HL7.FHIR.US.SDOH-CLINICALCARE\SDOHCC Questionnaire PRAPARE - XML Representation

This page is part of the SDOH Clinical Care for Multiple Domains (v2.0.0: STU 2) based on FHIR R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions
: SDOHCC Questionnaire PRAPARE - XML Representation

Draft as of 2021-04-01
Raw xml | Download


<Questionnaire xmlns="http://hl7.org/fhir">
  <id value="SDOHCC-QuestionnairePRAPARE"/>
  <meta>
    <versionId value="5"/>
    <lastUpdated value="2022-09-14T20:05:52.007+00:00"/>
    <source value="#triqDuazdqHqt7bE"/>
    <profile
             value="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-extr-smap"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><b>Structure</b><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 &amp; 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"/> SDOHCCQuestionnairePRAPARE</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"></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">http://hl7.org/fhir/us/sdoh-clinicalcare/Questionnaire/SDOHCC-QuestionnairePRAPARE#2.0.0</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)" id="item./93025-5" 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-group.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Group" class="hierarchy"/> /93025-5</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]</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#item-type-group">group</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; 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: 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_bck011.png)" id="item./93043-8" 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.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: white; background-color: inherit" title="Group" class="hierarchy"/> /93043-8</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Personal characteristics</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#item-type-group">group</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 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_bck0110.png)" id="item./93043-8/56051-6" 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_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Coding" class="hierarchy"/> /93043-8/56051-6</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Do you consider yourself Hispanic/Latino?</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#item-type-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="#opt-item./93043-8/56051-6">3 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_bck0110.png)" id="item./93043-8/32624-9" 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_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="Coding" class="hierarchy"/> /93043-8/32624-9</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Race</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..*</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#item-type-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="#opt-item./93043-8/32624-9">8 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_bck0110.png)" id="item./93043-8/93035-4" 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_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Coding" class="hierarchy"/> /93043-8/93035-4</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?</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#item-type-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="#opt-item./93043-8/93035-4">3 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_bck0110.png)" id="item./93043-8/93034-7" 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_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="Coding" class="hierarchy"/> /93043-8/93034-7</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Have you been discharged from the armed forces of the United States?</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#item-type-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="#opt-item./93043-8/93034-7">3 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_bck0100.png)" id="item./93043-8/54899-0" 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_vline.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-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Coding" class="hierarchy"/> /93043-8/54899-0</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Preferred language</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#item-type-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="#opt-item./93043-8/54899-0">3 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_bck011.png)" id="item./93042-0" 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.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: white; background-color: inherit" title="Group" class="hierarchy"/> /93042-0</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Family and home</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#item-type-group">group</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 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_bck0110.png)" id="item./93042-0/63512-8" 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_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-integer.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Integer" class="hierarchy"/> /93042-0/63512-8</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">How many people are living or staying at this address?</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#item-type-integer">integer</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; 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: 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_bck0111.png)" id="item./93042-0/71802-3" 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_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="Coding" class="hierarchy"/> /93042-0/71802-3</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Housing status</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#item-type-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="#opt-item./93042-0/71802-3">3 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_bck01100.png)" id="item./93042-0/71802-3-help" 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_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.