{
"description": "Questionnaire for DVC Logical Model",
"_filename": "Questionnaire-Questionnaire-DVCModel.json",
"package_name": "smart.who.int.icvp",
"date": "2024-10-07T07:28:50+00:00",
"meta": {
"profile": [ "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-extr-smap" ]
},
"publisher": "WHO",
"name": null,
"item": [ {
"text": "Full Name of the client",
"type": "string",
"linkId": "name",
"repeats": false,
"required": true
}, {
"text": "Date of Birth",
"type": "date",
"linkId": "dob",
"repeats": false,
"required": true
}, {
"text": "Sex",
"type": "choice",
"linkId": "sex",
"repeats": false,
"required": false,
"answerValueSet": "http://terminology.hl7.org/ValueSet/v2-0001"
}, {
"text": "Nationality",
"type": "choice",
"linkId": "nationality",
"repeats": false,
"required": false,
"answerValueSet": "http://terminology.hl7.org/ValueSet/v3-Country"
}, {
"text": "National Identification Document",
"type": "string",
"linkId": "nid",
"repeats": false,
"required": false
}, {
"item": [ {
"text": "Name of Parent or Guardian",
"type": "string",
"linkId": "guardianName",
"repeats": false,
"required": false
}, {
"text": "Relationship Status",
"type": "choice",
"linkId": "guardianRelationship",
"repeats": false,
"required": false,
"answerValueSet": "#DVCRelationshipStatus"
} ],
"text": "Parent or Guardian Details",
"type": "group",
"linkId": "guardian",
"repeats": false,
"required": false
}, {
"item": [ {
"text": "Dose Number",
"type": "choice",
"linkId": "doseNumber",
"repeats": false,
"required": true,
"answerValueSet": "#doseNumber"
}, {
"text": "Name of disease of condition vaccinated or received prophylaxis against",
"type": "choice",
"linkId": "disease",
"repeats": false,
"required": true,
"answerValueSet": "#DiseaseTargeted"
}, {
"text": "Vaccine or Prophylaxis classification code",
"type": "choice",
"linkId": "vaccineClassification",
"repeats": false,
"required": true,
"answerValueSet": "#DVCVaccines"
}, {
"text": "Vaccine Trade Item",
"type": "string",
"linkId": "vaccineTradeItem",
"repeats": false,
"required": false
}, {
"text": "Date of Vaccination",
"type": "date",
"linkId": "date",
"repeats": false,
"required": true
}, {
"text": "Name of supervising clinician",
"type": "string",
"linkId": "clinicianName",
"repeats": false,
"required": false
}, {
"text": "Relevant authoring reponsible for issuing the certificate, or for overseeing the administration center",
"type": "string",
"linkId": "issuer",
"repeats": false,
"required": false
}, {
"text": "Manufacturer ID",
"type": "string",
"linkId": "manufacturerId",
"repeats": false,
"required": false
}, {
"text": "Name of Manufacturer of Vaccine",
"type": "string",
"linkId": "manufacturer",
"repeats": false,
"required": true
}, {
"text": "Batch Number",
"type": "string",
"linkId": "batchNo",
"repeats": false,
"required": true
}, {
"item": [ {
"text": "From",
"type": "date",
"linkId": "startDate",
"repeats": false,
"required": false
}, {
"text": "To",
"type": "date",
"linkId": "endDate",
"repeats": false,
"required": false
} ],
"text": "Certificate Validity Period",
"type": "group",
"linkId": "validityPeriod",
"repeats": false,
"required": false
} ],
"text": "Vaccine Certificate Details",
"type": "group",
"linkId": "vaccineDetails",
"repeats": true,
"required": true
} ],
"type": null,
"experimental": null,
"resourceType": "Questionnaire",
"title": "DVC Model Questionnaire",
