# SDOHCC Questionnaire PRAPARE - SDOH Clinical Care v3.0.0-ballot

## Questionnaire: SDOHCC Questionnaire PRAPARE 

*  [Tree view](#tabs-tree) 
*  [Sample Rendering](#tabs-sample) 
*  [Form Logic](#tabs-logic) 

### Test this Questionnaire

### Responses for this Questionnaire

* [(no description)](QuestionnaireResponse-SDOHCC-QuestionnaireResponseHungerVitalSignExample.md)
* [(no description)](QuestionnaireResponse-SDOHCC-QuestionnaireResponsePRAPAREExample.md)



## Resource Content

```json
{
  "resourceType" : "Questionnaire",
  "id" : "SDOHCC-QuestionnairePRAPARE",
  "meta" : {
    "profile" : [
      "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-extr-smap"
    ]
  },
  "extension" : [
    {
      "url" : "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-targetStructureMap",
      "valueCanonical" : "http://hl7.org/fhir/us/sdoh-clinicalcare/StructureMap/SDOHCC-StructureMapPRAPARE"
    }
  ],
  "url" : "http://hl7.org/fhir/us/sdoh-clinicalcare/Questionnaire/SDOHCC-QuestionnairePRAPARE",
  "version" : "3.0.0-ballot",
  "name" : "SDOHCCQuestionnairePRAPARE",
  "title" : "SDOHCC Questionnaire PRAPARE",
  "status" : "draft",
  "subjectType" : ["Patient"],
  "date" : "2021-04-01T04:01:34+00:00",
  "publisher" : "HL7 International / Patient Care",
  "contact" : [
    {
      "name" : "HL7 International / Patient Care",
      "telecom" : [
        {
          "system" : "url",
          "value" : "http://www.hl7.org/Special/committees/patientcare"
        },
        {
          "system" : "email",
          "value" : "patientcare@lists.hl7.org"
        }
      ]
    }
  ],
  "jurisdiction" : [
    {
      "coding" : [
        {
          "system" : "urn:iso:std:iso:3166",
          "code" : "US",
          "display" : "United States of America"
        }
      ]
    }
  ],
  "item" : [
    {
      "linkId" : "/93025-5",
      "code" : [
        {
          "system" : "http://loinc.org",
          "code" : "93025-5",
          "display" : "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]"
        }
      ],
      "text" : "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]",
      "type" : "group",
      "required" : false,
      "item" : [
        {
          "linkId" : "/93043-8",
          "code" : [
            {
              "system" : "http://loinc.org",
              "code" : "93043-8",
              "display" : "Personal characteristics [PRAPARE]"
            }
          ],
          "text" : "Personal characteristics",
          "type" : "group",
          "required" : false,
          "item" : [
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://hl7.org/fhir/questionnaire-item-control",
                        "code" : "drop-down",
                        "display" : "Drop down"
                      }
                    ],
                    "text" : "Drop down"
                  }
                }
              ],
              "linkId" : "/93043-8/56051-6",
              "code" : [
                {
                  "system" : "http://loinc.org",
                  "code" : "56051-6",
                  "display" : "Hispanic or Latino"
                }
              ],
              "text" : "Hispanic or Latino",
              "type" : "choice",
              "required" : false,
              "answerOption" : [
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA33-6",
                    "display" : "Yes"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA32-8",
                    "display" : "No"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA30122-8",
                    "display" : "I choose not to answer this question"
                  }
                }
              ]
            },
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://hl7.org/fhir/questionnaire-item-control",
                        "code" : "drop-down",
                        "display" : "Drop down"
                      }
                    ],
                    "text" : "Drop down"
                  }
                }
              ],
              "linkId" : "/93043-8/32624-9",
              "code" : [
                {
                  "system" : "http://loinc.org",
                  "code" : "32624-9",
                  "display" : "Race"
                }
              ],
              "text" : "Race",
              "type" : "choice",
              "required" : false,
              "repeats" : true,
              "answerOption" : [
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA6156-9",
                    "display" : "Asian"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA14045-1",
                    "display" : "Native Hawaiian"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA30187-1",
                    "display" : "Pacific Islander"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA14042-8",
                    "display" : "Black/African American"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA4457-3",
                    "display" : "White"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA4-4",
                    "display" : "American Indian/Alaskan Native"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA46-8",
                    "display" : "Other"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA30122-8",
                    "display" : "I choose not to answer this question"
                  }
                }
              ]
            },
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://hl7.org/fhir/questionnaire-item-control",
                        "code" : "drop-down",
                        "display" : "Drop down"
                      }
                    ],
                    "text" : "Drop down"
                  }
                }
              ],
              "linkId" : "/93043-8/93035-4",
              "code" : [
                {
                  "system" : "http://loinc.org",
                  "code" : "93035-4",
                  "display" : "Has season or migrant farm work been your or your family's main source of income at any point in past 2 years [PRAPARE]"
                }
              ],
              "text" : "Has season or migrant farm work been your or your family's main source of income at any point in past 2 years?",
              "type" : "choice",
              "required" : false,
              "answerOption" : [
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA33-6",
                    "display" : "Yes"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA32-8",
                    "display" : "No"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA30122-8",
                    "display" : "I choose not to answer this question"
                  }
                }
              ]
            },