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: #F7F7F7; background-color: inherit" title="Display" class="hierarchy"/> /93042-0/71802-3-help</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Describes patients living arrangement</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#item-type-display">display</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; 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: 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_bck0110.png)" id="item./93042-0/93033-9" 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_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="Coding" class="hierarchy"/> /93042-0/93033-9</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Are you worried about losing your housing?</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#item-type-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="#opt-item./93042-0/93033-9">3 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_bck0100.png)" id="item./93042-0/56799-0" 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_vline.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="String" class="hierarchy"/> /93042-0/56799-0</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Address</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#item-type-string">string</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; 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: 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_bck011.png)" id="item./93041-2" 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.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: white; background-color: inherit" title="Group" class="hierarchy"/> /93041-2</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Money and resources</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#item-type-group">group</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 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_bck0110.png)" id="item./93041-2/82589-3" 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_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Coding" class="hierarchy"/> /93041-2/82589-3</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Highest level of educ</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#item-type-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="#opt-item./93041-2/82589-3">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_bck0110.png)" id="item./93041-2/67875-5" 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_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="Coding" class="hierarchy"/> /93041-2/67875-5</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Employment status current</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#item-type-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="#opt-item./93041-2/67875-5">5 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_bck0110.png)" id="item./93041-2/76437-3" 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_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Coding" class="hierarchy"/> /93041-2/76437-3</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Primary insurance</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#item-type-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="#opt-item./93041-2/76437-3">7 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_bck0110.png)" id="item./93041-2/63586-2" 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_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-decimal.png" alt="." style="background-color: white; background-color: inherit" title="Decimal" class="hierarchy"/> /93041-2/63586-2</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">What was your best estimate of the total income of all family members from all sources, before taxes, in last year?</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#item-type-decimal">decimal</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 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_bck0110.png)" id="item./93041-2/93031-3" 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_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Coding" class="hierarchy"/> /93041-2/93031-3</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">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?</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..*</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#item-type-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="#opt-item./93041-2/93031-3">8 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_bck0100.png)" id="item./93041-2/93030-5" 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_vline.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-coding.png" alt="." style="background-color: white; background-color: inherit" title="Coding" class="hierarchy"/> /93041-2/93030-5</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living?</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..*</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#item-type-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="#opt-item./93041-2/93030-5">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_bck011.png)" id="item./93040-4" 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.