{
"description": "This form was developed to clearly document agreements resulting from the advance care planning (ACP) process. It is NOT a checklist. It can only be completed by a healthcare provider after a professional and nuanced conversation. For advice on conducting these conversations, please refer to the guideline for advance care planning in the palliative phase and Palliaweb, see https://palliaweb.nl/zorgpraktijk/proactieve-zorgplanning. \\nEnter 'unknown' if a topic is not discussed or if the patient does not (yet) have an opinion.When transferring to a long-term care setting, consider adding conversation records about advance care planning (ACP) to the transfer documents.",
"_filename": "Questionnaire-ACP-zib2020.json",
"package_name": "iknl.fhir.r4.pzp",
"date": "2026-08-11T11:51:27+02:00",
"publisher": "IKNL",
"purpose": "This form was developed to clearly document agreements resulting from the advance care planning (ACP) process.",
"name": "ACPzib2020",
"item": [ {
"text": "Datum van invullen",
"type": "dateTime",
"linkId": "963",
"repeats": false,
"required": false
}, {
"item": [ {
"text": "Voornamen",
"type": "string",
"linkId": "964",
"repeats": false,
"required": false
}, {
"text": "Voorvoegsels",
"type": "string",
"linkId": "965",
"repeats": false,
"required": false
}, {
"text": "Achternaam",
"type": "string",
"linkId": "966",
"repeats": false,
"required": false
} ],
"text": "Naam patiënt",
"type": "group",
"linkId": "7",
"repeats": false
}, {
"text": "Geboortedatum patiënt",
"type": "date",
"linkId": "967",
"repeats": false,
"required": false
}, {
"item": [ {
"item": [ {
"text": "Voornamen",
"type": "string",
"linkId": "968",
"repeats": false,
"required": false
}, {
"text": "Voorvoegsels",
"type": "string",
"linkId": "969",
"repeats": false,
"required": false
}, {
"text": "Achternaam",
"type": "string",
"linkId": "970",
"repeats": false,
"required": false
} ],
"text": "Naam zorgverlener",
"type": "group",
"linkId": "16",
"repeats": false
}, {
"text": "Functie (Specialisme)",
"type": "choice",
"linkId": "1405",
"repeats": false,
"required": false,
"answerValueSet": "http://decor.nictiz.nl/fhir/ValueSet/2.16.840.1.113883.2.4.3.11.60.121.11.22--20200901000000|2020-09-01T00:00:00"
} ],
"text": "Gesprek gevoerd door:",
"type": "group",
"linkId": "8",
"repeats": false
}, {
"item": [ {
"item": [ {
"text": "Toelichting",
"type": "string",
"linkId": "1407",
"repeats": false,
"required": false
} ],
"text": "Is de patiënt op dit moment wilsbekwaam m.b.t. medische behandelbeslissingen?",
"type": "boolean",
"linkId": "1651",
"repeats": false,
"required": false
}, {
"item": [ {
"item": [ {
"text": "Voornamen",
"type": "string",
"linkId": "973",
"repeats": false,
"required": false
}, {
"text": "Voorvoegsels",
"type": "string",
"linkId": "974",
"repeats": false,
"required": false
}, {
"text": "Achternaam",
"type": "string",
"linkId": "975",
"repeats": false,
"required": false
} ],
"text": "Naam wettelijk vertegenwoordiger",
"type": "group",
"linkId": "30",
"prefix": "a)",
"repeats": false
}, {
"item": [ {
"item": [ {
"text": "Telefoonnummer",
"type": "string",
"linkId": "976",
"repeats": false,
"required": false
}, {
"text": "TelecomType",
"type": "choice",
"linkId": "977",
"repeats": false,
"required": false,
"answerOption": [ {
"valueCoding": {
"code": "LL",
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.22.1",
"display": "Land Line"
}
}, {
"valueCoding": {
"code": "FAX",
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.22.1",
"display": "Fax"
}
}, {
"valueCoding": {
"code": "PG",
"system": "http://terminology.hl7.org/CodeSystem/v3-AddressUse",
"display": "Pieper"
}
}, {
"valueCoding": {
"code": "MC",
"system": "http://terminology.hl7.org/CodeSystem/v3-AddressUse",
"display": "Mobiel telefoonnummer"
}
} ]
}, {
"text": "NummerSoort",
"type": "choice",
"linkId": "978",
"repeats": false,
"required": false,
"answerOption": [ {
"valueCoding": {
"code": "HP",
"system": "http://terminology.hl7.org/CodeSystem/v3-AddressUse",
"display": "Telefoonnummer thuis"
}
}, {
"valueCoding": {
"code": "TMP",
"system": "http://terminology.hl7.org/CodeSystem/v3-AddressUse",
"display": "Tijdelijk telefoonnummer"
}
}, {
"valueCoding": {
"code": "WP",
"system": "http://terminology.hl7.org/CodeSystem/v3-AddressUse",
"display": "Zakelijk telefoonnummer"
}
} ]
}, {
"text": "Toelichting",
"type": "string",
"linkId": "979",
"repeats": false,
"required": false
} ],
"text": "Telefoonnummers",
"type": "group",
"linkId": "40",
"repeats": true
}, {
"item": [ {
"text": "EmailAdres",
"type": "string",
"linkId": "980",