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://hl7.org/fhir/questionnaire-item-control",
                        "code" : "drop-down",
                        "display" : "Drop down"
                      }
                    ],
                    "text" : "Drop down"
                  }
                }
              ],
              "linkId" : "/93043-8/93034-7",
              "code" : [
                {
                  "system" : "http://loinc.org",
                  "code" : "93034-7",
                  "display" : "Discharged from the U.S. Armed Forces"
                }
              ],
              "text" : "Have you been discharged from the armed forces of the United States?",
              "type" : "choice",
              "required" : false,
              "answerOption" : [
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA33-6",
                    "display" : "Yes"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA32-8",
                    "display" : "No"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA30122-8",
                    "display" : "I choose not to answer this question"
                  }
                }
              ]
            },
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://hl7.org/fhir/questionnaire-item-control",
                        "code" : "drop-down",
                        "display" : "Drop down"
                      }
                    ],
                    "text" : "Drop down"
                  }
                }
              ],
              "linkId" : "/93043-8/54899-0",
              "code" : [
                {
                  "system" : "http://loinc.org",
                  "code" : "54899-0",
                  "display" : "Preferred language"
                }
              ],
              "text" : "Preferred language",
              "type" : "choice",
              "required" : false,
              "answerOption" : [
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA43-5",
                    "display" : "English"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA30188-9",
                    "display" : "Language other than English"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA30122-8",
                    "display" : "I choose not to answer this question"
                  }
                }
              ]
            }
          ]
        },
        {
          "linkId" : "/93042-0",
          "code" : [
            {
              "system" : "http://loinc.org",
              "code" : "93042-0",
              "display" : "Family and home [PRAPARE]"
            }
          ],
          "text" : "Family and home",
          "type" : "group",
          "required" : false,
          "item" : [
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-unit",
                  "valueCoding" : {
                    "system" : "http://unitsofmeasure.org",
                    "code" : "{#}",
                    "display" : "{#}"
                  }
                }
              ],
              "linkId" : "/93042-0/63512-8",
              "code" : [
                {
                  "system" : "http://loinc.org",
                  "code" : "63512-8",
                  "display" : "How many people are living or staying at this address [#]"
                }
              ],
              "text" : "How many people are living or staying at this address?",
              "type" : "integer",
              "required" : false
            },
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://hl7.org/fhir/questionnaire-item-control",
                        "code" : "drop-down",
                        "display" : "Drop down"
                      }
                    ],
                    "text" : "Drop down"
                  }
                }
              ],
              "linkId" : "/93042-0/71802-3",
              "code" : [
                {
                  "system" : "http://loinc.org",
                  "code" : "71802-3",
                  "display" : "Housing status"
                }
              ],
              "text" : "Housing status",
              "type" : "choice",
              "required" : false,
              "answerOption" : [
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA30189-7",
                    "display" : "I have housing"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA30190-5",
                    "display" : "I do not have housing (staying with others, in a hotel, in a shelter, living outside on the street, on a beach, in a car, or in a park)"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA30122-8",
                    "display" : "I choose not to answer this question"
                  }
                }
              ],
              "item" : [
                {
                  "extension" : [
                    {
                      "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept" : {
                        "coding" : [
                          {
                            "system" : "http://hl7.org/fhir/questionnaire-item-control",
                            "code" : "help",
                            "display" : "Help-Button"
                          }
                        ],
                        "text" : "Help-Button"
                      }
                    }
                  ],
                  "linkId" : "/93042-0/71802-3-help",
                  "text" : "Describes patients living arrangement",
                  "type" : "display"
                }
              ]
            },
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://hl7.org/fhir/questionnaire-item-control",
                        "code" : "drop-down",
                        "display" : "Drop down"
                      }
                    ],
                    "text" : "Drop down"
                  }
                }
              ],
              "linkId" : "/93042-0/93033-9",
              "code" : [
                {
                  "system" : "http://loinc.org",
                  "code" : "93033-9",
                  "display" : "Are you worried about losing your housing [PRAPARE]"
                }
              ],
              "text" : "Are you worried about losing your housing?",
              "type" : "choice",
              "required" : false,
              "answerOption" : [
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA33-6",
                    "display" : "Yes"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA32-8",
                    "display" : "No"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA30122-8",
                    "display" : "I choose not to answer this question"
                  }
                }
              ]
