GShockEligibility
type: Questionnaire
node role: treeRoot
id:
  v: GShockEligibility
text:
  status:
    v: extensions
  div:
    v: Generated Narrative: Questionnaire GShockEligibility Structure LinkID Text Cardinality Type Description & Constraints<img src="[binary]" alt="doco" style="background-color: inherit"/> 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 #xD; intro G-SHOCK Centrifugal Trainer Eligibility Assessment 0..1 display #xD; personal-info Personal Information 0..1 group #xD; personal-info.sex Sex 1..1 choice Options: 3 options #xD; personal-info.height Height (m) 1..1 quantity #xD; personal-info.weight Weight (kg) 1..1 quantity #xD; medical-history Medical History 0..1 group #xD; medical-history.head-neck-back Do you have any current or past head, neck, or back injuries? 1..1 boolean #xD; medical-history.dizziness Do you experience dizziness or vertigo? 1..1 boolean #xD; medical-history.claustrophobia Do you experience claustrophobia (fear of enclosed spaces)? 1..1 boolean #xD; medical-history.pregnant Are you currently pregnant? 1..1 boolean Enable When: personal-info.sex = #xD; medical-history.seizures Do you have a history of seizures or epilepsy? 1..1 boolean #xD; medical-history.heart-issues Do you have any heart or circulatory conditions, including high blood pressure? 1..1 boolean #xD; medical-history.heart-issues-details Please describe any heart or circulatory conditions 0..1 text Enable When: medical-history.heart-issues = #xD; medications Current Medications 0..1 group #xD; medications.current Are you currently taking any medications? 1..1 boolean #xD; medications.list Please list all current medications 0..1 text Enable When: medications.current = #xD; symptoms Current Symptoms 0..1 group #xD; symptoms.nausea Are you currently experiencing any nausea? 1..1 boolean #xD; symptoms.headache Are you currently experiencing any headache? 1..1 boolean #xD; previous-experience Previous Experience 0..1 group…
url:
  v: http://aerospace-medicine.org/fhir/Questionnaire/g-shock-eligibility
  l: g-shock-eligibility
version:
  v: 0.5.12
name:
  v: GShockEligibilityQuestionnaire
title:
  v: G-SHOCK Centrifugal Trainer Eligibility Questionnaire
status:
  v: active
experimental:
  v: false
date:
  v: 2025-05-19
publisher:
  v: MITRE
contact:
  name:
    v: MITRE
  telecom:
    system:
      v: url
    value:
      v: https://www.mitre.org/
description:
  v: Pre-training screening questionnaire to determine eligibility for G-SHOCK multi-axis gimbal training
item:
  link id:
    v: intro
  text:
    v: G-SHOCK Centrifugal Trainer Eligibility Assessment
  type:
    v: display
item:
  link id:
    v: personal-info
  text:
    v: Personal Information
  type:
    v: group
  item:
    link id:
      v: personal-info.sex
    text:
      v: Sex
    type:
      v: choice
    required:
      v: true
    answer option:
      value: Coding
    answer option:
      value: Coding
    answer option:
      value: Coding
  item:
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/minValue
        l: minValue
      value: Decimal
        v: 1.22
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/maxValue
        l: maxValue
      value: Decimal
        v: 1.88
    link id:
      v: personal-info.height
    code: https://loinc.org/rdf/8302-2
      system:
        v: http://loinc.org
        l: loinc.org
      code:
        v: 8302-2
      display:
        v: Body height
    text:
      v: Height (m)
    type:
      v: quantity
    required:
      v: true
  item:
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/maxValue
        l: maxValue
      value: Decimal
        v: 113.3
    link id:
      v: personal-info.weight
    code: https://loinc.org/rdf/29463-7
      system:
        v: http://loinc.org
        l: loinc.org
      code:
        v: 29463-7
      display:
        v: Body weight
    text:
      v: Weight (kg)
    type:
      v: quantity
    required:
      v: true
item:
  link id:
    v: medical-history
  text:
    v: Medical History
  type:
    v: group
  item:
    link id:
      v: medical-history.head-neck-back
    code: http://snomed.info/id/82271004
      system:
        v: http://snomed.info/sct
        l: sct
      code:
        v: 82271004
      display:
        v: Injury of head (disorder)
    text:
      v: Do you have any current or past head, neck, or back injuries?
    type:
      v: boolean
    required:
      v: true
  item:
    link id:
      v: medical-history.dizziness
    code: http://snomed.info/id/404640003
      system:
        v: http://snomed.info/sct
        l: sct
      code:
        v: 404640003
      display:
        v: Dizziness (finding)
    text:
      v: Do you experience dizziness or vertigo?
    type:
      v: boolean
    required:
      v: true
  item:
    link id:
      v: medical-history.claustrophobia
    code: http://snomed.info/id/19887002
      system:
        v: http://snomed.info/sct
        l: sct
      code:
        v: 19887002
      display:
        v: Claustrophobia (finding)
    text:
      v: Do you experience claustrophobia (fear of enclosed spaces)?
    type:
      v: boolean
    required:
      v: true
  item:
    link id:
      v: medical-history.pregnant
    code: http://snomed.info/id/77386006
      system:
        v: http://snomed.info/sct
        l: sct
      code:
        v: 77386006
      display:
        v: Pregnancy (finding)
    text:
      v: Are you currently pregnant?
    type:
      v: boolean
    enable when:
      question:
        v: personal-info.sex
      operator:
        v: =
      answer: Coding
    required:
      v: true
  item:
    link id:
      v: medical-history.seizures
    code: http://snomed.info/id/225931003
      system:
        v: http://snomed.info/sct
        l: sct

