{
"description": null,
"_filename": "example/Questionnaire-SDOHCC-QuestionnairePRAPARE.json",
"package_name": "hl7.fhir.us.sdoh-clinicalcare",
"subjectType": [ "Patient" ],
"date": "2021-04-01T04:01:34+00:00",
"meta": {
"profile": [ "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-extr-smap" ]
},
"publisher": "HL7 International / Patient Care",
"jurisdiction": [ {
"coding": [ {
"code": "US",
"system": "urn:iso:std:iso:3166",
"display": "United States of America"
} ]
} ],
"name": "SDOHCCQuestionnairePRAPARE",
"item": [ {
"code": [ {
"code": "93025-5",
"system": "http://loinc.org",
"display": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]"
} ],
"item": [ {
"code": [ {
"code": "93043-8",
"system": "http://loinc.org",
"display": "Personal characteristics [PRAPARE]"
} ],
"item": [ {
"code": [ {
"code": "56051-6",
"system": "http://loinc.org",
"display": "Hispanic or Latino"
} ],
"text": "Hispanic or Latino",
"type": "choice",
"linkId": "/93043-8/56051-6",
"required": false,
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"text": "Drop down",
"coding": [ {
"code": "drop-down",
"system": "http://hl7.org/fhir/questionnaire-item-control",
"display": "Drop down"
} ]
}
} ],
"answerOption": [ {
"valueCoding": {
"code": "LA33-6",
"system": "http://loinc.org",
"display": "Yes"
}
}, {
"valueCoding": {
"code": "LA32-8",
"system": "http://loinc.org",
"display": "No"
}
}, {
"valueCoding": {
"code": "LA30122-8",
"system": "http://loinc.org",
"display": "I choose not to answer this question"
}
} ]
}, {
"code": [ {
"code": "32624-9",
"system": "http://loinc.org",
"display": "Race"
} ],
"text": "Race",
"type": "choice",
"linkId": "/93043-8/32624-9",
"repeats": true,
"required": false,
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"text": "Drop down",
"coding": [ {
"code": "drop-down",
"system": "http://hl7.org/fhir/questionnaire-item-control",
"display": "Drop down"
} ]
}
} ],
"answerOption": [ {
"valueCoding": {
"code": "LA6156-9",
"system": "http://loinc.org",
"display": "Asian"
}
}, {
"valueCoding": {
"code": "LA14045-1",
"system": "http://loinc.org",
"display": "Native Hawaiian"
}
}, {
"valueCoding": {
"code": "LA30187-1",
"system": "http://loinc.org",
"display": "Pacific Islander"
}
}, {
"valueCoding": {
"code": "LA14042-8",
"system": "http://loinc.org",
"display": "Black/African American"
}
}, {
"valueCoding": {
"code": "LA4457-3",
"system": "http://loinc.org",
"display": "White"
}
}, {
"valueCoding": {
"code": "LA4-4",
"system": "http://loinc.org",
"display": "American Indian/Alaskan Native"
}
}, {
"valueCoding": {
"code": "LA46-8",
"system": "http://loinc.org",
"display": "Other"
}
}, {
"valueCoding": {
"code": "LA30122-8",
"system": "http://loinc.org",
"display": "I choose not to answer this question"
}
} ]
}, {
"code": [ {
"code": "93035-4",
"system": "http://loinc.org",
"display": "Has season or migrant farm work been your or your family's main source of income at any point in past 2 years [PRAPARE]"
} ],
"text": "Has season or migrant farm work been your or your family's main source of income at any point in past 2 years?",
"type": "choice",
"linkId": "/93043-8/93035-4",
"required": false,
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"text": "Drop down",
"coding": [ {
"code": "drop-down",
"system": "http://hl7.org/fhir/questionnaire-item-control",
"display": "Drop down"
} ]
}
} ],
"answerOption": [ {
"valueCoding": {
"code": "LA33-6",
"system": "http://loinc.org",
"display": "Yes"
}
}, {
"valueCoding": {
"code": "LA32-8",
"system": "http://loinc.org",
"display": "No"
}
}, {
"valueCoding": {
"code": "LA30122-8",
"system": "http://loinc.org",
