Questionnaires (120)

NameSourceVerDescription
Aboriginal and Torres Strait Islander Health Checkcsiro.fhir.au.smartforms#currentR4Aboriginal and Torres Strait Islander Health Check assessment form.
Aboriginal and Torres Strait Islander Health Check - About The Health Checkcsiro.fhir.au.smartforms#currentR4About The Health Check sub-questionnaire for Aboriginal and Torres Strait Islander Health Check.
Aboriginal and Torres Strait Islander Health Check - Absolute Cardiovascular Disease Risk Calculationcsiro.fhir.au.smartforms#currentR4Absolute Cardiovascular Disease Risk Calculation sub-questionnaire for Aboriginal and Torres Strait Islander Health Check.
Aboriginal and Torres Strait Islander Health Check - Allergies/Adverse Reactionscsiro.fhir.au.smartforms#currentR4Allergies/Adverse Reactions sub-questionnaire for Aboriginal and Torres Strait Islander Health Check.
Aboriginal and Torres Strait Islander Health Check - Chronic Disease Ageingcsiro.fhir.au.smartforms#currentR4Chronic Disease Ageing sub-questionnaire for Aboriginal and Torres Strait Islander Health Check.
Aboriginal and Torres Strait Islander Health Check - Consentcsiro.fhir.au.smartforms#currentR4Consent sub-questionnaire for Aboriginal and Torres Strait Islander Health Check.
Aboriginal and Torres Strait Islander Health Check - Current Prioritiescsiro.fhir.au.smartforms#currentR4Current Priorities sub-questionnaire for Aboriginal and Torres Strait Islander Health Check.
Aboriginal and Torres Strait Islander Health Check - Ear Health And Hearingcsiro.fhir.au.smartforms#currentR4Ear Health And Hearing sub-questionnaire for Aboriginal and Torres Strait Islander Health Check.
Aboriginal and Torres Strait Islander Health Check - Examinationcsiro.fhir.au.smartforms#currentR4Examination sub-questionnaire for Aboriginal and Torres Strait Islander Health Check.
Aboriginal and Torres Strait Islander Health Check - Eye Healthcsiro.fhir.au.smartforms#currentR4Eye Health sub-questionnaire for Aboriginal and Torres Strait Islander Health Check.
Aboriginal and Torres Strait Islander Health Check - Family Historycsiro.fhir.au.smartforms#currentR4Family History sub-questionnaire for Aboriginal and Torres Strait Islander Health Check.
Aboriginal and Torres Strait Islander Health Check - Finalising the Health Checkcsiro.fhir.au.smartforms#currentR4Finalising the Health Check sub-questionnaire for Aboriginal and Torres Strait Islander Health Check.
Aboriginal and Torres Strait Islander Health Check - Gamblingcsiro.fhir.au.smartforms#currentR4Gambling sub-questionnaire for Aboriginal and Torres Strait Islander Health Check.
Aboriginal and Torres Strait Islander Health Check - Health Priorities, Actions And Follow-Up Summarycsiro.fhir.au.smartforms#currentR4Health Priorities, Actions And Follow-Up Summary sub-questionnaire for Aboriginal and Torres Strait Islander Health Check.
Aboriginal and Torres Strait Islander Health Check - Healthy Eatingcsiro.fhir.au.smartforms#currentR4Healthy Eating sub-questionnaire for Aboriginal and Torres Strait Islander Health Check.
Aboriginal and Torres Strait Islander Health Check - Home And Familycsiro.fhir.au.smartforms#currentR4Home And Family sub-questionnaire for Aboriginal and Torres Strait Islander Health Check.
Aboriginal and Torres Strait Islander Health Check - Immunisationcsiro.fhir.au.smartforms#currentR4Immunisation sub-questionnaire for Aboriginal and Torres Strait Islander Health Check.
Aboriginal and Torres Strait Islander Health Check - Investigationscsiro.fhir.au.smartforms#currentR4Investigations sub-questionnaire for Aboriginal and Torres Strait Islander Health Check.
Aboriginal and Torres Strait Islander Health Check - Learning And Developmentcsiro.fhir.au.smartforms#currentR4Learning And Development sub-questionnaire for Aboriginal and Torres Strait Islander Health Check.
Aboriginal and Torres Strait Islander Health Check - Learning And Workcsiro.fhir.au.smartforms#currentR4Learning And Work sub-questionnaire for Aboriginal and Torres Strait Islander Health Check.
Aboriginal and Torres Strait Islander Health Check - Medical History And Current Problemscsiro.fhir.au.smartforms#currentR4Medical History sub-questionnaire for Aboriginal and Torres Strait Islander Health Check.
