Care Coordination and 360 Referrals (Proof of Concept)
0.1.0 - proof-of-concept United Kingdom flag

Care Coordination and 360 Referrals (Proof of Concept) - Local Development build (v0.1.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Questionnaire: Physical activity readiness (PAR-Q+ structure, illustrative) (Experimental)

Official URL: https://fhir.acmeexample.org.uk/PatientCareCoordination/Questionnaire/ExercisePreParticipationForm Version: 0.1.0
Draft as of 2026-11-03 Computable Name: ExercisePreParticipationForm

Copyright/Legal: Structure based on the PAR-Q+ (Copyright PAR-Q+ Collaboration). This is not the PAR-Q+: item text is descriptive only. Reproducing the PAR-Q+, or incorporating it into electronic forms, needs prior written authorisation from the PAR-Q+ Collaboration (https://eparmedx.com/about/terms-and-conditions/).

Pre-participation screening completed by the patient before the first session, following the structure of the PAR-Q+ for individuals (2025): seven general health questions; follow-up questions about medical conditions, shown only if any answer is yes (one of the ten condition sections, cardiovascular, is shown); and the participant declaration. Item text is short descriptive labels, not the official PAR-Q+ wording.

LinkIDTextCardinalityTypeDescription & Constraintsdoco
ExercisePreParticipationForm Pre-participation screening completed by the patient before the first session, following the **structure** of the PAR-Q+ for individuals (2025): seven general health questions; follow-up questions about medical conditions, shown only if any answer is yes (one of the ten condition sections, cardiovascular, is shown); and the participant declaration. Item text is short descriptive labels, **not** the official PAR-Q+ wording. Questionnaire https://fhir.acmeexample.org.uk/PatientCareCoordination/Questionnaire/ExercisePreParticipationForm#0.1.0
ExercisePreParticipationForm / general General health questions 0..1 group Value Set:
ExercisePreParticipationForm / general / q1 1. Heart condition or high blood pressure diagnosed by a doctor 1..1 boolean Value Set:
ExercisePreParticipationForm / general / q2 2. Chest pain (at rest, daily activities or physical activity) 1..1 boolean Value Set:
ExercisePreParticipationForm / general / q3 3. Dizziness causing loss of balance, or loss of consciousness, in the last 12 months 1..1 boolean Value Set:
ExercisePreParticipationForm / general / q4 4. Other chronic medical condition diagnosed 1..1 boolean Value Set:
ExercisePreParticipationForm / general / q4-conditions Conditions 0..* string Enable When: q4 = true
Value Set:
ExercisePreParticipationForm / general / q5 5. Currently taking prescribed medication for a chronic condition 1..1 boolean Value Set:
ExercisePreParticipationForm / general / q5-medications Conditions and medications 0..* string Enable When: q5 = true
Value Set:
ExercisePreParticipationForm / general / q6 6. Bone, joint or soft tissue problem that activity could make worse (last 12 months) 1..1 boolean Value Set:
ExercisePreParticipationForm / general / q6-conditions Conditions 0..* string Enable When: q6 = true
Value Set:
ExercisePreParticipationForm / general / q7 7. Advised by a doctor to do only medically supervised physical activity 1..1 boolean Value Set:
ExercisePreParticipationForm / follow-up Follow-up questions about medical conditions (completed if any general health answer is yes) 0..1 group Enable When:
Value Set:
ExercisePreParticipationForm / follow-up / fu-cardiovascular 3. Heart or cardiovascular condition (one of ten condition sections; the others are not shown) 0..1 group Value Set:
ExercisePreParticipationForm / follow-up / fu-cardiovascular / fu3 Has a heart or cardiovascular condition 1..1 boolean Value Set:
ExercisePreParticipationForm / follow-up / fu-cardiovascular / fu3a 3a. Condition hard to control with current treatment 0..1 boolean Enable When: fu3 = true
Value Set:
ExercisePreParticipationForm / follow-up / fu-cardiovascular / fu3b 3b. Irregular heartbeat needing medical management 0..1 boolean Enable When: fu3 = true
Value Set:
ExercisePreParticipationForm / follow-up / fu-cardiovascular / fu3c 3c. Chronic heart failure 0..1 boolean Enable When: fu3 = true
Value Set:
ExercisePreParticipationForm / follow-up / fu-cardiovascular / fu3d 3d. Coronary artery disease and not regularly active in the last 2 months 0..1 boolean Enable When: fu3 = true
Value Set:
ExercisePreParticipationForm / declaration Participant declaration 0..1 group Value Set:
ExercisePreParticipationForm / declaration / declaration-agreed I have read and completed this questionnaire; clearance is valid for up to 12 months and ends if my health changes 1..1 boolean Value Set:
ExercisePreParticipationForm / declaration / declaration-name Name 1..1 string Value Set:
ExercisePreParticipationForm / declaration / declaration-date Date 1..1 date Value Set:

