HL7® FHIR® Malaysia Core (MY Core) Implementation Guide
2.0.1 - ci-build

HL7® FHIR® Malaysia Core (MY Core) Implementation Guide - Local Development build (v2.0.1) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Questionnaire: Questionnaire Initial Guarantee Letter

Official URL: http://fhir.hie.moh.gov.my/Questionnaire/q-gl-initial Version: 2.0.1
Active as of 2024-03-13 Computable Name: QGlInitial

Questionnaire for requesting a Guarantee Letter.

Structure
LinkIDTextCardinalityTypeDescription & Constraintsdoco
.. QGlInitialQuestionnaire for requesting a Guarantee Letter.Questionnairehttp://fhir.hie.moh.gov.my/Questionnaire/q-gl-initial#2.0.1
... HEADERHeader0..1group
.... GE HOSP_CODEGE PROVIDER CODE0..1string
.... REQ_TYPERequest type0..1choiceOptions: 2 options
.... REQ_DATECurrent date & time stamp0..1dateTime
.... HOSP_CASENOHospital admission case no0..1string
... D1Details0..1group
.... REC-IDREC-ID0..1stringMax Length: 20
.... PATIENTPatient Name0..1stringMax Length: 200
.... NEWICIC (new)0..1stringMax Length: 14
.... IDNUMIC (old / others)0..1stringMax Length: 24
.... CLTSEXSex0..1choiceOptions: 2 options
.... CLTAGEAge of Patient0..1stringMax Length: 3
.... POLICY_NOPolicy No0..1stringMax Length: 10
.... HOSP_CONTACTHospital contact number0..1stringMax Length: 20
.... HOSP_FAXHospital Fax number0..1stringMax Length: 20
.... ADMISSION_DATEAdmission /Planned Admission Date & Time0..1dateTime
.... EXP_LOSExpected days of stay / Discharge date0..1stringMax Length: 10
.... SYMPTOMSSymtoms /Conditions requiring admission0..1textMax Length: 500
.... BP_PULSEPatient's BP/Temp/Pulse0..1textMax Length: 200
.... CLT_AWAREHow long is patient aware of the condition0..1dateTime
.... SYMPTOMS_DATEDate symptoms first appeared0..1dateTime
.... DATE_CONSULTEDDate first consulted0..1dateTime
.... PREV_CONSULTAny previous consultation/treatment/hospitalization for this symptoms/illness or related conditions whether in this hospital or any other facilities0..1boolean
.... REFERREDWas the patient referred?0..1booleanEnable When: PREV_CONSULT =
.... MEDICAL_HISTReferred hospital & details0..1textMax Length: 200
Enable When: REFERRED =
.... OUTPATIENTThe condition can be managed under outpatient basis0..1boolean
.... REASON_NO_OPReason of admission0..1textMax Length: 200
Enable When: OUTPATIENT =
.... ICD_CODEDiagnosis Description0..1stringMax Length: 100
.... 2nd_ICDSecondary Diagnosis code0..1stringMax Length: 100
.... ICD_DESCExpected days of stay / Discharge date0..1textMax Length: 500
.... DIAGNOSIS_DATEDiagnosis confirmed on date0..1dateTime
.... ADVISED_DATEDate when doctor first advised the diagnosis to patient0..1dateTime
.... RELAPSEAny possibility of relapse0..1boolean
.... EST_COSTEstimated Cost0..1decimal
.... ADMISSION_TYPEType of admission0..1choiceOptions: 3 options
.... ILLNESS_CONDITIONselected illness/condition related to the diagnosis0..1choiceOptions: 8 options
.... TREATMENT_PLANMedical treatment, Investigation and Surgical procedure to be performed0..1textMax Length: 500
.... DIABETES_MELLITUSDoes the patient have any Diabetes Mellitus condition?0..1boolean
.... DIABETES_SINCE_WHENDate first diagnosed with Diabetes Mellitus0..1dateTimeEnable When: DIABETES_MELLITUS =
.... DIABETES_MED_DET1) doctor who first diagnosed (Name & Hosp) 2) usual treating doctor 3) current medications (name/dosage)0..1textMax Length: 500
Enable When: DIABETES_MELLITUS =
.... HYPERTENSIONDoes the patient have any hypertension condition?0..1boolean
.... HYPERTENSION_SINCE_WHENDate first diagnosed with hypertension0..1dateTimeEnable When: HYPERTENSION =
.... HYPERTENSION_MED_DET1) doctor who first diagnosed (Name & Hosp) 2) usual treating doctor 3) current medications (name/dosage)0..1textMax Length: 500
Enable When: HYPERTENSION =
.... HEART_DISEASEDoes the patient have any heart disease condition?0..1boolean
.... HEART_DISEASE_SINCE_WHENDate first diagnosed with heart disease0..1dateTimeEnable When: HEART_DISEASE =
.... HEART_DIASEASE_MED_DET1) doctor who first diagnosed (Name & Hosp) 2) usual treating doctor 3) current medications (name/dosage)0..1stringMax Length: 500
Enable When: HEART_DISEASE =
.... OTH_MEDICALOther than above 3 specific illness. Does the patient have any other medical condition0..1boolean
.... OTH_MEDICAL_DETOther than above 3 specific illness. Doctor to provide other medical conditions if exist, if possible to provide medical conditions since date0..1textEnable When: OTH_MEDICAL =
.... PREGNANTWas the patient pregnant at the time of hospitalization0..1boolean
.... ACCIDENTALAccidental case0..1boolean
.... ACCIDENT_DATEDate & time of Accident0..1dateTimeEnable When: ACCIDENTAL =
.... ACCIDENT_DETDetails of Accident0..1textEnable When: ACCIDENTAL =
.... SURGICALSurgery is required0..1boolean
.... SURGICAL_DATEDate of Surgical0..1dateTimeEnable When: SURGICAL =
.... INJURY_DESCInjury description0..1text
.... HOSP_DOCTOR_CODEHospital doctor User Code0..1string
.... PHYSICIANName of Admitting / Treating doctor0..1string
.... PHYSICIAN_SPECIALTYPhysician Specialty0..1string
.... GL NumberGE Guarantee Letter Number0..1string
Checklist - Patient's Consent and witness signature obtained0..1boolean

doco Documentation for this format

Options Sets

Answer options for REQ_TYPE

  • null#PA ("Pre-Authorization Form /Initial GL request")
  • null#EA ("Elective Admission")

Answer options for CLTSEX

  • http://hl7.org/fhir/administrative-gender#male ("Male")
  • http://hl7.org/fhir/administrative-gender#female ("Female")

Answer options for ADMISSION_TYPE

  • null#IP ("Hospitalisation")
  • null#DC ("Day Care")
  • null#PR ("On patient's request")

Answer options for ILLNESS_CONDITION

  • null#a ("Pregnancy / Childbirth / Infertility / Caesarean section/ miscarriage Or any complications arising therefrom")
  • null#b ("Congenital / Hereditary diseases")
  • null#c ("Influence of Drugs / Alcohol")
  • null#d ("Nervous / Mental / Emotional / Sleeping Disorder")
  • null#e ("Cosmetic reason / Dental care / refractive errors correction")
  • null#f ("AIDS / STD / VD / HIV")
  • null#g ("Self-inflicted injuries / Violation of laws / Strike / Riots")
  • null#h ("None of the above")