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

: SDOHCC QuestionnaireResponse PRAPARE Example - JSON Representation

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{
  "resourceType" : "QuestionnaireResponse",
  "id" : "SDOHCC-QuestionnaireResponsePRAPAREExample",
  "meta" : {
    "versionId" : "1",
    "lastUpdated" : "2021-06-03T00:48:30.721+00:00",
    "source" : "#lELuFd3L32Xc9mgx",
    "profile" : [
      "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaireresponse|2.7"
    ]
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>Generated Narrative</b></p><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">Resource \"SDOHCC-QuestionnaireResponsePRAPAREExample\" Version \"1\" Updated \"2021-06-03T00:48:30.721Z\" </p><p style=\"margin-bottom: 0px\">Information Source: #lELuFd3L32Xc9mgx!</p><p style=\"margin-bottom: 0px\">Profile: <a href=\"http://hl7.org/fhir/uv/sdc/2019May/sdc-questionnaireresponse.html\">SDC Questionnaire Response (version 2.7.0)</a></p></div><p><b>questionnaire</b>: <a href=\"http://hl7.org/fhir/us/sdoh-clinicalcare/Questionnaire/SDOHCC-QuestionnairePRAPARE\">http://hl7.org/fhir/us/sdoh-clinicalcare/Questionnaire/SDOHCC-QuestionnairePRAPARE</a></p><p><b>status</b>: completed</p><p><b>subject</b>: <a href=\"Patient-pat-53234.html\">Patient/pat-53234: COLIN ABBAS</a> \" ABBAS\"</p><p><b>authored</b>: 2021-04-26T13:56:33.747Z</p><blockquote><p><b>item</b></p><p><b>linkId</b>: /93025-5</p><p><b>text</b>: Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]</p><blockquote><p><b>item</b></p><p><b>linkId</b>: /93043-8</p><p><b>text</b>: Personal characteristics</p></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: /93042-0</p><p><b>text</b>: Family and home</p></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: /93041-2</p><p><b>text</b>: Money and resources</p></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: /93040-4</p><p><b>text</b>: Social and emotional health</p></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: /93039-6</p><p><b>text</b>: Optional additional questions</p></blockquote></blockquote></div>"
  },
  "questionnaire" : "http://hl7.org/fhir/us/sdoh-clinicalcare/Questionnaire/SDOHCC-QuestionnairePRAPARE",
  "_questionnaire" : {
    "extension" : [
      {
        "url" : "http://hl7.org/fhir/StructureDefinition/display",
        "valueString" : "SDOHCC Questionnaire PRAPARE"
      }
    ]
  },
  "status" : "completed",
  "subject" : {
    "reference" : "Patient/pat-53234",
    "display" : "COLIN ABBAS"
  },
  "authored" : "2021-04-26T13:56:33.747Z",
  "item" : [
    {
      "linkId" : "/93025-5",
      "text" : "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]",
      "item" : [
        {
          "linkId" : "/93043-8",
          "text" : "Personal characteristics",
          "item" : [
            {
              "linkId" : "/93043-8/56051-6",
              "text" : "Do you consider yourself Hispanic/Latino?",
              "answer" : [
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA32-8",
                    "display" : "No"
                  }
                }
              ]
            },
            {
              "linkId" : "/93043-8/32624-9",
              "text" : "Race",
              "answer" : [
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA4457-3",
                    "display" : "White"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA30187-1",
                    "display" : "Pacific Islander"
                  }
                }
              ]
            },
            {
              "linkId" : "/93043-8/93035-4",
              "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?",
              "answer" : [
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA33-6",
                    "display" : "Yes"
                  }
                }
              ]
            },
            {
              "linkId" : "/93043-8/93034-7",
              "text" : "Have you been discharged from the armed forces of the United States?",
              "answer" : [
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA32-8",
                    "display" : "No"
                  }
                }
              ]
            },
            {
              "linkId" : "/93043-8/54899-0",
              "text" : "Preferred language",
              "answer" : [
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA43-5",
                    "display" : "English"
                  }
                }
              ]
            }
          ]
        },
        {
          "linkId" : "/93042-0",
          "text" : "Family and home",
          "item" : [
            {
              "linkId" : "/93042-0/63512-8",
              "text" : "How many people are living or staying at this address?",
              "answer" : [
                {
                  "valueInteger" : 6
                }
              ]
            },
            {
              "linkId" : "/93042-0/71802-3",
              "text" : "Housing status",
              "answer" : [
                {
                  "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)"
                  }
