DEPRECATED Te Whatu Ora Shared Care FHIR API - see https://fhir-ig.digital.health.nz/shared-care
0.4.0 - release
DEPRECATED Te Whatu Ora Shared Care FHIR API - see https://fhir-ig.digital.health.nz/shared-care
0.4.0 - release
DEPRECATED Te Whatu Ora Shared Care FHIR API - see https://fhir-ig.digital.health.nz/shared-care, published by Te Whatu Ora. 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/tewhatuora/cinc-fhir-ig/ and changes regularly. See the Directory of published versions
| Draft as of 2023-07-19 |
{
"resourceType" : "Questionnaire",
"id" : "COVIDPublicHealthHistoryQuestionnaire",
"text" : {
"status" : "extensions",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Questionnaire COVIDPublicHealthHistoryQuestionnaire</b></p><a name=\"COVIDPublicHealthHistoryQuestionnaire\"> </a><a name=\"hcCOVIDPublicHealthHistoryQuestionnaire\"> </a><a name=\"hcCOVIDPublicHealthHistoryQuestionnaire-en-NZ\"> </a><b>Structure</b><table border=\"1\" cellpadding=\"0\" cellspacing=\"0\" style=\"border: 1px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;\"><tr style=\"border: 2px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top\"><th style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/formats.html#table\" title=\"The linkID for the item\">LinkID</a></th><th style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/formats.html#table\" title=\"Text for the item\">Text</a></th><th style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/formats.html#table\" title=\"Minimum and Maximum # of times the item can appear in the instance\">Cardinality</a></th><th style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/formats.html#table\" title=\"The type of the item\">Type</a></th><th style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/formats.html#table\" title=\"Additional information about the item\">Description & Constraints</a><span style=\"float: right\"><a href=\"http://hl7.org/fhir/R4/formats.html#table\" title=\"Legend for this format\"><img src=\"data:image/png;base64,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\" alt=\"doco\" style=\"background-color: inherit\"/></a></span></th></tr><tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_q_root.gif\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"QuestionnaireRoot\" class=\"hierarchy\"/> COVIDPublicHealthHistoryQuestionnaire</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Questions about a patient's recent COVID-19 history</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Questionnaire</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/Questionnaire/COVIDPublicHealthHistoryQuestionnaire#0.4.0</td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)\" id=\"item.summary\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-display.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"display\" class=\"hierarchy\"/> summary</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Questions about a patient's recent COVID-19 history</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-display\">display</a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck01.png)\" id=\"item.p01\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"group\" class=\"hierarchy\"/> p01</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Public Health History</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)\" id=\"item.p01-q01-PlacesVisitedRecently\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-text.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"text\" class=\"hierarchy\"/> p01-q01-PlacesVisitedRecently</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">question 1. Places visited in last 14 days</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-text\">text</a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)\" id=\"item.p01-q02-PrevPositive\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-boolean.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"boolean\" class=\"hierarchy\"/> p01-q02-PrevPositive</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">question 2. Previous positive COVID-19 test?</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-boolean\">boolean</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)\" id=\"item.p01-q02-1-PrevPositiveMonth\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> p01-q02-1-PrevPositiveMonth</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">question 2-1. Month of positive COVID-19 test?