Generated Narrative: Questionnaire AstronautFlightReadinessQuestionnaire Structure LinkID Text Cardinality Type Description & Constraints AstronautFlightReadinessQuestionnaire A medical screening form for astronaut or space tourism flight readiness, based on FAA Form 8500-8, NASA/ESA standards, and commercial vendor practices. Questionnaire https://mitre.org/fhir/space-health/Questionnaire/AstronautFlightReadinessQuestionnaire#0.5.12 #xD; intro Application for Space Tourism activities. 0..1 display #xD; citizenship Are you a United States citizen? 1..1 boolean #xD; demographic-info Demographic Information 1..1 group #xD; firstName First Name 1..1 string #xD; middleName Middle Name 0..1 string #xD; lastName Last Name 1..1 string #xD; phoneNumber Phone Number 1..1 string #xD; emailAddress Email Address 1..1 string #xD; confirmEmailAddress Confirm Email Address 1..1 string #xD; age-check Are you currently between the ages of 28 and 55? 1..1 boolean #xD; birthdate Birthdate 1..1 date #xD; sex Sex 1..1 choice Options: 2 options #xD; mission Flight Profile 0..1 group #xD; flightType Type of Flight 0..1 choice Options: 2 options #xD; flightDuration Planned Mission Duration (days) 0..1 integer #xD; crewRole Crew Role 0..1 choice Options: 3 options #xD; medicalHistory Medical History 0..1 group #xD; cardiacHistory History of cardiac disease (e.g. heart attack, arrhythmia)? 0..1 boolean #xD; neuroHistory History of neurological issues (e.g. stroke, seizures)? 0..1 boolean #xD; psychHistory History of mental health disorders? 0..1 boolean #xD; respiratoryHistory History of respiratory disorders (e.g. asthma, COPD)? 0..1 boolean #xD; gastroHistory History of gastrointestinal disease? 0..1 boolean #xD; renalHistory History of kidney stones or renal disease? 0..1 boolean #xD; allergyHistory Do you have any allergies? 0..1 boolean #xD; motionSickness History of motion sickness requiring medication? 0..1 boolean #xD; pregnancyStatus Are you currently pregnant? 0..1 boolean #xD; medications Medications and Supplements 0..1 group #xD; medicationList List all current medications and supplements 0..1 text #xD; vitals Vital Signs and Physical Exam 0..1 group #xD; height Height (cm) 0..1 decimal #xD; weight Weight (kg) 0..1 decimal #xD; bloodPressure Blood Pressure (mmHg) 0..1 string #xD; heartRate Heart Rate (bpm) 0..1 integer #xD; functionalTests Functional Capacity 0..1 group #xD; stairClimb Able to climb 7 flights of stairs in under 90 seconds? 0..1 boolean #xD; egressTest Able to exit seat unassisted in emergency simulation? 0..1 boolean #xD; certification Medical Clearance and Physician Certification 0..1 group #xD; certStatus Medically cleared for spaceflight? 0..1 choice #xD; certPhysician Physician Name and Contact 0..1 string #xD; certDate Date of Medical Certification 0..1 date #xD; Documentation for this format Options Sets Answer options for sex http://hl7.org/fhir/administrative-gender#male ("Male") http://hl7.org/fhir/administrative-gender#female ("Female") Answer options for flightType Suborbital Orbital Answer options for crewRole Tourist Pilot Mission Specialist
Astronaut and Space Tourist Medical Screening Questionnaire
A medical screening form for astronaut or space tourism flight readiness, based on FAA Form 8500-8, NASA/ESA standards, and commercial vendor practices.
Application for Space Tourism activities.
Are you currently between the ages of 28 and 55?
History of cardiac disease (e.g. heart attack, arrhythmia)?
History of neurological issues (e.g. stroke, seizures)?
History of respiratory disorders (e.g. asthma, COPD)?
History of kidney stones or renal disease?
History of motion sickness requiring medication?
List all current medications and supplements
Able to climb 7 flights of stairs in under 90 seconds?
Able to exit seat unassisted in emergency simulation?
Medical Clearance and Physician Certification