SDOH Clinical Care
1.1.0 - STU 2 ballot
SDOH Clinical Care
1.1.0 - STU 2 ballot
This page is part of the SDOH Clinical Care for Multiple Domains (v1.1.0: STU 2 Ballot 1) based on FHIR R4. The current version which supercedes this version is 2.0.0. For a full list of available versions, see the Directory of published versions 
{
"resourceType" : "Questionnaire",
"id" : "SDOHCC-QuestionnairePRAPARE",
"meta" : {
"versionId" : "2",
"lastUpdated" : "2021-07-13T20:27:25.959+00:00",
"source" : "#rku93oA0ZVERGZAr",
"profile" : [
"http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-extract|2.7"
]
},
"text" : {
"status" : "generated",
"div" : "<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=\"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\"/> SDOHCCQuestionnairePRAPARE</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\"></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\"/></tr>\r\n<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)\" 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-group.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Group\" class=\"hierarchy\"/> /93025-5</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]</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-group\">group</a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<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_bck011.png)\" 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.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Group\" class=\"hierarchy\"/> /93043-8</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Personal characteristics</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-group\">group</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<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_bck0110.png)\" 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_vline.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\"/> /93043-8/56051-6</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Do you consider yourself Hispanic/Latino?</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\">Options: <a href=\"#opt-item./93043-8/56051-6\">3 options</a></td></tr>\r\n<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_bck0110.png)\" 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_vline.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\"/> /93043-8/32624-9</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Race</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</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\">Options: <a href=\"#opt-item./93043-8/32624-9\">8 options</a></td></tr>\r\n<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_bck0110.png)\" 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_vline.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\"/> /93043-8/93035-4</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?</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\">Options: <a href=\"#opt-item./93043-8/93035-4\">3 options</a></td></tr>\r\n<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_bck0110.png)\" 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_vline.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\"/> /93043-8/93034-7</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Have you been discharged from the armed forces of the United States?</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\">Options: <a href=\"#opt-item./93043-8/93034-7\">3 options</a></td></tr>\r\n<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_bck0100.png)\" 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_vline.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\"/> /93043-8/54899-0</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Preferred language</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\">Options: <a href=\"#opt-item./93043-8/54899-0\">3 options</a></td></tr>\r\n<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_bck011.png)\" 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.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Group\" class=\"hierarchy\"/> /93042-0</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Family and home</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-group\">group</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<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_bck0110.png)\" 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_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-integer.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Integer\" class=\"hierarchy\"/> /93042-0/63512-8</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">How many people are living or staying at this address?</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-integer\">integer</a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<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_bck0111.png)\" 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_vline.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\"/> /93042-0/71802-3</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Housing status</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\">Options: <a href=\"#opt-item./93042-0/71802-3\">3 options</a></td></tr>\r\n<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_bck01100.png)\" 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_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.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: #F7F7F7; background-color: inherit\" title=\"Display\" class=\"hierarchy\"/> /93042-0/71802-3-help</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Describes patients living arrangement</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-display\">display</a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<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_bck0110.png)\" 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_vline.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\"/> /93042-0/93033-9</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Are you worried about losing your housing?</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\">Options: <a href=\"#opt-item./93042-0/93033-9\">3 options</a></td></tr>\r\n<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_bck0100.png)\" 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_vline.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-string.