doco Documentation for this format

General health questions

  • linkId: general
  • Answers:

1: Heart condition or high blood pressure diagnosed by a doctor*

  • linkId: q1
  • Answers:

2: Chest pain (at rest, daily activities or physical activity)*

  • linkId: q2
  • Answers:

3: Dizziness causing loss of balance, or loss of consciousness, in the last 12 months*

  • linkId: q3
  • Answers:

4: Other chronic medical condition diagnosed*

  • linkId: q4
  • Answers:

Conditions

  • linkId: q4-conditions
  • Enable When: todo
  • Answers:

5: Currently taking prescribed medication for a chronic condition*

  • linkId: q5
  • Answers:

Conditions and medications

  • linkId: q5-medications
  • Enable When: todo
  • Answers:

6: Bone, joint or soft tissue problem that activity could make worse (last 12 months)*

  • linkId: q6
  • Answers:

Conditions

  • linkId: q6-conditions
  • Enable When: todo
  • Answers:

7: Advised by a doctor to do only medically supervised physical activity*

  • linkId: q7
  • Answers:

Follow-up questions about medical conditions (completed if any general health answer is yes)

  • linkId: follow-up
  • Enable When: todo
  • Answers:

3: Heart or cardiovascular condition (one of ten condition sections; the others are not shown)

  • linkId: fu-cardiovascular
  • Answers:

Has a heart or cardiovascular condition*

  • linkId: fu3
  • Answers:

3a: Condition hard to control with current treatment

  • linkId: fu3a
  • Enable When: todo
  • Answers:

3b: Irregular heartbeat needing medical management

  • linkId: fu3b
  • Enable When: todo
  • Answers:

3c: Chronic heart failure

  • linkId: fu3c
  • Enable When: todo
  • Answers:

3d: Coronary artery disease and not regularly active in the last 2 months

  • linkId: fu3d
  • Enable When: todo
  • Answers:

Participant declaration

  • linkId: declaration
  • Answers:

I have read and completed this questionnaire; clearance is valid for up to 12 months and ends if my health changes*

  • linkId: declaration-agreed
  • Answers:

Name*

  • linkId: declaration-name
  • Answers:

Date*

  • linkId: declaration-date
  • Answers:

LinkIDDescription & Constraintsdoco
general Value Set:
general / q1 Value Set:
general / q2 Value Set:
general / q3 Value Set:
general / q4 Value Set:
general / q4-conditions Enable When: Not done yet
Value Set:
general / q5 Value Set:
general / q5-medications Enable When: Not done yet
Value Set:
general / q6 Value Set:
general / q6-conditions Enable When: Not done yet
Value Set:
general / q7 Value Set:
follow-up Enable When: Not done yet
Value Set:
follow-up / fu-cardiovascular Value Set:
follow-up / fu-cardiovascular / fu3 Value Set:
follow-up / fu-cardiovascular / fu3a Enable When: Not done yet
Value Set:
follow-up / fu-cardiovascular / fu3b Enable When: Not done yet
Value Set:
follow-up / fu-cardiovascular / fu3c Enable When: Not done yet
Value Set:
follow-up / fu-cardiovascular / fu3d Enable When: Not done yet
Value Set:
declaration Value Set:
declaration / declaration-agreed Value Set:
declaration / declaration-name Value Set:
declaration / declaration-date Value Set:

doco Documentation for this format

Test this Questionnaire

Try this questionnaire out:

Responses for this Questionnaire