Structured Data Capture 2.5.0 - Edition 3(STU), For Comment 2018Sep Ballot
This page is part of the Structured Data Capture FHIR IG (v2.5.0: STU 3 Ballot 1) based on FHIR v3.5.0. The current version which supercedes this version is 3.0.0. For a full list of available versions, see the Directory of published versions 
Format(s):
Narrative view
Bundle questionnaire-sdc-profile-example-ussg-fht of type transaction
Entry 1 - Full URL = http://hl7.org/fhir/uv/sdc/Questionnaire/54127-6
Response:
PUT http://hl7.org/fhir/uv/sdc/Questionnaire/54127-6
Resource Questionnaire:
Generated Narrative with Details
url: http://hl7.org/fhir/uv/sdc/Questionnaire/54127-6
identifier: 54127-6
title: US Surgeon General - Family Health Portrait
status: ACTIVE
experimental: true
subjectType: Patient
date: 01/01/2015
publisher: Regenstrief Institute, Inc and the LOINC Committee
contact:
description: This represents an implementation of the "US Surgeon General family health portrait" form found at https://lforms-demo.nlm.nih.gov
useContext:
jurisdiction: United States of America (Details : {urn:iso:std:iso:3166 code 'US' = 'United States of America)
purpose: Captures basic family history information
copyright: (c) 2015 Regenstrief Institute
approvalDate: 31/10/2015
lastReviewDate: 15/03/2017
code: US Surgeon General family health portrait [USSG-FHT] (Details: LOINC code 54127-6 = 'US Surgeon General family health portrait [USSG-FHT]', stated as 'US Surgeon General family health portrait [USSG-FHT]')
item
linkId: 0
type: GROUP
Items
- LinkId Text Type * 0.1 Date Done DATE * 0.2 Time Done TIME * 0.3 Where Done STRING * 0.4 Comment STRING item
linkId: 1
definition: http://loinc.org/fhir/DataElement/54126-8
code: My health history [USSG-FHT] (Details: LOINC code 54126-8 = 'My health history [USSG-FHT]', stated as 'null')
text: Your health information
type: GROUP
required: true
item
item
item
linkId: 2
definition: http://loinc.org/fhir/DataElement/54114-4
code: Family member health history [USSG-FHT] Family member (Details: LOINC code 54114-4 = 'Family member health history [USSG-FHT] Family member', stated as 'null')
text: Family member health information
type: GROUP
repeats: true
item
item
Entry 2 - Full URL = http://hl7.org/fhir/uv/sdc/ValueSet/LL1-9
Response:
PUT http://hl7.org/fhir/uv/sdc/ValueSet/LL1-9
Resource ValueSet:
Gender_M/F
Male=1, Female=2
Copyright Statement: Refer to https://loinc.org/terms-of-use
This value set includes codes from the following code systems:
- Include these codes as defined in
http://loinc.org
Code Display LA2-8 Male LA3-6 Female LA46-8 Other
Entry 3 - Full URL = http://hl7.org/fhir/uv/sdc/ValueSet/LL623-0
Response:
PUT http://hl7.org/fhir/uv/sdc/ValueSet/LL623-0
Resource ValueSet:
USSG-FHT twin
Family history tool twin
Copyright Statement: Refer to https://loinc.org/terms-of-use
This value set includes codes from the following code systems:
- Include these codes as defined in
http://loinc.org
Code Display LA10427-5 Yes - Identical (Same) LA10428-3 Yes - Fraternal (Different) LA32-8 No
Entry 4 - Full URL = http://hl7.org/fhir/uv/sdc/ValueSet/LL361-7
Response:
PUT http://hl7.org/fhir/uv/sdc/ValueSet/LL361-7
Resource ValueSet:
Y/N1
Yes/No
Copyright Statement: Refer to https://loinc.org/terms-of-use
This value set includes codes from the following code systems:
- Include these codes as defined in
http://loinc.org
Code Display LA33-6 Yes LA32-8 No
Entry 5 - Full URL = http://hl7.org/fhir/uv/sdc/ValueSet/LL629-7
Response:
PUT http://hl7.org/fhir/uv/sdc/ValueSet/LL629-7
Resource ValueSet:
USSG-FHT race
Family history tool race
Copyright Statement: Refer to https://loinc.org/terms-of-use
This value set includes codes from the following code systems:
- Include these codes as defined in
http://loinc.org
