{ "resourceType" : "Questionnaire", "id" : "EInfectionReport-IAE-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
LinkIdTextCardinalityTypeDescription & Constraints\"doco\"
\".\"\".\" JP_Questionnaire_eInfectionReport_EHEC別紙様式5-5急性脳炎（ウエストナイル脳炎、西部ウマ脳炎、ダニ媒介脳炎、東部ウマ脳炎、日本脳炎、ベネズエラウマ脳炎及びリフトバレー熱を除く）感染症 発生届Questionnairehttp://jpfhir.jp/fhir/eInfectionReport/mhlw/Questionnaire/JP_Questionnaire_eInfectionReport_IAE#1.0.0
\".\"\".\"\".\" block_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
\".\"\".\"\".\" block_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: 急性脳炎 診断（検案）した者（死体）の類型
\".\"\".\"\".\"\".\" i1_2性別1..1choiceValue Set: AdministrativeGender
\".\"\".\"\".\"\".\" i1_3診断時の年齢（0歳は月齢）1..1integer
\".\"\".\"\".\" block_Contents届出内容1..1group
\".\"\".\"\".\"\".\" i1_n11病型1..1group
\".\"\".\"\".\"\".\"\".\" i1_n11_11）病原体（ ）0..1string
\".\"\".\"\".\"\".\"\".\" i1_n11_22)病原体不明0..1choiceValue Set: 質問票の回答のための Unknown (不明)
\".\"\".\"\".\"\".\" i1_14症状1..1choiceValue Set: 質問票の回答のためのYES/NO ValueSet
\".\"\".\"\".\"\".\"\".\" i1_14_1症状選択肢0..*choiceValue Set: 急性脳炎\u3000症状コード ValueSet
\".\"\".\"\".\"\".\"\".\" i1_14_2その他の症状0..*string
\".\"\".\"\".\"\".\" i1_5診断方法1..1group
\".\"\".\"\".\"\".\"\".\" i1_5_1意識障害を伴って死亡した者、または意識障害を伴って24 時間以上入院した者のうち、次の1,2,3の少なくとも1つの症状を呈したことを確認1..1group
\".\"\".\"\".\"\".\"\".\"\".\" i1_5_1_11: 38度以上の高熱、2:何らかの中枢神経症状、3:先行感染症状（熱性痙攣、代謝疾患、脳血管障害、脳腫瘍、外傷等、明らかに感染性とは異なる場合は除外する。）0..*choiceValue Set: 急性脳炎 診断方法
\".\"\".\"\".\"\".\" i1_6初診年月日1..1date
\".\"\".\"\".\"\".\" i1_7診断（検案）年月日1..1date
\".\"\".\"\".\"\".\" i1_8感染したと推定される年月日1..1date
\".\"\".\"\".\"\".\" i1_9発病年月日0..1date
\".\"\".\"\".\"\".\" i1_10死亡年月日0..1date
\".\"\".\"\".\"\".\" i1_11感染原因・感染経路・感染地域1..1group
\".\"\".\"\".\"\".\"\".\" i1_11_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_11_1_1飛沫・飛沫核感染（感染源の種類・状況：）1..1string
\".\"\".\"\".\"\".\"\".\"\".\" i1_11_1_2経口感染（飲食物の種類・状況：）0..1string
\".\"\".\"\".\"\".\"\".\"\".\" i1_11_1_3接触感染（接触した人・物の種類・状況：）0..1string
\".\"\".\"\".\"\".\"\".\"\".\" i1_11_1_4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_11_1_5その他0..1string
\".\"\".\"\".\"\".\"\".\" i1_11_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_11_2_1日本国内（都道府県,市区町村）0..*string
\".\"\".\"\".\"\".\"\".\"\".\" i1_11_2_2国外（国,詳細地域）0..*string

\"doco\" Documentation for this format
" }, "url" : "http://jpfhir.jp/fhir/eInfectionReport/mhlw/Questionnaire/JP_Questionnaire_eInfectionReport_IAE", "identifier" : [{ "system" : "http://jpfhir.jp/fhir/core/IdSystem/resourceInstance-identifier", "value" : "MHLW-sample-20230531-5-5" }], "version" : "1.0.0", "name" : "JP_Questionnaire_eInfectionReport_EHEC", "title" : "急性脳炎 発生届 acute encephalitis", "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5-5急性脳炎（ウエストナイル脳炎、西部ウマ脳炎、ダニ媒介脳炎、東部ウマ脳炎、日本脳炎、ベネズエラウマ脳炎及びリフトバレー熱を除く）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" : "block_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" : "block_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/subjectClassIAE_VS" }, { "linkId" : "i1_2", "text" : "性別", "type" : "choice", "required" : true, "repeats" : false, "answerValueSet" : "http://hl7.org/fhir/ValueSet/administrative-gender" }, { "linkId" : "i1_3", "text" : "診断時の年齢（0歳は月齢）", "type" : "integer", "required" : true, "repeats" : false }] }, { "linkId" : "block_Contents", "text" : "届出内容", "type" : "group", "required" : true, "repeats" : false, "item" : [{ "linkId" : "i1_n11", "text" : "病型", "type" : "group", "required" : true, "repeats" : false, "item" : [{ "linkId" : "i1_n11_1", "text" : "1）病原体（ ）", "type" : "string", "required" : false, "repeats" : false }, { "linkId" : "i1_n11_2", "text" : "2)病原体不明", "type" : "choice", "required" : false, "repeats" : false, "answerValueSet" : "http://jpfhir.jp/fhir/core/ValueSet/JP_eQuestionaire_Unknown_VS" }] }, { "linkId" : "i1_14", "text" : "症状", "type" : "choice", "required" : true, "repeats" : false, "answerValueSet" : "http://jpfhir.jp/fhir/core/ValueSet/JP_eQuestionaire_YesNo_VS", "item" : [{ "linkId" : "i1_14_1", "text" : "症状選択肢", "type" : "choice", "required" : false, "repeats" : true, "answerValueSet" : "http://jpfhir.jp/fhir/eInfectionReport/ValueSet/JP_eInfectionReport_IAE_symptom_VS" }, { "linkId" : "i1_14_2", "text" : "その他の症状", "type" : "string", "required" : false, "repeats" : true }] }, { "linkId" : "i1_5", "text" : "診断方法", "type" : "group", "required" : true, "repeats" : false, "item" : [{ "linkId" : "i1_5_1", "text" : "意識障害を伴って死亡した者、または意識障害を伴って24 時間以上入院した者のうち、次の1,2,3の少なくとも1つの症状を呈したことを確認", "type" : "group", "required" : true, "repeats" : false, "item" : [{ "linkId" : "i1_5_1_1", "text" : "1: 38度以上の高熱、2:何らかの中枢神経症状、3:先行感染症状（熱性痙攣、代謝疾患、脳血管障害、脳腫瘍、外傷等、明らかに感染性とは異なる場合は除外する。）", "type" : "choice", "required" : false, "repeats" : true, "answerValueSet" : "http://jpfhir.jp/fhir/eInfectionReport/ValueSet/JP_eInfectionReport_IAE_dxsource_VS" }] }] }, { "linkId" : "i1_6", "text" : "初診年月日", "type" : "date", "required" : true, "repeats" : false }, { "linkId" : "i1_7", "text" : "診断（検案）年月日", "type" : "date", "required" : true, "repeats" : false }, { "linkId" : "i1_8", "text" : "感染したと推定される年月日", "type" : "date", "required" : true, "repeats" : false }, { "linkId" : "i1_9", "text" : "発病年月日", "type" : "date", "required" : false, "repeats" : false }, { "linkId" : "i1_10", "text" : "死亡年月日", "type" : "date", "required" : false, "repeats" : false }, { "linkId" : "i1_11", "text" : "感染原因・感染経路・感染地域", "type" : "group", "required" : true, "repeats" : false, "item" : [{ "linkId" : "i1_11_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_11_1_1", "text" : "飛沫・飛沫核感染（感染源の種類・状況：）", "type" : "string", "required" : true, "repeats" : false }, { "linkId" : "i1_11_1_2", "text" : "経口感染（飲食物の種類・状況：）", "type" : "string", "required" : false, "repeats" : false }, { "linkId" : "i1_11_1_3", "text" : "接触感染（接触した人・物の種類・状況：）", "type" : "string", "required" : false, "repeats" : false }, { "linkId" : "i1_11_1_4", "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_11_1_5", "text" : "その他", "type" : "string", "required" : false, "repeats" : false }] }, { "linkId" : "i1_11_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_11_2_1", "text" : "日本国内（都道府県,市区町村）", "type" : "string", "required" : false, "repeats" : true }, { "linkId" : "i1_11_2_2", "text" : "国外（国,詳細地域）", "type" : "string", "required" : false, "repeats" : true }] }] }] }] }