US Core Implementation Guide
8.0.0 - STU 8
US Core Implementation Guide
8.0.0 - STU 8
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
| Page standards status: Informative |
<Questionnaire xmlns="http://hl7.org/fhir">
<id value="prapare-example"/>
<meta>
<profile
value="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire"/>
</meta>
<text>
<status value="extensions"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: Questionnaire prapare-example</b></p><a name="prapare-example"> </a><a name="hcprapare-example"> </a><a name="prapare-example-en-US"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Profile: <a href="http://hl7.org/fhir/uv/sdc/STU3/StructureDefinition-sdc-questionnaire.html">SDCBaseQuestionnaire</a></p></div><b>Structure</b><table border="1" cellpadding="0" cellspacing="0" style="border: 1px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;"><tr style="border: 2px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top"><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="The linkID for the item">LinkID</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="Text for the item">Text</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="Minimum and Maximum # of times the item can appear in the instance">Cardinality</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="The type of the item">Type</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="Additional information about the item">Description & Constraints</a><span style="float: right"><a href="https://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAABAAAAAQCAYAAAAf8/9hAAAABmJLR0QA/wD/AP+gvaeTAAAACXBIWXMAAAsTAAALEwEAmpwYAAAAB3RJTUUH3goXBCwdPqAP0wAAAldJREFUOMuNk0tIlFEYhp9z/vE2jHkhxXA0zJCMitrUQlq4lnSltEqCFhFG2MJFhIvIFpkEWaTQqjaWZRkp0g26URZkTpbaaOJkDqk10szoODP//7XIMUe0elcfnPd9zsfLOYplGrpRwZaqTtw3K7PtGem7Q6FoidbGgqHVy/HRb669R+56zx7eRV1L31JGxYbBtjKK93cxeqfyQHbehkZbUkK20goELEuIzEd+dHS+qz/Y8PTSif0FnGkbiwcAjHaU1+QWOptFiyCLp/LnKptpqIuXHx6rbR26kJcBX3yLgBfnd7CxwJmflpP2wUg0HIAoUUpZBmKzELGWcN8nAr6Gpu7tLU/CkwAaoKTWRSQyt89Q8w6J+oVQkKnBoblH7V0PPvUOvDYXfopE/SJmALsxnVm6LbkotrUtNowMeIrVrBcBpaMmdS0j9df7abpSuy7HWehwJdt1lhVwi/J58U5beXGAF6c3UXLycw1wdFklArBn87xdh0ZsZtArghBdAA3+OEDVubG4UEzP6x1FOWneHh2VDAHBAt80IbdXDcesNoCvs3E5AFyNSU5nbrDPZpcUEQQTFZiEVx+51fxMhhyJEAgvlriadIJZZksRuwBYMOPBbO3hePVVqgEJhFeUuFLhIPkRP6BQLIBrmMenujm/3g4zc398awIe90Zb5A1vREALqneMcYgP/xVQWlG+Ncu5vgwwlaUNx+3799rfe96u9K0JSDXcOzOTJg4B6IgmXfsygc7/Bvg9g9E58/cDVmGIBOP/zT8Bz1zqWqpbXIsd0O9hajXfL6u4BaOS6SeWAAAAAElFTkSuQmCC" alt="doco" style="background-color: inherit"/></a></span></th></tr><tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_q_root.gif" alt="." style="background-color: white; background-color: inherit" title="QuestionnaireRoot" class="hierarchy"/> PRAPAREExample</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Questionnaire</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">http://hl7.org/fhir/us/core/Questionnaire/prapare-example#8.0.0</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck01.png)" id="item./93025-5" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="group" class="hierarchy"/> /93025-5</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group">group</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck011.png)" id="item./93043-8" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: white; background-color: inherit" title="group" class="hierarchy"/> /93043-8</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Personal characteristics</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group">group</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0110.png)" id="item./93043-8/56051-6" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> /93043-8/56051-6</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Hispanic or Latino</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item./93043-8/56051-6">3 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0110.png)" id="item./93043-8/32624-9" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="coding" class="hierarchy"/> /93043-8/32624-9</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Race</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..*</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item./93043-8/32624-9">8 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0110.png)" id="item./93043-8/93035-4" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> /93043-8/93035-4</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Has season or migrant farm work been your or your family's main source of income at any point in past 2 years [PRAPARE]</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item./93043-8/93035-4">3 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0110.png)" id="item./93043-8/93034-7" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="coding" class="hierarchy"/> /93043-8/93034-7</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Discharged from the U.S. Armed Forces</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item./93043-8/93034-7">3 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0100.png)" id="item./93043-8/54899-0" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> /93043-8/54899-0</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Preferred language</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item./93043-8/54899-0">3 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck011.png)" id="item./93042-0" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: white; background-color: inherit" title="group" class="hierarchy"/> /93042-0</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Family and home</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group">group</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0110.png)" id="item./93042-0/63512-8" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-integer.