Structured Data Capture
4.0.0-ballot - STU 4 ballot
Structured Data Capture
4.0.0-ballot - STU 4 ballot
This page is part of the Structured Data Capture FHIR IG (v4.0.0-ballot: STU 4 Ballot 1) based on FHIR (HL7® FHIR® Standard) R4. The current version which supersedes this version is 3.0.0. For a full list of available versions, see the Directory of published versions
{
"resourceType" : "Parameters",
"id" : "populate-response",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/uv/sdc/StructureDefinition/parameters-questionnaire-populate-out"
]
},
"parameter" : [
{
"name" : "response",
"resource" : {
"resourceType" : "QuestionnaireResponse",
"id" : "questionnaireresponse-sdc-example-ussg-fht-answers",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaireresponse"
]
},
"questionnaire" : "http://hl7.org/fhir/uv/sdc/Questionnaire/questionnaire-sdc-profile-example-ussg-fht|4.0.0-ballot",
"status" : "in-progress",
"subject" : {
"reference" : "http://hl7.org/fhir/Patient/proband"
},
"authored" : "2008-01-17",
"item" : [
{
"linkId" : "0",
"item" : [
{
"linkId" : "0.1",
"text" : "Date Done",
"answer" : [
{
"valueDate" : "2008-01-17"
}
]
}
]
},
{
"linkId" : "1",
"definition" : "http://loinc.org/fhir/DataElement/54126-8",
"text" : "Your health information",
"item" : [
{
"linkId" : "1.1",
"item" : [
{
"linkId" : "1.1.1",
"definition" : "http://loinc.org/fhir/DataElement/54125-0",
"text" : "Name",
"answer" : [
{
"valueString" : "Annie Proband"
}
]
},
{
"linkId" : "1.1.2",
"definition" : "http://loinc.org/fhir/DataElement/54131-8",
"text" : "Gender",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA3-6",
"display" : "Female"
}
}
]
},
{
"linkId" : "1.1.3",
"definition" : "http://loinc.org/fhir/DataElement/21112-8",
"text" : "Date of Birth",
"answer" : [
{
"valueDate" : "1966-04-04"
}
]
},
{
"linkId" : "1.1.4",
"definition" : "http://loinc.org/fhir/DataElement/54132-6",
"text" : "Were you born a twin?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
}
}
]
},
{
"linkId" : "1.1.5",
"definition" : "http://loinc.org/fhir/DataElement/54128-4",
"text" : "Were you adopted?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
}
}
]
},
{
"linkId" : "1.1.6",
"definition" : "http://loinc.org/fhir/DataElement/54135-9",
"text" : "Are your parents related to each other in any way other than marriage?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
}
}
]
},
{
"linkId" : "1.1.7",
"definition" : "http://loinc.org/fhir/DataElement/8302-2",
"text" : "Height",
"answer" : [
{
"valueDecimal" : 63,
"item" : [
{
"linkId" : "1.1.7.1.1",
"text" : "Units",
"answer" : [
{
"valueCoding" : {
"system" : "http://unitsofmeasure.org",
"code" : "[in_i]",
"display" : "[in_i]"
}
}
]
}
]
}
]
},
{
"linkId" : "1.1.8",
"definition" : "http://loinc.org/fhir/DataElement/29463-7",
"text" : "Weight",
"answer" : [
{
"valueDecimal" : 127,
"item" : [
{
"linkId" : "1.1.8.1.1",
"text" : "Units",
"answer" : [
{
"valueCoding" : {
"system" : "http://unitsofmeasure.org",
"code" : "[lb_av]",
"display" : "[lb_av]"
}
}
]
}
]
}
]
},
{
"linkId" : "1.1.9",
"definition" : "http://loinc.org/fhir/DataElement/39156-5",
"text" : "Body mass index (BMI) [Ratio]",
"answer" : [
{
"valueDecimal" : 22.5
}
]
},
{
"linkId" : "1.1.10",
"definition" : "http://loinc.org/fhir/DataElement/54134-2",
"text" : "Race",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA4457-3",
"display" : "White"
}
}
]
},
{
"linkId" : "1.1.11",
"definition" : "http://loinc.org/fhir/DataElement/54133-4",
"text" : "Ethnicity",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA4611-5",
"display" : "Mexican"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA10606-4",
"display" : "South American"
}
}
]
}
]
}
]
},
{
"linkId" : "2",
"definition" : "http://loinc.org/fhir/DataElement/54114-4",
"text" : "Family member health information",
"item" : [
{
"linkId" : "2.1.1",
"item" : [
{
"linkId" : "2.1.1.1",
"definition" : "http://loinc.org/fhir/DataElement/54136-7",
"text" : "Relationship to you",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA10405-1",
"display" : "Daughter"
}
}
]
},
{
"linkId" : "2.1.1.2",
"definition" : "http://loinc.org/fhir/DataElement/54138-3",
"text" : "Name",
"answer" : [
{
"valueString" : "Susan"
}
]
},
{
"linkId" : "2.1.1.3",
"definition" : "http://loinc.org/fhir/DataElement/54123-5",
"text" : "Gender",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA3-6",
"display" : "Female"
}
}
]
},
{
"linkId" : "2.1.1.4",
"definition" : "http://loinc.org/fhir/DataElement/54139-1",
"text" : "Living?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA33-6",
"display" : "Yes"
},
"item" : [
{
"linkId" : "2.1.1.4.2",
"item" : [
{
"linkId" : "2.1.1.4.2.2",
"definition" : "http://loinc.org/fhir/DataElement/54141-7",
"text" : "Age",
"answer" : [
{
"valueDecimal" : 17
}
]
}
]
}
]
}
]
},
{
"linkId" : "2.1.1.5",
"definition" : "http://loinc.org/fhir/DataElement/54121-9",
"text" : "Was this person born a twin?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
}
}
]
},
{
"linkId" : "2.1.1.6",
"definition" : "http://loinc.org/fhir/DataElement/54122-7",
"text" : "Was this person adopted?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
}
}
]
}
]
}
]
},
{
"linkId" : "2",
"definition" : "http://loinc.org/fhir/DataElement/54114-4",
"text" : "Family member health information",
"item" : [
{
"linkId" : "2.1.1",
"item" : [
{
"linkId" : "2.1.1.1",
"definition" : "http://loinc.org/fhir/DataElement/54136-7",
"text" : "Relationship to you",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA10415-0",
"display" : "Brother"
}
}
]
},
{
"linkId" : "2.1.1.2",
"definition" : "http://loinc.org/fhir/DataElement/54138-3",
"text" : "Name",
"answer" : [
{
"valueString" : "Brian"
}
]
},
{
"linkId" : "2.1.1.3",
"definition" : "http://loinc.org/fhir/DataElement/54123-5",
"text" : "Gender",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA2-8",
"display" : "Male"
}
}
]
},
{
"linkId" : "2.1.1.4",
"definition" : "http://loinc.org/fhir/DataElement/54139-1",
"text" : "Living?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA33-6",
"display" : "Yes"
},
"item" : [
{
"linkId" : "2.1.1.4.2",
"item" : [
{
"linkId" : "2.1.1.4.2.2",
"definition" : "http://loinc.org/fhir/DataElement/54141-7",
"text" : "Age",
"answer" : [
{
"valueDecimal" : 32
}
]
}
]
}
]
}
]
},
{
"linkId" : "2.1.1.5",
"definition" : "http://loinc.org/fhir/DataElement/54121-9",
"text" : "Was this person born a twin?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
}
}
]
},
{
"linkId" : "2.1.1.6",
"definition" : "http://loinc.org/fhir/DataElement/54122-7",
"text" : "Was this person adopted?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
}
}
]
}
]
},
{
"linkId" : "2.1.2",
"text" : "This family member's history of disease",
"item" : [
{
"linkId" : "2.1.2.1",
"text" : "Disease or Condition",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA14284-6",
"display" : "Other Cancer"
}
}
]
},
{
"linkId" : "2.1.2.2",
"text" : "Age at Diagnosis",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA10397-0",
"display" : "30-39"
}
}
]
}
]
}
]
},
{
"linkId" : "2",
"definition" : "http://loinc.org/fhir/DataElement/54114-4",
"text" : "Family member health information",
"item" : [
{
"linkId" : "2.1.1",
"item" : [
{
"linkId" : "2.1.1.1",
"definition" : "http://loinc.org/fhir/DataElement/54136-7",
"text" : "Relationship to you",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA10418-4",
"display" : "Sister"
}
}
]
},
{
"linkId" : "2.1.1.2",
"definition" : "http://loinc.org/fhir/DataElement/54138-3",
"text" : "Name",
"answer" : [
{
"valueString" : "Janet"
}
]
},
{
"linkId" : "2.1.1.3",
"definition" : "http://loinc.org/fhir/DataElement/54123-5",
"text" : "Gender",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA3-6",
"display" : "Female"
}
}
]
},
{
"linkId" : "2.1.1.4",
"definition" : "http://loinc.org/fhir/DataElement/54139-1",
"text" : "Living?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA33-6",
"display" : "Yes"
},
"item" : [
{
"linkId" : "2.1.1.4.2",
"item" : [
{
"linkId" : "2.1.1.4.2.2",
"definition" : "http://loinc.org/fhir/DataElement/54141-7",
"text" : "Age",
"answer" : [
{
"valueDecimal" : 36
}
]
}
]
}
]
}
]
},
{
"linkId" : "2.1.1.5",
"definition" : "http://loinc.org/fhir/DataElement/54121-9",
"text" : "Was this person born a twin?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
}
}
]
},
{
"linkId" : "2.1.1.6",
