| Source | cinc.fhir.ig#current:Care In The Community FHIR API (v4.0.1) |
| resourceType | Questionnaire |
| id | MentalHealthAssessmentSurveyQuestionnaire |
| canonical | https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/Questionnaire/MentalHealthAssessmentSurveyQuestionnaire |
| version | 0.2.8 |
| status | draft |
| publisher | Te Whatu Ora |
| name | MentalHealthAssessmentSurveyQuestionnaire |
| title | Mental Health Assessment Survey |
| date | 2023-09-04T01:21:52+00:00 |
| description | Te Whatu Ora Mental Health Assessment Survey |
| jurisdictions | nz |
| Usages | (none) |
page 1: History and Examination
page 1 question 1: Description of presenting issue *
page 1 question 2: Assessment of Mood *
page 1 question 3: Assessment of sleep hygiene *
page 1 question 4: Assessment of whanau and support structures *
page 1 question 5: Is there a history of previous trauma and stressors? *
page 1 question 5.1: Please provide information surrounding this history. *
page 1 question 6: Have there been any previous suicide attempts? *
page 1 question 6.1: Please provide details surrounding these attempts *
page 1 question 7: Is the patient smoking cigarettes? *
page 1 question 7.1: How many cigarettes per day? *
page 1 question 8: Does the patient consume alcohol? *
page 1 question 8.1: How many drinks per week? *
page 1 question 9: Does the patient use recreational drugs? *
page 1 question 10: Psychiatric Medication?
page 2: Risk Assessment
page 2 question 1: Suicidal Intent? *
page 2 question 2: Threat to others? *
page 3: Current and past psychiatric diagnosis
page 3 group 1: Add Diagnosis
page 3 group 1 question 1: Diagnosis *
page 3 group 1 question 2: Year of Diagnosis *
page 3 group 1 question 3: Place of Diagnosis *
page 3 group 1 question 4: Hospitalisation? *
page 3 group 1 question 5: Active? *
page 4: General Practice Information
page 4 question 1: Send note to GP Inbox? *
page 4 question 2: GP Practice Name
page 4 question 3: Practice EDI
Produced 08 Sep 2023