SOTMeasles-AFRO-MRCIF
type: Questionnaire
node role: treeRoot
id:
  v: SOTMeasles-AFRO-MRCIF
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"/> SOTMeasles-AFRO-MRCIF AFRO Measles Case Investigation Questionnaire Questionnaire http://worldhealthorganization.github.io/smart-ot/Questionnaire/SOTMeasles-AFRO-MRCIF#0.2.1 investigationForm Measles/ rubella suspected case investigation form for immediate reporting 0..1 group description Complete this form for: health facility / district to the national level 0..1 display reportingSource For Official Use Only -to be completed by the district / national team 0..1 group caseID EPID Number: Country-Province-District-year-onset-case # 0..1 string reportingInstitution Reporting Institution 0..1 group reportingFacility Reporting Health Facility 0..1 string locality Reporting District 0..1 string DateReportedNational Date the form was received at national level 0..1 date demographics IDENTIFICATION: 0..1 group name Name of Patient 0..1 string DoB Date of Birth 0..1 date ageOnset If date of birth is unknown, age 0..1 integer sex Sex 0..1 choice Value Set: SOT Biological Sex address Address 0..1 string localityType Urban/Rural 0..1 choice Value Set: SOT Measles Locality Type vaccinationStatus VACCINATION STATUS: 0..* group vaccineType Type of Vaccine received 0..1 choice Value Set: SOT Measles Vaccine Type noOfDoses Number of measles containing vaccine doses received in routine EPI and/or SIAs -valid values: 1 - 4 doses 0..1 choice Value Set: SOT Measles No Of Doses lastDoseDate Date of last dose 0..1 date caseInvestigation CASE INVESTIGATION: 0..* group dateReported Date case was notified to the district 0..1 date DateOfConsultation Date Of case investigation 0..1 date rashOnsetDate Date of rash onset 0..1 date clinical Clinical HISTORY: 0..1 group fever Fever 0..1 choice Value Set: Yes No Unknown rash Generalized Rash 0..1 choice Value Set: Yes No Unknown cough Cough 0..1 choice Value Set: Yes No Unknown conjunctivitis Red Eyes 0..1 choice Value Set: Ye…
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: Result
  url:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/Result
  name:
    v: Result
  title:
    v: Result
  status:
    v: draft
  description:
    v: Result
  compose:
    include:
      system:
        v: http://worldhealthorganization.github.io/smart-ot/Result
url:
  v: http://worldhealthorganization.github.io/smart-ot/Questionnaire/SOTMeasles-AFRO-MRCIF
version:
  v: 0.2.1
name:
  v: SOTMeasles-AFRO-MRCIF
title:
  v: AFRO Measles Case Investigation Questionnaire
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: AFRO Measles Case Investigation Questionnaire
jurisdiction:
  coding:
    system:
      v: http://unstats.un.org/unsd/methods/m49/m49.htm
    code:
      v: 001
item:
  link id:
    v: investigationForm
  text:
    v: Measles/ rubella suspected case investigation form for immediate reporting
  type:
    v: group
  repeats:
    v: false
  item:
    link id:
      v: description
    text:
      v: Complete this form for: health facility / district to the national level
    type:
      v: display
    repeats:
      v: false
  item:
    link id:
      v: reportingSource
    text:
      v: For Official Use Only -to be completed by the district / national team
    type:
      v: group
    repeats:
      v: false
    item:
      link id:
        v: caseID
      text:
        v: EPID Number: Country-Province-District-year-onset-case #
      type:
        v: string
      repeats:
        v: false
    item:
      link id:
        v: reportingInstitution
      text:
        v: Reporting Institution
      type:
        v: group
      repeats:
        v: false
    item:
      link id:
        v: DateReportedNational
      text:
        v: Date the form was received at national level
      type:
        v: date
      repeats:
        v: false
  item:
    link id:
      v: demographics
    text:
      v: IDENTIFICATION:
    type:
      v: group
    repeats:
      v: false
    item:
      link id:
        v: name
      text:
        v: Name of Patient
      type:
        v: string
      repeats:
        v: false
    item:
      link id:
        v: DoB
      text:
        v: Date of Birth
      type:
        v: date
      repeats:
        v: false
    item:
      link id:
        v: ageOnset
      text:
        v: If date of birth is unknown, age
      type:
        v: integer
      repeats:
        v: false
    item:
      link id:
        v: sex
      text:
        v: Sex
      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: address
      text:
        v: Address
      type:
        v: string
      repeats:
        v: false
    item:
      link id:
        v: localityType
      text:
        v: Urban/Rural
      type:
        v: choice
      repeats:
        v: false
      answer value set:
        v: http://worldhealthorganization.github.io/smart-ot/ValueSet/LocType
        link: http://worldhealthorganization.github.io/smart-ot/ValueSet/LocType

