patient_onboard_questionnaire.json

{
    "resourceType": "Questionnaire",
    "id": "61",
    "url": "https://raw.githubusercontent.com/turnhub/mamatoto/main/patient_onboard_questionnaire.json",
    "status": "active",
    "subjectType": [
        "Patient"
    ],
    "date": "2024-08-16",
    "item": [
        {
            "linkId": "hospital_selection",
            "text": "Which hospital would you like to be treated at?",
            "type": "choice",
            "repeats": false,
            "answerOption": [
                {
                    "valueCoding": {
                        "code": "nmslk",
                        "display": "Nimoli Hospital - Kasarani"
                    }
                },
                {
                    "valueCoding": {
                        "code": "nmslt",
                        "display": "Nimoli Hospital - Tassia"
                    }
                },
                {
                    "valueCoding": {
                        "code": "msnhe",
                        "display": "Marie Stopes Nursing Home Eastleigh"
                    }
                },
                {
                    "valueCoding": {
                        "code": "gm",
                        "display": "Gawa Medical"
                    }
                },
                {
                    "valueCoding": {
                        "code": "wj",
                        "display": "Wananchi Jamii"
                    }
                },
                {
                    "valueCoding": {
                        "code": "pmcu",
                        "display": "Penda Medical Centre Umoja"
                    }
                },
                {
                    "valueCoding": {
                        "code": "pmcu1",
                        "display": "Penda Medical Centre Umoja 1"
                    }
                },
                {
                    "valueCoding": {
                        "code": "pmcz",
                        "display": "Penda Medical Centre Zimmerman"
                    }
                },
                {
                    "valueCoding": {
                        "code": "pmct",
                        "display": "Penda Medical Centre Tassia"
                    }
                },
                {
                    "valueCoding": {
                        "code": "pmcmn",
                        "display": "Penda Medical Centre Mathare North"
                    }
                },
                {
                    "valueCoding": {
                        "code": "pmckw",
                        "display": "Penda Medical Centre Kahawa West"
                    }
                },
                {
                    "valueCoding": {
                        "code": "pmcg45",
                        "display": "Penda Medical Centre Githurai 45"
                    }
                },
                {
                    "valueCoding": {
                        "code": "pmck",
                        "display": "Penda Medical Centre Kasarani"
                    }
                },
                {
                    "valueCoding": {
                        "code": "pmck2",
                        "display": "Penda Medical Centre Kawangware"
                    }
                },
                {
                    "valueCoding": {
                        "code": "pmcks",
                        "display": "Penda Medical Centre Kimathi Street"
                    }
                },
                {
                    "valueCoding": {
                        "code": "smmhm",
                        "display": "St. Mary's Mission Hospital Mumias"
                    }
                },
                {
                    "valueCoding": {
                        "code": "mch",
                        "display": "Mother and Child Hospital"
                    }
                },
                {
                    "valueCoding": {
                        "code": "shar",
                        "display": "Shalom Hospital - Arthi River"
                    }
                },
                {
                    "valueCoding": {
                        "code": "mmnh",
                        "display": "Mkunga Maternity and Nursing Home"
                    }
                },
                {
                    "valueCoding": {
                        "code": "sh",
                        "display": "Scion Hospital"
                    }
                },
                {
                    "valueCoding": {
                        "code": "jh",
                        "display": "Jumuia Hospital"
                    }
                }
            ]
        },
        {
            "linkId": "last_menstrual_cycle",
            "text": "When was your last menstrual period?",
            "type": "date",
            "required": "true"
        },
        {
            "linkId": "prev_pregnancy",
            "text": "Have you ever been pregnant before?",
            "type": "choice",
            "answerOption": [
                {
                    "valueCoding": {
                        "code": "yes",
                        "display": "Yes"
                    }
                },
                {
                    "valueCoding": {
                        "code": "no",
                        "display": "No"
                    }
                },
                {
                    "valueCoding": {
                        "code": "prefernottosay",
                        "display": "Prefer not to say"
                    }
                }
            ]
        },
        {
            "linkId": "health_conditions",
            "text": "Do you have any health conditions?",
            "type": "choice",
