{ "resourceType" : "Questionnaire", "id" : "drespairwaystenosisschema", "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-drespairwaystenosisschema#2.2.0
\".\"\".\"\".\" diagnosis_as_pft1. Gold Standard Diagnosis4. Disease Severity: Has the patient had pulmonary function testing within the past 3 months?0..1choiceOptions: 3 options
\".\"\".\"\".\" diagnosis_as_pft_documentPlease upload the PFT document0..1stringEnable When: diagnosis_as_pft = 'yes'
\".\"\".\"\".\" diagnosis_as_gsdDoes the patient have airway stenosis confirmed by a laryngoscopy, bronchoscopy or CT imaging?0..1choiceOptions: 3 options
\".\"\".\"\".\" diagnosis_as_gsd_yesConfirmed by0..1stringEnable When: diagnosis_as_gsd = 'yes'
\".\"\".\"\".\" diagnosis_as_ds2. Disease Subtype: Disease Subtype0..1choiceOptions: 5 options
\".\"\".\"\".\" diagnosis_as_ds_bvfi_gsBilateral Vocal fold immobility or Glottic Stenosis Subtype0..1choiceEnable When: diagnosis_as_ds = 'bilateralVocalFoldImmobilityGlotticStenosis'
Options: 5 options
\".\"\".\"\".\" diagnosis_as_ds_bvfi_gs_otherOther, Please specify0..1stringEnable When: diagnosis_as_ds_bvfi_gs = 'other'
\".\"\".\"\".\" diagnosis_as_etiology3. Etiology: What is the etiology?0..1choiceOptions: 9 options
\".\"\".\"\".\" diagnosis_as_etiology_otherOther, Please specify0..1stringEnable When: diagnosis_as_etiology = 'other'
\".\"\".\"\".\" diagnosis_as_etiology_auto_immuneAuto-immune or granulomatous disease Subcategory0..1choiceEnable When: diagnosis_as_etiology = 'autoImmune'
Options: 3 options
\".\"\".\"\".\" diagnosis_as_ds_mcgDegree of Stenosis (Myer-Cotton Grade)0..1choiceEnable When:
Options: 4 options
\".\"\".\"\".\" diagnosis_as_ds_mcg_refDegree of Stenosis (Myer-Cotton Grade) \nPicture for reference0..1stringEnable When:
\".\"\".\"\".\" diagnosis_as_ds_bcDegree of Stenosis (Bogdasarian Classification)0..1choiceEnable When: diagnosis_as_ds_bvfi_gs = 'posteriorGlotticStenosis'
Options: 4 options
\".\"\".\"\".\" diagnosis_as_ds_bc_refDegree of Stenosis (Bogdasarian Classification)\nPicture for reference0..1stringEnable When: diagnosis_as_ds_bvfi_gs = 'posteriorGlotticStenosis'
\".\"\".\"\".\" diagnosis_as_ds_agwAnterior Glottic Web classification (Cohen)0..1choiceEnable When: diagnosis_as_ds_bvfi_gs = 'anteriorGlotticWeb'
Options: 4 options
\".\"\".\"\".\" diagnosis_as_ds_cc_refAnterior Glottic Web classification (Cohen)\nPicture for reference0..1stringEnable When: diagnosis_as_ds_bvfi_gs = 'anteriorGlotticWeb'
\".\"\".\"\".\" diagnosis_as_ds_acGrade of Stenosis (Aziz Classification of Supraglottic Stenosis)0..1choiceEnable When: diagnosis_as_ds = 'supraglotticStenosis'
Options: 5 options
\".\"\".\"\".\" diagnosis_as_ds_ac_grade_4Grade of Stenosis (Aziz Classification of Supraglottic Stenosis)0..1choiceEnable When: diagnosis_as_ds_ac = 'grade4'
Options: 3 options
\".\"\".\"\".\" diagnosis_as_ds_ac_refGrade of Stenosis (Aziz Classification of Supraglottic Stenosis)\nPicture for reference0..1stringEnable When: diagnosis_as_ds = 'supraglotticStenosis'
\".\"\".\"\".\" diagnosis_as_ds_mluasPlease describe levels and severity of stenosis involved0..1stringEnable When: diagnosis_as_ds = 'multilevelUpperAirwayStenosis'
\".\"\".\"\".\" diagnosis_as_ds_odsHow would you subjectively classify the overall degree of stenosis?0..1choiceOptions: 3 options
\".\"\".\"\".\" diagnosis_as_ds_epsHow would you subjectively estimate the percent of stenosis from 0 to 100?0..1string
\".\"\".\"\".\" diagnosis_as_treatment5. Treatment obtained: What treatment has the patient undergone for their stenosis?0..1string
\".\"\".\"\".\" diagnosis_as_treatment_surgerySurgery options0..1stringEnable When: diagnosis_as_treatment = '1'
\".\"\".\"\".\" diagnosis_as_treatment_surgery_otherOther Surgery option, Please Specify0..1stringEnable When: diagnosis_as_treatment_surgery = '1'
\".\"\".\"\".\" diagnosis_as_treatment_in_officeIn-office/awake treatment options0..1stringEnable When: diagnosis_as_treatment = '1'

