Release 4B Ballot #1

This page is part of the FHIR Specification (v4.1.0: Release 4B Ballot #1). The current version which supercedes this version is 5.0.0. For a full list of available versions, see the Directory of published versions . Page versions: R5 R4B R4 R3

Questionnaireresponse-example-ussg-fht-answers.xml

FHIR Infrastructure Work GroupMaturity Level: N/AStandards Status: InformativeCompartments: Device, Encounter, Patient, Practitioner, RelatedPerson

Raw XML (canonical form + also see XML Format Specification)

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Example response to the SDC-LOINC USSG Family History questionnaire (id = "ussg-fht-answers")

<?xml version="1.0" encoding="UTF-8"?>

<QuestionnaireResponse xmlns="http://hl7.org/fhir">
  <id value="ussg-fht-answers"/> 
  <text> <status value="generated"/> <div xmlns="http://www.w3.org/1999/xhtml"><div> todo</div> </div> </text> <questionnaire value="http://hl7.org/fhir/Questionnaire/ussg-fht"/> 
  <status value="in-progress"/> 
  <subject> 
    <reference value="http://hl7.org/fhir/Patient/proband"/> 
    <type value="Patient"/> 
  </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"/> 
            <item> 
              <linkId value="1.1.7.1.1"/> 
              <text value="Units"/> 
              <answer> 
                <valueCoding> 
                  <system value="http://unitsofmeasure.org"/> 
                  <code value="[in_i]"/> 
                  <display value="inches"/> 
                </valueCoding> 
              </answer> 
            </item> 
          </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"/> 
            <item> 
              <linkId value="1.1.8.1.1"/> 
              <text value="Units"/> 
              <answer> 
                <valueCoding> 
                  <system value="http://unitsofmeasure.org"/> 
                  <code value="[lb_av]"/> 
                  <display value="pounds"/> 
                </valueCoding> 
              </answer> 
            </item> 
          </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="LA10602-3"/> 
            <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"/> 
<!--    see comment in questionnaire     <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="2.1"/> 
      <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="LA10550-4"/> 
              <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="2.1"/> 
      <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="LA10536-3"/> 
              <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="2.1"/> 
      <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="2.1"/> 
      <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="2.1"/> 
      <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="2.1"/> 
      <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="2.1"/> 
      <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="2.1"/> 
      <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="2.1"/> 
      <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="2.1"/> 
      <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="LA10539-7"/> 
                    <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="LA10539-7"/> 
              <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="2.1"/> 
      <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="2.1"/> 
      <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="2.1"/> 
      <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="LA10558-7"/> 
                    <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="2.1"/> 
      <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="LA10571-0"/> 
                    <display value="-- Other/Unknown"/> 
                  </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="LA10536-3"/> 
              <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="LA10564-5"/> 
              <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="2.1"/> 
      <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="LA10536-3"/> 
              <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="2.1"/> 
      <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> 
  </item> 
</QuestionnaireResponse>

Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.