{ "resourceType" : "Questionnaire", "id" : "MEDB23TBTestingQuestionnaire", "text" : { "status" : "extensions", "div" : "

Generated Narrative: Questionnaire MEDB23TBTestingQuestionnaire

Structure\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
LinkIDTextCardinalityTypeFlagsDescription & Constraints\"doco\"
\".\"\".\" MEDB23TBTestingNASA Medical Requirements Integration Document for tuberculosis screening. Screens crew members for TB infection prior to spaceflight.Questionnairehttps://mitre.org/fhir/space-health/Questionnaire/medb-2-3-tb-testing#0.5.12
\".\"\".\"\".\" overviewMedical Requirements Overview0..1group
\".\"\".\"\".\"\".\" overview.mrid-numberMRID Number and Title0..1displayInitial Value: string = MEDB 2.3 Tuberculosis Testing
\".\"\".\"\".\"\".\" overview.sponsorSponsor1..1choice\"icon\"/\"icon\"/Options: 1 option
Initial Value: Coding = NASA MRID Sponsor Organizations#medical-operations "Medical Operations"
\".\"\".\"\".\"\".\" overview.purposePurpose/Objectives0..1textInitial Value: string = To screen crew members for latent or active tuberculosis infection prior to spaceflight.
\".\"\".\"\".\"\".\" overview.flight-durationFlight Duration0..1stringInitial Value: string = All flights
\".\"\".\"\".\" preflight-activitiesPreflight Activities0..1group
\".\"\".\"\".\"\".\" preflight-activities.scheduleSchedule0..1stringInitial Value: string = Annual medical examination
\".\"\".\"\".\"\".\" preflight-activities.test-dateTest Date0..1date
\".\"\".\"\".\"\".\" preflight-activities.test-completedTest Completed1..1boolean
\".\"\".\"\".\" tb-resultsTB Test Results0..1group
\".\"\".\"\".\"\".\" tb-results.test-typeTest Type0..1choiceOptions: 4 options
\".\"\".\"\".\"\".\" tb-results.resultTest Result0..1choiceOptions: 3 options
\".\"\".\"\".\"\".\" tb-results.tst-indurationTST Induration (mm)0..1integerEnable When: tb-results.test-type =
\".\"\".\"\".\"\".\" tb-results.chest-xray-requiredChest X-ray Required0..1booleanEnable When: tb-results.result =
\".\"\".\"\".\"\".\" tb-results.chest-xray-resultChest X-ray Result0..1choiceEnable When: tb-results.chest-xray-required =
Options: 2 options
\".\"\".\"\".\"\".\" tb-results.treatment-requiredTreatment Required0..1boolean
\".\"\".\"\".\"\".\" tb-results.flight-clearedCleared for Flight0..1boolean
\".\"\".\"\".\" data-deliveryData Delivery0..1group
\".\"\".\"\".\"\".\" data-delivery.archiveData Archive System0..1choiceOptions: 1 option
Initial Value: Coding = NASA Medical Data Archive Systems#mmis "Medical Mission Information System"

