Care Coordination and 360 Referrals (Proof of Concept)
0.1.0 - proof-of-concept
Care Coordination and 360 Referrals (Proof of Concept)
0.1.0 - proof-of-concept
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
| Draft as of 2026-11-03 |
{
"resourceType" : "Questionnaire",
"id" : "ExercisePreParticipationForm",
"language" : "en",
"text" : {
"status" : "extensions",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Questionnaire ExercisePreParticipationForm</b></p><a name=\"ExercisePreParticipationForm\"> </a><a name=\"hcExercisePreParticipationForm\"> </a><table border=\"1\" cellpadding=\"0\" cellspacing=\"0\" class=\"xhtTableBorder1\"><tr class=\"xhtRowBorder2\"><th scope=\"col\" style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"The linkID for the item\">LinkID</a></th><th scope=\"col\" style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Text for the item\">Text</a></th><th scope=\"col\" style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Minimum and Maximum # of times the item can appear in the instance\">Cardinality</a></th><th scope=\"col\" style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"The type of the item\">Type</a></th><th scope=\"col\" style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Additional information about the item\">Description & Constraints</a><span style=\"float: right\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Legend for this format\"><img src=\"data:image/png;base64,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\" alt=\"doco\" style=\"background-color: inherit\"/></a></span></th></tr><tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck1.png)\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_q_root.gif\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"QuestionnaireRoot\" class=\"hierarchy\"/> ExercisePreParticipationForm</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Pre-participation screening completed by the patient before the first session, following the\n**structure** of the PAR-Q+ for individuals (2025): seven general health questions; follow-up\nquestions about medical conditions, shown only if any answer is yes (one of the ten condition\nsections, cardiovascular, is shown); and the participant declaration. Item text is short\ndescriptive labels, **not** the official PAR-Q+ wording.</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/><td style=\"\" class=\"hierarchy xhtCellBorder1\">Questionnaire</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">https://fhir.acmeexample.org.uk/PatientCareCoordination/Questionnaire/ExercisePreParticipationForm#0.1.0</td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck11.png)\" id=\"item.general\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"group\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">ExercisePreParticipationForm / </span>general</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">General health questions</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.q1\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-boolean.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"boolean\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">ExercisePreParticipationForm / general / </span>q1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">1. Heart condition or high blood pressure diagnosed by a doctor</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">1..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-boolean\">boolean</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.q2\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-boolean.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"boolean\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">ExercisePreParticipationForm / general / </span>q2</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">2. Chest pain (at rest, daily activities or physical activity)</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">1..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-boolean\">boolean</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.q3\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-boolean.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"boolean\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">ExercisePreParticipationForm / general / </span>q3</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">3. Dizziness causing loss of balance, or loss of consciousness, in the last 12 months</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">1..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-boolean\">boolean</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.q4\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-boolean.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"boolean\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">ExercisePreParticipationForm / general / </span>q4</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">4. Other chronic medical condition diagnosed</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">1..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-boolean\">boolean</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.q4-conditions\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">ExercisePreParticipationForm / general / </span>q4-conditions</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Conditions</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..*</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Enable When: <span><a href=\"#item.q4\">q4</a> = true</span></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.q5\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-boolean.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"boolean\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">ExercisePreParticipationForm / general / </span>q5</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">5. Currently taking prescribed medication for a chronic condition</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">1..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-boolean\">boolean</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.q5-medications\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">ExercisePreParticipationForm / general / </span>q5-medications</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Conditions and medications</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..*</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Enable When: <span><a href=\"#item.q5\">q5</a> = true</span></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.q6\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-boolean.