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

Mapping Instructions

In this IG, information is first captured in QuestionnaireResponses and is then automatically transformed into Observations and Conditions (where appropriate) using the HL7 StructureMap resource. This approach is selected because it supports complex transformation of data and allows the conversion process between data and Questionnaire to be maintained independently. The StuctureMap-based extraction mechanism (considerations, error handling and other details) is documented in the HL7 Structured Data Capture IG here. Examples are provided of a Questionnaire, QuestionnaireResponse, resulting Observations and Conditions, and the StructureMap used to convert from one to the other:

  1. Hunger Vital Sign Examples
  2. PRAPARE Examples

The StructureMap resource examples in this IG are generated using the FHIR Mapping Language. Instructions and tutorials on how to use the FHIR Mapping Language to convert and transform resources are found here.

The following are the contents of the FHIR Mapping Language file that can be used to generate the StructureMaps for the Hunger Vital Sign (HVS) and PRAPARE Questionnaires:

  1. Hunger Vital Sign (HVS) FHIR Mapping Language file
  2. PRAPARE FHIR Mapping Language file

HVS

/// name = "SDOHCC-Hunger-Vital-Sign-Map"
/// status = draft

map "http://hl7.org/fhir/us/sdoh-clinicalcare/StructureMap/SDOHCC-StructureMapHungerVitalSign" = "SDOHCC StructureMap Hunger Vital Sign"

uses "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaireresponse" alias questionnaireResponse as source
uses "http://hl7.org/fhir/StructureDefinition/Bundle" as target
uses "http://hl7.org/fhir/StructureDefinition/Observation" as target
uses "http://hl7.org/fhir/us/sdoh-clinicalcare/StructureDefinition/SDOHCC-Condition" alias sdohccCondition as target
uses "http://hl7.org/fhir/us/sdoh-clinicalcare/StructureDefinition/SDOHCC-ObservationAssessment" alias sdohccObservation as target

group sdohMapping(source src : questionnaireResponse, target bundle : Bundle) {
  //temporarily set id to human-readable id as example
  //src -> bundle.id = uuid();
  src -> bundle.id = 'SDOHCC-BundleHungerVitalSignExample';
  src -> bundle.type = 'transaction';

  //for each answer item in the questionnareResponse, create an Observation and add it to the groupObservation
  src.item as answerItem1 where "linkId = '/88122-7'" -> bundle.entry as entry, entry.resource = create('sdohccObservation') as observation1 then
    TransformObservation(src, answerItem1, observation1, entry), TransformObservation1(src, answerItem1, observation1, entry);

  src.item as answerItem2 where "linkId = '/88123-5'" -> bundle.entry as entry, entry.resource = create('sdohccObservation') as observation2 then 
    TransformObservation(src, answerItem2, observation2, entry), TransformObservation2(src, answerItem2, observation2, entry);

  src.item as answerItem3 where "linkId = '/88124-3'" -> bundle.entry as entry, entry.resource = create('sdohccObservation') as observation3 then 
    TransformObservation(src, answerItem3, observation3, entry), TransformObservation3(src, answerItem3, bundle, observation3, entry); 

  //create group observation containing the 3 observations above as hasMember
  //TODO: group observation?
  src -> bundle.entry as entry, entry.resource = create('sdohccObservation') as groupObservation then 
	TransformGroupObservation(src, bundle, groupObservation, entry);

  //create condition if answer to third question is "At Risk"
  src.item where "linkId = '/88124-3' and answer.valueCoding.code ='LA19952-3'" -> bundle.entry as entry, entry.resource = create('sdohccCondition') as condition then
    TransformCondition(src, bundle, condition, entry);
}

group TransformObservation(source src: questionnaireResponse, source answerItem, target observation: sdohccObservation, target entry)
{
  //temporarily set id to human-readable id as example
  //src -> observation.id = uuid() then
  //  SetObservationFullUrl(observation, entry);
  src -> observation.status = 'final';

  src -> observation.meta = create('Meta') as newMeta then {
    src -> newMeta.profile = 'http://hl7.org/fhir/us/sdoh-clinicalcare/StructureDefinition/SDOHCC-ObservationScreeningResponse';
  };

  src -> observation.category = cc('http://terminology.hl7.org/CodeSystem/observation-category', 'social-history', 'Social History');
  src -> observation.category = cc('http://terminology.hl7.org/CodeSystem/observation-category', 'survey', 'Survey');

