WHO Case Reporting for COVID-19 Surveillance
0.1.0 - ci-build

WHO Case Reporting for COVID-19 Surveillance - Local Development build (v0.1.0). See the Directory of published versions

Questionnaire: Revised case report form for Confirmed Novel Coronavirus COVID-19

LinkIdTextCardinalityTypeDescription & Constraintsdoco
.. WhoCrQuestionnaireCovid19SurveillanceQuestionnaire
... instructionReport to WHO within 48 hours of case identification0..1display
... report_dateDate of reporting to national health authority:0..1date
... report_countryReporting country:0..1choiceValue Set: WhoCrValueSetQuestionnaireCountry
.... report_country_otherIf Other, please specify:0..1stringEnable When:
... report_test_reasonWhy tested for COVID-19:0..*choiceValue Set: WhoCrValueSetQuestionnaireReasonForTesting
.... report_test_reason_otherIf Other, please specify:0..1stringEnable When:
... section_patient_infoSection 1. Patient information0..1group
.... patinfo_IDUnique Case Identifier (used in country):0..1string
.... patinfo_ageonsetAge (use days if <1 month, months if <1 year):0..1quantity
.... patinfo_sexSex at birth:0..1choiceValue Set: Patient Sex at birth
.... patinfo_placediagnosedPlace where the case was diagnosed:0..1group
..... patinfo_idadmin0Country:0..1choiceValue Set: WhoCrValueSetQuestionnaireCountry
...... patinfo_idadmin0_otherIf Other, please specify:0..1stringEnable When:
...... patinfo_idadmin1Admin Level 1 (province):0..1choiceEnable When:
Value Set: WhoCrValueSetQuestionnaireAdmin1
....... patinfo_idadmin1_otherIf Other, please specify:0..1stringEnable When:
.... patinfo_placeresideCase usual place of residency:0..1group
..... patinfo_resadmin0Country:0..1choiceValue Set: WhoCrValueSetQuestionnaireCountry
...... patinfo_resadmin0_otherIf Other, please specify:0..1stringEnable When:
... section_clinical_statusSection 2. Clinical Status0..1group
.... Lab_date1Date of first laboratory confirmation test:0..1date
.... patcourse_asympAny symptoms or signs at time of specimen collection that resulted in first laboratory confirmation?0..1choiceValue Set: Yes/No/Unknown
..... patcourse_asymp_helpNo: Case was asymptomatic0..1display
..... patcourse_dateonsetDate of onset of symptoms:0..1dateEnable When:
.... section_comorbidityUnderlying conditions and comorbidity:0..1group
..... Comcond_anyAny underlying conditions?0..1choiceValue Set: Yes/No/Unknown
..... section_comorb_listIf yes, select all that apply:0..1groupEnable When:
...... comorbidityComorbidity or condition present0..*choiceValue Set: WhoCrValueSetQuestionnaireComorbidity
....... comorbidity_otherIf Other, please specify:0..1stringEnable When:
...... Comcond_pregIs the patient pregnant?0..1boolean
....... Comcond_pregtTrimester of pregnancy0..1choiceEnable When:
Value Set: Pregnancy Trimester
..... section_health_statusHealth Status at time of Reporting:0..1group
...... patcourse_admitAdmission to hospital:0..1choiceValue Set: Yes/No/Unknown
...... section_hospital_admissionif yes:0..1groupEnable When:
....... patcourse_presHCFFirst date of admission to hospital:0..1date
....... patcourse_icuDid the case receive care in an intensive care unit (ICU)?0..1choiceValue Set: Yes/No/Unknown
....... patcourse_ventDid the case receive ventilation?0..1choiceValue Set: Yes/No/Unknown
....... patcourse_ecmoDid the case receive extracorporeal membrane oxygenation?0..1choiceValue Set: Yes/No/Unknown
...... patcourse_isoIs case in isolation with Infection Control Practice in place?0..1choiceValue Set: Yes/No/Unknown
....... patcourse_dateisoDate of isolation:0..1dateEnable When:
... section_exposure_riskSection 3. Exposure risk in the 14 days prior to symptom onset (prior to testing if asymptomatic)0..1group
.... patinfo_occuhcwIs case a Health Care Worker (any job in a health care setting):0..1choiceValue Set: Yes/No/Unknown