</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.p01-q02-PrevPositive\">p01-q02-PrevPositive</a> = </span><br/>Options: <a href=\"#opt-item.p01-q02-1-PrevPositiveMonth\">12 options</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)\" id=\"item.p01-q02-2-PrevPositiveYear\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> p01-q02-2-PrevPositiveYear</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">question 2-2. Year of positive COVID-19 test?</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.p01-q02-PrevPositive\">p01-q02-PrevPositive</a> = </span><br/>Options: <a href=\"#opt-item.p01-q02-2-PrevPositiveYear\">11 options</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)\" id=\"item.p01-q03-HighSuspicionOfCOVID\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-boolean.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"boolean\" class=\"hierarchy\"/> p01-q03-HighSuspicionOfCOVID</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">question 3. High suspicion of prev. COVID-19?</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-boolean\">boolean</a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)\" id=\"item.p01-q04-PotentialCloseContact\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-boolean.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"boolean\" class=\"hierarchy\"/> p01-q04-PotentialCloseContact</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">question 4. Potential close contact with a COVID-19 positive person in the last 14 days?</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-boolean\">boolean</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)\" id=\"item.p01-q05-COVID19Vaccine\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> p01-q05-COVID19Vaccine</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">question 5. COVID-19 vaccine?</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">1..1</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item.p01-q05-COVID19Vaccine\">3 options</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)\" id=\"item.p01-q06-dose1-date\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-date.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"date\" class=\"hierarchy\"/> p01-q06-dose1-date</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">question 6 - 1st Dose. Date</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-date\">date</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)\" id=\"item.p01-q06-dose1-vaccine\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> p01-q06-dose1-vaccine</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">question 6 - 1st Dose. Vaccine given</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.p01-q06-dose1-date\">p01-q06-dose1-date</a> exists </span><br/>Options: <a href=\"#opt-item.p01-q06-dose1-vaccine\">8 options</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)\" id=\"item.p01-q06-dose1-country\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> p01-q06-dose1-country</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">question 6 - 1st Dose. Country where vaccinated</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.p01-q06-dose1-date\">p01-q06-dose1-date</a> exists </span><br/>Value Set: <a href=\"http://hl7.org/fhir/R4/valueset-iso3166-1-2.html\">Iso 3166 Part 1: 2 Letter Codes</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)\" id=\"item.p01-q06-dose2-date\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-date.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"date\" class=\"hierarchy\"/> p01-q06-dose2-date</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">question 6 - 2nd Dose. Date</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-date\">date</a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)\" id=\"item.p01-q06-dose2-vaccine\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> p01-q06-dose2-vaccine</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">question 6 - 2nd Dose. Vaccine given</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.p01-q06-dose2-date\">p01-q06-dose2-date</a> exists </span><br/>Options: <a href=\"#opt-item.p01-q06-dose2-vaccine\">8 options</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)\" id=\"item.p01-q06-dose2-country\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> p01-q06-dose2-country</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">question 6 - 2nd Dose. Country where vaccinated</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.p01-q06-dose2-date\">p01-q06-dose2-date</a> exists </span><br/>Value Set: <a href=\"http://hl7.org/fhir/R4/valueset-iso3166-1-2.html\">Iso 3166 Part 1: 2 Letter Codes</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)\" id=\"item.p01-q06-dose3-date\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-date.