HL7.FHIR.US.SDOH-CLINICALCARE\SDOHCC Questionnaire PRAPARE - XML Representation

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
: SDOHCC Questionnaire PRAPARE - XML Representation

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<Questionnaire xmlns="http://hl7.org/fhir">
  <id value="SDOHCC-QuestionnairePRAPARE"/>
  <meta>
    <versionId value="2"/>
    <lastUpdated value="2021-07-13T20:27:25.959+00:00"/>
    <source value="#rku93oA0ZVERGZAr"/>
    <profile
             value="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-extract|2.7"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><b>Structure</b><table border="1" cellpadding="0" cellspacing="0" style="border: 1px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;"><tr style="border: 2px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top"><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="The linkId for the item">LinkId</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Text for the item">Text</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Minimum and Maximum # of times the the itemcan appear in the instance">Cardinality</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="The type of the item">Type</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Additional information about the item">Description &amp; 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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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>
<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 (&quot;Yes&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA32-8 (&quot;No&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA30122-8 (&quot;I choose not to answer this question&quot;)</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 (&quot;Asian&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA14045-1 (&quot;Native Hawaiian&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA30187-1 (&quot;Pacific Islander&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA14042-8 (&quot;Black/African American&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA4457-3 (&quot;White&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA4-4 (&quot;American Indian/Alaskan Native&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA46-8 (&quot;Other&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA30122-8 (&quot;I choose not to answer this question&quot;)</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 (&quot;Yes&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA32-8 (&quot;No&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA30122-8 (&quot;I choose not to answer this question&quot;)</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 (&quot;Yes&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA32-8 (&quot;No&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA30122-8 (&quot;I choose not to answer this question&quot;)</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 (&quot;English&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA30188-9 (&quot;Language other than English&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA30122-8 (&quot;I choose not to answer this question&quot;)</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 (&quot;I have housing&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA30190-5 (&quot;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)&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA30122-8 (&quot;I choose not to answer this question&quot;)</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 (&quot;Yes&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA32-8 (&quot;No&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA30122-8 (&quot;I choose not to answer this question&quot;)</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 (&quot;Less than high school degree&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA30192-1 (&quot;High school diploma or GED&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA30193-9 (&quot;More than high school&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA30122-8 (&quot;I choose not to answer this question&quot;)</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 (&quot;Unemployed&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA30138-4 (&quot;Part-time or temporary work&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA30136-8 (&quot;Full-time work&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA30137-6 (&quot;Otherwise unemployed but not seeking work (ex: student, retired, disabled, unpaid primary care giver)&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA30122-8 (&quot;I choose not to answer this question&quot;)</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 (&quot;None/uninsured&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA17849-3 (&quot;Medicaid&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA30195-4 (&quot;CHIP Medicaid&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA15652-3 (&quot;Medicare&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA30196-2 (&quot;Other public insurance (not CHIP)&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA30197-0 (&quot;Other public insurance (CHIP)&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA6350-8 (&quot;Private insurance&quot;)</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 (&quot;Food&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA30126-9 (&quot;Clothing&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA30124-4 (&quot;Utilities&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA30127-7 (&quot;Child care&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA30128-5 (&quot;Medicine or Any Health Care (Medical, Dental, Mental Health, Vision)&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA30129-3 (&quot;Phone&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA46-8 (&quot;Other&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA30122-8 (&quot;I choose not to answer this question&quot;)</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 (&quot;Yes, it has kept me from medical appointments or from getting my medications&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA30134-3 (&quot;Yes, it has kept me from non-medical meetings, appointments, work, or from getting things that I need&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA32-8 (&quot;No&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA30257-2 (&quot;Patient unable to respond&quot;)</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 (&quot;Less than once a week&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA30130-1 (&quot;1 or 2 times a week&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA30131-9 (&quot;3 to 5 times a week&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA30132-7 (&quot;5 or more times a week&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA30122-8 (&quot;I choose not to answer this question&quot;)</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 (&quot;Not at all&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA13863-8 (&quot;A little bit&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA13909-9 (&quot;Somewhat&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA13902-4 (&quot;Quite a bit&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA13914-9 (&quot;Very much&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA30122-8 (&quot;I choose not to answer this question&quot;)</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 (&quot;Yes&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA32-8 (&quot;No&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA30122-8 (&quot;I choose not to answer this question&quot;)</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 (&quot;Yes&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA32-8 (&quot;No&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA30122-8 (&quot;I choose not to answer this question&quot;)</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 (&quot;Yes&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA32-8 (&quot;No&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA14072-5 (&quot;Unsure&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA30122-8 (&quot;I choose not to answer this question&quot;)</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 (&quot;Yes&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/3.0.0/CodeSystem-v3-loinc.html">LOINC</a>: LA32-8 (&quot;No&quot;)</li></ul></div>
  </text>
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  <title value="SDOHCC Questionnaire PRAPARE"/>
  <status value="draft"/>
  <subjectType value="Patient"/>
  <date value="2021-04-01T04:01:34+00:00"/>
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  <contact>
    <name value="HL7 International - Patient Care"/>
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  <jurisdiction>
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  <copyright
             value="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)"/>
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        <display value="Personal characteristics"/>
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      <text value="Personal characteristics"/>
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        <code>
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          <code value="56051-6"/>
          <display value="Do you consider yourself Hispanic/Latino?"/>
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        <text value="Do you consider yourself Hispanic/Latino?"/>
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          <display value="Race"/>
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        <text value="Race"/>
        <type value="choice"/>
        <required value="false"/>
        <repeats value="true"/>
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          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA6156-9"/>
            <display value="Asian"/>
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        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA14045-1"/>
            <display value="Native Hawaiian"/>
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        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30187-1"/>
            <display value="Pacific Islander"/>
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        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA14042-8"/>
            <display value="Black/African American"/>
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        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA4457-3"/>
            <display value="White"/>
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        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA4-4"/>
            <display value="American Indian/Alaskan Native"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA46-8"/>
            <display value="Other"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30122-8"/>
            <display value="I choose not to answer this question"/>
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          <display
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        <type value="choice"/>
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          <display
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        <text
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          <display value="Preferred language"/>
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        <text value="Preferred language"/>
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            <display value="English"/>
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            <display value="Language other than English"/>
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        <display value="Family and home"/>
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      <text value="Family and home"/>
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        <linkId value="/93042-0/71802-3"/>
        <code>
          <system value="http://loinc.org"/>
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          <display value="Housing status"/>
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        <text value="Housing status"/>
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        <required value="false"/>
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            <code value="LA30189-7"/>
            <display value="I have housing"/>
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            <display
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          <text value="Describes patients living arrangement"/>
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        <system value="http://loinc.org"/>
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      <text value="Money and resources"/>
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            <system value="http://loinc.org"/>
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            <display value="High school diploma or GED"/>
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            <system value="http://loinc.org"/>
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            <display value="More than high school"/>
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        </answerOption>
        <answerOption>
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            <system value="http://loinc.org"/>
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            <display value="I choose not to answer this question"/>
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          <display value="Employment status current"/>
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            <code value="LA17956-6"/>
            <display value="Unemployed"/>
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            <display value="Part-time or temporary work"/>
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            <display value="Full-time work"/>
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          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30137-6"/>
            <display
