{
  "description": "NHS Continuing Healthcare Checklist",
  "_filename": "examples/SHD-Questionnaire-CHCChecklist.json",
  "package_name": "SupportedHospitalDischarge.STU3",
  "date": null,
  "publisher": null,
  "name": "NHS Continuing Healthcare Checklist",
  "item": [ {
    "text": "Name of the assessor(s) who completed the CHC Checklist",
    "type": "string",
    "linkId": "1.1",
    "required": true
  }, {
    "text": "Contact details of assessors (name, role, organisation, telephone number, email address)",
    "type": "string",
    "linkId": "1.2",
    "required": false
  }, {
    "text": "Was the individual involved in the completion of the Checklist?",
    "type": "boolean",
    "linkId": "1.3",
    "required": true
  }, {
    "text": "Was the individual offered the opportunity to have a representative such as a family member or other advocate present when the checklist was completed",
    "type": "boolean",
    "linkId": "1.4",
    "required": true
  }, {
    "text": "If yes, did the representative attend the completion of the Checklist?",
    "type": "boolean",
    "linkId": "1.5",
    "required": true,
    "enableWhen": [ {
      "question": "1.4",
      "answerBoolean": true
    } ]
  }, {
    "text": "Please give the contact details of the representative (name, address and telephone number)",
    "type": "string",
    "linkId": "1.6",
    "required": true,
    "enableWhen": [ {
      "question": "1.5",
      "answerBoolean": true
    } ]
  }, {
    "text": "Did you explain to the individual how their personal information will be shared with the different organisations involved in their care, and did they consent to this information sharing?",
    "type": "boolean",
    "linkId": "1.7",
    "required": false
  }, {
    "text": "'Behaviour' Domain Level Score",
    "type": "choice",
    "linkId": "2.1",
    "options": {
      "reference": "https://fhir.nottinghamshire.gov.uk/STU3/valueset/CHC-DomainLevelScore"
    },
    "required": true
  }, {
    "text": "Evidence to support 'Behaviour' Domain Level",
    "type": "string",
    "linkId": "2.2",
    "required": true
  }, {
    "text": "'Cognition' Domain Level Score",
    "type": "choice",
    "linkId": "2.3",
    "options": {
      "reference": "https://fhir.nottinghamshire.gov.uk/STU3/valueset/CHC-DomainLevelScore"
    },
    "required": true
  }, {
    "text": "Evidence to support 'Cognition' Domain Level",
    "type": "string",
    "linkId": "2.4",
    "required": true
  }, {
    "text": "'Psychological/Emotional' Domain Level Score",
    "type": "choice",
    "linkId": "2.5",
    "options": {
      "reference": "https://fhir.nottinghamshire.gov.uk/STU3/valueset/CHC-DomainLevelScore"
    },
    "required": true
  }, {
    "text": "Evidence to support 'Psychological/Emotional' Domain Level",
    "type": "string",
    "linkId": "2.6",
    "required": true
  }, {
    "text": "'Communication' Domain Level Score",
    "type": "choice",
    "linkId": "2.7",
    "options": {
      "reference": "https://fhir.nottinghamshire.gov.uk/STU3/valueset/CHC-DomainLevelScore"
    },
    "required": true
  }, {
    "text": "Evidence to support 'Communication' Domain Level",
    "type": "string",
    "linkId": "2.8",
    "required": true
  }, {
    "text": "'Mobility' Domain Level Score",
    "type": "choice",
    "linkId": "2.9",
    "options": {
      "reference": "https://fhir.nottinghamshire.gov.uk/STU3/valueset/CHC-DomainLevelScore"
    },
    "required": true
  }, {
    "text": "Evidence to support 'Mobility' Domain Level",
    "type": "string",
    "linkId": "2.10",
    "required": true
  }, {
    "text": "'Nutrition' Domain Level Score",
    "type": "choice",
    "linkId": "2.11",
    "options": {
      "reference": "https://fhir.nottinghamshire.gov.uk/STU3/valueset/CHC-DomainLevelScore"
    },
    "required": true
  }, {
    "text": "Evidence to support 'Nutrition' Domain Level",
    "type": "string",
    "linkId": "2.12",
    "required": true
  }, {
    "text": "'Continence' Domain Level Score",
    "type": "choice",
    "linkId": "2.13",
    "options": {
      "reference": "https://fhir.nottinghamshire.gov.uk/STU3/valueset/CHC-DomainLevelScore"
    },
    "required": true
  }, {
    "text": "Evidence to support 'Continence' Domain Level",
    "type": "string",
    "linkId": "2.14",
    "required": true
  }, {
    "text": "'Skin integrity' Domain Level Score",
    "type": "choice",
    "linkId": "2.15",
    "options": {
      "reference": "https://fhir.nottinghamshire.gov.uk/STU3/valueset/CHC-DomainLevelScore"
    },
    "required": true
  }, {
    "text": "Evidence to support 'Skin integrity' Domain Level",
    "type": "string",
    "linkId": "2.16",
    "required": true
  }, {
    "text": "'Breathing' Domain Level Score",
    "type": "choice",
    "linkId": "2.17",
    "options": {
      "reference": "https://fhir.nottinghamshire.gov.uk/STU3/valueset/CHC-DomainLevelScore"
    },
    "required": true
  }, {
    "text": "Evidence to support 'Breathing' Domain Level",
    "type": "string",
    "linkId": "2.18",
    "required": true
  }, {
    "text": "'Drug therapies and medication: symptom control' Domain Level Score",
    "type": "choice",
    "linkId": "2.19",
    "options": {
      "reference": "https://fhir.nottinghamshire.gov.uk/STU3/valueset/CHC-DomainLevelScore"
    },
    "required": true
  }, {
    "text": "Evidence to support 'Drug therapies and medication: symptom control' Domain Level",
    "type": "string",
    "linkId": "2.20",
    "required": true
  }, {
    "text": "'Altered states of consciousness' Domain Level Score",
    "type": "choice",
    "linkId": "2.21",
    "options": {
      "reference": "https://fhir.nottinghamshire.gov.uk/STU3/valueset/CHC-DomainLevelScore"
    },
    "required": true
  }, {
    "text": "Evidence to support 'Altered states of consciousness' Domain Level",
    "type": "string",
    "linkId": "2.22",
    "required": true
  }, {
    "text": "Total Score from Checklist",
    "type": "string",
    "linkId": "2.23",
    "required": true
  }, {
    "text": "Outcome indicated by the Checklist",
    "type": "choice",
    "linkId": "2.24",
    "options": {
      "reference": "https://fhir.nottinghamshire.gov.uk/STU3/valueset/CHC-Outcome"
    },
    "required": true
  }, {
    "text": "Rationale for decision",
    "type": "string",
    "linkId": "2.25",
    "required": false
  } ],
  "type": null,
  "experimental": null,
  "resourceType": "Questionnaire",
  "title": "NHS Continuing Healthcare Checklist",
  "package_version": "0.1.2",
  "status": "active",
  "id": "b0666563-d2f3-4124-a2b2-f6fd9a5d4574",
  "kind": null,
  "url": "https://fhir.nottinghamshire.gov.uk/STU3/Questionnaire/SHD-Questionnaire-CHCChecklist",
  "version": "0.0.1"
}