"display": "I choose not to answer this question"
}
} ]
}, {
"code": [ {
"code": "93034-7",
"system": "http://loinc.org",
"display": "Discharged from the U.S. Armed Forces"
} ],
"text": "Have you been discharged from the armed forces of the United States?",
"type": "choice",
"linkId": "/93043-8/93034-7",
"required": false,
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"text": "Drop down",
"coding": [ {
"code": "drop-down",
"system": "http://hl7.org/fhir/questionnaire-item-control",
"display": "Drop down"
} ]
}
} ],
"answerOption": [ {
"valueCoding": {
"code": "LA33-6",
"system": "http://loinc.org",
"display": "Yes"
}
}, {
"valueCoding": {
"code": "LA32-8",
"system": "http://loinc.org",
"display": "No"
}
}, {
"valueCoding": {
"code": "LA30122-8",
"system": "http://loinc.org",
"display": "I choose not to answer this question"
}
} ]
}, {
"code": [ {
"code": "54899-0",
"system": "http://loinc.org",
"display": "Preferred language"
} ],
"text": "Preferred language",
"type": "choice",
"linkId": "/93043-8/54899-0",
"required": false,
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"text": "Drop down",
"coding": [ {
"code": "drop-down",
"system": "http://hl7.org/fhir/questionnaire-item-control",
"display": "Drop down"
} ]
}
} ],
"answerOption": [ {
"valueCoding": {
"code": "LA43-5",
"system": "http://loinc.org",
"display": "English"
}
}, {
"valueCoding": {
"code": "LA30188-9",
"system": "http://loinc.org",
"display": "Language other than English"
}
}, {
"valueCoding": {
"code": "LA30122-8",
"system": "http://loinc.org",
"display": "I choose not to answer this question"
}
} ]
} ],
"text": "Personal characteristics",
"type": "group",
"linkId": "/93043-8",
"required": false
}, {
"code": [ {
"code": "93042-0",
"system": "http://loinc.org",
"display": "Family and home [PRAPARE]"
} ],
"item": [ {
"code": [ {
"code": "63512-8",
"system": "http://loinc.org",
"display": "How many people are living or staying at this address [#]"
} ],
"text": "How many people are living or staying at this address?",
"type": "integer",
"linkId": "/93042-0/63512-8",
"required": false,
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-unit",
"valueCoding": {
"code": "{#}",
"system": "http://unitsofmeasure.org",
"display": "{#}"
}
} ]
}, {
"code": [ {
"code": "71802-3",
"system": "http://loinc.org",
"display": "Housing status"
} ],
"item": [ {
"text": "Describes patients living arrangement",
"type": "display",
"linkId": "/93042-0/71802-3-help",
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"text": "Help-Button",
"coding": [ {
"code": "help",
"system": "http://hl7.org/fhir/questionnaire-item-control",
"display": "Help-Button"
} ]
}
} ]
} ],
"text": "Housing status",
"type": "choice",
"linkId": "/93042-0/71802-3",
"required": false,
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"text": "Drop down",
"coding": [ {
"code": "drop-down",
"system": "http://hl7.org/fhir/questionnaire-item-control",
"display": "Drop down"
} ]
}
} ],
"answerOption": [ {
"valueCoding": {
"code": "LA30189-7",
"system": "http://loinc.org",
"display": "I have housing"
}
}, {
"valueCoding": {
"code": "LA30190-5",
"system": "http://loinc.org",
"display": "I do not have housing (staying with others, in a hotel, in a shelter, living outside on the street, on a beach, in a car, or in a park)"
}
}, {
"valueCoding": {
"code": "LA30122-8",
"system": "http://loinc.org",
"display": "I choose not to answer this question"
}
} ]
}, {
"code": [ {
"code": "93033-9",
"system": "http://loinc.org",
"display": "Are you worried about losing your housing [PRAPARE]"
} ],
"text": "Are you worried about losing your housing?",
"type": "choice",