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Group" class="hierarchy"/> /93040-4</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Social and emotional health</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#item-type-group">group</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; 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: 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_bck0110.png)" id="item./93040-4/93029-7" 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_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="Coding" class="hierarchy"/> /93040-4/93029-7</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">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)?</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#item-type-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="#opt-item./93040-4/93029-7">5 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_bck0100.png)" id="item./93040-4/93038-8" 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_vline.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-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Coding" class="hierarchy"/> /93040-4/93038-8</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Stress is when someone feels tense, nervous, anxious or can't sleep at night because their mind is troubled. How stressed are you?</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#item-type-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="#opt-item./93040-4/93038-8">6 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_bck001.png)" id="item./93039-6" 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-group.png" alt="." style="background-color: white; background-color: inherit" title="Group" class="hierarchy"/> /93039-6</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Optional additional questions</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#item-type-group">group</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 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_bck0010.png)" id="item./93039-6/93028-9" 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_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Coding" class="hierarchy"/> /93039-6/93028-9</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?</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#item-type-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="#opt-item./93039-6/93028-9">3 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_bck0010.png)" id="item./93039-6/93027-1" 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_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="Coding" class="hierarchy"/> /93039-6/93027-1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Are you a refugee?</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#item-type-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="#opt-item./93039-6/93027-1">3 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_bck0010.png)" id="item./93039-6/93026-3" 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_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Coding" class="hierarchy"/> /93039-6/93026-3</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Do you feel physically and emotionally safe where you currently live?</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#item-type-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="#opt-item./93039-6/93026-3">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_bck0000.png)" id="item./93039-6/76501-6" 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_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-coding.png" alt="." style="background-color: white; background-color: inherit" title="Coding" class="hierarchy"/> /93039-6/76501-6</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 last year, have you been afraid of your partner or ex-partner?</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#item-type-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="#opt-item./93039-6/76501-6">2 options</a></td></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><hr/><p><b>Option Sets</b></p><a name="opt-item./93043-8/56051-6"> </a><p><b>Answer options for /93043-8/56051-6</b></p><ul><li style="font-size: 11px">http://loinc.org#LA33-6 (&quot;Yes&quot;)</li><li style="font-size: 11px">http://loinc.org#LA32-8 (&quot;No&quot;)</li><li style="font-size: 11px">http://loinc.org#LA30122-8 (&quot;I choose not to answer this question&quot;)</li></ul><a name="opt-item./93043-8/32624-9"> </a><p><b>Answer options for /93043-8/32624-9</b></p><ul><li style="font-size: 11px">http://loinc.org#LA6156-9 (&quot;Asian&quot;)</li><li style="font-size: 11px">http://loinc.org#LA14045-1 (&quot;Native Hawaiian&quot;)</li><li style="font-size: 11px">http://loinc.org#LA30187-1 (&quot;Pacific Islander&quot;)</li><li style="font-size: 11px">http://loinc.org#LA14042-8 (&quot;Black/African American&quot;)</li><li style="font-size: 11px">http://loinc.org#LA4457-3 (&quot;White&quot;)</li><li style="font-size: 11px">http://loinc.org#LA4-4 (&quot;American Indian/Alaskan Native&quot;)</li><li style="font-size: 11px">http://loinc.org#LA46-8 (&quot;Other&quot;)</li><li style="font-size: 11px">http://loinc.org#LA30122-8 (&quot;I choose not to answer this question&quot;)</li></ul><a name="opt-item./93043-8/93035-4"> </a><p><b>Answer options for /93043-8/93035-4</b></p><ul><li style="font-size: 11px">http://loinc.org#LA33-6 (&quot;Yes&quot;)</li><li style="font-size: 11px">http://loinc.org#LA32-8 (&quot;No&quot;)</li><li style="font-size: 11px">http://loinc.org#LA30122-8 (&quot;I choose not to answer this question&quot;)</li></ul><a name="opt-item./93043-8/93034-7"> </a><p><b>Answer options for /93043-8/93034-7</b></p><ul><li style="font-size: 11px">http://loinc.org#LA33-6 (&quot;Yes&quot;)</li><li style="font-size: 11px">http://loinc.org#LA32-8 (&quot;No&quot;)</li><li style="font-size: 11px">http://loinc.org#LA30122-8 (&quot;I choose not to answer this question&quot;)</li></ul><a name="opt-item./93043-8/54899-0"> </a><p><b>Answer options for /93043-8/54899-0</b></p><ul><li style="font-size: 11px">http://loinc.org#LA43-5 (&quot;English&quot;)</li><li style="font-size: 11px">http://loinc.org#LA30188-9 (&quot;Language other than English&quot;)</li><li style="font-size: 