"repeats": false,
"required": false
}, {
"text": "EmailSoort",
"type": "choice",
"linkId": "981",
"repeats": false,
"required": false,
"answerOption": [ {
"valueCoding": {
"code": "HP",
"system": "http://terminology.hl7.org/CodeSystem/v3-AddressUse",
"display": "Privé e-mailadres"
}
}, {
"valueCoding": {
"code": "WP",
"system": "http://terminology.hl7.org/CodeSystem/v3-AddressUse",
"display": "Zakelijk e-mailadres"
}
} ]
} ],
"text": "EmailAdressen",
"type": "group",
"linkId": "41",
"repeats": true
} ],
"text": "Contactgegevens wettelijk vertegenwoordiger",
"type": "group",
"linkId": "39",
"prefix": "b)",
"repeats": false
}, {
"item": [ {
"text": "Anders, namelijk:",
"type": "string",
"linkId": "411",
"repeats": false,
"required": false,
"enableWhen": [ {
"operator": "=",
"question": "982",
"answerCoding": {
"code": "09",
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.22.472",
"display": "Anders"
}
} ],
"enableBehavior": "any"
} ],
"text": "Relatie tot patiënt (1)",
"type": "choice",
"linkId": "982",
"prefix": "c)",
"repeats": true,
"required": false,
"answerOption": [ {
"valueCoding": {
"code": "24",
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.22.472",
"display": "Wettelijke vertegenwoordiger"
},
"initialSelected": true
}, {
"valueCoding": {
"code": "01",
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.22.472",
"display": "Eerste relatie/contactpersoon"
}
}, {
"valueCoding": {
"code": "310141000146103",
"system": "http://snomed.info/sct",
"display": "Schriftelijk gemachtigde"
}
}, {
"valueCoding": {
"code": "03",
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.22.472",
"display": "Curator (juridisch)"
}
}, {
"valueCoding": {
"code": "15",
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.22.472",
"display": "Mentor"
}
}, {
"valueCoding": {
"code": "09",
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.22.472",
"display": "Anders"
}
} ]
}, {
"item": [ {
"text": "Anders, namelijk:",
"type": "string",
"linkId": "408",
"repeats": false,
"required": false,
"enableWhen": [ {
"operator": "=",
"question": "983",
"answerCoding": {
"code": "OTH",
"system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
"display": "Anders"
}
} ],
"enableBehavior": "any"
} ],
"text": "Relatie tot patiënt (2)",
"type": "choice",
"linkId": "983",
"prefix": "c)",
"repeats": false,
"required": false,
"answerOption": [ {
"valueCoding": {
"code": "DOMPART",
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"display": "Partner"
}
}, {
"valueCoding": {
"code": "HUSB",
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"display": "Echtgenoot"
}
}, {
"valueCoding": {
"code": "WIFE",
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"display": "Echtgenote"
}
}, {
"valueCoding": {
"code": "FTH",
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"display": "Vader"
}
}, {
"valueCoding": {
"code": "MTH",
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"display": "Moeder"
}
}, {
"valueCoding": {
"code": "SONC",
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"display": "Zoon"
}
}, {
"valueCoding": {
"code": "DAUC",
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"display": "Dochter"
}
}, {
"valueCoding": {
"code": "BRO",
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"display": "Broer"
}
}, {
"valueCoding": {
"code": "SIS",
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"display": "Zuster"
}
}, {
"valueCoding": {
"code": "OTH",
"system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
"display": "Anders"
}
} ]
}, {
"text": "Is de wettelijk vertegenwoordiger ook de eerste contactpersoon?",
"type": "boolean",
"linkId": "984",
"prefix": "d)",
"repeats": false,
"required": false
}, {
"item": [ {
"text": "Voornamen",
"type": "string",
"linkId": "985",
"repeats": false,
"required": false
}, {
"text": "Voorvoegsels",
"type": "string",
"linkId": "986",
"repeats": false,
"required": false
}, {
"text": "Achternaam",
"type": "string",
"linkId": "987",
"repeats": false,
"required": false
} ],
"text": "Naam eerste contactpersoon",
"type": "group",
"linkId": "53",
"prefix": "e)",
"repeats": false,
"enableWhen": [ {
"operator": "=",
"question": "984",
"answerBoolean": false
} ],
"enableBehavior": "any"
}, {
"item": [ {
"item": [ {
"text": "Telefoonnummer",
"type": "string",
"linkId": "988",
"repeats": false,
"required": false
}, {
"text": "TelecomType",
"type": "choice",
"linkId": "989",
"repeats": false,
"required": false,
"answerOption": [ {
"valueCoding": {
"code": "LL",
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.22.1",
"display": "Land Line"
}
}, {
"valueCoding": {
"code": "FAX",
