This page is part of the Smart Forms (v0.2.0-draft: R1 Draft) based on FHIR (HL7® FHIR® Standard) R4. . For a full list of available versions, see the Directory of published versions
Questionnaire: Aboriginal and Torres Strait Islander Health Check - Patient Details
| Official URL: http://www.health.gov.au/assessments/mbs/715/PatientDetails | Version: 0.2.0-draft | |||
| Draft as of 2024-04-02 | Computable Name: PatientDetails | |||
Copyright/Legal: Copyright © 2022+ Australian Government Department of Health and Aged Care - All rights reserved. This content is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License. See https://creativecommons.org/licenses/by-sa/4.0/. |
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Patient Details sub-questionnaire for Aboriginal and Torres Strait Islander Health Check.
Generated Narrative: Questionnaire PatientDetails
| LinkID | Text | Cardinality | Type | Flags | Description & Constraints |
|---|---|---|---|---|---|
  PatientDetails | Patient Details sub-questionnaire for Aboriginal and Torres Strait Islander Health Check. | Questionnaire | http://www.health.gov.au/assessments/mbs/715/PatientDetails#0.2.0-draft | ||
  5b224753-9365-44e3-823b-9c17e7394005 | Patient Details | 0..1 | group | ||
   CD-in-progress-32 | In progress | 0..1 | display | Enable When: MarkComplete-32 != | |
| CD-complete-32 | Complete | 0..1 | display | Enable When: MarkComplete-32 = | |
| RecordUpdate-Patient | Important: The patient record may not be updated with information entered here. Information intended for the patient record should be entered there first. | 0..1 | display | ||
 17596726-34cf-4133-9960-7081e1d63558 | Name | 0..1 | string |  | |
| 57093a06-62f7-4b8b-8cb4-2c9f451ac851 | Preferred name | 0..1 | string | | |
 540b1034-7c9a-4aba-a9ef-afb77d445a58 | Preferred pronouns | 0..1 | choice | | Value Set: Australian Pronouns |
| f669a4fe-4818-429a-8847-d20da88d2bb3 | Gender identity | 0..1 | choice | | Value Set: Gender Identity Response |
| 418e4a02-de77-48a0-a92a-fe8fcc52b1aa | Administrative gender | 0..1 | choice |  | Value Set: AdministrativeGender |
| 56ef44bb-3d1d-4972-aad1-834b69185d61 | Sex assigned at birth | 0..1 | choice | | Value Set: Biological Sex |
 90ad8f16-16e4-4438-a7aa-b3189f510da2 | Date of birth | 0..1 | date | | |
 e2a16e4d-2765-4b61-b286-82cfc6356b30 | Age | 0..1 | integer | | |
| 8acde9f8-7a91-4f0c-9216-38531ec984ef | Aboriginal and/or Torres Strait Islander status | 0..1 | choice | | Value Set: Aboriginal and/or Torres Strait Islander |
| c8852db9-efe9-4102-96db-cef3a8be0a5f | Parents/primary carer/s | 0..* | choice | Value Set: Primary Carer Of Parent Or Grandparent | |
| 7089c48e-4216-4089-a548-034cd585e4da | Other family | 0..* | string | ||
 70c45932-99dc-42a3-9650-4683892a0892 | details | 0..1 | display | ||
| 42b1f5e0-bf4a-47d9-86a4-f2fe946ac01f | Other | 0..* | string | ||
| dcbd3a54-9b68-4486-bf30-f6f1723bc39c | details | 0..1 | display | ||
| 06737e46-e880-4037-9a2c-bcd278cd70ba | Parents/primary carer/s details | 0..* | group | ||
| cc20ce96-af06-4cd7-aa9b-c2601a6169ad | Name of parent/primary carer | 0..1 | string | ||
| 372d79bb-9d0b-42d2-a98c-cbe332bd3745 | Relationship to child | 0..1 | string | ||
| f1262ade-843c-4eba-a86d-51a9c97d134b | Home address | 0..1 | group | ||