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"String\" class=\"hierarchy\"/> /93042-0/56799-0</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Address</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-string\">string</a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<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_bck011.png)\" 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.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Group\" class=\"hierarchy\"/> /93041-2</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Money and resources</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-group\">group</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<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_bck0110.png)\" 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_vline.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\"/> /93041-2/82589-3</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Highest level of educ</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\">Options: <a href=\"#opt-item./93041-2/82589-3\">4 options</a></td></tr>\r\n<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_bck0110.png)\" 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_vline.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\"/> /93041-2/67875-5</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Employment status current</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\">Options: <a href=\"#opt-item./93041-2/67875-5\">5 options</a></td></tr>\r\n<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_bck0110.png)\" 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_vline.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\"/> /93041-2/76437-3</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Primary insurance</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\">Options: <a href=\"#opt-item./93041-2/76437-3\">7 options</a></td></tr>\r\n<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_bck0110.png)\" 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_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-decimal.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Decimal\" class=\"hierarchy\"/> /93041-2/63586-2</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">What was your best estimate of the total income of all family members from all sources, before taxes, in last year?</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-decimal\">decimal</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<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_bck0110.png)\" 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_vline.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\"/> /93041-2/93031-3</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</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\">Options: <a href=\"#opt-item./93041-2/93031-3\">8 options</a></td></tr>\r\n<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_bck0100.png)\" 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_vline.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: white; background-color: inherit\" title=\"Coding\" class=\"hierarchy\"/> /93041-2/93030-5</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living?</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\">Options: <a href=\"#opt-item./93041-2/93030-5\">4 options</a></td></tr>\r\n<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_bck011.png)\" 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.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"Group\" class=\"hierarchy\"/> /93040-4</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Social and emotional health</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-group\">group</a></td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<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_bck0110.png)\" 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_vline.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\"/> /93040-4/93029-7</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?</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\">Options: <a href=\"#opt-item./93040-4/93029-7\">5 options</a></td></tr>\r\n<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_bck0100.png)\" 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_vline.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\"/> /93040-4/93038-8</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Stress is when someone feels tense, nervous, anxious or can't sleep at night because their mind is troubled. How stressed are you?</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\">Options: <a href=\"#opt-item./93040-4/93038-8\">6 options</a></td></tr>\r\n<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_bck001.png)\" 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-group.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Group\" class=\"hierarchy\"/> /93039-6</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Optional additional questions</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-group\">group</a></td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<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_bck0010.png)\" 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_blank.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\"/> /93039-6/93028-9</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?</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\">Options: <a href=\"#opt-item./93039-6/93028-9\">3 options</a></td></tr>\r\n<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_bck0010.png)\" 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_blank.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\"/> /93039-6/93027-1</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Are you a refugee?</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\">Options: <a href=\"#opt-item./93039-6/93027-1\">3 options</a></td></tr>\r\n<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_bck0010.png)\" 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_blank.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\"/> /93039-6/93026-3</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Do you feel physically and emotionally safe where you currently live?</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\">Options: <a href=\"#opt-item./93039-6/93026-3\">4 options</a></td></tr>\r\n<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_bck0000.png)\" 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_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-coding.