MEDB71PsychStatusQuestionnaire
type: Questionnaire
node role: treeRoot
id:
  v: MEDB71PsychStatusQuestionnaire
text:
  status:
    v: extensions
  div:
    v: Generated Narrative: Questionnaire MEDB71PsychStatusQuestionnaire Structure LinkID Text Cardinality Type Flags Description & Constraints<img src="[binary]" alt="doco" style="background-color: inherit"/> MEDB71PsychStatus NASA Medical Requirements Integration Document for preflight behavioral health assessment. Captures psychiatric/psychological assessment of behavioral readiness for flight and review of psychological services. Questionnaire https://mitre.org/fhir/space-health/Questionnaire/medb-7-1-psych-status#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 7.1 Preflight Psychiatric/Psychological Status Check #xD; overview.sponsor Sponsor 1..1 choice Options: 1 option Initial Value: Coding = NASA MRID Sponsor Organizations#bhp "Behavioral Health and Performance" #xD; overview.discipline Discipline 1..1 choice Options: 1 option Initial Value: Coding = NASA MRID Medical Disciplines#behavioral "Behavior and Performance" #xD; overview.category Category 1..1 string Initial Value: string = Medical Requirements (MR) #xD; overview.references References 0..1 text Initial Value: string = Medical Evaluation Documents (MED) Volume B, Section 7.1; ISS MORD #xD; overview.purpose Purpose/Objectives 1..1 text Initial Value: string = Psychiatric/Psychological assessment of behavioral readiness for flight. Review of individual and crew psychological services. #xD; overview.measurement-parameters Measurement Parameters 0..1 string Initial Value: string = N/A #xD; overview.deliverables Deliverables 0..1 string Initial Value: string = N/A #xD; overview.flight-duration Flight Duration 1..1 string Initial Value: string = >= 30 days #xD; overview.number-of-flights Number of Flights 1..1 string Initial Value: string = Each ISS long duration expedition #xD; overview.crew-members-required Number and Type of Crew Members Required 1..1 string Initial Value: string = All ISS crewmembers #xD; …
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-7-1-psych-status
  l: medb-7-1-psych-status
version:
  v: 0.5.12
name:
  v: MEDB71PsychStatus
title:
  v: MEDB 7.1 Preflight Psychiatric/Psychological Status Check
status:
  v: active
date:
  v: 2012-05-31
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 preflight behavioral health assessment. Captures psychiatric/psychological assessment of behavioral readiness for flight and review of psychological services.
purpose:
  v: Psychiatric/Psychological assessment of behavioral readiness for flight. Review of individual and crew psychological services.
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 7.1 Preflight Psychiatric/Psychological Status Check
  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.category
    text:
      v: Category
    type:
      v: string
    required:
      v: true
    read only:
      v: true
    initial:
      value: String
        v: Medical Requirements (MR)
  item:
    link id:
      v: overview.references
    text:
      v: References
    type:
      v: text
    required:
      v: false
    initial:
      value: String
        v: Medical Evaluation Documents (MED) Volume B, Section 7.1; ISS MORD
  item:
    link id:
      v: overview.purpose
    text:
      v: Purpose/Objectives
    type:
      v: text
    required:
      v: true
    initial:
      value: String
        v: Psychiatric/Psychological assessment of behavioral readiness for flight. Review of individual and crew psychological services.
  item:
    link id:
      v: overview.measurement-parameters
    text:
      v: Measurement Parameters
    type:
      v: string
    required:
      v: false
    initial:
      value: String
        v: N/A
  item:
    link id:
      v: overview.deliverables
    text:
      v: Deliverables
    type:
      v: string
    required:
      v: false
    initial:
      value: String
        v: N/A
  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: overview.number-of-flights
    text:
      v: Number of Flights
    type:
      v: string
    required:
      v: true
    initial:
      value: String
        v: Each ISS long duration expedition
  item:
    link id:
      v: overview.crew-members-required
    text:
      v: Number and Type of Crew Members Required

