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 |
<Questionnaire xmlns="http://hl7.org/fhir">
<id value="ExercisePreParticipationForm"/>
<language value="en"/>
<text>
<status value="extensions"/>
<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
**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.</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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
</text>
<url
value="https://fhir.acmeexample.org.uk/PatientCareCoordination/Questionnaire/ExercisePreParticipationForm"/>
<version value="0.1.0"/>
<name value="ExercisePreParticipationForm"/>
<title
value="Physical activity readiness (PAR-Q+ structure, illustrative)"/>
<status value="draft"/>
<experimental value="true"/>
<subjectType value="Patient"/>
<date value="2026-11-03T05:48:20+00:00"/>
<publisher value="Kevin Mayfield"/>
<contact>
<telecom>
<system value="url"/>
<value
value="https://github.com/KevinMayfield/PatientCareCoordination"/>
</telecom>
</contact>
<description
value="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."/>
<jurisdiction>
<coding>
<system value="urn:iso:std:iso:3166"/>
<code value="GB"/>
<display value="United Kingdom of Great Britain and Northern Ireland"/>
</coding>
</jurisdiction>
<copyright
value="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 value="general"/>
<text value="General health questions"/>
<type value="group"/>
<item>
<linkId value="q1"/>
<prefix value="1"/>
<text
value="Heart condition or high blood pressure diagnosed by a doctor"/>
<type value="boolean"/>
<required value="true"/>
</item>
<item>
<linkId value="q2"/>
<prefix value="2"/>
<text
value="Chest pain (at rest, daily activities or physical activity)"/>
<type value="boolean"/>
<required value="true"/>
</item>
<item>
<linkId value="q3"/>
<prefix value="3"/>
<text
value="Dizziness causing loss of balance, or loss of consciousness, in the last 12 months"/>
<type value="boolean"/>
<required value="true"/>
</item>
<item>
<linkId value="q4"/>
<prefix value="4"/>
<text value="Other chronic medical condition diagnosed"/>
<type value="boolean"/>
<required value="true"/>
</item>
<item>
<linkId value="q4-conditions"/>
<text value="Conditions"/>
<type value="string"/>
<enableWhen>
<question value="q4"/>
<operator value="="/>
<answerBoolean value="true"/>
</enableWhen>
<repeats value="true"/>
</item>
<item>
<linkId value="q5"/>
<prefix value="5"/>
<text
value="Currently taking prescribed medication for a chronic condition"/>
<type value="boolean"/>
<required value="true"/>
</item>
<item>
<linkId value="q5-medications"/>
<text value="Conditions and medications"/>
<type value="string"/>
<enableWhen>
<question value="q5"/>
<operator value="="/>
<answerBoolean value="true"/>
</enableWhen>
<repeats value="true"/>
</item>
<item>
<linkId value="q6"/>
<prefix value="6"/>
<text
value="Bone, joint or soft tissue problem that activity could make worse (last 12 months)"/>
<type value="boolean"/>
<required value="true"/>
</item>
<item>
<linkId value="q6-conditions"/>
<text value="Conditions"/>
<type value="string"/>
<enableWhen>
<question value="q6"/>
<operator value="="/>
<answerBoolean value="true"/>
</enableWhen>
<repeats value="true"/>
</item>
<item>
<linkId value="q7"/>
<prefix value="7"/>
<text
value="Advised by a doctor to do only medically supervised physical activity"/>
<type value="boolean"/>
<required value="true"/>
</item>
</item>
<item>
<linkId value="follow-up"/>
<text
value="Follow-up questions about medical conditions (completed if any general health answer is yes)"/>
<type value="group"/>
<enableWhen>
<question value="q1"/>
<operator value="="/>
<answerBoolean value="true"/>
</enableWhen>
<enableWhen>
<question value="q2"/>
<operator value="="/>
<answerBoolean value="true"/>
</enableWhen>
<enableWhen>
<question value="q3"/>
<operator value="="/>
<answerBoolean value="true"/>
</enableWhen>
<enableWhen>
<question value="q4"/>
<operator value="="/>
<answerBoolean value="true"/>
</enableWhen>
<enableWhen>
<question value="q5"/>
<operator value="="/>
<answerBoolean value="true"/>
</enableWhen>
<enableWhen>
<question value="q6"/>
<operator value="="/>
<answerBoolean value="true"/>
</enableWhen>
<enableWhen>
<question value="q7"/>
<operator value="="/>
<answerBoolean value="true"/>
</enableWhen>
<enableBehavior value="any"/>
<item>
<linkId value="fu-cardiovascular"/>
<prefix value="3"/>
<text
value="Heart or cardiovascular condition (one of ten condition sections; the others are not shown)"/>
<type value="group"/>
<item>
<linkId value="fu3"/>
<text value="Has a heart or cardiovascular condition"/>
<type value="boolean"/>
<required value="true"/>
</item>
<item>
<linkId value="fu3a"/>
<prefix value="3a"/>
<text value="Condition hard to control with current treatment"/>
<type value="boolean"/>
<enableWhen>
<question value="fu3"/>
<operator value="="/>
<answerBoolean value="true"/>
</enableWhen>
</item>
<item>
<linkId value="fu3b"/>
<prefix value="3b"/>
<text value="Irregular heartbeat needing medical management"/>
<type value="boolean"/>
<enableWhen>
<question value="fu3"/>
<operator value="="/>
<answerBoolean value="true"/>
</enableWhen>
</item>
<item>
<linkId value="fu3c"/>
<prefix value="3c"/>
<text value="Chronic heart failure"/>
<type value="boolean"/>
<enableWhen>
<question value="fu3"/>
<operator value="="/>
<answerBoolean value="true"/>
</enableWhen>
</item>
<item>
<linkId value="fu3d"/>
<prefix value="3d"/>
<text
value="Coronary artery disease and not regularly active in the last 2 months"/>
<type value="boolean"/>
<enableWhen>
<question value="fu3"/>
<operator value="="/>
<answerBoolean value="true"/>
</enableWhen>
</item>
</item>
</item>
<item>
<linkId value="declaration"/>
<text value="Participant declaration"/>
<type value="group"/>
<item>
<linkId value="declaration-agreed"/>
<text
value="I have read and completed this questionnaire; clearance is valid for up to 12 months and ends if my health changes"/>
<type value="boolean"/>
<required value="true"/>
</item>
<item>
<linkId value="declaration-name"/>
<text value="Name"/>
<type value="string"/>
<required value="true"/>
</item>
<item>
<linkId value="declaration-date"/>
<text value="Date"/>
<type value="date"/>
<required value="true"/>
</item>
</item>
</Questionnaire>