"package_version": "0.1.0",
"contained": [ {
"description": "FHIR Value set/code system definition for HL7 v2 table 0001 ( SEX)",
"compose": {
"include": [ {
"system": "http://terminology.hl7.org/CodeSystem/v2-0001"
} ]
},
"meta": {
"profile": [ "http://hl7.org/fhir/StructureDefinition/shareablevalueset" ]
},
"publisher": "HL7, Inc",
"name": "v2.0001",
"experimental": false,
"resourceType": "ValueSet",
"title": "v2 SEX",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status",
"valueCode": "external"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm",
"valueInteger": 0
} ],
"status": "active",
"language": "en",
"id": "v2-0001",
"url": "http://terminology.hl7.org/ValueSet/v2-0001",
"immutable": true,
"version": "2.9",
"contact": [ {
"telecom": [ {
"value": "http://hl7.org",
"system": "url"
} ]
} ]
}, {
"description": "Countries of the world. ISO 3166, part 1, alpha-3 set.",
"compose": {
"include": [ {
"filter": [ {
"op": "regex",
"value": "[A-Z]{3}",
"property": "code"
} ],
"system": "urn:iso:std:iso:3166"
} ]
},
"date": "2014-03-26",
"publisher": "Health Level Seven International",
"name": "Country",
"copyright": "This material derives from the HL7 Terminology THO. THO is copyright ©1989+ Health Level Seven International and is made available under the CC0 designation. For more licensing information see: https://terminology.hl7.org/license.html",
"experimental": false,
"resourceType": "ValueSet",
"title": "Country",
"status": "active",
"language": "en",
"id": "v3-Country",
"url": "http://terminology.hl7.org/ValueSet/v3-Country",
"identifier": [ {
"value": "urn:oid:2.16.840.1.113883.1.11.171",
"system": "urn:ietf:rfc:3986"
} ],
"version": "3.0.0",
"contact": [ {
"telecom": [ {
"value": "http://hl7.org",
"system": "url"
}, {
"value": "hq@HL7.org",
"system": "email"
} ]
} ],
"text": {
"div": "Generated Narrative: ValueSet v3-Country
Language: en
- Include codes from
urn:iso:std:iso:3166 where code matches (by regex) [A-Z]{3}
",
"status": "generated"
}
}, {
"id": "DiseaseTargeted",
"url": "http://smart.who.int/icvp/ValueSet/DiseaseTargeted",
"name": "DiseaseTargeted",
"title": "Disease Targeted",
"status": "draft",
"compose": {
"include": [ {
"system": "http://id.who.int/icd/release/11/mms",
"concept": [ {
"code": "1A07",
"display": "Typhoid"
}, {
"code": "1E32",
"display": "Influenza"
}, {
"code": "1F03",
"display": "Measles"
}, {
"code": "1C12",
"display": "Pertussis"
}, {
"code": "1D80",
"display": "Mumps"
}, {
"code": "1E90",
"display": "Varicella"
}, {
"code": "1E50.0",
"display": "Viral hepatitis A"
}, {
"code": "1B1Z",
"display": "Tuberculosis"
}, {
"code": "1E50.1",
"display": "Viral hepatitis B"
}, {
"code": "XN0FG",
"display": "Haemophilus influenzae type b"
}, {
"code": "1C13",
"display": "Tetanus"
}, {
"code": "XN6N7",
"display": "Rotavirus"
}, {
"code": "XN8JY",
"display": "Human papillomavirus"
}, {
"code": "1C85",
"display": "Japanese encephalitis"
}, {
"code": "1C81",
"display": "Poliomyelitis"
}, {
"code": "1C17",
"display": "Diphtheria"
}, {
"code": "CA40.07",
"display": "Pneumococcal disease"
}, {
"code": "1F02",
"display": "Rubella"
}, {
"code": "1D2Z",
"display": "Dengue"
}, {
"code": "1C82",
"display": "Rabies"
}, {
"code": "1C1C",
"display": "Meningococcal"
}, {
"code": "1A00",
"display": "Cholera"
}, {
"code": "1C80",
"display": "Tick-borne encephalitis"
}, {
"code": "1D47",
"display": "Yellow fever"