11px">http://loinc.org#LA30122-8 (&quot;I choose not to answer this question&quot;)</li></ul><a name="opt-item./93042-0/71802-3"> </a><p><b>Answer options for /93042-0/71802-3</b></p><ul><li style="font-size: 11px">http://loinc.org#LA30189-7 (&quot;I have housing&quot;)</li><li style="font-size: 11px">http://loinc.org#LA30190-5 (&quot;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)&quot;)</li><li style="font-size: 11px">http://loinc.org#LA30122-8 (&quot;I choose not to answer this question&quot;)</li></ul><a name="opt-item./93042-0/93033-9"> </a><p><b>Answer options for /93042-0/93033-9</b></p><ul><li style="font-size: 11px">http://loinc.org#LA33-6 (&quot;Yes&quot;)</li><li style="font-size: 11px">http://loinc.org#LA32-8 (&quot;No&quot;)</li><li style="font-size: 11px">http://loinc.org#LA30122-8 (&quot;I choose not to answer this question&quot;)</li></ul><a name="opt-item./93041-2/82589-3"> </a><p><b>Answer options for /93041-2/82589-3</b></p><ul><li style="font-size: 11px">http://loinc.org#LA30191-3 (&quot;Less than high school degree&quot;)</li><li style="font-size: 11px">http://loinc.org#LA30192-1 (&quot;High school diploma or GED&quot;)</li><li style="font-size: 11px">http://loinc.org#LA30193-9 (&quot;More than high school&quot;)</li><li style="font-size: 11px">http://loinc.org#LA30122-8 (&quot;I choose not to answer this question&quot;)</li></ul><a name="opt-item./93041-2/67875-5"> </a><p><b>Answer options for /93041-2/67875-5</b></p><ul><li style="font-size: 11px">http://loinc.org#LA17956-6 (&quot;Unemployed&quot;)</li><li style="font-size: 11px">http://loinc.org#LA30138-4 (&quot;Part-time or temporary work&quot;)</li><li style="font-size: 11px">http://loinc.org#LA30136-8 (&quot;Full-time work&quot;)</li><li style="font-size: 11px">http://loinc.org#LA30137-6 (&quot;Otherwise unemployed but not seeking work (ex: student, retired, disabled, unpaid primary care giver)&quot;)</li><li style="font-size: 11px">http://loinc.org#LA30122-8 (&quot;I choose not to answer this question&quot;)</li></ul><a name="opt-item./93041-2/76437-3"> </a><p><b>Answer options for /93041-2/76437-3</b></p><ul><li style="font-size: 11px">http://loinc.org#LA30194-7 (&quot;None/uninsured&quot;)</li><li style="font-size: 11px">http://loinc.org#LA17849-3 (&quot;Medicaid&quot;)</li><li style="font-size: 11px">http://loinc.org#LA30195-4 (&quot;CHIP Medicaid&quot;)</li><li style="font-size: 11px">http://loinc.org#LA15652-3 (&quot;Medicare&quot;)</li><li style="font-size: 11px">http://loinc.org#LA30196-2 (&quot;Other public insurance (not CHIP)&quot;)</li><li style="font-size: 11px">http://loinc.org#LA30197-0 (&quot;Other public insurance (CHIP)&quot;)</li><li style="font-size: 11px">http://loinc.org#LA6350-8 (&quot;Private insurance&quot;)</li></ul><a name="opt-item./93041-2/93031-3"> </a><p><b>Answer options for /93041-2/93031-3</b></p><ul><li style="font-size: 11px">http://loinc.org#LA30125-1 (&quot;Food&quot;)</li><li style="font-size: 11px">http://loinc.org#LA30126-9 (&quot;Clothing&quot;)</li><li style="font-size: 11px">http://loinc.org#LA30124-4 (&quot;Utilities&quot;)</li><li style="font-size: 11px">http://loinc.org#LA30127-7 (&quot;Child care&quot;)</li><li style="font-size: 11px">http://loinc.org#LA30128-5 (&quot;Medicine or Any Health Care (Medical, Dental, Mental Health, Vision)&quot;)</li><li style="font-size: 11px">http://loinc.org#LA30129-3 (&quot;Phone&quot;)</li><li style="font-size: 11px">http://loinc.org#LA46-8 (&quot;Other&quot;)</li><li style="font-size: 11px">http://loinc.org#LA30122-8 (&quot;I choose not to answer this question&quot;)</li></ul><a name="opt-item./93041-2/93030-5"> </a><p><b>Answer options for /93041-2/93030-5</b></p><ul><li style="font-size: 11px">http://loinc.org#LA30133-5 (&quot;Yes, it has kept me from medical appointments or from getting my medications&quot;)</li><li style="font-size: 11px">http://loinc.org#LA30134-3 (&quot;Yes, it has kept me from non-medical meetings, appointments, work, or from getting things that I need&quot;)</li><li style="font-size: 11px">http://loinc.org#LA32-8 (&quot;No&quot;)</li><li style="font-size: 11px">http://loinc.org#LA30257-2 (&quot;Patient unable to respond&quot;)</li></ul><a name="opt-item./93040-4/93029-7"> </a><p><b>Answer options for /93040-4/93029-7</b></p><ul><li style="font-size: 11px">http://loinc.org#LA27722-0 (&quot;Less than once a week&quot;)</li><li style="font-size: 11px">http://loinc.org#LA30130-1 (&quot;1 or 2 times a week&quot;)</li><li style="font-size: 11px">http://loinc.org#LA30131-9 (&quot;3 to 5 times a week&quot;)</li><li style="font-size: 11px">http://loinc.org#LA30132-7 (&quot;5 or more times a week&quot;)</li><li style="font-size: 11px">http://loinc.org#LA30122-8 (&quot;I choose not to answer this question&quot;)</li></ul><a name="opt-item./93040-4/93038-8"> </a><p><b>Answer options for /93040-4/93038-8</b></p><ul><li style="font-size: 11px">http://loinc.org#LA6568-5 (&quot;Not at all&quot;)</li><li style="font-size: 11px">http://loinc.org#LA13863-8 (&quot;A little bit&quot;)</li><li style="font-size: 11px">http://loinc.org#LA13909-9 (&quot;Somewhat&quot;)</li><li style="font-size: 11px">http://loinc.org#LA13902-4 (&quot;Quite a bit&quot;)</li><li style="font-size: 11px">http://loinc.org#LA13914-9 (&quot;Very much&quot;)</li><li style="font-size: 11px">http://loinc.org#LA30122-8 (&quot;I choose not to answer this question&quot;)</li></ul><a name="opt-item./93039-6/93028-9"> </a><p><b>Answer options for /93039-6/93028-9</b></p><ul><li style="font-size: 11px">http://loinc.org#LA33-6 (&quot;Yes&quot;)</li><li style="font-size: 11px">http://loinc.org#LA32-8 (&quot;No&quot;)</li><li style="font-size: 11px">http://loinc.org#LA30122-8 (&quot;I choose not to answer this question&quot;)</li></ul><a name="opt-item./93039-6/93027-1"> </a><p><b>Answer options for /93039-6/93027-1</b></p><ul><li style="font-size: 11px">http://loinc.org#LA33-6 (&quot;Yes&quot;)</li><li style="font-size: 11px">http://loinc.org#LA32-8 (&quot;No&quot;)</li><li style="font-size: 11px">http://loinc.org#LA30122-8 (&quot;I choose not to answer this question&quot;)</li></ul><a name="opt-item./93039-6/93026-3"> </a><p><b>Answer options for /93039-6/93026-3</b></p><ul><li style="font-size: 11px">http://loinc.org#LA33-6 (&quot;Yes&quot;)</li><li style="font-size: 11px">http://loinc.org#LA32-8 (&quot;No&quot;)</li><li style="font-size: 11px">http://loinc.org#LA14072-5 (&quot;Unsure&quot;)</li><li style="font-size: 11px">http://loinc.org#LA30122-8 (&quot;I choose not to answer this question&quot;)</li></ul><a name="opt-item./93039-6/76501-6"> </a><p><b>Answer options for /93039-6/76501-6</b></p><ul><li style="font-size: 11px">http://loinc.org#LA33-6 (&quot;Yes&quot;)</li><li style="font-size: 11px">http://loinc.org#LA32-8 (&quot;No&quot;)</li></ul></div>
