SpaceflightHealthSimulationsReferenceDocumentation - Local Development build (v0.5.12) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
Questionnaire: G-SHOCK Centrifugal Trainer Eligibility Questionnaire
| Official URL: http://aerospace-medicine.org/fhir/Questionnaire/g-shock-eligibility | Version: 0.5.12 | |||
| Active as of 2025-05-19 | Computable Name: GShockEligibilityQuestionnaire | |||
Pre-training screening questionnaire to determine eligibility for G-SHOCK multi-axis gimbal training
Structure
| LinkID | Text | Cardinality | Type | Description & Constraints |
|---|---|---|---|---|
  GShockEligibilityQuestionnaire | Pre-training screening questionnaire to determine eligibility for G-SHOCK multi-axis gimbal training | Questionnaire | http://aerospace-medicine.org/fhir/Questionnaire/g-shock-eligibility#0.5.12 | |
  intro | G-SHOCK Centrifugal Trainer Eligibility Assessment | 0..1 | display | |
  personal-info | Personal Information | 0..1 | group | |
  personal-info.sex | Sex | 1..1 | choice | Options: 3 options |
 personal-info.height | Height (m) | 1..1 | quantity | |
 personal-info.weight | Weight (kg) | 1..1 | quantity | |
| medical-history | Medical History | 0..1 | group | |
 medical-history.head-neck-back | Do you have any current or past head, neck, or back injuries? | 1..1 | boolean | |
| medical-history.dizziness | Do you experience dizziness or vertigo? | 1..1 | boolean | |
| medical-history.claustrophobia | Do you experience claustrophobia (fear of enclosed spaces)? | 1..1 | boolean | |
| medical-history.pregnant | Are you currently pregnant? | 1..1 | boolean | Enable When: personal-info.sex = |
| medical-history.seizures | Do you have a history of seizures or epilepsy? | 1..1 | boolean | |
| medical-history.heart-issues | Do you have any heart or circulatory conditions, including high blood pressure? | 1..1 | boolean | |
 medical-history.heart-issues-details | Please describe any heart or circulatory conditions | 0..1 | text | Enable When: medical-history.heart-issues = |
| medications | Current Medications | 0..1 | group | |
| medications.current | Are you currently taking any medications? | 1..1 | boolean | |
| medications.list | Please list all current medications | 0..1 | text | Enable When: medications.current = |
| symptoms | Current Symptoms | 0..1 | group | |
| symptoms.nausea | Are you currently experiencing any nausea? | 1..1 | boolean | |
| symptoms.headache | Are you currently experiencing any headache? | 1..1 | boolean | |
| previous-experience | Previous Experience | 0..1 | group | |
| previous-experience.centrifuge | Have you previously experienced centrifuge training? | 1..1 | boolean | |
| previous-experience.issues | Did you experience any issues during previous centrifuge training? | 0..1 | boolean | Enable When: previous-experience.centrifuge = |
| previous-experience.issues-details | Please describe any issues experienced during previous centrifuge training | 0..1 | text | Enable When: previous-experience.issues = |
| certification | Certification | 0..1 | group | |
| certification.accuracy | I certify that the information provided is accurate and complete | 1..1 | boolean | |
 examiner-section | To be completed by Medical Examiner | 0..1 | group | |
 examiner.clearance | Is the candidate medically cleared for G-SHOCK training? | 1..1 | boolean | |
| examiner.notes | Medical Examiner Notes | 0..1 | text | |
 examiner.name | Medical Examiner Name | 1..1 | string | |
 examiner.date | Examination Date | 1..1 | date | |
| Documentation for this format | ||||
Options Sets
Answer options for personal-info.sex
- http://hl7.org/fhir/administrative-gender#male ("Male")
- http://hl7.org/fhir/administrative-gender#female ("Female")
- http://hl7.org/fhir/administrative-gender#other ("Other")