This page is part of the Structured Data Capture FHIR IG (v3.0.0: STU 3) based on FHIR R4. This is the current published version in its permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions
Page standards status: Draft | Maturity Level: 0 |
<Questionnaire xmlns="http://hl7.org/fhir">
<id value="questionnaire-sdc-profile-example-hunger-vital-signs"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><b>Structure</b><table border="1" cellpadding="0" cellspacing="0" style="border: 1px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;"><tr style="border: 2px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top"><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="The linkId for the item">LinkId</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Text for the item">Text</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Minimum and Maximum # of times the the itemcan appear in the instance">Cardinality</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="The type of the item">Type</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Other attributes of the item">Flags</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Additional information about the item">Description & Constraints</a><span style="float: right"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="http://hl7.org/fhir/R4/help16.png" alt="doco" style="background-color: inherit"/></a></span></th></tr><tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_q_root.gif" alt="." style="background-color: white; background-color: inherit" title="QuestionnaireRoot" class="hierarchy"/> QuestionnaireSdcProfileExampleHungerVitalSigns</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">A hunger vital signs form (showing calculatedExpression selecting a value from a list).</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Questionnaire</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">http://hl7.org/fhir/uv/sdc/Questionnaire/questionnaire-sdc-profile-example-hunger-vital-signs#3.0.0</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item./88122-7" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Coding" class="hierarchy"/> /88122-7</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Within the past 12Mo we worried whether our food would run out before we got money to buy more</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item./88122-7">4 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item./88123-5" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="Coding" class="hierarchy"/> /88123-5</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Within the past 12Mo the food we bought just didn't last and we didn't have money to get more [U.S. FSS]</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item./88123-5">4 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck01.png)" id="item./88124-3" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Coding" class="hierarchy"/> /88124-3</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Food insecurity risk</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/questionnaire-definitions.html#Questionnaire.item.readOnly" title="Is Readonly"><img src="icon-qi-readonly.png"/></a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item./88124-3">2 options</a><br/>Expressions: <ul><li style="font-size: 11px"><a href="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-calculatedExpression">Calculated Value</a>: <code>iif(%answeredEitherQ, iif(%riskStatus, %atRiskCoding, %noRiskCoding), {})</code></li></ul></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck000.png)" id="item./88124-3-help" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-display.png" alt="." style="background-color: white; background-color: inherit" title="Display" class="hierarchy"/> /88124-3-help</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">An answer of "often true" or "sometimes true" to either or both of the Hunger Vital Sign™ questions identifies a patient as at risk for food insecurity (FI).</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-display">display</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr><td colspan="6" class="hierarchy"><br/><a href="http://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="http://hl7.org/fhir/R4/help16.png" alt="doco" style="background-color: inherit"/> Documentation for this format</a></td></tr></table><hr/><p><b>Option Sets</b></p><a name="opt-item./88122-7"> </a><p><b>Answer options for /88122-7</b></p><ul><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.1.0/CodeSystem-v3-loinc.html">LOINC</a>: LA28397-0 ("Often true")</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.1.0/CodeSystem-v3-loinc.html">LOINC</a>: LA6729-3 ("Sometimes true")</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.1.0/CodeSystem-v3-loinc.html">LOINC</a>: LA28398-8 ("Never true")</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.1.0/CodeSystem-v3-loinc.html">LOINC</a>: LA15775-2 ("Don't know/refused")</li></ul><a name="opt-item./88123-5"> </a><p><b>Answer options for /88123-5</b></p><ul><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.1.0/CodeSystem-v3-loinc.html">LOINC</a>: LA28397-0 ("Often true")</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.1.0/CodeSystem-v3-loinc.html">LOINC</a>: LA6729-3 ("Sometimes true")</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.1.0/CodeSystem-v3-loinc.html">LOINC</a>: LA28398-8 ("Never true")</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.1.0/CodeSystem-v3-loinc.html">LOINC</a>: LA15775-2 ("Don't know/refused")</li></ul><a name="opt-item./88124-3"> </a><p><b>Answer options for /88124-3</b></p><ul><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.1.0/CodeSystem-v3-loinc.html">LOINC</a>: LA19952-3 ("At risk")</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.1.0/CodeSystem-v3-loinc.html">LOINC</a>: LA19983-8 ("No risk")</li></ul></div>
</text>
<extension url="http://hl7.org/fhir/StructureDefinition/variable">
<valueExpression>
<name value="worriedAnsCode"/>
<language value="text/fhirpath"/>
<expression
value="%resource.item.where(linkId='/88122-7').answer.value.code"/>
</valueExpression>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/variable">
<valueExpression>
<name value="ranOutAnsCode"/>
<language value="text/fhirpath"/>
<expression
value="%resource.item.where(linkId='/88123-5').answer.value.code"/>
</valueExpression>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/variable">
<valueExpression>