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.22.1",
"display": "Fax"
}
}, {
"valueCoding": {
"code": "PG",
"system": "http://terminology.hl7.org/CodeSystem/v3-AddressUse",
"display": "Pieper"
}
}, {
"valueCoding": {
"code": "MC",
"system": "http://terminology.hl7.org/CodeSystem/v3-AddressUse",
"display": "Mobiel telefoonnummer"
}
} ]
}, {
"text": "NummerSoort",
"type": "choice",
"linkId": "990",
"repeats": false,
"required": false,
"answerOption": [ {
"valueCoding": {
"code": "HP",
"system": "http://terminology.hl7.org/CodeSystem/v3-AddressUse",
"display": "Telefoonnummer thuis"
}
}, {
"valueCoding": {
"code": "TMP",
"system": "http://terminology.hl7.org/CodeSystem/v3-AddressUse",
"display": "Tijdelijk telefoonnummer"
}
}, {
"valueCoding": {
"code": "WP",
"system": "http://terminology.hl7.org/CodeSystem/v3-AddressUse",
"display": "Zakelijk telefoonnummer"
}
} ]
}, {
"text": "Toelichting",
"type": "string",
"linkId": "991",
"repeats": false,
"required": false
} ],
"text": "Telefoonnummers",
"type": "group",
"linkId": "62",
"repeats": true
}, {
"item": [ {
"text": "EmailAdres",
"type": "string",
"linkId": "992",
"repeats": false,
"required": false
}, {
"text": "EmailSoort",
"type": "choice",
"linkId": "993",
"repeats": false,
"required": false,
"answerOption": [ {
"valueCoding": {
"code": "HP",
"system": "http://terminology.hl7.org/CodeSystem/v3-AddressUse",
"display": "Privé e-mailadres"
}
}, {
"valueCoding": {
"code": "WP",
"system": "http://terminology.hl7.org/CodeSystem/v3-AddressUse",
"display": "Zakelijk e-mailadres"
}
} ]
} ],
"text": "EmailAdressen",
"type": "group",
"linkId": "66",
"repeats": true
} ],
"text": "Contactgegevens eerste contactpersoon",
"type": "group",
"linkId": "61",
"prefix": "f)",
"repeats": false,
"enableWhen": [ {
"operator": "=",
"question": "984",
"answerBoolean": false
} ],
"enableBehavior": "any"
}, {
"enableBehavior": "any",
"linkId": "1644",
"repeats": false,
"type": "choice",
"enableWhen": [ {
"operator": "=",
"question": "984",
"answerBoolean": false
} ],
"answerOption": [ {
"valueCoding": {
"code": "01",
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.22.472",
"display": "Eerste relatie/contactpersoon"
},
"initialSelected": true
} ],
"readOnly": true,
"required": false,
"text": "Rol"
}, {
"enableBehavior": "any",
"linkId": "995",
"repeats": false,
"item": [ {
"text": "Anders, namelijk:",
"type": "string",
"linkId": "412",
"repeats": false,
"required": false,
"enableWhen": [ {
"operator": "=",
"question": "995",
"answerCoding": {
"code": "OTH",
"system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
"display": "Anders"
}
} ],
"enableBehavior": "any"
} ],
"type": "choice",
"enableWhen": [ {
"operator": "=",
"question": "984",
"answerBoolean": false
} ],
"answerOption": [ {
"valueCoding": {
"code": "DOMPART",
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"display": "Partner"
}
}, {
"valueCoding": {
"code": "HUSB",
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"display": "Echtgenoot"
}
}, {
"valueCoding": {
"code": "WIFE",
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"display": "Echtgenote"
}
}, {
"valueCoding": {
"code": "FTH",
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"display": "Vader"
}
}, {
"valueCoding": {
"code": "MTH",
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"display": "Moeder"
}
}, {
"valueCoding": {
"code": "SONC",
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"display": "Zoon"
}
}, {
"valueCoding": {
"code": "DAUC",
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"display": "Dochter"
}
}, {
"valueCoding": {
"code": "BRO",
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"display": "Broer"
}
}, {
"valueCoding": {
"code": "SIS",
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"display": "Zuster"
}
}, {
"valueCoding": {
"code": "OTH",
"system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
"display": "Anders"
}
} ],
"prefix": "g)",
"required": false,
"text": "Relatie tot patiënt"
} ],
"text": "Bij wilsonbekwaamheid m.b.t. medische behandelbeslissingen is/wordt de wettelijke vertegenwoordiger:",
"type": "group",
"linkId": "29",
"repeats": false
} ],
"text": "Wilsbekwaamheid & Wettelijke vertegenwoordiging",
"type": "group",
"linkId": "26",
"prefix": "1",
"repeats": false
}, {
"item": [ {
"text": "Patiënt",
"type": "choice",
"linkId": "82",
"repeats": false,
"required": false,
"answerOption": [ {
"valueCoding": {
"code": "Patiënt",
"display": "Patiënt"
}
} ]
}, {
"item": [ {
"item": [ {
"text": "Anders, namelijk:",
"type": "string",
"linkId": "414",
"repeats": false,
"required": false,