                     value="Otherwise unemployed but not seeking work (ex: student, retired, disabled, unpaid primary care giver)"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30122-8"/>
            <display value="I choose not to answer this question"/>
          </valueCoding>
        </answerOption>
      </item>
      <item>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="drop-down"/>
              <display value="Drop down"/>
            </coding>
            <text value="Drop down"/>
          </valueCodeableConcept>
        </extension>
        <linkId value="/93041-2/76437-3"/>
        <code>
          <system value="http://loinc.org"/>
          <code value="76437-3"/>
          <display value="Primary insurance"/>
        </code>
        <text value="Primary insurance"/>
        <type value="choice"/>
        <required value="false"/>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30194-7"/>
            <display value="None/uninsured"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA17849-3"/>
            <display value="Medicaid"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30195-4"/>
            <display value="CHIP Medicaid"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA15652-3"/>
            <display value="Medicare"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30196-2"/>
            <display value="Other public insurance (not CHIP)"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30197-0"/>
            <display value="Other public insurance (CHIP)"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA6350-8"/>
            <display value="Private insurance"/>
          </valueCoding>
        </answerOption>
      </item>
      <item>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-unit">
          <valueCoding>
            <system value="http://unitsofmeasure.org"/>
            <code value="/a"/>
            <display value="/a"/>
          </valueCoding>
        </extension>
        <linkId value="/93041-2/63586-2"/>
        <code>
          <system value="http://loinc.org"/>
          <code value="63586-2"/>
          <display
                   value="What was your best estimate of the total income of all family members from all sources, before taxes, in last year?"/>
        </code>
        <text
              value="What was your best estimate of the total income of all family members from all sources, before taxes, in last year?"/>
        <type value="decimal"/>
        <required value="false"/>
      </item>
      <item>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="drop-down"/>
              <display value="Drop down"/>
            </coding>
            <text value="Drop down"/>
          </valueCodeableConcept>
        </extension>
        <linkId value="/93041-2/93031-3"/>
        <code>
          <system value="http://loinc.org"/>
          <code value="93031-3"/>
          <display
                   value="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?"/>
        </code>
        <text
              value="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 value="choice"/>
        <required value="false"/>
        <repeats value="true"/>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30125-1"/>
            <display value="Food"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30126-9"/>
            <display value="Clothing"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30124-4"/>
            <display value="Utilities"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30127-7"/>
            <display value="Child care"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30128-5"/>
            <display
                     value="Medicine or Any Health Care (Medical, Dental, Mental Health, Vision)"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30129-3"/>
            <display value="Phone"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA46-8"/>
            <display value="Other"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30122-8"/>
            <display value="I choose not to answer this question"/>
          </valueCoding>
        </answerOption>
      </item>
      <item>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="drop-down"/>
              <display value="Drop down"/>
            </coding>
            <text value="Drop down"/>
          </valueCodeableConcept>
        </extension>
        <linkId value="/93041-2/93030-5"/>
        <code>
          <system value="http://loinc.org"/>
          <code value="93030-5"/>
          <display
                   value="Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living?"/>
        </code>
        <text
              value="Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living?"/>
        <type value="choice"/>
        <required value="false"/>
        <answerOption>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix">
            <valueString value="A"/>
          </extension>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30133-5"/>
            <display
                     value="Yes, it has kept me from medical appointments or from getting my medications"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix">
            <valueString value="B"/>
          </extension>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30134-3"/>
            <display
                     value="Yes, it has kept me from non-medical meetings, appointments, work, or from getting things that I need"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix">
            <valueString value="C"/>
          </extension>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA32-8"/>
            <display value="No"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix">
            <valueString value="X"/>
          </extension>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30257-2"/>
            <display value="Patient unable to respond"/>
          </valueCoding>
        </answerOption>
      </item>
    </item>
    <item>
      <linkId value="/93040-4"/>
      <code>
        <system value="http://loinc.org"/>
        <code value="93040-4"/>
        <display value="Social and emotional health"/>
      </code>
      <text value="Social and emotional health"/>
      <type value="group"/>
      <required value="false"/>
      <item>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="drop-down"/>
              <display value="Drop down"/>
            </coding>
            <text value="Drop down"/>
          </valueCodeableConcept>
        </extension>
        <linkId value="/93040-4/93029-7"/>
        <code>
          <system value="http://loinc.org"/>
          <code value="93029-7"/>
          <display
                   value="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)?"/>
        </code>
        <text
              value="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 value="choice"/>
        <required value="false"/>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA27722-0"/>
            <display value="Less than once a week"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30130-1"/>