  //Add sdoh category
  src -> observation.category = create('CodeableConcept') as newCC then {
      src -> newCC.coding = create('Coding') as newCoding then {
        src -> newCoding.system = 'http://hl7.org/fhir/us/sdoh-clinicalcare/CodeSystem/SDOHCC-CodeSystemTemporaryCodes';
        src -> newCoding.code = 'food-insecurity';
        src -> newCoding.display = 'Food Insecurity';
    };
  };  

  src.authored as authored -> observation.issued = authored, observation.effective = authored;

  answerItem.answer as answer -> observation.value = create('CodeableConcept') as newCC then {
    answer.valueCoding as coding -> newCC.coding = coding as newCoding;
  };

  src.subject as qSubject -> observation.subject = create('Reference') as newReference then {
    qSubject.reference as qReference -> newReference.reference = qReference;
    qSubject.display as qDisplay -> newReference.display = qDisplay;
  };
}

group TransformObservation1(source src: questionnaireResponse, source item, target observation: sdohccObservation, target entry)
{
  src -> observation.id = 'SDOHCC-ObservationResponseHungerVitalSignQuestion1Example' then
    SetObservationFullUrl(observation, entry);

  item as i -> observation.code = cc('http://loinc.org', '88122-7') as code;

  src.subject as qSubject -> observation.performer = create('Reference') as newReference then {
    qSubject.reference as qReference -> newReference.reference = qReference;
    qSubject.display as qDisplay -> newReference.display = qDisplay;
  };

  src.id as id -> observation.derivedFrom = create('Reference') as newReference then {
    id -> newReference.reference = append('QuestionnaireResponse/', id);
  };
}

group TransformObservation2(source src: questionnaireResponse, source item, target observation: sdohccObservation, target entry)
{
  src -> observation.id = 'SDOHCC-ObservationResponseHungerVitalSignQuestion2Example' then
   	SetObservationFullUrl(observation, entry);

  item as i -> observation.code = cc('http://loinc.org', '88123-5') as code;

  src.subject as qSubject -> observation.performer = create('Reference') as newReference then {
    qSubject.reference as qReference -> newReference.reference = qReference;
    qSubject.display as qDisplay -> newReference.display = qDisplay;
  };

  src.id as id -> observation.derivedFrom = create('Reference') as newReference then {
    id -> newReference.reference = append('QuestionnaireResponse/', id);
  };
}

group TransformObservation3(source src: questionnaireResponse, source item, source bundle, target observation: sdohccObservation, target entry)
{
  src -> observation.id = 'SDOHCC-ObservationResponseHungerVitalSignQuestion3Example' then
   	SetObservationFullUrl(observation, entry);

  item as i -> observation.code = cc('http://loinc.org', '88124-3') as code;
     
  bundle.entry as entries -> observation.derivedFrom = create('Reference') as df then 
    TransformObservationDerived(entries, df);
}

group TransformObservationDerived(source entries, target df) {
  entries.resource as obs1 where "code.coding.code = '88122-7'"-> df.reference = reference(obs1); 
  entries.resource as obs2 where "code.coding.code = '88123-5'" -> df.reference = reference(obs2); 
}

group TransformGroupObservation(source src: questionnaireResponse, source bundle:Bundle, target groupObservation: Observation, target entry)
{
  //temporarily set id to human-readable id as example
  //src -> groupObservation.id = uuid() then

  src -> groupObservation.meta = create('Meta') as newMeta then {
    src -> newMeta.profile = 'http://hl7.org/fhir/us/sdoh-clinicalcare/StructureDefinition/SDOHCC-ObservationScreeningResponse';
  };

  src -> groupObservation.id = 'SDOHCC-ObservationResponseHungerVitalSignGroupingExample' then
    SetObservationFullUrl(groupObservation, entry);  
  src -> groupObservation.status = 'final';
  src -> groupObservation.category = cc('http://terminology.hl7.org/CodeSystem/observation-category', 'social-history', 'Social History');
  src -> groupObservation.category = cc('http://terminology.hl7.org/CodeSystem/observation-category', 'survey', 'Survey');
  //Add sdoh category
  src -> groupObservation.category = create('CodeableConcept') as newCC then {
      src -> newCC.coding = create('Coding') as newCoding then {
        src -> newCoding.system = 'http://hl7.org/fhir/us/sdoh-clinicalcare/CodeSystem/SDOHCC-CodeSystemTemporaryCodes';
        src -> newCoding.code = 'food-insecurity';
        src -> newCoding.display = 'Food Insecurity';
    };
  };  