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"Coding\" class=\"hierarchy\"/> /93039-6/76501-6</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 last year, have you been afraid of your partner or ex-partner?</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\">Options: <a href=\"#opt-item./93039-6/76501-6\">2 options</a></td></tr>\r\n<tr><td colspan=\"5\" 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./93043-8/56051-6\"> </a><p><b>Answer options for /93043-8/56051-6</b></p><ul><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA33-6 ("Yes")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA32-8 ("No")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA30122-8 ("I choose not to answer this question")</li></ul><a name=\"opt-item./93043-8/32624-9\"> </a><p><b>Answer options for /93043-8/32624-9</b></p><ul><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA6156-9 ("Asian")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA14045-1 ("Native Hawaiian")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA30187-1 ("Pacific Islander")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA14042-8 ("Black/African American")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA4457-3 ("White")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA4-4 ("American Indian/Alaskan Native")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA46-8 ("Other")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA30122-8 ("I choose not to answer this question")</li></ul><a name=\"opt-item./93043-8/93035-4\"> </a><p><b>Answer options for /93043-8/93035-4</b></p><ul><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA33-6 ("Yes")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA32-8 ("No")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA30122-8 ("I choose not to answer this question")</li></ul><a name=\"opt-item./93043-8/93034-7\"> </a><p><b>Answer options for /93043-8/93034-7</b></p><ul><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA33-6 ("Yes")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA32-8 ("No")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA30122-8 ("I choose not to answer this question")</li></ul><a name=\"opt-item./93043-8/54899-0\"> </a><p><b>Answer options for /93043-8/54899-0</b></p><ul><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA43-5 ("English")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA30188-9 ("Language other than English")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA30122-8 ("I choose not to answer this question")</li></ul><a name=\"opt-item./93042-0/71802-3\"> </a><p><b>Answer options for /93042-0/71802-3</b></p><ul><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA30189-7 ("I have housing")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA30190-5 ("I do not have housing (staying with others, in a hotel, in a shelter, living outside on the street, on a beach, in a car, or in a park)")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA30122-8 ("I choose not to answer this question")</li></ul><a name=\"opt-item./93042-0/93033-9\"> </a><p><b>Answer options for /93042-0/93033-9</b></p><ul><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA33-6 ("Yes")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA32-8 ("No")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA30122-8 ("I choose not to answer this question")</li></ul><a name=\"opt-item./93041-2/82589-3\"> </a><p><b>Answer options for /93041-2/82589-3</b></p><ul><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA30191-3 ("Less than high school degree")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA30192-1 ("High school diploma or GED")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA30193-9 ("More than high school")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA30122-8 ("I choose not to answer this question")</li></ul><a name=\"opt-item./93041-2/67875-5\"> </a><p><b>Answer options for /93041-2/67875-5</b></p><ul><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA17956-6 ("Unemployed")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA30138-4 ("Part-time or temporary work")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA30136-8 ("Full-time work")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA30137-6 ("Otherwise unemployed but not seeking work (ex: student, retired, disabled, unpaid primary care giver)")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA30122-8 ("I choose not to answer this question")</li></ul><a name=\"opt-item./93041-2/76437-3\"> </a><p><b>Answer options for /93041-2/76437-3</b></p><ul><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA30194-7 ("None/uninsured")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA17849-3 ("Medicaid")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA30195-4 ("CHIP Medicaid")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA15652-3 ("Medicare")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA30196-2 ("Other public insurance (not CHIP)")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA30197-0 ("Other public insurance (CHIP)")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA6350-8 ("Private insurance")</li></ul><a name=\"opt-item./93041-2/93031-3\"> </a><p><b>Answer options for /93041-2/93031-3</b></p><ul><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA30125-1 ("Food")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA30126-9 ("Clothing")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA30124-4 ("Utilities")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA30127-7 ("Child care")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA30128-5 ("Medicine or Any Health Care (Medical, Dental, Mental Health, Vision)")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA30129-3 ("Phone")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA46-8 ("Other")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA30122-8 ("I choose not to answer this question")</li></ul><a name=\"opt-item./93041-2/93030-5\"> </a><p><b>Answer options for /93041-2/93030-5</b></p><ul><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA30133-5 ("Yes, it has kept me from medical appointments or from getting my medications")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA30134-3 ("Yes, it has kept me from non-medical meetings, appointments, work, or from getting things that I need")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA32-8 ("No")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA30257-2 ("Patient unable to respond")</li></ul><a name=\"opt-item./93040-4/93029-7\"> </a><p><b>Answer options for /93040-4/93029-7</b></p><ul><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA27722-0 ("Less than once a week")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA30130-1 ("1 or 2 times a week")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA30131-9 ("3 to 5 times a week")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA30132-7 ("5 or more times a week")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA30122-8 ("I choose not to answer this question")</li></ul><a name=\"opt-item./93040-4/93038-8\"> </a><p><b>Answer options for /93040-4/93038-8</b></p><ul><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA6568-5 ("Not at all")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA13863-8 ("A little bit")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA13909-9 ("Somewhat")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA13902-4 ("Quite a bit")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA13914-9 ("Very much")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA30122-8 ("I choose not to answer this question")</li></ul><a name=\"opt-item./93039-6/93028-9\"> </a><p><b>Answer options for /93039-6/93028-9</b></p><ul><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA33-6 ("Yes")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA32-8 ("No")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA30122-8 ("I choose not to answer this question")</li></ul><a name=\"opt-item./93039-6/93027-1\"> </a><p><b>Answer options for /93039-6/93027-1</b></p><ul><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA33-6 ("Yes")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA32-8 ("No")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA30122-8 ("I choose not to answer this question")</li></ul><a name=\"opt-item./93039-6/93026-3\"> </a><p><b>Answer options for /93039-6/93026-3</b></p><ul><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA33-6 ("Yes")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA32-8 ("No")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA14072-5 ("Unsure")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA30122-8 ("I choose not to answer this question")</li></ul><a name=\"opt-item./93039-6/76501-6\"> </a><p><b>Answer options for /93039-6/76501-6</b></p><ul><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA33-6 ("Yes")</li><li style=\"font-size: 11px\"><a href=\"http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html\">LOINC</a>: LA32-8 ("No")</li></ul></div>"
},
"extension" : [
{
"url" : "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-targetStructureMap",
"valueCanonical" : "http://hl7.org/fhir/us/sdoh-clinicalcare/StructureMap/SDOHCC-StructureMapPRAPARE"
}
],
"url" : "http://hl7.org/fhir/us/sdoh-clinicalcare/Questionnaire/SDOHCC-QuestionnairePRAPARE",
"version" : "1.1.0",
"name" : "SDOHCCQuestionnairePRAPARE",
"title" : "SDOHCC Questionnaire PRAPARE",
"status" : "draft",
"subjectType" : [
"Patient"
],
"date" : "2021-04-01T04:01:34+00:00",
"publisher" : "HL7 International - Patient Care WG",
"contact" : [
{
"name" : "HL7 International - Patient Care",
"telecom" : [
{
"system" : "url",
"value" : "http://www.hl7.org/Special/committees/patientcare"
}
]
}
],
"jurisdiction" : [
{
"coding" : [
{
"system" : "urn:iso:std:iso:3166",
"code" : "US",
"display" : "United States of America"
}
],
"text" : "United States of America"
}
],
"copyright" : "Content is from the PRAPARE Survey with permission: © 2019. This item comes from the national PRAPARE social determinants of health assessment protocol, developed and owned by the National Association of Community Health Centers (NACHC), in partnership with the Association of Asian Pacific Community Health Organization (AAPCHO), the Oregon Primary Care Association (OPCA), and the Institute for Alternative Futures (IAF). For more information, visit [www.nachc.org/prapare](http://www.nachc.org/prapare)",
"item" : [
{
"linkId" : "/93025-5",
"code" : [
{
"system" : "http://loinc.org",
"code" : "93025-5",
"display" : "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]"
}
],
"text" : "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]",
"type" : "group",
"required" : false,
"item" : [
{
"linkId" : "/93043-8",
"code" : [
{
"system" : "http://loinc.org",
"code" : "93043-8",
"display" : "Personal characteristics"
}
],
"text" : "Personal characteristics",
"type" : "group",
"required" : false,
"item" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "drop-down",
"display" : "Drop down"
}
],
"text" : "Drop down"
}
}
],
"linkId" : "/93043-8/56051-6",
"code" : [
{
"system" : "http://loinc.org",
"code" : "56051-6",
"display" : "Do you consider yourself Hispanic/Latino?"
}
],
"text" : "Do you consider yourself Hispanic/Latino?",
"type" : "choice",
"required" : false,
"answerOption" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA33-6",
"display" : "Yes"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA30122-8",
"display" : "I choose not to answer this question"
}
}
]
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "drop-down",
"display" : "Drop down"
}
],
"text" : "Drop down"
}
}
],
"linkId" : "/93043-8/32624-9",
"code" : [
{
"system" : "http://loinc.org",
"code" : "32624-9",
"display" : "Race"
}
],
"text" : "Race",
"type" : "choice",
"required" : false,
"repeats" : true,
"answerOption" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA6156-9",
"display" : "Asian"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA14045-1",
"display" : "Native Hawaiian"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA30187-1",
"display" : "Pacific Islander"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA14042-8",
"display" : "Black/African American"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA4457-3",
"display" : "White"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA4-4",
"display" : "American Indian/Alaskan Native"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA46-8",
"display" : "Other"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA30122-8",
"display" : "I choose not to answer this question"
}
}
]
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "drop-down",
"display" : "Drop down"
}
],
"text" : "Drop down"
}
}
],
"linkId" : "/93043-8/93035-4",
"code" : [
{
"system" : "http://loinc.org",
"code" : "93035-4",
"display" : "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?"
