SDC-Response to LOINC USSG Family History - Structured Data Capture v4.0.0-ballot

Structured Data Capture
4.0.0-ballot - STU 4 ballot International flag

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

Example QuestionnaireResponse: SDC-Response to LOINC USSG Family History

Page standards status: Informative

Generated Narrative: QuestionnaireResponse questionnaireresponse-sdc-example-ussg-fht-answers

LinkID	Text	Answer
questionnaireresponse-sdc-example-ussg-fht-answers		Questionnaire:US Surgeon General - Family Health Portrait
0
0.1	Date Done	2008-01-17
1	Your health information
1.1
1.1.1	Name	Annie Proband
1.1.2	Gender	LOINC LA3-6: Female
1.1.3	Date of Birth	1966-04-04
1.1.4	Were you born a twin?	LOINC LA32-8: No
1.1.5	Were you adopted?	LOINC LA32-8: No
1.1.6	Are your parents related to each other in any way other than marriage?	LOINC LA32-8: No
1.1.7	Height	63
1.1.7.1.1	Units	UCUM [in_i]: [in_i]
1.1.8	Weight	127
1.1.8.1.1	Units	UCUM [lb_av]: [lb_av]
1.1.9	Body mass index (BMI) [Ratio]	22.5
1.1.10	Race	LOINC LA4457-3: White
1.1.11	Ethnicity
2	Family member health information
2.1.1
2.1.1.1	Relationship to you	LOINC LA10405-1: Daughter
2.1.1.2	Name	Susan
2.1.1.3	Gender	LOINC LA3-6: Female
2.1.1.4	Living?	LOINC LA33-6: Yes
2.1.1.4.2
2.1.1.4.2.2	Age	17
2.1.1.5	Was this person born a twin?	LOINC LA32-8: No
2.1.1.6	Was this person adopted?	LOINC LA32-8: No
2	Family member health information
2.1.1
2.1.1.1	Relationship to you	LOINC LA10415-0: Brother
2.1.1.2	Name	Brian
2.1.1.3	Gender	LOINC LA2-8: Male
2.1.1.4	Living?	LOINC LA33-6: Yes
2.1.1.4.2
2.1.1.4.2.2	Age	32
2.1.1.5	Was this person born a twin?	LOINC LA32-8: No
2.1.1.6	Was this person adopted?	LOINC LA32-8: No
2.1.2	This family member's history of disease
2.1.2.1	Disease or Condition	LOINC LA14284-6: Other Cancer
2.1.2.2	Age at Diagnosis	LOINC LA10397-0: 30-39
2	Family member health information
2.1.1
2.1.1.1	Relationship to you	LOINC LA10418-4: Sister
2.1.1.2	Name	Janet
2.1.1.3	Gender	LOINC LA3-6: Female
2.1.1.4	Living?	LOINC LA33-6: Yes
2.1.1.4.2
2.1.1.4.2.2	Age	36
2.1.1.5	Was this person born a twin?	LOINC LA32-8: No
2.1.1.6	Was this person adopted?	LOINC LA32-8: No
2.1.2	This family member's history of disease
2.1.2.1	Disease or Condition	LOINC LA14283-8: Breast Cancer
2.1.2.2	Age at Diagnosis	LOINC LA10397-0: 30-39
2	Family member health information
2.1.1
2.1.1.1	Relationship to you	LOINC LA10419-2: Nephew
2.1.1.2	Name	Ian
2.1.1.3	Gender	LOINC LA2-8: Male
2.1.1.4	Living?	LOINC LA33-6: Yes
2.1.1.4.2
2.1.1.4.2.2	Age	16
2.1.1.5	Was this person born a twin?	LOINC LA32-8: No
2.1.1.6	Was this person adopted?	LOINC LA32-8: No
2	Family member health information
2.1.1
2.1.1.1	Relationship to you	LOINC LA10420-0: Niece
2.1.1.2	Name	Helen
