{
"resourceType": "Questionnaire",
"id": "nhsi-my-core",
"meta": {
"versionId": "1",
"lastUpdated": "2022-08-03T03:26:09.844+00:00",
"profile": [
"http://hl7.org/fhir/StructureDefinition/Questionnaire"
]
},
"url": "http://fhir.hie.moh.gov.my/Questionnaire/nhsi-my-core",
"version": "1.0.0",
"name": "NHSI",
"title": "Malaysia National Health Screening",
"status": "active",
"experimental": true,
"date": "2023-01-11T06:43:11.5383741+00:00",
"item": [
{
"linkId": "1",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "User Demographic"
}
],
"text": "User Demographic",
"type": "group",
"required": false,
"item": [
{
"linkId": "1.1",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "1.1",
"display": "Name"
}
],
"text": "Name",
"type": "string",
"required": false
},
{
"linkId": "1.2",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "1.2",
"display": "MySejahtera ID"
}
],
"text": "MySejahtera ID",
"type": "string",
"required": false
},
{
"linkId": "1.3",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "1.3",
"display": "Contact Number"
}
],
"text": "Contact Number",
"type": "string",
"required": false,
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "help",
"display": "Help-Button"
}
],
"text": "Help-Button"
}
}
],
"linkId": "1.3_helpText",
"text": "Must be valid phone number with +60 at start",
"type": "display"
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
],
"text": "Drop down"
}
}
],
"linkId": "1.4",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "1.4",
"display": "Type of Identification"
}
],
"text": "Type of Identification",
"type": "choice",
"required": false,
"answerOption": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Ic Numbers"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Passport Number"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "Others"
}
}
]
},
{
"linkId": "1.5",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "1.5",
"display": "IC Number/Passport"
}
],
"text": "IC Number/Passport",
"type": "string",
"required": false
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
],
"text": "Drop down"
}
}
],
"linkId": "1.6",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "1.6",
"display": "Gender"
}
],
"text": "Gender",
"type": "choice",
"required": false,
"answerOption": [
{
"valueCoding": {
"system": "http://hl7.org/fhir/administrative-gender",
"code": "male",
"display": "Male"
}
},
{
"valueCoding": {
"system": "http://hl7.org/fhir/administrative-gender",
"code": "female",
"display": "Female"
}
},
{
"valueCoding": {
"system": "http://hl7.org/fhir/administrative-gender",
"code": "other",
"display": "Others"
}
}
]
},
{
"linkId": "1.7",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "1.7",
"display": "Nationality"
}
],
"text": "Nationality",
"type": "string",
"required": false
},
{
"linkId": "1.8",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "1.8",
"display": "Address"
}
],
"text": "Address",
"type": "string",
"required": false
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
],
"text": "Drop down"
}
}
],
"linkId": "1.9",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "1.9",
"display": "Occupation"
}
],
"text": "Occupation",
"type": "choice",
"required": false,
"answerOption": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Manager"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Professional"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "Technician and Associate Professional"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "04",
"display": "Clerical Support Worker"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "05",
"display": "Services and Sales Worker"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "06",
"display": "Skilled Agricultural, Forestry, Livestock and Fishery Worker"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "07",
"display": "Craft and related Trades Worker"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "08",
"display": "Plant and Machine Operators and Assembler"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "09",
"display": "Elementary Worker"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "10",
"display": "Armed Forces Occupation"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "11",
"display": "Unemployed"
}
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
],
"text": "Drop down"
}
}
],
"linkId": "1.10",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "1.10",
"display": "Ethnicity"
}
],
"text": "Ethnicity",
"type": "choice",
"required": false,
"answerOption": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Malay"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Chinese"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "Indian"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "04",
"display": "Bumiputera Sabah"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "05",
"display": "Bumiputera Sarawak"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "06",
"display": "Orang Asli"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "07",
"display": "Others"
}
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
],
"text": "Drop down"
}
}
],
"linkId": "1.11",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "1.11",
"display": "Special Category of Population"
}
],
"text": "Special Category of Population",
"type": "choice",
"required": false,
"answerOption": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "00",
"display": "Not Applicable"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "High Risk/ Vulnerable Individuals"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Person with Disabilities"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "Individuals from old folks/ caretaker home"
}
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
],
"text": "Drop down"
}
}
],
"linkId": "1.12",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "1.12",
"display": "Industry"
}
],
"text": "Industry",
"type": "choice",
"required": false,
"answerOption": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Accomodations"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Advertising & Market Research"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "Agriculture"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "04",
"display": "Architectural and Landscape Activities"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "05",
"display": "Arts, entertainment & recreation"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "06",
"display": "Business services"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "07",
"display": "Community, social & personal services"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "08",
"display": "Construction"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "09",
"display": "Education"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "10",
"display": "Electricity, gas, steam & air conditioning supply"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "11",
"display": "Finance"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "12",
"display": "Fishing & aquaculture"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "13",
"display": "Food & beverage"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "14",
"display": "Forestry & logging"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "15",
"display": "Goverment services"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "16",
"display": "Healthcare"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "17",
"display": "Information & communication"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "18",
"display": "Insurance"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "19",
"display": "Legal & accounting activities manufacturing"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "20",
"display": "Mining & quarrying"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "21",
"display": "Owner occupied dwelling"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "22",
"display": "Petroleum & natural gas extraction"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "23",
"display": "Postal & courier activities"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "24",
"display": "Real estate"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "25",
"display": "Scientific engineering activities & technical testing/ analysis"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "26",
"display": "Security & investigation activities"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "27",
"display": "Security & investigation activities"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "28",
"display": "Transportation & storage"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "29",
"display": "Unemployed"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "30",
"display": "Utilities services"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "31",
"display": "Veterinary activities"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "32",
"display": "Wholesale & retail trade services"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "33",
"display": "Water supply, sewerage & waste management"
}
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
],
"text": "Drop down"
}
}
],
"linkId": "1.13",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "1.13",
"display": "Comorbidities Present"
}
],
"text": "Comorbidities Present",
"type": "choice",
"required": false,
"repeats": true,
"answerOption": [
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "385432009",
"display": "Not Applicable"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "73211009",
"display": "Diabetes Mellitus"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "38341003",
"display": "Hypertension"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "56265001",
"display": "Heart Disease"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "195967001",
"display": "Asthma"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "363346000",
"display": "Cancer"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "413839001",
"display": "Chronic Lung Disease"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "90708001",
"display": "Kidney Disease"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "235856003",
"display": "Liver Disease"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "230690007",
"display": "Stroke"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "370388006",
"display": "Immunocompromised"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "414916001",
"display": "Obesity"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "64779008",
"display": "Bleeding Tendency"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "39579001",
"display": "History of Severe Allergic Reaction"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "74964007",
"display": "Others"
}
}
]
},
{
"linkId": "1.14",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "1.14",
"display": "Last Screening Date"
}
],
"text": "Last Screening Date",
"type": "group",
"required": false,
"item": [
{
"linkId": "1.14.1",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "1.14.1",
"display": "Has the patient performed health screening before?"