Code Display LA10608-0 American Indian or Alaska Native LA6156-9 Asian LA10614-8 -- Asian Indian LA10615-5 -- Chinese LA10616-3 -- Filipino LA10617-1 -- Japanese LA10618-9 -- Korean LA10620-5 -- Vietnamese LA10619-7 -- Other Asian LA10610-6 Black or African American LA10611-4 Native Hawaiian or Other Pacific Islander LA10623-9 -- Native Hawaiian LA10622-1 -- Guamanian LA10621-3 -- Chamorro LA10625-4 -- Samoan LA10624-7 -- Other Pacific Islander LA4457-3 White LA10613-0 Other/Unknown/Refuse To Answer
Entry 6 - Full URL = http://hl7.org/fhir/uv/sdc/ValueSet/LL628-9
Response:
PUT http://hl7.org/fhir/uv/sdc/ValueSet/LL628-9
Resource ValueSet:
USSG-FHT ethnicity
Family history tool ethnicity
Copyright Statement: Refer to https://loinc.org/terms-of-use
This value set includes codes from the following code systems:
- Include these codes as defined in
http://loinc.org
Code Display LA6214-6 Hispanic or Latino LA10599-1 -- Central American LA10600-7 -- Cuban LA10601-5 -- Dominican(Republic) LA10602-3 -- Mexican LA10605-6 -- Puerto Rican LA10606-4 -- South American LA10604-9 -- Other Latin American LA10603-1 -- Other Hispanic/Latino/Spanish LA10597-5 Non-Hispanic or Latino LA10598-3 Ashkenazi Jewish LA10607-2 Unknown/No answer
Entry 7 - Full URL = http://hl7.org/fhir/uv/sdc/ValueSet/LL626-3
Response:
PUT http://hl7.org/fhir/uv/sdc/ValueSet/LL626-3
Resource ValueSet:
USSG-FHT diseases
Family history tool diseases
Copyright Statement: Refer to https://loinc.org/terms-of-use
This value set includes codes from the following code systems:
- Include these codes as defined in
http://loinc.org
Code Display LA10533-0 Blood Clots LA10572-8 -- Blood Clot in Leg LA10573-6 -- Blood Clot in Lungs LA10524-9 Cancer LA10549-6 -- Bone LA10536-3 -- Breast Cancer LA10537-1 -- Colon Cancer LA10548-8 -- Esophageal Cancer LA10547-0 -- Gastric Cancer LA10541-3 -- Kidney Cancer LA10545-4 -- Leukemia LA10542-1 -- Lung Cancer LA10546-2 -- Muscle Cancer LA10539-7 -- Ovarian Cancer LA10538-9 -- Prostate Cancer LA10543-9 -- Skin Cancer LA10540-5 -- Thyroid Cancer LA10544-7 -- Uterine Cancer LA10550-4 -- Other Cancer LA10529-8 Diabetes LA10551-2 -- Diabetes Type 1 LA10552-0 -- Diabetes Type 2 LA10553-8 -- Gestational Diabetes LA10532-2 Gastrointestinal Disease LA10554-6 -- Crohn's Disease LA10555-3 -- Irritable Bowel Syndrome LA10556-1 -- Ulceritive Colitis LA10557-9 -- Colon Polyps LA10523-1 Heart Disease LA10558-7 -- Heart Attack LA10526-4 High Cholesterol/Hyperlipidemia LA7444-8 Hypertension LA10528-0 Kidney Disease LA10565-2 -- Cystic Kidney Disease LA10566-0 -- Kidney Disease Present From Birth LA10567-8 -- Nephrosis LA10568-6 -- Nephritis LA10569-4 -- Nephrotic Syndrome LA10570-2 -- Diabetic Kidney Disease LA10571-0 -- Other/Unknown LA10531-4 Lung Disease LA10559-5 -- COPD LA10560-3 -- Chronic Bronchitis LA10561-1 -- Emphysema LA10562-9 -- Chronic Lower Respiratory Disease LA10563-7 -- Influenza/Pneumonia LA10564-5 -- Asthma LA10590-0 Neurological Disorders LA10527-2 Osteoporosis LA10535-5 Psychological Disorders LA10574-4 -- Anxiety LA10575-1 -- Bipolar/Manic Depressive Disorder LA10576-9 -- Depression LA10577-7 -- Attention Deficit Hyper Activity LA10578-5 -- Autism LA10579-3 -- Personality Disorder LA10580-1 -- Eating Disorder LA10581-9 -- Obsessive Compulsive Disorder LA10582-7 -- Panic Disorder LA10583-5 -- Post Traumatic Stress Disorder LA10584-3 -- Schizophrenia LA10585-0 -- Social Phobia LA10586-8 -- Dementia LA10591-8 Septicemia LA10522-3 Stroke/Brain Attack LA10530-6 Sudden Infant Death Syndrome
Entry 8 - Full URL = http://hl7.org/fhir/uv/sdc/ValueSet/LL619-8
Response:
PUT http://hl7.org/fhir/uv/sdc/ValueSet/LL619-8
Resource ValueSet:
USSG-FHT age
Family history tool age range
Copyright Statement: Refer to https://loinc.org/terms-of-use
This value set includes codes from the following code systems:
Entry 9 - Full URL = http://hl7.org/fhir/uv/sdc/ValueSet/LL621-4
Response:
PUT http://hl7.org/fhir/uv/sdc/ValueSet/LL621-4
Resource ValueSet:
USSG-FHT relationship
Family history tool relationship to patient
Copyright Statement: Refer to https://loinc.org/terms-of-use
This value set includes codes from the following code systems:
- Include these codes as defined in
http://loinc.org
Code Display LA10405-1 Daughter LA10406-9 Granddaughter LA10407-7 Grandson LA10408-5 Half-brother LA10409-3 Half-sister LA10410-1 Maternal Aunt LA10411-9 Maternal Cousin LA10412-7 Maternal Grandfather LA10413-5 Maternal Grandmother LA10414-3 Maternal Uncle LA10415-0 Brother LA10416-8 Father LA10417-6 Mother LA10418-4 Sister LA10419-2 Nephew LA10420-0 Niece LA10421-8 Paternal Aunt LA10422-6 Paternal Cousin LA10423-4 Paternal Grandfather LA10424-2 Paternal Grandmother LA10425-9 Paternal Uncle LA10426-7 Son
Entry 10 - Full URL = http://hl7.org/fhir/uv/sdc/ValueSet/LL624-8
Response:
PUT http://hl7.org/fhir/uv/sdc/ValueSet/LL624-8
Resource ValueSet:
USSG-FHT living
Family history tool living
Copyright Statement: Refer to https://loinc.org/terms-of-use
This value set includes codes from the following code systems:
- Include these codes as defined in
http://loinc.org
Code Display LA33-6 Yes LA32-8 No LA4489-6 Unknown
Entry 11 - Full URL = http://hl7.org/fhir/uv/sdc/ValueSet/LL627-1
Response:
PUT http://hl7.org/fhir/uv/sdc/ValueSet/LL627-1
Resource ValueSet:
USSG-FHT diseases & cause of death
Family history tool diseases and cause of death
Copyright Statement: Refer to https://loinc.org/terms-of-use
This value set includes codes from the following code systems:
- Include these codes as defined in
http://loinc.org
Code Display LA10533-0 Blood Clots LA10572-8 -- Blood Clot in Leg LA10573-6 -- Blood Clot in Lungs LA10524-9 Cancer LA10549-6 -- Bone LA10536-3 -- Breast Cancer LA10537-1 -- Colon Cancer LA10548-8 -- Esophageal Cancer LA10547-0 -- Gastric Cancer LA10541-3 -- Kidney Cancer LA10545-4 -- Leukemia LA10542-1 -- Lung Cancer LA10546-2 -- Muscle Cancer LA10539-7 -- Ovarian Cancer LA10538-9 -- Prostate Cancer LA10543-9 -- Skin Cancer LA10540-5 -- Thyroid Cancer LA10544-7 -- Uterine Cancer LA10550-4 -- Other Cancer LA10529-8 Diabetes LA10551-2 -- Diabetes Type 1 LA10552-0 -- Diabetes Type 2 LA10553-8 -- Gestational Diabetes LA10532-2 Gastrointestinal Disease LA10554-6 -- Crohn's Disease LA10555-3 -- Irritable Bowel Syndrome LA10556-1 -- Ulceritive Colitis LA10557-9 -- Colon Polyps LA10523-1 Heart Disease LA10558-7 -- Heart Attack LA10526-4 High Cholesterol/Hyperlipidemia LA7444-8 Hypertension LA10528-0 Kidney Disease LA10565-2 -- Cystic Kidney Disease LA10566-0 -- Kidney Disease Present From Birth LA10567-8 -- Nephrosis LA10568-6 -- Nephritis LA10569-4 -- Nephrotic Syndrome LA10570-2 -- Diabetic Kidney Disease LA10571-0 -- Other/Unknown LA10531-4 Lung Disease LA10559-5 -- COPD LA10560-3 -- Chronic Bronchitis LA10561-1 -- Emphysema LA10562-9 -- Chronic Lower Respiratory Disease LA10563-7 -- Influenza/Pneumonia LA10564-5 -- Asthma LA10590-0 Neurological Disorders LA10527-2 Osteoporosis LA10535-5 Psychological Disorders LA10574-4 -- Anxiety LA10575-1 -- Bipolar/Manic Depressive Disorder LA10576-9 -- Depression LA10577-7 -- Attention Deficit Hyper Activity LA10578-5 -- Autism LA10579-3 -- Personality Disorder LA10580-1 -- Eating Disorder LA10581-9 -- Obsessive Compulsive Disorder LA10582-7 -- Panic Disorder LA10583-5 -- Post Traumatic Stress Disorder LA10584-3 -- Schizophrenia LA10585-0 -- Social Phobia LA10586-8 -- Dementia LA10591-8 Septicemia LA10522-3 Stroke/Brain Attack LA10530-6 Sudden Infant Death Syndrome LA10595-9 Cause of Death LA10587-6 -- Suicide LA10588-4 -- Accidental Death LA10589-2 -- Other/Unexpected
© 2015+ HL7 International (OO work group). Based on FHIR version (3.5.0-14923). IG generated on Fri, Aug 31, 2018 16:04+1000.
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