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="integer" class="hierarchy"/> /93042-0/63512-8</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">How many people are living or staying at this address [#]</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-integer">integer</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0111.png)" id="item./93042-0/71802-3" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="coding" class="hierarchy"/> /93042-0/71802-3</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Housing status</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item./93042-0/71802-3">3 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck01100.png)" id="item./93042-0/71802-3-help" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-display.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="display" class="hierarchy"/> /93042-0/71802-3-help</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Describes patients living arrangement</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-display">display</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0110.png)" id="item./93042-0/93033-9" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="coding" class="hierarchy"/> /93042-0/93033-9</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Are you worried about losing your housing [PRAPARE]</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item./93042-0/93033-9">3 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0100.png)" id="item./93042-0/56799-0" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="string" class="hierarchy"/> /93042-0/56799-0</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Address</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string">string</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck011.png)" id="item./93041-2" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: white; background-color: inherit" title="group" class="hierarchy"/> /93041-2</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Money and resources</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group">group</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0110.png)" id="item./93041-2/82589-3" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> /93041-2/82589-3</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Highest level of educ</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item./93041-2/82589-3">4 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0110.png)" id="item./93041-2/67875-5" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="coding" class="hierarchy"/> /93041-2/67875-5</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Employment status current</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item./93041-2/67875-5">5 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0110.png)" id="item./93041-2/76437-3" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> /93041-2/76437-3</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Primary insurance</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item./93041-2/76437-3">7 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0110.png)" id="item./93041-2/63586-2" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-decimal.png" alt="." style="background-color: white; background-color: inherit" title="decimal" class="hierarchy"/> /93041-2/63586-2</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">What was your best estimate of the total income of all family members from all sources, before taxes, in last year [PhenX]</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-decimal">decimal</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0110.png)" id="item./93041-2/93031-3" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> /93041-2/93031-3</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">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]</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..*</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item./93041-2/93031-3">8 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0100.png)" id="item./93041-2/93030-5" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="coding" class="hierarchy"/> /93041-2/93030-5</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..*</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item./93041-2/93030-5">4 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck011.png)" id="item./93040-4" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="group" class="hierarchy"/> /93040-4</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Social and emotional health</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group">group</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0110.png)" id="item./93040-4/93029-7" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="coding" class="hierarchy"/> /93040-4/93029-7</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">How often do you see or talk to people that you care about and feel close to [PRAPARE]</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item./93040-4/93029-7">5 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0100.png)" id="item./93040-4/93038-8" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> /93040-4/93038-8</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Stress is when someone feels tense, nervous, anxious or can't sleep at night because their mind is troubled. How stressed are you?</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item./93040-4/93038-8">6 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck001.png)" id="item./93039-6" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: white; background-color: inherit" title="group" class="hierarchy"/> /93039-6</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Optional additional questions</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group">group</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0010.png)" id="item./93039-6/93028-9" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> /93039-6/93028-9</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">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]</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item./93039-6/93028-9">3 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0010.png)" id="item./93039-6/93027-1" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="coding" class="hierarchy"/> /93039-6/93027-1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Are you a refugee</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item./93039-6/93027-1">3 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0010.png)" id="item./93039-6/93026-3" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> /93039-6/93026-3</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Do you feel physically and emotionally safe where you currently live [PRAPARE]</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item./93039-6/93026-3">4 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0000.png)" id="item./93039-6/76501-6" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="coding" class="hierarchy"/> /93039-6/76501-6</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Within the last year, have you been afraid of your partner or ex-partner</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item./93039-6/76501-6">2 options</a></td></tr>
<tr><td colspan="5" class="hierarchy"><br/><a href="https://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="data:image/png;base64,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" alt="doco" style="background-color: inherit"/> Documentation for this format</a></td></tr></table><hr/><p><b>Options Sets</b></p><a name="opt-item./93043-8/56051-6"> </a><p><b>Answer options for /93043-8/56051-6 </b></p><ul><li style="font-size: 11px">http://loinc.org#LA33-6 ("Yes")</li><li style="font-size: 11px">http://loinc.org#LA32-8 ("No")</li><li style="font-size: 11px">http://loinc.org#LA30122-8 ("I choose not to answer this question")</li></ul><a name="opt-item./93043-8/32624-9"> </a><p><b>Answer options for /93043-8/32624-9 </b></p><ul><li style="font-size: 11px">http://loinc.org#LA6156-9 ("Asian")</li><li style="font-size: 11px">http://loinc.org#LA14045-1 ("Native Hawaiian")</li><li style="font-size: 11px">http://loinc.org#LA30187-1 ("Pacific Islander")</li><li style="font-size: 11px">http://loinc.org#LA14042-8 ("Black/African American")</li><li style="font-size: 11px">http://loinc.org#LA4457-3 ("White")</li><li style="font-size: 11px">http://loinc.org#LA4-4 ("American Indian/Alaskan Native")</li><li style="font-size: 11px">http://loinc.org#LA46-8 ("Other")</li><li style="font-size: 11px">http://loinc.org#LA30122-8 ("I choose not to answer this question")</li></ul><a name="opt-item./93043-8/93035-4"> </a><p><b>Answer options for /93043-8/93035-4 </b></p><ul><li style="font-size: 11px">http://loinc.org#LA33-6 ("Yes")</li><li style="font-size: 11px">http://loinc.org#LA32-8 ("No")</li><li style="font-size: 11px">http://loinc.org#LA30122-8 ("I choose not to answer this question")</li></ul><a name="opt-item./93043-8/93034-7"> </a><p><b>Answer options for /93043-8/93034-7 </b></p><ul><li style="font-size: 11px">http://loinc.org#LA33-6 ("Yes")</li><li style="font-size: 11px">http://loinc.org#LA32-8 ("No")</li><li style="font-size: 11px">http://loinc.org#LA30122-8 ("I choose not to answer this question")</li></ul><a name="opt-item./93043-8/54899-0"> </a><p><b>Answer