{
  "description": null,
  "_filename": "Questionnaire-questionnaire-example-housing.json",
  "package_name": "fhir.argonaut.questionnaire",
  "subjectType": [ "Patient" ],
  "date": "2018-07-26",
  "meta": {
    "profile": [ "http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/argo-questionnaire" ]
  },
  "publisher": "Argonaut Project",
  "jurisdiction": [ {
    "coding": [ {
      "code": "US",
      "system": "urn:iso:std:iso:3166",
      "display": "United States of America"
    } ]
  } ],
  "name": null,
  "item": [ {
    "item": [ {
      "text": "Accountable Health Communities Core Health-Related Social Needs Screening Questions \nUnderlined answer options indicate positive responses for the associated health-related social need. \nA value greater than 10 when the numerical values for answers to questions 7-10 are summed indicates a positive screen for interpersonal safety.",
      "type": "display",
      "linkId": "g1.d",
      "extension": [ {
        "url": "http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder",
        "valueInteger": 0
      } ]
    }, {
      "text": "What is your housing situation today?",
      "type": "choice",
      "linkId": "g1.1",
      "option": [ {
        "extension": [ {
          "url": "http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder",
          "valueInteger": 0
        } ],
        "valueString": "I do not have housing (I am staying with others, in a hotel, in a shelter, living outside on the street, on a beach, in a car, abandoned building, bus or train station, or in a park)"
      }, {
        "extension": [ {
          "url": "http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder",
          "valueInteger": 1
        } ],
        "valueString": "I have housing today, but I am worried about losing housing in the future"
      }, {
        "extension": [ {
          "url": "http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder",
          "valueInteger": 2
        } ],
        "valueString": "I have housing"
      } ],
      "prefix": "1",
      "repeats": false,
      "required": true,
      "extension": [ {
        "url": "http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder",
        "valueInteger": 1
      } ]
    }, {
      "text": "Think about the place you live. Do you have problems with any of the following? (check all that apply)",
      "type": "choice",
      "linkId": "g1.2",
      "option": [ {
        "extension": [ {
          "url": "http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder",
          "valueInteger": 0
        } ],
        "valueString": "Bug infestation"
      }, {
        "extension": [ {
          "url": "http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder",
          "valueInteger": 1
        } ],
        "valueString": "Mold"
      }, {
        "extension": [ {
          "url": "http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder",
          "valueInteger": 2
        } ],
        "valueString": "Lead paint or pipes"
      }, {
        "extension": [ {
          "url": "http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder",
          "valueInteger": 3
        } ],
        "valueString": "Inadequate heat"
      }, {
        "extension": [ {
          "url": "http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder",
          "valueInteger": 4
        } ],
        "valueString": "Oven or stove not working"
      }, {
        "extension": [ {
          "url": "http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder",
          "valueInteger": 5
        } ],
        "valueString": "No or not working smoke detectors"
      }, {
        "extension": [ {
          "url": "http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder",
          "valueInteger": 6
        } ],
        "valueString": "Water leaks"
      }, {
        "extension": [ {
          "url": "http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder",
          "valueInteger": 7
        } ],
        "valueString": "None of the above",
        "modifierExtension": [ {
          "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-optionExclusive",
          "valueBoolean": true
        } ]
      } ],
      "prefix": "2",
      "repeats": true,
      "required": true,
      "extension": [ {
        "url": "http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder",
        "valueInteger": 2
      } ]
    } ],
    "type": "group",
    "linkId": "g1"
  } ],
  "useContext": [ {
    "code": {
      "code": "task",
      "system": "http://hl7.org/fhir/usage-context-type",
      "display": "Workflow Task"
    },
    "valueCodeableConcept": {
      "coding": [ {
        "code": "example",
        "system": "http://acme.org",
        "display": "Example of Use"
      } ]
    }
  } ],
  "copyright": "Billioux, Alexander, MD, Dphil; Verlander, Katherine, MPH; Anthony, Susan, DrPH; Alley, Dawn, PhD; National Academy of Sciences, “Standardized Screening for Health-Related Social Needs in Clinical Settings - The Accountable Health Communities Screening Tool,“ https://nam.edu/wp-content/uploads/2017/05/Standardized-Screening-for-Health-Related-Social-Needs-in-Clinical-Settings.pdf  \n",
  "type": null,
  "experimental": null,
  "resourceType": "Questionnaire",
  "title": "Housing Questions",
  "package_version": "1.0.0",
  "status": "draft",
  "id": "5382eaac-b2c4-425a-9e8d-ed1a0cb17435",
  "kind": null,
  "url": "http://fhir.org/guides/argonaut/questionnaire/Questionnaire/questionnaire-example-housing",
  "code": [ {
    "code": "housing",
    "system": "http://acme.org/codes",
    "display": "Housing Questions"
  } ],
  "identifier": [ {
    "value": "business-identifier4",
    "system": "http://acme.org/q-identifiers"
  } ],
  "version": "0.0.0",
  "contact": [ {
    "telecom": [ {
      "value": "http://argonautwiki.hl7.org",
      "system": "url"
    } ]
  } ]
}