Care Connect Messaging - Local Development build (v3.0.0). See the Directory of published versions

COVID-19 Questionnaire Mock up - JSON Representation

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{
  "resourceType" : "Questionnaire",
  "id" : "covid-19-public",
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative with Details</b></p><p><b>id</b>: covid-19-public</p><p><b>url</b>: <a href=\"https://fhir.nhs.uk/Questionnaire/covid-19-public\">https://fhir.nhs.uk/Questionnaire/covid-19-public</a></p><p><b>identifier</b>: covid-19-public</p><p><b>version</b>: 3.0.0</p><p><b>name</b>: COVID-19 Assessment</p><p><b>title</b>: COVID-19 Assessment</p><p><b>status</b>: DRAFT</p><p><b>subjectType</b>: Patient</p><p><b>date</b>: 10 Mar 2020, 18:22:23</p><p><b>publisher</b>: mayfield-is.co.uk</p><p><b>contact</b>: </p><p><b>description</b>: To record the information required to evaluate the potential risk of Covid-19 infection, as part of professional screening or self-assessment. This is heavily based on the current NHS-111 UK self-assessment app at https://111.nhs.uk/covid-19 and a similar risk assessment app developed for pre-hospital admission by DIPS.no. The exact risk factors are subject to continual update as the disease progresses.</p><p><b>jurisdiction</b>: United Kingdom of Great Britain and Northern Ireland (GBR) <span style=\"background: LightGoldenRodYellow\">(Details : {http://unstats.un.org/unsd/methods/m49/m49.htm code '826' = 'United Kingdom of Great Britain and Northern Ireland (GBR))</span></p><blockquote><p><b>item</b></p><p><b>linkId</b>: symptom</p><p><b>type</b>: GROUP</p><p><b>repeats</b>: true</p><h3>Items</h3><table class=\"grid\"><tr><td>-</td><td><b>LinkId</b></td><td><b>Text</b></td><td><b>Type</b></td></tr><tr><td>*</td><td>sympton-type</td><td>Symptom</td><td>OPENCHOICE</td></tr><tr><td>*</td><td>sympton-date</td><td>onset</td><td>DATE</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: temp</p><p><b>text</b>: Body Temp</p><p><b>type</b>: GROUP</p><p><b>repeats</b>: true</p><h3>Items</h3><table class=\"grid\"><tr><td>-</td><td><b>LinkId</b></td><td><b>Text</b></td><td><b>Type</b></td></tr><tr><td>*</td><td>tempcel</td><td>Temperature (0-100 Celsius)</td><td>INTEGER</td></tr></table></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: travel</p><p><b>text</b>: Travel trip history</p><p><b>type</b>: GROUP</p><h3>Items</h3><table class=\"grid\"><tr><td>-</td><td><b>LinkId</b></td><td><b>Text</b></td><td><b>Type</b></td></tr><tr><td>*</td><td>recent</td><td>Recent Travel</td><td>DATE</td></tr><tr><td>*</td><td>dateofreturn</td><td>Date of Return</td><td>BOOLEAN</td></tr></table></blockquote></div>"
  },
  "url" : "https://fhir.nhs.uk/Questionnaire/covid-19-public",
  "identifier" : [
    {
      "system" : "https://fhir.nhs.uk/Questionnaire",
      "value" : "covid-19-public"
    }
  ],
  "version" : "3.0.0",
  "name" : "COVID-19 Assessment",
  "title" : "COVID-19 Assessment",
  "status" : "draft",
  "date" : "2020-03-10T18:22:23+00:00",
  "publisher" : "mayfield-is.co.uk",
  "description" : "To record the information required to evaluate the potential risk of Covid-19 infection, as part of professional screening or self-assessment. This is heavily based on the current NHS-111 UK self-assessment app at https://111.nhs.uk/covid-19 and a similar risk assessment app developed for pre-hospital admission by DIPS.no. The exact risk factors are subject to continual update as the disease progresses.",
  "jurisdiction" : [
    {
      "coding" : [
        {
          "system" : "http://unstats.un.org/unsd/methods/m49/m49.htm",
          "code" : "826"
        }
      ]
    }
  ],
  "contact" : [
    {
      "telecom" : [
        {
          "system" : "email",
          "value" : "kevin.mayfield@mayfield-is.co.uk"
        }
      ]
    }
  ],
  "subjectType" : [
    "Patient"
  ],
  "item" : [
    {
      "linkId" : "symptom",
      "type" : "group",
      "repeats" : true,
      "item" : [
        {
          "linkId" : "sympton-type",
          "text" : "Symptom",
          "type" : "open-choice",
          "option" : [
            {
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "315642008",
                "display" : "Influenza-like symptoms"
              }
            },
            {
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "49727002",
                "display" : "Cough"
              }
            },
            {
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "386661006",
                "display" : "Fever"
              }
            },
            {
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "230145002",
                "display" : "Difficulty breathing"
              }
            },
            {
              "valueCoding" : {
                "system" : "http://snomed.info/sct",
                "code" : "162397003",
                "display" : "Pain in throat"
              }
            }
          ]
        },
        {
          "linkId" : "sympton-date",
          "text" : "onset",
          "type" : "date"
        }
      ]
    },
    {
      "linkId" : "temp",
      "text" : "Body Temp",
      "type" : "group",
      "repeats" : true,
      "item" : [
        {
          "linkId" : "tempcel",
          "text" : "Temperature (0-100 Celsius)",
          "type" : "integer"
        }
      ]
    },
    {
      "linkId" : "travel",
      "text" : "Travel trip history",
      "type" : "group",
      "item" : [
        {
          "linkId" : "recent",
          "text" : "Recent Travel",
          "type" : "date"
        },
        {
          "linkId" : "dateofreturn",
          "text" : "Date of Return",
          "type" : "boolean"
        }
      ]
    }
  ]
}