  </text>
  <extension
             url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-targetStructureMap">
    <valueCanonical
                    value="http://hl7.org/fhir/us/sdoh-clinicalcare/StructureMap/SDOHCC-StructureMapPRAPARE"/>
  </extension>
  <url
       value="http://hl7.org/fhir/us/sdoh-clinicalcare/Questionnaire/SDOHCC-QuestionnairePRAPARE"/>
  <version value="2.0.0"/>
  <name value="SDOHCCQuestionnairePRAPARE"/>
  <title value="SDOHCC Questionnaire PRAPARE"/>
  <status value="draft"/>
  <subjectType value="Patient"/>
  <date value="2021-04-01T04:01:34+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"/>
      <display value="United States of America"/>
    </coding>
    <text value="United States of America"/>
  </jurisdiction>
  <item>
    <linkId value="/93025-5"/>
    <code>
      <system value="http://loinc.org"/>
      <code value="93025-5"/>
      <display
               value="Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]"/>
    </code>
    <text
          value="Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]"/>
    <type value="group"/>
    <required value="false"/>
    <item>
      <linkId value="/93043-8"/>
      <code>
        <system value="http://loinc.org"/>
        <code value="93043-8"/>
        <display value="Personal characteristics"/>
      </code>
      <text value="Personal characteristics"/>
      <type value="group"/>
      <required value="false"/>
      <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="/93043-8/56051-6"/>
        <code>
          <system value="http://loinc.org"/>
          <code value="56051-6"/>
          <display value="Do you consider yourself Hispanic/Latino?"/>
        </code>
        <text value="Do you consider yourself Hispanic/Latino?"/>
        <type value="choice"/>
        <required value="false"/>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA33-6"/>
            <display value="Yes"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA32-8"/>
            <display value="No"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30122-8"/>
            <display value="I choose not to answer this question"/>
          </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="/93043-8/32624-9"/>
        <code>
          <system value="http://loinc.org"/>
          <code value="32624-9"/>
          <display value="Race"/>
        </code>
        <text value="Race"/>
        <type value="choice"/>
        <required value="false"/>
        <repeats value="true"/>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA6156-9"/>
            <display value="Asian"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA14045-1"/>
            <display value="Native Hawaiian"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30187-1"/>
            <display value="Pacific Islander"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA14042-8"/>
            <display value="Black/African American"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA4457-3"/>
            <display value="White"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA4-4"/>
            <display value="American Indian/Alaskan Native"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA46-8"/>
            <display value="Other"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30122-8"/>
            <display value="I choose not to answer this question"/>
          </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="/93043-8/93035-4"/>
        <code>
          <system value="http://loinc.org"/>
          <code value="93035-4"/>
          <display
                   value="At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?"/>
        </code>
        <text
              value="At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?"/>
        <type value="choice"/>
        <required value="false"/>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA33-6"/>
            <display value="Yes"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA32-8"/>
            <display value="No"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30122-8"/>
            <display value="I choose not to answer this question"/>
          </valueCoding>
        </answerOption>
      </item>
      <item>
        <extension
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          <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="/93043-8/93034-7"/>
        <code>
          <system value="http://loinc.org"/>
          <code value="93034-7"/>
          <display
                   value="Have you been discharged from the armed forces of the United States?"/>
        </code>
        <text
              value="Have you been discharged from the armed forces of the United States?"/>
        <type value="choice"/>
        <required value="false"/>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA33-6"/>
            <display value="Yes"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA32-8"/>
            <display value="No"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30122-8"/>
            <display value="I choose not to answer this question"/>
          </valueCoding>
