{
  "description": null,
  "_filename": "q-tb-note.json",
  "package_name": "IdHIE.0v",
  "date": "2023-07-05T03:44:13.9017419+00:00",
  "meta": {
    "source": "#4cyS4XNkvUOq5plk",
    "versionId": "3",
    "lastUpdated": "2023-07-03T12:49:31.901+08:00"
  },
  "publisher": null,
  "name": "QTbNote",
  "item": [ {
    "item": [ {
      "text": "TB Contact",
      "type": "boolean",
      "linkId": "tb-note.1.1"
    }, {
      "text": "Pregnancy",
      "type": "boolean",
      "linkId": "tb-note.1.2"
    }, {
      "text": "Other comorbids (e.g Diabetes Mellitus or Hypertension)",
      "type": "boolean",
      "linkId": "tb-note.1.3"
    }, {
      "text": "Immunocompromised (e.g. on immunosupressants / HIV)",
      "type": "boolean",
      "linkId": "tb-note.1.4"
    }, {
      "text": "Special Group Remarks",
      "type": "text",
      "linkId": "tb-note.1.5"
    } ],
    "text": "Special Group",
    "type": "group",
    "linkId": "tb-note.1"
  }, {
    "item": [ {
      "text": "Past Medical History",
      "type": "text",
      "linkId": "tb-note.2.1"
    }, {
      "text": "Past Surgical History",
      "type": "text",
      "linkId": "tb-note.2.2"
    } ],
    "text": "Past Medical / Surgical History",
    "type": "group",
    "linkId": "tb-note.2"
  }, {
    "item": [ {
      "text": "Medication Details",
      "type": "text",
      "linkId": "tb-note.3.1"
    } ],
    "text": "Medication History",
    "type": "group",
    "linkId": "tb-note.3"
  }, {
    "item": [ {
      "text": "Social History",
      "type": "text",
      "linkId": "tb-note.4.2"
    }, {
      "text": "Family History",
      "type": "text",
      "linkId": "tb-note.4.1"
    } ],
    "text": "Social and Family History",
    "type": "group",
    "linkId": "tb-note.4"
  }, {
    "item": [ {
      "text": "Cough",
      "type": "boolean",
      "linkId": "tb-note.5.1"
    }, {
      "text": "Fever",
      "type": "boolean",
      "linkId": "tb-note.5.2"
    }, {
      "text": "Night Sweats",
      "type": "boolean",
      "linkId": "tb-note.5.3"
    }, {
      "text": "Haemoptysis",
      "type": "boolean",
      "linkId": "tb-note.5.4"
    }, {
      "text": "Weight loss",
      "type": "boolean",
      "linkId": "tb-note.5.5"
    }, {
      "text": "Chest pain",
      "type": "boolean",
      "linkId": "tb-note.5.6"
    }, {
      "text": "Shortness of breath",
      "type": "boolean",
      "linkId": "tb-note.5.7"
    }, {
      "text": "Lethargy",
      "type": "boolean",
      "linkId": "tb-note.5.8"
    }, {
      "text": "Symptoms Remark",
      "type": "text",
      "linkId": "tb-note.5.9"
    } ],
    "text": "Symptoms",
    "type": "group",
    "linkId": "tb-note.5"
  }, {
    "item": [ {
      "text": "Findings",
      "type": "text",
      "linkId": "tb-note.6.1"
    } ],
    "text": "History of Presenting Illness Summary",
    "type": "group",
    "linkId": "tb-note.6"
  }, {
    "item": [ {
      "code": [ {
        "code": "8480-6",
        "system": "http://loinc.org",
        "display": "Systolic Blood Pressure"
      } ],
      "text": "Systolic Blood Pressure (mmHg)",
      "type": "quantity",
      "linkId": "tb-note.7.1",
      "initial": [ {
        "valueQuantity": {
          "code": "mm[Hg]",
          "unit": "mmHg",
          "system": "http://unitsofmeasure.org"
        }
      } ],
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/minValue-my-core",
        "valueInteger": 1
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/maxValue-my-core",
        "valueInteger": 300
      } ]
    }, {
      "code": [ {
        "code": "8462-4",
        "system": "http://loinc.org",
        "display": "Diastolic Blood Pressure"
      } ],
      "text": "Diastolic Blood Pressure (mmHg)",
      "type": "quantity",
      "linkId": "tb-note.7.2",
      "initial": [ {
        "valueQuantity": {
          "code": "mm[Hg]",
          "unit": "mmHg",
          "system": "http://unitsofmeasure.org"
        }
      } ],
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/minValue-my-core",
        "valueInteger": 1
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/maxValue-my-core",
        "valueInteger": 250
      } ],
      "enableWhen": [ {
        "operator": "exists",
        "question": "tb-note.7.1",
        "answerBoolean": true
      } ]
    }, {
      "text": "Heart Rate (/min)",
      "type": "quantity",
      "linkId": "tb-note.7.3",