"definition" : "http://loinc.org/fhir/DataElement/54122-7",
"text" : "Was this person adopted?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
}
}
]
}
]
},
{
"linkId" : "2.1.2",
"text" : "This family member's history of disease",
"item" : [
{
"linkId" : "2.1.2.1",
"text" : "Disease or Condition",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA14283-8",
"display" : "Breast Cancer"
}
}
]
},
{
"linkId" : "2.1.2.2",
"text" : "Age at Diagnosis",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA10397-0",
"display" : "30-39"
}
}
]
}
]
}
]
},
{
"linkId" : "2",
"definition" : "http://loinc.org/fhir/DataElement/54114-4",
"text" : "Family member health information",
"item" : [
{
"linkId" : "2.1.1",
"item" : [
{
"linkId" : "2.1.1.1",
"definition" : "http://loinc.org/fhir/DataElement/54136-7",
"text" : "Relationship to you",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA10419-2",
"display" : "Nephew"
}
}
]
},
{
"linkId" : "2.1.1.2",
"definition" : "http://loinc.org/fhir/DataElement/54138-3",
"text" : "Name",
"answer" : [
{
"valueString" : "Ian"
}
]
},
{
"linkId" : "2.1.1.3",
"definition" : "http://loinc.org/fhir/DataElement/54123-5",
"text" : "Gender",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA2-8",
"display" : "Male"
}
}
]
},
{
"linkId" : "2.1.1.4",
"definition" : "http://loinc.org/fhir/DataElement/54139-1",
"text" : "Living?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA33-6",
"display" : "Yes"
},
"item" : [
{
"linkId" : "2.1.1.4.2",
"item" : [
{
"linkId" : "2.1.1.4.2.2",
"definition" : "http://loinc.org/fhir/DataElement/54141-7",
"text" : "Age",
"answer" : [
{
"valueDecimal" : 16
}
]
}
]
}
]
}
]
},
{
"linkId" : "2.1.1.5",
"definition" : "http://loinc.org/fhir/DataElement/54121-9",
"text" : "Was this person born a twin?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
}
}
]
},
{
"linkId" : "2.1.1.6",
"definition" : "http://loinc.org/fhir/DataElement/54122-7",
"text" : "Was this person adopted?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
}
}
]
}
]
}
]
},
{
"linkId" : "2",
"definition" : "http://loinc.org/fhir/DataElement/54114-4",
"text" : "Family member health information",
"item" : [
{
"linkId" : "2.1.1",
"item" : [
{
"linkId" : "2.1.1.1",
"definition" : "http://loinc.org/fhir/DataElement/54136-7",
"text" : "Relationship to you",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA10420-0",
"display" : "Niece"
}
}
]
},
{
"linkId" : "2.1.1.2",
"definition" : "http://loinc.org/fhir/DataElement/54138-3",
"text" : "Name",
"answer" : [
{
"valueString" : "Helen"
}
]
},
{
"linkId" : "2.1.1.3",
"definition" : "http://loinc.org/fhir/DataElement/54123-5",
"text" : "Gender",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA3-6",
"display" : "Female"
}
}
]
},
{
"linkId" : "2.1.1.4",
"definition" : "http://loinc.org/fhir/DataElement/54139-1",
"text" : "Living?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA33-6",
"display" : "Yes"
},
"item" : [
{
"linkId" : "2.1.1.4.2",
"item" : [
{
"linkId" : "2.1.1.4.2.2",
"definition" : "http://loinc.org/fhir/DataElement/54141-7",
"text" : "Age",
"answer" : [
{
"valueDecimal" : 15
}
]
}
]
}
]
}
]
},
{
"linkId" : "2.1.1.5",
"definition" : "http://loinc.org/fhir/DataElement/54121-9",
"text" : "Was this person born a twin?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
}
}
]
},
{
"linkId" : "2.1.1.6",
"definition" : "http://loinc.org/fhir/DataElement/54122-7",
"text" : "Was this person adopted?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
}
}
]
}
]
}
]
},
{
"linkId" : "2",
"definition" : "http://loinc.org/fhir/DataElement/54114-4",
"text" : "Family member health information",
"item" : [
{
"linkId" : "2.1.1",
"item" : [
{
"linkId" : "2.1.1.1",
"definition" : "http://loinc.org/fhir/DataElement/54136-7",
"text" : "Relationship to you",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA10416-8",
"display" : "Father"
}
}
]
},
{
"linkId" : "2.1.1.2",
"definition" : "http://loinc.org/fhir/DataElement/54138-3",
"text" : "Name",
"answer" : [
{
"valueString" : "Donald"
}
]
},
{
"linkId" : "2.1.1.3",
"definition" : "http://loinc.org/fhir/DataElement/54123-5",
"text" : "Gender",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA2-8",
"display" : "Male"