options for /93043-8/54899-0 </b></p><ul><li style="font-size: 11px">http://loinc.org#LA43-5 ("English")</li><li style="font-size: 11px">http://loinc.org#LA30188-9 ("Language other than English")</li><li style="font-size: 11px">http://loinc.org#LA30122-8 ("I choose not to answer this question")</li></ul><a name="opt-item./93042-0/71802-3"> </a><p><b>Answer options for /93042-0/71802-3 </b></p><ul><li style="font-size: 11px">http://loinc.org#LA30189-7 ("I have housing")</li><li style="font-size: 11px">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)")</li><li style="font-size: 11px">http://loinc.org#LA30122-8 ("I choose not to answer this question")</li></ul><a name="opt-item./93042-0/93033-9"> </a><p><b>Answer options for /93042-0/93033-9 </b></p><ul><li style="font-size: 11px">http://loinc.org#LA33-6 ("Yes")</li><li style="font-size: 11px">http://loinc.org#LA32-8 ("No")</li><li style="font-size: 11px">http://loinc.org#LA30122-8 ("I choose not to answer this question")</li></ul><a name="opt-item./93041-2/82589-3"> </a><p><b>Answer options for /93041-2/82589-3 </b></p><ul><li style="font-size: 11px">http://loinc.org#LA30191-3 ("Less than high school degree")</li><li style="font-size: 11px">http://loinc.org#LA30192-1 ("High school diploma or GED")</li><li style="font-size: 11px">http://loinc.org#LA30193-9 ("More than high school")</li><li style="font-size: 11px">http://loinc.org#LA30122-8 ("I choose not to answer this question")</li></ul><a name="opt-item./93041-2/67875-5"> </a><p><b>Answer options for /93041-2/67875-5 </b></p><ul><li style="font-size: 11px">http://loinc.org#LA17956-6 ("Unemployed")</li><li style="font-size: 11px">http://loinc.org#LA30138-4 ("Part-time or temporary work")</li><li style="font-size: 11px">http://loinc.org#LA30136-8 ("Full-time work")</li><li style="font-size: 11px">http://loinc.org#LA30137-6 ("Otherwise unemployed but not seeking work (ex: student, retired, disabled, unpaid primary care giver)")</li><li style="font-size: 11px">http://loinc.org#LA30122-8 ("I choose not to answer this question")</li></ul><a name="opt-item./93041-2/76437-3"> </a><p><b>Answer options for /93041-2/76437-3 </b></p><ul><li style="font-size: 11px">http://loinc.org#LA30194-7 ("None/uninsured")</li><li style="font-size: 11px">http://loinc.org#LA17849-3 ("Medicaid")</li><li style="font-size: 11px">http://loinc.org#LA30195-4 ("CHIP Medicaid")</li><li style="font-size: 11px">http://loinc.org#LA15652-3 ("Medicare")</li><li style="font-size: 11px">http://loinc.org#LA30196-2 ("Other public insurance (not CHIP)")</li><li style="font-size: 11px">http://loinc.org#LA30197-0 ("Other public insurance (CHIP)")</li><li style="font-size: 11px">http://loinc.org#LA6350-8 ("Private insurance")</li></ul><a name="opt-item./93041-2/93031-3"> </a><p><b>Answer options for /93041-2/93031-3 </b></p><ul><li style="font-size: 11px">http://loinc.org#LA30125-1 ("Food")</li><li style="font-size: 11px">http://loinc.org#LA30126-9 ("Clothing")</li><li style="font-size: 11px">http://loinc.org#LA30124-4 ("Utilities")</li><li style="font-size: 11px">http://loinc.org#LA30127-7 ("Child care")</li><li style="font-size: 11px">http://loinc.org#LA30128-5 ("Medicine or Any Health Care (Medical, Dental, Mental Health, Vision)")</li><li style="font-size: 11px">http://loinc.org#LA30129-3 ("Phone")</li><li style="font-size: 11px">http://loinc.org#LA46-8 ("Other")</li><li style="font-size: 11px">http://loinc.org#LA30122-8 ("I choose not to answer this question")</li></ul><a name="opt-item./93041-2/93030-5"> </a><p><b>Answer options for /93041-2/93030-5 </b></p><ul><li style="font-size: 11px">http://loinc.org#LA30133-5 ("Yes, it has kept me from medical appointments or from getting my medications")</li><li style="font-size: 11px">http://loinc.org#LA30134-3 ("Yes, it has kept me from non-medical meetings, appointments, work, or from getting things that I need")</li><li style="font-size: 11px">http://loinc.org#LA32-8 ("No")</li><li style="font-size: 11px">http://loinc.org#LA30257-2 ("Patient unable to respond")</li></ul><a name="opt-item./93040-4/93029-7"> </a><p><b>Answer options for /93040-4/93029-7 </b></p><ul><li style="font-size: 11px">http://loinc.org#LA27722-0 ("Less than once a week")</li><li style="font-size: 11px">http://loinc.org#LA30130-1 ("1 or 2 times a week")</li><li style="font-size: 11px">http://loinc.org#LA30131-9 ("3 to 5 times a week")</li><li style="font-size: 11px">http://loinc.org#LA30132-7 ("5 or more times a week")</li><li style="font-size: 11px">http://loinc.org#LA30122-8 ("I choose not to answer this question")</li></ul><a name="opt-item./93040-4/93038-8"> </a><p><b>Answer options for /93040-4/93038-8 </b></p><ul><li style="font-size: 11px">http://loinc.org#LA6568-5 ("Not at all")</li><li style="font-size: 11px">http://loinc.org#LA13863-8 ("A little bit")</li><li style="font-size: 11px">http://loinc.org#LA13909-9 ("Somewhat")</li><li style="font-size: 11px">http://loinc.org#LA13902-4 ("Quite a bit")</li><li style="font-size: 11px">http://loinc.org#LA13914-9 ("Very much")</li><li style="font-size: 