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"boolean\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">ExercisePreParticipationForm / general / </span>q6</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">6. Bone, joint or soft tissue problem that activity could make worse (last 12 months)</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">1..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-boolean\">boolean</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck110.png)\" id=\"item.q6-conditions\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">ExercisePreParticipationForm / general / </span>q6-conditions</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Conditions</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..*</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Enable When: <span><a href=\"#item.q6\">q6</a> = true</span></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck100.png)\" id=\"item.q7\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-boolean.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"boolean\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">ExercisePreParticipationForm / general / </span>q7</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">7. Advised by a doctor to do only medically supervised physical activity</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">1..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-boolean\">boolean</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck11.png)\" id=\"item.follow-up\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"group\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">ExercisePreParticipationForm / </span>follow-up</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Follow-up questions about medical conditions (completed if any general health answer is yes)</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Enable When: <ul><li><a href=\"#item.q1\">q1</a> = true</li><li><a href=\"#item.q2\">q2</a> = true</li><li><a href=\"#item.q3\">q3</a> = true</li><li><a href=\"#item.q4\">q4</a> = true</li><li><a href=\"#item.q5\">q5</a> = true</li><li><a href=\"#item.q6\">q6</a> = true</li><li><a href=\"#item.q7\">q7</a> = true</li></ul></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck101.png)\" id=\"item.fu-cardiovascular\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"group\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">ExercisePreParticipationForm / follow-up / </span>fu-cardiovascular</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">3. Heart or cardiovascular condition (one of ten condition sections; the others are not shown)</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck1010.png)\" id=\"item.fu3\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-boolean.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"boolean\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">ExercisePreParticipationForm / follow-up / fu-cardiovascular / </span>fu3</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Has a heart or cardiovascular condition</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">1..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-boolean\">boolean</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck1010.png)\" id=\"item.fu3a\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-boolean.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"boolean\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">ExercisePreParticipationForm / follow-up / fu-cardiovascular / </span>fu3a</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">3a. Condition hard to control with current treatment</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-boolean\">boolean</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Enable When: <span><a href=\"#item.fu3\">fu3</a> = true</span></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck1010.png)\" id=\"item.fu3b\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-boolean.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"boolean\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">ExercisePreParticipationForm / follow-up / fu-cardiovascular / </span>fu3b</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">3b. Irregular heartbeat needing medical management</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-boolean\">boolean</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Enable When: <span><a href=\"#item.fu3\">fu3</a> = true</span></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck1010.png)\" id=\"item.fu3c\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-boolean.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"boolean\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">ExercisePreParticipationForm / follow-up / fu-cardiovascular / </span>fu3c</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">3c. Chronic heart failure</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-boolean\">boolean</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Enable When: <span><a href=\"#item.fu3\">fu3</a> = true</span></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck1000.png)\" id=\"item.fu3d\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-boolean.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"boolean\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">ExercisePreParticipationForm / follow-up / fu-cardiovascular / </span>fu3d</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">3d. Coronary artery disease and not regularly active in the last 2 months</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-boolean\">boolean</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Enable When: <span><a href=\"#item.fu3\">fu3</a> = true</span></td></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck01.png)\" id=\"item.declaration\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"group\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">ExercisePreParticipationForm / </span>declaration</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Participant declaration</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">0..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck010.png)\" id=\"item.declaration-agreed\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-boolean.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"boolean\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">ExercisePreParticipationForm / declaration / </span>declaration-agreed</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">I have read and completed this questionnaire; clearance is valid for up to 12 months and ends if my health changes</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">1..