Aboriginal and Torres Strait Islander Health Check - Memory And Thinkingcsiro.fhir.au.smartforms#currentR4Memory And Thinking sub-questionnaire for Aboriginal and Torres Strait Islander Health Check.
Aboriginal and Torres Strait Islander Health Check - Moodcsiro.fhir.au.smartforms#currentR4Mood sub-questionnaire for Aboriginal and Torres Strait Islander Health Check.
Aboriginal and Torres Strait Islander Health Check - Oral And Dental Healthcsiro.fhir.au.smartforms#currentR4Oral And Dental Health sub-questionnaire for Aboriginal and Torres Strait Islander Health Check.
Aboriginal and Torres Strait Islander Health Check - Patient Detailscsiro.fhir.au.smartforms#currentR4Patient Details sub-questionnaire for Aboriginal and Torres Strait Islander Health Check.
Aboriginal and Torres Strait Islander Health Check - Physical Activity And Screen Timecsiro.fhir.au.smartforms#currentR4Physical Activity And Screen Time sub-questionnaire for Aboriginal and Torres Strait Islander Health Check.
Aboriginal and Torres Strait Islander Health Check - Red Flags Early Identification Guide For Childrencsiro.fhir.au.smartforms#currentR4Red Flags Early Identification Guide For Children sub-questionnaire for Aboriginal and Torres Strait Islander Health Check.
Aboriginal and Torres Strait Islander Health Check - Regular Medicationscsiro.fhir.au.smartforms#currentR4Regular Medications sub-questionnaire for Aboriginal and Torres Strait Islander Health Check.
Aboriginal and Torres Strait Islander Health Check - Screening Programscsiro.fhir.au.smartforms#currentR4Screening Programs sub-questionnaire for Aboriginal and Torres Strait Islander Health Check.
Aboriginal and Torres Strait Islander Health Check - Sexual Healthcsiro.fhir.au.smartforms#currentR4Sexual Health sub-questionnaire for Aboriginal and Torres Strait Islander Health Check.
Aboriginal and Torres Strait Islander Health Check - Skincsiro.fhir.au.smartforms#currentR4Skin sub-questionnaire for Aboriginal and Torres Strait Islander Health Check.
Aboriginal and Torres Strait Islander Health Check - Social And Emotional Wellbeingcsiro.fhir.au.smartforms#currentR4Social And Emotional Wellbeing sub-questionnaire for Aboriginal and Torres Strait Islander Health Check.
Aboriginal and Torres Strait Islander Health Check - Social History Childcsiro.fhir.au.smartforms#currentR4Social History Child sub-questionnaire for Aboriginal and Torres Strait Islander Health Check.
Aboriginal and Torres Strait Islander Health Check - Substance Usecsiro.fhir.au.smartforms#currentR4Substance Use sub-questionnaire for Aboriginal and Torres Strait Islander Health Check.
Adverse Medical Event Questionnairehl7.fhir.us.sirb#currentR4
Alcohol Use Disorder Identification Test - Consumption [AUDIT-C]fhir.argonaut.questionnaire#1.0.0R3The Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) is a brief validated screen for risky drinking and alcohol abuse and dependence (alcohol misuse).
ANC.A. Registrationwho.fhir.anc-cds#currentR4The registration process performed to identify and register a pregnant woman so that she can proceed to the antenatal care consultation.
ANC.B10 Counselling & treatmentwho.fhir.anc-cds#currentR4Based on the previous steps, health worker provides counselling for potential risk, behaviours and diagnoses, as well as preventive services and any treatment that can be provided at the facility, including through admission to a different part of the facility.
ANC.B11 Referral needed?who.fhir.anc-cds#currentR4If there are any diagnoses requiring referral or services that cannot be provided at the facility, health worker refers pregnant woman based on findings during counselling.
ANC.B12 Schedulingwho.fhir.anc-cds#currentR4If a referral is not required, health worker schedules follow-up contact.
ANC.B4 Confirm pregnancywho.fhir.anc-cds#currentR4Confirm the woman is pregnant using a urine dipstick test or by a blood test.
ANC.B5 Quick checkwho.fhir.anc-cds#currentR4Health worker assesses woman to see whether there are any danger signs that warrant in-facility management or referral, or if possible, to proceed with the routine ANC contact.
ANC.B6 Profilewho.fhir.anc-cds#currentR4If this is the woman’s first ANC contact, the health worker records information on her current pregnancy, past medical and obstetric history, medications, behaviour, immunization status and other background information.
ANC.B7 Symptoms & Follow-upwho.fhir.anc-cds#currentR4Health worker follows up on any previously reported behaviours, medications and symptoms. Steps 8–10 below are all conducted within the ANC assessment.
ANC.B8 Physical examwho.fhir.anc-cds#currentR4Health worker conducts a physical exam for weight, height (if first contact), maternal exam and fetal assessment.