}, {
"code": "RA01",
"display": "COVID-19"
} ]
} ]
},
"description": "Value set for all diseases",
"resourceType": "ValueSet"
}, {
"id": "DVCVaccines",
"url": "http://smart.who.int/icvp/ValueSet/DVCVaccines",
"name": "DVCVaccines",
"title": "DVC - Vaccines",
"status": "draft",
"compose": {
"include": [ {
"system": "http://id.who.int/icd/release/11/mms",
"concept": [ {
"code": "XM4639",
"display": "Tuberculosis vaccines"
}, {
"code": "XM8142",
"display": "Tuberculosis, live attenuated vaccines"
}, {
"code": "XM29K4",
"display": "Cholera vaccines"
}, {
"code": "XM3Z26",
"display": "Cholera, inactivated, whole cell vaccines"
}, {
"code": "XM72A0",
"display": "Cholera, live attenuated vaccines"
}, {
"code": "XM1FT6",
"display": "Cholera, combinations with typhoid vaccine, inactivated, whole cell vaccines"
}, {
"code": "XM8AW3",
"display": "Diphtheria vaccines"
}, {
"code": "XM9744",
"display": "Diphtheria, rubella, tetanus vaccines"
}, {
"code": "XM31Q8",
"display": "Tetanus, diphtheria, acellular pertussis"
}, {
"code": "XM8AW1",
"display": "Diphtheria, poliomyelitis, tetanus vaccines"
}, {
"code": "XM09Q7",
"display": "Diphtheria, pertussis, poliomyelitis, tetanus vaccines"
}, {
"code": "XM41N3",
"display": "Diphtheria, hepatitis B, pertussis, tetanus vaccines"
}, {
"code": "XM1LX9",
"display": "Diphtheria, hemophilus influenzae B, pertussis, poliomyelitis, tetanus vaccines"
}, {
"code": "XM3G68",
"display": "Diphtheria, hepatitis B, tetanus vaccines"
}, {
"code": "XM0LT9",
"display": "Diphtheria, pertussis, poliomyelitis, tetanus, hepatitis B vaccines"
}, {
"code": "XM7JP3",
"display": "Diphtheria, hemophilus influenzae B, pertussis, tetanus, hepatitis B vaccines"
}, {
"code": "XM5XP9",
"display": "Diphtheria, hemophilus influenzae B, pertussis, tetanus-hepatitis B, meningococcus A + C vaccines"
}, {
"code": "XM1G86",
"display": "Tetanus toxoid, combinations with diphtheria toxoid vaccines"
}, {
"code": "XM32Q5",
"display": "Tetanus and diphtheria vaccines"
}, {
"code": "XM2CV8",
"display": "Vaccines pertussis with diphtheria"
}, {
"code": "XM21E6",
"display": "Diphtheria tetanus, acellular pertussis, inactivated polio virus, haemophilus Influenzae type B vaccines"
}, {
"code": "XM84S1",
"display": "Diphtheria, hepatitis B, tetanus, acellular pertussis, inactivated polio virus, haemophilus Influenzae type B vaccines"
}, {
"code": "XM9JP8",
"display": "Diphtheria, tetanus, acellular pertussis, inactivated polio virus vaccines"
}, {
"code": "XM46V1",
"display": "Diphtheria vaccines combination including pertussis"
}, {
"code": "XM4039",
"display": "Vaccines diphtheria with tetanus"
}, {
"code": "XM11V3",
"display": "Haemophilus influenzae B vaccines"
}, {
"code": "XM01H1",
"display": "Hemophilus influenzae B and poliomyelitis vaccines"
}, {
"code": "XM32L7",
"display": "Hemophilus influenzae B and hepatitis B vaccines"
}, {
"code": "XM6LL6",
"display": "Hepatitis vaccines"
}, {
"code": "XM2A12",
"display": "Hepatitis A, inactivated, whole virus"
}, {
"code": "XM3JA6",
"display": "Typhoid, hepatitis A vaccines"
}, {
"code": "XM03Y7",
"display": "Combinations hepatitis vaccines"
}, {
"code": "XM9V38",
"display": "Hepatitis B, purified antigen"
}, {
"code": "XM9QP0",
"display": "Papillomavirus vaccine"
}, {
"code": "XM1821",
"display": "Papillomavirus (human types 6,11,16,18)"
}, {
"code": "XM9BT4",