"linkId": "/93042-0/93033-9",
"required": false,
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"text": "Drop down",
"coding": [ {
"code": "drop-down",
"system": "http://hl7.org/fhir/questionnaire-item-control",
"display": "Drop down"
} ]
}
} ],
"answerOption": [ {
"valueCoding": {
"code": "LA33-6",
"system": "http://loinc.org",
"display": "Yes"
}
}, {
"valueCoding": {
"code": "LA32-8",
"system": "http://loinc.org",
"display": "No"
}
}, {
"valueCoding": {
"code": "LA30122-8",
"system": "http://loinc.org",
"display": "I choose not to answer this question"
}
} ]
}, {
"code": [ {
"code": "56799-0",
"system": "http://loinc.org",
"display": "Address"
} ],
"text": "Address",
"type": "string",
"linkId": "/93042-0/56799-0",
"required": false
} ],
"text": "Family and home",
"type": "group",
"linkId": "/93042-0",
"required": false
}, {
"code": [ {
"code": "93041-2",
"system": "http://loinc.org",
"display": "Money and resources [PRAPARE]"
} ],
"item": [ {
"code": [ {
"code": "82589-3",
"system": "http://loinc.org",
"display": "Highest level of educ"
} ],
"text": "Highest level of educ",
"type": "choice",
"linkId": "/93041-2/82589-3",
"required": false,
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"text": "Drop down",
"coding": [ {
"code": "drop-down",
"system": "http://hl7.org/fhir/questionnaire-item-control",
"display": "Drop down"
} ]
}
} ],
"answerOption": [ {
"valueCoding": {
"code": "LA30191-3",
"system": "http://loinc.org",
"display": "Less than high school degree"
}
}, {
"valueCoding": {
"code": "LA30192-1",
"system": "http://loinc.org",
"display": "High school diploma or GED"
}
}, {
"valueCoding": {
"code": "LA30193-9",
"system": "http://loinc.org",
"display": "More than high school"
}
}, {
"valueCoding": {
"code": "LA30122-8",
"system": "http://loinc.org",
"display": "I choose not to answer this question"
}
} ]
}, {
"code": [ {
"code": "67875-5",
"system": "http://loinc.org",
"display": "Employment status current"
} ],
"text": "Employment status current",
"type": "choice",
"linkId": "/93041-2/67875-5",
"required": false,
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"text": "Drop down",
"coding": [ {
"code": "drop-down",
"system": "http://hl7.org/fhir/questionnaire-item-control",
"display": "Drop down"
} ]
}
} ],
"answerOption": [ {
"valueCoding": {
"code": "LA17956-6",
"system": "http://loinc.org",
"display": "Unemployed"
}
}, {
"valueCoding": {
"code": "LA30138-4",
"system": "http://loinc.org",
"display": "Part-time or temporary work"
}
}, {
"valueCoding": {
"code": "LA30136-8",
"system": "http://loinc.org",
"display": "Full-time work"
}
}, {
"valueCoding": {
"code": "LA30137-6",
"system": "http://loinc.org",
"display": "Otherwise unemployed but not seeking work (ex: student, retired, disabled, unpaid primary care giver)"
}
}, {
"valueCoding": {
"code": "LA30122-8",
"system": "http://loinc.org",
"display": "I choose not to answer this question"
}
} ]
}, {
"code": [ {
"code": "76437-3",
"system": "http://loinc.org",
"display": "Primary insurance"
} ],
"text": "Primary insurance",
"type": "choice",
"linkId": "/93041-2/76437-3",
"required": false,
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"text": "Drop down",
"coding": [ {
"code": "drop-down",
"system": "http://hl7.org/fhir/questionnaire-item-control",
"display": "Drop down"
} ]
}
} ],
"answerOption": [ {
"valueCoding": {
"code": "LA30194-7",
"system": "http://loinc.org",
"display": "None/uninsured"
}
}, {
"valueCoding": {
"code": "LA17849-3",
"system": "http://loinc.org",
"display": "Medicaid"
}
}, {
"valueCoding": {
"code": "LA30195-4",
"system": "http://loinc.org",
"display": "CHIP Medicaid"