      "initial": [ {
        "valueQuantity": {
          "code": "/min",
          "unit": "/min",
          "system": "http://unitsofmeasure.org"
        }
      } ],
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/minValue-my-core",
        "valueInteger": 0
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/maxValue-my-core",
        "valueInteger": 400
      } ]
    }, {
      "text": "Body Temperature (°C)",
      "type": "quantity",
      "linkId": "tb-note.7.4",
      "initial": [ {
        "valueQuantity": {
          "code": "Cel",
          "unit": "°C",
          "system": "http://unitsofmeasure.org"
        }
      } ],
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/minValue-my-core",
        "valueInteger": 0
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/maxValue-my-core",
        "valueInteger": 100
      } ]
    }, {
      "text": "Oxygen Saturation (%)",
      "type": "quantity",
      "linkId": "tb-note.7.5",
      "initial": [ {
        "valueQuantity": {
          "code": "%",
          "unit": "%",
          "system": "http://unitsofmeasure.org"
        }
      } ],
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/minValue-my-core",
        "valueInteger": 0
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/maxValue-my-core",
        "valueInteger": 100
      } ]
    }, {
      "text": "Respiratory Rate (/min)",
      "type": "quantity",
      "linkId": "tb-note.7.6",
      "initial": [ {
        "valueQuantity": {
          "code": "/min",
          "unit": "/min",
          "system": "http://unitsofmeasure.org"
        }
      } ],
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/minValue-my-core",
        "valueInteger": 0
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/maxValue-my-core",
        "valueInteger": 80
      } ]
    }, {
      "text": "Pain score",
      "type": "quantity",
      "linkId": "tb-note.7.7",
      "extension": [ {
        "url": "http://hl7.org/fhir/StructureDefinition/minValue",
        "valueInteger": 1
      }, {
        "url": "http://hl7.org/fhir/StructureDefinition/maxValue",
        "valueInteger": 10
      } ]
    } ],
    "text": "Vital Signs",
    "type": "group",
    "linkId": "tb-note.7"
  }, {
    "item": [ {
      "text": "Findings",
      "type": "text",
      "linkId": "tb-note.8.1"
    } ],
    "text": "Physical Examination",
    "type": "group",
    "linkId": "tb-note.8"
  }, {
    "item": [ {
      "text": "Findings",
      "type": "text",
      "linkId": "tb-note.9.1"
    } ],
    "text": "Investigations / Special Test",
    "type": "group",
    "linkId": "tb-note.9"
  }, {
    "item": [ {
      "text": "Chest X ray Intepretation",
      "type": "text",
      "linkId": "tb-note.10.1"
    } ],
    "text": "Imaging",
    "type": "group",
    "linkId": "tb-note.10"
  }, {
    "item": [ {
      "text": "Diagnosis",
      "type": "text",
      "linkId": "tb-note.11.1"
    } ],
    "text": "Diagnosis",
    "type": "group",
    "linkId": "tb-note.11"
  }, {
    "item": [ {
      "text": "Management Summary",
      "type": "text",
      "linkId": "tb-note.12.1"
    } ],
    "text": "Management / Treatment",
    "type": "group",
    "linkId": "tb-note.12"
  }, {
    "item": [ {
      "text": "Spoken To",
      "type": "text",
      "linkId": "tb-note.13.1"
    }, {
      "text": "Time of Notification",
      "type": "dateTime",
      "linkId": "tb-note.13.2"
    } ],
    "text": "Notification of Infectious Disease",
    "type": "group",
    "linkId": "tb-note.13"
  }, {
    "item": [ {
      "text": "Date",
      "type": "dateTime",
      "linkId": "tb-note.14.1"
    } ],
    "text": "TCA Date",
    "type": "group",
    "linkId": "tb-note.14"
  }, {
    "item": [ {
      "text": "Reason for Referral",
      "type": "text",
      "linkId": "tb-note.15.1"
    }, {
      "text": "Spoken To",
      "type": "string",
      "linkId": "tb-note.15.2"
    }, {
      "text": "Time of Referral",
      "type": "dateTime",
      "linkId": "tb-note.15.3"
    } ],
    "text": "Referral",
    "type": "group",
    "linkId": "tb-note.15"
  } ],
  "type": null,
  "experimental": null,
  "resourceType": "Questionnaire",
  "title": "TB Clerking Template",
  "package_version": "0.0.1",
  "status": "active",
  "id": "2ed16c5e-0326-4c0b-b33d-d25eee776624",
  "kind": null,
  "url": "http://fhir.hie.moh.gov.id/Questionnaire/q-tb-note",
  "version": "1.0.0"
}