            },
            {
              "linkId" : "/93042-0/56799-0",
              "code" : [
                {
                  "system" : "http://loinc.org",
                  "code" : "56799-0",
                  "display" : "Address"
                }
              ],
              "text" : "Address",
              "type" : "string",
              "required" : false
            }
          ]
        },
        {
          "linkId" : "/93041-2",
          "code" : [
            {
              "system" : "http://loinc.org",
              "code" : "93041-2",
              "display" : "Money and resources [PRAPARE]"
            }
          ],
          "text" : "Money and resources",
          "type" : "group",
          "required" : false,
          "item" : [
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://hl7.org/fhir/questionnaire-item-control",
                        "code" : "drop-down",
                        "display" : "Drop down"
                      }
                    ],
                    "text" : "Drop down"
                  }
                }
              ],
              "linkId" : "/93041-2/82589-3",
              "code" : [
                {
                  "system" : "http://loinc.org",
                  "code" : "82589-3",
                  "display" : "Highest level of educ"
                }
              ],
              "text" : "Highest level of educ",
              "type" : "choice",
              "required" : false,
              "answerOption" : [
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA30191-3",
                    "display" : "Less than high school degree"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA30192-1",
                    "display" : "High school diploma or GED"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA30193-9",
                    "display" : "More than high school"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA30122-8",
                    "display" : "I choose not to answer this question"
                  }
                }
              ]
            },
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://hl7.org/fhir/questionnaire-item-control",
                        "code" : "drop-down",
                        "display" : "Drop down"
                      }
                    ],
                    "text" : "Drop down"
                  }
                }
              ],
              "linkId" : "/93041-2/67875-5",
              "code" : [
                {
                  "system" : "http://loinc.org",
                  "code" : "67875-5",
                  "display" : "Employment status current"
                }
              ],
              "text" : "Employment status current",
              "type" : "choice",
              "required" : false,
              "answerOption" : [
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA17956-6",
                    "display" : "Unemployed"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA30138-4",
                    "display" : "Part-time or temporary work"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA30136-8",
                    "display" : "Full-time work"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA30137-6",
                    "display" : "Otherwise unemployed but not seeking work (ex: student, retired, disabled, unpaid primary care giver)"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA30122-8",
                    "display" : "I choose not to answer this question"
                  }
                }
              ]
            },
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://hl7.org/fhir/questionnaire-item-control",
                        "code" : "drop-down",
                        "display" : "Drop down"
                      }
                    ],
                    "text" : "Drop down"
                  }
                }
              ],
              "linkId" : "/93041-2/76437-3",
              "code" : [
                {
                  "system" : "http://loinc.org",
                  "code" : "76437-3",
                  "display" : "Primary insurance"
                }
              ],
              "text" : "Primary insurance",
              "type" : "choice",
              "required" : false,
              "answerOption" : [
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA30194-7",
                    "display" : "None/uninsured"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA17849-3",
                    "display" : "Medicaid"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA30195-4",
                    "display" : "CHIP Medicaid"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA15652-3",
                    "display" : "Medicare"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA30196-2",
                    "display" : "Other public insurance (not CHIP)"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA30197-0",
                    "display" : "Other public insurance (CHIP)"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA6350-8",
                    "display" : "Private insurance"
                  }
                }
              ]
            },
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-unit",
                  "valueCoding" : {
                    "system" : "http://unitsofmeasure.org",
                    "code" : "/a",
                    "display" : "/a"
                  }
                }
              ],
              "linkId" : "/93041-2/63586-2",
              "code" : [
                {
                  "system" : "http://loinc.org",
                  "code" : "63586-2",
                  "display" : "What was your best estimate of the total income of all family members from all sources, before taxes, in last year [PhenX]"
                }
              ],
              "text" : "What was your best estimate of the total income of all family members from all sources, before taxes, in last year?",
              "type" : "decimal",
              "required" : false
            },
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://hl7.org/fhir/questionnaire-item-control",
                        "code" : "drop-down",
                        "display" : "Drop down"
                      }
                    ],
                    "text" : "Drop down"
                  }
                }
              ],
              "linkId" : "/93041-2/93031-3",
              "code" : [
                {
                  "system" : "http://loinc.org",
                  "code" : "93031-3",
                  "display" : "Have you or any family members you live with been unable to get any of the following when it was really needed in past 1 year [PRAPARE]"
