FHIR © HL7.org  |  Server Home  |  Health Intersections FHIR Server v1.0.287  |  FHIR Version 4.0.0  | User: ANONYMOUS (Unknown)  

Resource "bb" Version "1" (Questionnaire)

Tags:

XML or JSON representation. Try out the Questionnaire as a web form . provenance for this resource

        Birth details - To be completed by health professional
  Name of child: ____________________________________
            Sex: __
            
  Neonatal Information
    Birth Weight (kg): ___________
    Birth Length (cm): ___________
    Vitamin K given  : __
             1st dose: ___________
             2nd dose: ___________
    Hep B given      : __
      Date given     : ___________
    Abnormalities noted at birth:
      _______________________________________________
      

{
  "resourceType" : "Questionnaire",
  "id" : "bb",
  "meta" : {
    "versionId" : "1",
    "lastUpdated" : "2018-12-14T02:02:48.879Z"
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n <pre>\n <b>Birth details - To be completed by health professional</b>\n Name of child: ____________________________________\n Sex: __\n \n Neonatal Information\n Birth Weight (kg): ___________\n Birth Length (cm): ___________\n Vitamin K given : __\n 1st dose: ___________\n 2nd dose: ___________\n Hep B given : __\n Date given : ___________\n Abnormalities noted at birth:\n _______________________________________________\n </pre>\n </div>"
  },
  "url" : "http://hl7.org/fhir/Questionnaire/bb",
  "title" : "NSW Government My Personal Health Record",
  "status" : "draft",
  "subjectType" : [
    "Patient"
  ],
  "date" : "2013-02-19",
  "publisher" : "New South Wales Department of Health",
  "jurisdiction" : [
    {
      "coding" : [
        {
          "system" : "urn:iso:std:iso:3166",
          "code" : "AU"
        }
      ]
    }
  ],
  "item" : [
    {
      "linkId" : "birthDetails",
      "text" : "Birth details - To be completed by health professional",
      "type" : "group",
      "item" : [
        {
          "linkId" : "group",
          "type" : "group",
          "item" : [
            {
              "linkId" : "nameOfChild",
              "text" : "Name of child",
              "type" : "string"
            },
            {
              "linkId" : "sex",
              "text" : "Sex",
              "type" : "choice",
              "answerOption" : [
                {
                  "valueCoding" : {
                    "code" : "F"
                  }
                },
                {
                  "valueCoding" : {
                    "code" : "M"
                  }
                }
              ]
            }
          ]
        },
        {
          "linkId" : "neonatalInformation",
          "text" : "Neonatal Information",
          "type" : "group",
          "item" : [
            {
              "linkId" : "birthWeight",
              "text" : "Birth weight (kg)",
              "type" : "decimal"
            },
            {
              "linkId" : "birthLength",
              "text" : "Birth length (cm)",
              "type" : "decimal"
            },
            {
              "linkId" : "vitaminKgiven",
              "text" : "Vitamin K given",
              "type" : "choice",
              "answerOption" : [
                {
                  "valueCoding" : {
                    "code" : "INJECTION"
                  }
                },
                {
                  "valueCoding" : {
                    "code" : "INTRAVENOUS"
                  }
                },
                {
                  "valueCoding" : {
                    "code" : "ORAL"
                  }
                }
              ],
              "item" : [
                {
                  "linkId" : "vitaminKgivenDoses",
                  "type" : "group",
                  "enableWhen" : [
                    {
                      "question" : "vitaminKgiven",
                      "operator" : "exists",
                      "answerBoolean" : true
                    }
                  ],
                  "item" : [
                    {
                      "linkId" : "vitaminiKDose1",
                      "text" : "1st dose",
                      "type" : "dateTime"
                    },
                    {
                      "linkId" : "vitaminiKDose2",
                      "text" : "2nd dose",
                      "type" : "dateTime"
                    }
                  ]
                }
              ]
            },
            {
              "linkId" : "hepBgiven",
              "text" : "Hep B given y / n",
              "type" : "boolean",
              "item" : [
                {
                  "linkId" : "hepBgivenDate",
                  "text" : "Date given",
                  "type" : "date"
                }
              ]
            },
            {
              "linkId" : "abnormalitiesAtBirth",
              "text" : "Abnormalities noted at birth",
              "type" : "string"
            }
          ]
        }
      ]
    }
  ]
}