}
],
"text": "Has the patient performed health screening before?",
"type": "boolean",
"required": false
},
{
"linkId": "1.14.2",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "1.14.2",
"display": "If Yes:"
}
],
"text": "If Yes:",
"type": "date",
"required": false
}
]
}
]
},
{
"linkId": "2",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Assessments"
}
],
"text": "Assessments",
"type": "group",
"required": false,
"item": [
{
"linkId": "2.1",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "2.1",
"display": "Does the patient have any family history?"
}
],
"text": "Does the patient have any family history?",
"type": "boolean",
"required": false,
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
],
"text": "Drop down"
}
}
],
"linkId": "2.1.1",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "2.1.1",
"display": "If yes:"
}
],
"text": "If yes:",
"type": "choice",
"required": false,
"repeats": true,
"answerOption": [
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "38341003",
"display": "Hypertension"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "73211009",
"display": "Diabetes Mellitus"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "13644009",
"display": "Hypercholesterolemia"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "56265001",
"display": "Coronary Heart Disease"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "230690007",
"display": "Stroke"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "709044004",
"display": "Chronic Kidney Disease"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "363346000",
"display": "Cancer"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "26636000",
"display": "Sudden Death"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "74732009",
"display": "Mental Illness"
}
}
]
}
]
},
{
"linkId": "2.2",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "2.2",
"display": "Does the patient have any medical history?"
},
{
"code": "2.2",
"display": "Does the patient have any medical history?"
}
],
"text": "Does the patient have any medical history?",
"type": "boolean",
"required": false,
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
],
"text": "Drop down"
}
}
],
"linkId": "2.2.1",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "2.2.1",
"display": "If yes:"
},
{
"code": "2.2.1",
"display": "If yes:"
}
],
"text": "If yes:",
"type": "choice",
"required": false,
"repeats": true,
"answerOption": [
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "38341003",
"display": "Hypertension"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "73211009",
"display": "Diabetes Mellitus"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "13644009",
"display": "Hypercholesterolemia"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "56265001",
"display": "Coronary Heart Disease"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "230690007",
"display": "Stroke"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "709044004",
"display": "Chronic Kidney Disease"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "363346000",
"display": "Cancer"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "195967001",
"display": "Asthma"
}
}
]
}
]
}
]
},
{
"linkId": "3",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "Mental Health Assessments"
}
],
"text": "Mental Health Assessments",
"type": "group",
"required": false,
"item": [
{
"linkId": "3.1",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "3.1",
"display": "In the past 2 weeks, how often does this patient:"
}
],
"text": "In the past 2 weeks, how often does this patient:",
"type": "group",
"required": false,
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
],
"text": "Drop down"
}
}
],
"linkId": "3.1.1",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "3.1.1",
"display": "Felt Down, depressed or hopeless"
}
],
"text": "Felt Down, depressed or hopeless",
"type": "choice",
"required": false,
"answerOption": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "00",
"display": "Not At All"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Several Days"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "> 7 days"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "Almost everyday"
}
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
],
"text": "Drop down"
}
}
],
"linkId": "3.1.2",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "3.1.2",
"display": "Little interest to do things"
}
],
"text": "Little interest to do things",
"type": "choice",
"required": false,
"answerOption": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "00",
"display": "Not At All"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Several Days"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "> 7 days"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "Almost everyday"
}
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
],
"text": "Drop down"
}
}
],
"linkId": "3.1.3",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "3.1.3",
"display": "Trouble falling asleep/staying asleep or sleeping too much"
}
],
"text": "Trouble falling asleep/staying asleep or sleeping too much",
"type": "choice",
"required": false,
"answerOption": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "00",
"display": "Not At All"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Several Days"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "> 7 days"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "Almost everyday"
}
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
],
"text": "Drop down"
}
}
],
"linkId": "3.1.4",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "3.1.4",
"display": "Felt tired or having little energy"
}
],
"text": "Felt tired or having little energy",
"type": "choice",
"required": false,
"answerOption": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 0
}
],
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "00",
"display": "Not At All"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 1
}
],
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Several Days"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 2
}
],
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "> 7 days"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 3
}
],
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "Almost everyday"
}
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
],
"text": "Drop down"
}
}
],
"linkId": "3.1.5",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "3.1.5",
"display": "Had poor appetite or over eating"
}
],
"text": "Had poor appetite or over eating",
"type": "choice",
"required": false,
"answerOption": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 0
}
],
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "00",
"display": "Not At All"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 1
}
],
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Several Days"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 2
}
],
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "> 7 days"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 3
}
],
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "Almost everyday"
}
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
],
"text": "Drop down"
}
}
],
"linkId": "3.1.6",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "3.1.6",
"display": "Felt bad about himself/herself, felt like a failure or he/she has let his/her family down"
}
],
"text": "Felt bad about himself/herself, felt like a failure or he/she has let his/her family down",
"type": "choice",
"required": false,
"answerOption": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 0
}
],
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "00",
"display": "Not At All"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 1
}
],
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Several Days"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 2
}
],
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "> 7 days"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 3
}
],
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "Almost everyday"
}
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
],
"text": "Drop down"
}
}
],
"linkId": "3.1.7",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "3.1.7",
"display": "Trouble concentrating (e.g. watching television or reading newspaper)"
}
],
"text": "Trouble concentrating (e.g. watching television or reading newspaper)",
"type": "choice",
"required": false,
"answerOption": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 0
}
],
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "00",
"display": "Not At All"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 1
}
],
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Several Days"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 2
}
],
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "> 7 days"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 3
}
],
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "Almost everyday"
}
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
],
"text": "Drop down"
}
}
],
"linkId": "3.1.8",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "3.1.8",
"display": "Moved slowly or fidgeted excessively that is noticeable by people around him/her"
}
],
"text": "Moved slowly or fidgeted excessively that is noticeable by people around him/her",
"type": "choice",
"required": false,
"answerOption": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 0
}
],
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "00",
"display": "Not At All"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 1
}
],
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Several Days"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 2
}
],
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "> 7 days"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 3
}
],
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "Almost everyday"
}
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
],
"text": "Drop down"
}
}
],
"linkId": "3.1.9",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "3.1.9",
"display": "Had thoughts that he/she would be better dead, or hurting yourself"
}
],
"text": "Had thoughts that he/she would be better dead, or hurting yourself",
"type": "choice",
"required": false,
"answerOption": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 0
}
],
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "00",
"display": "Not At All"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 1
}
],
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Several Days"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 2
}
],
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "> 7 days"
}
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 3
}
],
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "Almost everyday"
}
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
],
"text": "Drop down"
}
}
],
"linkId": "3.1.10",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "3.1.10",
"display": "Total Mental Health Test Score"
}
],
"text": "Total Mental Health Test Score",
"type": "choice",
"required": false,
"answerOption": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "00",
"display": "0-4 : None-minimal depression"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "5-9 : Mild Depression"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "10-14 : Moderate Depression"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "15-19 :Moderate severe depression"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "04",
"display": "20-27 : Severe Depression"
}
}
]
}
]
},
{
"linkId": "3.2",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "3.2",
"display": "In the last 2 weeks, indicate how difficult these problems made it for this patient"
},
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "3,2",
"display": "In the last 2 weeks, indicate how difficult these problems made it for this patient"
}
],
"text": "In the last 2 weeks, indicate how difficult these problems made it for this patient",
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"required": false,
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
],
"text": "Drop down"
}
}
],
"linkId": "3.2.1",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "3.2.1",
"display": "Do your work, take care of things at home, or get along with others"
}
],
"text": "Do your work, take care of things at home, or get along with others",
"type": "choice",
"required": false,
"answerOption": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "00",
"display": "Not Difficult"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Somewhat difficult"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Very difficult"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
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}
}
]
}
]
}
]
},
{
"linkId": "4",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "04",
"display": "Lifestyle Health Assessment"
}
],
"text": "Lifestyle Health Assessment",
"type": "group",
"required": false,
"item": [
{
"linkId": "4.1",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "4.1",
"display": "Alcohol consumption"
}
],
"text": "Alcohol consumption",
"type": "group",
"required": false,
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
],
"text": "Drop down"
}
}
],
"linkId": "4.1.1",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "4.1.1",
"display": "How often do you consume alcohol?"
}
],
"text": "How often do you consume alcohol?",
"type": "choice",
"required": false,
"answerOption": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "00",
"display": "Never"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Once a month"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "2-4 times a month"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "2-3 times week"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "04",
"display": "> 4 times a weeks"
}
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
],
"text": "Drop down"
}
}
],
"linkId": "4.1.2",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "4.1.2",
"display": "How many alcoholic beverages do you consume in a day?"
}
],
"text": "How many alcoholic beverages do you consume in a day?",
"type": "choice",
"required": false,
"answerOption": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "00",
"display": "<2"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "3-4"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "5-6"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "7-9"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "04",
"display": ">10"
}
}
]
},
{
"linkId": "4.1.3",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "4.1.3",
"display": "How often within the last year,"
}
],
"text": "How often within the last year,",
"type": "group",
"required": false,
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
],
"text": "Drop down"
}
}
],
"linkId": "4.1.3.1",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "4.1.3.1",
"display": "Do you consume 6 or more drink in a day?"
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],
"text": "Do you consume 6 or more drink in a day?",
"type": "choice",
"required": false,
"answerOption": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "00",
"display": "Never"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "< Once a month"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Once a month"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "Weekly"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "04",
"display": "Almost daily"
}
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
],
"text": "Drop down"
}
}
],
"linkId": "4.1.3.2",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "4.1.3.2",
"display": "Were you not able to stop drinking once started?"
}
],
"text": "Were you not able to stop drinking once started?",
"type": "choice",
"required": false,
"answerOption": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "00",
"display": "Never"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "< Once a month"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Once a month"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "Weekly"
}
},
{
"valueCoding": {
"code": "04",
"display": "Almost daily"
}
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
],
"text": "Drop down"
}
}
],
"linkId": "4.1.3.3",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "4.1.3.3",
"display": "Were you not able to perform normal activities due to drinking?"
}
],
"text": "Were you not able to perform normal activities due to drinking?",
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"required": false,
"answerOption": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "00",
"display": "Never"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "< Once a month"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Once a month"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "Weekly"
}
},
{
"valueCoding": {
"code": "04",
"display": "Almost daily"
}
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
],
"text": "Drop down"
}
}
],
"linkId": "4.1.3.4",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "4.1.3.4",
"display": "You needed to drink first thing in the morning to get going after a heavy drinking session?"
}
],
"text": "You needed to drink first thing in the morning to get going after a heavy drinking session?",
"type": "choice",
"required": false,
"answerOption": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "00",
"display": "Never"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "< Once a month"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Once a month"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "Weekly"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "04",
"display": "Almost daily"
}
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
],
"text": "Drop down"
}
}
],
"linkId": "4.1.3.5",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "4.1.3.5",
"display": "That you felt guilt or remorse after drinking?"
}
],
"text": "That you felt guilt or remorse after drinking?",
"type": "choice",
"required": false,
"answerOption": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "00",
"display": "Never"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "< Once a month"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Once a month"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "Weekly"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "04",
"display": "Almost daily"
}
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
],
"text": "Drop down"
}
}
],
"linkId": "4.1.3.6",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "4.1.3.6",
"display": "Were you unable to remember what happened the night before due to drinking?"
}
],
"text": "Were you unable to remember what happened the night before due to drinking?",
"type": "choice",
"required": false,
"answerOption": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "00",
"display": "Never"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "< Once a month"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Once a month"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "Weekly"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "04",
"display": "Almost daily"
}
}
]
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
],
"text": "Drop down"
}
}
],
"linkId": "4.1.4",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "4.1.4",
"display": "Have you or someone else been injured because of your drinking?"
}
],
"text": "Have you or someone else been injured because of your drinking?",
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"required": false,
"answerOption": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "00",
"display": "No"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Yes, but not last year"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Yes, during last year"
}
}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
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"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
}
],
"text": "Drop down"
}
}
],
"linkId": "4.1.5",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "4.1.5",
"display": "Has a relative, friend, doctor, been concerned about your drinking habits?"
}
],
"text": "Has a relative, friend, doctor, been concerned about your drinking habits?",
"type": "choice",
"required": false,
"answerOption": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "00",
"display": "No"
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},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Yes, but not last year"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Yes, during last year"
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}
]
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"coding": [
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"system": "http://hl7.org/fhir/questionnaire-item-control",
"code": "drop-down",
"display": "Drop down"
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],
"text": "Drop down"
}
}
],
"linkId": "4.1.6",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "4.1.6",
"display": "Total Alcohol Consumption Test Score"
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],
"text": "Total Alcohol Consumption Test Score",
"type": "choice",
"required": false,
"answerOption": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "00",
"display": "1-7 Low Risk"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "8-12 Moderate Risk"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": ">13 High Risk"
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}
]
}
]
},
{
"linkId": "4.2",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "4.2",
"display": "Smoking Status"
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],
"text": "Smoking Status",
"type": "group",
"required": false,
"item": [
{
"linkId": "4.2.1",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "4.2.1",
"display": "Does the patient smoke?"