}
}, {
"valueCoding": {
"code": "LA15652-3",
"system": "http://loinc.org",
"display": "Medicare"
}
}, {
"valueCoding": {
"code": "LA30196-2",
"system": "http://loinc.org",
"display": "Other public insurance (not CHIP)"
}
}, {
"valueCoding": {
"code": "LA30197-0",
"system": "http://loinc.org",
"display": "Other public insurance (CHIP)"
}
}, {
"valueCoding": {
"code": "LA6350-8",
"system": "http://loinc.org",
"display": "Private insurance"
}
} ]
}, {
"code": [ {
"code": "63586-2",
"system": "http://loinc.org",
"display": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year [PhenX]"
} ],
"text": "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?",
"type": "decimal",
"linkId": "/93041-2/63586-2",
"required": false,
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-unit",
"valueCoding": {
"code": "/a",
"system": "http://unitsofmeasure.org",
"display": "/a"
}
} ]
}, {
"code": [ {
"code": "93031-3",
"system": "http://loinc.org",
"display": "Have you or any family members you live with been unable to get any of the following when it was really needed in past 1 year [PRAPARE]"
} ],
"text": "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?",
"type": "choice",
"linkId": "/93041-2/93031-3",
"repeats": true,
"required": false,
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"text": "Drop down",
"coding": [ {
"code": "drop-down",
"system": "http://hl7.org/fhir/questionnaire-item-control",
"display": "Drop down"
} ]
}
} ],
"answerOption": [ {
"valueCoding": {
"code": "LA30125-1",
"system": "http://loinc.org",
"display": "Food"
}
}, {
"valueCoding": {
"code": "LA30126-9",
"system": "http://loinc.org",
"display": "Clothing"
}
}, {
"valueCoding": {
"code": "LA30124-4",
"system": "http://loinc.org",
"display": "Utilities"
}
}, {
"valueCoding": {
"code": "LA30127-7",
"system": "http://loinc.org",
"display": "Child care"
}
}, {
"valueCoding": {
"code": "LA30128-5",
"system": "http://loinc.org",
"display": "Medicine or Any Health Care (Medical, Dental, Mental Health, Vision)"
}
}, {
"valueCoding": {
"code": "LA30129-3",
"system": "http://loinc.org",
"display": "Phone"
}
}, {
"valueCoding": {
"code": "LA46-8",
"system": "http://loinc.org",
"display": "Other"
}
}, {
"valueCoding": {
"code": "LA30122-8",
"system": "http://loinc.org",
"display": "I choose not to answer this question"
}
} ]
}, {
"code": [ {
"code": "93030-5",
"system": "http://loinc.org",
"display": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living"
} ],
"text": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living?",
"type": "choice",
"linkId": "/93041-2/93030-5",
"repeats": true,
"required": false,
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"text": "Drop down",
"coding": [ {
"code": "drop-down",
"system": "http://hl7.org/fhir/questionnaire-item-control",
"display": "Drop down"
} ]
}
} ],
"answerOption": [ {
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
"valueString": "A"
} ],
"valueCoding": {
"code": "LA30133-5",
"system": "http://loinc.org",
"display": "Yes, it has kept me from medical appointments or from getting my medications"
}
}, {
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
"valueString": "B"
} ],
"valueCoding": {
"code": "LA30134-3",
"system": "http://loinc.org",
"display": "Yes, it has kept me from non-medical meetings, appointments, work, or from getting things that I need"
}
}, {
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
"valueString": "C"
} ],
"valueCoding": {
"code": "LA32-8",
"system": "http://loinc.org",
"display": "No"
}
}, {
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
"valueString": "X"
} ],
"valueCoding": {