v: bhp

v: Behavioral Health and Performance

v: bhp

v: Behavioral Health and Performance

v: behavioral

v: Behavior and Performance

v: behavioral

v: Behavior and Performance

v: string

v: true

value: String
  v: All ISS crewmembers

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

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
  required:
    v: false
  initial:
    value: String
      v: An assessment of crew flight readiness is conducted by BHP personnel. Preflight briefings between the crewmembers & BHP specialist are required to confirm behavioral readiness for flight & review of individual & crew psychological services. This will include a check of life events that would have an impact on the astronaut's fitness for launch. Behavioral Medicine Assessments to include Neurocognitive baseline and Behavioral health baseline needed for in flight monitoring to be completed between L-12 and launch.
item:
  link id:
    v: preflight-activities.assessment1
  text:
    v: Behavioral Medicine Assessment 1
  type:
    v: group
  item:
    link id:
      v: preflight-activities.assessment1.duration
    text:
      v: Duration (minutes)
    type:
      v: integer
    required:
      v: true
    initial:
      value: Integer
        v: 60
  item:
    link id:
      v: preflight-activities.assessment1.schedule
    text:
      v: Schedule
    type:
      v: string
    required:
      v: true
    initial:
      value: String
        v: L-12 m, L-240/180 d
  item:
    link id:
      v: preflight-activities.assessment1.date
    text:
      v: Assessment Date
    type:
      v: date
    required:
      v: false
  item:
    link id:
      v: preflight-activities.assessment1.completed
    text:
      v: Assessment Completed
    type:
      v: boolean
    required:
      v: true
item:
  link id:
    v: preflight-activities.assessment2
  text:
    v: Behavioral Medicine Assessment 2
  type:
    v: group
  item:
    link id:
      v: preflight-activities.assessment2.duration
    text:
      v: Duration (minutes)
    type:
      v: integer
    required:
      v: true
    initial:
      value: Integer
        v: 60
  item:
    link id:
      v: preflight-activities.assessment2.schedule
    text:
      v: Schedule
    type:
      v: string
    required:
      v: true
    initial:
      value: String
        v: L-90/30 days
  item:
    link id:
      v: preflight-activities.assessment2.date
    text:
      v: Assessment Date
    type:
      v: date
    required:
      v: false
  item:
    link id:
      v: preflight-activities.assessment2.completed
    text:
      v: Assessment Completed
    type:
      v: boolean
    required:
      v: true
item:
  link id:
    v: preflight-activities.flexibility
  text:
    v: Flexibility
  type:
    v: string
  required:
    v: false
  initial:
    value: String
      v: May be conducted over 2 days between L-90/30
item:
  link id:
    v: preflight-activities.personnel
  text:
    v: Personnel Required
  type:
    v: choice
  required:
    v: true
  repeats:
    v: true
  answer option:
    value: Coding
      system:
        v: https://mitre.org/fhir/space-health/CodeSystem/nasa-medical-roles-cs
        l: nasa-medical-roles-cs
      code:
        v: crewmember
      display:
        v: Crewmember
  answer option:
    value: Coding
      system:
        v: https://mitre.org/fhir/space-health/CodeSystem/nasa-medical-roles-cs
        l: nasa-medical-roles-cs
      code:
        v: bhp-specialist
      display:
        v: BHP Specialist
item:
  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
  answer option:
    value: Coding
      system:
        v: https://mitre.org/fhir/space-health/CodeSystem/nasa-medical-facility-cs
        l: nasa-medical-facility-cs
      code:
        v: russia-gctc
      display:
        v: Gagarin Cosmonaut Training Center
item:
  link id:
    v: preflight-activities.room-requirements
  text:
    v: Room Requirements
  type:
    v: string
  required:
    v: false
  initial:
    value: String
      v: 8' x 10' private room free of distractions
item:
  link id:
    v: preflight-activities.constraints
  text:
    v: Constraints/Special Requirements

v: text

v: false

value: String
  v: Request that the L-90/30 event be scheduled as close as possible to the crewmember's final departure from the US prior to their Soyuz launch.

link id:
  v: assessment-results
text:
  v: Behavioral Assessment Results
type:
  v: group
item:
  link id:
    v: assessment-results.behavioral-readiness
  code: https://loinc.org/rdf/44249-1
    system:
      v: http://loinc.org
      l: loinc.org
    code:
      v: 44249-1
    display:
      v: Mental status Narrative
  text:
    v: Behavioral Readiness for Flight
  type:
    v: choice
  required:
    v: true
  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
  answer option:
    value: String
      v: Cleared with conditions
  answer option:
    value: String
      v: Not cleared
item:
  link id:
    v: assessment-results.neurocognitive-baseline
  text:
    v: Neurocognitive Baseline Completed
  type:
    v: boolean
  required:
    v: true
item:
  link id:
    v: assessment-results.behavioral-baseline
  text:
    v: Behavioral Health Baseline Completed
  type:
    v: boolean
  required:
    v: true
item:
  link id:
    v: assessment-results.life-events-review
  text:
    v: Life Events Review Completed
  type:
    v: boolean
  required:
    v: true
item:
  link id:
    v: assessment-results.life-events-impact
  text:
    v: Life Events with Potential Impact Identified
  type:
    v: boolean
  required:
    v: false
item:
  link id:
    v: assessment-results.psych-services-review
  text:
    v: Individual Psychological Services Reviewed
  type:
    v: boolean
  required:
    v: true
item:
  link id:
    v: assessment-results.crew-services-review
  text:
    v: Crew Psychological Services Reviewed
  type:
    v: boolean
  required:
    v: true
item:
  link id:
    v: assessment-results.aeromedical-concerns
  text:
    v: Aeromedical Concerns Identified
  type:
    v: boolean
  required:
    v: true
item:
  link id:
    v: assessment-results.aeromedical-concerns-details
  text:
    v: Aeromedical Concerns Details
  type:
    v: text
  enable when:
    question:
      v: assessment-results.aeromedical-concerns
    operator:
      v: =
    answer: Boolean
      v: true
  required:
    v: false