}
],
"text": "Does the patient smoke?",
"type": "boolean",
"required": false
},
{
"linkId": "4.2.2",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "4.2.2",
"display": "Cigarettes per Day"
}
],
"text": "Cigarettes per Day",
"type": "integer",
"required": false
},
{
"linkId": "4.2.3",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "4.2.3",
"display": "Years of Smoking"
}
],
"text": "Years of Smoking",
"type": "integer",
"required": false
},
{
"linkId": "4.2.4",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "4.2.4",
"display": "Total pack-years"
}
],
"text": "Total pack-years",
"type": "quantity",
"required": false
}
]
}
]
},
{
"linkId": "5",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "05",
"display": "Clinical Parameters"
}
],
"text": "Clinical Parameters",
"type": "group",
"required": false,
"item": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-unitOption",
"valueCoding": {
"display": "cm"
}
}
],
"linkId": "5.1",
"code": [
{
"system": "http://loinc.org",
"code": "8302-2",
"display": "Anthropometry: Height"
},
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "5.1",
"display": "Anthropometry: Height"
}
],
"text": "Anthropometry: Height",
"type": "quantity",
"required": false
},
{
"extension": [
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{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "05",
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}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "06",
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},
{
"valueCoding": {
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]
},
{
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{
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{
"valueCoding": {
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},
{
"valueCoding": {
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},
{
"valueCoding": {
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},
{
"valueCoding": {
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},
{
"valueCoding": {
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},
{
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},
{
"valueCoding": {
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},
{
"valueCoding": {
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},
{
"valueCoding": {
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{
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"system": "http://hl7.org/fhir/questionnaire-item-control",
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],
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},
{
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{
"valueCoding": {
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},
{
"valueCoding": {
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}
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},
{
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],
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"item": [
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{
"valueCoding": {
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"item": [
{
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],
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{
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},
{
"valueCoding": {
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"code": "03",
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},
{
"valueCoding": {
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"code": "04",
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},
{
"valueCoding": {
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},
{
"valueCoding": {
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},
{
"valueCoding": {
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},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
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},
{
"valueCoding": {
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},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "10",
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},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "11",
"display": "Present of vision aid (eg: Spectacles)"
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},
{
"valueCoding": {
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},
{
"valueCoding": {
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]
}
]
},
{
"linkId": "9385492769029",
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],
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},
{
"valueCoding": {
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}
],
"item": [
{
"linkId": "2706469979386",
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{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
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],
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"type": "choice",
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"answerOption": [
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},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
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},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "Leuchonychia"
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},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "04",
"display": "Palmar erythema"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "05",
"display": "Dupuytren’s contracture"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "06",
"display": "Cyanosis"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "07",
"display": "Tremors"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "08",
"display": "Bruising"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "09",
"display": "Muscle Wasting"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "10",
"display": "Bruising"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "11",
"display": "Splinter Haemorrhage"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "12",
"display": "Osler's Node"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "13",
"display": "Janeway Lesion"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "14",
"display": "Onycholysis"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "15",
"display": "1skin Lesion"
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},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "16",
"display": "Joint Deformity"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "17",
"display": "Bony Deformity"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "18",
"display": "others"
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}
]
}
]
},
{
"linkId": "803255584502",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "73"
}
],
"text": "Head",
"type": "choice",
"answerOption": [
{
"valueCoding": {
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"code": "00",
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}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Abnormal"
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}
],
"item": [
{
"linkId": "2706057387357",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "7.3.1"
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],
"text": "If Abnormal:",
"type": "choice",
"repeats": true,
"answerOption": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "00",
"display": "Frontal Bossing"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Microcephaly"
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},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Macrocephaly"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "Psoriatic plaque"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "04",
"display": "Alopecia"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "05",
"display": "Scaly Patches"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "06",
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}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "07",
"display": "Discharges"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "08",
"display": "Fleas"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "09",
"display": "Others"
}
}
]
}
]
},
{
"linkId": "5438686906842",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "7.4"
}
],
"text": "Neck",
"type": "choice",
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{
"valueCoding": {
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}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Abnormal"
}
}
],
"item": [
{
"linkId": "8525967233111",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "7.4.1"
}
],
"text": "If Abnormal:",
"type": "choice",
"repeats": true,
"answerOption": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "00",
"display": "Lymphadenopathy"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Neck Lump"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Trachea Deviation"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "Skin Lesion"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "04",
"display": "Others"
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}
]
}
]
},
{
"linkId": "6320853137177",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "7.5"
}
],
"text": "Face",
"type": "choice",
"answerOption": [
{
"valueCoding": {
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"code": "00",
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},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Abnormal"
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}
],
"item": [
{
"linkId": "3567829538338",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "7.5.1"
}
],
"text": "If Abnormal:",
"type": "choice",
"repeats": true,
"answerOption": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Wide Nasal Bridge"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Facial asymmetry"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "Malar rash"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "04",
"display": "Maxillary hyperplasia"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "05",
"display": "Moon face"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "06",
"display": "Increase of facial hair"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "07",
"display": "Cleft lips"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "08",
