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
<Questionnaire xmlns="http://hl7.org/fhir">
<id value="SDOHCC-Questionnaire-HungerVitalSign-1"/>
<meta>
<versionId value="14"/>
<lastUpdated value="2020-12-02T16:48:56.335+00:00"/>
<source value="#vSXMyVKOnmiiPM8K"/>
</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">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>
<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>
<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>
<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>
<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>
<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>
</text>
<extension url="http://hl7.org/fhir/StructureDefinition/variable">
<valueExpression>
<name value="worriedAnsCode"/>
<language value="text/fhirpath"/>
<expression
value="%resource.item.where(linkId='/88122-7').answer.value.code"/>
</valueExpression>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/variable">
<valueExpression>
<name value="ranOutAnsCode"/>
<language value="text/fhirpath"/>
<expression
value="%resource.item.where(linkId='/88123-5').answer.value.code"/>
</valueExpression>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/variable">
<valueExpression>
<name value="riskCodes"/>
<language value="text/fhirpath"/>
<expression value="'LA28397-0'.combine('LA6729-3')"/>
</valueExpression>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/variable">
<valueExpression>
<name value="riskStatus"/>
<language value="text/fhirpath"/>
<expression
value="%riskCodes contains %worriedAnsCode or %riskCodes contains %ranOutAnsCode"/>
</valueExpression>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/variable">
<valueExpression>
<name value="answeredEitherQ"/>
<language value="text/fhirpath"/>
<expression value="%worriedAnsCode.exists() or %ranOutAnsCode.exists()"/>
</valueExpression>
</extension>
<extension
url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-targetStructureMap">
<valueCanonical
value="http://hl7.org/fhir/us/sdoh-clinicalcare/StructureMap/SDOHCC-StructureMap-HungerVitalSignMapper-1"/>
</extension>
<url
value="http://hl7.org/fhir/us/sdoh-clinicalcare/Questionnaire/SDOHCC-Questionnaire-HungerVitalSign-1"/>
<version value="0.1.0"/>
<name value="SDOHCC_Questionnaire_HungerVitalSign_1"/>
<title value="SDOHCC Questionnaire HungerVitalSign 1"/>
<status value="draft"/>
<subjectType value="Patient"/>
<date value="2020-12-16T20:13:36+00:00"/>
<publisher value="HL7 International - Patient Care WG"/>
<contact>
<name value="HL7 International - Patient Care"/>
<telecom>
<system value="url"/>
<value value="http://www.hl7.org/Special/committees/patientcare"/>
</telecom>
</contact>
<jurisdiction>
<coding>
<system value="urn:iso:std:iso:3166"/>
<code value="US"/>
</coding>
</jurisdiction>
<item>
<extension
url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
<valueCodeableConcept>
<coding>
<system value="http://hl7.org/fhir/questionnaire-item-control"/>
<code value="drop-down"/>
<display value="Drop down"/>
</coding>
<text value="Drop down"/>
</valueCodeableConcept>
</extension>
<linkId value="/88122-7"/>
<code>
<system value="http://loinc.org"/>
<code value="88122-7"/>
<display
value="Within the past 12 months we worried whether our food would run out before we got money to buy more [U.S. FSS]"/>
</code>
<text
value="Within the past 12 months we worried whether our food would run out before we got money to buy more [U.S. FSS]"/>
<type value="choice"/>
<required value="false"/>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA28397-0"/>
<display value="Often true"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA6729-3"/>
<display value="Sometimes true"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA28398-8"/>
<display value="Never true"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA15775-2"/>
<display value="Don't know/refused"/>
</valueCoding>
</answerOption>
</item>
<item>
<extension
url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
<valueCodeableConcept>
<coding>
<system value="http://hl7.org/fhir/questionnaire-item-control"/>
<code value="drop-down"/>
<display value="Drop down"/>
</coding>
<text value="Drop down"/>
</valueCodeableConcept>
</extension>
<linkId value="/88123-5"/>
<code>
<system value="http://loinc.org"/>
<code value="88123-5"/>
<display
value="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]"/>
</code>
<text
value="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 value="choice"/>
<required value="false"/>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA28397-0"/>
<display value="Often true"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA6729-3"/>
<display value="Sometimes true"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA28398-8"/>
<display value="Never true"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA15775-2"/>
<display value="Don't know/refused"/>
</valueCoding>
</answerOption>
</item>
<item>
<extension
url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
<valueCodeableConcept>
<coding>
<system value="http://hl7.org/fhir/questionnaire-item-control"/>
<code value="drop-down"/>
<display value="Drop down"/>
</coding>
<text value="Drop down"/>
</valueCodeableConcept>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/variable">
<valueExpression>
<name value="thisItem"/>
<language value="text/fhirpath"/>
<expression
value="%questionnaire.item.where(linkId = '/88124-3')"/>
</valueExpression>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/variable">
<valueExpression>
<name value="atRiskCoding"/>
<language value="text/fhirpath"/>
<expression
value="%thisItem.answerOption.valueCoding.where(code='LA19952-3')"/>
</valueExpression>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/variable">
<valueExpression>
<name value="noRiskCoding"/>
<language value="text/fhirpath"/>
<expression
value="%thisItem.answerOption.valueCoding.where(code='LA19983-8')"/>
</valueExpression>
</extension>
<extension
url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-calculatedExpression">
<valueExpression>
<description value="risk determination"/>
<language value="text/fhirpath"/>
<expression
value="iif(%answeredEitherQ, iif(%riskStatus, %atRiskCoding, %noRiskCoding), {})"/>
</valueExpression>
</extension>
<linkId value="/88124-3"/>
<code>
<system value="http://loinc.org"/>
<code value="88124-3"/>
<display value="Food insecurity risk [HVS]"/>
</code>
<text value="Food insecurity risk [HVS]"/>
<type value="choice"/>
<required value="false"/>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA19952-3"/>
<display value="At risk"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA19983-8"/>
<display value="No risk"/>
</valueCoding>
</answerOption>
<item>
<extension
url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
<valueCodeableConcept>
<coding>
<system value="http://hl7.org/fhir/questionnaire-item-control"/>
<code value="help"/>
<display value="Help-Button"/>
</coding>
<text value="Help-Button"/>
</valueCodeableConcept>
</extension>
<linkId value="/88124-3-help"/>
<text
value="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 value="display"/>
</item>
</item>
</Questionnaire>