\"doco\" Documentation for this format

Options Sets

Answer options for overview.sponsor

Answer options for tb-results.test-type

Answer options for tb-results.result

Answer options for tb-results.chest-xray-result

Answer options for data-delivery.archive

" }, "extension" : [{ "extension" : [{ "url" : "name", "valueCoding" : { "system" : "http://hl7.org/fhir/uv/sdc/CodeSystem/launchContext", "code" : "patient" } }, { "url" : "type", "valueCode" : "Patient" }, { "url" : "description", "valueString" : "The astronaut/crewmember subject of this medical requirement" }], "url" : "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-launchContext" }], "url" : "https://mitre.org/fhir/space-health/Questionnaire/medb-2-3-tb-testing", "version" : "0.5.12", "name" : "MEDB23TBTesting", "title" : "MEDB 2.3 Tuberculosis Testing", "status" : "active", "date" : "2017-06-05", "publisher" : "MITRE", "contact" : [{ "name" : "MITRE", "telecom" : [{ "system" : "url", "value" : "https://www.mitre.org/" }] }], "description" : "NASA Medical Requirements Integration Document for tuberculosis screening. Screens crew members for TB infection prior to spaceflight.", "purpose" : "To screen crew members for tuberculosis infection prior to spaceflight", "copyright" : "NASA Johnson Space Center - Medical Requirements Integration Documents (MRIDs) JSC28913", "item" : [{ "linkId" : "overview", "text" : "Medical Requirements Overview", "type" : "group", "item" : [{ "linkId" : "overview.mrid-number", "text" : "MRID Number and Title", "type" : "display", "initial" : [{ "valueString" : "MEDB 2.3 Tuberculosis Testing" }] }, { "linkId" : "overview.sponsor", "text" : "Sponsor", "type" : "choice", "required" : true, "readOnly" : true, "answerOption" : [{ "valueCoding" : { "system" : "https://mitre.org/fhir/space-health/CodeSystem/nasa-mrid-sponsor-cs", "code" : "medical-operations", "display" : "Medical Operations" } }], "initial" : [{ "valueCoding" : { "system" : "https://mitre.org/fhir/space-health/CodeSystem/nasa-mrid-sponsor-cs", "code" : "medical-operations", "display" : "Medical Operations" } }] }, { "linkId" : "overview.purpose", "text" : "Purpose/Objectives", "type" : "text", "initial" : [{ "valueString" : "To screen crew members for latent or active tuberculosis infection prior to spaceflight." }] }, { "linkId" : "overview.flight-duration", "text" : "Flight Duration", "type" : "string", "initial" : [{ "valueString" : "All flights" }] }] }, { "linkId" : "preflight-activities", "text" : "Preflight Activities", "type" : "group", "item" : [{ "linkId" : "preflight-activities.schedule", "text" : "Schedule", "type" : "string", "initial" : [{ "valueString" : "Annual medical examination" }] }, { "linkId" : "preflight-activities.test-date", "text" : "Test Date", "type" : "date" }, { "linkId" : "preflight-activities.test-completed", "text" : "Test Completed", "type" : "boolean", "required" : true }] }, { "linkId" : "tb-results", "text" : "TB Test Results", "type" : "group", "item" : [{ "linkId" : "tb-results.test-type", "text" : "Test Type", "type" : "choice", "answerOption" : [{ "valueString" : "Tuberculin Skin Test (TST/PPD)" }, { "valueString" : "Interferon-Gamma Release Assay (IGRA)" }, { "valueString" : "QuantiFERON-TB Gold" }, { "valueString" : "T-SPOT.TB" }] }, { "linkId" : "tb-results.result", "code" : [{ "system" : "http://loinc.org", "code" : "71773-6", "display" : "Mycobacterium tuberculosis stimulated gamma interferon [Presence] in Blood" }], "text" : "Test Result", "type" : "choice", "answerOption" : [{ "valueCoding" : { "system" : "http://snomed.info/sct", "code" : "260385009", "display" : "Negative" } }, { "valueCoding" : { "system" : "http://snomed.info/sct", "code" : "10828004", "display" : "Positive" } }, { "valueCoding" : { "system" : "http://snomed.info/sct", "code" : "419984006", "display" : "Indeterminate" } }] }, { "linkId" : "tb-results.tst-induration", "text" : "TST Induration (mm)", "type" : "integer", "enableWhen" : [{ "question" : "tb-results.test-type", "operator" : "=", "answerString" : "Tuberculin Skin Test (TST/PPD)" }] }, { "linkId" : "tb-results.chest-xray-required", "text" : "Chest X-ray Required", "type" : "boolean", "enableWhen" : [{ "question" : "tb-results.result", "operator" : "=", "answerCoding" : { "system" : "http://snomed.info/sct", "code" : "10828004", "display" : "Positive" } }] }, { "linkId" : "tb-results.chest-xray-result", "text" : "Chest X-ray Result", "type" : "choice", "enableWhen" : [{ "question" : "tb-results.chest-xray-required", "operator" : "=", "answerBoolean" : true }], "answerOption" : [{ "valueCoding" : { "system" : "http://snomed.info/sct", "code" : "17621005", "display" : "Normal" } }, { "valueCoding" : { "system" : "http://snomed.info/sct", "code" : "263654008", "display" : "Abnormal" } }] }, { "linkId" : "tb-results.treatment-required", "text" : "Treatment Required", "type" : "boolean" }, { "linkId" : "tb-results.flight-cleared", "text" : "Cleared for Flight", "type" : "boolean" }] }, { "linkId" : "data-delivery", "text" : "Data Delivery", "type" : "group", "item" : [{ "linkId" : "data-delivery.archive", "text" : "Data Archive System", "type" : "choice", "answerOption" : [{ "valueCoding" : { "system" : "https://mitre.org/fhir/space-health/CodeSystem/nasa-data-archive-cs", "code" : "mmis", "display" : "Medical Mission Information System" } }], "initial" : [{ "valueCoding" : { "system" : "https://mitre.org/fhir/space-health/CodeSystem/nasa-data-archive-cs", "code" : "mmis", "display" : "Medical Mission Information System" } }] }] }] }