"display": "Swelling"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "09",
"display": "Others"
}
}
]
}
]
},
{
"linkId": "2775452197874",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "7.6"
}
],
"text": "Mouth",
"type": "choice",
"answerOption": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "00",
"display": "Normal"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Abnormal"
}
}
],
"item": [
{
"linkId": "2293927557638",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "7.6.1"
}
],
"text": "If Abnormal, Lips:",
"type": "choice",
"repeats": true,
"answerOption": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Angular"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Stomatitis"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "Ulceritis"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "04",
"display": "Pigmentation"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "05",
"display": "Others"
}
}
]
},
{
"linkId": "4080959756844",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "7.6.2"
}
],
"text": "If Abnormal, Gums:",
"type": "choice",
"repeats": true,
"answerOption": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Gingvitis"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Hyperthropic gums"
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},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "Ulcer"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "04",
"display": "Others"
}
}
]
},
{
"linkId": "9937565309207",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "7.6.3"
}
],
"text": "If Abnormal, Tongue:",
"type": "choice",
"repeats": true,
"answerOption": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Athropic glossitis Thrush"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Macroglossia"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "Cyanosis"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "04",
"display": "Leukplakia"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "05",
"display": "Others"
}
}
]
}
]
},
{
"linkId": "681882410657",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "7.7"
}
],
"text": "Ears, Nose, Throat",
"type": "choice",
"answerOption": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "00",
"display": "Normal"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Abnormal"
}
}
],
"item": [
{
"linkId": "1009194092473",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "7.7.1"
}
],
"text": "If Abnormal, Ears:",
"type": "choice",
"repeats": true,
"answerOption": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Bleeding"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Discharges"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "Impacted earwax"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "04",
"display": "Perforated tympanic membrane"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "05",
"display": "Microtia"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "06",
"display": "Low set ears"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "07",
"display": "Foreign body"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "08",
"display": "Others"
}
}
]
},
{
"linkId": "5071830545688",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "7.7.2"
}
],
"text": "If Abnormal, Nose:",
"type": "choice",
"repeats": true,
"answerOption": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Epistaxis"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Discharges"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "Deviated nasal septum"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "04",
"display": "Turbinate hyperthropy"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "05",
"display": "Foreign body"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "06",
"display": "Others"
}
}
]
},
{
"linkId": "1032584307566",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "7.7.3"
}
],
"text": "If Abnormal, Throat:",
"type": "choice",
"repeats": true,
"answerOption": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Injected tonsil"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Hyperthropic tonsil"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "Deviated uvula"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "04",
"display": "White plaque"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "05",
"display": "Others"
}
}
]
}
]
},
{
"linkId": "1760871504781",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "7.8"
}
],
"text": "Eyes",
"type": "choice",
"answerOption": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "00",
"display": "Normal"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Abnormal"
}
}
],
"item": [
{
"linkId": "2830264276824",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "7.8.1"
}
],
"text": "If Abnormal, General:",
"type": "choice",
"repeats": true,
"answerOption": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Discharge"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Squint"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "Xanthelasma"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "04",
"display": "Ptosis"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "05",
"display": "Periorbital edema"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "06",
"display": "Exopthalmos"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "07",
"display": "Lump"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "08",
"display": "Pterygium"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "09",
"display": "Ectropion/Entropion"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "10",
"display": "Dry eyes"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "11",
"display": "Foreign Bodies"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "12",
"display": "Others"
}
}
]
},
{
"linkId": "9200420167241",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "7.8.2"
}
],
"text": "If Abnormal, Conjunctiva:",
"type": "choice",
"repeats": true,
"answerOption": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Pallor"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Injected Conjunctival"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "Hemorrhage"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "04",
"display": "Others"
}
}
]
},
{
"linkId": "3896132461914",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "7.8.3"
}
],
"text": "If Abnormal, Cornea:",
"type": "choice",
"repeats": true,
"answerOption": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Arcus"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Kaiser Fleischer's ring (Wilson Disease)"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "Others"
}
}
]
}
]
},
{
"linkId": "4541398644599",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "7.9"
}
],
"text": "Fundoscopy",
"type": "choice",
"answerOption": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "00",
"display": "Normal"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Abnormal"
}
}
],
"item": [
{
"linkId": "4508425091768",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "7.9.1"
}
],
"text": "If Abnormal, General:",
"type": "choice",
"repeats": true,
"answerOption": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Absence of reflex"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Others"
}
}
]
},
{
"linkId": "3275429148998",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "7.9.2"
}
],
"text": "If Abnormal, Optic Disc",
"type": "choice",
"repeats": true,
"answerOption": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Swollen"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Pale"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "Cup-Disc Ratio >0.5"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "04",
"display": "Others"
}
}
]
},
{
"linkId": "87716190119",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "7.9.3"
}
],
"text": "If Abnormal, Retina:",
"type": "choice",
"repeats": true,
"answerOption": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Arteriolar narrowing"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Arteriovenous nicking"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "Cotton-wool spots"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "04",
"display": "Exudates"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "05",
"display": "Hemorrhages"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "06",
"display": "Others"
}
}
]
},
{
"linkId": "1106310017866",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "7.9.4"
}
],
"text": "If Abnormal, Macula:",
"type": "choice",
"repeats": true,
"answerOption": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Exudates"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Pigmented"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "Others"
}
}
]
}
]
},
{
"linkId": "7802596122190",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "7.10"
}
],
"text": "Ishihara Chart:",
"type": "choice",
"answerOption": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Normal"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Abnormal"
}
}
]
},
{
"linkId": "1772552914755",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "7.11"
}
],
"text": "Snellen Eye Chart Score",
"type": "group",
"item": [
{
"linkId": "5634044053426",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "7.11.1"
}
],
"text": "Snellen Eye Chart Right eye With Lens",
"type": "choice",
"repeats": false,
"answerOption": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "6/60"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "6/36"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "6/24"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "04",
"display": "6/18"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "05",
"display": "6/12"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "06",
"display": "6/9"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "07",
"display": "6/6"
}
}
]
},
{
"linkId": "6868904614360",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "7.11.2"
}
],
"text": "Snellen Eye Chart Right eye Without Lens",
"type": "choice",
"answerOption": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "6/60"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "6/36"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "6/24"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "04",
"display": "6/18"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "05",