                }
              ]
            },
            {
              "linkId" : "/93042-0/93033-9",
              "text" : "Are you worried about losing your housing?",
              "answer" : [
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA30122-8",
                    "display" : "I choose not to answer this question"
                  }
                }
              ]
            },
            {
              "linkId" : "/93042-0/56799-0",
              "text" : "Address",
              "answer" : [
                {
                  "valueString" : "Broadway"
                }
              ]
            }
          ]
        },
        {
          "linkId" : "/93041-2",
          "text" : "Money and resources",
          "item" : [
            {
              "linkId" : "/93041-2/82589-3",
              "text" : "Highest level of educ",
              "answer" : [
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA30191-3",
                    "display" : "Less than high school degree"
                  }
                }
              ]
            },
            {
              "linkId" : "/93041-2/67875-5",
              "text" : "Employment status current",
              "answer" : [
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA17956-6",
                    "display" : "Unemployed"
                  }
                }
              ]
            },
            {
              "linkId" : "/93041-2/76437-3",
              "text" : "Primary insurance",
              "answer" : [
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA17849-3",
                    "display" : "Medicaid"
                  }
                }
              ]
            },
            {
              "linkId" : "/93041-2/63586-2",
              "text" : "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?",
              "answer" : [
                {
                  "valueDecimal" : 25000
                }
              ]
            },
            {
              "linkId" : "/93041-2/93031-3",
              "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?",
              "answer" : [
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA30126-9",
                    "display" : "Clothing"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA30127-7",
                    "display" : "Child care"
                  }
                }
              ]
            },
            {
              "linkId" : "/93041-2/93030-5",
              "text" : "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living?",
              "answer" : [
                {
                  "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"
                  }
                }
              ]
            }
          ]
        },
        {
          "linkId" : "/93040-4",
          "text" : "Social and emotional health",
          "item" : [
            {
              "linkId" : "/93040-4/93029-7",
              "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)?",
              "answer" : [
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA30130-1",
                    "display" : "1 or 2 times a week"
                  }
                }
              ]
            },
            {
              "linkId" : "/93040-4/93038-8",
              "text" : "Stress is when someone feels tense, nervous, anxious or can't sleep at night because their mind is troubled. How stressed are you?",
              "answer" : [
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA13909-9",
                    "display" : "Somewhat"
                  }
                }
              ]
            }
          ]
        },
        {
          "linkId" : "/93039-6",
          "text" : "Optional additional questions",
          "item" : [
            {
              "linkId" : "/93039-6/93028-9",
              "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?",
              "answer" : [
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA32-8",
                    "display" : "No"
                  }
                }
              ]
            },
            {
              "linkId" : "/93039-6/93027-1",
              "text" : "Are you a refugee?",
              "answer" : [
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA32-8",
                    "display" : "No"
                  }
                }
              ]
            },
            {
              "linkId" : "/93039-6/93026-3",
              "text" : "Do you feel physically and emotionally safe where you currently live?",
              "answer" : [
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA32-8",
                    "display" : "No"
                  }
                }
              ]
            },
            {
              "linkId" : "/93039-6/76501-6",
              "text" : "Within the last year, have you been afraid of your partner or ex-partner?",
              "answer" : [
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA32-8",
                    "display" : "No"
                  }
                }
              ]
            }
          ]
        }
      ]
    }
  ]
}