<name value="riskCodes"/>
<language value="text/fhirpath"/>
<expression value="'LA28397-0'.combine('LA6729-3')"/>
</valueExpression>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/variable">
<valueExpression>
<name value="riskStatus"/>
<language value="text/fhirpath"/>
<expression
value="%riskCodes contains %worriedAnsCode or %riskCodes contains %ranOutAnsCode"/>
</valueExpression>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/variable">
<valueExpression>
<name value="answeredEitherQ"/>
<language value="text/fhirpath"/>
<expression value="%worriedAnsCode.exists() or %ranOutAnsCode.exists()"/>
</valueExpression>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-standards-status">
<valueCode value="draft"/>
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<extension
url="http://hl7.org/fhir/StructureDefinition/structuredefinition-fmm">
<valueInteger value="0"/>
</extension>
<url
value="http://hl7.org/fhir/uv/sdc/Questionnaire/questionnaire-sdc-profile-example-hunger-vital-signs"/>
<version value="3.0.0"/>
<name value="QuestionnaireSdcProfileExampleHungerVitalSigns"/>
<title value="Hunger Vital Sign [HVS]"/>
<status value="draft"/>
<experimental value="true"/>
<subjectType value="Patient"/>
<date value="2022-03-08T18:33:14+00:00"/>
<publisher value="HL7 International - FHIR Infrastructure Work Group"/>
<contact>
<telecom>
<system value="url"/>
<value value="http://hl7.org/Special/committees/fiwg"/>
</telecom>
</contact>
<description
value="A hunger vital signs form (showing calculatedExpression selecting a value from a list)."/>
<jurisdiction>
<coding>
<system value="http://unstats.un.org/unsd/methods/m49/m49.htm"/>
<code value="001"/>
</coding>
</jurisdiction>
<code>
<system value="http://loinc.org"/>
<code value="88121-9"/>
<display value="Hunger Vital Sign [HVS]"/>
</code>
<item>
<extension
url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
<valueCodeableConcept>
<coding>
<system value="http://hl7.org/fhir/questionnaire-item-control"/>
<code value="drop-down"/>
<display value="Drop down"/>
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<text value="Drop down"/>
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</extension>
<linkId value="/88122-7"/>
<code>
<system value="http://loinc.org"/>
<code value="88122-7"/>
<display
value="Within the past 12 months we worried whether our food would run out before we got money to buy more [U.S. FSS]"/>
</code>
<text
value="Within the past 12Mo we worried whether our food would run out before we got money to buy more"/>
<type value="choice"/>
<required value="false"/>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA28397-0"/>
<display value="Often true"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA6729-3"/>
<display value="Sometimes true"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA28398-8"/>
<display value="Never true"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA15775-2"/>
<display value="Don't know/refused"/>
</valueCoding>
</answerOption>
</item>
<item>
<extension
url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
<valueCodeableConcept>
<coding>
<system value="http://hl7.org/fhir/questionnaire-item-control"/>
<code value="drop-down"/>
<display value="Drop down"/>
</coding>
<text value="Drop down"/>
</valueCodeableConcept>
</extension>
<linkId value="/88123-5"/>
<code>
<system value="http://loinc.org"/>
<code value="88123-5"/>
<display
value="Within the past 12 months the food we bought just didn't last and we didn't have money to get more [U.S. FSS]"/>
</code>
<text
value="Within the past 12Mo the food we bought just didn't last and we didn't have money to get more [U.S. FSS]"/>
<type value="choice"/>
<required value="false"/>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA28397-0"/>
<display value="Often true"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA6729-3"/>
<display value="Sometimes true"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA28398-8"/>
<display value="Never true"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA15775-2"/>
<display value="Don't know/refused"/>
</valueCoding>
</answerOption>
</item>
<item>
<extension
url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
<valueCodeableConcept>
<coding>
<system value="http://hl7.org/fhir/questionnaire-item-control"/>
<code value="drop-down"/>
<display value="Drop down"/>
</coding>
<text value="Drop down"/>
</valueCodeableConcept>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/variable">
<valueExpression>
<name value="thisItem"/>
<language value="text/fhirpath"/>
<expression
value="%questionnaire.item.where(linkId = '/88124-3')"/>
</valueExpression>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/variable">
<valueExpression>
<name value="atRiskCoding"/>
<language value="text/fhirpath"/>
<expression
value="%thisItem.answerOption.valueCoding.where(code='LA19952-3')"/>
</valueExpression>
</extension>
<extension url="http://hl7.org/fhir/StructureDefinition/variable">
<valueExpression>
<name value="noRiskCoding"/>
<language value="text/fhirpath"/>
<expression
value="%thisItem.answerOption.valueCoding.where(code='LA19983-8')"/>
</valueExpression>
</extension>
<extension
url="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-calculatedExpression">
<valueExpression>
<description value="risk determination"/>
<language value="text/fhirpath"/>
<expression
value="iif(%answeredEitherQ, iif(%riskStatus, %atRiskCoding, %noRiskCoding), {})"/>
</valueExpression>
</extension>
<linkId value="/88124-3"/>
<code>
<system value="http://loinc.org"/>
<code value="88124-3"/>
<display value="Food insecurity risk [HVS]"/>
</code>
<text value="Food insecurity risk"/>
<type value="choice"/>
<required value="false"/>
<readOnly value="true"/>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA19952-3"/>
<display value="At risk"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA19983-8"/>
<display value="No risk"/>
</valueCoding>
</answerOption>
<item>
<extension
url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
<valueCodeableConcept>
<coding>
<system value="http://hl7.org/fhir/questionnaire-item-control"/>
<code value="help"/>
<display value="Help-Button"/>
</coding>
<text value="Help-Button"/>
</valueCodeableConcept>
</extension>
<linkId value="/88124-3-help"/>
<text
value="An answer of "often true" or "sometimes true" to either or both of the Hunger Vital Sign™ questions identifies a patient as at risk for food insecurity (FI)."/>
<type value="display"/>
</item>
</item>
</Questionnaire>