@prefix fhir: . @prefix owl: . @prefix rdf: . @prefix rdfs: . @prefix xsd: . # - resource ------------------------------------------------------------------- a fhir:Questionnaire ; fhir:nodeRole fhir:treeRoot ; fhir:id [ fhir:v "HERAAnalogMissionApplication"] ; # fhir:text [ fhir:status [ fhir:v "extensions" ] ; fhir:div [ fhir:v "

Generated Narrative: Questionnaire HERAAnalogMissionApplication

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LinkIDTextCardinalityTypeDescription & Constraints\"doco\"
\".\"\".\" HERAAnalogMissionApplicationApplication for the Human Exploration Research Analog (HERA) mission at NASA Johnson Space CenterQuestionnairehttp://example.org/Questionnaire/hera-analog-mission-application#0.5.12
\".\"\".\"\".\" introApplication for Analog Missions. Additional information regarding HERA studies at the Johnson Space Center including a video tour of the HERA facility can be found on the NASA website. Before applying to be a study participant we ask that you review this information for a better understanding of what your participation would entail if chosen as a subject for a future HERA mission.0..1display
\".\"\".\"\".\" privacy-statementPrivacy Act Statement: Pursuant to the Privacy Act of 1974, 5 U.S.C. § 552a, the following statement is furnished to individuals applying to become ground study subjects for the Flight Analog Project. Authority: This collection is authorized by 51 U.S.C. 20113(a) and 44 U.S.C. 3101. Purpose: We will use the information to determine eligibility for the Flight Analog Project. Effect of Nondisclosure: Supplying the information is voluntary on your part. However, failing to provide all or part of the information may prevent an accurate and timely decision on your application.0..1display
\".\"\".\"\".\" consentBy submitting this form, you consent to adding your responses to the analog subject registry. After reviewing your responses, further information may be requested. You may withdraw your information from this registry at any time by sending an e-mail to the recruitment team.0..1display
\".\"\".\"\".\" citizenshipAre you a United States citizen?1..1boolean
\".\"\".\"\".\" confinement-consentFor HERA missions, are you willing to be confined and isolated for required periods of time?1..1boolean
\".\"\".\"\".\"\".\" confinement-detailsHERA mission duration includes a confined isolation of 45 days. In addition to the isolation phase, each mission includes 16 days of pre-mission data collection and training and 7 days of post-mission data collection, requiring a stay in Houston, TX of up to 72 days.0..1display
\".\"\".\"\".\" demographic-infoDemographic Information1..1group
\".\"\".\"\".\"\".\" firstNameFirst Name1..1string
\".\"\".\"\".\"\".\" middleNameMiddle Name0..1string
\".\"\".\"\".\"\".\" lastNameLast Name1..1string
\".\"\".\"\".\"\".\" phoneNumberPhone Number1..1string
\".\"\".\"\".\"\".\" emailAddressEmail Address1..1string
\".\"\".\"\".\"\".\" confirmEmailAddressConfirm Email Address1..1string
\".\"\".\"\".\" age-checkAre you currently between the ages of 28 and 55?1..1boolean
\".\"\".\"\".\" birthdateBirthdate1..1date
\".\"\".\"\".\" sexSex1..1choiceOptions: 2 options
\".\"\".\"\".\" heightHeight (in inches). For HERA missions, height not to exceed 6' 2\" (74 inches)1..1decimal
\".\"\".\"\".\" weightWeight (in pounds)1..1decimal
\".\"\".\"\".\" born-outside-usWere you born outside of the United States?1..1boolean
