v: 444447009
      display:
        v: Grade 3 on a scale of 0 to 3
item:
  link id:
    v: D3_VerminderdeEetlust
  code: http://snomed.info/id/64379006
    system:
      v: http://snomed.info/sct
      l: sct
    code:
      v: 64379006
    display:
      v: Decrease in appetite
  text:
    v: Verminderde eetlust of smaakverandering
  type:
    v: choice
  answer option:
    value: Coding
      type: http://snomed.info/id/444431007
      system:
        v: http://snomed.info/sct
        l: sct
      code:
        v: 444431007
      display:
        v: Grade 0 on a scale of 0 to 3
  answer option:
    value: Coding
      type: http://snomed.info/id/444456001
      system:
        v: http://snomed.info/sct
        l: sct
      code:
        v: 444456001
      display:
        v: Grade 1 on a scale of 0 to 3
  answer option:
    value: Coding
      type: http://snomed.info/id/444457005
      system:
        v: http://snomed.info/sct
        l: sct
      code:
        v: 444457005
      display:
        v: Grade 2 on a scale of 0 to 3
  answer option:
    value: Coding
      type: http://snomed.info/id/444447009
      system:
        v: http://snomed.info/sct
        l: sct
      code:
        v: 444447009
      display:
        v: Grade 3 on a scale of 0 to 3
item:
  link id:
    v: D4_Buikloop
  code: http://snomed.info/id/62315008
    system:
      v: http://snomed.info/sct
      l: sct
    code:
      v: 62315008
    display:
      v: Diarrhea
  text:
    v: Buikloop
  type:
    v: choice
  answer option:
    value: Coding
      type: http://snomed.info/id/444431007
      system:
        v: http://snomed.info/sct
        l: sct
      code:
        v: 444431007
      display:
        v: Grade 0 on a scale of 0 to 3
  answer option:
    value: Coding
      type: http://snomed.info/id/444456001
      system:
        v: http://snomed.info/sct
        l: sct
      code:
        v: 444456001

v: Grade 1 on a scale of 0 to 3

value: Coding
  type: http://snomed.info/id/444457005
  system:
    v: http://snomed.info/sct
    l: sct
  code:
    v: 444457005
  display:
    v: Grade 2 on a scale of 0 to 3

value: Coding
  type: http://snomed.info/id/444447009
  system:
    v: http://snomed.info/sct
    l: sct
  code:
    v: 444447009
  display:
    v: Grade 3 on a scale of 0 to 3

link id:
  v: D5_Verstopping
code: http://snomed.info/id/14760008
  system:
    v: http://snomed.info/sct
    l: sct
  code:
    v: 14760008
  display:
    v: Constipation
text:
  v: Verstopping
type:
  v: choice
answer option:
  value: Coding
    type: http://snomed.info/id/444431007
    system:
      v: http://snomed.info/sct
      l: sct
    code:
      v: 444431007
    display:
      v: Grade 0 on a scale of 0 to 3
answer option:
  value: Coding
    type: http://snomed.info/id/444456001
    system:
      v: http://snomed.info/sct
      l: sct
    code:
      v: 444456001
    display:
      v: Grade 1 on a scale of 0 to 3
answer option:
  value: Coding
    type: http://snomed.info/id/444457005
    system:
      v: http://snomed.info/sct
      l: sct
    code:
      v: 444457005
    display:
      v: Grade 2 on a scale of 0 to 3
answer option:
  value: Coding
    type: http://snomed.info/id/444447009
    system:
      v: http://snomed.info/sct
      l: sct
    code:
      v: 444447009
    display:
      v: Grade 3 on a scale of 0 to 3

link id:
  v: D6_Vermoeidheid
code: http://snomed.info/id/224960004
  system:
    v: http://snomed.info/sct
    l: sct
  code:
    v: 224960004
  display:
    v: Tired
text:
  v: Vermoeidheid/futloosheid
type:
  v: choice
answer option:
  value: Coding
    type: http://snomed.info/id/444431007
    system:
      v: http://snomed.info/sct
      l: sct
    code:
      v: 444431007
    display:
      v: Grade 0 on a scale of 0 to 3
answer option:
  value: Coding
    type: http://snomed.info/id/444456001
    system:
      v: http://snomed.info/sct
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v: 373066001

v: Yes

v: 373067005

v: No

v: 373067005

v: No

v: 373066001

v: Yes

v: 373067005

v: No

v: 373067005

v: No

link id:
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type:
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