This page is part of the SDOH Clinical Care for Multiple Domains (v0.1.0: STU 1 Ballot 1) based on FHIR R4. The current version which supercedes this version is 2.0.0. For a full list of available versions, see the Directory of published versions
{
"resourceType" : "Questionnaire",
"id" : "SDOHCC-Questionnaire-HungerVitalSign-1",
"meta" : {
"versionId" : "14",
"lastUpdated" : "2020-12-02T16:48:56.335+00:00",
"source" : "#vSXMyVKOnmiiPM8K"
},
"text" : {
"status" : "generated",
"div" : "<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\">Cardinality</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\">Type</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=\"Additional information about the item\">Description & Constraints</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=\"QuestionnaireRoot\" class=\"hierarchy\"/> SDOHCC_Questionnaire_HungerVitalSign_1</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\"></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Questionnaire</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<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-choice.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Choice\" 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 12 months we worried whether our food would run out before we got money to buy more [U.S. FSS]</td><td style=\"vertical-align: top; text-align : 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 : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/codesystem-item-type.html#choice\">choice</a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"null#item./88122-7\">4 options</a></td></tr>\r\n<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-choice.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Choice\" 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 12 months 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\">0..1</td><td 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/codesystem-item-type.html#choice\">choice</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"null#item./88123-5\">4 options</a></td></tr>\r\n<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_bck01.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-choice.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Choice\" 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 [HVS]</td><td style=\"vertical-align: top; text-align : 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 : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/codesystem-item-type.html#choice\">choice</a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"null#item./88124-3\">2 options</a><br/>Expressions: <ul><li style=\"font-size: 11px\"><a href=\"http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-calculatedExpression\">Calculated Value</a>: <code>iif(%answeredEitherQ, iif(%riskStatus, %atRiskCoding, %noRiskCoding), {})</code></li></ul></td></tr>\r\n<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_bck000.png)\" 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-display.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Display\" class=\"hierarchy\"/> /88124-3-help</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">An answer of "often true" or "sometimes true" to either or both of the Hunger Vital Sign™ questions identifies a patient as at risk for food insecurity (FI).</td><td style=\"vertical-align: top; text-align : 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 : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"http://hl7.org/fhir/R4/codesystem-item-type.html#display\">display</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr><td colspan=\"5\" 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>"
},
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/variable",
"valueExpression" : {
"name" : "worriedAnsCode",
"language" : "text/fhirpath",
"expression" : "%resource.item.where(linkId='/88122-7').answer.value.code"
}
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/variable",
"valueExpression" : {
"name" : "ranOutAnsCode",
"language" : "text/fhirpath",
"expression" : "%resource.item.where(linkId='/88123-5').answer.value.code"
}
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/variable",
"valueExpression" : {
"name" : "riskCodes",
"language" : "text/fhirpath",
"expression" : "'LA28397-0'.combine('LA6729-3')"
}
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/variable",
"valueExpression" : {
"name" : "riskStatus",
"language" : "text/fhirpath",
"expression" : "%riskCodes contains %worriedAnsCode or %riskCodes contains %ranOutAnsCode"
}
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/variable",
"valueExpression" : {
"name" : "answeredEitherQ",
"language" : "text/fhirpath",
"expression" : "%worriedAnsCode.exists() or %ranOutAnsCode.exists()"
}
},
{
"url" : "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-targetStructureMap",
"valueCanonical" : "http://hl7.org/fhir/us/sdoh-clinicalcare/StructureMap/SDOHCC-StructureMap-HungerVitalSignMapper-1"
}
],
"url" : "http://hl7.org/fhir/us/sdoh-clinicalcare/Questionnaire/SDOHCC-Questionnaire-HungerVitalSign-1",
"version" : "0.1.0",
"name" : "SDOHCC_Questionnaire_HungerVitalSign_1",
"title" : "SDOHCC Questionnaire HungerVitalSign 1",
"status" : "draft",
"subjectType" : [
"Patient"
],
"date" : "2020-12-16T20:13:36+00:00",
"publisher" : "HL7 International - Patient Care WG",
"contact" : [
{
"name" : "HL7 International - Patient Care",
"telecom" : [
{
"system" : "url",
"value" : "http://www.hl7.org/Special/committees/patientcare"
}
]
}
],
"jurisdiction" : [
{
"coding" : [
{
"system" : "urn:iso:std:iso:3166",
"code" : "US"
}
]
}
],
"item" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "drop-down",
"display" : "Drop down"
}
],
"text" : "Drop down"
}
}
],
"linkId" : "/88122-7",
"code" : [
{
"system" : "http://loinc.org",
"code" : "88122-7",
"display" : "Within the past 12 months we worried whether our food would run out before we got money to buy more [U.S. FSS]"
}
],
"text" : "Within the past 12 months we worried whether our food would run out before we got money to buy more [U.S. FSS]",
"type" : "choice",
"required" : false,
"answerOption" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA28397-0",
"display" : "Often true"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA6729-3",
"display" : "Sometimes true"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA28398-8",
"display" : "Never true"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA15775-2",
"display" : "Don't know/refused"
}
}
]
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "drop-down",
"display" : "Drop down"
}
],
"text" : "Drop down"
}
}
],
"linkId" : "/88123-5",
"code" : [
{
"system" : "http://loinc.org",
"code" : "88123-5",
"display" : "Within the past 12 months the food we bought just didn't last and we didn't have money to get more [U.S. FSS]"
}
],
"text" : "Within the past 12 months the food we bought just didn't last and we didn't have money to get more [U.S. FSS]",
"type" : "choice",
"required" : false,
"answerOption" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA28397-0",
"display" : "Often true"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA6729-3",
"display" : "Sometimes true"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA28398-8",
"display" : "Never true"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA15775-2",
"display" : "Don't know/refused"
}
}
]
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "drop-down",
"display" : "Drop down"
}
],
"text" : "Drop down"
}
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/variable",
"valueExpression" : {
"name" : "thisItem",
"language" : "text/fhirpath",
"expression" : "%questionnaire.item.where(linkId = '/88124-3')"
}
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/variable",
"valueExpression" : {
"name" : "atRiskCoding",
"language" : "text/fhirpath",
"expression" : "%thisItem.answerOption.valueCoding.where(code='LA19952-3')"
}
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/variable",
"valueExpression" : {
"name" : "noRiskCoding",
"language" : "text/fhirpath",
"expression" : "%thisItem.answerOption.valueCoding.where(code='LA19983-8')"
}
},
{
"url" : "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-calculatedExpression",
"valueExpression" : {
"description" : "risk determination",
"language" : "text/fhirpath",
"expression" : "iif(%answeredEitherQ, iif(%riskStatus, %atRiskCoding, %noRiskCoding), {})"
}
}
],
"linkId" : "/88124-3",
"code" : [
{
"system" : "http://loinc.org",
"code" : "88124-3",
"display" : "Food insecurity risk [HVS]"
}
],
"text" : "Food insecurity risk [HVS]",
"type" : "choice",
"required" : false,
"answerOption" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA19952-3",
"display" : "At risk"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA19983-8",
"display" : "No risk"
}
}
],
"item" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "help",
"display" : "Help-Button"
}
],
"text" : "Help-Button"
}
}
],
"linkId" : "/88124-3-help",
"text" : "An answer of \"often true\" or \"sometimes true\" to either or both of the Hunger Vital Sign™ questions identifies a patient as at risk for food insecurity (FI).",
"type" : "display"
}
]
}
]
}