HL7.FHIR.UV.SDC\SDC-Response to LOINC USSG Family History

Structured Data Capture
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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

Example QuestionnaireResponse: SDC-Response to LOINC USSG Family History

Page standards status: Informative

LinkId	Text	Definition	Answer
questionnaireresponse-sdc-example-ussg-fht-answers		QuestionnaireResponse
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]: inch (international)
1.1.8	Weight		127
1.1.8.1.1	Units		UCUM [lb_av]: pound (US and British)
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

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