MCC eCare Plan Implementation Guide
1.0.0-ballot - Comment only US

This page is part of the MCC eCare Plan Implementation Guide (v1.0.0-ballot: STU 1 Ballot 1) based on FHIR R4. . For a full list of available versions, see the Directory of published versions

: MCC QuestionnaireResponse Example - XML Representation

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<QuestionnaireResponse xmlns="http://hl7.org/fhir">
  <id value="hunger-vital-sign-example"/>
  <meta>
    <extension url="http://hl7.org/fhir/StructureDefinition/instance-name">
      <valueString value="Hunger Vital Sign [HVS] Example"/>
    </extension>
    <extension
               url="http://hl7.org/fhir/StructureDefinition/instance-description">
      <valueMarkdown
                     value="'An example of an SDC QuestionnaireResponse that represents questions and selected answers from the Hunger Vital Sign Example questionnaire represented in LOINC (code 88122-7). The example is generated using the LHC-Forms SDC Questionnaire App.'"/>
    </extension>
    <versionId value="10"/>
    <lastUpdated value="2022-11-28T16:54:42.582+00:00"/>
    <source value="#Sz7vloFQzLmNxe1e"/>
    <profile
             value="http://hl7.org/fhir/us/mcc/StructureDefinition/MCCQuestionnaireResponse"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><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 : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="The linkId for the item">LinkId</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Text for the item">Text</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Minimum and Maximum # of times the the itemcan appear in the instance">Definition</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="The type of the item">Answer</a><span style="float: right"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="http://hl7.org/fhir/R4/help16.png" 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 : 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="QuestionnaireResponseRoot" class="hierarchy"/> hunger-vital-sign-example</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">QuestionnaireResponse</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Item" class="hierarchy"/> /88122-7</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Within the past 12Mo we worried whether our food would run out before we got money to buy more</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span><span><a href="https://loinc.org/LA28397-0">Logical Observation Identifiers, Names and Codes (LOINC)</a> LA28397-0: Often true</span></span></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-string.png" alt="." style="background-color: white; background-color: inherit" title="Item" class="hierarchy"/> /88123-5</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Within the past 12Mo the food we bought just didn't last and we didn't have money to get more [U.S. FSS]</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span><span><a href="https://loinc.org/LA28397-0">Logical Observation Identifiers, Names and Codes (LOINC)</a> LA28397-0: Often true</span></span></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck00.png)" 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-string.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Item" class="hierarchy"/> /88124-3</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Food insecurity risk</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><span><span><a href="https://loinc.org/LA19952-3">Logical Observation Identifiers, Names and Codes (LOINC)</a> LA19952-3: At risk</span></span></td></tr>
<tr><td colspan="4" class="hierarchy"><br/><a href="http://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="http://hl7.org/fhir/R4/help16.png" alt="doco" style="background-color: inherit"/> Documentation for this format</a></td></tr></table></div>
  </text>
  <extension
             url="http://hl7.org/fhir/StructureDefinition/resource-pertainsToGoal">
    <valueReference>
      <reference value="Goal/HPT-WNL"/>
    </valueReference>
  </extension>
  <questionnaire
                 value="http://hl7.org/fhir/uv/sdc/Questionnaire/questionnaire-sdc-profile-example-hunger-vital-signs">
    <extension
               url="http://hl7.org/fhir/us/core/StructureDefinition/us-core-extension-questionnaire-uri">
      <valueUri value="https://example.org/forms/hsv"/>
    </extension>
  </questionnaire>
  <status value="completed"/>
  <subject>
    <reference value="Patient/cc-pat-pnoelle"/>
  </subject>
  <authored value="2020-09-10T21:56:54.671Z"/>
  <author>
    <reference value="RelatedPerson/caregiver-of-noelle"/>
  </author>
  <item>
    <linkId value="/88122-7"/>
    <text
          value="Within the past 12Mo we worried whether our food would run out before we got money to buy more"/>
    <answer>
      <valueCoding>
        <system value="http://loinc.org"/>
        <code value="LA28397-0"/>
        <display value="Often true"/>
      </valueCoding>
    </answer>
  </item>
  <item>
    <linkId value="/88123-5"/>
    <text
          value="Within the past 12Mo the food we bought just didn't last and we didn't have money to get more [U.S. FSS]"/>
    <answer>
      <valueCoding>
        <system value="http://loinc.org"/>
        <code value="LA28397-0"/>
        <display value="Often true"/>
      </valueCoding>
    </answer>
  </item>
  <item>
    <linkId value="/88124-3"/>
    <text value="Food insecurity risk"/>
    <answer>
      <valueCoding>
        <system value="http://loinc.org"/>
        <code value="LA19952-3"/>
        <display value="At risk"/>
      </valueCoding>
    </answer>
  </item>
</QuestionnaireResponse>