"enableWhen": [ {
"operator": "=",
"question": "997",
"answerCoding": {
"code": "09",
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.22.472",
"display": "Anders"
}
} ],
"enableBehavior": "any"
} ],
"text": "Rol",
"type": "choice",
"linkId": "997",
"repeats": true,
"required": false,
"answerOption": [ {
"valueCoding": {
"code": "03",
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.22.472",
"display": "Curator (juridisch)"
}
}, {
"valueCoding": {
"code": "15",
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.22.472",
"display": "Mentor"
}
}, {
"valueCoding": {
"code": "310141000146103",
"system": "http://snomed.info/sct",
"display": "Schriftelijk gemachtigde"
}
}, {
"valueCoding": {
"code": "09",
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.22.472",
"display": "Anders"
}
} ]
}, {
"item": [ {
"text": "Anders, namelijk:",
"type": "string",
"linkId": "413",
"repeats": false,
"required": false,
"enableWhen": [ {
"operator": "=",
"question": "998",
"answerCoding": {
"code": "OTH",
"system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
"display": "Anders"
}
} ],
"enableBehavior": "any"
} ],
"text": "Relatie tot patiënt",
"type": "choice",
"linkId": "998",
"repeats": true,
"required": false,
"answerOption": [ {
"valueCoding": {
"code": "DOMPART",
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"display": "Partner"
}
}, {
"valueCoding": {
"code": "HUSB",
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"display": "Echtgenoot"
}
}, {
"valueCoding": {
"code": "WIFE",
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"display": "Echtgenote"
}
}, {
"valueCoding": {
"code": "FTH",
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"display": "Vader"
}
}, {
"valueCoding": {
"code": "MTH",
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"display": "Moeder"
}
}, {
"valueCoding": {
"code": "SONC",
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"display": "Zoon"
}
}, {
"valueCoding": {
"code": "DAUC",
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"display": "Dochter"
}
}, {
"valueCoding": {
"code": "BRO",
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"display": "Broer"
}
}, {
"valueCoding": {
"code": "SIS",
"system": "http://terminology.hl7.org/CodeSystem/v3-RoleCode",
"display": "Zuster"
}
}, {
"valueCoding": {
"code": "OTH",
"system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
"display": "Anders"
}
} ]
} ],
"text": "Contactperso(o)n(en)",
"type": "group",
"linkId": "1652",
"repeats": false
} ],
"text": "Gesprek gevoerd in bijzijn van",
"type": "group",
"linkId": "78",
"prefix": "2",
"repeats": false
}, {
"item": [ {
"text": "Belangrijkste doel van behandeling ([MetingNaam])",
"type": "choice",
"linkId": "1408",
"repeats": false,
"readOnly": true,
"required": false,
"answerOption": [ {
"valueCoding": {
"code": "180771000146100",
"system": "http://snomed.info/sct",
"display": "Focus van behandeling (waarneembare entiteit)"
},
"initialSelected": true
} ]
}, {
"text": "Doel ([MetingWaarde])",
"type": "choice",
"linkId": "999",
"repeats": false,
"required": false,
"answerValueSet": "https://api.iknl.nl/docs/pzp/r4/ValueSet/ACP-MedicalPolicyGoalVS|1.0.0"
} ],
"text": "Belangrijkste overeengekomen doel van medisch beleid",
"type": "group",
"linkId": "586",
"prefix": "3",
"repeats": false
}, {
"item": [ {
"item": [ {
"text": "Behandeling",
"type": "choice",
"linkId": "1410",
"repeats": false,
"readOnly": true,
"required": false,
"answerOption": [ {
"valueCoding": {
"code": "89666000",
"system": "http://snomed.info/sct",
"display": "cardiopulmonale resuscitatie"
},
"initialSelected": true
} ]
}, {
"item": [ {
"text": "SpecificatieAnders",
"type": "string",
"linkId": "1001",
"repeats": false,
"required": false,
"enableWhen": [ {
"operator": "=",
"question": "1386",
"answerCoding": {
"code": "1",
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.25.1",
"display": "Anders"
}
} ],
"enableBehavior": "any"
}, {
"text": "Toelichting",
"type": "string",
"linkId": "1002",
"repeats": false,
"required": false
} ],
"text": "BehandelBesluit",
"type": "choice",
"linkId": "1386",
"repeats": false,
"required": false,
"answerOption": [ {
"valueCoding": {
"code": "0",
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.25.1",
"display": "Wel uitvoeren"
}
}, {
"valueCoding": {
"code": "1",
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.25.1",
"display": "Anders"
}
}, {
"valueCoding": {
"code": "2",
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.25.1",
"display": "Niet uitvoeren"
}
}, {
"valueCoding": {
"code": "UNK",
"system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
