Questionnaire-SOTGenericRespiratoryDiseaseCIF
type: Questionnaire
node role: treeRoot
id:
  v: Questionnaire-SOTGenericRespiratoryDiseaseCIF
meta:
  profile:
    v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-extr-smap
    link: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-extr-smap
language:
  v: en
text:
  status:
    v: generated
  div: LinkId Text Cardinality Type Description & Constraints<img src="[binary]" alt="doco" style="background-color: inherit"/> Questionnaire-SOTGenericRespiratoryDiseaseCIF Generic Respiratory Disease Case Investigation Form Questionnaire http://worldhealthorganization.github.io/smart-ot/Questionnaire/Questionnaire-SOTGenericRespiratoryDiseaseCIF#0.2.1 investigationForm Generic Respiratory Disease Case Investigation Form 0..1 group basicInformation Section 1: Essential basic Information 0..1 group dataCollectorInformation A. Data collector Information 0..1 group nameOfDataCollector Name of data collector 0..1 string dataCollectorTelephoneNumber Data collector telephone number 0..1 string dataCollectorInstitution Data collector institution 0..1 string formCompletionDate Form completion date (dd/mm/yyyy) 0..1 date respondentInformation B. Interview respondent Information (if not patient) 0..1 group nameOfRespondent Name of respondent 0..1 string respondentTelephoneNumber Respondent telephone number 0..1 string respondentAddress Respondent address 0..1 string relationshipToPatient Relationship to patient 0..1 string signs C. Patient identifier Information 0..1 group identification Unique Case ID/cluster number (if applicable) 0..1 string caseStatus Case Status 0..1 choice Value Set: Case Status Name Name 0..1 string country Country of residence 0..1 string Sex Sex at birth 0..1 choice Value Set: SOT Biological Sex BirthDate Date of birth (dd/mm/yyyy) 0..1 date Age Age (years,months) 0..1 string address Address (village/town, district, province/region) 0..1 string telephone Patient telephone number 0..1 string Clinical Section 2: Clinical Information 0..1 group clinicalCourse D. Patient clinical course 0..1 group symptoms Symptom 0..1 choice Value Set: Yes No Unknown symptomOnsetDate date of onset of symptoms:____/____/______ 0..1 date Enable When: symptoms = Yes (YesNoUnknown#Yes) presentedToHCF Health facility visit (including traditional care) 0..1 choice Value Set: Yes No…
contained: ValueSet
  id:
    v: BiologicalSex
  url:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/BiologicalSex
  name:
    v: BiologicalSex
  title:
    v: SOT Biological Sex
  status:
    v: draft
  description:
    v: Biological Sex
  compose:
    include:
      system:
        v: http://hl7.org/fhir/administrative-gender
    exclude:
      system:
        v: http://hl7.org/fhir/administrative-gender
contained: ValueSet
  id:
    v: YesNoUnknown
  url:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
  name:
    v: YesNoUnknown
  title:
    v: Yes No Unknown
  status:
    v: draft
  description:
    v: Yes No Unknown
  compose:
    include:
      system:
        v: http://worldhealthorganization.github.io/smart-ot/YesNoUnknown
contained: ValueSet
  id:
    v: CaseStatus
  url:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/CaseStatus
  name:
    v: CaseStatus
  title:
    v: Case Status
  status:
    v: draft
  description:
    v: Case Status
  compose:
    include:
      system:
        v: http://worldhealthorganization.github.io/smart-ot/CaseStatus
contained: ValueSet
  id:
    v: PatientOutcome
  url:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/PatientOutcome
  name:
    v: PatientOutcome
  title:
    v: Patient Clinical Course Outcome
  status:
    v: draft
  description:
    v: Patient Clinical Course Outcome
  compose:
    include:
      system:
        v: http://worldhealthorganization.github.io/smart-ot/PatientOutcome
contained: ValueSet
  id:
    v: ExposureLocation
  url:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/ExposureLocation
  name:
    v: ExposureLocation
  title:
    v: Exposure Location
  status:
    v: draft
  description:
    v: Exposure Location
  compose:
    include:
      system:
        v: http://worldhealthorganization.github.io/smart-ot/ExposureLocation
contained: ValueSet
  id:
    v: ContactType
  url:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/ContactType
  name:
    v: ContactType
  title:
    v: Contact Type
  status:
    v: draft
  description:
    v: Contact Type
  compose:
    include:
      system:
        v: http://worldhealthorganization.github.io/smart-ot/ContactType
contained: ValueSet
  id:
    v: AnimalContactLocation
  url:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/AnimalContactLocation
  name:
    v: AnimalContactLocation
  title:
    v: Animal Contact Location
  status:
    v: draft
  description:
    v: Animal Contact Location
  compose:
    include:
      system:
        v: http://worldhealthorganization.github.io/smart-ot/AnimalContactLocation
contained: ValueSet
  id:
    v: AnimalExposureLocation
  url:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/AnimalExposureLocation
  name:
    v: AnimalExposureLocation
  title:
    v: Animal Exposure Location
  status:
    v: draft
  description:
    v: Animal Exposure Location
  compose:
    include:
      system:
        v: http://worldhealthorganization.github.io/smart-ot/ExposureLocation
url:
  v: http://worldhealthorganization.github.io/smart-ot/Questionnaire/Questionnaire-SOTGenericRespiratoryDiseaseCIF
version:
  v: 0.2.1
name:
  v: Questionnaire-SOTGenericRespiratoryDiseaseCIF
title:
  v: Generic Respiratory Disease Case Investigation Form
status:
  v: draft
subject type:
  v: Patient
date:
  v: 2023-11-07T05:59:29+00:00
publisher:
  v: WHO
contact:
  name:
    v: WHO
  telecom:
    system:
      v: url
    value:
      v: http://who.int
description:
  v: Generic Respiratory Disease Case Investigation Form
jurisdiction:
  coding:
    system:
      v: http://unstats.un.org/unsd/methods/m49/m49.htm
    code:
      v: 001
item:
  link id:
    v: investigationForm
  text:
    v: Generic Respiratory Disease Case Investigation Form
  type:
    v: group
  repeats:
    v: false
  item:
    link id:
      v: basicInformation
    text:
      v: Section 1: Essential basic Information
    type:
      v: group
    repeats:
      v: false

