FHIR Implementation Guide for Stroke - Local Development build (v0.0.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
Questionnaire: Patient Reported Questionnaire 01 - Baseline (Experimental)
| Official URL: https://m-caretech.com.br/interopera/stroke-fhirig/Questionnaire/PatientReportedBaseline | Version: 0.0.0 | |||
| Draft as of 2024-02-20 | Computable Name: PatientReportedBaseline | |||
| Other Identifiers: id: patient-reported-baseline (use: OFFICIAL) | ||||
| LinkId | Text | Cardinality | Type | Description & Constraints |
|---|---|---|---|---|
  PatientReportedBaseline | Questionnaire | https://m-caretech.com.br/interopera/stroke-fhirig/Questionnaire/PatientReportedBaseline#0.0.0 | ||
  General-Information-Clinical | General information. | 1..1 | group | |
  Patient-ID | What is the patient's identification? | 1..1 | string | |
 FullName-Clinical | What is the patient's full name? | 1..1 | string | |
| Demographics | Demographic factors. | 1..1 | group | |
 Gender-Identity | Indicate the patient's gender identity. Do you think of yourself as…? | 0..1 | coding | Value Set: Gender Identity |
| Ethnicity | Please indicate the ethnicity that you identify with. | 1..1 | coding | Value Set: Ethnicity |
| Race | Please indicate the biological race that you identify with. | 1..1 | coding | Value Set: Race |
| LivingLocPre | Where were you living prior to your stroke or transient ischaemic attack (TIA)? The most recent place of residence pre stroke. | 1..1 | coding | Value Set: Patient's Residence Prior to a Stroke |
| LiveAloneVs | Did you live alone prior to your stroke or transient ischaemic attack (TIA)? | 0..1 | coding | Value Set: Live Alone Pre-Stroke |
| PreStrokeAmb | Were you able to walk prior to your stroke or transient ischaemic attack (TIA)? | 1..1 | coding | Value Set: Prestroke and Poststroke Functional Status: Ambulation |
| PreStrokeToileting | Did you need help from anybody to go to the toilet prior to your stroke or transient ischaemic attack (TIA)? | 1..1 | coding | Value Set: Prestroke and Poststroke Functional Status: Toileting |
| PreStrokeDress | Did you need help with dressing/undressing prior to your stroke or transient ischaemic attack (TIA)? | 1..1 | coding | Value Set: Prestroke and Poststroke Functional Status: Dressing |
| Vascular-Systemic | Vascular and Systemic | 1..1 | group | |
 SmokingStatus | A person's current and past smoking behavior. | 1..1 | coding | Value Set: Smoking Status |
 AlcoholAmount | How many standard alcoholic drinks do you drink per week? One standard drink is equal to 12.5ml of pure alcohol, or roughly 1 small glass of wine/25cl of regular beer (5% alcohol). | 1..1 | integer | Max Length: 2 |
| Documentation for this format | ||||