Patient Document Generator

Welcome to the Patient Document Generator.

  • This website allows a patient to provide a health summary and summary of care needs to the healthcare system using the International Patient Summary Standard
  • This is not a medical history and is not intended to be complete enough to enable disability/impairment related care (or any other kind of care) by itself
  • This is not a beautifully crafted user interface; it's a sample interface intended to help people discuss/describe the requirements for these kind of statements.
  • The form is processed locally in your browser; no information is shared with any other system or server, but in general, this form is intended for test data, not real protected health PHI.

I'm an IPS nerd, show me IPS mappings.

Patient Details
Consumer Name (mandatory)
IPS: Patient.name.text
Date of Birth (mandatory, YYYY-MM-DD)
IPS: Patient.dateOfBirth
National Health Identifier (if you know it; in some countries you will)
IPS: Patient.identifier.value where identifier.type is NIIP
Country Code (2 or 3 letter code e.g. US, AU, NZ)
IPS: Patient.address.country
Email
IPS: Patient.telecom
Mobile Phone
IPS: Patient.telecom
Next of Kin
Name
IPS: Patient.nok
Email
IPS: Patient.nok.telecom
Mobile Phone
IPS: Patient.nok.telecom
Cultural Identity
Your Culture (if you think this is relevant)
IPS: Patient.extension('http://healthintersections.com.au/fhir/StructureDefinition/patient-cultural-background')
Your place
IPS: Patient.extension('http://hl7.org.au/fhir/StructureDefinition/community-affiliation')
Your country and/or community, if important / relevant
Preferred Language
IPS: Patient.communication.language(preferred=true)
I can get by in English (e.g. or the local official language)
IPS: Patient.communication.language
Religion
IPS: Patient.extension('http://hl7.org/fhir/StructureDefinition/patient-religion') . Details:
Gender
Gender
IPS: Patient.extension('http://hl7.org/fhir/StructureDefinition/individual-genderIdentity') or
Pronouns
IPS: Patient.extension('http://hl7.org/fhir/StructureDefinition/individual-pronouns') or
Sex characteristics
IPS: Patient.extension('http://healthintersections.com.au/fhir/StructureDefinition/sex-characteristic-variation')
Details:
Author
Name leave this blank if self-authored
IPS: Composition.author.display
My Story
Who are you? How would you describe your health? What matters to you?

(note for techies: this can be markdown)
IPS: Composition.section[patient-story].text
My Goals
What specific outcomes are important to you from your care?
Making Progress
IPS: Composition.section[patient-story].entry->Goal.description + Goal.achievementStatus

Care Planning / Advance Directives

Care Advocate
Name
IPS: Composition.section[care-directives].entry->RelatedPerson.name.text		(optional - leave all blank if no care advocate)
Email
IPS: RelatedPerson.telecom
Mobile Phone
IPS: RelatedPerson.telecom
Status Legal Power of Attorney
IPS: RelatedPerson.relationship		(check if care advocate has legal rights)

Is there anyone we should avoid contacting, or speaking to, on your behalf - for example, due to an avoidance relationship / family issues?


IPS: todo
Note: Providing Names + Relationship works best (one per line)

Check any appropriate:

  • I consent to all treatments aimed at sustaining or prolonging my life OR
    I refuse any treatments aimed at sustaining or prolonging my life (DNR)
    Composition.section[care-directives].entry->Consent.provision.deny, .provision.code = SCT 439569004
  • I am willing to be an organ donor OR
    I am NOT willing to be an organ donor
    Composition.section[care-directives].entry->Consent.provision.deny, .provision.code = SCT 1148553005
  • I consent to receive a blood transfusion OR
    I do not consent to a blood transfusion
    Composition.section[care-directives].entry->Consent.provision.deny, .provision.code = SCT 116859006

If you have a full Advance Care Directive, attach it here (as a .pdf):
Composition.section[care-directives].entry->DocumentReference

Allergies
Allergy Manifestation

IPS: Composition.section[allergies].entry->AllergyIntolerance.code		 IPS: AllergyIntolerance.reaction.manifestation
Ongoing Health Issues
Health Issue Level

IPS: Composition.section[problem-list].entry->Condition.code		 IPS: Condition.severity
Medications
Medication + Dosage
+ IPS: Composition.section[medications].entry->MedicationStatement.medicationCodeableConcept + MedicationStatement.dosage.text
Past Events/Illnesses
Event When
IPS: Composition.section[pasthistory].entry->Condition.code IPS: Condition.onsetDateTime
Common events include serious illnesses, operations, pregnancy/births, marriages and deaths. For when, a year is generally enough, but you can provide month/day using yyyy-mm-dd if desired

My functional and identity needs

Note: You don't tick the boxes if they're not appropriate for you.