v: unknown

v: Unknown

v: other

v: Other

link id:
  v: dataCollectorInformation
text:
  v: A. Data collector Information
type:
  v: group
repeats:
  v: false
item:
  link id:
    v: nameOfDataCollector
  text:
    v: Name of data collector
  type:
    v: string
  repeats:
    v: false
item:
  link id:
    v: dataCollectorTelephoneNumber
  text:
    v: Data collector telephone number
  type:
    v: string
  repeats:
    v: false
item:
  link id:
    v: dataCollectorInstitution
  text:
    v: Data collector institution
  type:
    v: string
  repeats:
    v: false
item:
  link id:
    v: formCompletionDate
  text:
    v: Form completion date (dd/mm/yyyy)
  type:
    v: date
  repeats:
    v: false

link id:
  v: respondentInformation
text:
  v: B. Interview respondent Information (if not patient)
type:
  v: group
repeats:
  v: false
item:
  link id:
    v: nameOfRespondent
  text:
    v: Name of respondent
  type:
    v: string
  repeats:
    v: false
item:
  link id:
    v: respondentTelephoneNumber
  text:
    v: Respondent telephone number
  type:
    v: string
  repeats:
    v: false
item:
  link id:
    v: respondentAddress
  text:
    v: Respondent address
  type:
    v: string
  repeats:
    v: false
item:
  link id:
    v: relationshipToPatient
  text:
    v: Relationship to patient
  type:
    v: string
  repeats:
    v: false

link id:
  v: signs
text:
  v: C. Patient identifier Information
type:
  v: group
repeats:
  v: false
item:
  link id:
    v: identification
  text:
    v: Unique Case ID/cluster number (if applicable)
  type:
    v: string
  repeats:
    v: false
item:
  link id:
    v: caseStatus
  text:
    v: Case Status
  type:
    v: choice
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/CaseStatus
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/CaseStatus
item:
  link id:
    v: Name
  text:
    v: Name
  type:
    v: string
  repeats:
    v: false
item:
  link id:
    v: country
  text:
    v: Country of residence
  type:
    v: string
  repeats:
    v: false
item:
  link id:
    v: Sex
  text:
    v: Sex at birth
  type:
    v: choice
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/BiologicalSex
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/BiologicalSex
item:
  link id:
    v: BirthDate
  text:
    v: Date of birth (dd/mm/yyyy)
  type:
    v: date
  repeats:
    v: false
item:
  link id:
    v: Age
  text:
    v: Age (years,months)
  type:
    v: string
  repeats:
    v: false
item:
  link id:
    v: address
  text:
    v: Address (village/town, district, province/region)
  type:
    v: string
  repeats:
    v: false
item:
  link id:
    v: telephone
  text:
    v: Patient telephone number
  type:
    v: string
  repeats:
    v: false

link id:
  v: Clinical
text:
  v: Section 2: Clinical Information
type:
  v: group
repeats:
  v: false
item:
  link id:
    v: clinicalCourse
  text:
    v: D. Patient clinical course
  type:
    v: group
  repeats:
    v: false
  item:
    link id:
      v: symptoms
    text:
      v: Symptom
    type:
      v: choice
    repeats:
      v: false
    answer value set:
      v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
      link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
  item:
    link id:
      v: symptomOnsetDate
    text:
      v: date of onset of symptoms:____/____/______
    type:
      v: date
    enable when:
      question:
        v: symptoms
      operator:
        v: =
      answer: Coding
    repeats:
      v: false
  item:
    link id:
      v: presentedToHCF
    text:
      v: Health facility visit (including traditional care)
    type:
      v: choice
    repeats:
      v: false
    answer value set:
      v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
      link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
  item:
    link id:
      v: presentedToHCFDate
    text:
      v: Date of first health facility visit (including traditional care)
    type:
      v: date
    enable when:
      question:
        v: presentedToHCF
      operator:
        v: =
      answer: Coding
    repeats:
      v: false
  item:
    link id:
      v: totalHealthFacilitiesVisited
    text:
      v: Total health facilities visited till outcome
    type:
      v: integer
    repeats:
      v: false
  item:
    link id:
      v: dateOfFirstHospitalization
    text:
      v: Date of first hospitalization
    type:
      v: date
    repeats:
      v: false
    answer value set:
      v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
      link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
  item:
    link id:
      v: dateOfICUAdmission
    text:
      v: Date of intensive care unit admission
    type:
      v: date
    repeats:
      v: false
    answer value set:
      v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
      link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
  item:
    link id:
      v: startICU
    text:
      v: Start: ICU
    type:
      v: date
    repeats:
      v: false
  item:
    link id:
      v: stopICU
    text:
      v: Stop: ICU
    type:
      v: date
    repeats:
      v: false
  item:
    link id:
      v: dateOfMechanicalVentilation
    text:
      v: Date of mechanical ventilation
    type:
      v: date
    repeats:
      v: false
    answer value set:
      v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
      link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
  item:
    link id:
      v: startVentilation
    text:
      v: Start: Mechanical Ventilation
    type:
      v: date
    repeats:
      v: false
  item:
    link id:
      v: stopVentilation
    text:
      v: Stop: Mechanical Ventilation
    type:
      v: date
    repeats:
      v: false
  item:
    link id:
      v: dateOfAntiviralTreatment
    text:
      v: Antiviral Treatment
    type:
      v: date
    repeats:
      v: false
    answer value set:
      v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
      link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
  item:
    link id:
      v: startVentilation
    text:
      v: Start: Antiviral Treatment
    type:
      v: date
    repeats:
      v: false
  item:
    link id:
      v: stopVentilation
    text:
      v: Stop: Antiviral Treatment
    type:
      v: date
    repeats:
      v: false
  item:
    link id:
      v: outcome
    text:
      v: Outcome
    type:
      v: choice
    repeats:
      v: false
    answer value set:
      v: http://worldhealthorganization.github.io/smart-ot/ValueSet/PatientOutcome
      link: http://worldhealthorganization.github.io/smart-ot/ValueSet/PatientOutcome
  item:
    link id:
      v: outcomeDate
    text:
      v: Outcome date
    type:
      v: date
    repeats:
      v: false