11px">http://loinc.org#LA30122-8 ("I choose not to answer this question")</li></ul><a name="opt-item./93039-6/93028-9"> </a><p><b>Answer options for /93039-6/93028-9 </b></p><ul><li style="font-size: 11px">http://loinc.org#LA33-6 ("Yes")</li><li style="font-size: 11px">http://loinc.org#LA32-8 ("No")</li><li style="font-size: 11px">http://loinc.org#LA30122-8 ("I choose not to answer this question")</li></ul><a name="opt-item./93039-6/93027-1"> </a><p><b>Answer options for /93039-6/93027-1 </b></p><ul><li style="font-size: 11px">http://loinc.org#LA33-6 ("Yes")</li><li style="font-size: 11px">http://loinc.org#LA32-8 ("No")</li><li style="font-size: 11px">http://loinc.org#LA30122-8 ("I choose not to answer this question")</li></ul><a name="opt-item./93039-6/93026-3"> </a><p><b>Answer options for /93039-6/93026-3 </b></p><ul><li style="font-size: 11px">http://loinc.org#LA33-6 ("Yes")</li><li style="font-size: 11px">http://loinc.org#LA32-8 ("No")</li><li style="font-size: 11px">http://loinc.org#LA14072-5 ("Unsure")</li><li style="font-size: 11px">http://loinc.org#LA30122-8 ("I choose not to answer this question")</li></ul><a name="opt-item./93039-6/76501-6"> </a><p><b>Answer options for /93039-6/76501-6 </b></p><ul><li style="font-size: 11px">http://loinc.org#LA33-6 ("Yes")</li><li style="font-size: 11px">http://loinc.org#LA32-8 ("No")</li></ul></div>
</text>
<url value="http://hl7.org/fhir/us/core/Questionnaire/prapare-example"/>
<identifier>
<system value="urn:ietf:rfc:3986"/>
<value value="urn:oid:2.16.840.1.113883.4.642.40.2.35.6"/>
</identifier>
<version value="8.0.0"/>
<name value="PRAPAREExample"/>
<title
value="Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]"/>
<status value="active"/>
<experimental value="true"/>
<date value="2023-03-31"/>
<publisher value="HL7 International / Cross-Group Projects"/>
<contact>
<name value="HL7 International / Cross-Group Projects"/>
<telecom>
<system value="url"/>
<value value="http://www.hl7.org/Special/committees/cgp"/>
</telecom>
<telecom>
<system value="email"/>
<value value="cgp@lists.HL7.org"/>
</telecom>
</contact>
<useContext>
<code>
<system
value="http://terminology.hl7.org/CodeSystem/usage-context-type"/>
<code value="focus"/>
</code>
<valueCodeableConcept>
<coding>
<system
value="http://hl7.org/fhir/us/core/CodeSystem/us-core-category"/>
<code value="sdoh"/>
</coding>
</valueCodeableConcept>
</useContext>
<jurisdiction>
<coding>
<system value="urn:iso:std:iso:3166"/>
<code value="US"/>
</coding>
</jurisdiction>
<copyright
value="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."/>
<code>
<system value="http://loinc.org"/>
<code value="93025-5"/>
<display
value="Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]"/>
</code>
<item>
<linkId value="/93025-5"/>
<text
value="Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]"/>
<type value="group"/>
<required value="false"/>
<item>
<linkId value="/93043-8"/>
<code>
<system value="http://loinc.org"/>
<code value="93043-8"/>
<display value="Personal characteristics [PRAPARE]"/>
</code>
<text value="Personal characteristics"/>
<type value="group"/>
<required value="false"/>
<item>
<linkId value="/93043-8/56051-6"/>
<code>
<system value="http://loinc.org"/>
<code value="56051-6"/>
<display value="Hispanic or Latino"/>
</code>
<text value="Hispanic or Latino"/>
<type value="choice"/>
<required value="false"/>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA33-6"/>
<display value="Yes"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA32-8"/>
<display value="No"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30122-8"/>
<display value="I choose not to answer this question"/>
</valueCoding>
</answerOption>
</item>
<item>
<linkId value="/93043-8/32624-9"/>
<code>
<system value="http://loinc.org"/>
<code value="32624-9"/>
<display value="Race"/>
</code>
<text value="Race"/>
<type value="choice"/>
<required value="false"/>
<repeats value="true"/>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA6156-9"/>
<display value="Asian"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA14045-1"/>
<display value="Native Hawaiian"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30187-1"/>
<display value="Pacific Islander"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA14042-8"/>
<display value="Black/African American"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA4457-3"/>
<display value="White"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA4-4"/>
<display value="American Indian/Alaskan Native"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA46-8"/>
<display value="Other"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30122-8"/>
<display value="I choose not to answer this question"/>
</valueCoding>
</answerOption>
</item>
<item>
<linkId value="/93043-8/93035-4"/>
<code>
<system value="http://loinc.org"/>
<code value="93035-4"/>
<display
value="Has season or migrant farm work been your or your family's main source of income at any point in past 2 years [PRAPARE]"/>
</code>
<text
value="Has season or migrant farm work been your or your family's main source of income at any point in past 2 years [PRAPARE]"/>
