MEDB110OphthalmologicExamQuestionnaire
type: Questionnaire
node role: treeRoot
id:
  v: MEDB110OphthalmologicExamQuestionnaire
text:
  status:
    v: extensions
  div:
    v: Generated Narrative: Questionnaire MEDB110OphthalmologicExamQuestionnaire Structure LinkID Text Cardinality Type Flags Description & Constraints<img src="[binary]" alt="doco" style="background-color: inherit"/> MEDB110OphthalmologicExam NASA Medical Requirements Integration Document for ophthalmologic examination. Captures comprehensive eye examination data for monitoring Spaceflight Associated Neuro-ocular Syndrome (SANS). Questionnaire https://mitre.org/fhir/space-health/Questionnaire/medb-1-10-ophthalmologic-exam#0.5.12 #xD; overview Medical Requirements Overview 0..1 group #xD; overview.mrid-number MRID Number and Title 0..1 display Initial Value: string = MEDB 1.10 Ophthalmologic Examination #xD; overview.sponsor Sponsor 1..1 choice Options: 1 option Initial Value: Coding = NASA MRID Sponsor Organizations#medical-operations "Medical Operations" #xD; overview.discipline Discipline 1..1 choice Options: 1 option Initial Value: Coding = NASA MRID Medical Disciplines#ophthalmology "Ophthalmology" #xD; overview.purpose Purpose/Objectives 1..1 text Initial Value: string = To assess pre- and postflight ocular status, establish baseline measurements, and monitor for Spaceflight Associated Neuro-ocular Syndrome (SANS) including optic disc edema, globe flattening, choroidal folds, and refractive changes. #xD; overview.measurement-parameters Measurement Parameters 1..1 string Initial Value: string = Visual acuity, refraction, IOP, fundoscopy, OCT, visual fields #xD; overview.flight-duration Flight Duration 1..1 string Initial Value: string = >= 30 days #xD; preflight-training Preflight Training 0..1 group #xD; preflight-training.na No Preflight Training Required 0..1 display #xD; preflight-activities Preflight Activities 0..1 group #xD; preflight-activities.description Activity Description 0..1 text Initial Value: string = Comprehensive ophthalmologic examination including visual acuity, refraction, intraocular pressure, slit lamp examination, dilated fundoscopy, optical c…
extension:
  extension:
    url:
      v: name
      l: name
    value: Coding
      system:
        v: http://hl7.org/fhir/uv/sdc/CodeSystem/launchContext
        l: launchContext
      code:
        v: patient
  extension:
    url:
      v: type
      l: type
    value: Code
      v: Patient
  extension:
    url:
      v: description
      l: description
    value: String
      v: The astronaut/crewmember subject of this medical requirement
  url:
    v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-launchContext
    l: sdc-questionnaire-launchContext
url:
  v: https://mitre.org/fhir/space-health/Questionnaire/medb-1-10-ophthalmologic-exam
  l: medb-1-10-ophthalmologic-exam
version:
  v: 0.5.12
name:
  v: MEDB110OphthalmologicExam
title:
  v: MEDB 1.10 Ophthalmologic Examination
status:
  v: active
date:
  v: 2017-06-05
publisher:
  v: MITRE
contact:
  name:
    v: MITRE
  telecom:
    system:
      v: url
    value:
      v: https://www.mitre.org/
description:
  v: NASA Medical Requirements Integration Document for ophthalmologic examination. Captures comprehensive eye examination data for monitoring Spaceflight Associated Neuro-ocular Syndrome (SANS).
purpose:
  v: To assess pre- and postflight ocular status and monitor for Spaceflight Associated Neuro-ocular Syndrome (SANS)
copyright:
  v: NASA Johnson Space Center - Medical Requirements Integration Documents (MRIDs) JSC28913
item:
  link id:
    v: overview
  text:
    v: Medical Requirements Overview
  type:
    v: group
  item:
    link id:
      v: overview.mrid-number
    text:
      v: MRID Number and Title
    type:
      v: display
    initial:
      value: String
        v: MEDB 1.10 Ophthalmologic Examination
  item:
    link id:
      v: overview.sponsor
    text:
      v: Sponsor
    type:
      v: choice
    required:
      v: true
    read only:
      v: true
    answer option:
      value: Coding
    initial:
      value: Coding
  item:
    link id:
      v: overview.discipline
    text:
      v: Discipline
    type:
      v: choice
    required:
      v: true
    read only:
      v: true
    answer option:
      value: Coding
    initial:
      value: Coding
  item:
    link id:
      v: overview.purpose
    text:
      v: Purpose/Objectives
    type:
      v: text
    required:
      v: true
    initial:
      value: String
        v: To assess pre- and postflight ocular status, establish baseline measurements, and monitor for Spaceflight Associated Neuro-ocular Syndrome (SANS) including optic disc edema, globe flattening, choroidal folds, and refractive changes.
  item:
    link id:
      v: overview.measurement-parameters
    text:
      v: Measurement Parameters
    type:
      v: string
    required:
      v: true
    initial:
      value: String
        v: Visual acuity, refraction, IOP, fundoscopy, OCT, visual fields
  item:
    link id:
      v: overview.flight-duration
    text:
      v: Flight Duration
    type:
      v: string
    required:
      v: true
    initial:
      value: String
        v: >= 30 days
item:
  link id:
    v: preflight-training
  text:
    v: Preflight Training
  type:
    v: group
  item:
    link id:
      v: preflight-training.na
    text:
      v: No Preflight Training Required
    type:
      v: display
item:
  link id:
    v: preflight-activities
  text:
    v: Preflight Activities
  type:
    v: group
  item:
    link id:
      v: preflight-activities.description
    text:
      v: Activity Description
    type:
      v: text
    initial:
      value: String
        v: Comprehensive ophthalmologic examination including visual acuity, refraction, intraocular pressure, slit lamp examination, dilated fundoscopy, optical coherence tomography (OCT), and visual field testing.
  item:
    link id:
      v: preflight-activities.duration
    text:
      v: Duration (minutes)
    type:
      v: integer
    required:
      v: true
    initial:
      value: Integer
        v: 90
  item:
    link id:
      v: preflight-activities.schedule
    text:
      v: Schedule
    type:
      v: string
    required:
      v: true
    initial:
      value: String
        v: AME L-9/6 m, L-90 to L-30 days