  src.authored as authored -> groupObservation.effective = authored;
  src.subject as qSubject -> groupObservation.subject = create('Reference') as newReference then {
    qSubject.reference as qReference -> newReference.reference = qReference;
    qSubject.display as qDisplay -> newReference.display = qDisplay;
  };  

  src -> groupObservation.code = cc('http://loinc.org', '88121-9', 'Hunger Vital Sign [HVS]');   

  bundle.entry as entries -> groupObservation.hasMember = create('Reference') as df then {
  	entries.resource as obs1 where "code.coding.code = '88122-7'"-> df.reference = reference(obs1); 
	entries.resource as obs2 where "code.coding.code = '88123-5'" -> df.reference = reference(obs2); 
	entries.resource as obs3 where "code.coding.code = '88124-3'" -> df.reference = reference(obs3); 
  };

  src.id as id -> groupObservation.derivedFrom = create('Reference') as newReference then {
    id -> newReference.reference = append('QuestionnaireResponse/', id);
  };
}

group SetObservationFullUrl(source observation: Observation, target entry)
{
  observation.id as id -> entry.fullUrl = append('http://hl7.org/fhir/us/sdoh-clinicalcare/Observation/', id);
}

group TransformCondition(source src: questionnaireResponse, source bundle, target condition: sdohccCondition, target entry)
{
  //temporarily set id to human-readable id as example
  //src -> condition.id = uuid() then
  src -> condition.id = 'SDOHCC-ConditionFoodInsecurityExample' then
    SetConditionFullUrl(condition, entry);
       
  src -> condition.meta = create('Meta') as newMeta then {
    src -> newMeta.profile = 'http://hl7.org/fhir/us/sdoh-clinicalcare/StructureDefinition/SDOHCC-Condition';
  };

  src -> condition.clinicalStatus = cc('http://terminology.hl7.org/CodeSystem/condition-clinical', 'active', 'Active');
  src -> condition.verificationStatus = cc('http://terminology.hl7.org/CodeSystem/condition-ver-status', 'unconfirmed', 'Unconfirmed');
  src -> condition.category = create('CodeableConcept') as newCC then {
      src -> newCC.coding = create('Coding') as newCoding then {
        src -> newCoding.system = 'http://hl7.org/fhir/us/core/CodeSystem/condition-category';
        src -> newCoding.code = 'health-concern';
        src -> newCoding.display = 'Health Concern';
    };
  };
  //Add sdoh category
  src -> condition.category = create('CodeableConcept') as newCC then {
      src -> newCC.coding = create('Coding') as newCoding then {
        src -> newCoding.system = 'http://hl7.org/fhir/us/sdoh-clinicalcare/CodeSystem/SDOHCC-CodeSystemTemporaryCodes';
        src -> newCoding.code = 'food-insecurity';
        src -> newCoding.display = 'Food Insecurity';
    };
  };

  src -> condition.code = create('CodeableConcept') as newCodeCC then {
      src -> newCodeCC.coding = create('Coding') as newCoding then {
        src -> newCoding.system = 'http://snomed.info/sct';
        src -> newCoding.code = '733423003';
        src -> newCoding.display = 'Food insecurity';
    };
    src -> newCodeCC.coding = create('Coding') as newCoding2 then {
        src -> newCoding2.system = 'http://hl7.org/fhir/sid/icd-10-cm';
        src -> newCoding2.code = 'Z59.4';
        src -> newCoding2.display = 'Lack of adequate food and safe drinking water';
    };
  };
      
  src.authored as authored -> condition.onset = create('Period') as period,
    period.start = authored;

  bundle.entry as entries -> condition.evidence as evidence, evidence.detail = create('Reference') as detailReference then {
  	entries.resource as obs3 where "code.coding.code = '88124-3'"-> detailReference.reference = reference(obs3); 
  };

  src.subject as qSubject -> condition.subject = create('Reference') as newReference then {
    qSubject.reference as qReference -> newReference.reference = qReference;
    qSubject.display as qDisplay -> newReference.display = qDisplay;
  };
}

group SetConditionFullUrl(source condition: sdohccCondition, target entry)
{
  condition.id as id -> entry.fullUrl = append('http://hl7.org/fhir/us/sdoh-clinicalcare/Condition/', id);
}