<type value="choice"/>
<required value="false"/>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA33-6"/>
<display value="Yes"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA32-8"/>
<display value="No"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30122-8"/>
<display value="I choose not to answer this question"/>
</valueCoding>
</answerOption>
</item>
<item>
<linkId value="/93043-8/93034-7"/>
<code>
<system value="http://loinc.org"/>
<code value="93034-7"/>
<display value="Discharged from the U.S. Armed Forces"/>
</code>
<text value="Discharged from the U.S. Armed Forces"/>
<type value="choice"/>
<required value="false"/>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA33-6"/>
<display value="Yes"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA32-8"/>
<display value="No"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30122-8"/>
<display value="I choose not to answer this question"/>
</valueCoding>
</answerOption>
</item>
<item>
<linkId value="/93043-8/54899-0"/>
<code>
<system value="http://loinc.org"/>
<code value="54899-0"/>
<display value="Preferred language"/>
</code>
<text value="Preferred language"/>
<type value="choice"/>
<required value="false"/>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA43-5"/>
<display value="English"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30188-9"/>
<display value="Language other than English"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30122-8"/>
<display value="I choose not to answer this question"/>
</valueCoding>
</answerOption>
</item>
</item>
<item>
<linkId value="/93042-0"/>
<code>
<system value="http://loinc.org"/>
<code value="93042-0"/>
<display value="Family and home [PRAPARE]"/>
</code>
<text value="Family and home"/>
<type value="group"/>
<required value="false"/>
<item>
<linkId value="/93042-0/63512-8"/>
<code>
<system value="http://loinc.org"/>
<code value="63512-8"/>
<display
value="How many people are living or staying at this address [#]"/>
</code>
<text
value="How many people are living or staying at this address [#]"/>
<type value="integer"/>
<required value="false"/>
</item>
<item>
<linkId value="/93042-0/71802-3"/>
<code>
<system value="http://loinc.org"/>
<code value="71802-3"/>
<display value="Housing status"/>
</code>
<text value="Housing status"/>
<type value="choice"/>
<required value="false"/>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30189-7"/>
<display value="I have housing"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30190-5"/>
<display
value="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>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30122-8"/>
<display value="I choose not to answer this question"/>
</valueCoding>
</answerOption>
<item>
<linkId value="/93042-0/71802-3-help"/>
<text value="Describes patients living arrangement"/>
<type value="display"/>
</item>
</item>
<item>
<linkId value="/93042-0/93033-9"/>
<code>
<system value="http://loinc.org"/>
<code value="93033-9"/>
<display
value="Are you worried about losing your housing [PRAPARE]"/>
</code>
<text value="Are you worried about losing your housing [PRAPARE]"/>
<type value="choice"/>
<required value="false"/>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA33-6"/>
<display value="Yes"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA32-8"/>
<display value="No"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30122-8"/>
<display value="I choose not to answer this question"/>
</valueCoding>
</answerOption>
</item>
<item>
<linkId value="/93042-0/56799-0"/>
<code>
<system value="http://loinc.org"/>
<code value="56799-0"/>
<display value="Address"/>
</code>
<text value="Address"/>
<type value="string"/>
<required value="false"/>
</item>
</item>
<item>
<linkId value="/93041-2"/>
<code>
<system value="http://loinc.org"/>
<code value="93041-2"/>
<display value="Money and resources [PRAPARE]"/>
</code>
<text value="Money and resources"/>
<type value="group"/>
<required value="false"/>
<item>
<linkId value="/93041-2/82589-3"/>
<code>
<system value="http://loinc.org"/>
<code value="82589-3"/>
<display value="Highest level of educ"/>
</code>
<text value="Highest level of educ"/>
<type value="choice"/>
<required value="false"/>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30191-3"/>
<display value="Less than high school degree"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30192-1"/>
<display value="High school diploma or GED"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30193-9"/>
<display value="More than high school"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30122-8"/>
<display value="I choose not to answer this question"/>
</valueCoding>
</answerOption>
</item>
<item>
<linkId value="/93041-2/67875-5"/>
<code>
<system value="http://loinc.org"/>
<code value="67875-5"/>
<display value="Employment status current"/>
</code>
<text value="Employment status current"/>
<type value="choice"/>
<required value="false"/>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA17956-6"/>
<display value="Unemployed"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30138-4"/>