v: male

v: Male

v: female

v: Female

v: other

v: Other

v: female

v: 225931003

v: At risk of epileptic fits (finding)

v: Do you have a history of seizures or epilepsy?

v: boolean

v: true

link id:
  v: medical-history.heart-issues
code: http://snomed.info/id/49436004
  system:
    v: http://snomed.info/sct
    l: sct
  code:
    v: 49436004
  display:
    v: Atrial fibrillation (disorder)
text:
  v: Do you have any heart or circulatory conditions, including high blood pressure?
type:
  v: boolean
required:
  v: true

link id:
  v: medical-history.heart-issues-details
text:
  v: Please describe any heart or circulatory conditions
type:
  v: text
enable when:
  question:
    v: medical-history.heart-issues
  operator:
    v: =
  answer: Boolean
    v: true

link id:
  v: medications
text:
  v: Current Medications
type:
  v: group
item:
  link id:
    v: medications.current
  text:
    v: Are you currently taking any medications?
  type:
    v: boolean
  required:
    v: true
item:
  link id:
    v: medications.list
  text:
    v: Please list all current medications
  type:
    v: text
  enable when:
    question:
      v: medications.current
    operator:
      v: =
    answer: Boolean
      v: true

link id:
  v: symptoms
text:
  v: Current Symptoms
type:
  v: group
item:
  link id:
    v: symptoms.nausea
  code: http://snomed.info/id/422587007
    system:
      v: http://snomed.info/sct
      l: sct
    code:
      v: 422587007
    display:
      v: Nausea (finding)
  text:
    v: Are you currently experiencing any nausea?
  type:
    v: boolean
  required:
    v: true
item:
  link id:
    v: symptoms.headache
  code: http://snomed.info/id/25064002
    system:
      v: http://snomed.info/sct
      l: sct
    code:
      v: 25064002
    display:
      v: Headache (finding)
  text:
    v: Are you currently experiencing any headache?
  type:
    v: boolean
  required:
    v: true

link id:
  v: previous-experience
text:
  v: Previous Experience
type:
  v: group
item:
  link id:
    v: previous-experience.centrifuge
  text:
    v: Have you previously experienced centrifuge training?
  type:
    v: boolean
  required:
    v: true
item:
  link id:
    v: previous-experience.issues
  text:
    v: Did you experience any issues during previous centrifuge training?
  type:
    v: boolean
  enable when:
    question:
      v: previous-experience.centrifuge
    operator:
      v: =
    answer: Boolean
      v: true
item:
  link id:
    v: previous-experience.issues-details
  text:
    v: Please describe any issues experienced during previous centrifuge training
  type:
    v: text
  enable when:
    question:
      v: previous-experience.issues
    operator:
      v: =
    answer: Boolean
      v: true

link id:
  v: certification
text:
  v: Certification
type:
  v: group
item:
  link id:
    v: certification.accuracy
  text:
    v: I certify that the information provided is accurate and complete
  type:
    v: boolean
  required:
    v: true

link id:
  v: examiner-section
text:
  v: To be completed by Medical Examiner
type:
  v: group
item:
  link id:
    v: examiner.clearance
  text:
    v: Is the candidate medically cleared for G-SHOCK training?
  type:
    v: boolean
  required:
    v: true
item:
  link id:
    v: examiner.notes
  text:
    v: Medical Examiner Notes
  type:
    v: text
item:
  link id:
    v: examiner.name
  text:
    v: Medical Examiner Name
  type:
    v: string
  required:
    v: true
item:
  link id:
    v: examiner.date
  text:
    v: Examination Date
  type:
    v: date
  required:
    v: true