ANC.B9 Lab tests & imagingwho.fhir.anc-cds#currentR4Health worker orders or follows up on required laboratory tests and ultrasound, as necessary. Health worker informs woman of all tests ordered and explains why.
ANC.C. Referralwho.fhir.anc-cds#currentR4An antenatal care referral to provide timely and appropriate referrals to a higher-level facility or health-care provider.
ANC.End Endwho.fhir.anc-cds#currentR4Closing the antenatal care record
Annual follow-up of clinical questionnaire responsehl7.fhir.uv.ichom-breast-cancer#currentR4Clinical response questionnaire at annual post-treatment follow-up
Antiviral medication eligibility questionnairecinc.fhir.ig#currentR4A questionnaire defining eligibility criteria for anti-viral medication
Argonaut Questionnaire Samplerfhir.argonaut.questionnaire#1.0.0R3
Cancer Quality Forum Questionnaire 2012hl7.fhirpath#currentR4
Check-In Monitoring-Fragebogenfhir.qpath4ms#currentR4Fragebogen zum Check-In beim Besuch nach Basismonitoringschema
Clinical response at 6 months post-treatment follow-uphl7.fhir.uv.ichom-breast-cancer#currentR4Clinical response questionnaire at 6 months post-treatment follow-up
Clinical response questionnaire at baselinehl7.fhir.uv.ichom-breast-cancer#currentR4Clinical response questionnaire at baseline (first doctors' visit)
Consent Questionnairehl7.fhir.us.sirb#currentR4
Continuing Reviewhl7.fhir.us.sirb#currentR4
COVID19 Initial Health Assessment Questionnairecinc.fhir.ig#currentR4An initial assessment for a patient who has tested positive for COVID-19
COVID19 Public Health History Questionnairecinc.fhir.ig#currentR4Questions about a patient's recent COVID-19 history
COVID19 Vaccination Side Effects Questionnairecinc.fhir.ig#currentR4Te Whatu Ora post COVID-19 vaccination survey.
Drug Abuse Screening Test-10 [DAST-10]fhir.argonaut.questionnaire#1.0.0R3
Exercise Mental Illness Questionnairefhir.qpath4ms#currentR4The Exercise Mental Illness Questionnaire (EMIQ)
Fatigue Scale for Motor and Cognitive Functions Questionnairefhir.qpath4ms#currentR4Fatigue Scale for Motor and Cognitive Functions (FSMC) Questionnaire
Food Allergy self-reportmycompany.fhir.foodallergyExample#currentR4Food Allergy self-report
Hamburg Quality of Life Questionnaire in Multiple Sclerosisfhir.qpath4ms#currentR4Hamburg Quality of Life Questionnaire in Multiple Sclerosis (HAQUAMS)
Hostpital Anxiety and Depression Scale Questionnaire, deutsche Versionfhir.qpath4ms#currentR4Hostpital Anxiety and Depression Scale Questionnaire, deutsche Version (HADS-D)
Housing Questionsfhir.argonaut.questionnaire#1.0.0R3
Influenza and COVID-19 Booster Vaccination 42 Day Review Questionnairecinc.fhir.ig#currentR4Te Whatu Ora 42-day post Influenza/Covid-19 booster vaccination survey.
Influenza and COVID-19 Booster Vaccination 7 Day Review Questionnairecinc.fhir.ig#currentR4Te Whatu Ora 7-day post Influenza/Covid-19 booster vaccination survey.
Initiate a Study Questionnairehl7.fhir.us.sirb#currentR4Initiate a Study Questionnaire
Mental Health Assessment Surveycinc.fhir.ig#currentR4Te Whatu Ora Mental Health Assessment Survey
Modified Fatigue Impact Scale Questionnairefhir.qpath4ms#currentR4Modified Fatigue Impact Scale (MFIS) Questionnaire
Module Questionnaire Addressch.fhir.ig.ch-orf#currentR4
Module Questionnaire Order Appointmentch.fhir.ig.ch-orf#currentR4
Module Questionnaire Order Coveragech.fhir.ig.ch-orf#currentR4
Module Questionnaire Order Formch.fhir.ig.ch-orf#currentR4
Module Questionnaire Order Initiatorch.fhir.ig.ch-orf#currentR4
Module Questionnaire Order Patientch.fhir.ig.ch-orf#currentR4
Module Questionnaire Order Receiverch.fhir.ig.ch-orf#currentR4
Module Questionnaire Order Receiverch.fhir.ig.ch-orf#currentR4
Module Questionnaire Order Receiver Copych.fhir.ig.ch-orf#currentR4
Module Questionnaire Order Requested Encounterch.fhir.ig.ch-orf#currentR4
Module Questionnaire Order Senderch.fhir.ig.ch-orf#currentR4
Module Questionnaire Patient Consentch.fhir.ig.ch-orf#currentR4
Module Questionnaire Practitioner with Name and Telecomch.fhir.ig.ch-orf#currentR4
Multiple Sclerosis Health Resource Utilization Survey Questionnairefhir.qpath4ms#currentR4Multiple Sclerosis Health Resource Utilization Survey (MS-HRS) Questionnaire
MyPain Questionnairecqf.fhir.cds4cpm#currentR4A questionnaire to use with the MyPAIN application for a patient to assess their pain levels, locations, and treatments for use in consultation with a clinician to determine further treatments. Created for UFL pilot.