"display": "Onbekend"
}
} ]
} ],
"text": "Reanimatie",
"type": "group",
"linkId": "1409",
"prefix": "a)",
"repeats": false
}, {
"item": [ {
"text": "Behandeling",
"type": "choice",
"linkId": "1412",
"repeats": false,
"readOnly": true,
"required": false,
"answerOption": [ {
"valueCoding": {
"code": "40617009",
"system": "http://snomed.info/sct",
"display": "kunstmatige beademing"
},
"initialSelected": true
} ]
}, {
"item": [ {
"text": "SpecificatieAnders",
"type": "string",
"linkId": "1388",
"repeats": false,
"required": false,
"enableWhen": [ {
"operator": "=",
"question": "1387",
"answerCoding": {
"code": "1",
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.25.1",
"display": "Anders"
}
} ],
"enableBehavior": "any"
}, {
"text": "Toelichting",
"type": "string",
"linkId": "1389",
"repeats": false,
"required": false
} ],
"text": "BehandelBesluit",
"type": "choice",
"linkId": "1387",
"repeats": false,
"required": false,
"answerOption": [ {
"valueCoding": {
"code": "0",
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.25.1",
"display": "Wel uitvoeren"
}
}, {
"valueCoding": {
"code": "1",
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.25.1",
"display": "Anders"
}
}, {
"valueCoding": {
"code": "2",
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.25.1",
"display": "Niet uitvoeren"
}
}, {
"valueCoding": {
"code": "UNK",
"system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
"display": "Onbekend"
}
} ]
} ],
"text": "Kunstmatige invasieve beademing",
"type": "group",
"linkId": "1411",
"prefix": "b)",
"repeats": false
}, {
"item": [ {
"text": "Behandeling",
"type": "choice",
"linkId": "1414",
"repeats": false,
"readOnly": true,
"required": false,
"answerOption": [ {
"valueCoding": {
"code": "305351004",
"system": "http://snomed.info/sct",
"display": "opname op intensive care"
},
"initialSelected": true
} ]
}, {
"item": [ {
"text": "SpecificatieAnders",
"type": "string",
"linkId": "1391",
"repeats": false,
"required": false,
"enableWhen": [ {
"operator": "=",
"question": "1390",
"answerCoding": {
"code": "1",
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.25.1",
"display": "Anders"
}
} ],
"enableBehavior": "any"
}, {
"text": "Toelichting",
"type": "string",
"linkId": "1392",
"repeats": false,
"required": false
} ],
"text": "BehandelBesluit",
"type": "choice",
"linkId": "1390",
"repeats": false,
"required": false,
"answerOption": [ {
"valueCoding": {
"code": "0",
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.25.1",
"display": "Wel uitvoeren"
}
}, {
"valueCoding": {
"code": "1",
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.25.1",
"display": "Anders"
}
}, {
"valueCoding": {
"code": "2",
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.25.1",
"display": "Niet uitvoeren"
}
}, {
"valueCoding": {
"code": "UNK",
"system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
"display": "Onbekend"
}
} ]
} ],
"text": "Opname op intensive care",
"type": "group",
"linkId": "1413",
"prefix": "c)",
"repeats": false
}, {
"item": [ {
"text": "Behandeling",
"type": "choice",
"linkId": "1416",
"repeats": false,
"readOnly": true,
"required": false,
"answerOption": [ {
"valueCoding": {
"code": "32485007",
"system": "http://snomed.info/sct",
"display": "opname in ziekenhuis"
},
"initialSelected": true
} ]
}, {
"item": [ {
"text": "SpecificatieAnders",
"type": "string",
"linkId": "1394",
"repeats": false,
"required": false,
"enableWhen": [ {
"operator": "=",
"question": "1393",
"answerCoding": {
"code": "1",
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.25.1",
"display": "Anders"
}
} ],
"enableBehavior": "any"
}, {
"text": "Toelichting",
"type": "string",
"linkId": "1395",
"repeats": false,
"required": false
} ],
"text": "BehandelBesluit",
"type": "choice",
"linkId": "1393",
"repeats": false,
"required": false,
"answerOption": [ {
"valueCoding": {
"code": "0",
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.25.1",
"display": "Wel uitvoeren"
}
}, {
"valueCoding": {
"code": "1",
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.25.1",
"display": "Anders"
}
}, {
"valueCoding": {
"code": "2",
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.25.1",
"display": "Niet uitvoeren"
}
}, {
"valueCoding": {
"code": "UNK",
"system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
"display": "Onbekend"
}
} ]
} ],
"text": "Opname in ziekenhuis",
"type": "group",
"linkId": "1415",
"prefix": "d)",
"repeats": false
}, {
"item": [ {
"text": "Behandeling",
"type": "choice",
"linkId": "1418",
"repeats": false,
"readOnly": true,
"required": false,
