Generated Narrative: Questionnaire GShockEligibility 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 #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 #xD; previous-experience.centrifuge Have you previously experienced centrifuge training? 1..1 boolean #xD; previous-experience.issues Did you experience any issues during previous centrifuge training? 0..1 boolean Enable When: previous-experience.centrifuge = #xD; previous-experience.issues-details Please describe any issues experienced during previous centrifuge training 0..1 text Enable When: previous-experience.issues = #xD; certification Certification 0..1 group #xD; certification.accuracy I certify that the information provided is accurate and complete 1..1 boolean #xD; examiner-section To be completed by Medical Examiner 0..1 group #xD; examiner.clearance Is the candidate medically cleared for G-SHOCK training? 1..1 boolean #xD; examiner.notes Medical Examiner Notes 0..1 text #xD; examiner.name Medical Examiner Name 1..1 string #xD; examiner.date Examination Date 1..1 date #xD; 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")
G-SHOCK Centrifugal Trainer Eligibility Questionnaire
Pre-training screening questionnaire to determine eligibility for G-SHOCK multi-axis gimbal training
G-SHOCK Centrifugal Trainer Eligibility Assessment
Do you have any current or past head, neck, or back injuries?
Do you experience claustrophobia (fear of enclosed spaces)?
Do you have a history of seizures or epilepsy?
Do you have any heart or circulatory conditions, including high blood pressure?
Please describe any heart or circulatory conditions
Are you currently taking any medications?
Are you currently experiencing any nausea?
Are you currently experiencing any headache?
Have you previously experienced centrifuge training?
Did you experience any issues during previous centrifuge training?
Please describe any issues experienced during previous centrifuge training
I certify that the information provided is accurate and complete
Is the candidate medically cleared for G-SHOCK training?