PRAPARE

/// name = "SDOHCC-PRAPARE-Map"
/// status = draft

map "http://hl7.org/fhir/us/sdoh-clinicalcare/StructureMap/SDOHCC-StructureMapPRAPARE" = "SDOHCC StructureMap PRAPARE"

uses "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaireresponse" alias questionnaireResponse as source
uses "http://hl7.org/fhir/StructureDefinition/Bundle" as target
uses "http://hl7.org/fhir/StructureDefinition/Observation" as target
uses "http://hl7.org/fhir/us/sdoh-clinicalcare/StructureDefinition/SDOHCC-Condition" alias sdohccCondition as target
uses "http://hl7.org/fhir/us/sdoh-clinicalcare/StructureDefinition/SDOHCC-ObservationAssessment" alias sdohccObservation as target

group sdohMapping(source src : questionnaireResponse, target bundle : Bundle) {
  //temporarily set id to human-readable id as example
  //src -> bundle.id = uuid();
  src -> bundle.id = 'SDOHCC-BundlePRAPAREExample';
  src -> bundle.type = 'transaction';
  
  //for each answer item in the questionnareResponse, create an Observation and add it to the groupObservation
  src.item as rootItem -> bundle.entry as entry then 
    rootContent(src, rootItem, bundle);

  //create group observation containing all observations as hasMember
  src -> bundle.entry as entry, entry.resource = create('sdohccObservation') as groupObservation then 
    TransformGroupObservation(src, bundle, groupObservation, entry);
}

group rootContent(source qResponse: questionnaireResponse, source rootItem, target bundle) {
  rootItem.item as groupItem -> bundle.entry as entry then 
    groupContent(qResponse, groupItem, bundle);
}

group groupContent(source qResponse: questionnaireResponse, source groupItem, target bundle) {
  groupItem.item as questionItem -> bundle.entry as entry, entry.resource = create('sdohccObservation') as observation then
    TransformObservation(qResponse, questionItem, bundle, observation, entry, bundle);
}

group TransformObservation(source src: questionnaireResponse, source answerItem, source bundle, target observation: sdohccObservation, target entry, target bundle)
{
  src -> observation.id = uuid() then
  	SetObservationFullUrl(observation, entry);
  src -> observation.status = 'final';
  src -> observation.category = cc('http://terminology.hl7.org/CodeSystem/observation-category', 'social-history', 'Social History');
  src -> observation.category = cc('http://terminology.hl7.org/CodeSystem/observation-category', 'survey', 'Survey');
 
  src -> observation.meta = create('Meta') as newMeta then {
    src -> newMeta.profile = 'http://hl7.org/fhir/us/sdoh-clinicalcare/StructureDefinition/SDOHCC-ObservationScreeningResponse';
  };

  //set dates
  src.authored as authored -> observation.issued = authored, observation.effective = authored;
  
  src.subject as qSubject -> observation.subject = create('Reference') as newReference then {
    qSubject.reference as qReference -> newReference.reference = qReference;
    qSubject.display as qDisplay -> newReference.display = qDisplay;
  };
  src.subject as qSubject -> observation.performer = create('Reference') as newReference then {
    qSubject.reference as qReference -> newReference.reference = qReference;
    qSubject.display as qDisplay -> newReference.display = qDisplay;
  };  

  src.id as id -> observation.derivedFrom = create('Reference') as newReference then {
    id -> newReference.reference = append('QuestionnaireResponse/', id);
  };

  //answerItem.answer as answer -> observation.id = uuid() then
  //	SetValue(answer, observation);

  //Set observation.code mapping for each corresponding answer

  // 1. Ethnicity
  answerItem where "linkId = '/93043-8/56051-6'" -> observation.code = cc('http://loinc.org', '56051-6') as code then 
    SetValueCodeableConcept(answerItem, observation);
  
  // 2. Race
  //TBD: How to handle "Others" text?
  answerItem where "linkId = '/93043-8/32624-9'" -> observation.code = cc('http://loinc.org', '32624-9') as code then 
    SetValuesToComponents(answerItem, observation, observation);

  // 3. Farm Worker Status
  answerItem where "linkId = '/93043-8/93035-4'" -> observation.code = cc('http://loinc.org', '93035-4') as code then
    SetValueCodeableConcept(answerItem, observation);
  answerItem where "linkId = '/93043-8/93035-4'" -> observation.category = create('CodeableConcept') as newCC then {
    src -> newCC.coding = create('Coding') as newCoding then {
      src -> newCoding.system = 'http://hl7.org/fhir/us/sdoh-clinicalcare/CodeSystem/SDOHCC-CodeSystemTemporaryCodes';
      src -> newCoding.code = 'sdoh-category-unspecified';
      src -> newCoding.display = 'SDOH Category Unspecified';
    };
  };