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"date\" class=\"hierarchy\"/> p01-q06-dose3-date</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">question 6 - 3rd Dose. Date</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-date\">date</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck010.png)\" id=\"item.p01-q06-dose3-vaccine\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> p01-q06-dose3-vaccine</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">question 6 - 3rd Dose. Vaccine given</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.p01-q06-dose3-date\">p01-q06-dose3-date</a> exists </span><br/>Options: <a href=\"#opt-item.p01-q06-dose3-vaccine\">8 options</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck000.png)\" id=\"item.p01-q06-dose3-country\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> p01-q06-dose3-country</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">question 6 - 3rd Dose. Country where vaccinated</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Enable When: <span><a href=\"#item.p01-q06-dose3-date\">p01-q06-dose3-date</a> exists </span><br/>Value Set: <a href=\"http://hl7.org/fhir/R4/valueset-iso3166-1-2.html\">Iso 3166 Part 1: 2 Letter Codes</a></td></tr>\r\n<tr><td colspan=\"5\" class=\"hierarchy\"><br/><a href=\"http://hl7.org/fhir/R4/formats.html#table\" title=\"Legend for this format\"><img src=\"data:image/png;base64,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\" alt=\"doco\" style=\"background-color: inherit\"/> Documentation for this format</a></td></tr></table><hr/><p><b>Options Sets</b></p><a name=\"opt-item.p01-q02-1-PrevPositiveMonth\"> </a><p><b>Answer options for p01-q02-1-PrevPositiveMonth </b></p><ul><li style=\"font-size: 11px\">January</li><li style=\"font-size: 11px\">February</li><li style=\"font-size: 11px\">March</li><li style=\"font-size: 11px\">April</li><li style=\"font-size: 11px\">May</li><li style=\"font-size: 11px\">June</li><li style=\"font-size: 11px\">July</li><li style=\"font-size: 11px\">August</li><li style=\"font-size: 11px\">September</li><li style=\"font-size: 11px\">October</li><li style=\"font-size: 11px\">November</li><li style=\"font-size: 11px\">December</li></ul><a name=\"opt-item.p01-q02-2-PrevPositiveYear\"> </a><p><b>Answer options for p01-q02-2-PrevPositiveYear </b></p><ul><li style=\"font-size: 11px\">2020</li><li style=\"font-size: 11px\">2021</li><li style=\"font-size: 11px\">2022</li><li style=\"font-size: 11px\">2023</li><li style=\"font-size: 11px\">2024</li><li style=\"font-size: 11px\">2025</li><li style=\"font-size: 11px\">2026</li><li style=\"font-size: 11px\">2027</li><li style=\"font-size: 11px\">2028</li><li style=\"font-size: 11px\">2029</li><li style=\"font-size: 11px\">2030</li></ul><a name=\"opt-item.p01-q05-COVID19Vaccine\"> </a><p><b>Answer options for p01-q05-COVID19Vaccine </b></p><ul><li style=\"font-size: 11px\">null#null ("Full")</li><li style=\"font-size: 11px\">null#null ("Partial")</li><li style=\"font-size: 11px\">null#null ("Nil")</li></ul><a name=\"opt-item.p01-q06-dose1-vaccine\"> </a><p><b>Answer options for p01-q06-dose1-vaccine </b></p><ul><li style=\"font-size: 11px\">null#207 ("Moderna")</li><li style=\"font-size: 11px\">null#208 ("Pfizer/BioNtech")</li><li style=\"font-size: 11px\">null#210 ("AstraZeneca / Covishield")</li><li style=\"font-size: 11px\">null#211 ("Novavax")</li><li style=\"font-size: 11px\">null#212 ("Janssen")</li><li style=\"font-size: 11px\">null#505 ("Sputnik V")</li><li style=\"font-size: 11px\">null#510 ("Sinopharm")</li><li style=\"font-size: 11px\">null#511 ("CoronaVac")</li></ul><a name=\"opt-item.p01-q06-dose2-vaccine\"> </a><p><b>Answer options for p01-q06-dose2-vaccine </b></p><ul><li style=\"font-size: 11px\">null#207 ("Moderna")</li><li style=\"font-size: 11px\">null#208 ("Pfizer/BioNtech")</li><li style=\"font-size: 11px\">null#210 ("AstraZeneca / Covishield")</li><li style=\"font-size: 