v: Yes

v: Yes

link id:
  v: symptoms
text:
  v: E. Patient symptoms (from disease onset) and complications
type:
  v: group
repeats:
  v: false
item:
  link id:
    v: fever
  text:
    v: Fever (>=38 °C) or history of fever
  type:
    v: choice
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
item:
  link id:
    v: chills
  text:
    v: Chills
  type:
    v: choice
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
item:
  link id:
    v: cough
  text:
    v: Cough
  type:
    v: choice
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
item:
  link id:
    v: soreThroat
  text:
    v: Sore throat
  type:
    v: choice
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
item:
  link id:
    v: runnyNose
  text:
    v: Runny nose
  type:
    v: choice
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
item:
  link id:
    v: vomiting
  text:
    v: Vomiting
  type:
    v: choice
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
item:
  link id:
    v: diarrhoea
  text:
    v: Diarrhoea
  type:
    v: choice
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
item:
  link id:
    v: headache
  text:
    v: Headache
  type:
    v: choice
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
item:
  link id:
    v: neurologicalSigns
  text:
    v: Neurological signs
  type:
    v: choice
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
item:
  link id:
    v: specifyNeurologicalSigns
  text:
    v: Specify
  type:
    v: string
  enable when:
    question:
      v: neurologicalSigns
    operator:
      v: =
    answer: Coding
      system:
        v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
      code:
        v: Yes
  repeats:
    v: false
item:
  link id:
    v: rash
  text:
    v: Rash
  type:
    v: choice
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
item:
  link id:
    v: conjunctivitis
  text:
    v: Conjunctivitis
  type:
    v: choice
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
item:
  link id:
    v: shortnessOfBreath
  text:
    v: Shortness of breath
  type:
    v: choice
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
item:
  link id:
    v: muscleAches
  text:
    v: Muscle aches
  type:
    v: choice
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
item:
  link id:
    v: pneumoniaByChestXRay
  text:
    v: Pneumonia by chest X-ray
  type:
    v: choice
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
item:
  link id:
    v: pneumoniaDateStarted
  text:
    v: Date Started __/__/____
  type:
    v: date

question:
  v: pneumoniaByChestXRay
operator:
  v: =
answer: Coding
  system:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
  code:
    v: Yes

v: false

link id:
  v: acuteRespiratoryDistressSyndrome
text:
  v: Acute respiratory distress syndrome
type:
  v: choice
repeats:
  v: false
answer value set:
  v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
  link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown

link id:
  v: aRDSDateStarted
text:
  v: Date Started __/__/____
type:
  v: date
enable when:
  question:
    v: acuteRespiratoryDistressSyndrome
  operator:
    v: =
  answer: Coding
    system:
      v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
    code:
      v: Yes
repeats:
  v: false

link id:
  v: acuteRenalFailure
text:
  v: Acute renal failure
type:
  v: choice
repeats:
  v: false
answer value set:
  v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
  link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown

link id:
  v: acuteRenalFailureDateStarted
text:
  v: Date Started __/__/____
type:
  v: date
enable when:
  question:
    v: acuteRenalFailure
  operator:
    v: =
  answer: Coding
    system:
      v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
    code:
      v: Yes
repeats:
  v: false

link id:
  v: cardiacFailure
text:
  v: Cardiac failure
type:
  v: choice
repeats:
  v: false
answer value set:
  v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
  link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown

link id:
  v: cardiacFailureDateStarted
text:
  v: Date Started __/__/____
type:
  v: date
enable when:
  question:
    v: cardiacFailure
  operator:
    v: =
  answer: Coding
    system:
      v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
    code:
      v: Yes
repeats:
  v: false

link id:
  v: consumptiveCoagulopathy
text:
  v: Consumptive coagulopathy
type:
  v: choice
repeats:
  v: false
answer value set:
  v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
  link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown

link id:
  v: otherSymptoms
text:
  v: Other symptoms (if yes, specify)
type:
  v: choice
repeats:
  v: false
answer value set:
  v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
  link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown

link id:
  v: otherSymptomsSpecify
text:
  v: Specify
type:
  v: string
enable when:
  question:
    v: otherSymptoms
  operator:
    v: =
  answer: Coding
    system:
      v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
    code:
      v: Yes
repeats:
  v: false

link id:
  v: comorbidity
text:
  v: F. Patient pre-existing condition
type:
  v: group
repeats:
  v: false
item:
  link id:
    v: cancer
  text:
    v: Cancer
  type:
    v: choice
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
item:
  link id:
    v: diabetes
  text:
    v: Diabetes
  type:
    v: choice
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
item:
  link id:
    v: hivImmuneDeficiency
  text:
    v: HIV/other immune deficiency
  type:
    v: choice
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
item:
  link id:
    v: heartDisease
  text:
    v: Heart disease
  type:
    v: choice
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
item:
  link id:
    v: asthma
  text:
    v: Asthma
  type:
    v: choice
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
item:
  link id:
    v: chronicLungDisease
  text:
    v: Chronic lung disease (non-asthma)
  type:
    v: choice
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
item:
  link id:
    v: chronicLiverDisease
  text:
    v: Chronic liver disease
  type:
    v: choice
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
item:
  link id:
    v: chronicHaematologicalDisorder
  text:
    v: Chronic haematological disorder
  type:
    v: choice
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
item:
  link id:
    v: pregnancy
  text:
    v: Pregnancy
  type:
    v: choice
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
item:
  link id:
    v: trimester
  text:
    v: If yes, specify trimester
  type:
    v: string
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
item:
  link id:
    v: chronicKidneyDisease
  text:
    v: Chronic kidney disease
  type:
    v: choice
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
item:
  link id:
    v: chronicNeurologicalImpairment
  text:
    v: Chronic neurological impairment
  type:
    v: choice
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
item:
  link id:
    v: obesity
  text:
    v: Obesity
  type:
    v: choice
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
item:
  link id:
    v: otherConditions
  text:
    v: Other (if yes, specify)
  type:
    v: string
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
item:
  link id:
    v: influenzaVaccination
  text:
    v: Patient was vaccinated for influenza in the past 12 months
  type:
    v: choice
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown

link id:
  v: Exposure
text:
  v: Section 3: Exposure and travel history
type:
  v: group
repeats:
  v: false
item:
  link id:
    v: comorbidity
  text:
    v: G. Patient occupational exposures
  type:
    v: group
  repeats:
    v: false
  item:
    link id:
      v: occupation
    text:
      v: Occupation (specify location/facility)
    type:
      v: choice
    repeats:
      v: false
    answer value set:
      v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
      link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
  item:
    link id:
      v: healthcareWorker
    text:
      v: Health-care worker (if yes, specify type/location)
    type:
      v: choice
    repeats:
      v: false
    answer value set:
      v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
      link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
  item:
    link id:
      v: laboratoryWorker
    text:
      v: Laboratory worker (if yes, specify type/location)
    type:
      v: choice
    repeats:
      v: false
    answer value set:
      v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
      link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
  item:
    link id:
      v: veterinaryWorker
    text:
      v: Veterinary worker (if yes, specify animal types handled in the 10 days before illness)
    type:
      v: choice
    repeats:
      v: false
    answer value set:
      v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
      link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
  item:
    link id:
      v: wildlifeWorker
    text:
      v: Wildlife worker (if yes, specify animal types handled in the 10 days before illness)
    type:
      v: choice
    repeats:
      v: false
    answer value set:
      v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
      link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
  item:
    link id:
      v: liveAnimalMarketWorker
    text:
      v: Live animal market worker (if yes, specify animal types handled in the 10 days before illness)
    type:
      v: choice
    repeats:
      v: false
    answer value set:
      v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
      link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
  item:
    link id:
      v: farmWorker
    text:
      v: Farm worker (if yes, specify animal types handled in the 10 days before illness)
    type:
      v: choice
    repeats:
      v: false
    answer value set:
      v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
      link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
item:
  link id:
    v: humanExposure
  text:
    v: H. Patient human exposures in the 14 days before illness onset
  type:
    v: group
  repeats:
    v: false
  item:
    link id:
      v: visitedOutpatientFacility
    text:
      v: Patient visited outpatient treatment facility (if yes, specify)
    type:
      v: choice
    repeats:
      v: false
    answer value set:
      v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
      link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
  item:
    link id:
      v: visitedTraditionalHealer
    text:
      v: Patient visited traditional healer (if yes, specify)
    type:
      v: choice
    repeats:
      v: false
    answer value set:
      v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
      link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
  item:
    link id:
      v: visitedInpatientFacility
    text:
      v: Patient visited or was admitted to inpatient health facility (if yes, specify)
    type:
      v: choice
    repeats:
      v: false
    answer value set:
      v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
      link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
  item:
    link id:
      v: attendedMassGathering
    text:
      v: Patient attended festival or mass gathering (if yes, specify)
    type:
      v: choice
    repeats:
      v: false
    answer value set:
      v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
      link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
  item:
    link id:
      v: exposedToSimilarIllness
    text:
      v: Patient exposed to person with similar illness
    type:
      v: choice
    repeats:
      v: false
    answer value set:
      v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
      link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
  item:
    link id:
      v: typeOfContact
    text:
      v: Type of contact
    type:
      v: choice
    repeats:
      v: false
    answer value set:
      v: http://worldhealthorganization.github.io/smart-ot/ValueSet/ContactType
      link: http://worldhealthorganization.github.io/smart-ot/ValueSet/ContactType
  item:
    link id:
      v: locationOfExposure
    text:
      v: Location of exposure
    type:
      v: choice
    repeats:
      v: false
    answer value set:
      v: http://worldhealthorganization.github.io/smart-ot/ValueSet/ExposureLocation
      link: http://worldhealthorganization.github.io/smart-ot/ValueSet/ExposureLocation
  item:
    link id:
      v: uniqueCaseId
    text:
      v: Unique case ID of sick person (if available)
    type:
      v: choice
    repeats:
      v: false

link id:
  v: relationshipToPatient
text:
  v: Relationship to current patient (specify, e.g. family, friend, health-care worker, colleague)
type:
  v: string
repeats:
  v: false

link id:
  v: bloodLinked
text:
  v: Blood linked (if yes, specify link)
type:
  v: choice
repeats:
  v: false
answer value set:
  v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
  link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown

link id:
  v: confirmedProbableCase
text:
  v: Sick person confirmed or deemed a probable case in current event
type:
  v: choice
repeats:
  v: false
answer value set:
  v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
  link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown

link id:
  v: travelExposure
text:
  v: I. Patient travel history in the 14 days before illness onset (add sheets if multiple locations visited)
type:
  v: group
repeats:
  v: false
item:
  link id:
    v: travelledOutside
  text:
    v: Patient travelled out of first administrative region
  type:
    v: choice
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
item:
  link id:
    v: travelDetails
  text:
    v: specify location (city or region, country)
  type:
    v: group
  repeats:
    v: true
  item:
    link id:
      v: destination
    text:
      v: Destination
    type:
      v: string
    repeats:
      v: false
  item:
    link id:
      v: transportType
    text:
      v: model of Travel
    type:
      v: string
    repeats:
      v: false
  item:
    link id:
      v: arrivalDate
    text:
      v: Arrival: __/__/__
    type:
      v: date
    repeats:
      v: false
  item:
    link id:
      v: departureDate
    text:
      v: Departure: __/__/__
    type:
      v: date
    repeats:
      v: false
item:
  link id:
    v: companion
  text:
    v: Patient travelled with companions (if yes, specify)
  type:
    v: choice
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown

link id:
  v: animalExposure
text:
  v: J. Patient animal exposures in the 14 days before illness onset
type:
  v: group
repeats:
  v: false
item:
  link id:
    v: patientHandledAnimals
  text:
    v: Patient handled animals
  type:
    v: choice
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
item:
  link id:
    v: typesOfAnimalsHandled
  text:
    v: Types of animals handled (e.g. pigs, chicken, ducks or others)
  type:
    v: string
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
item:
  link id:
    v: natureOfContact
  text:
    v: Nature of contact (e.g. feed, groom or slaughter)
  type:
    v: string
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
item:
  link id:
    v: locationOfAnimalContact
  text:
    v: Location of animal contact
  type:
    v: string
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/AnimalContactLocation
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/AnimalContactLocation
item:
  link id:
    v: animalsSickOrDead
  text:
    v: Within 2 weeks before or after contact, any animals sick or dead? (if yes, specify type and number, and proportion from flock or herd)
  type:
    v: string
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
item:
  link id:
    v: animalsInEnvironment
  text:
    v: Patient exposed to animals in environment but did not handle them (e.g. in neighbourhood, farm, zoo, at home, agricultural fair or work)
  type:
    v: choice
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
item:
  link id:
    v: typesOfAnimalsInEnvironment
  text:
    v: Types of animals in that environment (e.g. pigs, chicken, ducks or others)
  type:
    v: string
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
item:
  link id:
    v: locationOfExposureToAnimals
  text:
    v: Location of exposure
  type:
    v: string
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/AnimalExposureLocation
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/AnimalExposureLocation
item:
  link id:
    v: animalsInEnvironmentSickOrDead
  text:
    v: Within 2 weeks before or after exposure to animals in the environment, any animals sick or dead? (if yes, specify type and number, and proportion from flock or herd)
  type:
    v: string
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
item:
  link id:
    v: animalByProductsExposure
  text:
    v: Patient exposed to animal by-products (e.g. bird feathers) or animal excreta (if yes, specify product)
  type:
    v: string
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
item:
  link id:
    v: visitedLiveAnimalMarket
  text:
    v: Patient visited live animal market (if yes, specify market)
  type:
    v: choice
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
item:
  link id:
    v: foodExposure
  text:
    v: K. Patient food exposures in the 14 days before illness onset
  type:
    v: group
  repeats:
    v: false
item:
  link id:
    v: rawConsumption
  text:
    v: Patient consumed raw or unpasteurized animal products (if yes, specify products)
  type:
    v: choice
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
item:
  link id:
    v: rawRemedyConsumption
  text:
    v: Patient consumed health or traditional remedies with raw or unpasteurized animal products (if yes, specify products)
  type:
    v: choice
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown

link id:
  v: perceivedExposure
text:
  v: L. Patient perceived exposure
type:
  v: group
repeats:
  v: false
item:
  link id:
    v: source
  text:
    v: From the point of view of the patient or family, what is the likely source of infection and geographic location of exposure?
  type:
    v: string
  repeats:
    v: false

link id:
  v: Laboratory
text:
  v: Section 4: Laboratory Information
type:
  v: group
repeats:
  v: false
item:
  link id:
    v: specimensCollected
  text:
    v: Specimens collected from patient (tick as needed)
  type:
    v: choice
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/SpecimenCollected
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/SpecimenCollected
item:
  link id:
    v: pathogenTestingDone
  text:
    v: Pathogen testing done (tick as needed)
  type:
    v: choice
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/PathogenTested
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/PathogenTested
item:
  link id:
    v: specimensShipped
  text:
    v: Specimens shipped to international reference laboratories
  type:
    v: choice
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/YesNoUnknown
item:
  link id:
    v: shipmentDate
  text:
    v: shipment date:
  type:
    v: date
  repeats:
    v: false
item:
  link id:
    v: specifySpecimensPositive
  text:
    v: Specify specimen(s) positive
  type:
    v: string
  repeats:
    v: false
item:
  link id:
    v: specifyPathogensPositive
  text:
    v: Specify pathogen(s) positive
  type:
    v: string
  repeats:
    v: false
item:
  link id:
    v: specifyTargetsPositive
  text:
    v: Specify targets positive (e.g. for MERS-CoV)
  type:
    v: string
  repeats:
    v: false
item:
  link id:
    v: specifySubtypePositive
  text:
    v: Specify subtype positive (e.g. for influenza)
  type:
    v: string
  repeats:
    v: false
item:
  link id:
    v: specifyTitres
  text:
    v: Specify titres (e.g. paired serum for influenza)
  type:
    v: string
  repeats:
    v: false