AstronautFlightReadinessQuestionnaire
type: Questionnaire
node role: treeRoot
id:
  v: AstronautFlightReadinessQuestionnaire
text:
  status:
    v: extensions
  div:
    v: Generated Narrative: Questionnaire AstronautFlightReadinessQuestionnaire Structure LinkID Text Cardinality Type Description & Constraints<img src="[binary]" alt="doco" style="background-color: inherit"/> 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;…
url:
  v: https://mitre.org/fhir/space-health/Questionnaire/AstronautFlightReadinessQuestionnaire
  l: AstronautFlightReadinessQuestionnaire
version:
  v: 0.5.12
name:
  v: AstronautFlightReadinessQuestionnaire
title:
  v: Astronaut and Space Tourist Medical Screening Questionnaire
status:
  v: active
date:
  v: 2025-05-18
publisher:
  v: MITRE
contact:
  name:
    v: MITRE
  telecom:
    system:
      v: url
    value:
      v: https://www.mitre.org/
description:
  v: A medical screening form for astronaut or space tourism flight readiness, based on FAA Form 8500-8, NASA/ESA standards, and commercial vendor practices.
item:
  link id:
    v: intro
  text:
    v: Application for Space Tourism activities.
  type:
    v: display
item:
  link id:
    v: citizenship
  text:
    v: Are you a United States citizen?
  type:
    v: boolean
  required:
    v: true
item:
  link id:
    v: demographic-info
  text:
    v: Demographic Information
  type:
    v: group
  required:
    v: true
  item:
    link id:
      v: firstName
    text:
      v: First Name
    type:
      v: string
    required:
      v: true
  item:
    link id:
      v: middleName
    text:
      v: Middle Name
    type:
      v: string
  item:
    link id:
      v: lastName
    text:
      v: Last Name
    type:
      v: string
    required:
      v: true
  item:
    link id:
      v: phoneNumber
    text:
      v: Phone Number
    type:
      v: string
    required:
      v: true
  item:
    link id:
      v: emailAddress
    text:
      v: Email Address
    type:
      v: string
    required:
      v: true
  item:
    link id:
      v: confirmEmailAddress
    text:
      v: Confirm Email Address
    type:
      v: string
    required:
      v: true
item:
  link id:
    v: age-check
  text:
    v: Are you currently between the ages of 28 and 55?
  type:
    v: boolean
  required:
    v: true
item:
  link id:
    v: birthdate
  text:
    v: Birthdate
  type:
    v: date
  required:
    v: true
item:
  link id:
    v: sex
  text:
    v: Sex
  type:
    v: choice
  required:
    v: true
  answer option:
    value: Coding
      system:
        v: http://hl7.org/fhir/administrative-gender
        l: administrative-gender
      code:
        v: male
      display:
        v: Male
  answer option:
    value: Coding
      system:
        v: http://hl7.org/fhir/administrative-gender
        l: administrative-gender
      code:
        v: female
      display:
        v: Female
item:
  link id:
    v: mission
  text:
    v: Flight Profile
  type:
    v: group
  item:
    link id:
      v: flightType
    text:
      v: Type of Flight
    type:
      v: choice
    answer option:
      value: String
        v: Suborbital
    answer option:
      value: String
        v: Orbital
  item:
    link id:
      v: flightDuration
    text:
      v: Planned Mission Duration (days)
    type:
      v: integer
  item:
    link id:
      v: crewRole
    text:
      v: Crew Role
    type:
      v: choice
    answer option:
      value: String
        v: Tourist
    answer option:
      value: String
        v: Pilot
    answer option:
      value: String
        v: Mission Specialist
item:
  link id:
    v: medicalHistory

v: Medical History

v: group

link id:
  v: cardiacHistory
text:
  v: History of cardiac disease (e.g. heart attack, arrhythmia)?
type:
  v: boolean

link id:
  v: neuroHistory
text:
  v: History of neurological issues (e.g. stroke, seizures)?
type:
  v: boolean

link id:
  v: psychHistory
text:
  v: History of mental health disorders?
type:
  v: boolean

link id:
  v: respiratoryHistory
text:
  v: History of respiratory disorders (e.g. asthma, COPD)?
type:
  v: boolean

link id:
  v: gastroHistory
text:
  v: History of gastrointestinal disease?
type:
  v: boolean

link id:
  v: renalHistory
text:
  v: History of kidney stones or renal disease?
type:
  v: boolean

link id:
  v: allergyHistory
text:
  v: Do you have any allergies?
type:
  v: boolean

link id:
  v: motionSickness
text:
  v: History of motion sickness requiring medication?
type:
  v: boolean

link id:
  v: pregnancyStatus
text:
  v: Are you currently pregnant?
type:
  v: boolean

link id:
  v: medications
text:
  v: Medications and Supplements
type:
  v: group
item:
  link id:
    v: medicationList
  text:
    v: List all current medications and supplements
  type:
    v: text

link id:
  v: vitals
text:
  v: Vital Signs and Physical Exam
type:
  v: group
item:
  link id:
    v: height
  text:
    v: Height (cm)
  type:
    v: decimal
item:
  link id:
    v: weight
  text:
    v: Weight (kg)
  type:
    v: decimal
item:
  link id:
    v: bloodPressure
  text:
    v: Blood Pressure (mmHg)
  type:
    v: string
item:
  link id:
    v: heartRate
  text:
    v: Heart Rate (bpm)
  type:
    v: integer

link id:
  v: functionalTests
text:
  v: Functional Capacity
type:
  v: group
item:
  link id:
    v: stairClimb
  text:
    v: Able to climb 7 flights of stairs in under 90 seconds?
  type:
    v: boolean
item:
  link id:
    v: egressTest
  text:
    v: Able to exit seat unassisted in emergency simulation?
  type:
    v: boolean

link id:
  v: certification
text:
  v: Medical Clearance and Physician Certification
type:
  v: group
item:
  link id:
    v: certStatus
  text:
    v: Medically cleared for spaceflight?
  type:
    v: choice
item:
  link id:
    v: certPhysician
  text:
    v: Physician Name and Contact
  type:
    v: string
item:
  link id:
    v: certDate
  text:
    v: Date of Medical Certification
  type:
    v: date