{ "resourceType" : "Questionnaire", "id" : "dneuroamyotrophiclateralsclerosisalsschema", "text" : { "status" : "generated", "div" : "
Structure\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\"
\".\"\".\" Questionnairehttps://kind-lab.github.io/vbai-fhir/Questionnaire-dneuroamyotrophiclateralsclerosisalsschema#2.2.0
\".\"\".\"\".\" diagnosis_als_gsd_category_11. Gold Standard Diagnosis\nDoes the patient meet the diagnostic criteria for Amyotrophic Lateral Sclerosis (ALS) based on:: (1) Progressive motor impairment documented by history or repeated clinical assessment, preceded by normal motor function;0..1choiceOptions: 3 options
\".\"\".\"\".\" diagnosis_als_gsd_category_2(2) presence of UMN and LMN signs in at least 1 body region (with UMN and LMN dysfunction noted in the same body region if only one body region is involved) or LMN dysfunction in at least 2 body regions;0..1choiceOptions: 3 options
\".\"\".\"\".\" diagnosis_als_gsd_category_3(3) investigations excluding other disease processes.0..1choiceOptions: 3 options
\".\"\".\"\".\" diagnosis_als_gsd_calculationDoes the patient meet the diagnostic criteria for Amyotrophic Lateral Sclerosis (ALS) based on the criteria above?0..1string
\".\"\".\"\".\" diagnosis_als_disease_subtype2. Type of ALS: Specify the type of ALS in the patient:0..1choiceOptions: 4 options
\".\"\".\"\".\" diagnosis_als_disease_subtype_familialIf you selected "Familial ALS", please specify the genetic mutation if known:0..1stringEnable When: diagnosis_als_disease_subtype = 'familialAls'
\".\"\".\"\".\" diagnosis_als_etiology3. Etiology: What is the suspected or known etiology of ALS in the patient?0..1string
\".\"\".\"\".\" diagnosis_als_etiology_genetic_factorsGenetic Factors0..1stringEnable When: diagnosis_als_etiology = 1
\".\"\".\"\".\" diagnosis_als_etiology_genetic_factors_otherIf you selected "Other genetic factors", please specify:0..1stringEnable When: diagnosis_als_etiology_genetic_factors = 1
\".\"\".\"\".\" diagnosis_als_etiology_environmental_factorsIf you selected "Environmental factors", please specify:0..1stringEnable When: diagnosis_als_etiology = 1
\".\"\".\"\".\" diagnosis_als_cp4. Clinical Presentation: Describe the clinical features and symptoms of ALS in the patient:0..1string
\".\"\".\"\".\" diagnosis_als_dp5. Disease Progression: Please provide information on the current stage and progression of ALS:0..1choiceOptions: 3 options
\".\"\".\"\".\" diagnosis_als_na_alsfrs_r_score6. Neurological Assessment\nPlease provide results from relevant neurological assessments:: Revised ALS Functional Rating Scale (ALSFRS-R) score:0..1string
\".\"\".\"\".\" diagnosis_als_na_fvc_percentageForced Vital Capacity (FVC) percentage (if measured):0..1string
\".\"\".\"\".\" diagnosis_als_na_otherOther neurological assessment (please specify):0..1string
\".\"\".\"\".\" diagnosis_als_idt_emg_ncs7. Imaging and Diagnostic Tests: Electromyography (EMG) and Nerve Conduction Studies (NCS):0..1string
\".\"\".\"\".\" diagnosis_als_idt_mriMagnetic Resonance Imaging (MRI) of the brain and spinal cord:0..1string
\".\"\".\"\".\" diagnosis_als_idt_lumbar_punctureLumbar Puncture (if performed, specify findings):0..1string
\".\"\".\"\".\" diagnosis_als_idt_genetic_testingGenetic testing (if applicable, specify results):0..1string
\".\"\".\"\".\" diagnosis_als_idt_otherOther diagnostic tests (please specify):0..1string
\".\"\".\"\".\" diagnosis_als_treatment_and_management8. Treatment and Management: Has the patient undergone any treatment or interventions for ALS?0..1choiceOptions: 2 options
\".\"\".\"\".\" diagnosis_als_treatment_and_management_yesYes0..1stringEnable When: diagnosis_als_treatment_and_management = 'yes'
\".\"\".\"\".\" diagnosis_als_treatment_and_management_yes_medicationsMedications (if applicable):0..1stringEnable When:
\".\"\".\"\".\" diagnosis_als_treatment_and_management_yes_medications_otherIf you selected "Other", please specify:0..1stringEnable When:
\".\"\".\"\".\" diagnosis_als_treatment_and_management_yes_supportive_careSupportive Care:0..1stringEnable When:
\".\"\".\"\".\" diagnosis_als_treatment_and_management_yes_supportive_care_otherIf you selected "Other", please specify:0..1stringEnable When:

