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

COVID-19 Questionnaire Mock up - XML Representation

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<Questionnaire xmlns="http://hl7.org/fhir">
  <id value="covid-19-public"/>
  <text>
    <status value="generated"/>
    <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>
  </text>
  <url value="https://fhir.nhs.uk/Questionnaire/covid-19-public"/>
  <identifier>
    <system value="https://fhir.nhs.uk/Questionnaire"/>
    <value value="covid-19-public"/>
  </identifier>
  <version value="3.0.0"/>
  <name value="COVID-19 Assessment"/>
  <title value="COVID-19 Assessment"/>
  <status value="draft"/>
  <date value="2020-03-10T18:22:23+00:00"/>
  <publisher value="mayfield-is.co.uk"/>
  <description
               value="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 value="http://unstats.un.org/unsd/methods/m49/m49.htm"/>
      <code value="826"/>
    </coding>
  </jurisdiction>
  <contact>
    <telecom>
      <system value="email"/>
      <value value="kevin.mayfield@mayfield-is.co.uk"/>
    </telecom>
  </contact>
  <subjectType value="Patient"/>
  <item>
    <linkId value="symptom"/>
    <type value="group"/>
    <repeats value="true"/>
    <item>
      <linkId value="sympton-type"/>
      <text value="Symptom"/>
      <type value="open-choice"/>
      <option>
        <valueCoding>
          <system value="http://snomed.info/sct"/>
          <code value="315642008"/>
          <display value="Influenza-like symptoms"/>
        </valueCoding>
      </option>
      <option>
        <valueCoding>
          <system value="http://snomed.info/sct"/>
          <code value="49727002"/>
          <display value="Cough"/>
        </valueCoding>
      </option>
      <option>
        <valueCoding>
          <system value="http://snomed.info/sct"/>
          <code value="386661006"/>
          <display value="Fever"/>
        </valueCoding>
      </option>
      <option>
        <valueCoding>
          <system value="http://snomed.info/sct"/>
          <code value="230145002"/>
          <display value="Difficulty breathing"/>
        </valueCoding>
      </option>
      <option>
        <valueCoding>
          <system value="http://snomed.info/sct"/>
          <code value="162397003"/>
          <display value="Pain in throat"/>
        </valueCoding>
      </option>
    </item>
    <item>
      <linkId value="sympton-date"/>
      <text value="onset"/>
      <type value="date"/>
    </item>
  </item>
  <item>
    <linkId value="temp"/>
    <text value="Body Temp"/>
    <type value="group"/>
    <repeats value="true"/>
    <item>
      <linkId value="tempcel"/>
      <text value="Temperature (0-100 Celsius)"/>
      <type value="integer"/>
    </item>
  </item>
  <item>
    <linkId value="travel"/>
    <text value="Travel trip history"/>
    <type value="group"/>
    <item>
      <linkId value="recent"/>
      <text value="Recent Travel"/>
      <type value="date"/>
    </item>
    <item>
      <linkId value="dateofreturn"/>
      <text value="Date of Return"/>
      <type value="boolean"/>
    </item>
  </item>
</Questionnaire>