        </answerOption>
      </item>
      <item>
        <extension
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          <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="/93043-8/54899-0"/>
        <code>
          <system value="http://loinc.org"/>
          <code value="54899-0"/>
          <display value="Preferred language"/>
        </code>
        <text value="Preferred language"/>
        <type value="choice"/>
        <required value="false"/>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA43-5"/>
            <display value="English"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30188-9"/>
            <display value="Language other than English"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30122-8"/>
            <display value="I choose not to answer this question"/>
          </valueCoding>
        </answerOption>
      </item>
    </item>
    <item>
      <linkId value="/93042-0"/>
      <code>
        <system value="http://loinc.org"/>
        <code value="93042-0"/>
        <display value="Family and home"/>
      </code>
      <text value="Family and home"/>
      <type value="group"/>
      <required value="false"/>
      <item>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-unit">
          <valueCoding>
            <system value="http://unitsofmeasure.org"/>
            <code value="{#}"/>
            <display value="{#}"/>
          </valueCoding>
        </extension>
        <linkId value="/93042-0/63512-8"/>
        <code>
          <system value="http://loinc.org"/>
          <code value="63512-8"/>
          <display
                   value="How many people are living or staying at this address?"/>
        </code>
        <text value="How many people are living or staying at this address?"/>
        <type value="integer"/>
        <required value="false"/>
      </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="/93042-0/71802-3"/>
        <code>
          <system value="http://loinc.org"/>
          <code value="71802-3"/>
          <display value="Housing status"/>
        </code>
        <text value="Housing status"/>
        <type value="choice"/>
        <required value="false"/>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30189-7"/>
            <display value="I have housing"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30190-5"/>
            <display
                     value="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)"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30122-8"/>
            <display value="I choose not to answer this question"/>
          </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="/93042-0/71802-3-help"/>
          <text value="Describes patients living arrangement"/>
          <type value="display"/>
        </item>
      </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="/93042-0/93033-9"/>
        <code>
          <system value="http://loinc.org"/>
          <code value="93033-9"/>
          <display value="Are you worried about losing your housing?"/>
        </code>
        <text value="Are you worried about losing your housing?"/>
        <type value="choice"/>
        <required value="false"/>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA33-6"/>
            <display value="Yes"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA32-8"/>
            <display value="No"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30122-8"/>
            <display value="I choose not to answer this question"/>
          </valueCoding>
        </answerOption>
      </item>
      <item>
        <linkId value="/93042-0/56799-0"/>
        <code>
          <system value="http://loinc.org"/>
          <code value="56799-0"/>
          <display value="Address"/>
        </code>
        <text value="Address"/>
        <type value="string"/>
        <required value="false"/>
      </item>
    </item>
    <item>
      <linkId value="/93041-2"/>
      <code>
        <system value="http://loinc.org"/>
        <code value="93041-2"/>
        <display value="Money and resources"/>
      </code>
      <text value="Money and resources"/>
      <type value="group"/>
      <required value="false"/>
      <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="/93041-2/82589-3"/>
        <code>
          <system value="http://loinc.org"/>
          <code value="82589-3"/>
          <display value="Highest level of educ"/>
        </code>
        <text value="Highest level of educ"/>
        <type value="choice"/>
        <required value="false"/>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30191-3"/>
            <display value="Less than high school degree"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30192-1"/>
            <display value="High school diploma or GED"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30193-9"/>
            <display value="More than high school"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30122-8"/>
            <display value="I choose not to answer this question"/>
          </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="/93041-2/67875-5"/>
        <code>
          <system value="http://loinc.org"/>
          <code value="67875-5"/>
          <display value="Employment status current"/>
        </code>
        <text value="Employment status current"/>
        <type value="choice"/>
        <required value="false"/>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA17956-6"/>
            <display value="Unemployed"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30138-4"/>
            <display value="Part-time or temporary work"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30136-8"/>
            <display value="Full-time work"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30137-6"/>
            <display
                     value="Otherwise unemployed but not seeking work (ex: student, retired, disabled, unpaid primary care giver)"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30122-8"/>