}
],
"text" : "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?",
"type" : "choice",
"required" : false,
"answerOption" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA33-6",
"display" : "Yes"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA30122-8",
"display" : "I choose not to answer this question"
}
}
]
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "drop-down",
"display" : "Drop down"
}
],
"text" : "Drop down"
}
}
],
"linkId" : "/93043-8/93034-7",
"code" : [
{
"system" : "http://loinc.org",
"code" : "93034-7",
"display" : "Have you been discharged from the armed forces of the United States?"
}
],
"text" : "Have you been discharged from the armed forces of the United States?",
"type" : "choice",
"required" : false,
"answerOption" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA33-6",
"display" : "Yes"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA30122-8",
"display" : "I choose not to answer this question"
}
}
]
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "drop-down",
"display" : "Drop down"
}
],
"text" : "Drop down"
}
}
],
"linkId" : "/93043-8/54899-0",
"code" : [
{
"system" : "http://loinc.org",
"code" : "54899-0",
"display" : "Preferred language"
}
],
"text" : "Preferred language",
"type" : "choice",
"required" : false,
"answerOption" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA43-5",
"display" : "English"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA30188-9",
"display" : "Language other than English"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA30122-8",
"display" : "I choose not to answer this question"
}
}
]
}
]
},
{
"linkId" : "/93042-0",
"code" : [
{
"system" : "http://loinc.org",
"code" : "93042-0",
"display" : "Family and home"
}
],
"text" : "Family and home",
"type" : "group",
"required" : false,
"item" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-unit",
"valueCoding" : {
"system" : "http://unitsofmeasure.org",
"code" : "{#}",
"display" : "{#}"
}
}
],
"linkId" : "/93042-0/63512-8",
"code" : [
{
"system" : "http://loinc.org",
"code" : "63512-8",
"display" : "How many people are living or staying at this address?"
}
],
"text" : "How many people are living or staying at this address?",
"type" : "integer",
"required" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "drop-down",
"display" : "Drop down"
}
],
"text" : "Drop down"
}
}
],
"linkId" : "/93042-0/71802-3",
"code" : [
{
"system" : "http://loinc.org",
"code" : "71802-3",
"display" : "Housing status"
}
],
"text" : "Housing status",
"type" : "choice",
"required" : false,
"answerOption" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA30189-7",
"display" : "I have housing"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA30190-5",
"display" : "I do not have housing (staying with others, in a hotel, in a shelter, living outside on the street, on a beach, in a car, or in a park)"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA30122-8",
"display" : "I choose not to answer this question"
}
}
],
"item" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "help",
"display" : "Help-Button"
}
],
"text" : "Help-Button"
}
}
],
"linkId" : "/93042-0/71802-3-help",
"text" : "Describes patients living arrangement",
"type" : "display"
}
]
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "drop-down",
"display" : "Drop down"
}
],
"text" : "Drop down"
}
}
],
"linkId" : "/93042-0/93033-9",
"code" : [
{
"system" : "http://loinc.org",
"code" : "93033-9",
"display" : "Are you worried about losing your housing?"