MyPain Questionnairecqf.fhir.cds4cpm#currentR4A questionnaire to use with the MyPAIN application for a patient to assess their pain levels, locations, and treatments for use in consultation with a clinician to determine further treatments.
NACHC.A0 Contact & Profilefhir.nachc.hiv-cds#currentR4TODO: description goes here
NACHC.A1 HIVfhir.nachc.hiv-cds#currentR4TODO: description goes here
NACHC.A2 HIV testfhir.nachc.hiv-cds#currentR4TODO: description goes here
NACHC.B1 HCVfhir.nachc.hiv-cds#currentR4TODO: description goes here
NACHC.B2 HCV testfhir.nachc.hiv-cds#currentR4TODO: description goes here
NACHC.C1 Syphilisfhir.nachc.hiv-cds#currentR4TODO: description goes here
NACHC.C2 Syphilis testfhir.nachc.hiv-cds#currentR4TODO: description goes here
NACHC.D1 Gonorrheafhir.nachc.hiv-cds#currentR4TODO: description goes here
NACHC.D2 Gonorrhea testfhir.nachc.hiv-cds#currentR4TODO: description goes here
NACHC.E1 Chlamydiafhir.nachc.hiv-cds#currentR4TODO: description goes here
NACHC.E2 Chlamydia testfhir.nachc.hiv-cds#currentR4TODO: description goes here
NACHC.F1 Injection Drug Usefhir.nachc.hiv-cds#currentR4TODO: description goes here
NACHC.F2 Pregnancyfhir.nachc.hiv-cds#currentR4TODO: description goes here
NACHC.G1 Pepfhir.nachc.hiv-cds#currentR4TODO: description goes here
NACHC.G2 Prepfhir.nachc.hiv-cds#currentR4TODO: description goes here
NACHC.H1 Risk Factorsfhir.nachc.hiv-cds#currentR4TODO: description goes here
NACHC.H2 DAST 10fhir.nachc.hiv-cds#currentR4TODO: description goes here
Patient Health Questionnaire (PHQ-9)example.fhir.uv.mycontentig#currentR4
Patient Health Questionnaire (PHQ-9)fhir.qpath4ms#currentR4Gesundheitsfragebogen für Patienten zur Depressivität
Patient Health Questionnaire (PHQ-9)fhir.argonaut.questionnaire#1.0.0R3
Patient reported response at baselinehl7.fhir.uv.ichom-breast-cancer#currentR4Patient-reported response at baseline (first doctors' visit)
Patient reported response at post-treatment follow-uphl7.fhir.uv.ichom-breast-cancer#currentR4Patient-reported response at every 6 months for first 2 years post-treatment, after 2 years tracked annually for up to 10 years
Pregnancy Assessment Surveycinc.fhir.ig#currentR4Te Whatu Ora pregnancy assessment survey.
Protocol Questionnairehl7.fhir.us.sirb#currentR4
Psykisk helbred questionnairehl7.fhir.dk.hackathon.2022#currentR4Spørgeskema der undersøger psykisk helbred for børn og unge, der er i risiko for at udvikle depression eller angst
Question Template for COVID-19 Privacy Statement Questioncinc.fhir.ig#currentR4Collects responses confirming that a patient consents to data collection and sharing.
Question Template for COVID-19 Regular Health Checkcinc.fhir.ig#currentR4Gather the status of a patient who is self isolating
Recruitment Materialshl7.fhir.us.sirb#currentR4
sIRB Determination Questionnairehl7.fhir.us.sirb#currentR4
Twelve Item MS Walking Scale Questionnairefhir.qpath4ms#currentR4Twelve Item MS Walking Scale (MSWS-12) Questionnaire
Unanticipated Problems Involving Risk to Subjects or Others (UPIRTSO)/Adverse Non-Medical Event Questionnairehl7.fhir.us.sirb#currentR4
United Kingdom Neurological Disability Rating Scale Questionnairefhir.qpath4ms#currentR4United Kingdom Neurological Disability Rating Scale Questionnaire (UNDS), deutsche Version

Produced 08 Sep 2023