  // 4. Veteran Status
  answerItem where "linkId = '/93043-8/93034-7'" -> observation.code = cc('http://loinc.org', '93034-7') as code then
    SetValueCodeableConcept(answerItem, observation);
  answerItem where "linkId = '/93043-8/93034-7'" -> observation.category = create('CodeableConcept') as newCC then {
    src -> newCC.coding = create('Coding') as newCoding then {
      src -> newCoding.system = 'http://hl7.org/fhir/us/sdoh-clinicalcare/CodeSystem/SDOHCC-CodeSystemTemporaryCodes';
      src -> newCoding.code = 'veteran-status';
      src -> newCoding.display = 'Veteran Status';
    };
  };  
  
  // 5. English Proficiency
  answerItem where "linkId = '/93043-8/54899-0'" -> observation.code = cc('http://loinc.org', '54899-0') as code then
    SetValueCodeableConcept(answerItem, observation);

  // 6. Household Size
  answerItem where "linkId = '/93042-0/63512-8'" -> observation.code = cc('http://loinc.org', '63512-8') as code then {
    answerItem.answer as answer -> observation.value = create('Quantity') as newQty then {
      answer.value as vs -> newQty.value = vs;
      src -> newQty.unit = '{#}';
      src -> newQty.system = 'http://unitsofmeasure.org';
      src -> newQty.code = '{#}';
    };
  };

  // 7. Housing
  answerItem where "linkId = '/93042-0/71802-3'" -> observation.code = cc('http://loinc.org', '71802-3') as code then
    SetValueCodeableConcept(answerItem, observation);
  answerItem where "linkId = '/93042-0/71802-3'" -> observation.category = create('CodeableConcept') as newCC then {
    src -> newCC.coding = create('Coding') as newCoding then {
      src -> newCoding.system = 'http://hl7.org/fhir/us/sdoh-clinicalcare/CodeSystem/SDOHCC-CodeSystemTemporaryCodes';
      src -> newCoding.code = 'homelessness';
      src -> newCoding.display = 'Homelessness';
    };
  };

  // 8. Housing Status
  answerItem where "linkId = '/93042-0/93033-9'" -> observation.code = cc('http://loinc.org', '93033-9') as code then
    SetValueCodeableConcept(answerItem, observation);
  answerItem where "linkId = '/93042-0/93033-9'" -> observation.category = create('CodeableConcept') as newCC then {
    src -> newCC.coding = create('Coding') as newCoding then {
      src -> newCoding.system = 'http://hl7.org/fhir/us/sdoh-clinicalcare/CodeSystem/SDOHCC-CodeSystemTemporaryCodes';
      src -> newCoding.code = 'housing-instability';
      src -> newCoding.display = 'Housing Instability';
    };
  };  

  // 9. Neighborhood
  answerItem where "linkId = '/93042-0/56799-0'" -> observation.code = cc('http://loinc.org', '56799-0') as code then
    SetValue(answerItem, observation);

  // 10. Education
  answerItem where "linkId = '/93041-2/82589-3'" -> observation.code = cc('http://loinc.org', '82589-3') as code then
    SetValueCodeableConcept(answerItem, observation);
  answerItem where "linkId = '/93041-2/82589-3'" -> observation.category = create('CodeableConcept') as newCC then {
    src -> newCC.coding = create('Coding') as newCoding then {
      src -> newCoding.system = 'http://hl7.org/fhir/us/sdoh-clinicalcare/CodeSystem/SDOHCC-CodeSystemTemporaryCodes';
      src -> newCoding.code = 'educational-attainment';
      src -> newCoding.display = 'Educational Attainment';
    };
  }; 

  // 11. Employment
  answerItem where "linkId = '/93041-2/67875-5'" -> observation.code = cc('http://loinc.org', '67875-5') as code then
    SetValueCodeableConcept(answerItem, observation);
  answerItem where "linkId = '/93041-2/67875-5'" -> observation.category = create('CodeableConcept') as newCC then {
    src -> newCC.coding = create('Coding') as newCoding then {
      src -> newCoding.system = 'http://hl7.org/fhir/us/sdoh-clinicalcare/CodeSystem/SDOHCC-CodeSystemTemporaryCodes';
      src -> newCoding.code = 'employment-status';
      src -> newCoding.display = 'Employment Status';
    };
  };

  // 12. Insurance
  answerItem where "linkId = '/93041-2/76437-3'" -> observation.code = cc('http://loinc.org', '76437-3') as code then
    SetValueCodeableConcept(answerItem, observation);