"display": "6/12"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "06",
"display": "6/9"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "07",
"display": "6/6"
}
}
]
},
{
"linkId": "9535262095025",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "7.11.3"
}
],
"text": "Snellen Eye Chart Left eye With Lens",
"type": "choice",
"answerOption": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "6/60"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "6/36"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "6/24"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "04",
"display": "6/18"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "05",
"display": "6/12"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "06",
"display": "6/9"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "07",
"display": "6/6"
}
}
]
},
{
"linkId": "3784286555747",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "7.11.4"
}
],
"text": "Snellen Eye Chart Left eye Without Lens",
"type": "choice",
"answerOption": [
{
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},
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},
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},
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},
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},
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},
{
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},
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{
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},
{
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},
{
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},
{
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},
{
"valueCoding": {
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},
{
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},
{
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},
{
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},
{
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},
{
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{
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{
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{
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{
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{
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{
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},
{
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],
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{
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{
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},
{
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},
{
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},
{
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]
},
{
"linkId": "8660013226797",
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{
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{
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{
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},
{
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},
{
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},
{
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},
{
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},
{
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},
{
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]
},
{
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"type": "group",
"item": [
{
"linkId": "7571418373717",
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],
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]
},
{
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{
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],
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"type": "boolean"
}
]
},
{
"linkId": "7928508760431",
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{
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],
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"type": "boolean",
"item": [
{
"linkId": "5584007098886",
"code": [
{
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},
{
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{
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"code": "7.14.4"
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],
"text": "Breast Examination, other",
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}
]
},
{
"linkId": "4960397935179",
"code": [
{
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],
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{
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],
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"type": "choice",
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{
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},
{
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{
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},
{
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},
{
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{
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},
{
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},
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},
{
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{
"linkId": "6294648899702",
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"code": "7.16"
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"code": "7.16.1"
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],
"text": "If Abnormal:",
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"repeats": true,
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{
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{
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{
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{
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{
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{
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{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "38",
"display": "T. WARFARIN 1MG"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "39",
"display": "T. WARFARIN 2MG"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "40",
"display": "T. WARFARIN 5MG"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "41",
"display": "T. OMEPRAZOLE 20MG"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "42",
"display": "T. RANITIDINE 150MG"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "43",
"display": "T. BENZHEXOL 2MG"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "44",
"display": "T. NEUROBION"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "45",
"display": "T. ZINCOFER"
}
}
]
}
]
}
]
},
{
"linkId": "11",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "11",
"display": "Verified by"
},
{
"code": "11",
"display": "Verified by"
}
],
"text": "Verified by",
"type": "group",
"required": false,
"item": [
{
"linkId": "11.1",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "11.1",
"display": "Officer incharge"
}
],
"text": "Officer incharge",
"type": "string",
"required": false
},
{
"linkId": "11.2",
"code": [
{
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "11.2",
"display": "Registration Number/ IC number"
}
],
"text": "Registration Number/ IC number",
"type": "string",
"required": false
}
]
}
]
}
{
"resourceType": "QuestionnaireResponse",
"id": "MYSJ-123",
"meta": {
"source": "http://peka40.moh.gov.my",
"profile": [
"http://hl7.org/fhir/StructureDefinition/QuestionnaireResponse"
]
},
"extension": [
{
"url": "http://fhir.hie.moh.gov.my/StructureDefinition/service-provider-my-core",
"valueReference": {
"reference": "Organization/PH"
}
}
],
"identifier": {
"value": "MYSJ-123"
},
"questionnaire": "https://fhir.hie.moh.gov.my/baseR4/Questionnaire/nhsi-my-core",
"status": "completed",
"subject": {
"reference": "Patient/example-NHSI-patient"
},
"authored": "2022-11-16T04:40:46.883Z",
"author": {
"text": "Dr Susan"
},
"item": [
{
"linkId": "1",
"text": "User Demographic",
"item": [
{
"linkId": "1.1",
"text": "Name",
"answer": [
{
"valueString": "Test"
}
]
},
{
"linkId": "1.2",
"text": "MySejahtera ID",
"answer": [
{
"valueString": "123"
}
]
},
{
"linkId": "1.3",
"text": "Contact Number",
"answer": [
{
"valueString": "123"
}
]
},
{
"linkId": "1.4",
"text": "Type of Identification",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Ic Numbers"
}
}
]
},
{
"linkId": "1.5",
"text": "IC Number/Passport",
"answer": [
{
"valueString": "92100514552"
}
]
},
{
"linkId": "1.6",
"text": "Gender",
"answer": [
{
"valueCoding": {
"system": "http://hl7.org/fhir/administrative-gender",
"code": "male",
"display": "Male"
}
}
]
},
{
"linkId": "1.7",
"text": "Nationality",
"answer": [
{
"valueString": "123"
}
]
},
{
"linkId": "1.8",
"text": "Address",
"answer": [
{
"valueString": "LOT 1655-10B, JALAN SAUJANA KAMPUNG SUNGAI RAMAL DALAM"
}
]
},
{
"linkId": "1.9",
"text": "Occupation",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Professional"
}
}
]
},
{
"linkId": "1.10",
"text": "Ethnicity",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Malay"
}
}
]
},
{
"linkId": "1.11",
"text": "Special Category of Population",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "00",
"display": "Not Applicable"
}
}
]
},
{
"linkId": "1.12",
"text": "Industry",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Advertising & Market Research"
}
}
]
},
{
"linkId": "1.13",
"text": "Comorbidities Present",
"answer": [
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "73211009",
"display": "Diabetes Mellitus"
}
}
]
},
{
"linkId": "1.14",
"text": "Last Screening Date",
"item": [
{
"linkId": "1.14.1",
"text": "Has the patient performed health screening before?",
"answer": [
{
"valueBoolean": true
}
]
},
{
"linkId": "1.14.2",
"text": "If Yes:",
"answer": [
{
"valueDate": "2022-11-16"
}
]
}
]
}
]
},
{
"linkId": "2",
"text": "Assessments",
"item": [
{
"linkId": "2.1",
"text": "Does the patient have any family history?",
"answer": [
{
"valueBoolean": true,
"item": [
{
"linkId": "2.1.1",
"text": "If yes:",
"answer": [
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "38341003",
"display": "Hypertension"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "73211009",
"display": "Diabetes Mellitus"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "13644009",
"display": "Hypercholesterolemia"
}
}
]
}
]
}
]
},
{
"linkId": "2.2",
"text": "Does the patient have any medical history?",
"answer": [
{
"valueBoolean": true,
"item": [
{
"linkId": "2.2.1",
"text": "If yes:",
"answer": [
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "13644009",
"display": "Hypercholesterolemia"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "73211009",
"display": "Diabetes Mellitus"
}
},
{
"valueCoding": {
"system": "http://snomed.info/sct",
"code": "56265001",
"display": "Coronary Heart Disease"
}
}
]
}
]
}
]
}
]
},
{
"linkId": "3",
"text": "Mental Health Assessments",
"item": [
{
"linkId": "3.1",
"text": "In the past 2 weeks, how often does this patient:",
"item": [
{
"linkId": "3.1.1",
"text": "Felt Down, depressed or hopeless",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Several Days"
}
}
]
},
{
"linkId": "3.1.2",
"text": "Little interest to do things",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Several Days"
}
}
]
},
{
"linkId": "3.1.3",
"text": "Trouble falling asleep/staying asleep or sleeping too much",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "> 7 days"
}
}
]
},
{
"linkId": "3.1.4",
"text": "Felt tired or having little energy",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Several Days"
}
}
]
},
{
"linkId": "3.1.5",
"text": "Had poor appetite or over eating",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "00",
"display": "Not At All"
}
}
]
},
{
"linkId": "3.1.6",
"text": "Felt bad about himself/herself, felt like a failure or he/she has let his/her family down",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "Almost everyday"
}
}
]
},
{
"linkId": "3.1.7",
"text": "Trouble concentrating (e.g. watching television or reading newspaper)",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "00",
"display": "Not At All"
}
}
]
},
{
"linkId": "3.1.8",
"text": "Moved slowly or fidgeted excessively that is noticeable by people around him/her",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "00",
"display": "Not At All"
}
}
]
},
{
"linkId": "3.1.9",
"text": "Had thoughts that he/she would be better dead, or hurting yourself",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Several Days"
}
}
]
},
{
"linkId": "3.1.10",
"text": "Total Mental Health Test Score",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "5-9 : Mild Depression"
}
}
]
}
]
},
{
"linkId": "3.2",
"text": "In the last 2 weeks, indicate how difficult these problems made it for this patient",
"item": [
{
"linkId": "3.2.1",
"text": "Do your work, take care of things at home, or get along with others",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Very difficult"
}
}
]
}
]
}
]
},
{
"linkId": "4",
"text": "Lifestyle Health Assessment",
"item": [
{
"linkId": "4.1",
"text": "Alcohol consumption",
"item": [
{
"linkId": "4.1.1",
"text": "How often do you consume alcohol?",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "00",
"display": "Never"
}
}
]
},
{
"linkId": "4.1.2",
"text": "How many alcoholic beverages do you consume in a day?",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "5-6"
}
}
]
},
{
"linkId": "4.1.3",
"text": "How often within the last year,",
"item": [
{
"linkId": "4.1.3.1",
"text": "Do you consume 6 or more drink in a day?",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Once a month"
}
}
]
},
{
"linkId": "4.1.3.2",
"text": "Were you not able to stop drinking once started?",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Once a month"
}
}
]
},
{
"linkId": "4.1.3.3",
"text": "Were you not able to perform normal activities due to drinking?",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "Weekly"
}
}
]
},
{
"linkId": "4.1.3.4",
"text": "You needed to drink first thing in the morning to get going after a heavy drinking session?",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Once a month"
}
}
]
},
{
"linkId": "4.1.3.5",
"text": "That you felt guilt or remorse after drinking?",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "< Once a month"
}
}
]
},
{
"linkId": "4.1.3.6",
"text": "Were you unable to remember what happened the night before due to drinking?",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Once a month"
}
}
]
}
]
},
{
"linkId": "4.1.4",
"text": "Have you or someone else been injured because of your drinking?",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Yes, during last year"
}
}
]
},
{
"linkId": "4.1.5",
"text": "Has a relative, friend, doctor, been concerned about your drinking habits?",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "00",
"display": "No"
}
}
]
},
{
"linkId": "4.1.6",
"text": "Total Alcohol Consumption Test Score",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "8-12 Moderate Risk"
}
}
]
}
]
},
{
"linkId": "4.2",
"text": "Smoking Status",
"item": [
{
"linkId": "4.2.1",
"text": "Does the patient smoke?",
"answer": [
{
"valueBoolean": true
}
]
},
{
"linkId": "4.2.2",
"text": "Cigarettes per Day",
"answer": [
{
"valueInteger": 1
}
]
},
{
"linkId": "4.2.3",
"text": "Years of Smoking",
"answer": [
{
"valueInteger": 12
}
]
},
{
"linkId": "4.2.4",
"text": "Total pack-years",
"answer": [
{
"valueQuantity": {
"value": 1
}
}
]
}
]
}
]
},
{
"linkId": "5",
"text": "Clinical Parameters",
"item": [
{
"linkId": "5.1",
"text": "Anthropometry: Height",
"answer": [
{
"valueQuantity": {
"value": 168,
"unit": "cm"
}
}
]
},
{
"linkId": "5.2",
"text": "Anthropometry: Weight",
"answer": [
{
"valueQuantity": {
"value": 58,
"unit": "kg"
}
}
]
},
{
"linkId": "5.3",
"text": "Anthropometry: Waistline",
"answer": [
{
"valueQuantity": {
"value": 30,
"unit": "cm"
}
}
]
},
{
"linkId": "5.4",
"text": "BMI calculation",
"answer": [
{
"valueQuantity": {
"value": 30,
"unit": "kg/m2"
}
}
]
},
{
"linkId": "5.5",
"text": "BMI Outcome",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "Overweight (25-29.9)"
}
}
]
},
{
"linkId": "5.6",
"text": "Vital Signs: Blood Pressure (systolic)",
"answer": [
{
"valueQuantity": {
"value": 120,
"unit": "mm[Hg]"
}
}
]
},
{
"linkId": "5.7",
"text": "Vital Signs: Blood Pressure (diastolic)",
"answer": [
{
"valueQuantity": {
"value": 90,
"unit": "mm[Hg]"
}
}
]
},
{
"linkId": "5.8",
"text": "Vital Signs: Pulse Rate",
"answer": [
{
"valueQuantity": {
"value": 80,
"unit": "/min"
}
}
]
},
{
"linkId": "5.9",
"text": "Blood Pressure Outcome",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Normal (Systolic <130,Diastolic <85)"
}
}
]
},
{
"linkId": "5.10",
"text": "Point of Care Testing: Blood Glucose",
"item": [
{
"linkId": "5.10.1",
"text": "Fasting",
"answer": [
{
"valueQuantity": {
"value": 12,
"unit": "mmol/L"
}
}
]
},
{
"linkId": "5.10.2",
"text": "Random",
"answer": [
{
"valueQuantity": {
"value": 12,
"unit": "mmol/L"
}
}
]
},
{
"linkId": "5.10.3",
"text": "Blood Glucose Outcome",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Normal Fasting (<5.6)"
}
}
]
}
]
},
{
"linkId": "5.11",
"text": "Point of Care Testing: Blood Cholesterol",
"item": [
{
"linkId": "5.11.1",
"text": "Fasting",
"answer": [
{
"valueQuantity": {
"value": 12,
"unit": "mmol/L"
}
}
]
},
{
"linkId": "5.11.2",
"text": "Random",
"answer": [
{
"valueQuantity": {
"value": 12,
"unit": "mmol/L"
}
}
]
},
{
"linkId": "5.11.3",
"text": "Blood Cholesterol Outcome",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "High >= 5.2 mmol/L"
}
}
]
}
]
}
]
},
{
"linkId": "6",
"text": "Advanced Health Screening (Optional)",
"item": [
{
"linkId": "6.1",
"text": "Cardiovascular",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Ankle Swelling"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "Shortness of breath"
}
}
]
},
{
"linkId": "6.2",
"text": "Gastrointestinal",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Nausea and/or vomiting"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "Bowel pattern and any changes"
}
}
]
},
{
"linkId": "6.3",
"text": "Genitourinary",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Dysuria"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "04",
"display": "Nocturia"
}
}
]
},
{
"linkId": "6.4",
"text": "Locomotor",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Change in mobility"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Joint pain"
}
}
]
},
{
"linkId": "6.5",
"text": "Neurological",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Seizures"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "Transient loss of function (vision, speech, sight)"
}
}
]
},
{
"linkId": "6.6",
"text": "ENT Symptoms",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "Snoring"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Epistaxis"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "04",
"display": "Otalgia"
}
}
]
},
{
"linkId": "6.7",
"text": "Dermatology",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Skin color changes"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Rashes"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "Ulcers"
}
}
]
}
]
},
{
"linkId": "7",
"text": "Advanced Systemic Examination (Optional)",
"item": [
{
"linkId": "7430591698512",
"text": "General Appearance",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Abnormal"
},
"item": [
{
"linkId": "9491690640065",
"text": "If Abnormal:",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Cyanosed"
}
}
]
}
]
}
]
},
{
"linkId": "9385492769029",
"text": "Hands and Arms",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Abnormal"
},
"item": [
{
"linkId": "2706469979386",
"text": "If Abnormal:",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "05",
"display": "Dupuytren’s contracture"
}
}
]
}
]
}
]
},
{
"linkId": "803255584502",
"text": "Head",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Abnormal"
},
"item": [
{
"linkId": "2706057387357",
"text": "If Abnormal:",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "Psoriatic plaque"
}
}
]
}
]
}
]
},
{
"linkId": "5438686906842",
"text": "Neck",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Abnormal"
},
"item": [
{
"linkId": "8525967233111",
"text": "If Abnormal:",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Trachea Deviation"
}
}
]
}
]
}
]
},
{
"linkId": "6320853137177",
"text": "Face",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Abnormal"
},
"item": [
{
"linkId": "3567829538338",
"text": "If Abnormal:",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "06",
"display": "Increase of facial hair"