"display": "Papillomavirus (human types 16,18)"
}, {
"code": "XM5CE9",
"display": "Papillomavirus (human types 6,11,16,18,31,33,45,52,58)"
}, {
"code": "XM0LB5",
"display": "Encephalitis, Japanese, inactivated, whole virus"
}, {
"code": "XM47S0",
"display": "Encephalitis, Japanese, live attenuated"
}, {
"code": "XM28X5",
"display": "Measles vaccines"
}, {
"code": "XM8L15",
"display": "Measles, live attenuated"
}, {
"code": "XM8TF3",
"display": "Measles, combinations with mumps and rubella, live attenuated"
}, {
"code": "XM21H2",
"display": "Measles, combinations with rubella, live attenuated"
}, {
"code": "XM4AJ8",
"display": "Measles, combinations with mumps, rubella and varicella, live attenuated"
}, {
"code": "XM9439",
"display": "Measles, combinations with mumps, live attenuated"
}, {
"code": "XM2WV4",
"display": "Meningococcal vaccines"
}, {
"code": "XM92B2",
"display": "Meningococcal monovalent purified polysaccharides antigen vaccines"
}, {
"code": "XM5LC2",
"display": "Meningococcal polyvalent purified polysaccharides antigen vaccines"
}, {
"code": "XM18Y8",
"display": "Meningococcus C, purified polysaccharides antigen conjugated vaccines"
}, {
"code": "XM2280",
"display": "Meningococcus A, purified polysaccharides antigen conjugated vaccines"
}, {
"code": "XM9GJ1",
"display": "Meningococcus B, outer membrane vesicle vaccines"
}, {
"code": "XM1X81",
"display": "Meningococcus B, multicomponent vaccines"
}, {
"code": "XM37L5",
"display": "Meningococcus A, purified polysaccharides antigen vaccines"
}, {
"code": "XM1131",
"display": "Mumps vaccine"
}, {
"code": "XM2340",
"display": "Mumps, live attenuated"
}, {
"code": "XM3B09",
"display": "Rubella, combinations with mumps, live attenuated"
}, {
"code": "XM43M9",
"display": "Pertussis vaccines"
}, {
"code": "XM45L8",
"display": "Pertussis, inactivated, whole cell vaccines"
}, {
"code": "XM62J1",
"display": "Pertussis, purified antigen vaccines"
}, {
"code": "XM2TK2",
"display": "Pertussis, inactivated, whole cell, combinations with toxoids vaccines"
}, {
"code": "XM4082",
"display": "Pertussis, purified antigen, combinations with toxoids vaccines"
}, {
"code": "XM9EM7",
"display": "Pneumococcal vaccines"
}, {
"code": "XM9G97",
"display": "Pneumococcal conjugate (13-valent) vaccines"
}, {
"code": "XM2249",
"display": "Pneumococcal polysaccharide 23-valent vaccines"
}, {
"code": "XM91D7",
"display": "Pneumococcus, purified polysaccharides antigen vaccines"
}, {
"code": "XM96S7",
"display": "Pneumococcus, purified polysaccharides antigen conjugated vaccines"
}, {
"code": "XM4R39",
"display": "Pneumococcus purified polysaccharides antigen and Haemophilus influenzae, conjugated vaccines"
}, {
"code": "XM0N50",
"display": "Poliomyelitis vaccines"
}, {
"code": "XM5V19",
"display": "Poliomyelitis, trivalent, inactivated, whole virus"
}, {
"code": "XM79H3",
"display": "Poliomyelitis oral, bivalent, live attenuated"
}, {
"code": "XM0VX8",
"display": "Poliomyelitis oral, monovalent live attenuated"
}, {
"code": "XM0KZ1",
"display": "Poliomyelitis oral, trivalent, live attenuated"
}, {
"code": "XM6T09",
"display": "Rabies vaccine"
}, {
"code": "XM7BE8",
"display": "Rabies, inactivated, whole virus"
}, {
"code": "XM1CE0",
"display": "Rotavirus diarrhoea vaccines"
}, {
"code": "XM4GV0",
"display": "Rota virus, live attenuated"
}, {
"code": "XM4VG1",
"display": "Rota virus, pentavalent, live, reassorted"