  // 13. Household Income
  answerItem where "linkId = '/93041-2/63586-2'" -> observation.code = cc('http://loinc.org', '63586-2') as code then {
    answerItem.answer as answer -> observation.value = create('Quantity') as newQty then {
      answer.value as vs -> newQty.value = vs;
      src -> newQty.unit = '/a';
      src -> newQty.system = 'http://unitsofmeasure.org';
      src -> newQty.code = '/a';
    };
  };

  // 14. Material Security
  answerItem where "linkId = '/93041-2/93031-3'" -> observation.code = cc('http://loinc.org', '93031-3') as code then 
    SetValuesToComponents(answerItem, observation, observation);
  // answer: Food
  answerItem where "linkId = '/93041-2/93031-3'" -> observation.category = create('CodeableConcept') as newCC then {
    src -> newCC.coding = create('Coding') as newCoding then {
      src -> newCoding.system = 'http://hl7.org/fhir/us/sdoh-clinicalcare/CodeSystem/SDOHCC-CodeSystemTemporaryCodes';
      src -> newCoding.code = 'sdoh-category-unspecified';
      src -> newCoding.display = 'SDOH Category Unspecified';
    };
  };
  
  // 15. Transportation
  answerItem where "linkId = '/93041-2/93030-5'" -> observation.code = cc('http://loinc.org', '93030-5') as code then
    SetValueCodeableConcept(answerItem, observation);
  answerItem where "linkId = '/93041-2/93030-5'" -> observation.category = create('CodeableConcept') as newCC then {
    src -> newCC.coding = create('Coding') as newCoding then {
      src -> newCoding.system = 'http://hl7.org/fhir/us/sdoh-clinicalcare/CodeSystem/SDOHCC-CodeSystemTemporaryCodes';
      src -> newCoding.code = 'transportation-insecurity';
      src -> newCoding.display = 'Transportation Insecurity';
    };
  };

  // 16. Social Integration
  answerItem where "linkId = '/93040-4/93029-7'" -> observation.code = cc('http://loinc.org', '93029-7') as code then
    SetValueCodeableConcept(answerItem, observation);
  answerItem where "linkId = '/93040-4/93029-7'" -> observation.category = create('CodeableConcept') as newCC then {
    src -> newCC.coding = create('Coding') as newCoding then {
      src -> newCoding.system = 'http://hl7.org/fhir/us/sdoh-clinicalcare/CodeSystem/SDOHCC-CodeSystemTemporaryCodes';
      src -> newCoding.code = 'sdoh-category-unspecified';
      src -> newCoding.display = 'SDOH Category Unspecified';
    };
  };

  // 17. Stress
  answerItem where "linkId = '/93040-4/93038-8'" -> observation.code = cc('http://loinc.org', '93038-8') as code then
    SetValueCodeableConcept(answerItem, observation);
  answerItem where "linkId = '/93040-4/93038-8'" -> observation.category = create('CodeableConcept') as newCC then {
    src -> newCC.coding = create('Coding') as newCoding then {
      src -> newCoding.system = 'http://hl7.org/fhir/us/sdoh-clinicalcare/CodeSystem/SDOHCC-CodeSystemTemporaryCodes';
      src -> newCoding.code = 'stress';
      src -> newCoding.display = 'Stress';
    };
  };

  // 18. Incarceration
  answerItem where "linkId = '/93039-6/93028-9'" -> observation.code = cc('http://loinc.org', '93028-9') as code then
    SetValueCodeableConcept(answerItem, observation);
  answerItem where "linkId = '/93039-6/93028-9'" -> observation.category = create('CodeableConcept') as newCC then {
    src -> newCC.coding = create('Coding') as newCoding then {
      src -> newCoding.system = 'http://hl7.org/fhir/us/sdoh-clinicalcare/CodeSystem/SDOHCC-CodeSystemTemporaryCodes';
      src -> newCoding.code = 'sdoh-category-unspecified';
      src -> newCoding.display = 'SDOH Category Unspecified';
    };
  };  

  // 19. Refugee
  answerItem where "linkId = '/93039-6/93027-1'" -> observation.code = cc('http://loinc.org', '93027-1') as code then
    SetValueCodeableConcept(answerItem, observation);
  answerItem where "linkId = '/93039-6/93027-1'" -> observation.category = create('CodeableConcept') as newCC then {
    src -> newCC.coding = create('Coding') as newCoding then {
      src -> newCoding.system = 'http://hl7.org/fhir/us/sdoh-clinicalcare/CodeSystem/SDOHCC-CodeSystemTemporaryCodes';
      src -> newCoding.code = 'sdoh-category-unspecified';
      src -> newCoding.display = 'SDOH Category Unspecified';
    };
  };  