\"doco\" Documentation for this format

Options Sets

Answer options for diagnosis_als_gsd_category_1

Answer options for diagnosis_als_gsd_category_2

Answer options for diagnosis_als_gsd_category_3

Answer options for diagnosis_als_disease_subtype

Answer options for diagnosis_als_dp

Answer options for diagnosis_als_treatment_and_management

" }, "url" : "https://kind-lab.github.io/vbai-fhir/Questionnaire-dneuroamyotrophiclateralsclerosisalsschema", "version" : "2.2.0", "title" : "d_neuro_amyotrophic_lateral_sclerosis_als_schema", "status" : "active", "date" : "2024-05-29T18:29:19Z", "publisher" : "KinD Lab", "contact" : [{ "name" : "KinD Lab", "telecom" : [{ "system" : "url", "value" : "http://fhir.kindlab.sickkids.ca" }] }], "item" : [{ "linkId" : "diagnosis_als_gsd_category_1", "text" : "1. Gold Standard Diagnosis\nDoes the patient meet the diagnostic criteria for Amyotrophic Lateral Sclerosis (ALS) based on:: (1) Progressive motor impairment documented by history or repeated clinical assessment, preceded by normal motor function;", "type" : "choice", "answerOption" : [{ "valueString" : "Yes" }, { "valueString" : "No" }, { "valueString" : "Not certain" }] }, { "linkId" : "diagnosis_als_gsd_category_2", "text" : "(2) presence of UMN and LMN signs in at least 1 body region (with UMN and LMN dysfunction noted in the same body region if only one body region is involved) or LMN dysfunction in at least 2 body regions;", "type" : "choice", "answerOption" : [{ "valueString" : "Yes" }, { "valueString" : "No" }, { "valueString" : "Not certain" }] }, { "linkId" : "diagnosis_als_gsd_category_3", "text" : "(3) investigations excluding other disease processes.", "type" : "choice", "answerOption" : [{ "valueString" : "Yes" }, { "valueString" : "No" }, { "valueString" : "Not certain" }] }, { "linkId" : "diagnosis_als_gsd_calculation", "text" : "Does the patient meet the diagnostic criteria for Amyotrophic Lateral Sclerosis (ALS) based on the criteria above?", "type" : "string" }, { "linkId" : "diagnosis_als_disease_subtype", "text" : "2. Type of ALS: Specify the type of ALS in the patient:", "type" : "choice", "answerOption" : [{ "valueString" : "Sporadic ALS" }, { "valueString" : "Familial ALS" }, { "valueString" : "Spinal/limb-onset ALS" }, { "valueString" : "Bulbar-onset ALS" }] }, { "linkId" : "diagnosis_als_disease_subtype_familial", "text" : "If you selected \"Familial ALS\", please specify the genetic mutation if known:", "type" : "string", "enableWhen" : [{ "question" : "diagnosis_als_disease_subtype", "operator" : "=", "answerString" : "'familialAls'" }] }, { "linkId" : "diagnosis_als_etiology", "text" : "3. Etiology: What is the suspected or known etiology of ALS in the patient?", "type" : "string" }, { "linkId" : "diagnosis_als_etiology_genetic_factors", "text" : "Genetic Factors", "type" : "string", "enableWhen" : [{ "question" : "diagnosis_als_etiology", "operator" : "=", "answerString" : "1" }] }, { "linkId" : "diagnosis_als_etiology_genetic_factors_other", "text" : "If you selected \"Other genetic factors\", please specify:", "type" : "string", "enableWhen" : [{ "question" : "diagnosis_als_etiology_genetic_factors", "operator" : "=", "answerString" : "1" }] }, { "linkId" : "diagnosis_als_etiology_environmental_factors", "text" : "If you selected \"Environmental factors\", please specify:", "type" : "string", "enableWhen" : [{ "question" : "diagnosis_als_etiology", "operator" : "=", "answerString" : "1" }] }, { "linkId" : "diagnosis_als_cp", "text" : "4. Clinical Presentation: Describe the clinical features and symptoms of ALS in the patient:", "type" : "string" }, { "linkId" : "diagnosis_als_dp", "text" : "5. Disease