}, {
"code": "XM7PP1",
"display": "Rubella vaccine"
}, {
"code": "XM9PS9",
"display": "Rubella, live attenuated"
}, {
"code": "XM1LR5",
"display": "Influenza vaccines"
}, {
"code": "XM8857",
"display": "Influenza vaccine, inactivated, whole virus"
}, {
"code": "XM5V64",
"display": "Influenza vaccines, live attenuated"
}, {
"code": "XM8MP2",
"display": "Influenza vaccines, inactivated, split virus or surface antigen"
}, {
"code": "XM9E16",
"display": "Influenza vaccines, virus like particle"
}, {
"code": "XM33X8",
"display": "Influenza, purified antigen"
}, {
"code": "XM5L44",
"display": "Tetanus vaccines"
}, {
"code": "XM29H5",
"display": "Tetanus toxoid vaccines"
}, {
"code": "XM9AK2",
"display": "Tetanus toxoid, combinations with tetanus immunoglobulin vaccines"
}, {
"code": "XM0RC1",
"display": "Encephalitis vaccines"
}, {
"code": "XM8MP6",
"display": "Encephalitis, tick borne, inactivated, whole virus"
}, {
"code": "XM8BU8",
"display": "Typhoid vaccines"
}, {
"code": "XM33K4",
"display": "Typhoid, oral, live attenuated vaccines"
}, {
"code": "XM89G3",
"display": "Typhoid, inactivated, whole cell vaccines"
}, {
"code": "XM3SF6",
"display": "Typhoid, purified polysaccharide antigen vaccines"
}, {
"code": "XM9UB1",
"display": "Typhoid-paratyphoid vaccines"
}, {
"code": "XM8DG3",
"display": "Varicella zoster vaccines"
}, {
"code": "XM0NS8",
"display": "Varicella, live attenuated "
}, {
"code": "XM0N24",
"display": "Yellow fever vaccine"
}, {
"code": "XM3418",
"display": "Yellow fever, live attenuated"
}, {
"code": "XM38G7",
"display": "Dengue vaccine"
}, {
"code": "XM68M6",
"display": "COVID-19 vaccines"
}, {
"code": "XM0GQ8",
"display": "COVID-19 vaccine, RNA based"
}, {
"code": "XM1NL1",
"display": "COVID-19 vaccine, inactivated virus"
}, {
"code": "XM1J92",
"display": "COVID-19 vaccine, virus like particle"
}, {
"code": "XM9QW8",
"display": "COVID-19 vaccine, non-replicating viral vector"
}, {
"code": "XM6AT1",
"display": "COVID-19 vaccine, DNA based"
}, {
"code": "XM5JC5",
"display": "COVID-19 vaccine, virus protein subunit"
}, {
"code": "XM3CT4",
"display": "Recombinant SARS-CoV-2 vaccine"
}, {
"code": "XM0CX4",
"display": "COVID-19 vaccine, replicating viral vector"
}, {
"code": "XM5DF6",
"display": "COVID-19 vaccine, live attenuated virus"
} ]
} ]
},
"description": "This value set includes codes from ICD",
"resourceType": "ValueSet"
}, {
"id": "doseNumber",
"url": "http://smart.who.int/icvp/ValueSet/doseNumber",
"name": "doseNumber",
"title": "Dose Number",
"status": "draft",
"compose": {
"include": [ {
"system": "http://smart.who.int/icvp/CodeSystem/doseNumber"
} ]
},
"description": "Dose Number value set",
"resourceType": "ValueSet"
}, {
"id": "DVCRelationshipStatus",
"url": "http://smart.who.int/icvp/ValueSet/DVCRelationshipStatus",
"name": "DVCRelationshipStatus",
"title": "Relationship Status for Contact in Patient",
"status": "draft",
"compose": {
"include": [ {
"system": "http://smart.who.int/icvp/CodeSystem/DVCRelationshipStatus"
} ]
},
"description": "Relationship Status for Contact in Patient",
"resourceType": "ValueSet"
} ],
"status": "draft",
"id": "22beca28-726e-495e-b623-5c04db094b19",
"kind": null,
"url": "http://smart.who.int/icvp/Questionnaire/Questionnaire-DVCModel",
"version": "0.1.0",
"contact": [ {
"name": "WHO",
"telecom": [ {
"value": "http://who.int",
"system": "url"
} ]
} ]
}