11px\">null#211 ("Novavax")</li><li style=\"font-size: 11px\">null#212 ("Janssen")</li><li style=\"font-size: 11px\">null#505 ("Sputnik V")</li><li style=\"font-size: 11px\">null#510 ("Sinopharm")</li><li style=\"font-size: 11px\">null#511 ("CoronaVac")</li></ul><a name=\"opt-item.p01-q06-dose3-vaccine\"> </a><p><b>Answer options for p01-q06-dose3-vaccine </b></p><ul><li style=\"font-size: 11px\">null#207 ("Moderna")</li><li style=\"font-size: 11px\">null#208 ("Pfizer/BioNtech")</li><li style=\"font-size: 11px\">null#210 ("AstraZeneca / Covishield")</li><li style=\"font-size: 11px\">null#211 ("Novavax")</li><li style=\"font-size: 11px\">null#212 ("Janssen")</li><li style=\"font-size: 11px\">null#505 ("Sputnik V")</li><li style=\"font-size: 11px\">null#510 ("Sinopharm")</li><li style=\"font-size: 11px\">null#511 ("CoronaVac")</li></ul></div>"
},
"url" : "https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/Questionnaire/COVIDPublicHealthHistoryQuestionnaire",
"identifier" : [
{
"use" : "official",
"value" : "COVIDRegularHealthCheckQuestionnaire",
"period" : {
"start" : "2023-07-01"
}
}
],
"version" : "0.4.0",
"name" : "COVIDPublicHealthHistoryQuestionnaire",
"title" : "COVID19 Public Health History Questionnaire",
"status" : "draft",
"experimental" : false,
"subjectType" : [
"Patient"
],
"date" : "2023-07-19",
"publisher" : "Te Whatu Ora",
"contact" : [
{
"name" : "Te Whatu Ora",
"telecom" : [
{
"system" : "url",
"value" : "https://www.tewhatuora.govt.nz/"
}
]
},
{
"name" : "David Grainger",
"telecom" : [
{
"system" : "email",
"value" : "david.grainger@middleware.co.nz",
"use" : "work"
}
]
}
],
"description" : "Questions about a patient's recent COVID-19 history",
"useContext" : [
{
"code" : {
"system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
"code" : "workflow",
"display" : "Workflow Setting"
},
"valueCodeableConcept" : {
"text" : "COVID Public Health History Questionnaire"
}
}
],
"jurisdiction" : [
{
"coding" : [
{
"system" : "urn:iso:std:iso:3166",
"code" : "NZ",
"display" : "New Zealand"
}
]
}
],
"purpose" : "For assessing patient's recent history of COVID-19 for public health purposes",
"code" : [
{
"system" : "http://snomed.info/sct",
"code" : "292508471000119105",
"display" : "History of disease caused by severe acute respiratory syndrome coronavirus 2 (situation)"
}
],
"item" : [
{
"linkId" : "summary",
"text" : "Questions about a patient's recent COVID-19 history",
"type" : "display"
},
{
"linkId" : "p01",
"text" : "Public Health History",
"type" : "group",
"item" : [
{
"linkId" : "p01-q01-PlacesVisitedRecently",
"prefix" : "question 1",
"text" : "Places visited in last 14 days",
"type" : "text",
"required" : false
},
{
"linkId" : "p01-q02-PrevPositive",
"prefix" : "question 2",
"text" : "Previous positive COVID-19 test?",
"type" : "boolean",
"required" : true
},
{
"linkId" : "p01-q02-1-PrevPositiveMonth",
"prefix" : "question 2-1",
"text" : "Month of positive COVID-19 test?",
"type" : "choice",
"enableWhen" : [
{
"question" : "p01-q02-PrevPositive",
"operator" : "=",
"answerBoolean" : true
}
],
"enableBehavior" : "any",
"required" : true,
"answerOption" : [
{
"valueString" : "January"
},
{
"valueString" : "February"
},
{
"valueString" : "March"
},
{
"valueString" : "April"
},
{
"valueString" : "May"
},
{
"valueString" : "June"
},
{
"valueString" : "July"
},
{
"valueString" : "August"
},
{
"valueString" : "September"
},
{
"valueString" : "October"
},
{
"valueString" : "November"
},
{
"valueString" : "December"
}
]
},
{
"linkId" : "p01-q02-2-PrevPositiveYear",
"prefix" : "question 2-2",
"text" : "Year of positive COVID-19 test?",
"type" : "choice",
"enableWhen" : [
{
"question" : "p01-q02-PrevPositive",
"operator" : "=",
"answerBoolean" : true
}
],
"enableBehavior" : "any",
"required" : true,
"answerOption" : [
{
"valueDate" : "2020"
},
{
"valueDate" : "2021"
},
{
"valueDate" : "2022"
},
{
"valueDate" : "2023"
},
{
"valueDate" : "2024"
},
{
"valueDate" : "2025"
},
{
"valueDate" : "2026"
},
{
"valueDate" : "2027"
},
{
"valueDate" : "2028"
},
{
"valueDate" : "2029"
},
{
"valueDate" : "2030"
}
]
},
{
"linkId" : "p01-q03-HighSuspicionOfCOVID",
"prefix" : "question 3",
"text" : "High suspicion of prev. COVID-19?",
"type" : "boolean",
"required" : true
},
{
"linkId" : "p01-q04-PotentialCloseContact",
"prefix" : "question 4",
"text" : "Potential close contact with a COVID-19 positive person in the last 14 days?",
