US Core Implementation Guide
8.0.0 - STU 8 United States of America flag

This page is part of the US Core (v8.0.0: STU8) based on FHIR (HL7® FHIR® Standard) R4. This is the current published version. For a full list of available versions, see the Directory of published versions. Page versions: R8 R7 R6

Questionnaire: Questionnaire PRAPARE Example (Experimental)

Official URL: http://hl7.org/fhir/us/core/Questionnaire/prapare-example Version: 8.0.0
Standards status: Informative Computable Name: PRAPAREExample
Other Identifiers: OID:2.16.840.1.113883.4.642.40.2.35.6

Usage:Clinical Focus: SDOH

Copyright/Legal: This material contains content from LOINC® (http://loinc.org). LOINC is copyright © 1995-2024, Regenstrief Institute, Inc. and the LOINC Committee, and is available at no cost under the license at http://loinc.org/license. Copyright © 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. Used with permission.
Structure
LinkIDTextCardinalityTypeDescription & Constraintsdoco
.. PRAPAREExampleQuestionnairehttp://hl7.org/fhir/us/core/Questionnaire/prapare-example#8.0.0
... /93025-5Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]0..1group
.... /93043-8Personal characteristics0..1group
..... /93043-8/56051-6Hispanic or Latino0..1choiceOptions: 3 options
..... /93043-8/32624-9Race0..*choiceOptions: 8 options
..... /93043-8/93035-4Has season or migrant farm work been your or your family's main source of income at any point in past 2 years [PRAPARE]0..1choiceOptions: 3 options
..... /93043-8/93034-7Discharged from the U.S. Armed Forces0..1choiceOptions: 3 options
..... /93043-8/54899-0Preferred language0..1choiceOptions: 3 options
.... /93042-0Family and home0..1group
..... /93042-0/63512-8How many people are living or staying at this address [#]0..1integer
..... /93042-0/71802-3Housing status0..1choiceOptions: 3 options
...... /93042-0/71802-3-helpDescribes patients living arrangement0..1display
..... /93042-0/93033-9Are you worried about losing your housing [PRAPARE]0..1choiceOptions: 3 options
..... /93042-0/56799-0Address0..1string
.... /93041-2Money and resources0..1group
..... /93041-2/82589-3Highest level of educ0..1choiceOptions: 4 options
..... /93041-2/67875-5Employment status current0..1choiceOptions: 5 options
..... /93041-2/76437-3Primary insurance0..1choiceOptions: 7 options
..... /93041-2/63586-2What was your best estimate of the total income of all family members from all sources, before taxes, in last year [PhenX]0..1decimal
..... /93041-2/93031-3Have 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]0..*choiceOptions: 8 options
..... /93041-2/93030-5Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living0..*choiceOptions: 4 options
.... /93040-4Social and emotional health0..1group
..... /93040-4/93029-7How often do you see or talk to people that you care about and feel close to [PRAPARE]0..1choiceOptions: 5 options
..... /93040-4/93038-8Stress is when someone feels tense, nervous, anxious or can't sleep at night because their mind is troubled. How stressed are you?0..1choiceOptions: 6 options
.... /93039-6Optional additional questions0..1group
..... /93039-6/93028-9Have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility in past 1 year [PRAPARE]0..1choiceOptions: 3 options
..... /93039-6/93027-1Are you a refugee0..1choiceOptions: 3 options
..... /93039-6/93026-3Do you feel physically and emotionally safe where you currently live [PRAPARE]0..1choiceOptions: 4 options
..... /93039-6/76501-6Within the last year, have you been afraid of your partner or ex-partner0..1choiceOptions: 2 options

doco Documentation for this format

Options Sets

Answer options for /93043-8/56051-6

  • http://loinc.org#LA33-6 ("Yes")
  • http://loinc.org#LA32-8 ("No")
  • http://loinc.org#LA30122-8 ("I choose not to answer this question")

Answer options for /93043-8/32624-9

  • http://loinc.org#LA6156-9 ("Asian")
  • http://loinc.org#LA14045-1 ("Native Hawaiian")
  • http://loinc.org#LA30187-1 ("Pacific Islander")
  • http://loinc.org#LA14042-8 ("Black/African American")
  • http://loinc.org#LA4457-3 ("White")
  • http://loinc.org#LA4-4 ("American Indian/Alaskan Native")
  • http://loinc.org#LA46-8 ("Other")
  • http://loinc.org#LA30122-8 ("I choose not to answer this question")

Answer options for /93043-8/93035-4

  • http://loinc.org#LA33-6 ("Yes")
  • http://loinc.org#LA32-8 ("No")
  • http://loinc.org#LA30122-8 ("I choose not to answer this question")

Answer options for /93043-8/93034-7

  • http://loinc.org#LA33-6 ("Yes")
  • http://loinc.org#LA32-8 ("No")
  • http://loinc.org#LA30122-8 ("I choose not to answer this question")