}
}
]
},
{
"linkId" : "2.1.1.4",
"definition" : "http://loinc.org/fhir/DataElement/54139-1",
"text" : "Living?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA33-6",
"display" : "Yes"
},
"item" : [
{
"linkId" : "2.1.1.4.2",
"item" : [
{
"linkId" : "2.1.1.4.2.2",
"definition" : "http://loinc.org/fhir/DataElement/54141-7",
"text" : "Age",
"answer" : [
{
"valueDecimal" : 52
}
]
}
]
}
]
}
]
},
{
"linkId" : "2.1.1.5",
"definition" : "http://loinc.org/fhir/DataElement/54121-9",
"text" : "Was this person born a twin?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
}
}
]
},
{
"linkId" : "2.1.1.6",
"definition" : "http://loinc.org/fhir/DataElement/54122-7",
"text" : "Was this person adopted?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
}
}
]
}
]
}
]
},
{
"linkId" : "2",
"definition" : "http://loinc.org/fhir/DataElement/54114-4",
"text" : "Family member health information",
"item" : [
{
"linkId" : "2.1.1",
"item" : [
{
"linkId" : "2.1.1.1",
"definition" : "http://loinc.org/fhir/DataElement/54136-7",
"text" : "Relationship to you",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA10425-9",
"display" : "Paternal Uncle"
}
}
]
},
{
"linkId" : "2.1.1.2",
"definition" : "http://loinc.org/fhir/DataElement/54138-3",
"text" : "Name",
"answer" : [
{
"valueString" : "Eric"
}
]
},
{
"linkId" : "2.1.1.3",
"definition" : "http://loinc.org/fhir/DataElement/54123-5",
"text" : "Gender",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA2-8",
"display" : "Male"
}
}
]
},
{
"linkId" : "2.1.1.4",
"definition" : "http://loinc.org/fhir/DataElement/54139-1",
"text" : "Living?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA33-6",
"display" : "Yes"
},
"item" : [
{
"linkId" : "2.1.1.4.2",
"item" : [
{
"linkId" : "2.1.1.4.2.2",
"definition" : "http://loinc.org/fhir/DataElement/54141-7",
"text" : "Age",
"answer" : [
{
"valueDecimal" : 56
}
]
}
]
}
]
}
]
},
{
"linkId" : "2.1.1.5",
"definition" : "http://loinc.org/fhir/DataElement/54121-9",
"text" : "Was this person born a twin?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
}
}
]
},
{
"linkId" : "2.1.1.6",
"definition" : "http://loinc.org/fhir/DataElement/54122-7",
"text" : "Was this person adopted?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
}
}
]
}
]
}
]
},
{
"linkId" : "2",
"definition" : "http://loinc.org/fhir/DataElement/54114-4",
"text" : "Family member health information",
"item" : [
{
"linkId" : "2.1.1",
"item" : [
{
"linkId" : "2.1.1.1",
"definition" : "http://loinc.org/fhir/DataElement/54136-7",
"text" : "Relationship to you",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA10421-8",
"display" : "Paternal Aunt"
}
}
]
},
{
"linkId" : "2.1.1.2",
"definition" : "http://loinc.org/fhir/DataElement/54138-3",
"text" : "Name",
"answer" : [
{
"valueString" : "Fiona"
}
]
},
{
"linkId" : "2.1.1.3",
"definition" : "http://loinc.org/fhir/DataElement/54123-5",
"text" : "Gender",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA3-6",
"display" : "Female"
}
}
]
},
{
"linkId" : "2.1.1.4",
"definition" : "http://loinc.org/fhir/DataElement/54139-1",
"text" : "Living?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA33-6",
"display" : "Yes"
},
"item" : [
{
"linkId" : "2.1.1.4.2",
"item" : [
{
"linkId" : "2.1.1.4.2.2",
"definition" : "http://loinc.org/fhir/DataElement/54141-7",
"text" : "Age",
"answer" : [
{
"valueDecimal" : 57
}
]
}
]
}
]
}
]
},
{
"linkId" : "2.1.1.5",
"definition" : "http://loinc.org/fhir/DataElement/54121-9",
"text" : "Was this person born a twin?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
}
}
]
},
{
"linkId" : "2.1.1.6",
"definition" : "http://loinc.org/fhir/DataElement/54122-7",
"text" : "Was this person adopted?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
}
}
]
}
]
},
{
"linkId" : "2.1.2",
"text" : "This family member's history of disease",
"item" : [
{
"linkId" : "2.1.2.1",
"text" : "Disease or Condition",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA10543-9",
"display" : "Skin Cancer"
}
}
]
}
]
}
]
},
{
"linkId" : "2",
"definition" : "http://loinc.org/fhir/DataElement/54114-4",
"text" : "Family member health information",
"item" : [
{
"linkId" : "2.1.1",
"item" : [
{
"linkId" : "2.1.1.1",
