Questionnaires (21)

NameSourceVerDescription
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
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)
Food Allergy self-reportmycompany.fhir.foodallergyExample#currentR4Food Allergy self-report
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.
Patient Health Questionnaire (PHQ-9)example.fhir.uv.mycontentig#currentR4
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

Produced 08 Sep 2023