Answer options for /93043-8/54899-0

  • http://loinc.org#LA43-5 ("English")
  • http://loinc.org#LA30188-9 ("Language other than English")
  • http://loinc.org#LA30122-8 ("I choose not to answer this question")

Answer options for /93042-0/71802-3

  • http://loinc.org#LA30189-7 ("I have housing")
  • http://loinc.org#LA30190-5 ("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)")
  • http://loinc.org#LA30122-8 ("I choose not to answer this question")

Answer options for /93042-0/93033-9

  • http://loinc.org#LA33-6 ("Yes")
  • http://loinc.org#LA32-8 ("No")
  • http://loinc.org#LA30122-8 ("I choose not to answer this question")

Answer options for /93041-2/82589-3

  • http://loinc.org#LA30191-3 ("Less than high school degree")
  • http://loinc.org#LA30192-1 ("High school diploma or GED")
  • http://loinc.org#LA30193-9 ("More than high school")
  • http://loinc.org#LA30122-8 ("I choose not to answer this question")

Answer options for /93041-2/67875-5

  • http://loinc.org#LA17956-6 ("Unemployed")
  • http://loinc.org#LA30138-4 ("Part-time or temporary work")
  • http://loinc.org#LA30136-8 ("Full-time work")
  • http://loinc.org#LA30137-6 ("Otherwise unemployed but not seeking work (ex: student, retired, disabled, unpaid primary care giver)")
  • http://loinc.org#LA30122-8 ("I choose not to answer this question")

Answer options for /93041-2/76437-3

  • http://loinc.org#LA30194-7 ("None/uninsured")
  • http://loinc.org#LA17849-3 ("Medicaid")
  • http://loinc.org#LA30195-4 ("CHIP Medicaid")
  • http://loinc.org#LA15652-3 ("Medicare")
  • http://loinc.org#LA30196-2 ("Other public insurance (not CHIP)")
  • http://loinc.org#LA30197-0 ("Other public insurance (CHIP)")
  • http://loinc.org#LA6350-8 ("Private insurance")

Answer options for /93041-2/93031-3

  • http://loinc.org#LA30125-1 ("Food")
  • http://loinc.org#LA30126-9 ("Clothing")
  • http://loinc.org#LA30124-4 ("Utilities")
  • http://loinc.org#LA30127-7 ("Child care")
  • http://loinc.org#LA30128-5 ("Medicine or Any Health Care (Medical, Dental, Mental Health, Vision)")
  • http://loinc.org#LA30129-3 ("Phone")
  • http://loinc.org#LA46-8 ("Other")
  • http://loinc.org#LA30122-8 ("I choose not to answer this question")

Answer options for /93041-2/93030-5

  • http://loinc.org#LA30133-5 ("Yes, it has kept me from medical appointments or from getting my medications")
  • http://loinc.org#LA30134-3 ("Yes, it has kept me from non-medical meetings, appointments, work, or from getting things that I need")
  • http://loinc.org#LA32-8 ("No")
  • http://loinc.org#LA30257-2 ("Patient unable to respond")

Answer options for /93040-4/93029-7

  • http://loinc.org#LA27722-0 ("Less than once a week")
  • http://loinc.org#LA30130-1 ("1 or 2 times a week")
  • http://loinc.org#LA30131-9 ("3 to 5 times a week")
  • http://loinc.org#LA30132-7 ("5 or more times a week")
  • http://loinc.org#LA30122-8 ("I choose not to answer this question")

Answer options for /93040-4/93038-8

  • http://loinc.org#LA6568-5 ("Not at all")
  • http://loinc.org#LA13863-8 ("A little bit")
  • http://loinc.org#LA13909-9 ("Somewhat")
  • http://loinc.org#LA13902-4 ("Quite a bit")
  • http://loinc.org#LA13914-9 ("Very much")
  • http://loinc.org#LA30122-8 ("I choose not to answer this question")

Answer options for /93039-6/93028-9

  • http://loinc.org#LA33-6 ("Yes")
  • http://loinc.org#LA32-8 ("No")
  • http://loinc.org#LA30122-8 ("I choose not to answer this question")

Answer options for /93039-6/93027-1

  • http://loinc.org#LA33-6 ("Yes")
  • http://loinc.org#LA32-8 ("No")
  • http://loinc.org#LA30122-8 ("I choose not to answer this question")

Answer options for /93039-6/93026-3

  • http://loinc.org#LA33-6 ("Yes")
  • http://loinc.org#LA32-8 ("No")
  • http://loinc.org#LA14072-5 ("Unsure")
  • http://loinc.org#LA30122-8 ("I choose not to answer this question")

Answer options for /93039-6/76501-6

  • http://loinc.org#LA33-6 ("Yes")
  • http://loinc.org#LA32-8 ("No")