"definition" : "http://loinc.org/fhir/DataElement/54136-7",
"text" : "Relationship to you",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA10423-4",
"display" : "Paternal Grandfather"
}
}
]
},
{
"linkId" : "2.1.1.2",
"definition" : "http://loinc.org/fhir/DataElement/54138-3",
"text" : "Name",
"answer" : [
{
"valueString" : "Bob"
}
]
},
{
"linkId" : "2.1.1.3",
"definition" : "http://loinc.org/fhir/DataElement/54123-5",
"text" : "Gender",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA2-8",
"display" : "Male"
}
}
]
},
{
"linkId" : "2.1.1.4",
"definition" : "http://loinc.org/fhir/DataElement/54139-1",
"text" : "Living?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
},
"item" : [
{
"linkId" : "2.1.1.4.1",
"item" : [
{
"linkId" : "2.1.1.4.1.1",
"definition" : "http://loinc.org/fhir/DataElement/54112-8",
"text" : "Cause of Death",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA10537-1",
"display" : "Colon Cancer"
}
}
]
},
{
"linkId" : "2.1.1.4.1.2",
"definition" : "http://loinc.org/fhir/DataElement/54113-6",
"text" : "Age at Death",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA10400-2",
"display" : "OVER 60"
}
}
]
}
]
}
]
}
]
},
{
"linkId" : "2.1.1.5",
"definition" : "http://loinc.org/fhir/DataElement/54121-9",
"text" : "Was this person born a twin?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
}
}
]
},
{
"linkId" : "2.1.1.6",
"definition" : "http://loinc.org/fhir/DataElement/54122-7",
"text" : "Was this person adopted?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
}
}
]
}
]
},
{
"linkId" : "2.1.2",
"text" : "This family member's history of disease",
"item" : [
{
"linkId" : "2.1.2.1",
"text" : "Disease or Condition",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA10537-1",
"display" : "Colon Cancer"
}
}
]
},
{
"linkId" : "2.1.2.2",
"text" : "Age at Diagnosis",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA10400-2",
"display" : "OVER 60"
}
}
]
}
]
}
]
},
{
"linkId" : "2",
"definition" : "http://loinc.org/fhir/DataElement/54114-4",
"text" : "Family member health information",
"item" : [
{
"linkId" : "2.1.1",
"item" : [
{
"linkId" : "2.1.1.1",
"definition" : "http://loinc.org/fhir/DataElement/54136-7",
"text" : "Relationship to you",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA10424-2",
"display" : "Paternal Grandmother"
}
}
]
},
{
"linkId" : "2.1.1.2",
"definition" : "http://loinc.org/fhir/DataElement/54138-3",
"text" : "Name",
"answer" : [
{
"valueString" : "Claire"
}
]
},
{
"linkId" : "2.1.1.3",
"definition" : "http://loinc.org/fhir/DataElement/54123-5",
"text" : "Gender",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA3-6",
"display" : "Female"
}
}
]
},
{
"linkId" : "2.1.1.4",
"definition" : "http://loinc.org/fhir/DataElement/54139-1",
"text" : "Living?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
},
"item" : [
{
"linkId" : "2.1.1.4.1",
"item" : [
{
"linkId" : "2.1.1.4.1.1",
"definition" : "http://loinc.org/fhir/DataElement/54112-8",
"text" : "Cause of Death",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA10589-2",
"display" : "Other/Unexpected"
},
"item" : [
{
"linkId" : "2.1.1.4.1.1.1",
"text" : "Please specify",
"answer" : [
{
"valueString" : "Lou Gehrigs"
}
]
}
]
}
]
},
{
"linkId" : "2.1.1.4.1.2",
"definition" : "http://loinc.org/fhir/DataElement/54113-6",
"text" : "Age at Death",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA10400-2",
"display" : "OVER 60"
}
}
]
}
]
}
]
}
]
},
{
"linkId" : "2.1.1.5",
"definition" : "http://loinc.org/fhir/DataElement/54121-9",
"text" : "Was this person born a twin?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
}
}
]
},
{
"linkId" : "2.1.1.6",
"definition" : "http://loinc.org/fhir/DataElement/54122-7",
"text" : "Was this person adopted?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
}
}
]
}
]
}
]
},
{
"linkId" : "2",
"definition" : "http://loinc.org/fhir/DataElement/54114-4",
"text" : "Family member health information",
"item" : [
{
"linkId" : "2.1.1",
"item" : [
{
"linkId" : "2.1.1.1",
"definition" : "http://loinc.org/fhir/DataElement/54136-7",
"text" : "Relationship to you",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA10417-6",
"display" : "Mother"
}
}
]
},
{
