{
  "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"
}