This page is part of the SDOH Clinical Care for Multiple Domains (v2.1.0: STU 2.1) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 2.2.0. For a full list of available versions, see the Directory of published versions

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Example QuestionnaireResponse: SDOHCC QuestionnaireResponse PRAPARE Example

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	Do you consider yourself Hispanic/Latino?		Logical Observation Identifiers, Names and Codes (LOINC) LA32-8: No
/93043-8/32624-9	Race
/93043-8/93035-4	At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?		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
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