{
"description": null,
"_filename": "q-dengue-checklist.json",
"package_name": "IdHIE.0v",
"date": "2023-07-05T03:44:13.9017419+00:00",
"meta": {
"source": "#lU4f3puLhNvf40h3",
"versionId": "3",
"lastUpdated": "2023-07-03T12:47:59.716+08:00"
},
"publisher": null,
"name": "QDengueChecklist",
"item": [ {
"item": [ {
"text": "Fever",
"type": "boolean",
"linkId": "dengue-cl.1.1"
}, {
"text": "Aches and pain",
"type": "boolean",
"linkId": "dengue-cl.1.2"
}, {
"text": "Nausea and / or vomitting",
"type": "boolean",
"linkId": "dengue-cl.1.3"
}, {
"text": "Rash",
"type": "boolean",
"linkId": "dengue-cl.1.4"
}, {
"text": "Leucopenia",
"type": "boolean",
"linkId": "dengue-cl.1.5"
}, {
"text": "Any warning signs",
"type": "boolean",
"linkId": "dengue-cl.1.6"
}, {
"text": "Remarks",
"type": "text",
"linkId": "dengue-cl.1.7"
} ],
"text": "Recognition",
"type": "group",
"linkId": "dengue-cl.1"
}, {
"item": [ {
"text": "Persistent vomiting (3 or more than 3 times over the last 24 hours)",
"type": "boolean",
"linkId": "dengue-cl.2.1"
}, {
"text": "Persistent diarrhea (3 or more than 3 times over the last 24 hours)",
"type": "boolean",
"linkId": "dengue-cl.2.2"
}, {
"text": "Any abdominal pain / tenderness",
"type": "boolean",
"linkId": "dengue-cl.2.3"
}, {
"text": "Lethargy / Restlessness / Confusion",
"type": "boolean",
"linkId": "dengue-cl.2.4"
}, {
"text": "Tender liver",
"type": "boolean",
"linkId": "dengue-cl.2.5"
}, {
"text": "Third space fluid accumulation",
"type": "boolean",
"linkId": "dengue-cl.2.6"
}, {
"text": "Spontaneous bleeding tendencies",
"type": "boolean",
"linkId": "dengue-cl.2.7"
}, {
"text": "Raised HCT with rapid drop in platelet. \nMale age ≤ 60 : HCT >46 \nMale age >60 : HCT > 42 \nFemale all ages : >40",
"type": "boolean",
"linkId": "dengue-cl.2.8"
}, {
"text": "Remarks",
"type": "text",
"linkId": "dengue-cl.2.9"
} ],
"text": "Warning signs",
"type": "group",
"linkId": "dengue-cl.2"
}, {
"item": [ {
"text": "Syncope",
"type": "boolean",
"linkId": "dengue-cl.3.1"
}, {
"text": "Social factor",
"type": "boolean",
"linkId": "dengue-cl.3.2"
}, {
"text": "Remarks",
"type": "text",
"linkId": "dengue-cl.3.3"
} ],
"text": "Other criteria",
"type": "group",
"linkId": "dengue-cl.3"
}, {
"item": [ {
"text": "Obese",
"type": "boolean",
"linkId": "dengue-cl.4.1"
}, {
"text": "Pregnant",
"type": "boolean",
"linkId": "dengue-cl.4.2"
}, {
"text": "Heart failure / CKD / CLD",
"type": "boolean",
"linkId": "dengue-cl.4.3"
}, {
"text": "Diabetes Mellitus",
"type": "boolean",
"linkId": "dengue-cl.4.4"
}, {
"text": "Hypertension",
"type": "boolean",
"linkId": "dengue-cl.4.5"
}, {
"text": "IHD",
"type": "boolean",
"linkId": "dengue-cl.4.6"
}, {
"text": "COPD",
"type": "boolean",
"linkId": "dengue-cl.4.7"
}, {
"text": "Age > 65",
"type": "boolean",
"linkId": "dengue-cl.4.8"
}, {
"text": "Remarks",
"type": "text",
"linkId": "dengue-cl.4.9"
} ],
"text": "Special Group",
"type": "group",
"linkId": "dengue-cl.4"
}, {
"item": [ {
"text": "Physical Examination findings",
"type": "text",
"linkId": "dengue-cl.5.1"
}, {
"code": [ {
"code": "8480-6",
"system": "http://loinc.org",
"display": "Systolic Blood Pressure"
} ],
"text": "Systolic Blood Pressure (mmHg)",
"type": "quantity",
"linkId": "dengue-cl.5.2",
"initial": [ {
"valueQuantity": {
"code": "mm[Hg]",
"unit": "mmHg",
"system": "http://unitsofmeasure.org"
}
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/minValue",
"valueInteger": 1
}, {
"url": "http://hl7.org/fhir/StructureDefinition/maxValue",
"valueInteger": 300
} ]
}, {
"code": [ {
"code": "8462-4",
"system": "http://loinc.org",
"display": "Diastolic Blood Pressure"
