{
"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": {
"source": "#rku93oA0ZVERGZAr",
"profile": [ "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-extract|2.7" ],
"versionId": "2",
"lastUpdated": "2021-07-13T20:27:25.959+00:00"
},
"publisher": "HL7 International - Patient Care WG",
"jurisdiction": [ {
"text": "United States of America",
"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"
} ],
"item": [ {
"code": [ {
"code": "56051-6",
"system": "http://loinc.org",
"display": "Do you consider yourself Hispanic/Latino?"
} ],
"text": "Do you consider yourself Hispanic/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": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?"
} ],
"text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?",
"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": "Have you been discharged from the armed forces of the United States?"
} ],
"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"
} ],
"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?"
} ],
"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"
} ],
"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?"
} ],
"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": "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?"
} ],
"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",
"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"
} ],
"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 (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?"
} ],
"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 is when someone feels tense, nervous, anxious or can't sleep at night because their mind is troubled. How stressed are you?"
} ],
"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"
} ],
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"code": [ {
"code": "93028-9",
"system": "http://loinc.org",
"display": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?"
} ],
"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?"
} ],
"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
} ],
"copyright": "Content is from the PRAPARE Survey with permission: © 2019. This item comes from the national PRAPARE social determinants of health assessment protocol, developed and owned by the National Association of Community Health Centers (NACHC), in partnership with the Association of Asian Pacific Community Health Organization (AAPCHO), the Oregon Primary Care Association (OPCA), and the Institute for Alternative Futures (IAF). For more information, visit [www.nachc.org/prapare](http://www.nachc.org/prapare)",
"type": null,
"experimental": null,
"resourceType": "Questionnaire",
"title": "SDOHCC Questionnaire PRAPARE",
"package_version": "1.1.0",
"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": "88c1287d-7e1b-4a39-b79c-5605803987cf",
"kind": null,
"url": "http://hl7.org/fhir/us/sdoh-clinicalcare/Questionnaire/SDOHCC-QuestionnairePRAPARE",
"version": "1.1.0",
"contact": [ {
"name": "HL7 International - Patient Care",
"telecom": [ {
"value": "http://www.hl7.org/Special/committees/patientcare",
"system": "url"
} ]
} ]
}