<display value="Part-time or temporary work"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30136-8"/>
<display value="Full-time work"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30137-6"/>
<display
value="Otherwise unemployed but not seeking work (ex: student, retired, disabled, unpaid primary care giver)"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30122-8"/>
<display value="I choose not to answer this question"/>
</valueCoding>
</answerOption>
</item>
<item>
<linkId value="/93041-2/76437-3"/>
<code>
<system value="http://loinc.org"/>
<code value="76437-3"/>
<display value="Primary insurance"/>
</code>
<text value="Primary insurance"/>
<type value="choice"/>
<required value="false"/>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30194-7"/>
<display value="None/uninsured"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA17849-3"/>
<display value="Medicaid"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30195-4"/>
<display value="CHIP Medicaid"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA15652-3"/>
<display value="Medicare"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30196-2"/>
<display value="Other public insurance (not CHIP)"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30197-0"/>
<display value="Other public insurance (CHIP)"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA6350-8"/>
<display value="Private insurance"/>
</valueCoding>
</answerOption>
</item>
<item>
<linkId value="/93041-2/63586-2"/>
<code>
<system value="http://loinc.org"/>
<code value="63586-2"/>
<display
value="What was your best estimate of the total income of all family members from all sources, before taxes, in last year [PhenX]"/>
</code>
<text
value="What was your best estimate of the total income of all family members from all sources, before taxes, in last year [PhenX]"/>
<type value="decimal"/>
<required value="false"/>
</item>
<item>
<linkId value="/93041-2/93031-3"/>
<code>
<system value="http://loinc.org"/>
<code value="93031-3"/>
<display
value="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]"/>
</code>
<text
value="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]"/>
<type value="choice"/>
<required value="false"/>
<repeats value="true"/>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30125-1"/>
<display value="Food"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30126-9"/>
<display value="Clothing"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30124-4"/>
<display value="Utilities"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30127-7"/>
<display value="Child care"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30128-5"/>
<display
value="Medicine or Any Health Care (Medical, Dental, Mental Health, Vision)"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30129-3"/>
<display value="Phone"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA46-8"/>
<display value="Other"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30122-8"/>
<display value="I choose not to answer this question"/>
</valueCoding>
</answerOption>
</item>
<item>
<linkId value="/93041-2/93030-5"/>
<code>
<system value="http://loinc.org"/>
<code value="93030-5"/>
<display
value="Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living"/>
</code>
<text
value="Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living"/>
<type value="choice"/>
<required value="false"/>
<repeats value="true"/>
<answerOption>
<extension
url="http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix">
<valueString value="A"/>
</extension>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30133-5"/>
<display
value="Yes, it has kept me from medical appointments or from getting my medications"/>
</valueCoding>
</answerOption>
<answerOption>
<extension
url="http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix">
<valueString value="B"/>
</extension>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30134-3"/>
<display
value="Yes, it has kept me from non-medical meetings, appointments, work, or from getting things that I need"/>
</valueCoding>
</answerOption>
<answerOption>
<extension
url="http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix">
<valueString value="C"/>
</extension>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA32-8"/>
<display value="No"/>
</valueCoding>
</answerOption>
<answerOption>
<extension
url="http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix">
<valueString value="X"/>
</extension>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30257-2"/>
<display value="Patient unable to respond"/>
</valueCoding>
</answerOption>
</item>
</item>
<item>
<linkId value="/93040-4"/>
<code>
<system value="http://loinc.org"/>
<code value="93040-4"/>
<display value="Social and emotional health [PRAPARE]"/>
</code>
<text value="Social and emotional health"/>
<type value="group"/>
<required value="false"/>
<item>
<linkId value="/93040-4/93029-7"/>
<code>
<system value="http://loinc.org"/>
<code value="93029-7"/>
<display
value="How often do you see or talk to people that you care about and feel close to [PRAPARE]"/>