v: reportingFacility

v: Reporting Health Facility

v: string

v: false

v: locality

v: Reporting District

v: string

v: false

link id:
  v: vaccinationStatus
text:
  v: VACCINATION STATUS:
type:
  v: group
repeats:
  v: true
item:
  link id:
    v: vaccineType
  text:
    v: Type of Vaccine received
  type:
    v: choice
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/VaccineType
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/VaccineType
item:
  link id:
    v: noOfDoses
  text:
    v: Number of measles containing vaccine doses received in routine EPI and/or SIAs -valid values: 1 - 4 doses
  type:
    v: choice
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/NoOfDoses
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/NoOfDoses
item:
  link id:
    v: lastDoseDate
  text:
    v: Date of last dose
  type:
    v: date
  repeats:
    v: false

link id:
  v: caseInvestigation
text:
  v: CASE INVESTIGATION:
type:
  v: group
repeats:
  v: true
item:
  link id:
    v: dateReported
  text:
    v: Date case was notified to the district
  type:
    v: date
  repeats:
    v: false
item:
  link id:
    v: DateOfConsultation
  text:
    v: Date Of case investigation
  type:
    v: date
  repeats:
    v: false
item:
  link id:
    v: rashOnsetDate
  text:
    v: Date of rash onset
  type:
    v: date
  repeats:
    v: false

link id:
  v: clinical
text:
  v: Clinical HISTORY:
type:
  v: group
repeats:
  v: false
item:
  link id:
    v: fever
  text:
    v: 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: rash
  text:
    v: Generalized 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: 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: conjunctivitis
  text:
    v: Red Eyes
  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: coryza
  text:
    v: Running 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: lymphadenopathy
  text:
    v: Swollen lymph nodes behind ears
  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: jointPain
  text:
    v: Joint pain/swelling
  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: admitted
  text:
    v: In/out-patient
  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: 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: travelledOutside
  text:
    v: History of travel outside the village/ town/ district in last 7 - 21 days before onset of 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: infectionSetting
  text:
    v: Most probable place of exposure to measles/ rubella: district
  type:
    v: string
  repeats:
    v: false

link id:
  v: classification
text:
  v: FINAL CLASSIFICATION:
type:
  v: group
repeats:
  v: false
item:
  link id:
    v: finalClassification
  text:
    v: Final Classification
  type:
    v: choice
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/FinalClassification
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/FinalClassification
item:
  link id:
    v: reportedBy
  text:
    v: Person Completing the form: Name
  type:
    v: string
  repeats:
    v: false

link id:
  v: laboratoryResults
text:
  v: FOR SUSPECTED MEASLES/ RUBELLA CASES WITH LAB SPECIMENS
type:
  v: group
repeats:
  v: false
item:
  link id:
    v: sampleType
  text:
    v: Specimen source
  type:
    v: choice
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/SampleType
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/SampleType
item:
  link id:
    v: collectionDate
  text:
    v: Date specimen obtained
  type:
    v: date
  repeats:
    v: false
item:
  link id:
    v: specimenSentDate
  text:
    v: Date specimen was sent to lab
  type:
    v: date
  repeats:
    v: false
item:
  link id:
    v: specimenReceivedDate
  text:
    v: Date Received
  type:
    v: date
  repeats:
    v: false
item:
  link id:
    v: testPerformed
  text:
    v: Type of test
  type:
    v: choice
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/TestType
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/TestType
item:
  link id:
    v: result
  text:
    v: Result
  type:
    v: choice
  repeats:
    v: false
  answer value set:
    v: http://worldhealthorganization.github.io/smart-ot/ValueSet/Result
    link: http://worldhealthorganization.github.io/smart-ot/ValueSet/Result
item:
  link id:
    v: specifyVirus
  text:
    v: Virus Detection -Genotype
  type:
    v: string
  repeats:
    v: false
item:
  link id:
    v: labName
  text:
    v: Laboratory Name
  type:
    v: string
  repeats:
    v: false