"code": "LA30257-2",
"system": "http://loinc.org",
"display": "Patient unable to respond"
}
} ]
} ],
"text": "Money and resources",
"type": "group",
"linkId": "/93041-2",
"required": false
}, {
"code": [ {
"code": "93040-4",
"system": "http://loinc.org",
"display": "Social and emotional health [PRAPARE]"
} ],
"item": [ {
"code": [ {
"code": "93029-7",
"system": "http://loinc.org",
"display": "How often do you see or talk to people that you care about and feel close to [PRAPARE]"
} ],
"text": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?",
"type": "choice",
"linkId": "/93040-4/93029-7",
"required": false,
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"text": "Drop down",
"coding": [ {
"code": "drop-down",
"system": "http://hl7.org/fhir/questionnaire-item-control",
"display": "Drop down"
} ]
}
} ],
"answerOption": [ {
"valueCoding": {
"code": "LA27722-0",
"system": "http://loinc.org",
"display": "Less than once a week"
}
}, {
"valueCoding": {
"code": "LA30130-1",
"system": "http://loinc.org",
"display": "1 or 2 times a week"
}
}, {
"valueCoding": {
"code": "LA30131-9",
"system": "http://loinc.org",
"display": "3 to 5 times a week"
}
}, {
"valueCoding": {
"code": "LA30132-7",
"system": "http://loinc.org",
"display": "5 or more times a week"
}
}, {
"valueCoding": {
"code": "LA30122-8",
"system": "http://loinc.org",
"display": "I choose not to answer this question"
}
} ]
}, {
"code": [ {
"code": "93038-8",
"system": "http://loinc.org",
"display": "Stress level"
} ],
"text": "Stress is when someone feels tense, nervous, anxious or can't sleep at night because their mind is troubled. How stressed are you?",
"type": "choice",
"linkId": "/93040-4/93038-8",
"required": false,
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"text": "Drop down",
"coding": [ {
"code": "drop-down",
"system": "http://hl7.org/fhir/questionnaire-item-control",
"display": "Drop down"
} ]
}
} ],
"answerOption": [ {
"valueCoding": {
"code": "LA6568-5",
"system": "http://loinc.org",
"display": "Not at all"
}
}, {
"valueCoding": {
"code": "LA13863-8",
"system": "http://loinc.org",
"display": "A little bit"
}
}, {
"valueCoding": {
"code": "LA13909-9",
"system": "http://loinc.org",
"display": "Somewhat"
}
}, {
"valueCoding": {
"code": "LA13902-4",
"system": "http://loinc.org",
"display": "Quite a bit"
}
}, {
"valueCoding": {
"code": "LA13914-9",
"system": "http://loinc.org",
"display": "Very much"
}
}, {
"valueCoding": {
"code": "LA30122-8",
"system": "http://loinc.org",
"display": "I choose not to answer this question"
}
} ]
} ],
"text": "Social and emotional health",
"type": "group",
"linkId": "/93040-4",
"required": false
}, {
"code": [ {
"code": "93039-6",
"system": "http://loinc.org",
"display": "Optional additional questions [PRAPARE]"
} ],
"item": [ {
"code": [ {
"code": "93028-9",
"system": "http://loinc.org",
"display": "Have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility in past 1 year [PRAPARE]"
} ],
"text": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?",
"type": "choice",
"linkId": "/93039-6/93028-9",
"required": false,
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"text": "Drop down",
"coding": [ {
"code": "drop-down",
"system": "http://hl7.org/fhir/questionnaire-item-control",
"display": "Drop down"
} ]
}
} ],
"answerOption": [ {
"valueCoding": {
"code": "LA33-6",
"system": "http://loinc.org",
"display": "Yes"
}
}, {
"valueCoding": {
"code": "LA32-8",
"system": "http://loinc.org",
"display": "No"
}
}, {
"valueCoding": {
"code": "LA30122-8",
"system": "http://loinc.org",
"display": "I choose not to answer this question"
}
} ]
}, {
"code": [ {
"code": "93027-1",