v: medical-operations

v: Medical Operations

v: medical-operations

v: Medical Operations

v: ophthalmology

v: Ophthalmology

v: ophthalmology

v: Ophthalmology

link id:
  v: preflight-activities.location
text:
  v: Test Location
type:
  v: choice
required:
  v: true
answer option:
  value: Coding
    system:
      v: https://mitre.org/fhir/space-health/CodeSystem/nasa-medical-facility-cs
      l: nasa-medical-facility-cs
    code:
      v: jsc
    display:
      v: Johnson Space Center
initial:
  value: Coding
    system:
      v: https://mitre.org/fhir/space-health/CodeSystem/nasa-medical-facility-cs
      l: nasa-medical-facility-cs
    code:
      v: jsc
    display:
      v: Johnson Space Center

link id:
  v: preflight-activities.test-date
text:
  v: Preflight Exam Date
type:
  v: date

link id:
  v: preflight-activities.test-completed
text:
  v: Preflight Exam Completed
type:
  v: boolean
required:
  v: true

link id:
  v: preflight-ophth-results
text:
  v: Preflight Ophthalmologic Results
type:
  v: group
item:
  link id:
    v: preflight-ophth-results.visual-acuity
  text:
    v: Visual Acuity
  type:
    v: group
  item:
    link id:
      v: preflight-ophth-results.visual-acuity.right-uncorrected
    code: https://loinc.org/rdf/79880-1
      system:
        v: http://loinc.org
        l: loinc.org
      code:
        v: 79880-1
      display:
        v: Visual acuity uncorrected Right eye
    text:
      v: Right Eye Uncorrected
    type:
      v: string
  item:
    link id:
      v: preflight-ophth-results.visual-acuity.right-corrected
    code: https://loinc.org/rdf/79881-9
      system:
        v: http://loinc.org
        l: loinc.org
      code:
        v: 79881-9
      display:
        v: Visual acuity best corrected Right eye
    text:
      v: Right Eye Best Corrected
    type:
      v: string
  item:
    link id:
      v: preflight-ophth-results.visual-acuity.left-uncorrected
    code: https://loinc.org/rdf/79882-7
      system:
        v: http://loinc.org
        l: loinc.org
      code:
        v: 79882-7
      display:
        v: Visual acuity uncorrected Left eye
    text:
      v: Left Eye Uncorrected
    type:
      v: string
  item:
    link id:
      v: preflight-ophth-results.visual-acuity.left-corrected
    code: https://loinc.org/rdf/79883-5
      system:
        v: http://loinc.org
        l: loinc.org
      code:
        v: 79883-5
      display:
        v: Visual acuity best corrected Left eye
    text:
      v: Left Eye Best Corrected
    type:
      v: string
item:
  link id:
    v: preflight-ophth-results.refraction
  text:
    v: Refraction
  type:
    v: group
  item:
    link id:
      v: preflight-ophth-results.refraction.right-sphere
    text:
      v: Right Eye Sphere (D)
    type:
      v: decimal
  item:
    link id:
      v: preflight-ophth-results.refraction.right-cylinder
    text:
      v: Right Eye Cylinder (D)
    type:
      v: decimal
  item:
    link id:
      v: preflight-ophth-results.refraction.right-axis
    text:
      v: Right Eye Axis (degrees)
    type:
      v: integer
  item:
    link id:
      v: preflight-ophth-results.refraction.left-sphere
    text:
      v: Left Eye Sphere (D)
    type:
      v: decimal
  item:
    link id:
      v: preflight-ophth-results.refraction.left-cylinder
    text:
      v: Left Eye Cylinder (D)
    type:
      v: decimal
  item:
    link id:
      v: preflight-ophth-results.refraction.left-axis
