SDOH Clinical Care
1.1.0 - STU 2 ballot
SDOH Clinical Care
1.1.0 - STU 2 ballot
This page is part of the SDOH Clinical Care for Multiple Domains (v1.1.0: STU 2 Ballot 1) based on FHIR R4. The current version which supercedes this version is 2.0.0. For a full list of available versions, see the Directory of published versions 
<QuestionnaireResponse xmlns="http://hl7.org/fhir">
<id value="SDOHCC-QuestionnaireResponsePRAPAREExample"/>
<meta>
<versionId value="1"/>
<lastUpdated value="2021-06-03T00:48:30.721+00:00"/>
<source value="#lELuFd3L32Xc9mgx"/>
<profile
value="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaireresponse|2.7"/>
</meta>
<text>
<status value="generated"/>
<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>
</text>
<questionnaire
value="http://hl7.org/fhir/us/sdoh-clinicalcare/Questionnaire/SDOHCC-QuestionnairePRAPARE">
<extension url="http://hl7.org/fhir/StructureDefinition/display">
<valueString value="SDOHCC Questionnaire PRAPARE"/>
</extension>
</questionnaire>
<status value="completed"/>
<subject>
<reference value="Patient/pat-53234"/>
<display value="COLIN ABBAS"/>
</subject>
<authored value="2021-04-26T13:56:33.747Z"/>
<item>
<linkId value="/93025-5"/>
<text
value="Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]"/>
<item>
<linkId value="/93043-8"/>
<text value="Personal characteristics"/>
<item>
<linkId value="/93043-8/56051-6"/>
<text value="Do you consider yourself Hispanic/Latino?"/>
<answer>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA32-8"/>
<display value="No"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="/93043-8/32624-9"/>
<text value="Race"/>
<answer>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA4457-3"/>
<display value="White"/>
</valueCoding>
</answer>
<answer>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30187-1"/>
<display value="Pacific Islander"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="/93043-8/93035-4"/>
<text
value="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 value="http://loinc.org"/>
<code value="LA33-6"/>
<display value="Yes"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="/93043-8/93034-7"/>
<text
value="Have you been discharged from the armed forces of the United States?"/>
<answer>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA32-8"/>
<display value="No"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="/93043-8/54899-0"/>
<text value="Preferred language"/>
<answer>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA43-5"/>
<display value="English"/>
</valueCoding>
</answer>
</item>
</item>
<item>
<linkId value="/93042-0"/>
<text value="Family and home"/>
<item>
<linkId value="/93042-0/63512-8"/>
<text value="How many people are living or staying at this address?"/>
<answer>
<valueInteger value="6"/>
</answer>
</item>
<item>
<linkId value="/93042-0/71802-3"/>
<text value="Housing status"/>
<answer>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30190-5"/>
<display
value="I do not have housing (staying with others, in a hotel, in a shelter, living outside on the street, on a beach, in a car, or in a park)"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="/93042-0/93033-9"/>
<text value="Are you worried about losing your housing?"/>
<answer>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30122-8"/>
<display value="I choose not to answer this question"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="/93042-0/56799-0"/>
<text value="Address"/>
<answer>
<valueString value="Broadway"/>
</answer>
</item>
</item>
<item>
<linkId value="/93041-2"/>
<text value="Money and resources"/>
<item>
<linkId value="/93041-2/82589-3"/>
<text value="Highest level of educ"/>
<answer>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30191-3"/>
<display value="Less than high school degree"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="/93041-2/67875-5"/>
<text value="Employment status current"/>
<answer>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA17956-6"/>
<display value="Unemployed"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="/93041-2/76437-3"/>
<text value="Primary insurance"/>
<answer>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA17849-3"/>
<display value="Medicaid"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="/93041-2/63586-2"/>
<text
value="What was your best estimate of the total income of all family members from all sources, before taxes, in last year?"/>
<answer>
<valueDecimal value="25000"/>
</answer>
</item>
<item>
<linkId value="/93041-2/93031-3"/>
<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?"/>
<answer>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30126-9"/>
<display value="Clothing"/>
</valueCoding>
</answer>
<answer>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30127-7"/>
<display value="Child care"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="/93041-2/93030-5"/>
<text
value="Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living?"/>
<answer>
<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>
</answer>
</item>
</item>
<item>
<linkId value="/93040-4"/>
<text value="Social and emotional health"/>
<item>
<linkId value="/93040-4/93029-7"/>
<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)?"/>
<answer>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30130-1"/>
<display value="1 or 2 times a week"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="/93040-4/93038-8"/>
<text
value="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 value="http://loinc.org"/>
<code value="LA13909-9"/>
<display value="Somewhat"/>
</valueCoding>
</answer>
</item>
</item>
<item>
<linkId value="/93039-6"/>
<text value="Optional additional questions"/>
<item>
<linkId value="/93039-6/93028-9"/>
<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?"/>
<answer>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA32-8"/>
<display value="No"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="/93039-6/93027-1"/>
<text value="Are you a refugee?"/>
<answer>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA32-8"/>
<display value="No"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="/93039-6/93026-3"/>
<text
value="Do you feel physically and emotionally safe where you currently live?"/>
<answer>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA32-8"/>
<display value="No"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="/93039-6/76501-6"/>
<text
value="Within the last year, have you been afraid of your partner or ex-partner?"/>
<answer>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA32-8"/>
<display value="No"/>
</valueCoding>
</answer>
</item>
</item>
</item>
</QuestionnaireResponse>
IG © 2020+ HL7 International - Patient Care WG. Package hl7.fhir.us.sdoh-clinicalcare#1.1.0 based on FHIR 4.0.1. Generated 2021-12-07
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