\".\"\".\"\".\" other-citizenshipDo you hold citizenship in any country other than the United States?1..1boolean
\".\"\".\"\".\" tobacco-nicotineDo you use any tobacco or nicotine products (select all that apply)?1..*choiceOptions: 6 options
\".\"\".\"\".\" medical-sectionMedical History1..1group
\".\"\".\"\".\"\".\" metal-in-bodyDo you have any metal in your body other than dental work?1..1boolean
\".\"\".\"\".\"\".\" claustrophobiaAre you claustrophobic?1..1boolean
\".\"\".\"\".\"\".\" allergies-gi-dietDo you have any of the following?0..*choiceOptions: 3 options
\".\"\".\"\".\"\".\" cardiovascularAny cardiovascular or circulatory system issues?1..1boolean
\".\"\".\"\".\"\".\" neurologicalAny neurological problems?1..1boolean
\".\"\".\"\".\"\".\" musculoskeletalAny musculoskeletal problems?1..1boolean
\".\"\".\"\".\"\".\" medicationsAre you taking any medications?1..1boolean
\".\"\".\"\".\"\".\" sleep-disordersAny sleep disorders such as sleep walking or use of sleep aids?1..1boolean
\".\"\".\"\".\"\".\" psychiatricAny psychiatric disorders or history of mental illness?1..1boolean
\".\"\".\"\".\"\".\" motion-sicknessAny motion sickness (not a disqualifier)?1..1boolean
\".\"\".\"\".\"\".\" adhd-treatmentAny pharmacological treatment for ADHD?1..1boolean
\".\"\".\"\".\"\".\" kidney-stonesAny history of kidney stones?1..1boolean
\".\"\".\"\".\"\".\" ulcersAny history of ulcers?1..1boolean
\".\"\".\"\".\"\".\" epilepsyAny history of epilepsy or other disorders of the brain?1..1boolean
\".\"\".\"\".\"\".\" blood-clotsAny history of blood clots?1..1boolean
\".\"\".\"\".\"\".\" family-seizuresAny history of close relatives with seizures?1..1boolean
\".\"\".\"\".\"\".\" bisphosphonateAre you currently on Bis-Phosphonate (for example, Fosamax, Boniva, or Reclast)?1..1boolean
\".\"\".\"\".\"\".\" seizure-medsAre you currently on any medication that might increase chances of seizures?1..1boolean
\".\"\".\"\".\" experience-backgroundExperience and Background0..1group
\".\"\".\"\".\"\".\" vr-experienceHave you ever experienced virtual reality?1..1boolean
\".\"\".\"\".\"\".\" military-backgroundDo you have a military background?1..1boolean
\".\"\".\"\".\"\".\" educationWhat is your highest level of education in a STEM related field?1..1choiceOptions: 5 options
\".\"\".\"\".\"\".\" employmentEmployment Status1..1choiceOptions: 5 options
\".\"\".\"\".\"\".\" referral-sourceHow did you hear about HERA?1..1choiceOptions: 7 options
\".\"\".\"\".\" additional-infoPlease provide any additional information you wish us to consider in your application0..1textMax Length: 500
\".\"\".\"\".\" submission-consentSubmitting voluntary information constitutes your consent to the use of the information for the stated purpose. By submitting this form, you are providing voluntary consent to use the information submitted for the purpose stated. The final determination for clearance is the responsibility of NASA. You may be provided the opportunity to personally explain, refute, or clarify any information before a final decision is made.0..1display
\".\"\".\"\".\" process-infoTypically, all applicants will be contacted within 5 to 7 business days following the submission of this application regarding its status. Eligible applicants may then be asked to provide additional screening information such as a professional resume or CV and must pass a federal background check.0..1display