"linkId" : "2.1.1.2",
"definition" : "http://loinc.org/fhir/DataElement/54138-3",
"text" : "Name",
"answer" : [
{
"valueString" : "Harriet"
}
]
},
{
"linkId" : "2.1.1.3",
"definition" : "http://loinc.org/fhir/DataElement/54123-5",
"text" : "Gender",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA3-6",
"display" : "Female"
}
}
]
},
{
"linkId" : "2.1.1.4",
"definition" : "http://loinc.org/fhir/DataElement/54139-1",
"text" : "Living?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
},
"item" : [
{
"linkId" : "2.1.1.4.1",
"item" : [
{
"linkId" : "2.1.1.4.1.1",
"definition" : "http://loinc.org/fhir/DataElement/54112-8",
"text" : "Cause of Death",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA15682-0",
"display" : "Ovarian Cancer"
}
}
]
},
{
"linkId" : "2.1.1.4.1.2",
"definition" : "http://loinc.org/fhir/DataElement/54113-6",
"text" : "Age at Death",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA10399-6",
"display" : "50-59"
}
}
]
}
]
}
]
}
]
},
{
"linkId" : "2.1.1.5",
"definition" : "http://loinc.org/fhir/DataElement/54121-9",
"text" : "Was this person born a twin?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
}
}
]
},
{
"linkId" : "2.1.1.6",
"definition" : "http://loinc.org/fhir/DataElement/54122-7",
"text" : "Was this person adopted?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
}
}
]
}
]
},
{
"linkId" : "2.1.2",
"text" : "This family member's history of disease",
"item" : [
{
"linkId" : "2.1.2.1",
"text" : "Disease or Condition",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA15682-0",
"display" : "Ovarian Cancer"
}
}
]
},
{
"linkId" : "2.1.2.2",
"text" : "Age at Diagnosis",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA10398-8",
"display" : "40-49"
}
}
]
}
]
}
]
},
{
"linkId" : "2",
"definition" : "http://loinc.org/fhir/DataElement/54114-4",
"text" : "Family member health information",
"item" : [
{
"linkId" : "2.1.1",
"item" : [
{
"linkId" : "2.1.1.1",
"definition" : "http://loinc.org/fhir/DataElement/54136-7",
"text" : "Relationship to you",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA10414-3",
"display" : "Maternal Uncle"
}
}
]
},
{
"linkId" : "2.1.1.2",
"definition" : "http://loinc.org/fhir/DataElement/54138-3",
"text" : "Name",
"answer" : [
{
"valueString" : "Rudy"
}
]
},
{
"linkId" : "2.1.1.3",
"definition" : "http://loinc.org/fhir/DataElement/54123-5",
"text" : "Gender",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA2-8",
"display" : "Male"
}
}
]
},
{
"linkId" : "2.1.1.4",
"definition" : "http://loinc.org/fhir/DataElement/54139-1",
"text" : "Living?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA33-6",
"display" : "Yes"
},
"item" : [
{
"linkId" : "2.1.1.4.2",
"item" : [
{
"linkId" : "2.1.1.4.2.2",
"definition" : "http://loinc.org/fhir/DataElement/54141-7",
"text" : "Age",
"answer" : [
{
"valueDecimal" : 60
}
]
}
]
}
]
}
]
},
{
"linkId" : "2.1.1.5",
"definition" : "http://loinc.org/fhir/DataElement/54121-9",
"text" : "Was this person born a twin?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
}
}
]
},
{
"linkId" : "2.1.1.6",
"definition" : "http://loinc.org/fhir/DataElement/54122-7",
"text" : "Was this person adopted?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
}
}
]
}
]
}
]
},
{
"linkId" : "2",
"definition" : "http://loinc.org/fhir/DataElement/54114-4",
"text" : "Family member health information",
"item" : [
{
"linkId" : "2.1.1",
"item" : [
{
"linkId" : "2.1.1.1",
"definition" : "http://loinc.org/fhir/DataElement/54136-7",
"text" : "Relationship to you",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA10410-1",
"display" : "Maternal Aunt"
}
}
]
},
{
"linkId" : "2.1.1.2",
"definition" : "http://loinc.org/fhir/DataElement/54138-3",
"text" : "Name",
"answer" : [
{
"valueString" : "Julie"
}
]
},
{
"linkId" : "2.1.1.3",
"definition" : "http://loinc.org/fhir/DataElement/54123-5",
"text" : "Gender",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA3-6",
"display" : "Female"
}
}
]
},
{
"linkId" : "2.1.1.4",
"definition" : "http://loinc.org/fhir/DataElement/54139-1",
"text" : "Living?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA33-6",
"display" : "Yes"
},
"item" : [
{
"linkId" : "2.1.1.4.2",
"item" : [
{