    text:
      v: Left Eye Axis (degrees)
    type:
      v: integer
item:
  link id:
    v: preflight-ophth-results.iop
  text:
    v: Intraocular Pressure
  type:
    v: group
  item:
    link id:
      v: preflight-ophth-results.iop.right
    code: https://loinc.org/rdf/79893-4
      system:
        v: http://loinc.org
        l: loinc.org
      code:
        v: 79893-4
      display:
        v: Intraocular pressure of Eye - right
    text:
      v: Right Eye IOP (mmHg)
    type:
      v: integer
  item:
    link id:
      v: preflight-ophth-results.iop.left
    code: https://loinc.org/rdf/79892-6
      system:
        v: http://loinc.org
        l: loinc.org
      code:
        v: 79892-6
      display:
        v: Intraocular pressure of Eye - left
    text:
      v: Left Eye IOP (mmHg)
    type:
      v: integer
item:
  link id:
    v: preflight-ophth-results.fundoscopy
  text:
    v: Fundoscopy Findings
  type:
    v: group
  item:
    link id:
      v: preflight-ophth-results.fundoscopy.optic-disc-right
    text:
      v: Optic Disc Right Eye
    type:
      v: choice
    answer option:
      value: Coding
        type: http://snomed.info/id/17621005
    answer option:
      value: Coding
        type: http://snomed.info/id/423341008
    answer option:
      value: Coding
        type: http://snomed.info/id/263654008
  item:
    link id:
      v: preflight-ophth-results.fundoscopy.optic-disc-left
    text:
      v: Optic Disc Left Eye
    type:
      v: choice
    answer option:
      value: Coding
        type: http://snomed.info/id/17621005
    answer option:
      value: Coding
        type: http://snomed.info/id/423341008
    answer option:
      value: Coding
        type: http://snomed.info/id/263654008
  item:
    link id:
      v: preflight-ophth-results.fundoscopy.choroidal-folds
    text:
      v: Choroidal Folds Present

v: 17621005

v: Normal

v: 423341008

v: Optic disc edema

v: 263654008

v: Abnormal

v: 17621005

v: Normal

v: 423341008

v: Optic disc edema

v: 263654008

v: Abnormal

v: boolean

link id:
  v: preflight-ophth-results.fundoscopy.globe-flattening
text:
  v: Globe Flattening Present
type:
  v: boolean

link id:
  v: preflight-ophth-results.oct
text:
  v: OCT Measurements
type:
  v: group
item:
  link id:
    v: preflight-ophth-results.oct.rnfl-right
  text:
    v: Right Eye RNFL Average (microns)
  type:
    v: decimal
item:
  link id:
    v: preflight-ophth-results.oct.rnfl-left
  text:
    v: Left Eye RNFL Average (microns)
  type:
    v: decimal
item:
  link id:
    v: preflight-ophth-results.oct.total-retinal-thickness-right
  text:
    v: Right Eye Total Retinal Thickness (microns)
  type:
    v: decimal
item:
  link id:
    v: preflight-ophth-results.oct.total-retinal-thickness-left
  text:
    v: Left Eye Total Retinal Thickness (microns)
  type:
    v: decimal

link id:
  v: preflight-ophth-results.interpretation
text:
  v: Overall Ophthalmologic Interpretation
type:
  v: choice
answer option:
  value: Coding
    type: http://snomed.info/id/17621005
    system:
      v: http://snomed.info/sct
      l: sct
    code:
      v: 17621005
    display:
      v: Normal
answer option:
  value: Coding
    type: http://snomed.info/id/263654008
    system:
      v: http://snomed.info/sct
      l: sct
    code:
      v: 263654008
    display:
      v: Abnormal

link id:
  v: preflight-ophth-results.notes
text:
  v: Examination Notes
type:
  v: text