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-boolean\">boolean</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowOdd\"><td style=\"background-image: url(tbl_bck010.png)\" id=\"item.declaration-name\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\"\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">ExercisePreParticipationForm / declaration / </span>declaration-name</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Name</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">1..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr class=\"xhtRowBorder1 xhtRowEven\"><td style=\"background-image: url(tbl_bck000.png)\" id=\"item.declaration-date\" class=\"hierarchy xhtCellBorder1 xhtCellNoWrap\"><img src=\"tbl_spacer.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\"\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-date.png\" alt=\"\" style=\"background-color: white; background-color: inherit\" title=\"date\" class=\"hierarchy\"/> <span style=\"position: absolute; width: 1px; height: 1px; padding: 0; margin: -1px; overflow: hidden; clip: rect(0, 0, 0, 0); white-space: nowrap; border: 0\" class=\"sr-only\">ExercisePreParticipationForm / declaration / </span>declaration-date</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">Date</td><td style=\"\" class=\"hierarchy xhtCellBorder1\">1..1</td><td style=\"\" class=\"hierarchy xhtCellBorder1\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-date\">date</a></td><td style=\"\" class=\"hierarchy xhtCellBorder1\"/></tr>\r\n<tr><td colspan=\"5\" class=\"hierarchy\"><br/><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Legend for this format\"><img src=\"data:image/png;base64,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\" alt=\"doco\" style=\"background-color: inherit\"/> Documentation for this format</a></td></tr></table></div>"
},
"url" : "https://fhir.acmeexample.org.uk/PatientCareCoordination/Questionnaire/ExercisePreParticipationForm",
"version" : "0.1.0",
"name" : "ExercisePreParticipationForm",
"title" : "Physical activity readiness (PAR-Q+ structure, illustrative)",
"status" : "draft",
"experimental" : true,
"subjectType" : [
"Patient"
],
"date" : "2026-11-03T05:48:20+00:00",
"publisher" : "Kevin Mayfield",
"contact" : [
{
"telecom" : [
{
"system" : "url",
"value" : "https://github.com/KevinMayfield/PatientCareCoordination"
}
]
}
],
"description" : "Pre-participation screening completed by the patient before the first session, following the\n**structure** of the PAR-Q+ for individuals (2025): seven general health questions; follow-up\nquestions about medical conditions, shown only if any answer is yes (one of the ten condition\nsections, cardiovascular, is shown); and the participant declaration. Item text is short\ndescriptive labels, **not** the official PAR-Q+ wording.",
"jurisdiction" : [
{
"coding" : [
{
"system" : "urn:iso:std:iso:3166",
"code" : "GB",
"display" : "United Kingdom of Great Britain and Northern Ireland"
}
]
}
],
"copyright" : "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/).",
"item" : [
{
"linkId" : "general",
"text" : "General health questions",
"type" : "group",
"item" : [
{
"linkId" : "q1",
"prefix" : "1",
"text" : "Heart condition or high blood pressure diagnosed by a doctor",
"type" : "boolean",
"required" : true
},
{
"linkId" : "q2",
"prefix" : "2",
"text" : "Chest pain (at rest, daily activities or physical activity)",
"type" : "boolean",
"required" : true
},
{
"linkId" : "q3",
"prefix" : "3",
"text" : "Dizziness causing loss of balance, or loss of consciousness, in the last 12 months",
"type" : "boolean",
"required" : true
},
{
"linkId" : "q4",
"prefix" : "4",
"text" : "Other chronic medical condition diagnosed",
"type" : "boolean",
"required" : true
},
{
"linkId" : "q4-conditions",
"text" : "Conditions",
"type" : "string",
"enableWhen" : [
{
"question" : "q4",
"operator" : "=",
"answerBoolean" : true
}
],
"repeats" : true
},
{
"linkId" : "q5",
"prefix" : "5",
"text" : "Currently taking prescribed medication for a chronic condition",
"type" : "boolean",
"required" : true
},
{
"linkId" : "q5-medications",
"text" : "Conditions and medications",
"type" : "string",
"enableWhen" : [
{
"question" : "q5",
"operator" : "=",
"answerBoolean" : true
}
],
"repeats" : true
},
{
"linkId" : "q6",
"prefix" : "6",
"text" : "Bone, joint or soft tissue problem that activity could make worse (last 12 months)",
"type" : "boolean",
"required" : true
},
{
"linkId" : "q6-conditions",
"text" : "Conditions",
"type" : "string",
"enableWhen" : [
{
"question" : "q6",
"operator" : "=",
"answerBoolean" : true
}
],
"repeats" : true
},
{
"linkId" : "q7",
"prefix" : "7",
"text" : "Advised by a doctor to do only medically supervised physical activity",
"type" : "boolean",
"required" : true
}
]
},
{
"linkId" : "follow-up",
"text" : "Follow-up questions about medical conditions (completed if any general health answer is yes)",
"type" : "group",
"enableWhen" : [
{
"question" : "q1",
"operator" : "=",
"answerBoolean" : true
},
{
"question" : "q2",
"operator" : "=",
"answerBoolean" : true
},
{
"question" : "q3",
"operator" : "=",
"answerBoolean" : true
},
{
"question" : "q4",
"operator" : "=",
"answerBoolean" : true
},
{
"question" : "q5",
"operator" : "=",
"answerBoolean" : true
},
{
"question" : "q6",
"operator" : "=",
"answerBoolean" : true
},
{
"question" : "q7",
"operator" : "=",
"answerBoolean" : true
}
],
"enableBehavior" : "any",
"item" : [
{
"linkId" : "fu-cardiovascular",
"prefix" : "3",
"text" : "Heart or cardiovascular condition (one of ten condition sections; the others are not shown)",
"type" : "group",
"item" : [
{
"linkId" : "fu3",
"text" : "Has a heart or cardiovascular condition",
"type" : "boolean",
"required" : true
},
{
"linkId" : "fu3a",
"prefix" : "3a",
"text" : "Condition hard to control with current treatment",
"type" : "boolean",
"enableWhen" : [
{
"question" : "fu3",
"operator" : "=",
"answerBoolean" : true
}
]
},
{
"linkId" : "fu3b",
"prefix" : "3b",
"text" : "Irregular heartbeat needing medical management",
"type" : "boolean",
"enableWhen" : [
{
"question" : "fu3",
"operator" : "=",
"answerBoolean" : true
}
]
},
{
"linkId" : "fu3c",
"prefix" : "3c",
"text" : "Chronic heart failure",
"type" : "boolean",
"enableWhen" : [
{
"question" : "fu3",
"operator" : "=",
"answerBoolean" : true
}
]
},
{
"linkId" : "fu3d",
"prefix" : "3d",
"text" : "Coronary artery disease and not regularly active in the last 2 months",
"type" : "boolean",
"enableWhen" : [
{
"question" : "fu3",
"operator" : "=",
"answerBoolean" : true
}
]
}
]
}
]
},
{
"linkId" : "declaration",
"text" : "Participant declaration",
"type" : "group",
"item" : [
{
"linkId" : "declaration-agreed",
"text" : "I have read and completed this questionnaire; clearance is valid for up to 12 months and ends if my health changes",
"type" : "boolean",
"required" : true
},
{
"linkId" : "declaration-name",
"text" : "Name",
"type" : "string",
"required" : true
},
{
"linkId" : "declaration-date",
"text" : "Date",
"type" : "date",
"required" : true
}
]
}
]
}