..... patinfo_occuhcw_ifyesIf yes:0..1groupEnable When:
...... patinfo_occuhcw_hcf_infonull0..*group
....... patinfo_occuhcw_countryCountry:0..1choiceValue Set: WhoCrValueSetQuestionnaireCountry
........ patinfo_occuhcw_country_otherIf Other, please specify:0..1stringEnable When:
....... patinfo_occuhcw_cityCity:0..1string
....... patinfo_occuhcw_nameName of Facility:0..1string
.... expo_travelHas the case travelled in the 14 days prior to symptom onset?0..1choiceValue Set: Yes/No/Unknown
..... expo_travel_ifyesIf yes, please specify the places the patient travelled to and date of departure from the places:0..*groupEnable When:
...... expo_travel_countryCountry:0..1choiceValue Set: WhoCrValueSetQuestionnaireCountry
....... expo_travel_country_otherIf Other, please specify:0..1stringEnable When:
...... expo_travel_cityCity:0..1string
...... expo_travel_dateDate of Departure from the place:0..1dateTime
.... expo_visit_healthcareHas case visited any health care facility in the 14 days prior to symptom onset?0..1choiceValue Set: Yes/No/Unknown
.... expo_contact_caseHas case had contact with a confirmed case in the 14 days prior to symptom onset?0..1choiceValue Set: Yes/No/Unknown
..... expo_contactsIf yes, please list unique case identifiers of all probable or confirmed cases:0..*groupEnable When:
...... expo_IDContact ID0..1string
...... exposure_contact_exposure_detailsExposure details0..*group
....... expo_case_date_firstFirst Date of Contact0..1dateTime
....... expo_case_date_lastLast Date of Contact0..1dateTime
....... expo_case_setting_detailContact setting:0..1text
.... expo_case_locationMost likely country of exposure:0..1choiceValue Set: WhoCrValueSetQuestionnaireCountry
..... expo_case_location_otherIf Other, please specify:0..1stringEnable When:
... section_outcomeSection 4. Outcome0..1group
.... outcome_instructComplete and re-send the full form as soon as outcome of disease is known or after 30 days after initial report.0..1display
.... outcome_submitted_dateDate of re-submission of this report:0..1date
.... outcome_asympIf case was asymptomatic at time of specimen collection resulting in first laboratory confirmation, did the case develop any symptoms or signs at any time prior to discharge or death?0..1choiceValue Set: Yes/No/Unknown
..... outcome_asymp_helpNo: the case remains asymptomatic; Yes: the previously asymptomatic case developed symptoms and/or signs of illness.0..1display
.... outcome_asymp_dateDate of onset of symptoms/signs of illness:0..1dateEnable When:
.... section_clinical_courseClinical Course:0..1group
..... outcome_patcourse_admitAdmission to hospital (may have been previously reported):0..1choiceValue Set: Yes/No/Unknown
..... outcome_patcourse_presHCFFirst date of admission to hospital:0..1dateEnable When:
..... section_outcome_admissionIf yes:0..1groupEnable When:
...... outcome_patcourse_icuDid the case receive care in an intensive care unit (ICU)?0..1choiceValue Set: Yes/No/Unknown
...... outcome_patcourse_ventDid the case receive ventilation?0..1choiceValue Set: Yes/No/Unknown
...... outcome_patcourse_ecmoDid the case receive extracorporeal membrane oxygenation?0..1choiceValue Set: Yes/No/Unknown
.... outcome_patcourse_statusHealth Outcome:0..1choiceValue Set: WhoCrValueSetQuestionnairePatientOutcome
..... outcome_patcourse_status_otherIf other, please explain:0..1stringEnable When:
.... outcome_date_of_outcomeDate of Release from isolation/hospital or Date of Death:0..1date
.... outcome_labIf released from hospital/isolation, details of last laboratory test0..1groupEnable When:
..... outcome_lab_dateDate of last test:0..1date
..... outcome_lab_resultResults of last test:0..1choiceValue Set: Test Result
.... outcome_contacts_followedTotal number of contacts followed for this case:0..1integer
.... outcome_contacts_followed_unknownUnknown:0..1boolean

doco Documentation for this format