\"doco\" 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 tobacco-nicotine

  • None
  • Smoking
  • Vaping
  • Chewing
  • Skin Patches
  • Other

Answer options for allergies-gi-diet

  • Allergies (including food)
  • GI Disorders
  • Dietary Limitations

Answer options for education

  • Bachelor
  • Master of Science
  • PhD
  • Medical Doctor
  • Other

Answer options for employment

  • US Civil Servant
  • Government Contractor
  • Military
  • Other
  • Unemployed

Answer options for referral-source

  • Professional Organization
  • Recruitment Announcement
  • Conference
  • Social Media
  • Referred by Friend or Colleague
  • Online Search
  • Other
"^^rdf:XMLLiteral ] ] ; # fhir:url [ fhir:v "http://example.org/Questionnaire/hera-analog-mission-application"^^xsd:anyURI ; fhir:l ] ; # fhir:version [ fhir:v "0.5.12"] ; # fhir:name [ fhir:v "HERAAnalogMissionApplication"] ; # fhir:title [ fhir:v "NASA HERA Analog Mission Application"] ; # fhir:status [ fhir:v "active"] ; # fhir:subjectType ( [ fhir:v "Patient"] ) ; # fhir:date [ fhir:v "2025-05-18"^^xsd:date] ; # fhir:publisher [ fhir:v "MITRE"] ; # fhir:contact ( [ fhir:name [ fhir:v "MITRE" ] ; fhir:telecom ( [ fhir:system [ fhir:v "url" ] ; fhir:value [ fhir:v "https://www.mitre.org/" ] ] ) ] ) ; # fhir:description [ fhir:v "Application for the Human Exploration Research Analog (HERA) mission at NASA Johnson Space Center"] ; # fhir:purpose [ fhir:v "To determine eligibility for the Flight Analog Project, including initial screening and evaluation to become a ground study subject."] ; # fhir:copyright [ fhir:v "This information collection meets the requirements of 44 U.S.C 3507. OMB control number 2700-0174, expires 04/30/2026."] ; # fhir:item ( [ fhir:linkId [ fhir:v "intro" ] ; fhir:text [ fhir:v "Application for Analog Missions. Additional information regarding HERA studies at the Johnson Space Center including a video tour of the HERA facility can be found on the NASA website. Before applying to be a study participant we ask that you review this information for a better understanding of what your participation would entail if chosen as a subject for a future HERA mission." ] ; fhir:type [ fhir:v "display" ] ] [ fhir:linkId [ fhir:v "privacy-statement" ] ; fhir:text [ fhir:v "Privacy Act Statement: Pursuant to the Privacy Act of 1974, 5 U.S.C. § 552a, the following statement is furnished to individuals applying to become ground study subjects for the Flight Analog Project. Authority: This collection is authorized by 51 U.S.C. 20113(a) and 44 U.S.C. 3101. Purpose: We will use the information to determine eligibility for the Flight Analog Project. Effect of Nondisclosure: Supplying the information is voluntary on your part. However, failing to provide all or part of the information may prevent an accurate and timely decision on your application." ] ; fhir:type [ fhir:v "display" ] ] [ fhir:linkId [ fhir:v "consent" ] ; fhir:text [ fhir:v "By submitting this form, you consent to adding your responses to the analog subject registry. After reviewing your responses, further information may be requested. You may withdraw your information from this registry at any time by sending an e-mail to the recruitment team." ] ; fhir:type [ fhir:v "display" ] ] [ fhir:linkId [ fhir:v "citizenship" ] ; fhir:text [ fhir:v "Are you a United States citizen?" ] ; fhir:type [ fhir:v "boolean" ] ; fhir:required [ fhir:v true ] ] [ fhir:linkId [ fhir:v "confinement-consent" ] ; fhir:text [ fhir:v "For HERA missions, are