"answerOption": [ {
"valueCoding": {
"code": "281789004",
"system": "http://snomed.info/sct",
"display": "antibiotische therapie"
},
"initialSelected": true
} ]
}, {
"item": [ {
"text": "SpecificatieAnders",
"type": "string",
"linkId": "1397",
"repeats": false,
"required": false,
"enableWhen": [ {
"operator": "=",
"question": "1396",
"answerCoding": {
"code": "1",
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.25.1",
"display": "Anders"
}
} ],
"enableBehavior": "any"
}, {
"text": "Toelichting",
"type": "string",
"linkId": "1398",
"repeats": false,
"required": false
} ],
"text": "BehandelBesluit",
"type": "choice",
"linkId": "1396",
"repeats": false,
"required": false,
"answerOption": [ {
"valueCoding": {
"code": "0",
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.25.1",
"display": "Wel uitvoeren"
}
}, {
"valueCoding": {
"code": "1",
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.25.1",
"display": "Anders"
}
}, {
"valueCoding": {
"code": "2",
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.25.1",
"display": "Niet uitvoeren"
}
}, {
"valueCoding": {
"code": "UNK",
"system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
"display": "Onbekend"
}
} ]
} ],
"text": "Behandeling met antibiotica",
"type": "group",
"linkId": "1417",
"prefix": "e)",
"repeats": false
}, {
"item": [ {
"text": "Behandeling",
"type": "choice",
"linkId": "1420",
"repeats": false,
"readOnly": true,
"required": false,
"answerOption": [ {
"valueCoding": {
"code": "116762002",
"system": "http://snomed.info/sct",
"display": "toediening van bloedproduct"
},
"initialSelected": true
} ]
}, {
"item": [ {
"text": "SpecificatieAnders",
"type": "string",
"linkId": "1400",
"repeats": false,
"required": false,
"enableWhen": [ {
"operator": "=",
"question": "1399",
"answerCoding": {
"code": "1",
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.25.1",
"display": "Anders"
}
} ],
"enableBehavior": "any"
}, {
"text": "Toelichting",
"type": "string",
"linkId": "1401",
"repeats": false,
"required": false
} ],
"text": "BehandelBesluit",
"type": "choice",
"linkId": "1399",
"repeats": false,
"required": false,
"answerOption": [ {
"valueCoding": {
"code": "0",
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.25.1",
"display": "Wel uitvoeren"
}
}, {
"valueCoding": {
"code": "1",
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.25.1",
"display": "Anders"
}
}, {
"valueCoding": {
"code": "2",
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.25.1",
"display": "Niet uitvoeren"
}
}, {
"valueCoding": {
"code": "UNK",
"system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
"display": "Onbekend"
}
} ]
} ],
"text": "Toediening van een bloedproduct",
"type": "group",
"linkId": "1419",
"prefix": "f)",
"repeats": false
}, {
"item": [ {
"item": [ {
"text": "Anders, namelijk:",
"type": "string",
"linkId": "1645",
"repeats": false,
"required": false
} ],
"text": "Behandeling",
"type": "choice",
"linkId": "1422",
"repeats": false,
"readOnly": true,
"required": false,
"answerOption": [ {
"valueCoding": {
"code": "OTH",
"system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
"display": "Anders"
},
"initialSelected": true
} ]
}, {
"item": [ {
"text": "Toelichting",
"type": "string",
"linkId": "1404",
"repeats": false,
"required": false
} ],
"text": "BehandelBesluit",
"type": "choice",
"linkId": "1402",
"repeats": false,
"required": false,
"answerOption": [ {
"valueCoding": {
"code": "0",
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.25.1",
"display": "Wel uitvoeren"
}
}, {
"valueCoding": {
"code": "2",
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.25.1",
"display": "Niet uitvoeren"
}
}, {
"valueCoding": {
"code": "UNK",
"system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
"display": "Onbekend"
}
} ]
} ],
"text": "Overige behandelgrenzen",
"type": "group",
"linkId": "1421",
"prefix": "g)",
"repeats": false
}, {
"item": [ {
"text": "ProductType van ICD",
"type": "choice",
"linkId": "1008",
"repeats": false,
"required": false,
"enableWhen": [ {
"operator": "=",
"question": "1006",
"answerCoding": {
"code": "373066001",
"system": "http://snomed.info/sct",
"display": "ja"
}
} ],
"answerValueSet": "https://api.iknl.nl/docs/pzp/r4/ValueSet/ACP-MedicalDeviceProductType-ICDVS|1.0.0",
"enableBehavior": "any"
}, {
"text": "Toelichting",
"type": "string",
"linkId": "1009",
"repeats": false,
"required": false,
"enableWhen": [ {
"operator": "=",
"question": "1006",
"answerCoding": {
"code": "373066001",
"system": "http://snomed.info/sct",
"display": "ja"
}
} ],
"enableBehavior": "any"
} ],
"text": "Heeft de patiënt een ICD?",