  // 20. Safety
  answerItem where "linkId = '/93039-6/93026-3'" -> observation.code = cc('http://loinc.org', '93026-3') as code then
    SetValueCodeableConcept(answerItem, observation);

  // 21. Domestic Violence
  answerItem where "linkId = '/93039-6/76501-6'" -> observation.code = cc('http://loinc.org', '76501-6') as code then
    SetValueCodeableConcept(answerItem, observation);
  answerItem where "linkId = '/93039-6/76501-6'" -> observation.category = create('CodeableConcept') as newCC then {
    src -> newCC.coding = create('Coding') as newCoding then {
      src -> newCoding.system = 'http://hl7.org/fhir/us/sdoh-clinicalcare/CodeSystem/SDOHCC-CodeSystemTemporaryCodes';
      src -> newCoding.code = 'sdoh-category-unspecified';
      src -> newCoding.display = 'SDOH Category Unspecified';
    };
  };  

  //create a Condition if homeless
  answerItem where "linkId = '/93042-0/71802-3' and answer.valueCoding.code ='LA30190-5'" -> bundle.entry as entry, entry.resource = create('sdohccCondition') as condition then
    TransformCondition(src, bundle, condition, entry), SetConditionCodeAndEvidence1(src, bundle, condition);

  //create a Condition if unemployed
  answerItem where "linkId = '/93041-2/67875-5' and answer.valueCoding.code ='LA17956-6'" -> bundle.entry as entry, entry.resource = create('sdohccCondition') as condition then
    TransformCondition(src, bundle, condition, entry), SetConditionCodeAndEvidence2(src, bundle, condition);
}

group SetValue(source answerItem, target observation) {
  answerItem.answer as answer -> observation.id as id then {
    answer.value as vs -> observation.value = vs;
  };
}

group SetValueCodeableConcept(source src, target observation) {
  src.answer as answer -> observation.value = create('CodeableConcept') as newCC then {
    answer.valueCoding as coding -> newCC.coding = coding as newCoding;
  };
}

group SetValuesToComponents(source answerItem, source srcObservation, target observation) {
  answerItem.answer as answer -> observation.component as newComponent, newComponent.value = create('CodeableConcept') as newCC then {
    answer.valueCoding as coding -> newCC.coding = coding as newCoding;
    srcObservation.code as code ->  newComponent.code = code;
  };
}

group SetObservationFullUrl(source observation: Observation, target entry)
{
  observation.id as id -> entry.fullUrl = append('http://hl7.org/fhir/us/sdoh-clinicalcare/Observation/', id);
}

group TransformCondition(source src: questionnaireResponse, source bundle, target condition: sdohccCondition, target entry)
{
  src -> condition.id = uuid() then
    SetConditionFullUrl(condition, entry);

  src -> condition.id = uuid() then
    SetConditionFullUrl(condition, entry);

  src -> condition.meta = create('Meta') as newMeta then {
    src -> newMeta.profile = 'http://hl7.org/fhir/us/sdoh-clinicalcare/StructureDefinition/SDOHCC-Condition';
  };

  src -> condition.clinicalStatus = cc('http://terminology.hl7.org/CodeSystem/condition-clinical', 'active', 'Active');
  src -> condition.verificationStatus = cc('http://terminology.hl7.org/CodeSystem/condition-ver-status', 'unconfirmed', 'Unconfirmed');

  src -> condition.category = create('CodeableConcept') as newCC then {
    src -> newCC.coding = create('Coding') as newCoding then {
      src -> newCoding.system = 'http://hl7.org/fhir/us/core/CodeSystem/condition-category';
      src -> newCoding.code = 'health-concern';
      src -> newCoding.display = 'Health Concern';
    };
  };
    
  src.authored as authored -> condition.onset = create('Period') as period,
    period.start = authored;

  src.subject as qSubject -> condition.subject = create('Reference') as newReference then {
    qSubject.reference as qReference -> newReference.reference = qReference;
    qSubject.display as qDisplay -> newReference.display = qDisplay;
  };

  src.subject as qSubject -> condition.asserter = create('Reference') as newReference then {
    qSubject.reference as qReference -> newReference.reference = qReference;
    qSubject.display as qDisplay -> newReference.display = qDisplay;
  };
}