}
],
"text" : "Are you worried about losing your housing?",
"type" : "choice",
"required" : false,
"answerOption" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA33-6",
"display" : "Yes"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA30122-8",
"display" : "I choose not to answer this question"
}
}
]
},
{
"linkId" : "/93042-0/56799-0",
"code" : [
{
"system" : "http://loinc.org",
"code" : "56799-0",
"display" : "Address"
}
],
"text" : "Address",
"type" : "string",
"required" : false
}
]
},
{
"linkId" : "/93041-2",
"code" : [
{
"system" : "http://loinc.org",
"code" : "93041-2",
"display" : "Money and resources"
}
],
"text" : "Money and resources",
"type" : "group",
"required" : false,
"item" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "drop-down",
"display" : "Drop down"
}
],
"text" : "Drop down"
}
}
],
"linkId" : "/93041-2/82589-3",
"code" : [
{
"system" : "http://loinc.org",
"code" : "82589-3",
"display" : "Highest level of educ"
}
],
"text" : "Highest level of educ",
"type" : "choice",
"required" : false,
"answerOption" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA30191-3",
"display" : "Less than high school degree"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA30192-1",
"display" : "High school diploma or GED"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA30193-9",
"display" : "More than high school"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA30122-8",
"display" : "I choose not to answer this question"
}
}
]
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "drop-down",
"display" : "Drop down"
}
],
"text" : "Drop down"
}
}
],
"linkId" : "/93041-2/67875-5",
"code" : [
{
"system" : "http://loinc.org",
"code" : "67875-5",
"display" : "Employment status current"
}
],
"text" : "Employment status current",
"type" : "choice",
"required" : false,
"answerOption" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA17956-6",
"display" : "Unemployed"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA30138-4",
"display" : "Part-time or temporary work"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA30136-8",
"display" : "Full-time work"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA30137-6",
"display" : "Otherwise unemployed but not seeking work (ex: student, retired, disabled, unpaid primary care giver)"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA30122-8",
"display" : "I choose not to answer this question"
}
}
]
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "drop-down",
"display" : "Drop down"
}
],
"text" : "Drop down"
}
}
],
"linkId" : "/93041-2/76437-3",
"code" : [
{
"system" : "http://loinc.org",
"code" : "76437-3",
"display" : "Primary insurance"
}
],
"text" : "Primary insurance",
"type" : "choice",
"required" : false,
"answerOption" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA30194-7",
"display" : "None/uninsured"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA17849-3",
"display" : "Medicaid"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA30195-4",
"display" : "CHIP Medicaid"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA15652-3",
"display" : "Medicare"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA30196-2",
"display" : "Other public insurance (not CHIP)"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA30197-0",
"display" : "Other public insurance (CHIP)"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA6350-8",
"display" : "Private insurance"
}
}
]
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-unit",
"valueCoding" : {
"system" : "http://unitsofmeasure.org",
"code" : "/a",
"display" : "/a"
}
}
],
"linkId" : "/93041-2/63586-2",
"code" : [
{
"system" : "http://loinc.org",
"code" : "63586-2",
"display" : "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?"
}
],
"text" : "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?",
"type" : "decimal",
"required" : false
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "drop-down",
"display" : "Drop down"
}
],
"text" : "Drop down"
}
}
],
"linkId" : "/93041-2/93031-3",
"code" : [
{
"system" : "http://loinc.org",
"code" : "93031-3",
"display" : "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?"
}
],
"text" : "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?",
"type" : "choice",
"required" : false,
"repeats" : true,
"answerOption" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA30125-1",
"display" : "Food"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA30126-9",
"display" : "Clothing"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA30124-4",
"display" : "Utilities"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA30127-7",
"display" : "Child care"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA30128-5",
"display" : "Medicine or Any Health Care (Medical, Dental, Mental Health, Vision)"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA30129-3",
"display" : "Phone"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA46-8",
"display" : "Other"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA30122-8",
"display" : "I choose not to answer this question"
}
}
]
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "drop-down",
"display" : "Drop down"
}
],
"text" : "Drop down"
}
}
],
"linkId" : "/93041-2/93030-5",
"code" : [
{
"system" : "http://loinc.org",
"code" : "93030-5",
"display" : "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living?"
}
],
"text" : "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living?",
"type" : "choice",
"required" : false,
"answerOption" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
"valueString" : "A"
}
],
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA30133-5",
"display" : "Yes, it has kept me from medical appointments or from getting my medications"
}
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
"valueString" : "B"
}
],
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA30134-3",
"display" : "Yes, it has kept me from non-medical meetings, appointments, work, or from getting things that I need"
}
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
"valueString" : "C"
}
],
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
}
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
"valueString" : "X"
}
],
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA30257-2",
"display" : "Patient unable to respond"
}
}
]
}
]
},
{
"linkId" : "/93040-4",
"code" : [
{
"system" : "http://loinc.org",
"code" : "93040-4",
"display" : "Social and emotional health"
}
],
"text" : "Social and emotional health",
"type" : "group",
"required" : false,
"item" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "drop-down",
"display" : "Drop down"
}
],
"text" : "Drop down"
}
}
],
"linkId" : "/93040-4/93029-7",
"code" : [
{
"system" : "http://loinc.org",
"code" : "93029-7",
"display" : "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?"
