New Zealand Rheumatic Fever FHIR Implementation Guide
1.0.0 - draft
New Zealand Rheumatic Fever FHIR Implementation Guide, published by Te Whatu Ora. This guide is not an authorized publication; it is the continuous build for version 1.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/tewhatuora/fhir-rheumatic-fever/ and changes regularly. See the Directory of published versions
Draft as of 2023-11-10 |
<Questionnaire xmlns="http://hl7.org/fhir">
<id value="SecondaryProphylaxisHealthAssessmentQuestionnaire"/>
<url
value="https://fhir-ig.digital.health.nz/rheumatic-fever/Questionnaire/SecondaryProphylaxisHealthAssessmentQuestionnaire"/>
<identifier>
<use value="official"/>
<value value="SecondaryProphylaxisHealthAssessmentQuestionnaire"/>
<period>
<start value="2023-10-16"/>
</period>
</identifier>
<version value="1.0.0"/>
<name value="SecondaryProphylaxisHealthAssessmentQuestionnaire"/>
<title value="Secondary Prophylaxis Health Assessment Questionnaire"/>
<status value="draft"/>
<experimental value="false"/>
<subjectType value="Patient"/>
<date value="2023-11-10"/>
<publisher value="Te Whatu Ora"/>
<contact>
<name value="Te Whatu Ora"/>
<telecom>
<system value="url"/>
<value value="https://www.tewhatuora.govt.nz/"/>
</telecom>
<telecom>
<system value="email"/>
<value value="integration@tewhatuora.govt.nz"/>
</telecom>
</contact>
<contact>
<name value="HNZ Integration Team"/>
<telecom>
<system value="email"/>
<value value="integration@tewhatuora.govt.nz"/>
<use value="work"/>
</telecom>
</contact>
<description
value="Gathers information about patient health at a secondary prophylaxis medication appointment"/>
<purpose
value="Gathers information about patient health at a secondary prophylaxis medication appointment"/>
<item>
<linkId value="page1"/>
<prefix value="page1"/>
<text
value="Please complete this questionnaire at the secondary prophylaxis appointment to assess a rheumatic fever patient's health."/>
<type value="display"/>
</item>
<item>
<linkId value="ReasonsInjectionOverdue"/>
<prefix value="2)"/>
<text value="Reason(s) injection was give late? (multiple choice)"/>
<type value="choice"/>
<required value="true"/>
<repeats value="true"/>
<answerOption>
<valueString value="Previously Care On-Hold"/>
</answerOption>
<answerOption>
<valueString value="Unable to Contact Patient"/>
</answerOption>
<answerOption>
<valueString value="Patient Not Available on the Day"/>
</answerOption>
<answerOption>
<valueString value="Patient Declined Treatment"/>
</answerOption>
<answerOption>
<valueString value="INR Too High"/>
</answerOption>
<answerOption>
<valueString value="Patient Lost to Follow-Up"/>
</answerOption>
<answerOption>
<valueString value="Service Delayed To Follow-Up"/>
</answerOption>
<answerOption>
<valueString value="Service Unavailable on the Day"/>
</answerOption>
<answerOption>
<valueString value="Service Error"/>
</answerOption>
<answerOption>
<valueString value="Other"/>
</answerOption>
</item>
<item>
<linkId value="OverdueInjectionOtherDetail"/>
<prefix value="3)"/>
<text value="Other details for late injection (enter text)"/>
<type value="text"/>
<required value="true"/>
</item>
<item>
<linkId value="OtherPainManagementToolsUsed"/>
<prefix value="11)"/>
<text value="Pain management tools used? (multiple choice)"/>
<type value="choice"/>
<required value="true"/>
<repeats value="true"/>
<answerOption>
<valueString value="Ice pack"/>
</answerOption>
<answerOption>
<valueString value="Buzzy bee"/>
</answerOption>
<answerOption>
<valueString value="Numbing cream (Emla)"/>
</answerOption>
<answerOption>
<valueString value="Numbing spray"/>
</answerOption>
<answerOption>
<valueString value="Distraction"/>
</answerOption>
<answerOption>