 311d83bb-f22e-4f60-9b50-b6e38dd2059b | No fixed address | 0..1 | boolean | Definition: Address.extension:noFixedAddress | |
| 4e0dc185-f83e-4027-b7a8-ecb543d42c6d | null | 0..* | group | Enable When: 311d83bb-f22e-4f60-9b50-b6e38dd2059b != | |
| 2fee2d51-7828-4178-b8c1-35edd32ba338 | Street address | 0..1 | string | Definition: Address.line | |
| ddb65ed1-f4b2-4730-af2a-2f98bc73c76f | City | 0..1 | string | Definition: Address.city | |
| d9a1236c-8d6e-4f20-a12a-9d5de5a1d0f6 | State | 0..1 | choice | Definition: Address.state Value Set: Australian States and Territories | |
| 3f61a1ea-1c74-4f52-8519-432ce861a74f | Postcode | 0..1 | string | Definition: Address.postalCode | |
| edc081ea-b5ba-4234-9234-8ee598c2f95f | Postal address | 0..* | group | | |
| 622970f1-3cf1-4f0a-bf05-b00a08046eba | Purpose of use | 0..1 | string | Definition: Address.use | |
| 2e8437cd-5ea0-4d44-8ab2-d2aa9ef18ba7 | Address | 0..1 | string | Definition: Address.line | |
| 2bde25e5-2c4c-4c0c-b6f3-c6859535a764 | City | 0..1 | string | Definition: Address.city | |
| b41a8b11-8dbf-4999-9d0a-71d39240fed1 | State | 0..1 | choice | Definition: Address.state Value Set: Australian States and Territories | |
| 28b58e50-2a04-4192-9655-efc8d72f32fa | Postcode | 0..1 | string | Definition: Address.postalCode | |
| 9541f0b0-f5ba-4fe7-a8e9-ad003cef897b | Home phone | 0..* | string | ||
| 4037a02b-4a85-40e0-9be6-5b17df1aac56 | Mobile phone | 0..* | string | ||
| c22390d3-1be6-4fd1-b775-6443b7239a6b | Emergency contact | 0..* | group | ||
| d7f2dd75-20c8-480f-8c22-71d604ebee8d | Name | 0..1 | string | ||
| aa35d559-f45b-4d35-9453-dd02e4a790f3 | Relationship to child | 0..1 | string | ||
| 27099697-d6d1-42c0-bb0a-5e9ff7372a96 | Relationship to patient | 0..1 | string | ||
| 626e3723-6310-4b99-81c1-525676b027c8 | Phone | 0..* | string | ||
| df1475ea-bf7e-4bf0-a69f-7f9608c3ed3c | Medicare number | 0..1 | group | ||
| eb2a59ed-9632-4df1-b5b1-1e85c3b4b7cf | Number | 0..1 | string | ||
| d6253253-a124-494e-a1d8-7ce02c69ec11 | Reference number | 0..1 | string | ||
| c520e213-5313-42c3-860a-d30206620290 | Expiry | 0..1 | string | ||
| c1e4e967-c0aa-4280-b5d4-ab1f375ed9ac | Pensioner Card Number | 0..1 | string | Max Length: 10 | |
| a7e97574-3cea-4dfa-bef2-2665e7748364 | Health Care Card Number | 0..1 | string | Max Length: 10 | |
| 83814495-3a81-43f4-88df-42186cce516a | Registered for Closing the Gap PBS Co-payment Measure (CTG) | 0..1 | choice |  | Value Set: Yes/No/NA |
| e63547c6-1623-412f-963f-5f1ebf23563f | Child has a birth certificate | 0..1 | choice | | Value Set: Yes/No/NA |
| a8143230-b30d-4b85-9805-5f2f73f2dffa | My Aged Care | 0..1 | group | ||
| 7165c072-e3d8-4564-9d1d-d17f6807787c | Registered for My Aged Care | 0..1 | choice | | Value Set: Yes/No/NA |
| 04e50521-dc85-4744-b7ab-6f8682aacb11 | My Aged Care Number | 0..1 | string | Enable When: 7165c072-e3d8-4564-9d1d-d17f6807787c = | |
| 2bfe50cb-7913-4f31-bce2-763c17ff8b1a | National Disability Insurance Scheme | 0..1 | group | ||
| 924b4500-53ac-4c4e-831b-7ab5569ff981 | Registered for NDIS | 0..1 | choice | | Value Set: Yes/No/NA |
| 7379a0fd-d95b-4ecb-a781-9f43d1394f10 | NDIS Number | 0..1 | string | Enable When: 924b4500-53ac-4c4e-831b-7ab5569ff981 = | |
| 9bc882bc-e989-4600-9587-8089fb757641 | Children | 0..1 | group | ||
