{
"description": null,
"_filename": "examples/QuestionnaireCreateRequest.json",
"package_name": "synapxe.sgcdi",
"date": null,
"publisher": null,
"name": null,
"item": [ {
"code": [ {
"code": "oral",
"system": "https://fhir.synapxe.sg/CodeSystem/assessment-item-type",
"display": "Oral Screening"
} ],
"item": [ {
"text": "Is the participant currently wearing dentures or has dentures?",
"type": "choice",
"linkId": "1.1",
"answerOption": [ {
"valueCoding": {
"code": "yes",
"system": "https://fhir.synapxe.sg/CodeSystem/assessment-answer-type",
"display": "Yes"
}
}, {
"valueCoding": {
"code": "no",
"system": "https://fhir.synapxe.sg/CodeSystem/assessment-answer-type",
"display": "No"
}
} ]
} ],
"type": "group",
"linkId": "1"
}, {
"code": [ {
"code": "vision",
"system": "https://fhir.synapxe.sg/CodeSystem/assessment-item-type",
"display": "Vision Screening"
} ],
"item": [ {
"code": [ {
"code": "29271-4",
"system": "http://loinc.org",
"display": "Visual acuity left eye"
} ],
"text": "Snellen Test Result",
"type": "choice",
"linkId": "2.1",
"answerOption": [ {
"valueCoding": {
"code": "6-6",
"system": "http://loinc.org",
"display": "6/6"
}
}, {
"valueCoding": {
"code": "6-12",
"system": "http://loinc.org",
"display": "6/12"
}
} ]
} ],
"type": "group",
"linkId": "2"
}, {
"code": [ {
"code": "hearing",
"system": "https://fhir.synapxe.sg/CodeSystem/assessment-item-type",
"display": "Hearing Screening"
} ],
"item": [ {
"text": "Is the participant wearing hearing aids?",
"type": "choice",
"linkId": "3.1",
"answerOption": [ {
"valueCoding": {
"code": "yes",
"system": "https://fhir.synapxe.sg/CodeSystem/assessment-answer-type",
"display": "Yes"
}
}, {
"valueCoding": {
"code": "no",
"system": "https://fhir.synapxe.sg/CodeSystem/assessment-answer-type",
"display": "No"
}
} ]
}, {
"text": "Does the participant need to change the hearing aids?",
"type": "choice",
"linkId": "3.2",
"enableWhen": [ {
"operator": "=",
"question": "3.1",
"answerCoding": {
"code": "yes",
"system": "https://fhir.synapxe.sg/CodeSystem/assessment-answer-type",
"display": "Yes"
}
} ],
"answerOption": [ {
"valueCoding": {
"code": "yes",
"system": "https://fhir.synapxe.sg/CodeSystem/assessment-answer-type",
"display": "Yes"
}
}, {
"valueCoding": {
"code": "no",
"system": "https://fhir.synapxe.sg/CodeSystem/assessment-answer-type",
"display": "No"
}
} ]
}, {
"text": "Proceed with hearing screening?",
"type": "choice",
"linkId": "3.3",
"enableWhen": [ {
"operator": "=",
"question": "3.1",
"answerCoding": {
"code": "no",
"system": "https://fhir.synapxe.sg/CodeSystem/assessment-answer-type",
"display": "No"
}
} ],
"answerOption": [ {
"valueCoding": {
"code": "yes",
"system": "https://fhir.synapxe.sg/CodeSystem/assessment-answer-type",
"display": "Yes"
}
}, {
"valueCoding": {
"code": "no",
"system": "https://fhir.synapxe.sg/CodeSystem/assessment-answer-type",
"display": "No"
}
} ]
}, {
"text": "Visual Examination (Left Ear)",
"type": "choice",
"linkId": "3.4",
"enableWhen": [ {
"operator": "=",
"question": "3.3",
"answerCoding": {
"code": "yes",
"system": "https://fhir.synapxe.sg/CodeSystem/assessment-answer-type",
"display": "Yes"
}
} ],
"answerOption": [ {
"valueCoding": {
"code": "pass",
"system": "https://fhir.synapxe.sg/CodeSystem/assessment-answer-type",
"display": "Pass"
}
}, {
"valueCoding": {
"code": "refer",
"system": "https://fhir.synapxe.sg/CodeSystem/assessment-answer-type",
"display": "Refer"
}
} ]
}, {
"code": [ {
"code": "91375-6",
"system": "http://loinc.org",
"display": "Hearing threshold 250 Hz Ear-L"
} ],
"text": "Pure Tone Test Result (Left Ear)",
"type": "choice",
"linkId": "3.5",
"enableWhen": [ {
"operator": "=",
"question": "3.3",
"answerCoding": {
"code": "yes",
"system": "https://fhir.synapxe.sg/CodeSystem/assessment-answer-type",
"display": "Yes"
}
} ],
"answerOption": [ {
"valueCoding": {
"code": "0-25",
"system": "http://loinc.org",
"display": "0-25 dB"
}
}, {
"valueCoding": {
"code": ">25",
"system": "http://loinc.org",
"display": ">25 dB"
}
} ]
} ],
"type": "group",
"linkId": "3"
} ],
"type": null,
"experimental": null,
"resourceType": "Questionnaire",
"title": "Project Silver Screen Assessment",
"package_version": "1.0.7",
"status": "active",
"id": "a9390579-5cdc-4d1f-84d3-38e8717dc60d",
"kind": null,
"url": "https://fhir.synapxe.sg/Questionnaire/pss-screen",
"code": [ {
"code": "pss-screen",
"system": "https://fhir.synapxe.sg/CodeSystem/assessment-type",
"display": "Project Silver Screen"
} ],
"version": "1.0.0",
"effectivePeriod": {
"end": "2025-12-31",
"start": "2025-09-16"
}
}