Functional / Identity Flags I would like my carers to be aware of my concerns around:

  • Vision
    IPS: Composition.section[functional-status].entry->Condition.code = SCT 397540003
  • Hearing / Listening IPS: Condition.code = SCT 15188001
  • Cognition / thinking / understanding / information processing IPS: Condition.code = SCT 386806002
  • Speaking / communicating / Conversation / Verbal interactions IPS: Condition.code = SCT 29164008
  • Mobility / moving myself around IPS: Condition.code = SCT 82971005
  • Use of gender specific areas IPS: Condition.code = SCT 93461009
  • Memory IPS: Condition.code = SCT 386807006
  • Past Trauma IPS: Condition.code = SCT 161472001
  • Staying focused / Concentration IPS: Condition.code = SCT 1144748009
  • Managing my addiction(s) IPS: Condition.code = SCT 32709003

I am from a small and/or remote community and cities and/or lots of people are an unfamiliar environment for me. IPS: Condition.code = SCT 5794003 SCT

I may need help with

  • Eating / Drinking IPS: Condition.code = SCT 110292000
  • Toileting IPS: Condition.code = SCT 284911003
  • Getting out of bed IPS: Condition.code = SCT 301666002
  • Moving in bed IPS: Condition.code = SCT 301685004
  • Getting orientated in a new environment IPS: Condition.code = SCT 72440003
  • Dressing IPS: Condition.code = SCT 284977008
  • Bathing / Cleaning IPS: Condition.code = SCT 284807005
  • Taking my medications IPS: Condition.code = SCT 715037005
  • Reading Documentation IPS: Condition.code = SCT 309253009

I have:

  • A Guide Dog / Service Animal IPS: Condition.code = SCT 105506000
  • A Wheelchair IPS: Condition.code = SCT 105503008
  • A Communication Device IPS: Condition.code = SCT 719369003

Notes: other possible candidates = Hearing aid or cochlear implant, Walking stick, Prosthetic leg (….this list goes on and on)?

Anything else you want to say about your general care needs or anxieties, or to explain any of the boxes you ticked above:

IPS: Composition.section[functional-status].entry->Condition.code.text

Due to congenital birth variations, accidents or medical treatment, you might be missing organs or limbs that might impact your treatment or care, or have replacements.

OrganStatus
Arm L:
R:
IPS: Composition.section[functional-status].entry->Observation.bodySite + Observation.valueCodeableConcept for status, SCT 368208006 / 368209003
Hand L:
R:
SCT 85151006 / 78791008
Fingers L:
R:
SCT 786841006 / 786842004
Leg L:
R:
SCT 48979004 / 32696007
Calf L:
R:
SCT 48979004 / 32696007
Foot L:
R:
SCT 22335008 / 7769000
Toe L:
R:
SCT 785708006 / 785709003
Hip L:
R:
SCT 32709003
Eye L:
R:
SCT 67923007
Hypothalamus
SCT 67923007
Pituitary
SCT 181125003
Tongue
SCT 32709003
Jaw
SCT 661005
Salivary Glands L:
R:
SCT 725037009 / SCTID: 725038004
Oesophagus
SCT 32849002
Large Colon
SCT 71854001
Stomach
SCT 69695003
Gall Bladder
SCT 28231008
Kidney L:
R:
SCT 18639004 / 9846003
Liver
SCT 10200004
Bladder
SCT 89837001
Lung L:
R:
SCT 44029006 / 3341006
Breasts L:
R:
SCT 80248007 / 73056007
Ovary L:
R:
SCT 43981004 / 20837000
Uterus
SCT 35039007
Cervix
SCT 71252005
Vagina
SCT 76784001
Penis
SCT 18911002
Prostate
SCT 41216001
Testis L:
R:
SCT 40689003
Pregnancy
Status
IPS: Composition.section[pregnancy].entry->Observation[pregnancyStatus].valueCodeableConcept
LMP (YYYY-MM(-DD))
IPS: Composition.section[pregnancy].entry->Observation[LOINC:8665-2].value
Estimated Del. Date (YYY-MM(-DD))
IPS: Composition.section[pregnancy].entry->Observation[LOINC:11778-8].value
Menstruation
Status
IPS: Composition.section[reproductiveHealth].entry->Observation[LOINC:8678-5].valueCodeableConcept : 22636003 | 289904000 | 289903006
Frequency
IPS: Composition.section[reproductiveHealth].entry->Observation[SCT:289887006].valueCodeableConcept : SCT:14302001|289892008|282027006|52073004
Duration
IPS: : Composition.section[reproductiveHealth].entry->Observation[SCT:161720007].valueCodeableConcept : 17621005 | 255224006
Regularity
IPS: : Composition.section[reproductiveHealth].entry->Observation[SCT:364307006].valueCodeableConcept : 302757007 | 80182007
Flow Volume
IPS: : Composition.section[reproductiveHealth].entry->Observation[Custom:menstrual-flow].valueCodeableConcept : 386692008 | 282027006 | 64206003
Intermenstrual Bleeding
IPS: : Composition.section[reproductiveHealth].entry->Observation[SCT:248965005].valueCodeableConcept : SCT 78456001 | 64996003 | 237132003
Iron Status
IPS: ?
Men's Health
Erectile Function
IPS: ?
Urination
IPS: ?
Prostate Cancer
IPS: ?

Test Patients: