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