</code>
<text
value="How often do you see or talk to people that you care about and feel close to [PRAPARE]"/>
<type value="choice"/>
<required value="false"/>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA27722-0"/>
<display value="Less than once a week"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30130-1"/>
<display value="1 or 2 times a week"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30131-9"/>
<display value="3 to 5 times a week"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30132-7"/>
<display value="5 or more times a week"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30122-8"/>
<display value="I choose not to answer this question"/>
</valueCoding>
</answerOption>
</item>
<item>
<linkId value="/93040-4/93038-8"/>
<code>
<system value="http://loinc.org"/>
<code value="93038-8"/>
<display value="Stress level"/>
</code>
<text
value="Stress is when someone feels tense, nervous, anxious or can't sleep at night because their mind is troubled. How stressed are you?"/>
<type value="choice"/>
<required value="false"/>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA6568-5"/>
<display value="Not at all"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA13863-8"/>
<display value="A little bit"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA13909-9"/>
<display value="Somewhat"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA13902-4"/>
<display value="Quite a bit"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA13914-9"/>
<display value="Very much"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30122-8"/>
<display value="I choose not to answer this question"/>
</valueCoding>
</answerOption>
</item>
</item>
<item>
<linkId value="/93039-6"/>
<code>
<system value="http://loinc.org"/>
<code value="93039-6"/>
<display value="Optional additional questions [PRAPARE]"/>
</code>
<text value="Optional additional questions"/>
<type value="group"/>
<required value="false"/>
<item>
<linkId value="/93039-6/93028-9"/>
<code>
<system value="http://loinc.org"/>
<code value="93028-9"/>
<display
value="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]"/>
</code>
<text
value="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]"/>
<type value="choice"/>
<required value="false"/>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA33-6"/>
<display value="Yes"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA32-8"/>
<display value="No"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30122-8"/>
<display value="I choose not to answer this question"/>
</valueCoding>
</answerOption>
</item>
<item>
<linkId value="/93039-6/93027-1"/>
<code>
<system value="http://loinc.org"/>
<code value="93027-1"/>
<display value="Are you a refugee"/>
</code>
<text value="Are you a refugee"/>
<type value="choice"/>
<required value="false"/>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA33-6"/>
<display value="Yes"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA32-8"/>
<display value="No"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30122-8"/>
<display value="I choose not to answer this question"/>
</valueCoding>
</answerOption>
</item>
<item>
<linkId value="/93039-6/93026-3"/>
<code>
<system value="http://loinc.org"/>
<code value="93026-3"/>
<display
value="Do you feel physically and emotionally safe where you currently live [PRAPARE]"/>
</code>
<text
value="Do you feel physically and emotionally safe where you currently live [PRAPARE]"/>
<type value="choice"/>
<required value="false"/>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA33-6"/>
<display value="Yes"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA32-8"/>
<display value="No"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA14072-5"/>
<display value="Unsure"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30122-8"/>
<display value="I choose not to answer this question"/>
</valueCoding>
</answerOption>
</item>
<item>
<linkId value="/93039-6/76501-6"/>
<code>
<system value="http://loinc.org"/>
<code value="76501-6"/>
<display
value="Within the last year, have you been afraid of your partner or ex-partner"/>
</code>
<text
value="Within the last year, have you been afraid of your partner or ex-partner"/>
<type value="choice"/>
<required value="false"/>
<answerOption>
<extension
url="http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix">
<valueString value="1"/>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="1"/>
</extension>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA33-6"/>
<display value="Yes"/>
</valueCoding>
</answerOption>
<answerOption>
<extension
url="http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix">
<valueString value="0"/>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="0"/>
</extension>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA32-8"/>
<display value="No"/>
</valueCoding>
</answerOption>
</item>
</item>
</item>
</Questionnaire>
IG © 2025+ HL7 International / Cross-Group Projects. Package hl7.fhir.us.core#8.0.0 based on FHIR 4.0.1. Generated 2025-06-10
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