"linkId" : "2.1.1.4.2.2",
"definition" : "http://loinc.org/fhir/DataElement/54141-7",
"text" : "Age",
"answer" : [
{
"valueDecimal" : 57
}
]
}
]
}
]
}
]
},
{
"linkId" : "2.1.1.5",
"definition" : "http://loinc.org/fhir/DataElement/54121-9",
"text" : "Was this person born a twin?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
}
}
]
},
{
"linkId" : "2.1.1.6",
"definition" : "http://loinc.org/fhir/DataElement/54122-7",
"text" : "Was this person adopted?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
}
}
]
}
]
}
]
},
{
"linkId" : "2",
"definition" : "http://loinc.org/fhir/DataElement/54114-4",
"text" : "Family member health information",
"item" : [
{
"linkId" : "2.1.1",
"item" : [
{
"linkId" : "2.1.1.1",
"definition" : "http://loinc.org/fhir/DataElement/54136-7",
"text" : "Relationship to you",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA10412-7",
"display" : "Maternal Grandfather"
}
}
]
},
{
"linkId" : "2.1.1.2",
"definition" : "http://loinc.org/fhir/DataElement/54138-3",
"text" : "Name",
"answer" : [
{
"valueString" : "Ian"
}
]
},
{
"linkId" : "2.1.1.3",
"definition" : "http://loinc.org/fhir/DataElement/54123-5",
"text" : "Gender",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA2-8",
"display" : "Male"
}
}
]
},
{
"linkId" : "2.1.1.4",
"definition" : "http://loinc.org/fhir/DataElement/54139-1",
"text" : "Living?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
},
"item" : [
{
"linkId" : "2.1.1.4.1",
"item" : [
{
"linkId" : "2.1.1.4.1.1",
"definition" : "http://loinc.org/fhir/DataElement/54112-8",
"text" : "Cause of Death",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA16286-9",
"display" : "Heart attack"
}
}
]
},
{
"linkId" : "2.1.1.4.1.2",
"definition" : "http://loinc.org/fhir/DataElement/54113-6",
"text" : "Age at Death",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA10400-2",
"display" : "OVER 60"
}
}
]
}
]
}
]
}
]
},
{
"linkId" : "2.1.1.5",
"definition" : "http://loinc.org/fhir/DataElement/54121-9",
"text" : "Was this person born a twin?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
}
}
]
},
{
"linkId" : "2.1.1.6",
"definition" : "http://loinc.org/fhir/DataElement/54122-7",
"text" : "Was this person adopted?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
}
}
]
}
]
}
]
},
{
"linkId" : "2",
"definition" : "http://loinc.org/fhir/DataElement/54114-4",
"text" : "Family member health information",
"item" : [
{
"linkId" : "2.1.1",
"item" : [
{
"linkId" : "2.1.1.1",
"definition" : "http://loinc.org/fhir/DataElement/54136-7",
"text" : "Relationship to you",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA10413-5",
"display" : "Maternal Grandmother"
}
}
]
},
{
"linkId" : "2.1.1.2",
"definition" : "http://loinc.org/fhir/DataElement/54138-3",
"text" : "Name",
"answer" : [
{
"valueString" : "Gladys"
}
]
},
{
"linkId" : "2.1.1.3",
"definition" : "http://loinc.org/fhir/DataElement/54123-5",
"text" : "Gender",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA3-6",
"display" : "Female"
}
}
]
},
{
"linkId" : "2.1.1.4",
"definition" : "http://loinc.org/fhir/DataElement/54139-1",
"text" : "Living?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
},
"item" : [
{
"linkId" : "2.1.1.4.1",
"item" : [
{
"linkId" : "2.1.1.4.1.1",
"definition" : "http://loinc.org/fhir/DataElement/54112-8",
"text" : "Cause of Death",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA10589-2",
"display" : "Other/Unexpected"
}
}
]
},
{
"linkId" : "2.1.1.4.1.2",
"definition" : "http://loinc.org/fhir/DataElement/54113-6",
"text" : "Age at Death",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA10400-2",
"display" : "OVER 60"
}
}
]
}
]
}
]
}
]
},
{
"linkId" : "2.1.1.5",
"definition" : "http://loinc.org/fhir/DataElement/54121-9",
"text" : "Was this person born a twin?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
}
}
]
},
{
"linkId" : "2.1.1.6",
"definition" : "http://loinc.org/fhir/DataElement/54122-7",
"text" : "Was this person adopted?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
}
}
]
}
]
},
{
"linkId" : "2.1.2",
"text" : "This family member's history of disease",
"item" : [
{
"linkId" : "2.1.2.1",
"text" : "Disease or Condition",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA14283-8",
