{
"description": "Questionnaire for ICVP Logical Model",
"_filename": "Questionnaire-Questionnaire-ICVPModel.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": "#ICVPDiseaseTargeted"
}, {
"text": "Vaccine or Prophylaxis classification code",
"type": "choice",
"linkId": "vaccineClassification",
"repeats": false,
"required": true,
"answerValueSet": "#ICVPVaccineCodes"
}, {
"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": "vaccinDetails",
"repeats": true,
"required": true
} ],
"type": null,
"experimental": null,
"resourceType": "Questionnaire",
"title": "ICVP 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": "ICVPDiseaseTargeted",
"url": "http://smart.who.int/icvp/ValueSet/ICVPDiseaseTargeted",
"name": "ICVPDiseaseTargeted",
"title": "ICVP Disease Targeted",
"status": "draft",
"compose": {
"include": [ {
"system": "http://id.who.int/icd/release/11/mms",
"concept": [ {
"code": "1D47",
"display": "Yellow fever"
}, {
"code": "1C81",
"display": "Poliomyelitis"
} ]
} ]
},
"description": "Value set for yellow fever and polio only",
"resourceType": "ValueSet"
}, {
"id": "ICVPVaccineCodes",
"url": "http://smart.who.int/icvp/ValueSet/ICVPVaccineCodes",
"name": "ICVPVaccineCodes",
"title": "ICVP - Vaccine Codes",
"status": "draft",
"compose": {
"include": [ {
"system": "http://id.who.int/icd/release/11/mms",
"concept": [ {
"code": "XM0N24",
"display": "Yellow fever vaccines"
}, {
"code": "XM3418",
"display": "Yellow fever, live attenuated"
}, {
"code": "XM0N50",
"display": "Poliomyelitis vaccines"
}, {
"code": "XM1LX9",
"display": "Diphtheria, hemophilus influenzae B, pertussis, poliomyelitis, tetanus vaccines"
}, {
"code": "XM09Q7",
"display": "Diphtheria, pertussis, poliomyelitis, tetanus vaccines"
}, {
"code": "XM0LT9",
"display": "Diphtheria, pertussis, poliomyelitis, tetanus, hepatitis B vaccines"
}, {
"code": "XM8AW1",
"display": "Diphtheria, poliomyelitis, tetanus vaccines"
}, {
"code": "XM01H1",
"display": "Hemophilus influenzae B and poliomyelitis vaccines"
}, {
"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": "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"
} ]
} ]
},
"description": "This value set includes codes from ICVP",
"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": "3b09cc20-d5d6-4812-aed7-893806663c91",
"kind": null,
"url": "http://smart.who.int/icvp/Questionnaire/Questionnaire-ICVPModel",
"version": "0.1.0",
"contact": [ {
"name": "WHO",
"telecom": [ {
"value": "http://who.int",
"system": "url"
} ]
} ]
}