link id:
  v: behavioral-metrics
text:
  v: Behavioral State Metrics
type:
  v: group
item:
  link id:
    v: behavioral-metrics.mood-level
  code:
    system:
      v: http://hl7.org/fhir/uv/aerospace/CodeSystem/aerospace-behavioral-state-cs
      l: aerospace-behavioral-state-cs
    code:
      v: mood-level
    display:
      v: Mood level
  text:
    v: Mood Level (-3 to +3)
  type:
    v: integer
  required:
    v: false
item:
  link id:
    v: behavioral-metrics.anxiety-level
  code:
    system:
      v: http://hl7.org/fhir/uv/aerospace/CodeSystem/aerospace-behavioral-state-cs
      l: aerospace-behavioral-state-cs
    code:
      v: anxiety-level
    display:
      v: Anxiety level
  text:
    v: Anxiety Level (0-10)
  type:
    v: integer
  required:
    v: false
item:
  link id:
    v: behavioral-metrics.coping-capacity
  code:
    system:
      v: http://hl7.org/fhir/uv/aerospace/CodeSystem/aerospace-behavioral-state-cs
      l: aerospace-behavioral-state-cs
    code:
      v: coping-capacity
    display:
      v: Coping capacity
  text:
    v: Coping Capacity Assessment
  type:
    v: choice
  required:
    v: false
  answer option:
    value: String
      v: Excellent
  answer option:
    value: String
      v: Good
  answer option:
    value: String
      v: Adequate
  answer option:
    value: String
      v: Marginal
  answer option:
    value: String
      v: Inadequate
item:
  link id:
    v: behavioral-metrics.sleep-quality
  code:
    system:
      v: http://hl7.org/fhir/uv/aerospace/CodeSystem/aerospace-behavioral-state-cs
      l: aerospace-behavioral-state-cs
    code:
      v: sleep-quality
    display:
      v: Sleep quality
  text:
    v: Sleep Quality Assessment
  type:
    v: choice
  required:
    v: false
  answer option:
    value: String
      v: Excellent
  answer option:
    value: String
      v: Good
  answer option:
    value: String
      v: Fair
  answer option:
    value: String
      v: Poor
item:
  link id:
    v: behavioral-metrics.cognitive-readiness
  code:
    system:
      v: http://hl7.org/fhir/uv/aerospace/CodeSystem/aerospace-behavioral-state-cs
      l: aerospace-behavioral-state-cs
    code:
      v: cognitive-readiness
    display:
      v: Cognitive readiness
  text:
    v: Cognitive Readiness for Mission
  type:
    v: choice
  required:
    v: false
  answer option:
    value: String
      v: Fully ready
  answer option:
    value: String
      v: Ready with minor concerns
  answer option:
    value: String
      v: Ready with monitoring
  answer option:
    value: String
      v: Not ready
item:
  link id:
    v: behavioral-metrics.social-connectedness
  code:
    system:
      v: http://hl7.org/fhir/uv/aerospace/CodeSystem/aerospace-behavioral-state-cs
      l: aerospace-behavioral-state-cs
    code:
      v: social-connectedness
    display:
      v: Social connectedness
  text:
    v: Social Connectedness (with crew/family)
  type:
    v: choice
  required:
    v: false
  answer option:
    value: String
      v: Strong
  answer option:
    value: String
      v: Adequate
  answer option:
    value: String
      v: Weak
  answer option:
    value: String
      v: Concerning

link id:
  v: inflight-activities
text:
  v: In-Flight Activities
type:
  v: group
item:
  link id:
    v: inflight-activities.na
  text:
    v: No In-Flight Activities
  type:
    v: display

link id:
  v: postflight-activities
text:
  v: Postflight Activities
type:
  v: group
item:
  link id:
    v: postflight-activities.na
  text:
    v: No Postflight Activities
  type:
    v: display

link id:
  v: data-delivery
text:
  v: Data Delivery
type:
  v: group
item:
  link id:
    v: data-delivery.data-control
  text:
    v: Data Control
  type:
    v: text
  required:
    v: false
  initial:
    value: String
      v: Data are crew member controlled. The crewmember is the designated recipient of the data and sharing this information is at his/her discretion.
item:
  link id:
    v: data-delivery.emr-entry
  text:
    v: EMR Entry Made
  type:
    v: boolean
  required:
    v: true
item:
  link id:
    v: data-delivery.emr-entry-notes
  text:
    v: EMR Entry Notes
  type:
    v: text
  required:
    v: false
  initial:
    value: String
      v: Entries will be made in the EMR for each event showing completion of the MEDB requirement and stating if any aeromedical concerns were identified.
item:
  link id:
    v: data-delivery.archive
  text:
    v: Data Archive System
  type:
    v: choice
  required:
    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: emr
      display:
        v: Electronic Medical Record

link id:
  v: postflight-debrief
text:
  v: Postflight Debrief
type:
  v: group
item:
  link id:
    v: postflight-debrief.na
  text:
    v: No Postflight Debrief Required
  type:
    v: display