| e90b436b-2751-4e07-a40c-adfe951b6528 | Do you have children? | 0..1 | choice | | Value Set: Yes/No/NA |
| 241f5fca-f61a-49bd-8972-52613c0e6d15 | Number of children | 0..1 | integer | Enable When: e90b436b-2751-4e07-a40c-adfe951b6528 = | |
| 74ce4c60-31d6-4e78-9056-579937379451 | Number of children in your care | 0..1 | integer | Enable When: e90b436b-2751-4e07-a40c-adfe951b6528 = | |
| 2b5ae784-4341-4172-875d-1698cc8069f0 | Someone's carer | 0..1 | group | ||
| a08271f1-194b-4fe9-91f9-4f3398858eb0 | Are you responsible for caring for someone else? | 0..1 | choice | | Value Set: Yes/No/NA |
 4c14b158-3ae4-4994-8446-76e02640702c | Details | 0..1 | text | Enable When: a08271f1-194b-4fe9-91f9-4f3398858eb0 = | |
| 6c80c675-1320-4ca3-ae3f-51ad173da741 | Your carer | 0..1 | group | ||
| d05558fb-a3cc-4bd6-b803-b672b36b9c51 | Do you have a carer? | 0..1 | choice | | Value Set: Yes/No/NA |
| b9991e7e-ce03-465d-b4b0-5a1725b24e02 | Details | 0..1 | text | Enable When: d05558fb-a3cc-4bd6-b803-b672b36b9c51 = | |
| 3494631c-6b56-46dc-abf7-a17bfc1d025f | Providers | 0..1 | group | ||
| 41210be5-d441-4c44-b9c2-8dd94a44cbb4 | Are name and contact details of other key providers (eg case workers, support services) up to date? | 0..1 | choice | | Value Set: Yes/No/NA |
| 6733d6ec-5b6b-4ee2-a21e-0e9474c2b22b | Details | 0..1 | text | ||
| 38f81a73-447f-4ecd-a8eb-6eccd9dee050 | Advance care planning | 0..1 | group | ||
| c023ef16-b554-4ed9-8993-1331e5f5a3b4 | Enduring Power of Attorney | 0..1 | group | ||
| 036eace9-ea83-46ec-9d01-f2093f710816 | Enduring Power of Attorney | 0..1 | choice | | Value Set: Yes/No/NA |
| 83518215-7151-4365-b745-d7464bbb9528 | Discussed today | 0..1 | text | ||
| c4f68251-26af-462f-879a-a69b449066ff | Advance Health Directive | 0..1 | group | ||
| b0632039-c12b-4748-9e94-52073590c0ba | Advance Health Directive | 0..1 | choice | | Value Set: Yes/No/NA |
| c4bc2d84-e411-488d-9c0d-761f0377a026 | Discussed today | 0..1 | text | ||
| MarkComplete-32 | Mark section as complete | 0..1 | boolean | ||
| Documentation for this format | |||||
Contained Resources
Generated Narrative: ValueSet #YesNoNA
Expansion based on system expandedYes-NoIndicator v2.1.0 (CodeSystem)
This value set contains 3 concepts
| Code | System | Display | Definition |
| Y | http://terminology.hl7.org/CodeSystem/v2-0532 | Yes | Yes |
| N | http://terminology.hl7.org/CodeSystem/v2-0532 | No | No |
| NA | http://terminology.hl7.org/CodeSystem/v2-0532 | N/A | not applicable |
Generated Narrative: ValueSet #AboriginalTorresStraitIslander
Expansion based on system australian-indigenous-status-1 version1.0.3
This value set contains 3 concepts
Generated Narrative: ValueSet #PrimaryCarerParentGrandparent
Expansion based on:
- system NullFlavor version2018-08-12
- system RoleCode version2018-08-12
This value set contains 4 concepts
| Code | System | Display | Definition |
| MTH | http://terminology.hl7.org/CodeSystem/v3-RoleCode | mother | The player of the role is a female who conceives, gives birth to, or raises and nurtures the scoping entity (child). |
| FTH | http://terminology.hl7.org/CodeSystem/v3-RoleCode | father | The player of the role is a male who begets or raises or nurtures the scoping entity (child). |