2.1.1.3	Gender	LOINC LA3-6: Female
2.1.1.4	Living?	LOINC LA33-6: Yes
2.1.1.4.2
2.1.1.4.2.2	Age	15
2.1.1.5	Was this person born a twin?	LOINC LA32-8: No
2.1.1.6	Was this person adopted?	LOINC LA32-8: No
2	Family member health information
2.1.1
2.1.1.1	Relationship to you	LOINC LA10416-8: Father
2.1.1.2	Name	Donald
2.1.1.3	Gender	LOINC LA2-8: Male
2.1.1.4	Living?	LOINC LA33-6: Yes
2.1.1.4.2
2.1.1.4.2.2	Age	52
2.1.1.5	Was this person born a twin?	LOINC LA32-8: No
2.1.1.6	Was this person adopted?	LOINC LA32-8: No
2	Family member health information
2.1.1
2.1.1.1	Relationship to you	LOINC LA10425-9: Paternal Uncle
2.1.1.2	Name	Eric
2.1.1.3	Gender	LOINC LA2-8: Male
2.1.1.4	Living?	LOINC LA33-6: Yes
2.1.1.4.2
2.1.1.4.2.2	Age	56
2.1.1.5	Was this person born a twin?	LOINC LA32-8: No
2.1.1.6	Was this person adopted?	LOINC LA32-8: No
2	Family member health information
2.1.1
2.1.1.1	Relationship to you	LOINC LA10421-8: Paternal Aunt
2.1.1.2	Name	Fiona
2.1.1.3	Gender	LOINC LA3-6: Female
2.1.1.4	Living?	LOINC LA33-6: Yes
2.1.1.4.2
2.1.1.4.2.2	Age	57
2.1.1.5	Was this person born a twin?	LOINC LA32-8: No
2.1.1.6	Was this person adopted?	LOINC LA32-8: No
2.1.2	This family member's history of disease
2.1.2.1	Disease or Condition	LOINC LA10543-9: Skin Cancer
2	Family member health information
2.1.1
2.1.1.1	Relationship to you	LOINC LA10423-4: Paternal Grandfather
2.1.1.2	Name	Bob
2.1.1.3	Gender	LOINC LA2-8: Male
2.1.1.4	Living?	LOINC LA32-8: No
2.1.1.4.1
2.1.1.4.1.1	Cause of Death	LOINC LA10537-1: Colon Cancer
2.1.1.4.1.2	Age at Death	LOINC LA10400-2: OVER 60
2.1.1.5	Was this person born a twin?	LOINC LA32-8: No
2.1.1.6	Was this person adopted?	LOINC LA32-8: No
2.1.2	This family member's history of disease
2.1.2.1	Disease or Condition	LOINC LA10537-1: Colon Cancer
2.1.2.2	Age at Diagnosis	LOINC LA10400-2: OVER 60
2	Family member health information
2.1.1
2.1.1.1	Relationship to you	LOINC LA10424-2: Paternal Grandmother
2.1.1.2	Name	Claire
2.1.1.3	Gender	LOINC LA3-6: Female
2.1.1.4	Living?	LOINC LA32-8: No
2.1.1.4.1
2.1.1.4.1.1	Cause of Death	LOINC LA10589-2: Other/Unexpected
2.1.1.4.1.1.1	Please specify	Lou Gehrigs
2.1.1.4.1.2	Age at Death	LOINC LA10400-2: OVER 60
2.1.1.5	Was this person born a twin?	LOINC LA32-8: No
2.1.1.6	Was this person adopted?	LOINC LA32-8: No
2	Family member health information
2.1.1
2.1.1.1	Relationship to you	LOINC LA10417-6: Mother
2.1.1.2	Name	Harriet
2.1.1.3	Gender	LOINC LA3-6: Female
2.1.1.4	Living?	LOINC LA32-8: No
2.1.1.4.1
2.1.1.4.1.1	Cause of Death	LOINC LA15682-0: Ovarian Cancer
2.1.1.4.1.2	Age at Death	LOINC LA10399-6: 50-59
2.1.1.5	Was this person born a twin?	LOINC LA32-8: No
2.1.1.6	Was this person adopted?	LOINC LA32-8: No
2.1.2	This family member's history of disease
2.1.2.1	Disease or Condition	LOINC LA15682-0: Ovarian Cancer