"system": "http://loinc.org",
"display": "Are you a refugee"
} ],
"text": "Are you a refugee?",
"type": "choice",
"linkId": "/93039-6/93027-1",
"required": false,
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"text": "Drop down",
"coding": [ {
"code": "drop-down",
"system": "http://hl7.org/fhir/questionnaire-item-control",
"display": "Drop down"
} ]
}
} ],
"answerOption": [ {
"valueCoding": {
"code": "LA33-6",
"system": "http://loinc.org",
"display": "Yes"
}
}, {
"valueCoding": {
"code": "LA32-8",
"system": "http://loinc.org",
"display": "No"
}
}, {
"valueCoding": {
"code": "LA30122-8",
"system": "http://loinc.org",
"display": "I choose not to answer this question"
}
} ]
}, {
"code": [ {
"code": "93026-3",
"system": "http://loinc.org",
"display": "Do you feel physically and emotionally safe where you currently live [PRAPARE]"
} ],
"text": "Do you feel physically and emotionally safe where you currently live?",
"type": "choice",
"linkId": "/93039-6/93026-3",
"required": false,
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"text": "Drop down",
"coding": [ {
"code": "drop-down",
"system": "http://hl7.org/fhir/questionnaire-item-control",
"display": "Drop down"
} ]
}
} ],
"answerOption": [ {
"valueCoding": {
"code": "LA33-6",
"system": "http://loinc.org",
"display": "Yes"
}
}, {
"valueCoding": {
"code": "LA32-8",
"system": "http://loinc.org",
"display": "No"
}
}, {
"valueCoding": {
"code": "LA14072-5",
"system": "http://loinc.org",
"display": "Unsure"
}
}, {
"valueCoding": {
"code": "LA30122-8",
"system": "http://loinc.org",
"display": "I choose not to answer this question"
}
} ]
}, {
"code": [ {
"code": "76501-6",
"system": "http://loinc.org",
"display": "Within the last year, have you been afraid of your partner or ex-partner"
} ],
"text": "Within the last year, have you been afraid of your partner or ex-partner?",
"type": "choice",
"linkId": "/93039-6/76501-6",
"required": false,
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept": {
"text": "Drop down",
"coding": [ {
"code": "drop-down",
"system": "http://hl7.org/fhir/questionnaire-item-control",
"display": "Drop down"
} ]
}
} ],
"answerOption": [ {
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
"valueString": "1"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 1
} ],
"valueCoding": {
"code": "LA33-6",
"system": "http://loinc.org",
"display": "Yes"
}
}, {
"extension": [ {
"url": "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
"valueString": "0"
}, {
"url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal": 0
} ],
"valueCoding": {
"code": "LA32-8",
"system": "http://loinc.org",
"display": "No"
}
} ]
} ],
"text": "Optional additional questions",
"type": "group",
"linkId": "/93039-6",
"required": false
} ],
"text": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]",
"type": "group",
"linkId": "/93025-5",
"required": false
} ],
"type": null,
"experimental": null,
"resourceType": "Questionnaire",
"title": "SDOHCC Questionnaire PRAPARE",
"package_version": "2.2.0",
"extension": [ {
"url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-targetStructureMap",
"valueCanonical": "http://hl7.org/fhir/us/sdoh-clinicalcare/StructureMap/SDOHCC-StructureMapPRAPARE"
} ],
"status": "draft",
"id": "4db3a769-1673-40a8-86b2-dc796af40d12",
"kind": null,
"url": "http://hl7.org/fhir/us/sdoh-clinicalcare/Questionnaire/SDOHCC-QuestionnairePRAPARE",
"version": "2.2.0",
"contact": [ {
"name": "HL7 International / Patient Care",
"telecom": [ {
"value": "http://www.hl7.org/Special/committees/patientcare",
"system": "url"
}, {
"value": "patientcare@lists.hl7.org",
"system": "email"
} ]
} ]
}