| GRPRN | http://terminology.hl7.org/CodeSystem/v3-RoleCode | grandparent | The player of the role is a parent of the scoping person's mother or father. |
| NA | http://terminology.hl7.org/CodeSystem/v3-NullFlavor | not applicable | Known to have no proper value (e.g., last menstrual period for a male). |
Generated Narrative: ValueSet #administrative-gender
Expansion based on system AdministrativeGender v4.0.1 (CodeSystem)
This value set contains 4 concepts
| Code | System | Display | Definition | v2 map for AdministrativeGender | v3 map for AdministrativeGender |
| female | http://hl7.org/fhir/administrative-gender | Female | Female. | ~F | ~F |
| male | http://hl7.org/fhir/administrative-gender | Male | Male. | ~M | ~M |
| other | http://hl7.org/fhir/administrative-gender | Other | Other. | <A <O | <UN |
| unknown | http://hl7.org/fhir/administrative-gender | Unknown | Unknown. | ~U | ~UNK |
Generated Narrative: ValueSet #australian-pronouns-1
Expansion based on:
- Loinc v2.77
- system DataAbsentReason version5.0.0-ballot
This value set contains 7 concepts
| Code | System | Display | Definition |
| LA29518-0 | http://loinc.org | he/him/his/his/himself | |
| LA29519-8 | http://loinc.org | she/her/her/hers/herself | |
| LA29520-6 | http://loinc.org | they/them/their/theirs/themselves | |
| asked-declined | http://terminology.hl7.org/CodeSystem/data-absent-reason | Asked But Declined | The source was asked but declined to answer. |
| asked-unknown | http://terminology.hl7.org/CodeSystem/data-absent-reason | Asked But Unknown | The source was asked but does not know the value. |
| not-asked | http://terminology.hl7.org/CodeSystem/data-absent-reason | Not Asked | The workflow didn't lead to this value being known. |
| unknown | http://terminology.hl7.org/CodeSystem/data-absent-reason | Unknown | The value is expected to exist but is not known. |
Generated Narrative: ValueSet #gender-identity-response-1
Expansion based on:
- SNOMED CT Australian edition 31-Mar 2024
- system DataAbsentReason version5.0.0-ballot
This value set contains 6 concepts
| Code | System | Display | Definition |
| 446151000124109 | http://snomed.info/sct | Identifies as male gender | |
| 446141000124107 | http://snomed.info/sct | Identifies as female gender | |
| 33791000087105 | http://snomed.info/sct | Identifies as nonbinary gender | |
| unknown | http://terminology.hl7.org/CodeSystem/data-absent-reason | Unknown | The value is expected to exist but is not known. |
| asked-declined | http://terminology.hl7.org/CodeSystem/data-absent-reason | Asked But Declined | The source was asked but declined to answer. |
| not-asked | http://terminology.hl7.org/CodeSystem/data-absent-reason | Not Asked | The workflow didn't lead to this value being known. |
Generated Narrative: ValueSet #biological-sex-1
Expansion based on SNOMED CT Australian edition 31-Aug 2023
This value set contains 4 concepts
| Code | System | Display |
| 248152002 | http://snomed.info/sct | Female |
| 32570681000036106 | http://snomed.info/sct | Indeterminate sex |
| 32570691000036108 | http://snomed.info/sct | Intersex |
| 248153007 | http://snomed.info/sct | Male |
Generated Narrative: ValueSet #australian-states-territories-2
Expansion based on system australian-states-territories-1 version1.1.3
This value set contains 9 concepts