Questionnaire-COVIDInitialHealthAssessmentQuestionnaire

Sourcecinc.fhir.ig#current:Care In The Community FHIR API (v4.0.1)
resourceTypeQuestionnaire
idCOVIDInitialHealthAssessmentQuestionnaire
canonicalhttps://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/Questionnaire/COVIDInitialHealthAssessmentQuestionnaire
version0.2.8
statusdraft
publisherTe Whatu Ora
nameCOVIDInitialHealthAssessmentQuestionnaire
titleCOVID19 Initial Health Assessment Questionnaire
date2023-07-19
experimentalfalse
descriptionAn initial assessment for a patient who has tested positive for COVID-19
jurisdictionsnz
Usages(none)

1.: Past Health and Wellbeing History - ask questions to find out about:

  • linkId: 1

1.1.: Hypertension? *

  • linkId: 1.1
  • Initial Values: false

1.2.: Diabetes? *

  • linkId: 1.2
  • Initial Values: false

1.2.1: If using insulin please provide details?

  • linkId: 1.2.1
  • Enable When: todo

1.3.: Asthma? *

  • linkId: 1.3
  • Initial Values: false

1.4.: Previous stroke? *

  • linkId: 1.4
  • Initial Values: false

1.5.: Cancer? *

  • linkId: 1.5
  • Initial Values: false

1.5.1: Please provide cancer details

  • linkId: 1.5.1
  • Enable When: todo

1.6.: Current/recent pregnancy? *

  • linkId: 1.6
  • Initial Values: false

1.6.a.: Pregnancy assessment

  • linkId: 1.6.a
  • Enable When: todo

1.6.1: Gestation (number of weeks)

  • linkId: 1.6.1

1.6.2: Postpartum (number of weeks)

  • linkId: 1.6.2

1.7.: Immunocompromised? *

  • linkId: 1.7
  • Initial Values: false

1.7.1: Specify immunocompromised further details

  • linkId: 1.7.1
  • Enable When: todo

1.8.: Previous heart attack or heart failure? *

  • linkId: 1.8
  • Initial Values: false

1.9.: Epilepsy? *

  • linkId: 1.9
  • Initial Values: false

1.10.: Other respiratory disease? *

  • linkId: 1.10
  • Initial Values: false

1.11.: Mental health and/or addiction? *

  • linkId: 1.11
  • Initial Values: false

1.12.: Kidney disease? *

  • linkId: 1.12
  • Initial Values: false

1.13.: CPAP device used? *

  • linkId: 1.13
  • Initial Values: false

1.14.: Weight? *

1.15.: Other

  • linkId: 1.15

2.: Medication and Allergies

  • linkId: 2

2.1.: Smoking? *

  • linkId: 2.1
  • Initial Values: false

2.1b.: Would you like NRT?

  • linkId: 2.1b
  • Enable When: todo

2.2.: Alcohol? *

  • linkId: 2.2
  • Initial Values: false

2.2.1.: Drinks per week?

2.3.: Recreational drugs?

  • linkId: 2.3
  • Initial Values: false

2.4.: Allergies? *

  • linkId: 2.4
  • Initial Values: false

2.4.1.: Medication Allergies *

  • linkId: 2.4.1
  • Enable When: todo
  • Initial Values: false

2.4.1.1.: Medicine

  • linkId: 2.4.1.1
  • Enable When: todo

2.4.1.2.: Category (select)

2.4.1.3.: Reaction (select)

2.4.1.4.: Onset Date

  • linkId: 2.4.1.4
  • Enable When: todo

2.4.1.5.: Date of Entry

  • linkId: 2.4.1.5
  • Enable When: todo

2.4.1.6.: Active? *

  • linkId: 2.4.1.6
  • Enable When: todo
  • Initial Values: true

2.4.1.6.1.: Specify Reason for deactivation

  • linkId: 2.4.1.6.1
  • Enable When: todo

2.4.1.7.: Comments

  • linkId: 2.4.1.7
  • Enable When: todo

2.4.2.: Other allergies *

  • linkId: 2.4.2
  • Enable When: todo

2.5.: Prescription medication or medical devices (eg. CPAP, nebuliser, blood glucose meter)? *

  • linkId: 2.5
  • Initial Values: false

2.6.: Details of medications, medical devices, recreational drugs here

  • linkId: 2.6

2.7.: Able to manage meds independently?

  • linkId: 2.7
  • Initial Values: false

2.8.: Sufficient supply for 14 days?

  • linkId: 2.8

2.9.: Taking immunosuppressant?

  • linkId: 2.9

3.: Individual assessment plan/guideline

  • linkId: 3

3.1.: Individual assessment plan / guideline

  • linkId: 3.1

Produced 08 Sep 2023