} ],
"text": "Diastolic Blood Pressure (mmHg)",
"type": "quantity",
"linkId": "dengue-cl.5.3",
"initial": [ {
"valueQuantity": {
"code": "mm[Hg]",
"unit": "mmHg",
"system": "http://unitsofmeasure.org"
}
} ],
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/minValue",
"valueInteger": 1
}, {
"url": "http://hl7.org/fhir/StructureDefinition/maxValue",
"valueInteger": 250
} ]
}, {
"text": "Heart Rate (/min)",
"type": "quantity",
"linkId": "dengue-cl.5.4",
"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": "dengue-cl.5.5",
"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": "dengue-cl.5.6",
"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": "dengue-cl.5.7",
"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": "dengue-cl.5.8",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/minValue",
"valueInteger": 0
}, {
"url": "http://hl7.org/fhir/StructureDefinition/maxValue",
"valueInteger": 10
} ]
} ],
"text": "Physical Examination and Vital signs",
"type": "group",
"linkId": "dengue-cl.5"
}, {
"item": [ {
"text": "White cell counts",
"type": "string",
"linkId": "dengue-cl.6.1"
}, {
"text": "Hb",
"type": "string",
"linkId": "dengue-cl.6.2"
}, {
"text": "HCT",
"type": "string",
"linkId": "dengue-cl.6.3"
}, {
"text": "Platelet",
"type": "string",
"linkId": "dengue-cl.6.4"
}, {
"text": "Dengue Point of Care checklist (Combo / Rapid checklist)",
"type": "string",
"linkId": "dengue-cl.6.5"
} ],
"text": "Blood investigation",
"type": "group",
"linkId": "dengue-cl.6"
}, {
"item": [ {
"text": "Hypotension SBP <90 or MAP <60 or SBP drop > 40mmHg from known baseline",
"type": "boolean",
"linkId": "dengue-cl.7.1"
}, {
"text": "Shock Index: HR > SBP or abnormal CCTVR",
"type": "boolean",
"linkId": "dengue-cl.7.2"
}, {
"text": "Third Space fluid accumulation with respiratory distress",
"type": "boolean",
"linkId": "dengue-cl.7.3"
}, {
"text": "Altered concious level",
"type": "boolean",
"linkId": "dengue-cl.7.4"
}, {
"text": "Any bleed GI / non mucosal and non cutaneous / non physiological",
"type": "boolean",
"linkId": "dengue-cl.7.5"
}, {
"text": "Specific organ dysfunction",
"type": "boolean",
"linkId": "dengue-cl.7.6"
}, {
"text": "Remarks",
"type": "text",
"linkId": "dengue-cl.7.7"
} ],
"text": "Severe Dengue",
"type": "group",
"linkId": "dengue-cl.7"
}, {
"item": [ {
"text": "Fever onset",
"type": "dateTime",
"linkId": "dengue-cl.8,1"
}, {
"text": "Critical phase onset",
"type": "dateTime",
"linkId": "dengue-cl.8.2"
} ],
"text": "Onset of illness",
"type": "group",
"linkId": "dengue-cl.8"
}, {
"text": "Phase of illness",
"type": "choice",
"linkId": "dengue-cl.9",
"answerOption": [ {
"valueCoding": {
"code": "01",
"display": "Febrile"
}
}, {
"valueCoding": {
"code": "02",
"display": "Critical"
}
}, {
"valueCoding": {
"code": "03",
"display": "Recovery"
}
} ]
}, {
"text": "Diagnosis",
"type": "choice",
"linkId": "dengue-cl.10",
"answerOption": [ {
"valueCoding": {
"code": "01",
"display": "Dengue fever without warning signs"
}
}, {
"valueCoding": {
"code": "02",
"display": "Dengue fever with warning signs"
}
}, {
"valueCoding": {
"code": "03",
"display": "Severe Dengue"
}
} ]
}, {
"item": [ {
"text": "Management / Plans",
"type": "text",
"linkId": "dengue-cl.11.1"
} ],
"text": "Management",
"type": "group",
"linkId": "dengue-cl.11"
} ],
"type": null,
"experimental": null,
"resourceType": "Questionnaire",
"title": "Dengue Assessment Checklist",
"package_version": "0.0.1",
"status": "active",
"id": "dd974d84-40cb-4924-b5b4-1e737ec628c9",
"kind": null,
"url": "http://fhir.hie.moh.gov.id/Questionnaire/q-dengue-checklist",
"version": "1.0.0"
}