"display" : "Breast Cancer"
}
}
]
},
{
"linkId" : "2.1.2.2",
"text" : "Age at Diagnosis",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA10399-6",
"display" : "50-59"
}
}
]
}
]
},
{
"linkId" : "2.1.2",
"text" : "This family member's history of disease",
"item" : [
{
"linkId" : "2.1.2.1",
"text" : "Disease or Condition",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA16982-3",
"display" : "Asthma"
}
}
]
},
{
"linkId" : "2.1.2.2",
"text" : "Age at Diagnosis",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA10395-4",
"display" : "Childhood"
}
}
]
}
]
}
]
},
{
"linkId" : "2",
"definition" : "http://loinc.org/fhir/DataElement/54114-4",
"text" : "Family member health information",
"item" : [
{
"linkId" : "2.1.1",
"item" : [
{
"linkId" : "2.1.1.1",
"definition" : "http://loinc.org/fhir/DataElement/54136-7",
"text" : "Relationship to you",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA10411-9",
"display" : "Maternal Cousin"
}
}
]
},
{
"linkId" : "2.1.1.2",
"definition" : "http://loinc.org/fhir/DataElement/54138-3",
"text" : "Name",
"answer" : [
{
"valueString" : "Karren"
}
]
},
{
"linkId" : "2.1.1.3",
"definition" : "http://loinc.org/fhir/DataElement/54123-5",
"text" : "Gender",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA3-6",
"display" : "Female"
}
}
]
},
{
"linkId" : "2.1.1.4",
"definition" : "http://loinc.org/fhir/DataElement/54139-1",
"text" : "Living?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA33-6",
"display" : "Yes"
},
"item" : [
{
"linkId" : "2.1.1.4.2",
"item" : [
{
"linkId" : "2.1.1.4.2.2",
"definition" : "http://loinc.org/fhir/DataElement/54141-7",
"text" : "Age",
"answer" : [
{
"valueDecimal" : 30
}
]
}
]
}
]
}
]
},
{
"linkId" : "2.1.1.5",
"definition" : "http://loinc.org/fhir/DataElement/54121-9",
"text" : "Was this person born a twin?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
}
}
]
},
{
"linkId" : "2.1.1.6",
"definition" : "http://loinc.org/fhir/DataElement/54122-7",
"text" : "Was this person adopted?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
}
}
]
}
]
},
{
"linkId" : "2.1.2",
"text" : "This family member's history of disease",
"item" : [
{
"linkId" : "2.1.2.1",
"text" : "Disease or Condition",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA14283-8",
"display" : "Breast Cancer"
}
}
]
},
{
"linkId" : "2.1.2.2",
"text" : "Age at Diagnosis",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA10397-0",
"display" : "30-39"
}
}
]
}
]
}
]
},
{
"linkId" : "2",
"definition" : "http://loinc.org/fhir/DataElement/54114-4",
"text" : "Family member health information",
"item" : [
{
"linkId" : "2.1.1",
"item" : [
{
"linkId" : "2.1.1.1",
"definition" : "http://loinc.org/fhir/DataElement/54136-7",
"text" : "Relationship to you",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA10411-9",
"display" : "Maternal Cousin"
}
}
]
},
{
"linkId" : "2.1.1.2",
"definition" : "http://loinc.org/fhir/DataElement/54138-3",
"text" : "Name",
"answer" : [
{
"valueString" : "Mary"
}
]
},
{
"linkId" : "2.1.1.3",
"definition" : "http://loinc.org/fhir/DataElement/54123-5",
"text" : "Gender",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA3-6",
"display" : "Female"
}
}
]
},
{
"linkId" : "2.1.1.4",
"definition" : "http://loinc.org/fhir/DataElement/54139-1",
"text" : "Living?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA33-6",
"display" : "Yes"
},
"item" : [
{
"linkId" : "2.1.1.4.2",
"item" : [
{
"linkId" : "2.1.1.4.2.2",
"definition" : "http://loinc.org/fhir/DataElement/54141-7",
"text" : "Age",
"answer" : [
{
"valueDecimal" : 31
}
]
}
]
}
]
}
]
},
{
"linkId" : "2.1.1.5",
"definition" : "http://loinc.org/fhir/DataElement/54121-9",
"text" : "Was this person born a twin?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
}
}
]
},
{
"linkId" : "2.1.1.6",
"definition" : "http://loinc.org/fhir/DataElement/54122-7",
"text" : "Was this person adopted?",
"answer" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
}
}
]
}
]
}
]
}
]
}
}
]
}
IG © 2022+ HL7 International / FHIR Infrastructure. Package hl7.fhir.uv.sdc#4.0.0-ballot based on FHIR 4.0.1. Generated 2024-12-17
Links: Table of Contents |
QA Report
| Version History |
|
Propose a change