This page is part of the SDOH Clinical Care for Multiple Domains (v2.2.0: STU 2.2) 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 standards status: Informative |
Generated Narrative: QuestionnaireResponse SDOHCC-QuestionnaireResponsePRAPAREExample
LinkID | Text | Definition | Answer |
---|---|---|---|
SDOHCC-QuestionnaireResponsePRAPAREExample | Questionnaire:SDOHCC Questionnaire PRAPARE | ||
/93025-5 | Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE] | ||
/93043-8 | Personal characteristics | ||
/93043-8/56051-6 | Hispanic or Latino | Logical Observation Identifiers, Names and Codes (LOINC) LA32-8: No | |
/93043-8/32624-9 | Race | ||
/93043-8/93035-4 | Has season or migrant farm work been your or your family's main source of income at any point in past 2 years? | Logical Observation Identifiers, Names and Codes (LOINC) LA33-6: Yes | |
/93043-8/93034-7 | Have you been discharged from the armed forces of the United States? | Logical Observation Identifiers, Names and Codes (LOINC) LA32-8: No | |
/93043-8/54899-0 | Preferred language | Logical Observation Identifiers, Names and Codes (LOINC) LA43-5: English | |
/93042-0 | Family and home | ||
/93042-0/63512-8 | How many people are living or staying at this address? | 6 | |
/93042-0/71802-3 | Housing status | Logical Observation Identifiers, Names and Codes (LOINC) 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) | |
/93042-0/93033-9 | Are you worried about losing your housing? | Logical Observation Identifiers, Names and Codes (LOINC) LA30122-8: I choose not to answer this question | |
/93042-0/56799-0 | Address | Broadway | |
/93041-2 | Money and resources | ||
/93041-2/82589-3 | Highest level of educ | Logical Observation Identifiers, Names and Codes (LOINC) LA30191-3: Less than high school degree | |
/93041-2/67875-5 | Employment status current | Logical Observation Identifiers, Names and Codes (LOINC) LA17956-6: Unemployed | |
/93041-2/76437-3 | Primary insurance | Logical Observation Identifiers, Names and Codes (LOINC) LA17849-3: Medicaid | |
/93041-2/63586-2 | What was your best estimate of the total income of all family members from all sources, before taxes, in last year? | 25000 | |
/93041-2/93031-3 | In the past year, have you or any family members you live with been unable to get any of the following when it was really needed? | ||
/93041-2/93030-5 | Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living? | ||
/93040-4 | Social and emotional health | ||
/93040-4/93029-7 | How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)? | Logical Observation Identifiers, Names and Codes (LOINC) LA30130-1: 1 or 2 times a week | |
/93040-4/93038-8 | Stress is when someone feels tense, nervous, anxious or can't sleep at night because their mind is troubled. How stressed are you? | Logical Observation Identifiers, Names and Codes (LOINC) LA13909-9: Somewhat | |
/93039-6 | Optional additional questions | ||
/93039-6/93028-9 | In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility? | Logical Observation Identifiers, Names and Codes (LOINC) LA32-8: No | |
/93039-6/93027-1 | Are you a refugee? | Logical Observation Identifiers, Names and Codes (LOINC) LA32-8: No | |
/93039-6/93026-3 | Do you feel physically and emotionally safe where you currently live? | Logical Observation Identifiers, Names and Codes (LOINC) LA32-8: No | |
/93039-6/76501-6 | Within the last year, have you been afraid of your partner or ex-partner? | Logical Observation Identifiers, Names and Codes (LOINC) LA32-8: No | |
Documentation for this format |