2.1.2.2	Age at Diagnosis	LOINC LA10398-8: 40-49
2	Family member health information
2.1.1
2.1.1.1	Relationship to you	LOINC LA10414-3: Maternal Uncle
2.1.1.2	Name	Rudy
2.1.1.3	Gender	LOINC LA2-8: Male
2.1.1.4	Living?	LOINC LA33-6: Yes
2.1.1.4.2
2.1.1.4.2.2	Age	60
2.1.1.5	Was this person born a twin?	LOINC LA32-8: No
2.1.1.6	Was this person adopted?	LOINC LA32-8: No
2	Family member health information
2.1.1
2.1.1.1	Relationship to you	LOINC LA10410-1: Maternal Aunt
2.1.1.2	Name	Julie
2.1.1.3	Gender	LOINC LA3-6: Female
2.1.1.4	Living?	LOINC LA33-6: Yes
2.1.1.4.2
2.1.1.4.2.2	Age	57
2.1.1.5	Was this person born a twin?	LOINC LA32-8: No
2.1.1.6	Was this person adopted?	LOINC LA32-8: No
2	Family member health information
2.1.1
2.1.1.1	Relationship to you	LOINC LA10412-7: Maternal Grandfather
2.1.1.2	Name	Ian
2.1.1.3	Gender	LOINC LA2-8: Male
2.1.1.4	Living?	LOINC LA32-8: No
2.1.1.4.1
2.1.1.4.1.1	Cause of Death	LOINC LA16286-9: Heart attack
2.1.1.4.1.2	Age at Death	LOINC LA10400-2: OVER 60
2.1.1.5	Was this person born a twin?	LOINC LA32-8: No
2.1.1.6	Was this person adopted?	LOINC LA32-8: No
2	Family member health information
2.1.1
2.1.1.1	Relationship to you	LOINC LA10413-5: Maternal Grandmother
2.1.1.2	Name	Gladys
2.1.1.3	Gender	LOINC LA3-6: Female
2.1.1.4	Living?	LOINC LA32-8: No
2.1.1.4.1
2.1.1.4.1.1	Cause of Death	LOINC LA10589-2: Other/Unexpected
2.1.1.4.1.2	Age at Death	LOINC LA10400-2: OVER 60
2.1.1.5	Was this person born a twin?	LOINC LA32-8: No
2.1.1.6	Was this person adopted?	LOINC LA32-8: No
2.1.2	This family member's history of disease
2.1.2.1	Disease or Condition	LOINC LA14283-8: Breast Cancer
2.1.2.2	Age at Diagnosis	LOINC LA10399-6: 50-59
2.1.2	This family member's history of disease
2.1.2.1	Disease or Condition	LOINC LA16982-3: Asthma
2.1.2.2	Age at Diagnosis	LOINC LA10395-4: Childhood
2	Family member health information
2.1.1
2.1.1.1	Relationship to you	LOINC LA10411-9: Maternal Cousin
2.1.1.2	Name	Karren
2.1.1.3	Gender	LOINC LA3-6: Female
2.1.1.4	Living?	LOINC LA33-6: Yes
2.1.1.4.2
2.1.1.4.2.2	Age	30
2.1.1.5	Was this person born a twin?	LOINC LA32-8: No
2.1.1.6	Was this person adopted?	LOINC LA32-8: No
2.1.2	This family member's history of disease
2.1.2.1	Disease or Condition	LOINC LA14283-8: Breast Cancer
2.1.2.2	Age at Diagnosis	LOINC LA10397-0: 30-39
2	Family member health information
2.1.1
2.1.1.1	Relationship to you	LOINC LA10411-9: Maternal Cousin
2.1.1.2	Name	Mary
2.1.1.3	Gender	LOINC LA3-6: Female
2.1.1.4	Living?	LOINC LA33-6: Yes
2.1.1.4.2
2.1.1.4.2.2	Age	31
2.1.1.5	Was this person born a twin?	LOINC LA32-8: No
2.1.1.6	Was this person adopted?	LOINC LA32-8: No
Documentation for this format

<prev

top

next>

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