                }
              ],
              "text" : "In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?",
              "type" : "choice",
              "required" : false,
              "repeats" : true,
              "answerOption" : [
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA30125-1",
                    "display" : "Food"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA30126-9",
                    "display" : "Clothing"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA30124-4",
                    "display" : "Utilities"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA30127-7",
                    "display" : "Child care"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA30128-5",
                    "display" : "Medicine or Any Health Care (Medical, Dental, Mental Health, Vision)"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA30129-3",
                    "display" : "Phone"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA46-8",
                    "display" : "Other"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA30122-8",
                    "display" : "I choose not to answer this question"
                  }
                }
              ]
            },
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://hl7.org/fhir/questionnaire-item-control",
                        "code" : "drop-down",
                        "display" : "Drop down"
                      }
                    ],
                    "text" : "Drop down"
                  }
                }
              ],
              "linkId" : "/93041-2/93030-5",
              "code" : [
                {
                  "system" : "http://loinc.org",
                  "code" : "93030-5",
                  "display" : "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living"
                }
              ],
              "text" : "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living?",
              "type" : "choice",
              "required" : false,
              "repeats" : true,
              "answerOption" : [
                {
                  "extension" : [
                    {
                      "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
                      "valueString" : "A"
                    }
                  ],
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA30133-5",
                    "display" : "Yes, it has kept me from medical appointments or from getting my medications"
                  }
                },
                {
                  "extension" : [
                    {
                      "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
                      "valueString" : "B"
                    }
                  ],
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA30134-3",
                    "display" : "Yes, it has kept me from non-medical meetings, appointments, work, or from getting things that I need"
                  }
                },
                {
                  "extension" : [
                    {
                      "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
                      "valueString" : "C"
                    }
                  ],
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA32-8",
                    "display" : "No"
                  }
                },
                {
                  "extension" : [
                    {
                      "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
                      "valueString" : "X"
                    }
                  ],
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA30257-2",
                    "display" : "Patient unable to respond"
                  }
                }
              ]
            }
          ]
        },
        {
          "linkId" : "/93040-4",
          "code" : [
            {
              "system" : "http://loinc.org",
              "code" : "93040-4",
              "display" : "Social and emotional health [PRAPARE]"
            }
          ],
          "text" : "Social and emotional health",
          "type" : "group",
          "required" : false,
          "item" : [
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://hl7.org/fhir/questionnaire-item-control",
                        "code" : "drop-down",
                        "display" : "Drop down"
                      }
                    ],
                    "text" : "Drop down"
                  }
                }
              ],
              "linkId" : "/93040-4/93029-7",
              "code" : [
                {
                  "system" : "http://loinc.org",
                  "code" : "93029-7",
                  "display" : "How often do you see or talk to people that you care about and feel close to [PRAPARE]"
                }
              ],
              "text" : "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?",
              "type" : "choice",
              "required" : false,
              "answerOption" : [
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA27722-0",
                    "display" : "Less than once a week"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA30130-1",
                    "display" : "1 or 2 times a week"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA30131-9",
                    "display" : "3 to 5 times a week"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA30132-7",
                    "display" : "5 or more times a week"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA30122-8",
                    "display" : "I choose not to answer this question"
                  }
                }
              ]
            },
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://hl7.org/fhir/questionnaire-item-control",
                        "code" : "drop-down",
                        "display" : "Drop down"
                      }
                    ],
                    "text" : "Drop down"
                  }
                }
              ],
              "linkId" : "/93040-4/93038-8",
              "code" : [
                {
                  "system" : "http://loinc.org",
                  "code" : "93038-8",
                  "display" : "Stress level"
                }
              ],
              "text" : "Stress is when someone feels tense, nervous, anxious or can't sleep at night because their mind is troubled. How stressed are you?",
              "type" : "choice",
              "required" : false,
              "answerOption" : [
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA6568-5",
                    "display" : "Not at all"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA13863-8",