            <display value="I choose not to answer this question"/>
          </valueCoding>
        </answerOption>
      </item>
      <item>
        <extension
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          <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="/93041-2/76437-3"/>
        <code>
          <system value="http://loinc.org"/>
          <code value="76437-3"/>
          <display value="Primary insurance"/>
        </code>
        <text value="Primary insurance"/>
        <type value="choice"/>
        <required value="false"/>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30194-7"/>
            <display value="None/uninsured"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA17849-3"/>
            <display value="Medicaid"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30195-4"/>
            <display value="CHIP Medicaid"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA15652-3"/>
            <display value="Medicare"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30196-2"/>
            <display value="Other public insurance (not CHIP)"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30197-0"/>
            <display value="Other public insurance (CHIP)"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA6350-8"/>
            <display value="Private insurance"/>
          </valueCoding>
        </answerOption>
      </item>
      <item>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-unit">
          <valueCoding>
            <system value="http://unitsofmeasure.org"/>
            <code value="/a"/>
            <display value="/a"/>
          </valueCoding>
        </extension>
        <linkId value="/93041-2/63586-2"/>
        <code>
          <system value="http://loinc.org"/>
          <code value="63586-2"/>
          <display
                   value="What was your best estimate of the total income of all family members from all sources, before taxes, in last year?"/>
        </code>
        <text
              value="What was your best estimate of the total income of all family members from all sources, before taxes, in last year?"/>
        <type value="decimal"/>
        <required value="false"/>
      </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="/93041-2/93031-3"/>
        <code>
          <system value="http://loinc.org"/>
          <code value="93031-3"/>
          <display
                   value="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?"/>
        </code>
        <text
              value="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?"/>
        <type value="choice"/>
        <required value="false"/>
        <repeats value="true"/>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30125-1"/>
            <display value="Food"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30126-9"/>
            <display value="Clothing"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30124-4"/>
            <display value="Utilities"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30127-7"/>
            <display value="Child care"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30128-5"/>
            <display
                     value="Medicine or Any Health Care (Medical, Dental, Mental Health, Vision)"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30129-3"/>
            <display value="Phone"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA46-8"/>
            <display value="Other"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30122-8"/>
            <display value="I choose not to answer this question"/>
          </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="/93041-2/93030-5"/>
        <code>
          <system value="http://loinc.org"/>
          <code value="93030-5"/>
          <display
                   value="Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living?"/>
        </code>
        <text
              value="Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living?"/>
        <type value="choice"/>
        <required value="false"/>
        <repeats value="true"/>
        <answerOption>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix">
            <valueString value="A"/>
          </extension>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30133-5"/>
            <display
                     value="Yes, it has kept me from medical appointments or from getting my medications"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix">
            <valueString value="B"/>
          </extension>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30134-3"/>
            <display
                     value="Yes, it has kept me from non-medical meetings, appointments, work, or from getting things that I need"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix">
            <valueString value="C"/>
          </extension>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA32-8"/>
            <display value="No"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix">
            <valueString value="X"/>
          </extension>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30257-2"/>
            <display value="Patient unable to respond"/>
          </valueCoding>
        </answerOption>
      </item>
    </item>
    <item>
      <linkId value="/93040-4"/>
      <code>
        <system value="http://loinc.org"/>
        <code value="93040-4"/>
        <display value="Social and emotional health"/>
      </code>
      <text value="Social and emotional health"/>
      <type value="group"/>
      <required value="false"/>
      <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="/93040-4/93029-7"/>
        <code>
          <system value="http://loinc.org"/>
          <code value="93029-7"/>
          <display
                   value="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)?"/>
        </code>
        <text