}
],
"text" : "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?",
"type" : "choice",
"required" : false,
"answerOption" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA27722-0",
"display" : "Less than once a week"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA30130-1",
"display" : "1 or 2 times a week"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA30131-9",
"display" : "3 to 5 times a week"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA30132-7",
"display" : "5 or more times a week"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA30122-8",
"display" : "I choose not to answer this question"
}
}
]
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "drop-down",
"display" : "Drop down"
}
],
"text" : "Drop down"
}
}
],
"linkId" : "/93040-4/93038-8",
"code" : [
{
"system" : "http://loinc.org",
"code" : "93038-8",
"display" : "Stress is when someone feels tense, nervous, anxious or can't sleep at night because their mind is troubled. How stressed are you?"
}
],
"text" : "Stress is when someone feels tense, nervous, anxious or can't sleep at night because their mind is troubled. How stressed are you?",
"type" : "choice",
"required" : false,
"answerOption" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA6568-5",
"display" : "Not at all"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA13863-8",
"display" : "A little bit"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA13909-9",
"display" : "Somewhat"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA13902-4",
"display" : "Quite a bit"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA13914-9",
"display" : "Very much"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA30122-8",
"display" : "I choose not to answer this question"
}
}
]
}
]
},
{
"linkId" : "/93039-6",
"code" : [
{
"system" : "http://loinc.org",
"code" : "93039-6",
"display" : "Optional additional questions"
}
],
"text" : "Optional additional questions",
"type" : "group",
"required" : false,
"item" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "drop-down",
"display" : "Drop down"
}
],
"text" : "Drop down"
}
}
],
"linkId" : "/93039-6/93028-9",
"code" : [
{
"system" : "http://loinc.org",
"code" : "93028-9",
"display" : "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?"
}
],
"text" : "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?",
"type" : "choice",
"required" : false,
"answerOption" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA33-6",
"display" : "Yes"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA30122-8",
"display" : "I choose not to answer this question"
}
}
]
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "drop-down",
"display" : "Drop down"
}
],
"text" : "Drop down"
}
}
],
"linkId" : "/93039-6/93027-1",
"code" : [
{
"system" : "http://loinc.org",
"code" : "93027-1",
"display" : "Are you a refugee?"
}
],
"text" : "Are you a refugee?",
"type" : "choice",
"required" : false,
"answerOption" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA33-6",
"display" : "Yes"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA30122-8",
"display" : "I choose not to answer this question"
}
}
]
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "drop-down",
"display" : "Drop down"
}
],
"text" : "Drop down"
}
}
],
"linkId" : "/93039-6/93026-3",
"code" : [
{
"system" : "http://loinc.org",
"code" : "93026-3",
"display" : "Do you feel physically and emotionally safe where you currently live?"
}
],
"text" : "Do you feel physically and emotionally safe where you currently live?",
"type" : "choice",
"required" : false,
"answerOption" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA33-6",
"display" : "Yes"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA14072-5",
"display" : "Unsure"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA30122-8",
"display" : "I choose not to answer this question"
}
}
]
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
"valueCodeableConcept" : {
"coding" : [
{
"system" : "http://hl7.org/fhir/questionnaire-item-control",
"code" : "drop-down",
"display" : "Drop down"
}
],
"text" : "Drop down"
}
}
],
"linkId" : "/93039-6/76501-6",
"code" : [
{
"system" : "http://loinc.org",
"code" : "76501-6",
"display" : "Within the last year, have you been afraid of your partner or ex-partner?"
}
],
"text" : "Within the last year, have you been afraid of your partner or ex-partner?",
"type" : "choice",
"required" : false,
"answerOption" : [
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
"valueString" : "1"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal" : 1
}
],
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA33-6",
"display" : "Yes"
}
},
{
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
"valueString" : "0"
},
{
"url" : "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal" : 0
}
],
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
}
}
]
}
]
}
]
}
]
}
IG © 2020+ HL7 International - Patient Care WG. Package hl7.fhir.us.sdoh-clinicalcare#1.1.0 based on FHIR 4.0.1. Generated 2021-12-07
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