link id:
  v: inflight-activities
text:
  v: In-Flight Activities
type:
  v: group
item:
  link id:
    v: inflight-activities.description
  text:
    v: Activity Description
  type:
    v: text
  initial:
    value: String
      v: Fundoscopy using Fundoscope onboard ISS. Images reviewed by ground team for SANS monitoring.
item:
  link id:
    v: inflight-activities.schedule
  text:
    v: Schedule
  type:
    v: string
  initial:
    value: String
      v: Monthly during mission
item:
  link id:
    v: inflight-activities.fundoscopy-completed
  text:
    v: In-flight Fundoscopy Completed
  type:
    v: boolean
item:
  link id:
    v: inflight-activities.sans-suspected
  text:
    v: SANS Findings Suspected In-Flight
  type:
    v: boolean

link id:
  v: postflight-activities
text:
  v: Postflight Activities
type:
  v: group
item:
  link id:
    v: postflight-activities.schedule
  text:
    v: Schedule
  type:
    v: string
  initial:
    value: String
      v: R+1 to R+3 days, R+30 days, R+180 days
item:
  link id:
    v: postflight-activities.test-date
  text:
    v: Postflight Exam Date (Initial)
  type:
    v: date
item:
  link id:
    v: postflight-activities.test-completed
  text:
    v: Postflight Exam Completed
  type:
    v: boolean
  required:
    v: true

link id:
  v: postflight-ophth-results
text:
  v: Postflight Ophthalmologic Results
type:
  v: group
item:
  link id:
    v: postflight-ophth-results.visual-acuity
  text:
    v: Visual Acuity
  type:
    v: group
  item:
    link id:
      v: postflight-ophth-results.visual-acuity.right-corrected
    text:
      v: Right Eye Best Corrected
    type:
      v: string
  item:
    link id:
      v: postflight-ophth-results.visual-acuity.left-corrected
    text:
      v: Left Eye Best Corrected
    type:
      v: string
item:
  link id:
    v: postflight-ophth-results.iop
  text:
    v: Intraocular Pressure
  type:
    v: group
  item:
    link id:
      v: postflight-ophth-results.iop.right
    text:
      v: Right Eye IOP (mmHg)
    type:
      v: integer
  item:
    link id:
      v: postflight-ophth-results.iop.left
    text:
      v: Left Eye IOP (mmHg)
    type:
      v: integer
item:
  link id:
    v: postflight-ophth-results.sans-assessment
  text:
    v: SANS Assessment
  type:
    v: group
  item:
    link id:
      v: postflight-ophth-results.sans-assessment.optic-disc-edema
    text:
      v: Optic Disc Edema Present
    type:
      v: boolean
  item:
    link id:
      v: postflight-ophth-results.sans-assessment.globe-flattening
    text:
      v: Globe Flattening Present
    type:
      v: boolean
  item:
    link id:
      v: postflight-ophth-results.sans-assessment.choroidal-folds
    text:
      v: Choroidal Folds Present
    type:
      v: boolean
  item:
    link id:
      v: postflight-ophth-results.sans-assessment.hyperopic-shift
    text:
      v: Hyperopic Shift Present
    type:
      v: boolean
  item:
    link id:
      v: postflight-ophth-results.sans-assessment.cotton-wool-spots
    text:
      v: Cotton Wool Spots Present
    type:
      v: boolean
  item:
    link id:
      v: postflight-ophth-results.sans-assessment.sans-grade
    text:
      v: SANS Grade
    type:
      v: choice
    answer option:
      value: String
        v: No SANS
    answer option:
      value: String
        v: Grade 1 - Mild
    answer option:
      value: String
        v: Grade 2 - Moderate
    answer option:
      value: String
        v: Grade 3 - Severe
item:
  link id:
    v: postflight-ophth-results.comparison
  text:
    v: Comparison to Preflight
  type:
    v: choice
  answer option:
    value: String
      v: No significant change
  answer option:
    value: String
      v: SANS findings present
  answer option:
    value: String
      v: Other changes
item:
  link id:
    v: postflight-ophth-results.notes
  text:
    v: Examination Notes
  type:
    v: text

link id:
  v: data-delivery
text:
  v: Data Delivery
type:
  v: group
item:
  link id:
    v: data-delivery.archive
  text:
    v: Data Archive Systems
  type:
    v: choice
  repeats:
    v: true
  answer option:
    value: Coding
      system:
        v: https://mitre.org/fhir/space-health/CodeSystem/nasa-data-archive-cs
        l: nasa-data-archive-cs
      code:
        v: pacs
      display:
        v: Picture Archiving and Communication System
  answer option:
    value: Coding
      system:
        v: https://mitre.org/fhir/space-health/CodeSystem/nasa-data-archive-cs
        l: nasa-data-archive-cs
      code:
        v: mmis
      display:
        v: Medical Mission Information System

link id:
  v: postflight-debrief
text:
  v: Postflight Debrief
type:
  v: group
item:
  link id:
    v: postflight-debrief.na
  text:
    v: N/A - Included as part of Medical Operations overall debrief
  type:
    v: display