              value="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)?"/>
        <type value="choice"/>
        <required value="false"/>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA27722-0"/>
            <display value="Less than once a week"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30130-1"/>
            <display value="1 or 2 times a week"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30131-9"/>
            <display value="3 to 5 times a week"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30132-7"/>
            <display value="5 or more times a week"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30122-8"/>
            <display value="I choose not to answer this question"/>
          </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="/93040-4/93038-8"/>
        <code>
          <system value="http://loinc.org"/>
          <code value="93038-8"/>
          <display
                   value="Stress is when someone feels tense, nervous, anxious or can't sleep at night because their mind is troubled. How stressed are you?"/>
        </code>
        <text
              value="Stress is when someone feels tense, nervous, anxious or can't sleep at night because their mind is troubled. How stressed are you?"/>
        <type value="choice"/>
        <required value="false"/>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA6568-5"/>
            <display value="Not at all"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA13863-8"/>
            <display value="A little bit"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA13909-9"/>
            <display value="Somewhat"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA13902-4"/>
            <display value="Quite a bit"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA13914-9"/>
            <display value="Very much"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30122-8"/>
            <display value="I choose not to answer this question"/>
          </valueCoding>
        </answerOption>
      </item>
    </item>
    <item>
      <linkId value="/93039-6"/>
      <code>
        <system value="http://loinc.org"/>
        <code value="93039-6"/>
        <display value="Optional additional questions"/>
      </code>
      <text value="Optional additional questions"/>
      <type value="group"/>
      <required value="false"/>
      <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="/93039-6/93028-9"/>
        <code>
          <system value="http://loinc.org"/>
          <code value="93028-9"/>
          <display
                   value="In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?"/>
        </code>
        <text
              value="In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?"/>
        <type value="choice"/>
        <required value="false"/>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA33-6"/>
            <display value="Yes"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA32-8"/>
            <display value="No"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30122-8"/>
            <display value="I choose not to answer this question"/>
          </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="/93039-6/93027-1"/>
        <code>
          <system value="http://loinc.org"/>
          <code value="93027-1"/>
          <display value="Are you a refugee?"/>
        </code>
        <text value="Are you a refugee?"/>
        <type value="choice"/>
        <required value="false"/>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA33-6"/>
            <display value="Yes"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA32-8"/>
            <display value="No"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30122-8"/>
            <display value="I choose not to answer this question"/>
          </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="/93039-6/93026-3"/>
        <code>
          <system value="http://loinc.org"/>
          <code value="93026-3"/>
          <display
                   value="Do you feel physically and emotionally safe where you currently live?"/>
        </code>
        <text
              value="Do you feel physically and emotionally safe where you currently live?"/>
        <type value="choice"/>
        <required value="false"/>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA33-6"/>
            <display value="Yes"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA32-8"/>
            <display value="No"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA14072-5"/>
            <display value="Unsure"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30122-8"/>
            <display value="I choose not to answer this question"/>
          </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="/93039-6/76501-6"/>
        <code>
          <system value="http://loinc.org"/>
          <code value="76501-6"/>
          <display
                   value="Within the last year, have you been afraid of your partner or ex-partner?"/>
        </code>
        <text
              value="Within the last year, have you been afraid of your partner or ex-partner?"/>
        <type value="choice"/>
        <required value="false"/>
        <answerOption>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix">
            <valueString value="1"/>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
            <valueDecimal value="1"/>
          </extension>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA33-6"/>
            <display value="Yes"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix">
            <valueString value="0"/>
          </extension>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
            <valueDecimal value="0"/>
          </extension>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA32-8"/>
            <display value="No"/>
          </valueCoding>
        </answerOption>
      </item>
    </item>
  </item>
</Questionnaire>