                    "display" : "A little bit"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA13909-9",
                    "display" : "Somewhat"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA13902-4",
                    "display" : "Quite a bit"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA13914-9",
                    "display" : "Very much"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA30122-8",
                    "display" : "I choose not to answer this question"
                  }
                }
              ]
            }
          ]
        },
        {
          "linkId" : "/93039-6",
          "code" : [
            {
              "system" : "http://loinc.org",
              "code" : "93039-6",
              "display" : "Optional additional questions [PRAPARE]"
            }
          ],
          "text" : "Optional additional questions",
          "type" : "group",
          "required" : false,
          "item" : [
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://hl7.org/fhir/questionnaire-item-control",
                        "code" : "drop-down",
                        "display" : "Drop down"
                      }
                    ],
                    "text" : "Drop down"
                  }
                }
              ],
              "linkId" : "/93039-6/93028-9",
              "code" : [
                {
                  "system" : "http://loinc.org",
                  "code" : "93028-9",
                  "display" : "Have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility in past 1 year [PRAPARE]"
                }
              ],
              "text" : "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?",
              "type" : "choice",
              "required" : false,
              "answerOption" : [
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA33-6",
                    "display" : "Yes"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA32-8",
                    "display" : "No"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA30122-8",
                    "display" : "I choose not to answer this question"
                  }
                }
              ]
            },
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://hl7.org/fhir/questionnaire-item-control",
                        "code" : "drop-down",
                        "display" : "Drop down"
                      }
                    ],
                    "text" : "Drop down"
                  }
                }
              ],
              "linkId" : "/93039-6/93027-1",
              "code" : [
                {
                  "system" : "http://loinc.org",
                  "code" : "93027-1",
                  "display" : "Are you a refugee"
                }
              ],
              "text" : "Are you a refugee?",
              "type" : "choice",
              "required" : false,
              "answerOption" : [
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA33-6",
                    "display" : "Yes"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA32-8",
                    "display" : "No"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA30122-8",
                    "display" : "I choose not to answer this question"
                  }
                }
              ]
            },
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://hl7.org/fhir/questionnaire-item-control",
                        "code" : "drop-down",
                        "display" : "Drop down"
                      }
                    ],
                    "text" : "Drop down"
                  }
                }
              ],
              "linkId" : "/93039-6/93026-3",
              "code" : [
                {
                  "system" : "http://loinc.org",
                  "code" : "93026-3",
                  "display" : "Do you feel physically and emotionally safe where you currently live [PRAPARE]"
                }
              ],
              "text" : "Do you feel physically and emotionally safe where you currently live?",
              "type" : "choice",
              "required" : false,
              "answerOption" : [
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA33-6",
                    "display" : "Yes"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA32-8",
                    "display" : "No"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA14072-5",
                    "display" : "Unsure"
                  }
                },
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA30122-8",
                    "display" : "I choose not to answer this question"
                  }
                }
              ]
            },
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://hl7.org/fhir/questionnaire-item-control",
                        "code" : "drop-down",
                        "display" : "Drop down"
                      }
                    ],
                    "text" : "Drop down"
                  }
                }
              ],
              "linkId" : "/93039-6/76501-6",
              "code" : [
                {
                  "system" : "http://loinc.org",
                  "code" : "76501-6",
                  "display" : "Within the last year, have you been afraid of your partner or ex-partner"
                }
              ],
              "text" : "Within the last year, have you been afraid of your partner or ex-partner?",
              "type" : "choice",
              "required" : false,
              "answerOption" : [
                {
                  "extension" : [
                    {
                      "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
                      "valueString" : "1"
                    },
                    {
                      "url" : "http://hl7.org/fhir/StructureDefinition/itemWeight",
                      "valueDecimal" : 1
                    }
                  ],
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA33-6",
                    "display" : "Yes"
                  }
                },
                {
                  "extension" : [
                    {
                      "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix",
                      "valueString" : "0"
                    },
                    {
                      "url" : "http://hl7.org/fhir/StructureDefinition/itemWeight",
                      "valueDecimal" : 0
                    }
                  ],
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA32-8",
                    "display" : "No"
                  }
                }
              ]
            }
          ]
        }
      ]
    }
  ]
}

```