            "answerOption": [
                {
                    "valueCoding": {
                        "code": "yes",
                        "display": "Yes"
                    }
                },
                {
                    "valueCoding": {
                        "code": "none",
                        "display": "None"
                    }
                },
                {
                    "valueCoding": {
                        "code": "prefernottosay",
                        "display": "Prefer not to say"
                    }
                }
            ]
        },
        {
            "linkId": "health_conditions_list",
            "text": "Which health conditions do you have?",
            "type": "choice",
            "answerOption": [
                {
                    "valueCoding": {
                        "code": "diabetes",
                        "display": "Diabetes"
                    }
                },
                {
                    "valueCoding": {
                        "code": "high_blood_pressure",
                        "display": "High blood pressure"
                    }
                },
                {
                    "valueCoding": {
                        "code": "anemia",
                        "display": "Anemia"
                    }
                }
            ],
            "enableWhen": [
                {
                    "question": "health_conditions",
                    "operator": "=",
                    "answerBoolean": true,
                    "answerCoding": {
                        "code": "yes"
                    }
                }
            ],
            "repeats": true
        },
        {
            "linkId": "health_conditions_other",
            "text": "Please list any other conditions",
            "type": "string",
            "enableWhen": [
                {
                    "question": "health_conditions",
                    "operator": "=",
                    "answerBoolean": true,
                    "answerCoding": {
                        "code": "yes"
                    }
                }
            ]
        },
        {
            "linkId": "prev_pregnancy_complications",
            "text": "Did you have any complications in your previous pregnancy?",
            "type": "choice",
            "answerOption": [
                {
                    "valueCoding": {
                        "code": "yes",
                        "display": "Yes"
                    }
                },
                {
                    "valueCoding": {
                        "code": "no",
                        "display": "No"
                    }
                },
                {
                    "valueCoding": {
                        "code": "prefernottosay",
                        "display": "Prefer not to say"
                    }
                }
            ],
            "enableWhen": [
                {
                    "question": "prev_pregnancy",
                    "operator": "=",
                    "answerCoding": {
                        "code": "yes"
                    }
                }
            ]
        },
        {
            "linkId": "prev_pregnancy_complications_list",
            "text": "What complications did you experience in your previous pregnancy?",
            "type": "choice",
            "answerOption": [
                {
                    "valueCoding": {
                        "code": "diabetes",
                        "display": "Diabetes"
                    }
                },
                {
                    "valueCoding": {
                        "code": "hypertension",
                        "display": "Hypertension"
                    }
                },
                {
                    "valueCoding": {
                        "code": "premature",
                        "display": "Baby born more than 3 weeks early"
                    }
                },
                {
                    "valueCoding": {
                        "code": "bleed_before",
                        "display": "Heavy bleeding before birth"
                    }
                },
                {
                    "valueCoding": {
                        "code": "bleed_during",
                        "display": "Heavy bleeding during birth"
                    }
                },
                {
                    "valueCoding": {
                        "code": "bleed_after",
                        "display": "Heavy bleeding after birth"
                    }
                },
                {
                    "valueCoding": {
                        "code": "c_section",
                        "display": "C-section"
                    }
                },
                {
                    "valueCoding": {
                        "code": "loss_of_baby",
                        "display": "Loss of the baby after 3 months"
                    }
                }
            ],
            "enableWhen": [
                {
                    "question": "prev_pregnancy_complications",
                    "operator": "=",
                    "answerCoding": {
                        "code": "yes"
                    }
                }
            ],
            "repeats": true
        },
        {
            "linkId": "prev_pregnancy_complications_other",
            "text": "Can you specify your complication?",
            "type": "string",
            "enableWhen": [
                {
                    "question": "prev_pregnancy_complications",
                    "operator": "=",
                    "answerCoding": {
                        "code": "yes"
                    }
                }
            ]
        }
    ]
}