Progression: Please provide information on the current stage and progression of ALS:", "type" : "choice", "answerOption" : [{ "valueString" : "Early Stage" }, { "valueString" : "Intermediate Stage" }, { "valueString" : "Advanced Stage" }] }, { "linkId" : "diagnosis_als_na_alsfrs_r_score", "text" : "6. Neurological Assessment\nPlease provide results from relevant neurological assessments:: Revised ALS Functional Rating Scale (ALSFRS-R) score:", "type" : "string" }, { "linkId" : "diagnosis_als_na_fvc_percentage", "text" : "Forced Vital Capacity (FVC) percentage (if measured):", "type" : "string" }, { "linkId" : "diagnosis_als_na_other", "text" : "Other neurological assessment (please specify):", "type" : "string" }, { "linkId" : "diagnosis_als_idt_emg_ncs", "text" : "7. Imaging and Diagnostic Tests: Electromyography (EMG) and Nerve Conduction Studies (NCS):", "type" : "string" }, { "linkId" : "diagnosis_als_idt_mri", "text" : "Magnetic Resonance Imaging (MRI) of the brain and spinal cord:", "type" : "string" }, { "linkId" : "diagnosis_als_idt_lumbar_puncture", "text" : "Lumbar Puncture (if performed, specify findings):", "type" : "string" }, { "linkId" : "diagnosis_als_idt_genetic_testing", "text" : "Genetic testing (if applicable, specify results):", "type" : "string" }, { "linkId" : "diagnosis_als_idt_other", "text" : "Other diagnostic tests (please specify):", "type" : "string" }, { "linkId" : "diagnosis_als_treatment_and_management", "text" : "8. Treatment and Management: Has the patient undergone any treatment or interventions for ALS?", "type" : "choice", "answerOption" : [{ "valueString" : "Yes" }, { "valueString" : "No" }] }, { "linkId" : "diagnosis_als_treatment_and_management_yes", "text" : "Yes", "type" : "string", "enableWhen" : [{ "question" : "diagnosis_als_treatment_and_management", "operator" : "=", "answerString" : "'yes'" }] }, { "linkId" : "diagnosis_als_treatment_and_management_yes_medications", "text" : "Medications (if applicable):", "type" : "string", "enableWhen" : [{ "question" : "diagnosis_als_treatment_and_management", "operator" : "=", "answerString" : "'yes'" }, { "question" : "diagnosis_als_treatment_and_management_yes", "operator" : "=", "answerString" : "1" }], "enableBehavior" : "all" }, { "linkId" : "diagnosis_als_treatment_and_management_yes_medications_other", "text" : "If you selected \"Other\", please specify:", "type" : "string", "enableWhen" : [{ "question" : "diagnosis_als_treatment_and_management", "operator" : "=", "answerString" : "'yes'" }, { "question" : "diagnosis_als_treatment_and_management_yes", "operator" : "=", "answerString" : "1" }, { "question" : "diagnosis_als_treatment_and_management_yes_medications", "operator" : "=", "answerString" : "1" }], "enableBehavior" : "all" }, { "linkId" : "diagnosis_als_treatment_and_management_yes_supportive_care", "text" : "Supportive Care:", "type" : "string", "enableWhen" : [{ "question" : "diagnosis_als_treatment_and_management", "operator" : "=", "answerString" : "'yes'" }, { "question" : "diagnosis_als_treatment_and_management_yes", "operator" : "=", "answerString" : "1" }], "enableBehavior" : "all" }, { "linkId" : "diagnosis_als_treatment_and_management_yes_supportive_care_other", "text" : "If you selected \"Other\", please specify:", "type" : "string", "enableWhen" : [{ "question" : "diagnosis_als_treatment_and_management", "operator" : "=", "answerString" : "'yes'" }, { "question" : "diagnosis_als_treatment_and_management_yes", "operator" : "=", "answerString" : "1" }, { "question" : "diagnosis_als_treatment_and_management_yes_supportive_care", "operator" : "=", "answerString" : "1" }], "enableBehavior" : "all" }] }