"type": "choice",
"linkId": "1006",
"prefix": "h)",
"repeats": false,
"required": false,
"answerValueSet": "https://api.iknl.nl/docs/pzp/r4/ValueSet/ACP-YesNoUnknownVS|1.0.0"
}, {
"item": [ {
"text": "Behandeling van uitzetten ICD (Behandeling)",
"type": "choice",
"linkId": "1426",
"repeats": false,
"readOnly": true,
"required": false,
"answerOption": [ {
"valueCoding": {
"code": "400231000146108",
"system": "http://snomed.info/sct",
"display": "uitzetten van cardioverter-defibrillator in laatste levensfase (verrichting)"
},
"initialSelected": true
} ]
}, {
"enableBehavior": "any",
"linkId": "1005",
"repeats": false,
"item": [ {
"text": "Toelichting gemaakte afspraken",
"type": "string",
"linkId": "1010",
"repeats": false,
"required": false
} ],
"type": "choice",
"enableWhen": [ {
"operator": "=",
"question": "1006",
"answerCoding": {
"code": "373066001",
"system": "http://snomed.info/sct",
"display": "ja"
}
} ],
"answerOption": [ {
"valueCoding": {
"code": "0",
"system": "urn:oid:2.16.840.1.113883.2.4.3.11.60.40.4.25.1",
"display": "Wel uitvoeren"
}
}, {
"valueCoding": {
"code": "ASKU",
"system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
"display": "Nee, nog geen besluit genomen"
}
}, {
"valueCoding": {
"code": "NASK",
"system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
"display": "Niet besproken"
}
} ],
"required": false,
"text": "Afspraak uitzetten ICD (BehandelBesluit)"
} ],
"text": "Is er een afspraak over het moment van uitzetten ICD?",
"type": "group",
"linkId": "1425",
"prefix": "i)",
"repeats": false,
"enableWhen": [ {
"operator": "=",
"question": "1006",
"answerCoding": {
"code": "373066001",
"system": "http://snomed.info/sct",
"display": "ja"
}
} ],
"enableBehavior": "any"
} ],
"text": "Behandelgrenzen",
"type": "group",
"linkId": "83",
"prefix": "4",
"repeats": false
}, {
"item": [ {
"item": [ {
"text": "Wens en verwachting patient ([MetingNaam])",
"type": "choice",
"linkId": "1428",
"repeats": false,
"readOnly": true,
"required": false,
"answerOption": [ {
"valueCoding": {
"code": "153851000146100",
"system": "http://snomed.info/sct",
"display": "Wensen en verwachtingen met betrekking tot uitkomst van behandeling"
},
"initialSelected": true
} ]
}, {
"text": "Wens en verwachting patient ([MetingWaarde])",
"type": "string",
"linkId": "1190",
"repeats": false,
"required": false
}, {
"text": "Vaststellen wens en verwachting patiënt ([MeetMethode])",
"type": "choice",
"linkId": "1648",
"repeats": false,
"readOnly": true,
"required": false,
"answerOption": [ {
"valueCoding": {
"code": "370819000",
"system": "http://snomed.info/sct",
"display": "Vaststellen van persoonlijke waarden en wensen met betrekking tot zorg"
},
"initialSelected": true
} ]
} ],
"text": "Wat zouden zorgverleners, volgens de patiënt, moeten weten om goede zorg te kunnen verlenen? Heeft deze patiënt specifieke wensen met betrekking tot zijn zorg? (incl. culturele/religieuze/sociale/spirituele aspecten)",
"type": "group",
"linkId": "1427",
"prefix": "a)",
"repeats": false
}, {
"item": [ {
"text": "Gewenste plek van overlijden ([MetingNaam])",
"type": "choice",
"linkId": "1649",
"repeats": false,
"readOnly": true,
"required": false,
"answerOption": [ {
"valueCoding": {
"code": "395091006",
"system": "http://snomed.info/sct",
"display": "Voorkeur voor plaats van overlijden (waarneembare entiteit)"
},
"initialSelected": true
} ]
}, {
"item": [ {
"text": "Anders, namelijk:",
"type": "string",
"linkId": "1653",
"repeats": false,
"required": false,
"enableWhen": [ {
"operator": "=",
"question": "1191",
"answerCoding": {
"code": "OTH",
"system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
"display": "Anders"
}
} ],
"enableBehavior": "any"
}, {
"text": "Toelichting",
"type": "string",
"linkId": "1192",
"repeats": false,
"required": false
} ],
"text": "Voorkeursplek ([MetingWaarde])",
"type": "choice",
"linkId": "1191",
"repeats": false,
"required": false,
"answerValueSet": "https://api.iknl.nl/docs/pzp/r4/ValueSet/ACP-PreferredPlaceOfDeathVS|1.0.0"
} ],
"text": "Gewenste plek van overlijden",
"type": "group",
"linkId": "1429",
"prefix": "b)",
"repeats": false
}, {
"item": [ {
"text": "Euthanasie standpunt ([MetingNaam])",
"type": "choice",
"linkId": "1432",
"repeats": false,
"readOnly": true,
"required": false,
"answerOption": [ {
"valueCoding": {
"code": "340171000146104",
"system": "http://snomed.info/sct",
"display": "Standpunt ten opzichte van euthanasie (waarneembare entiteit)"
},
"initialSelected": true
} ]
}, {
"item": [ {
"text": "Toelichting",
"type": "string",
"linkId": "1194",
"repeats": false,
"required": false
