{ "resourceType" : "Questionnaire", "id" : "EInfectionReport-EHEC-Questionnaire-test", "meta" : { "profile" : ["http://jpfhir.jp/fhir/eInfectionReport/StructureDefinition/JP_Questionnaire_eInfectionReport_Common"] }, "text" : { "status" : "generated", "div" : "
\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
LinkIdTextCardinalityTypeDescription & Constraints\"doco\"
\".\"\".\" JP_Questionnaire_eInfectionReport_EHEC別紙様式３－３\u3000腸管出血性大腸菌感染症 発生届Questionnairehttp://jpfhir.jp/fhir/eInfectionReport/mhlw/Questionnaire/JP_Questionnaire_eInfectionReport_EHEC#1.0.0
\".\"\".\"\".\" group_Header届出元情報1..1group
\".\"\".\"\".\"\".\" i0_1報告年月日1..1date
\".\"\".\"\".\"\".\" i0_2医師氏名1..1string
\".\"\".\"\".\"\".\" i0_3従事する病院・診療所の名称1..1string
\".\"\".\"\".\"\".\" i0_4上記病院・診療所の所在地1..1string
\".\"\".\"\".\"\".\" i0_5電話番号1..1string
\".\"\".\"\".\" group_Subject当該者情報1..1group
\".\"\".\"\".\"\".\" i1_1診断（検案）した者（死体）の類型1..1choiceValue Set: 腸管出血性大腸菌感染症 診断（検案）した者（死体）の類型
\".\"\".\"\".\"\".\" i1_2当該者氏名1..1string
\".\"\".\"\".\"\".\" i1_3性別1..1choiceValue Set: AdministrativeGender
\".\"\".\"\".\"\".\" i1_4生年月日1..1date
\".\"\".\"\".\"\".\" i1_5診断時の年齢（0歳は月齢）1..1integer
\".\"\".\"\".\"\".\" i1_6当該者職業1..1string
\".\"\".\"\".\"\".\" i1_7-1当該者住所1..1string
\".\"\".\"\".\"\".\" i1_7-2当該者住所の電話1..*string
\".\"\".\"\".\"\".\" i1_8-1当該者所在地1..1string
\".\"\".\"\".\"\".\" i1_8-2当該者所在地の電話1..*string
\".\"\".\"\".\"\".\" i1_9保護者氏名0..1string
\".\"\".\"\".\"\".\" i1_10-1保護者住所0..1string
\".\"\".\"\".\"\".\" i1_10-2保護者電話0..*string
\".\"\".\"\".\" group_Contents届出内容1..1group
\".\"\".\"\".\"\".\" i1_11症状1..1choiceValue Set: 質問票の回答のためのYES/NO ValueSet
\".\"\".\"\".\"\".\"\".\" i1_11_1症状選択肢0..*choiceValue Set: 腸管出血性大腸菌感染症 症状コード ValueSet
\".\"\".\"\".\"\".\"\".\" i1_11_2その他の症状0..*string
\".\"\".\"\".\"\".\" i1_12診断方法1..1group
\".\"\".\"\".\"\".\"\".\" i1_12_1分離・同定による病原体の検出、かつ、分離菌における次の1、2いずれかによるベロ毒素の確認（1毒素産生 2ＰＣＲ法等による毒素遺伝子 ）1..1group
\".\"\".\"\".\"\".\"\".\"\".\" i1_12_1_11:毒素産生 2:ＰＣＲ法等による毒素遺伝子0..*choiceValue Set: 腸管出血性大腸菌感染症 分離・同定による病原体の検出、かつ、分離菌における ①毒素産生 ②ＰＣＲ法等による毒素遺伝子
\".\"\".\"\".\"\".\"\".\"\".\" i1_12_1_2検体：便・その他（ ）1..1group
\".\"\".\"\".\"\".\"\".\"\".\"\".\" i1_12_1_2_1検体：便0..1choiceValue Set: 質問票の回答のためのYES/NO ValueSet
\".\"\".\"\".\"\".\"\".\"\".\"\".\" i1_12_1_2_2検体：その他0..1string
\".\"\".\"\".\"\".\"\".\"\".\" i1_12_1_3Ｏ血清群：Ｏ( )・不明1..1group
\".\"\".\"\".\"\".\"\".\"\".\"\".\" i1_12_1_3_1Ｏ血清群：Ｏ( )0..1string
\".\"\".\"\".\"\".\"\".\"\".\"\".\" i1_12_1_3_2Ｏ血清群：不明0..1choiceValue Set: 質問票の回答のための Unknown (不明)
\".\"\".\"\".\"\".\"\".\"\".\" i1_12_1_4Ｈ血清群：Ｈ( )・不明1..1group
\".\"\".\"\".\"\".\"\".\"\".\"\".\" i1_12_1_4_1Ｈ血清群：Ｈ( )0..1string
\".\"\".\"\".\"\".\"\".\"\".\"\".\" i1_12_1_4_2Ｈ血清群：不明0..1choiceValue Set: 質問票の回答のための Unknown (不明)
\".\"\".\"\".\"\".\"\".\"\".\" i1_12_1_5ベロ毒素：VT1VT2 ・VT1 ・VT2 ・VT(型不明)0..1choiceValue Set: 腸管出血性大腸菌感染症 ベロ毒素 ValueSet
\".\"\".\"\".\"\".\"\".\" i1_12_2便でのベロ毒素の検出（HUS 発症例に限る）0..1boolean
\".\"\".\"\".\"\".\"\".\" i1_12_3血清でのＯ抗原凝集抗体又は抗ベロ毒素抗体の検出（HUS発症例に限る）0..1boolean
\".\"\".\"\".\"\".\"\".\" i1_12_4その他の方法0..1string
\".\"\".\"\".\"\".\"\".\"\".\" i1_12_4_1検体（ ）0..1string
\".\"\".\"\".\"\".\"\".\"\".\" i1_12_4_2結果（ ）0..1string
\".\"\".\"\".\"\".\" i1_13初診年月日1..1date
\".\"\".\"\".\"\".\" i1_14診断（検案）年月日1..1date
\".\"\".\"\".\"\".\" i1_15感染したと推定される年月日1..1date
\".\"\".\"\".\"\".\" i1_16発病年月日0..1date
\".\"\".\"\".\"\".\" i1_17死亡年月日0..1date
\".\"\".\"\".\"\".\" i1_18感染原因・感染経路・感染地域1..1group
\".\"\".\"\".\"\".\"\".\" i1_18_1感染原因・感染経路（確定・推定）0..1choiceValue Set: 診断等の診断事実の確からしさ ValueSet
\".\"\".\"\".\"\".\"\".\"\".\" i1_18_1_1経口感染（飲食物の種類・状況：）0..1string
\".\"\".\"\".\"\".\"\".\"\".\" i1_18_1_2接触感染（接触した人・物の種類・状況：）0..1string
\".\"\".\"\".\"\".\"\".\"\".\" i1_18_1_3動物・蚊・昆虫等からの感染（動物・蚊・昆虫等の種類・状況：)0..1string
\".\"\".\"\".\"\".\"\".\"\".\" i1_18_1_4その他0..1string
\".\"\".\"\".\"\".\"\".\" i1_18_2感染地域（確定・推定）0..1choiceValue Set: 診断等の診断事実の確からしさ ValueSet
\".\"\".\"\".\"\".\"\".\"\".\" i1_18_2_1日本国内（都道府県,市区町村）0..*string
\".\"\".\"\".\"\".\"\".\"\".\" i1_18_2_2国外（国,詳細地域）0..*string
\".\"\".\"\".\"\".\" i1_19その他感染症の蔓延防止及び当該者の医療のために医師が必要と認める事項0..1string

\"doco\" Documentation for this format
" }, "url" : "http://jpfhir.jp/fhir/eInfectionReport/mhlw/Questionnaire/JP_Questionnaire_eInfectionReport_EHEC", "identifier" : [{ "system" : "http://jpfhir.jp/fhir/core/IdSystem/resourceInstance-identifier", "value" : "MHLW-sample-20230531-3-3" }], "version" : "1.0.0", "name" : "JP_Questionnaire_eInfectionReport_EHEC", "title" : "腸管出血性大腸菌感染症 発生届 Enterohemorrhagic E. coli infection", "status" : "active", "subjectType" : ["Patient"], "date" : "2021-05-31T00:00:00+09:00", "publisher" : "The Department of Bio-Medical Informatics, The University of Tokyo", "contact" : [{ "name" : "The Department of Bio-Medical Informatics, The University of Tokyo", "telecom" : [{ "system" : "url", "value" : "http://std.jpfhir.jp" }, { "system" : "email", "value" : "office@jpfhir.jp" }] }], "description" : "別紙様式３－３\u3000腸管出血性大腸菌感染症 発生届", "jurisdiction" : [{ "coding" : [{ "system" : "urn:iso:std:iso:3166", "code" : "JP" }] }], "copyright" : "Copyright, The Department of Bio-Medical Informatics, The University of Tokyo. CC(Creative Commons license) BY-ND CC表示・改変禁止", "item" : [{ "linkId" : "group_Header", "text" : "届出元情報", "type" : "group", "required" : true, "repeats" : false, "item" : [{ "linkId" : "i0_1", "text" : "報告年月日", "type" : "date", "required" : true, "repeats" : false }, { "linkId" : "i0_2", "text" : "医師氏名", "type" : "string", "required" : true, "repeats" : false }, { "linkId" : "i0_3", "text" : "従事する病院・診療所の名称", "type" : "string", "required" : true, "repeats" : false }, { "linkId" : "i0_4", "text" : "上記病院・診療所の所在地", "type" : "string", "required" : true, "repeats" : false }, { "linkId" : "i0_5", "text" : "電話番号", "type" : "string", "required" : true, "repeats" : false }] }, { "linkId" : "group_Subject", "text" : "当該者情報", "type" : "group", "required" : true, "repeats" : false, "item" : [{ "linkId" : "i1_1", "text" : "診断（検案）した者（死体）の類型", "type" : "choice", "required" : true, "repeats" : false, "answerValueSet" : "http://jpfhir.jp/fhir/eInfectionReport/ValueSet/subjectClassEHEC_VS" }, { "linkId" : "i1_2", "text" : "当該者氏名", "type" : "string", "required" : true, "repeats" : false }, { "linkId" : "i1_3", "text" : "性別", "type" : "choice", "required" : true, "repeats" : false, "answerValueSet" : "http://hl7.org/fhir/ValueSet/administrative-gender" }, { "linkId" : "i1_4", "text" : "生年月日", "type" : "date", "required" : true, "repeats" : false }, { "linkId" : "i1_5", "text" : "診断時の年齢（0歳は月齢）", "type" : "integer", "required" : true, "repeats" : false }, { "linkId" : "i1_6", "text" : "当該者職業", "type" : "string", "required" : true, "repeats" : false }, { "linkId" : "i1_7-1", "text" : "当該者住所", "type" : "string", "required" : true, "repeats" : false }, { "linkId" : "i1_7-2", "text" : "当該者住所の電話", "type" : "string", "required" : true, "repeats" : true }, { "linkId" : "i1_8-1", "text" : "当該者所在地", "type" : "string", "required" : true, "repeats" : false }, { "linkId" : "i1_8-2", "text" : "当該者所在地の電話", "type" : "string", "required" : true, "repeats" : true }, { "linkId" : "i1_9", "text" : "保護者氏名", "type" : "string", "required" : false, "repeats" : false }, { "linkId" : "i1_10-1", "text" : "保護者住所", "type" : "string", "required" : false, "repeats" : false }, { "linkId" : "i1_10-2", "text" : "保護者電話", "type" : "string", "required" : false, "repeats" : true }] }, { "linkId" : "group_Contents", "text" : "届出内容", "type" : "group", "required" : true, "repeats" : false, "item" : [{ "linkId" : "i1_11", "text" : "症状", "type" : "choice", "required" : true, "repeats" : false, "answerValueSet" : "http://jpfhir.jp/fhir/core/ValueSet/JP_eQuestionaire_YesNo_VS", "item" : [{ "linkId" : "i1_11_1", "text" : "症状選択肢", "type" : "choice", "required" : false, "repeats" : true, "answerValueSet" : "http://jpfhir.jp/fhir/eInfectionReport/ValueSet/JP_eInfectionReport_EHEC_symptom_VS" }, { "linkId" : "i1_11_2", "text" : "その他の症状", "type" : "string", "required" : false, "repeats" : true }] }, { "linkId" : "i1_12", "text" : "診断方法", "type" : "group", "required" : true, "repeats" : false, "item" : [{ "linkId" : "i1_12_1", "text" : "分離・同定による病原体の検出、かつ、分離菌における次の1、2いずれかによるベロ毒素の確認（1毒素産生 2ＰＣＲ法等による毒素遺伝子 ）", "type" : "group", "required" : true, "repeats" : false, "item" : [{ "linkId" : "i1_12_1_1", "text" : "1:毒素産生 2:ＰＣＲ法等による毒素遺伝子", "type" : "choice", "required" : false, "repeats" : true, "answerValueSet" : "http://jpfhir.jp/fhir/eInfectionReport/ValueSet/JP_eInfectionReport_EHEC_dxsource_VS" }, { "linkId" : "i1_12_1_2", "text" : "検体：便・その他（ ）", "type" : "group", "required" : true, "repeats" : false, "item" : [{ "linkId" : "i1_12_1_2_1", "text" : "検体：便", "type" : "choice", "required" : false, "repeats" : false, "answerValueSet" : "http://jpfhir.jp/fhir/core/ValueSet/JP_eQuestionaire_YesNo_VS" }, { "linkId" : "i1_12_1_2_2", "text" : "検体：その他", "type" : "string", "required" : false, "repeats" : false }] }, { "linkId" : "i1_12_1_3", "text" : "Ｏ血清群：Ｏ( )・不明", "type" : "group", "required" : true, "repeats" : false, "item" : [{ "linkId" : "i1_12_1_3_1", "text" : "Ｏ血清群：Ｏ( )", "type" : "string", "required" : false, "repeats" : false }, { "linkId" : "i1_12_1_3_2", "text" : "Ｏ血清群：不明", "type" : "choice", "required" : false, "repeats" : false, "answerValueSet" : "http://jpfhir.jp/fhir/core/ValueSet/JP_eQuestionaire_Unknown_VS" }] }, { "linkId" : "i1_12_1_4", "text" : "Ｈ血清群：Ｈ( )・不明", "type" : "group", "required" : true, "repeats" : false, "item" : [{ "linkId" : "i1_12_1_4_1", "text" : "Ｈ血清群：Ｈ( )", "type" : "string", "required" : false, "repeats" : false }, { "linkId" : "i1_12_1_4_2", "text" : "Ｈ血清群：不明", "type" : "choice", "required" : false, "repeats" : false, "answerValueSet" : "http://jpfhir.jp/fhir/core/ValueSet/JP_eQuestionaire_Unknown_VS" }] }, { "linkId" : "i1_12_1_5", "text" : "ベロ毒素：VT1VT2 ・VT1 ・VT2 ・VT(型不明)", "type" : "choice", "required" : false, "repeats" : false, "answerValueSet" : "http://jpfhir.jp/fhir/eInfectionReport/ValueSet/JP_eInfectionReport_EHEC_verotoxintype_VS" }] }, { "linkId" : "i1_12_2", "text" : "便でのベロ毒素の検出（HUS 発症例に限る）", "type" : "boolean", "required" : false, "repeats" : false }, { "linkId" : "i1_12_3", "text" : "血清でのＯ抗原凝集抗体又は抗ベロ毒素抗体の検出（HUS発症例に限る）", "type" : "boolean", "required" : false, "repeats" : false }, { "linkId" : "i1_12_4", "text" : "その他の方法", "type" : "string", "required" : false, "repeats" : false, "item" : [{ "linkId" : "i1_12_4_1", "text" : "検体（ ）", "type" : "string", "required" : false, "repeats" : false }, { "linkId" : "i1_12_4_2", "text" : "結果（ ）", "type" : "string", "required" : false, "repeats" : false }] }] }, { "linkId" : "i1_13", "text" : "初診年月日", "type" : "date", "required" : true, "repeats" : false }, { "linkId" : "i1_14", "text" : "診断（検案）年月日", "type" : "date", "required" : true, "repeats" : false }, { "linkId" : "i1_15", "text" : "感染したと推定される年月日", "type" : "date", "required" : true, "repeats" : false }, { "linkId" : "i1_16", "text" : "発病年月日", "type" : "date", "required" : false, "repeats" : false }, { "linkId" : "i1_17", "text" : "死亡年月日", "type" : "date", "required" : false, "repeats" : false }, { "linkId" : "i1_18", "text" : "感染原因・感染経路・感染地域", "type" : "group", "required" : true, "repeats" : false, "item" : [{ "linkId" : "i1_18_1", "text" : "感染原因・感染経路（確定・推定）", "type" : "choice", "required" : false, "repeats" : false, "answerValueSet" : "http://jpfhir.jp/fhir/core/ValueSet/JP_eQuestionaire_Likelihood_VS", "item" : [{ "linkId" : "i1_18_1_1", "text" : "経口感染（飲食物の種類・状況：）", "type" : "string", "required" : false, "repeats" : false }, { "linkId" : "i1_18_1_2", "text" : "接触感染（接触した人・物の種類・状況：）", "type" : "string", "required" : false, "repeats" : false }, { "linkId" : "i1_18_1_3", "text" : "動物・蚊・昆虫等からの感染（動物・蚊・昆虫等の種類・状況：)", "type" : "string", "required" : false, "repeats" : false }, { "linkId" : "i1_18_1_4", "text" : "その他", "type" : "string", "required" : false, "repeats" : false }] }, { "linkId" : "i1_18_2", "text" : "感染地域（確定・推定）", "type" : "choice", "required" : false, "repeats" : false, "answerValueSet" : "http://jpfhir.jp/fhir/core/ValueSet/JP_eQuestionaire_Likelihood_VS", "item" : [{ "linkId" : "i1_18_2_1", "text" : "日本国内（都道府県,市区町村）", "type" : "string", "required" : false, "repeats" : true }, { "linkId" : "i1_18_2_2", "text" : "国外（国,詳細地域）", "type" : "string", "required" : false, "repeats" : true }] }] }, { "linkId" : "i1_19", "text" : "その他感染症の蔓延防止及び当該者の医療のために医師が必要と認める事項", "type" : "string", "required" : false, "repeats" : false }] }] }