group SetConditionFullUrl(source condition: sdohccCondition, target entry)
{
  condition.id as id -> entry.fullUrl = append('http://hl7.org/fhir/us/sdoh-clinicalcare/Condition/', id);
}

group SetConditionCodeAndEvidence1(source src: questionnaireResponse, source bundle, target condition)
{
  src -> condition.code = create('CodeableConcept') as newCodeCC then {
      src -> newCodeCC.coding = create('Coding') as newCoding then {
        src -> newCoding.system = 'http://snomed.info/sct';
        src -> newCoding.code = '32911000';
        src -> newCoding.display = 'Homeless';
    };
    src -> newCodeCC.coding = create('Coding') as newCoding2 then {
        src -> newCoding2.system = 'http://hl7.org/fhir/sid/icd-10-cm';
        src -> newCoding2.code = 'Z59.0';
        src -> newCoding2.display = 'Homelessness';
    };
  }; 
  //Add sdoh category
  src -> condition.category = create('CodeableConcept') as newCC then {
      src -> newCC.coding = create('Coding') as newCoding then {
        src -> newCoding.system = 'http://hl7.org/fhir/us/sdoh-clinicalcare/CodeSystem/SDOHCC-CodeSystemTemporaryCodes';
        src -> newCoding.code = 'homelessness';
        src -> newCoding.display = 'Homelessness';
    };
  };  
  bundle.entry as entries -> condition.evidence as evidence, evidence.detail = create('Reference') as detailReference then {
  	entries.resource as obs where "code.coding.code = '71802-3'"-> detailReference.reference = reference(obs); 
  };
}

group SetConditionCodeAndEvidence2(source src: questionnaireResponse, source bundle, target condition)
{
  src -> condition.code = create('CodeableConcept') as newCodeCC then {
      src -> newCodeCC.coding = create('Coding') as newCoding then {
        src -> newCoding.system = 'http://snomed.info/sct';
        src -> newCoding.code = '73438004';
        src -> newCoding.display = 'Unemployed';
    };
    src -> newCodeCC.coding = create('Coding') as newCoding2 then {
        src -> newCoding2.system = 'http://hl7.org/fhir/sid/icd-10-cm';
        src -> newCoding2.code = 'Z56.0';
        src -> newCoding2.display = 'Unemployment, unspecified';
    };
  };
  //Add sdoh category
  src -> condition.category = create('CodeableConcept') as newCC then {
      src -> newCC.coding = create('Coding') as newCoding then {
        src -> newCoding.system = 'http://hl7.org/fhir/us/sdoh-clinicalcare/CodeSystem/SDOHCC-CodeSystemTemporaryCodes';
        src -> newCoding.code = 'employment-status';
        src -> newCoding.display = 'Employment Status';
    };
  };    
  bundle.entry as entries -> condition.evidence as evidence, evidence.detail = create('Reference') as detailReference then {
  	entries.resource as obs where "code.coding.code = '67875-5'"-> detailReference.reference = reference(obs); 
  };
}

group TransformGroupObservation(source src: questionnaireResponse, source bundle:Bundle, target groupObservation: Observation, target entry)
{
  src -> groupObservation.id = uuid() then
    SetObservationFullUrl(groupObservation, entry);  
  src -> groupObservation.status = 'final';
  src -> groupObservation.category = cc('http://terminology.hl7.org/CodeSystem/observation-category', 'social-history', 'Social History');
  src -> groupObservation.category = cc('http://terminology.hl7.org/CodeSystem/observation-category', 'survey', 'Survey');

  src -> groupObservation.meta = create('Meta') as newMeta then {
    src -> newMeta.profile = 'http://hl7.org/fhir/us/sdoh-clinicalcare/StructureDefinition/SDOHCC-ObservationScreeningResponse';
  };

  src.authored as authored -> groupObservation.effective = authored;
  src.subject as qSubject -> groupObservation.subject = create('Reference') as newReference then {
    qSubject.reference as qReference -> newReference.reference = qReference;
    qSubject.display as qDisplay -> newReference.display = qDisplay;
  };  

  src -> groupObservation.code = cc('http://loinc.org', '93025-5');   

  //only add observations that are derived from the answers
  bundle.entry as entries -> groupObservation.hasMember = create('Reference') as df then {
    entries.resource as obs where "status.exists() and hasMember.exists().not()"-> df.reference = reference(obs); 
  };

  src.id as id -> groupObservation.derivedFrom = create('Reference') as newReference then {
    id -> newReference.reference = append('QuestionnaireResponse/', id);
  };
}