<valueString value="Very slow injection"/>
</answerOption>
<answerOption>
<valueString value="Other"/>
</answerOption>
</item>
<item>
<linkId value="PainManagementOtherDetails"/>
<prefix value="11.1)"/>
<text value="Details of other pain management (enter text)"/>
<type value="text"/>
<enableWhen>
<question value="OtherPainManagementToolsUsed"/>
<operator value="="/>
<answerString value="Other"/>
</enableWhen>
<required value="true"/>
</item>
<item>
<linkId value="PostInjectionConcern"/>
<prefix value="12)"/>
<text value="Post injection concern or possible reaction identified?"/>
<type value="boolean"/>
<required value="true"/>
<initial>
<valueBoolean value="false"/>
</initial>
</item>
<item>
<linkId value="PostInjectionConcernDetails"/>
<prefix value="12.1)"/>
<text
value="If Yes, Record Details, Symptoms, Actions Taken and Follow-Up Plan (enter text)"/>
<type value="text"/>
<enableWhen>
<question value="PostInjectionConcern"/>
<operator value="="/>
<answerBoolean value="true"/>
</enableWhen>
<required value="true"/>
</item>
<item>
<linkId value="AnyOtherConcerns"/>
<prefix value="13)"/>
<text
value="Were There Any Other Concerns or Issues Identified During the Visit?"/>
<type value="boolean"/>
<required value="true"/>
<initial>
<valueBoolean value="false"/>
</initial>
</item>
<item>
<linkId value="OtherConcernsDetail"/>
<prefix value="13.1)"/>
<text
value="If yes, describe details, actions taken, and follow-up planned (enter text)"/>
<type value="text"/>
<enableWhen>
<question value="AnyOtherConcerns"/>
<operator value="="/>
<answerBoolean value="true"/>
</enableWhen>
<required value="true"/>
</item>
<item>
<linkId value="HealthEducationTopicsDiscussed"/>
<prefix value="14)"/>
<text value="Health education topics discussed? (multiple choice)"/>
<type value="choice"/>
<required value="true"/>
<repeats value="true"/>
<answerOption>
<valueString value="Secondary prophylaxis"/>
</answerOption>
<answerOption>
<valueString value="Sore Throat Management"/>
</answerOption>
<answerOption>
<valueString value="Skin Infection Management"/>
</answerOption>
<answerOption>
<valueString value="Dental Health"/>
</answerOption>
<answerOption>
<valueString value="Endocarditis Prophylaxis"/>
</answerOption>
<answerOption>
<valueString value="Nutrition"/>
</answerOption>
<answerOption>
<valueString value="Physical Activity"/>
</answerOption>
<answerOption>
<valueString value="Healthy Home Environments"/>
</answerOption>
<answerOption>
<valueString value="Sexual Health"/>
</answerOption>
<answerOption>
<valueString value="Other"/>
</answerOption>
</item>
<item>
<linkId value="HealthEducationOtherDetail"/>
<prefix value="14.1)"/>
<text
value="Enter details of other health education topic discussed (enter text)"/>
<type value="text"/>
<enableWhen>
<question value="HealthEducationTopicsDiscussed"/>
<operator value="="/>
<answerString value="Other"/>
</enableWhen>
<required value="true"/>
</item>
<item>
<linkId value="RecentOrUpcomingAppointments"/>
<prefix value="15)"/>
<text value="Any recent or upcoming follow-up appointments?"/>
<type value="boolean"/>
<required value="true"/>
</item>
<item>
<linkId value="RecentOrUpcomingAppointmentsDetails"/>
<prefix value="15.1)"/>
<text
value="Enter details and dates of any recent or upcoming follow-up appointments (enter text)"/>
<type value="text"/>
<enableWhen>
<question value="RecentOrUpcomingAppointments"/>
<operator value="="/>
<answerBoolean value="true"/>
</enableWhen>
<required value="true"/>
</item>
<item>
<linkId value="PlanForNextMedicationAppointment"/>
<prefix value="16)"/>
<text value="Comments for the next appointment (enter text)"/>
<type value="text"/>
<required value="true"/>
</item>
</Questionnaire>