}
}
]
}
]
}
]
},
{
"linkId": "2775452197874",
"text": "Mouth",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "00",
"display": "Normal"
},
"item": [
{
"linkId": "2293927557638",
"text": "If Abnormal, Lips:",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Stomatitis"
}
}
]
},
{
"linkId": "4080959756844",
"text": "If Abnormal, Gums:",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Gingvitis"
}
}
]
},
{
"linkId": "9937565309207",
"text": "If Abnormal, Tongue:",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "04",
"display": "Leukplakia"
}
}
]
}
]
}
]
},
{
"linkId": "681882410657",
"text": "Ears, Nose, Throat",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Abnormal"
},
"item": [
{
"linkId": "1009194092473",
"text": "If Abnormal, Ears:",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Bleeding"
}
}
]
},
{
"linkId": "5071830545688",
"text": "If Abnormal, Nose:",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Epistaxis"
}
}
]
},
{
"linkId": "1032584307566",
"text": "If Abnormal, Throat:",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "Deviated uvula"
}
}
]
}
]
}
]
},
{
"linkId": "1760871504781",
"text": "Eyes",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Abnormal"
},
"item": [
{
"linkId": "2830264276824",
"text": "If Abnormal, General:",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Squint"
}
}
]
},
{
"linkId": "9200420167241",
"text": "If Abnormal, Conjunctiva:",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Pallor"
}
}
]
},
{
"linkId": "3896132461914",
"text": "If Abnormal, Cornea:",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Kaiser Fleischer's ring (Wilson Disease)"
}
}
]
}
]
}
]
},
{
"linkId": "4541398644599",
"text": "Fundoscopy",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "00",
"display": "Normal"
},
"item": [
{
"linkId": "4508425091768",
"text": "If Abnormal, General:",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Others"
}
}
]
},
{
"linkId": "3275429148998",
"text": "If Abnormal, Optic Disc",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Swollen"
}
}
]
},
{
"linkId": "87716190119",
"text": "If Abnormal, Retina:",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Arteriovenous nicking"
}
}
]
},
{
"linkId": "1106310017866",
"text": "If Abnormal, Macula:",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Exudates"
}
}
]
}
]
}
]
},
{
"linkId": "7802596122190",
"text": "Ishihara Chart:",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Abnormal"
}
}
]
},
{
"linkId": "1772552914755",
"text": "Snellen Eye Chart Score",
"item": [
{
"linkId": "5634044053426",
"text": "Snellen Eye Chart Right eye With Lens",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "6/60"
}
}
]
},
{
"linkId": "6868904614360",
"text": "Snellen Eye Chart Right eye Without Lens",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "6/36"
}
}
]
},
{
"linkId": "9535262095025",
"text": "Snellen Eye Chart Left eye With Lens",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "6/36"
}
}
]
},
{
"linkId": "3784286555747",
"text": "Snellen Eye Chart Left eye Without Lens",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "6/36"
}
}
]
}
]
},
{
"linkId": "4357973483106",
"text": "Cardiorespiratory Examination",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Abnormal"
},
"item": [
{
"linkId": "3684125820499",
"text": "Cardiorespiratory Examination, inspection:",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "Peripheral edema"
}
}
]
},
{
"linkId": "1021145880907",
"text": "Cardiorespiratory Examination, palpation:",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Tracheal Deviation"
}
}
]
},
{
"linkId": "5331561684920",
"text": "Cardiorespiratory Examination, percussion:",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Chest dullness"
}
}
]
},
{
"linkId": "9727586284871",
"text": "Cardiorespiratory Examination, auscultation",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Crepitations"
}
}
]
}
]
}
]
},
{
"linkId": "3445180818234",
"text": "Abdominal Examination",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Abnormal"
},
"item": [
{
"linkId": "1295584939146",
"text": "Abdominal Examination, inspection:",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "Prominent viens"
}
}
]
},
{
"linkId": "6163894014798",
"text": "Abdominal Examination, palpation",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Mass"
}
}
]
},
{
"linkId": "450925187844",
"text": "Abdominal Examination, percussion:",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Shufting dullness"
}
}
]
},
{
"linkId": "9695659964510",
"text": "Abdominal Examination, auscultation:",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Bruits"
},
"item": [
{
"linkId": "3097284117717",
"text": "Bowel Sound",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Absence"
}
}
]
}
]
}
]
},
{
"linkId": "896081526011",
"text": "Abdominal Examination, other",
"answer": [
{
"valueString": "free text"
}
]
}
]
}
]
},
{
"linkId": "8660013226797",
"text": "Breast Examination",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Abnormal"
},
"item": [
{
"linkId": "2152650190448",
"text": "Breast Examination, inspection:",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Scars"
}
}
]
},
{
"linkId": "5834188726294",
"text": "Breast Examination, palpation",
"item": [
{
"linkId": "7571418373717",
"text": "Lump",
"answer": [
{
"valueBoolean": true,
"item": [
{
"linkId": "8412518064517",
"text": "To state position, size, shape, consistency, overlying skin changes and mobility",
"answer": [
{
"valueString": "free text"
}
]
}
]
}
]
},
{
"linkId": "7708835727325",
"text": "Breast Examination, tenderness",
"answer": [
{
"valueBoolean": true
}
]
}
]
},
{
"linkId": "7928508760431",
"text": "Breast Examination, lymph node",
"answer": [
{
"valueBoolean": true,
"item": [
{
"linkId": "5584007098886",
"text": "If yes, state location",
"answer": [
{
"valueString": "free text"
}
]
}
]
}
]
},
{
"linkId": "7966899757129",
"text": "Breast Examination, other",
"answer": [
{
"valueString": "free text"
}
]
}
]
}
]
},
{
"linkId": "4960397935179",
"text": "Genital Examination",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "00",
"display": "Normal"
},
"item": [
{
"linkId": "129761420416",
"text": "If Abnormal:",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Skin lesion"
}
}
]
}
]
}
]
},
{
"linkId": "6294648899702",
"text": "Musculoskeletal Examination",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Abnormal"
},
"item": [
{
"linkId": "6506163486097",
"text": "If Abnormal:",
"answer": [
{
"valueCoding": {
"code": "01",
"display": "Muscle wasting"
}
}
]
}
]
}
]
},
{
"linkId": "8529069579767",
"text": "Neurological Examination",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "00",
"display": "Normal"
},
"item": [
{
"linkId": "2933999220096",
"text": "Neurological Examination, motor",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Right Upper Limb"
},
"item": [
{
"linkId": "5139376034252",
"text": "Neurological Examination, muscle tone",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Hypotonia"
}
}
]
},
{
"linkId": "2810983082307",
"text": "Neurological Examination, muscle power",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "1"
}
}
]
}
]
}
]
},
{
"linkId": "9525382653281",
"text": "Neurological Examination, reflexes",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Left Upper Limb"
},
"item": [
{
"linkId": "1871500398585",
"text": "Neurological Examination, hyperreflex/hyporeflex",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Hyperreflex"
}
}
]
}
]
}
]
},
{
"linkId": "3739755767869",
"text": "Neurological Examination, babinski",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Absent"
}
}
]
},
{
"linkId": "208277417057",
"text": "Neurological Examination, sensation",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Loss of pain sensation"
}
}
]
},
{
"linkId": "969352104031",
"text": "Neurological Examination, other",
"answer": [
{
"valueString": "asd"
}
]
}
]
}
]
}
]
},
{
"linkId": "8",
"text": "Further Investigations",
"item": [
{
"linkId": "8.1",
"text": "Urine dipstick",
"answer": [
{
"valueString": "123"
}
]
},
{
"linkId": "8.2",
"text": "Urine FEME",
"answer": [
{
"valueString": "123"
}
]
},
{
"linkId": "8.3",
"text": "ECG",
"answer": [
{
"valueString": "123"
}
]
},
{
"linkId": "8.4",
"text": "Haemoglobin",
"answer": [
{
"valueString": "123"
}
]
}
]
},
{
"linkId": "9",
"text": "Diagnosis",
"item": [
{
"linkId": "9.1",
"text": "Normal Healthy individual?",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "At risk"
}
}
]
},
{
"linkId": "9.2",
"text": "Diagnosis",
"item": [
{
"linkId": "9.2.1",
"text": "Display",
"answer": [
{
"valueString": "123"
}
]
},
{
"linkId": "9.2.2",
"text": "Code",
"answer": [
{
"valueString": "123"
}
]
},
{
"linkId": "9.2.3",
"text": "Code System",
"answer": [
{
"valueString": "123"
}
]
}
]
},
{
"linkId": "9.3",
"text": "Provisional diagnosis",
"item": [
{
"linkId": "9.3.1",
"text": "Display",
"answer": [
{
"valueString": "123"
}
]
},
{
"linkId": "9.3.2",
"text": "Code",
"answer": [
{
"valueString": "123"
}
]
},
{
"linkId": "9.3.3",
"text": "Code System",
"answer": [
{
"valueString": "123"
}
]
}
]
}
]
},
{
"linkId": "10",
"text": "Management",
"item": [
{
"linkId": "10.1",
"text": "General management",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "Smoking cessation"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "Dietary advice"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "04",
"display": "Physical activity advice"
}
}
]
},
{
"linkId": "10.2",
"text": "Doctor’s notes",
"answer": [
{
"valueString": "123"
}
]
},
{
"linkId": "10.3",
"text": "Prescription",
"item": [
{
"linkId": "10.3.1",
"text": "Any medication prescribed?",
"answer": [
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "03",
"display": "T. FELODIPINE 5MG"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "02",
"display": "T. AMLODIPINE 10MG"
}
},
{
"valueCoding": {
"system": "http://fhir.hie.moh.gov.my/CodeSystem/nhsi-my-core",
"code": "01",
"display": "T. AMLODIPINE 5MG"
}
}
]
}
]
}
]
},
{
"linkId": "11",
"text": "Verified by",
"item": [
{
"linkId": "11.1",
"text": "Officer incharge",
"answer": [
{
"valueString": "123"
}
]
},
{
"linkId": "11.2",
"text": "Registration Number/ IC number",
"answer": [
{
"valueString": "123"
}
]
}
]
}
]
}