you willing to be confined and isolated for required periods of time?" ] ; fhir:type [ fhir:v "boolean" ] ; fhir:required [ fhir:v true ] ; fhir:item ( [ fhir:linkId [ fhir:v "confinement-details" ] ; fhir:text [ fhir:v "HERA mission duration includes a confined isolation of 45 days. In addition to the isolation phase, each mission includes 16 days of pre-mission data collection and training and 7 days of post-mission data collection, requiring a stay in Houston, TX of up to 72 days." ] ; fhir:type [ fhir:v "display" ] ] ) ] [ fhir:linkId [ fhir:v "demographic-info" ] ; fhir:text [ fhir:v "Demographic Information" ] ; fhir:type [ fhir:v "group" ] ; fhir:required [ fhir:v true ] ; fhir:item ( [ fhir:linkId [ fhir:v "firstName" ] ; fhir:text [ fhir:v "First Name" ] ; fhir:type [ fhir:v "string" ] ; fhir:required [ fhir:v true ] ] [ fhir:linkId [ fhir:v "middleName" ] ; fhir:text [ fhir:v "Middle Name" ] ; fhir:type [ fhir:v "string" ] ] [ fhir:linkId [ fhir:v "lastName" ] ; fhir:text [ fhir:v "Last Name" ] ; fhir:type [ fhir:v "string" ] ; fhir:required [ fhir:v true ] ] [ fhir:linkId [ fhir:v "phoneNumber" ] ; fhir:text [ fhir:v "Phone Number" ] ; fhir:type [ fhir:v "string" ] ; fhir:required [ fhir:v true ] ] [ fhir:linkId [ fhir:v "emailAddress" ] ; fhir:text [ fhir:v "Email Address" ] ; fhir:type [ fhir:v "string" ] ; fhir:required [ fhir:v true ] ] [ fhir:linkId [ fhir:v "confirmEmailAddress" ] ; fhir:text [ fhir:v "Confirm Email Address" ] ; fhir:type [ fhir:v "string" ] ; fhir:required [ fhir:v true ] ] ) ] [ fhir:linkId [ fhir:v "age-check" ] ; fhir:text [ fhir:v "Are you currently between the ages of 28 and 55?" ] ; fhir:type [ fhir:v "boolean" ] ; fhir:required [ fhir:v true ] ] [ fhir:linkId [ fhir:v "birthdate" ] ; fhir:text [ fhir:v "Birthdate" ] ; fhir:type [ fhir:v "date" ] ; fhir:required [ fhir:v true ] ] [ fhir:linkId [ fhir:v "sex" ] ; fhir:text [ fhir:v "Sex" ] ; fhir:type [ fhir:v "choice" ] ; fhir:required [ fhir:v true ] ; fhir:answerOption ( [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://hl7.org/fhir/administrative-gender"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "male" ] ; fhir:display [ fhir:v "Male" ] ] ] [ fhir:value [ a fhir:Coding ; fhir:system [ fhir:v "http://hl7.org/fhir/administrative-gender"^^xsd:anyURI ; fhir:l ] ; fhir:code [ fhir:v "female" ] ; fhir:display [ fhir:v "Female" ] ] ] ) ] [ fhir:linkId [ fhir:v "height" ] ; fhir:text [ fhir:v "Height (in inches). For HERA missions, height not to exceed 6' 2\" (74 inches)" ] ; fhir:type [ fhir:v "decimal" ] ; fhir:required [ fhir:v true ] ] [ fhir:linkId [ fhir:v "weight" ] ; fhir:text [ fhir:v "Weight (in pounds)" ] ; fhir:type [ fhir:v "decimal" ] ; fhir:required [ fhir:v true ] ] [ fhir:linkId [ fhir:v "born-outside-us" ] ; fhir:text [ fhir:v "Were you born outside of the United States?" ] ; fhir:type [ fhir:v "boolean" ] ; fhir:required [ fhir:v true ] ] [ fhir:linkId [ fhir:v "other-citizenship" ] ; fhir:text [ fhir:v "Do you hold citizenship in any country other than the United States?" ] ; fhir:type [ fhir:v "boolean" ] ; fhir:required [ fhir:v true ] ] [ fhir:linkId [ fhir:v "tobacco-nicotine" ] ; fhir:text [ fhir:v "Do you use any tobacco or nicotine products (select all that apply)?" ] ; fhir:type [ fhir:v "choice" ] ; fhir:required [ fhir:v true ] ; fhir:repeats [ fhir:v true ] ; fhir:answerOption ( [ fhir:value [ a fhir:String ; fhir:v "None" ] ] [ fhir:value [ a fhir:String ; fhir:v "Smoking" ] ] [ fhir:value [ a fhir:String ; fhir:v "Vaping" ] ] [ fhir:value [ a fhir:String ; fhir:v "Chewing" ] ] [ fhir:value [ a fhir:String ; fhir:v "Skin Patches" ] ] [ fhir:value [ a fhir:String ; fhir:v "Other" ] ] ) ] [ fhir:linkId [ fhir:v "medical-section" ] ; fhir:text [ fhir:v "Medical History" ] ; fhir:type [ fhir:v "group" ] ; fhir:required [ fhir:v true ] ; fhir:item ( [ fhir:linkId [ fhir:v "metal-in-body" ] ; fhir:text [ fhir:v "Do you have any metal in your body other than dental work?" ] ; fhir:type [ fhir:v "boolean" ] ; fhir:required [ fhir:v true ] ] [ fhir:linkId [ fhir:v "claustrophobia" ] ; fhir:text [ fhir:v "Are you claustrophobic?" ] ; fhir:type [ fhir:v "boolean" ] ; fhir:required [ fhir:v true ] ] [ fhir:linkId [ fhir:v "allergies-gi-diet" ] ; fhir:text [ fhir:v "Do you have any of the following?" ] ; fhir:type [ fhir:v "choice" ] ; fhir:repeats [ fhir:v true ] ; fhir:answerOption ( [ fhir:value [ a fhir:String ; fhir:v "Allergies (including food)" ] ] [ fhir:value [ a fhir:String ; fhir:v "GI Disorders" ] ] [ fhir:value [ a fhir:String ; fhir:v "Dietary Limitations" ] ] ) ] [ fhir:linkId [ fhir:v "cardiovascular" ] ; fhir:text [ fhir:v "Any cardiovascular or circulatory system issues?" ] ; fhir:type [ fhir:v "boolean" ] ; fhir:required [ fhir:v true ] ] [ fhir:linkId [ fhir:v "neurological" ] ; fhir:text [ fhir:v "Any neurological problems?" ] ; fhir:type [ fhir:v "boolean" ] ; fhir:required [ fhir:v true ] ] [ fhir:linkId [ fhir:v "musculoskeletal" ] ; fhir:text [ fhir:v "Any musculoskeletal problems?" ] ; fhir:type [ fhir:v "boolean" ] ; fhir:required [ fhir:v true ] ] [ fhir:linkId [ fhir:v "medications" ] ; fhir:text [ fhir:v "Are you taking any medications?" ] ; fhir:type [ fhir:v "boolean" ] ; fhir:required [ fhir:v true ] ] [ fhir:linkId [ fhir:v "sleep-disorders" ] ; fhir:text [ fhir:v "Any sleep disorders such as sleep walking or use of sleep aids?" ] ; fhir:type [ fhir:v "boolean" ] ; fhir:required [ fhir:v true ] ] [ fhir:linkId [ fhir:v "psychiatric" ] ; fhir:text [ fhir:v "Any psychiatric disorders or history of mental illness?" ] ; fhir:type [ fhir:v "boolean" ] ; fhir:required [ fhir:v true ] ] [ fhir:linkId [ fhir:v "motion-sickness" ] ; fhir:text [ fhir:v "Any motion sickness (not a disqualifier)?" ] ; fhir:type [ fhir:v "boolean" ] ; fhir:required [ fhir:v true ] ] [ fhir:linkId [ fhir:v "adhd-treatment" ] ; fhir:text [ fhir:v "Any pharmacological treatment for ADHD?" ] ; fhir:type [ fhir:v "boolean" ] ; fhir:required [ fhir:v true ] ] [ fhir:linkId [ fhir:v "kidney-stones" ] ; fhir:text [ fhir:v "Any history of kidney stones?" ] ; fhir:type [ fhir:v "boolean" ] ; fhir:required [ fhir:v true ] ] [ fhir:linkId [ fhir:v "ulcers" ] ; fhir:text [ fhir:v "Any history of ulcers?" ] ; fhir:type [ fhir:v "boolean" ] ; fhir:required [ fhir:v true ] ] [ fhir:linkId [ fhir:v "epilepsy" ] ; fhir:text [ fhir:v "Any history of epilepsy or other disorders of the brain?" ] ; fhir:type [ fhir:v "boolean" ] ; fhir:required [ fhir:v true ] ] [ fhir:linkId [ fhir:v "blood-clots" ] ; fhir:text [ fhir:v "Any history of blood clots?" ] ; fhir:type [ fhir:v "boolean" ] ; fhir:required [ fhir:v true ] ] [ fhir:linkId [ fhir:v "family-seizures" ] ; fhir:text [ fhir:v "Any history of close relatives with seizures?" ] ; fhir:type [ fhir:v "boolean" ] ; fhir:required [ fhir:v true ] ] [ fhir:linkId [ fhir:v "bisphosphonate" ] ; fhir:text [ fhir:v "Are you currently on Bis-Phosphonate (for example, Fosamax, Boniva, or Reclast)?" ] ; fhir:type [ fhir:v "boolean" ] ; fhir:required [ fhir:v true ] ] [ fhir:linkId [ fhir:v "seizure-meds" ] ; fhir:text [ fhir:v "Are you currently on any medication that might increase chances of seizures?" ] ; fhir:type [ fhir:v "boolean" ] ; fhir:required [ fhir:v true ] ] ) ] [ fhir:linkId [ fhir:v "experience-background" ] ; fhir:text [ fhir:v "Experience and Background" ] ; fhir:type [ fhir:v "group" ] ; fhir:item ( [ fhir:linkId [ fhir:v "vr-experience" ] ; fhir:text [ fhir:v "Have you ever experienced virtual reality?" ] ; fhir:type [ fhir:v "boolean" ] ; fhir:required [ fhir:v true ] ] [ fhir:linkId [ fhir:v "military-background" ] ; fhir:text [ fhir:v "Do you have a military background?" ] ; fhir:type [ fhir:v "boolean" ] ; fhir:required [ fhir:v true ] ] [ fhir:linkId [ fhir:v "education" ] ; fhir:text [ fhir:v "What is your highest level of education in a STEM related field?" ] ; fhir:type [ fhir:v "choice" ] ; fhir:required [ fhir:v true ] ; fhir:answerOption ( [ fhir:value [ a fhir:String ; fhir:v "Bachelor" ] ] [ fhir:value [ a fhir:String ; fhir:v "Master of Science" ] ] [ fhir:value [ a fhir:String ; fhir:v "PhD" ] ] [ fhir:value [ a fhir:String ; fhir:v "Medical Doctor" ] ] [ fhir:value [ a fhir:String ; fhir:v "Other" ] ] ) ] [ fhir:linkId [ fhir:v "employment" ] ; fhir:text [ fhir:v "Employment Status" ] ; fhir:type [ fhir:v "choice" ] ; fhir:required [ fhir:v true ] ; fhir:answerOption ( [ fhir:value [ a fhir:String ; fhir:v "US Civil Servant" ] ] [ fhir:value [ a fhir:String ; fhir:v "Government Contractor" ] ] [ fhir:value [ a fhir:String ; fhir:v "Military" ] ] [ fhir:value [ a fhir:String ; fhir:v "Other" ] ] [ fhir:value [ a fhir:String ; fhir:v "Unemployed" ] ] ) ] [ fhir:linkId [ fhir:v "referral-source" ] ; fhir:text [ fhir:v "How did you hear about HERA?" ] ; fhir:type [ fhir:v "choice" ] ; fhir:required [ fhir:v true ] ; fhir:answerOption ( [ fhir:value [ a fhir:String ; fhir:v "Professional Organization" ] ] [ fhir:value [ a fhir:String ; fhir:v "Recruitment Announcement" ] ] [ fhir:value [ a fhir:String ; fhir:v "Conference" ] ] [ fhir:value [ a fhir:String ; fhir:v "Social Media" ] ] [ fhir:value [ a fhir:String ; fhir:v "Referred by Friend or Colleague" ] ] [ fhir:value [ a fhir:String ; fhir:v "Online Search" ] ] [ fhir:value [ a fhir:String ; fhir:v "Other" ] ] ) ] ) ] [ fhir:linkId [ fhir:v "additional-info" ] ; fhir:text [ fhir:v "Please provide any additional information you wish us to consider in your application" ] ; fhir:type [ fhir:v "text" ] ; fhir:maxLength [ fhir:v 500 ] ] [ fhir:linkId [ fhir:v "submission-consent" ] ; fhir:text [ fhir:v "Submitting voluntary information constitutes your consent to the use of the information for the stated purpose. By submitting this form, you are providing voluntary consent to use the information submitted for the purpose stated. The final determination for clearance is the responsibility of NASA. You may be provided the opportunity to personally explain, refute, or clarify any information before a final decision is made." ] ; fhir:type [ fhir:v "display" ] ] [ fhir:linkId [ fhir:v "process-info" ] ; fhir:text [ fhir:v "Typically, all applicants will be contacted within 5 to 7 business days following the submission of this application regarding its status. Eligible applicants may then be asked to provide additional screening information such as a professional resume or CV and must pass a federal background check." ] ; fhir:type [ fhir:v "display" ] ] ) . # # -------------------------------------------------------------------------------------