"type" : "boolean",
"required" : true
},
{
"linkId" : "p01-q05-COVID19Vaccine",
"prefix" : "question 5",
"text" : "COVID-19 vaccine?",
"type" : "choice",
"required" : true,
"answerOption" : [
{
"valueCoding" : {
"display" : "Full"
}
},
{
"valueCoding" : {
"display" : "Partial"
}
},
{
"valueCoding" : {
"display" : "Nil"
}
}
]
},
{
"linkId" : "p01-q06-dose1-date",
"prefix" : "question 6 - 1st Dose",
"text" : "Date",
"type" : "date",
"required" : false,
"repeats" : false
},
{
"linkId" : "p01-q06-dose1-vaccine",
"prefix" : "question 6 - 1st Dose",
"text" : "Vaccine given",
"type" : "choice",
"enableWhen" : [
{
"question" : "p01-q06-dose1-date",
"operator" : "exists",
"answerBoolean" : true
}
],
"enableBehavior" : "any",
"required" : false,
"repeats" : false,
"answerOption" : [
{
"valueCoding" : {
"code" : "207",
"display" : "Moderna"
}
},
{
"valueCoding" : {
"code" : "208",
"display" : "Pfizer/BioNtech"
}
},
{
"valueCoding" : {
"code" : "210",
"display" : "AstraZeneca / Covishield"
}
},
{
"valueCoding" : {
"code" : "211",
"display" : "Novavax"
}
},
{
"valueCoding" : {
"code" : "212",
"display" : "Janssen"
}
},
{
"valueCoding" : {
"code" : "505",
"display" : "Sputnik V"
}
},
{
"valueCoding" : {
"code" : "510",
"display" : "Sinopharm"
}
},
{
"valueCoding" : {
"code" : "511",
"display" : "CoronaVac"
}
}
]
},
{
"linkId" : "p01-q06-dose1-country",
"prefix" : "question 6 - 1st Dose",
"text" : "Country where vaccinated",
"type" : "choice",
"enableWhen" : [
{
"question" : "p01-q06-dose1-date",
"operator" : "exists",
"answerBoolean" : true
}
],
"enableBehavior" : "any",
"required" : false,
"repeats" : false,
"answerValueSet" : "http://hl7.org/fhir/ValueSet/iso3166-1-2"
},
{
"linkId" : "p01-q06-dose2-date",
"prefix" : "question 6 - 2nd Dose",
"text" : "Date",
"type" : "date",
"required" : false,
"repeats" : false
},
{
"linkId" : "p01-q06-dose2-vaccine",
"prefix" : "question 6 - 2nd Dose",
"text" : "Vaccine given",
"type" : "choice",
"enableWhen" : [
{
"question" : "p01-q06-dose2-date",
"operator" : "exists",
"answerBoolean" : true
}
],
"enableBehavior" : "any",
"required" : false,
"repeats" : false,
"answerOption" : [
{
"valueCoding" : {
"code" : "207",
"display" : "Moderna"
}
},
{
"valueCoding" : {
"code" : "208",
"display" : "Pfizer/BioNtech"
}
},
{
"valueCoding" : {
"code" : "210",
"display" : "AstraZeneca / Covishield"
}
},
{
"valueCoding" : {
"code" : "211",
"display" : "Novavax"
}
},
{
"valueCoding" : {
"code" : "212",
"display" : "Janssen"
}
},
{
"valueCoding" : {
"code" : "505",
"display" : "Sputnik V"
}
},
{
"valueCoding" : {
"code" : "510",
"display" : "Sinopharm"
}
},
{
"valueCoding" : {
"code" : "511",
"display" : "CoronaVac"
}
}
]
},
{
"linkId" : "p01-q06-dose2-country",
"prefix" : "question 6 - 2nd Dose",
"text" : "Country where vaccinated",
"type" : "choice",
"enableWhen" : [
{
"question" : "p01-q06-dose2-date",
"operator" : "exists",
"answerBoolean" : true
}
],
"enableBehavior" : "any",
"required" : false,
"repeats" : false,
"answerValueSet" : "http://hl7.org/fhir/ValueSet/iso3166-1-2"
},
{
"linkId" : "p01-q06-dose3-date",
"prefix" : "question 6 - 3rd Dose",
"text" : "Date",
"type" : "date",
"required" : false,
"repeats" : false
},
{
"linkId" : "p01-q06-dose3-vaccine",
"prefix" : "question 6 - 3rd Dose",
"text" : "Vaccine given",
"type" : "choice",
"enableWhen" : [
{
"question" : "p01-q06-dose3-date",
"operator" : "exists",
"answerBoolean" : true
}
],
"enableBehavior" : "any",
"required" : false,
"repeats" : false,
"answerOption" : [
{
"valueCoding" : {
"code" : "207",
"display" : "Moderna"
}
},
{
"valueCoding" : {
"code" : "208",
"display" : "Pfizer/BioNtech"
}
},
{
"valueCoding" : {
"code" : "210",
"display" : "AstraZeneca / Covishield"
}
},
{
"valueCoding" : {
"code" : "211",
"display" : "Novavax"
}
},
{
"valueCoding" : {
"code" : "212",
"display" : "Janssen"
}
},
{
"valueCoding" : {
"code" : "505",
"display" : "Sputnik V"
}
},
{
"valueCoding" : {
"code" : "510",
"display" : "Sinopharm"
}
},
{
"valueCoding" : {
"code" : "511",
"display" : "CoronaVac"
}
}
]
},
{
"linkId" : "p01-q06-dose3-country",
"prefix" : "question 6 - 3rd Dose",
"text" : "Country where vaccinated",
"type" : "choice",
"enableWhen" : [
{
"question" : "p01-q06-dose3-date",
"operator" : "exists",
"answerBoolean" : true
}
],
"enableBehavior" : "any",
"required" : false,
"repeats" : false,
"answerValueSet" : "http://hl7.org/fhir/ValueSet/iso3166-1-2"
}
]
}
]
}