} ],
"text": "Euthanasie standpunt ([MetingWaarde])",
"type": "choice",
"linkId": "1193",
"repeats": false,
"required": false,
"answerValueSet": "https://api.iknl.nl/docs/pzp/r4/ValueSet/ACP-PositionRegardingEuthanasiaVS|1.0.0"
} ],
"text": "Euthanasie standpunt",
"type": "group",
"linkId": "1431",
"prefix": "c)",
"repeats": false
}, {
"item": [ {
"text": "Keuze orgaandonatie vastgelegd in donorregister? ([MetingNaam])",
"type": "choice",
"linkId": "1434",
"repeats": false,
"readOnly": true,
"required": false,
"answerOption": [ {
"valueCoding": {
"code": "570801000146104",
"system": "http://snomed.info/sct",
"display": "Geregistreerd in orgaan donorregister (bevinding)"
},
"initialSelected": true
} ]
}, {
"text": "Keuze orgaandonatie in donorregister ([MetingWaarde])",
"type": "choice",
"linkId": "1435",
"repeats": false,
"required": false,
"answerValueSet": "https://api.iknl.nl/docs/pzp/r4/ValueSet/ACP-YesNoUnknownVS|1.0.0"
}, {
"text": "Keuze orgaandonatie vastgelegd in donorregister? ([MeetMethode])",
"type": "choice",
"linkId": "1650",
"repeats": false,
"readOnly": true,
"required": false,
"answerOption": [ {
"valueCoding": {
"code": "1156040003",
"system": "http://snomed.info/sct",
"display": "Self reported (qualifier value)"
},
"initialSelected": true
} ]
} ],
"text": "Keuze orgaandonatie vastgelegd in donorregister?",
"type": "group",
"linkId": "1433",
"prefix": "d)",
"repeats": false
} ],
"text": "Behandelwensen",
"type": "group",
"linkId": "107",
"prefix": "5",
"repeats": false
}, {
"item": [ {
"text": "Wat verder nog belangrijk is ([MetingNaam])",
"type": "choice",
"linkId": "1436",
"repeats": false,
"readOnly": true,
"required": false,
"answerOption": [ {
"valueCoding": {
"code": "247751003",
"system": "http://snomed.info/sct",
"display": "Gevoel van zingeving (waarneembare entiteit)"
},
"initialSelected": true
} ]
}, {
"text": "Wat verder nog belangrijk is ([MetingWaarde])",
"type": "string",
"linkId": "1196",
"repeats": false,
"required": false
} ],
"text": "Wat verder nog belangrijk is",
"type": "group",
"linkId": "598",
"prefix": "6",
"repeats": false
}, {
"item": [ {
"item": [ {
"text": "Toelichting",
"type": "string",
"linkId": "1198",
"repeats": false,
"required": false
} ],
"text": "Heeft de patiënt eerder behandelafspraken vastgelegd?",
"type": "choice",
"linkId": "1197",
"prefix": "a)",
"repeats": false,
"required": false,
"answerValueSet": "https://api.iknl.nl/docs/pzp/r4/ValueSet/ACP-YesNoUnknownVS|1.0.0"
}, {
"enableBehavior": "any",
"linkId": "1199",
"repeats": false,
"type": "choice",
"enableWhen": [ {
"operator": "=",
"question": "1197",
"answerCoding": {
"code": "373066001",
"system": "http://snomed.info/sct",
"display": "ja"
}
} ],
"prefix": "b)",
"answerValueSet": "https://api.iknl.nl/docs/pzp/r4/ValueSet/ACP-YesNoUnknownVS|1.0.0",
"required": false,
"text": "Staan in eerder vastgelegde behandelafspraken andere wensen dan nu in deze verklaring?"
} ],
"text": "Eerder vastgelegde behandelwensen",
"type": "group",
"linkId": "115",
"prefix": "7",
"repeats": false
}, {
"item": [ {
"text": "Heeft u patient geïnformeerd over eigen verantwoordelijkheid om deze behandelafspraken met naasten te bespreken?",
"type": "boolean",
"linkId": "1200",
"prefix": "a)",
"repeats": false,
"required": false
}, {
"text": "Patiënt gaat akkoord met het delen van deze behandelafspraken met andere betrokken hulpverleners",
"type": "choice",
"linkId": "1201",
"prefix": "b)",
"repeats": false,
"required": false,
"answerOption": [ {
"valueCoding": {
"code": "441898007",
"system": "http://snomed.info/sct",
"display": "Akkoord"
}
}, {
"valueCoding": {
"code": "UNK",
"system": "http://terminology.hl7.org/CodeSystem/v3-NullFlavor",
"display": "Nog onbekend"
}
} ]
} ],
"text": "Informatie delen",
"type": "group",
"linkId": "119",
"prefix": "8",
"repeats": false
} ],
"copyright": "This form is subject to copyright, user rights and a disclaimer, as specified for all IKNL information standards. For details, see the paragraph on Gebruikersrechten en disclaimer at https://iknl.nl/onderzoek/eenheid-van-taal.",
"type": null,
"experimental": "false",
"resourceType": "Questionnaire",
"title": "Uniform vastleggen proactieve zorgplanning (PZP) o.b.v. zibs2020 - Release 17-08-2026",
"package_version": "1.0.0",
"status": "draft",
"id": "b04555f2-148f-4dcb-83a1-a95c4edca50a",
"kind": null,
"url": "https://api.iknl.nl/docs/pzp/r4/Questionnaire/ACP-zib2020",
"version": "1.0.0",
"contact": [ {
"name": "IKNL",
"telecom": [ {
"value": "https://iknl.nl/",
"system": "url"
}, {
"value": "info@iknl.nl",
"system": "email"
} ]
} ]
}