            <display value="1 or 2 times a week"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30131-9"/>
            <display value="3 to 5 times a week"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30132-7"/>
            <display value="5 or more times a week"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30122-8"/>
            <display value="I choose not to answer this question"/>
          </valueCoding>
        </answerOption>
      </item>
      <item>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="drop-down"/>
              <display value="Drop down"/>
            </coding>
            <text value="Drop down"/>
          </valueCodeableConcept>
        </extension>
        <linkId value="/93040-4/93038-8"/>
        <code>
          <system value="http://loinc.org"/>
          <code value="93038-8"/>
          <display
                   value="Stress is when someone feels tense, nervous, anxious or can&#39;t sleep at night because their mind is troubled. How stressed are you?"/>
        </code>
        <text
              value="Stress is when someone feels tense, nervous, anxious or can&#39;t sleep at night because their mind is troubled. How stressed are you?"/>
        <type value="choice"/>
        <required value="false"/>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA6568-5"/>
            <display value="Not at all"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA13863-8"/>
            <display value="A little bit"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA13909-9"/>
            <display value="Somewhat"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA13902-4"/>
            <display value="Quite a bit"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA13914-9"/>
            <display value="Very much"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30122-8"/>
            <display value="I choose not to answer this question"/>
          </valueCoding>
        </answerOption>
      </item>
    </item>
    <item>
      <linkId value="/93039-6"/>
      <code>
        <system value="http://loinc.org"/>
        <code value="93039-6"/>
        <display value="Optional additional questions"/>
      </code>
      <text value="Optional additional questions"/>
      <type value="group"/>
      <required value="false"/>
      <item>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="drop-down"/>
              <display value="Drop down"/>
            </coding>
            <text value="Drop down"/>
          </valueCodeableConcept>
        </extension>
        <linkId value="/93039-6/93028-9"/>
        <code>
          <system value="http://loinc.org"/>
          <code value="93028-9"/>
          <display
                   value="In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?"/>
        </code>
        <text
              value="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 value="choice"/>
        <required value="false"/>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA33-6"/>
            <display value="Yes"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA32-8"/>
            <display value="No"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30122-8"/>
            <display value="I choose not to answer this question"/>
          </valueCoding>
        </answerOption>
      </item>
      <item>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="drop-down"/>
              <display value="Drop down"/>
            </coding>
            <text value="Drop down"/>
          </valueCodeableConcept>
        </extension>
        <linkId value="/93039-6/93027-1"/>
        <code>
          <system value="http://loinc.org"/>
          <code value="93027-1"/>
          <display value="Are you a refugee?"/>
        </code>
        <text value="Are you a refugee?"/>
        <type value="choice"/>
        <required value="false"/>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA33-6"/>
            <display value="Yes"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA32-8"/>
            <display value="No"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30122-8"/>
            <display value="I choose not to answer this question"/>
          </valueCoding>
        </answerOption>
      </item>
      <item>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="drop-down"/>
              <display value="Drop down"/>
            </coding>
            <text value="Drop down"/>
          </valueCodeableConcept>
        </extension>
        <linkId value="/93039-6/93026-3"/>
        <code>
          <system value="http://loinc.org"/>
          <code value="93026-3"/>
          <display
                   value="Do you feel physically and emotionally safe where you currently live?"/>
        </code>
        <text
              value="Do you feel physically and emotionally safe where you currently live?"/>
        <type value="choice"/>
        <required value="false"/>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA33-6"/>
            <display value="Yes"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA32-8"/>
            <display value="No"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA14072-5"/>
            <display value="Unsure"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA30122-8"/>
            <display value="I choose not to answer this question"/>
          </valueCoding>
        </answerOption>
      </item>
      <item>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
          <valueCodeableConcept>
            <coding>
              <system value="http://hl7.org/fhir/questionnaire-item-control"/>
              <code value="drop-down"/>
              <display value="Drop down"/>
            </coding>
            <text value="Drop down"/>
          </valueCodeableConcept>
        </extension>
        <linkId value="/93039-6/76501-6"/>
        <code>
          <system value="http://loinc.org"/>
          <code value="76501-6"/>
          <display
                   value="Within the last year, have you been afraid of your partner or ex-partner?"/>
        </code>
        <text
              value="Within the last year, have you been afraid of your partner or ex-partner?"/>
        <type value="choice"/>
        <required value="false"/>
        <answerOption>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix">
            <valueString value="1"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
            <valueDecimal value="1"/>
          </extension>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA33-6"/>
            <display value="Yes"/>
          </valueCoding>
        </answerOption>
        <answerOption>
          <extension
                     url="http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix">
            <valueString value="0"/>
          </extension>
          <extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
            <valueDecimal value="0"/>
          </extension>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA32-8"/>
            <display value="No"/>
          </valueCoding>
        </answerOption>
      </item>
    </item>
  </item>
</Questionnaire>