\"doco\" Documentation for this format

Options Sets

Answer options for diagnosis_as_pft

Answer options for diagnosis_as_gsd

Answer options for diagnosis_as_ds

Answer options for diagnosis_as_ds_bvfi_gs

Answer options for diagnosis_as_etiology

Answer options for diagnosis_as_etiology_auto_immune

Answer options for diagnosis_as_ds_mcg

Answer options for diagnosis_as_ds_bc

Answer options for diagnosis_as_ds_agw

Answer options for diagnosis_as_ds_ac

Answer options for diagnosis_as_ds_ac_grade_4

Answer options for diagnosis_as_ds_ods

" }, "url" : "https://kind-lab.github.io/vbai-fhir/Questionnaire-drespairwaystenosisschema", "version" : "2.2.0", "title" : "d_resp_airway_stenosis_schema", "status" : "active", "date" : "2024-05-29T18:29:21Z", "publisher" : "KinD Lab", "contact" : [{ "name" : "KinD Lab", "telecom" : [{ "system" : "url", "value" : "http://fhir.kindlab.sickkids.ca" }] }], "item" : [{ "linkId" : "diagnosis_as_pft", "text" : "1. Gold Standard Diagnosis4. Disease Severity: Has the patient had pulmonary function testing within the past 3 months?", "type" : "choice", "answerOption" : [{ "valueString" : "No" }, { "valueString" : "Yes" }, { "valueString" : "Not certain" }] }, { "linkId" : "diagnosis_as_pft_document", "text" : "Please upload the PFT document", "type" : "string", "enableWhen" : [{ "question" : "diagnosis_as_pft", "operator" : "=", "answerString" : "'yes'" }] }, { "linkId" : "diagnosis_as_gsd", "text" : "Does the patient have airway stenosis confirmed by a laryngoscopy, bronchoscopy or CT imaging?", "type" : "choice", "answerOption" : [{ "valueString" : "No" }, { "valueString" : "Yes" }, { "valueString" : "Not certain" }] }, { "linkId" : "diagnosis_as_gsd_yes", "text" : "Confirmed by", "type" : "string", "enableWhen" : [{ "question" : "diagnosis_as_gsd", "operator" : "=", "answerString" : "'yes'" }] }, { "linkId" : "diagnosis_as_ds", "text" : "2. Disease Subtype: Disease Subtype", "type" : "choice", "answerOption" : [{ "valueString" : "Subglottic Stenosis" }, { "valueString" : "Bilateral Vocal fold immobility or Glottic Stenosis" }, { "valueString" : "Supraglottic Stenosis" }, { "valueString" : "Tracheal Stenosis" }, { "valueString" : "Multi-Level Upper Airway Stenosis" }] }, { "linkId" : "diagnosis_as_ds_bvfi_gs", "text" : "Bilateral Vocal fold immobility or Glottic Stenosis Subtype", "type" : "choice", "enableWhen" : [{ "question" : "diagnosis_as_ds", "operator" : "=", "answerString" : "'bilateralVocalFoldImmobilityGlotticStenosis'" }], "answerOption" : [{ "valueString" : "Posterior Glottic Stenosis" }, { "valueString" : "Bilateral Vocal Fold Paralysis" }, { "valueString" : "Anterior glottic Web" }, { "valueString" : "Not certain or TBD" }, { "valueString" : "Other" }] }, { "linkId" : "diagnosis_as_ds_bvfi_gs_other", "text" : "Other, Please specify", "type" : "string", "enableWhen" : [{ "question" : "diagnosis_as_ds_bvfi_gs", "operator" : "=", "answerString" : "'other'" }] }, { "linkId" : "diagnosis_as_etiology", "text" : "3. Etiology: What is the etiology?", "type" : "choice", "answerOption" : [{ "valueString" : "Not certain or TBD" }, { "valueString" : "Iatrogenic (surgery or intubation)" }, { "valueString" : "Idiopathic" }, { "valueString" : "Auto-immune or granulomatous disease" }, { "valueString" : "Radiation" }, { "valueString" : "GERD" }, { "valueString" : "Caustic Injury or Inhalation Injury" }, { "valueString" : "Infectious (Diphtheria TB Bacterial Tracheitis other)" }, { "valueString" : "Other" }] }, { "linkId" : "diagnosis_as_etiology_other", "text" : "Other, Please specify", "type" : "string", "enableWhen" : [{ "question" : "diagnosis_as_etiology", "operator" : "=", "answerString" : "'other'" }] }, { "linkId" : "diagnosis_as_etiology_auto_immune", "text" : "Auto-immune or granulomatous disease Subcategory", "type" : "choice", "enableWhen" : [{ "question" : "diagnosis_as_etiology", "operator" : "=", "answerString" : "'autoImmune'" }], "answerOption" : [{ "valueString" : "Granulomatosis with polyangiitis (GPA) (Formerly known as Wegner's disease)" }, { "valueString" : "Relapsing Polychondritis" }, { "valueString" : "Other" }] }, { "linkId" : "diagnosis_as_ds_mcg", "text" : "Degree of Stenosis (Myer-Cotton Grade)", "type" : "choice", "enableWhen" : [{ "question" : "diagnosis_as_ds", "operator" : "=", "answerString" : "'subglotticStenosis'" }, { "question" : "diagnosis_as_ds", "operator" : "=", "answerString" : "'trachealStenosis'" }], "enableBehavior" : "any", "answerOption" : [{ "valueString" : "Grade I" }, { "valueString" : "Grade II" }, { "valueString" : "Grade III" }, { "valueString" : "Grade IV" }] }, { "linkId" : "diagnosis_as_ds_mcg_ref", "text" : "Degree of Stenosis (Myer-Cotton Grade) \nPicture for reference", "type" : "string", "enableWhen" : [{ "question" : "diagnosis_as_ds", "operator" : "=", "answerString" : "'subglotticStenosis'" }, { "question" : "diagnosis_as_ds", "operator" : "=", "answerString" : "'trachealStenosis'" }], "enableBehavior" : "any" }, { "linkId" : "diagnosis_as_ds_bc", "text" : "Degree of Stenosis (Bogdasarian Classification)", "type" : "choice", "enableWhen" : [{ "question" : "diagnosis_as_ds_bvfi_gs", "operator" : "=", "answerString" : "'posteriorGlotticStenosis'" }], "answerOption" : [{ "valueString" : "(a) Class 1" }, { "valueString" : "(b) Class 2" }, { "valueString" : "(c) Class 3" }, { "valueString" : "(d) Class 4" }] }, { "linkId" : "diagnosis_as_ds_bc_ref", "text" : "Degree of Stenosis (Bogdasarian Classification)\nPicture for reference", "type" : "string", "enableWhen" : [{ "question" : "diagnosis_as_ds_bvfi_gs", "operator" : "=", "answerString" : "'posteriorGlotticStenosis'" }] }, { "linkId" : "diagnosis_as_ds_agw", "text" : "Anterior Glottic Web classification (Cohen)", "type" : "choice", "enableWhen" : [{ "question" : "diagnosis_as_ds_bvfi_gs", "operator" : "=", "answerString" : "'anteriorGlotticWeb'" }], "answerOption" : [{ "valueString" : "Grade 1 (0-35% obstruction)" }, { "valueString" : "Grade 2 (35-50% obstruction)" }, { "valueString" : "Grade 3 (51-75% obstruction)" }, { "valueString" : "Grade 4 (76-100% obstruction)" }] }, { "linkId" : "diagnosis_as_ds_cc_ref", "text" : "Anterior Glottic Web classification (Cohen)\nPicture for reference", "type" : "string", "enableWhen" : [{ "question" : "diagnosis_as_ds_bvfi_gs", "operator" : "=", "answerString" : "'anteriorGlotticWeb'" }] }, { "linkId" : "diagnosis_as_ds_ac", "text" : "Grade of Stenosis (Aziz Classification of Supraglottic Stenosis)", "type" : "choice", "enableWhen" : [{ "question" : "diagnosis_as_ds", "operator" : "=", "answerString" : "'supraglotticStenosis'" }], "answerOption" : [{ "valueString" : "Grade 1" }, { "valueString" : "Grade 2" }, { "valueString" : "Grade 3" }, { "valueString" : "Grade 4" }, { "valueString" : "Unsure" }] }, { "linkId" : "diagnosis_as_ds_ac_grade_4", "text" : "Grade of Stenosis (Aziz Classification of Supraglottic Stenosis)", "type" : "choice", "enableWhen" : [{ "question" : "diagnosis_as_ds_ac", "operator" : "=", "answerString" : "'grade4'" }], "answerOption" : [{ "valueString" : "Grade 4T" }, { "valueString" : "Grade 4G" }, { "valueString" : "Grade 4TG" }] }, { "linkId" : "diagnosis_as_ds_ac_ref", "text" : "Grade of Stenosis (Aziz Classification of Supraglottic Stenosis)\nPicture for reference", "type" : "string", "enableWhen" : [{ "question" : "diagnosis_as_ds", "operator" : "=", "answerString" : "'supraglotticStenosis'" }] }, { "linkId" : "diagnosis_as_ds_mluas", "text" : "Please describe levels and severity of stenosis involved", "type" : "string", "enableWhen" : [{ "question" : "diagnosis_as_ds", "operator" : "=", "answerString" : "'multilevelUpperAirwayStenosis'" }] }, { "linkId" : "diagnosis_as_ds_ods", "text" : "How would you subjectively classify the overall degree of stenosis?", "type" : "choice", "answerOption" : [{ "valueString" : "Mild" }, { "valueString" : "Moderate" }, { "valueString" : "Severe" }] }, { "linkId" : "diagnosis_as_ds_eps", "text" : "How would you subjectively estimate the percent of stenosis from 0 to 100?", "type" : "string" }, { "linkId" : "diagnosis_as_treatment", "text" : "5. Treatment obtained: What treatment has the patient undergone for their stenosis?", "type" : "string" }, { "linkId" : "diagnosis_as_treatment_surgery", "text" : "Surgery options", "type" : "string", "enableWhen" : [{ "question" : "diagnosis_as_treatment", "operator" : "=", "answerString" : "'1'" }] }, { "linkId" : "diagnosis_as_treatment_surgery_other", "text" : "Other Surgery option, Please Specify", "type" : "string", "enableWhen" : [{ "question" : "diagnosis_as_treatment_surgery", "operator" : "=", "answerString" : "'1'" }] }, { "linkId" : "diagnosis_as_treatment_in_office", "text" : "In-office/awake treatment options", "type" : "string", "enableWhen" : [{ "question" : "diagnosis_as_treatment", "operator" : "=", "answerString" : "'1'" }] }] }