SDOH Clinical Care
3.0.0-ballot - STU 3 Ballot

SDOH Clinical Care - Downloaded Version 3.0.0-ballot See the Directory of published versions

## : SDOHCC Questionnaire PRAPARE

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    {
      "resourceType" : "Questionnaire",
      "id" : "SDOHCC-QuestionnairePRAPARE",
      "meta" : {
        "profile" : [
          🔗 "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-extr-smap"
        ]
      },
      "language" : "en",
      "text" : {
        "status" : "extensions",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Questionnaire SDOHCC-QuestionnairePRAPARE</b></p><a name=\"SDOHCC-QuestionnairePRAPARE\"> </a><a name=\"hcSDOHCC-QuestionnairePRAPARE\"> </a><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\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"http://hl7.org/fhir/uv/sdc/STU3/StructureDefinition-sdc-questionnaire-extr-smap.html\">Extractable Questionnaire - StructureMap</a></p></div><b>Structure</b><table border=\"1\" cellpadding=\"0\" cellspacing=\"0\" style=\"border: 1px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;\"><tr style=\"border: 2px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top\"><th style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"The linkID for the item\">LinkID</a></th><th style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Text for the item\">Text</a></th><th style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Minimum and Maximum # of times the item can appear in the instance\">Cardinality</a></th><th style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"The type of the item\">Type</a></th><th style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Additional information about the item\">Description &amp; Constraints</a><span style=\"float: right\"><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Legend for this format\"><img src=\"data:image/png;base64, \" alt=\"doco\" style=\"background-color: inherit\"/></a></span></th></tr><tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1.png)\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon_q_root.gif\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"QuestionnaireRoot\" class=\"hierarchy\"/> SDOHCCQuestionnairePRAPARE</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Questionnaire</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">http://hl7.org/fhir/us/sdoh-clinicalcare/Questionnaire/SDOHCC-QuestionnairePRAPARE#3.0.0-ballot</td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck01.png)\" id=\"item./93025-5\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"group\" class=\"hierarchy\"/> /93025-5</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck011.png)\" id=\"item./93043-8\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"group\" class=\"hierarchy\"/> /93043-8</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Personal characteristics</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0110.png)\" id=\"item./93043-8/56051-6\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> /93043-8/56051-6</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Hispanic or Latino</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item./93043-8/56051-6\">3 options</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0110.png)\" id=\"item./93043-8/32624-9\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> /93043-8/32624-9</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Race</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item./93043-8/32624-9\">8 options</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0110.png)\" id=\"item./93043-8/93035-4\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> /93043-8/93035-4</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Has season or migrant farm work been your or your family's main source of income at any point in past 2 years?</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item./93043-8/93035-4\">3 options</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0110.png)\" id=\"item./93043-8/93034-7\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> /93043-8/93034-7</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Have you been discharged from the armed forces of the United States?</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item./93043-8/93034-7\">3 options</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0100.png)\" id=\"item./93043-8/54899-0\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> /93043-8/54899-0</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Preferred language</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item./93043-8/54899-0\">3 options</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck011.png)\" id=\"item./93042-0\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"group\" class=\"hierarchy\"/> /93042-0</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Family and home</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0110.png)\" id=\"item./93042-0/63512-8\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-integer.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"integer\" class=\"hierarchy\"/> /93042-0/63512-8</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">How many people are living or staying at this address?</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-integer\">integer</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0111.png)\" id=\"item./93042-0/71802-3\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> /93042-0/71802-3</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Housing status</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item./93042-0/71802-3\">3 options</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck01100.png)\" id=\"item./93042-0/71802-3-help\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-display.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"display\" class=\"hierarchy\"/> /93042-0/71802-3-help</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Describes patients living arrangement</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-display\">display</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0110.png)\" id=\"item./93042-0/93033-9\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> /93042-0/93033-9</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Are you worried about losing your housing?</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item./93042-0/93033-9\">3 options</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0100.png)\" id=\"item./93042-0/56799-0\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-string.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> /93042-0/56799-0</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Address</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-string\">string</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck011.png)\" id=\"item./93041-2\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"group\" class=\"hierarchy\"/> /93041-2</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Money and resources</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0110.png)\" id=\"item./93041-2/82589-3\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> /93041-2/82589-3</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Highest level of educ</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item./93041-2/82589-3\">4 options</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0110.png)\" id=\"item./93041-2/67875-5\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> /93041-2/67875-5</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Employment status current</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item./93041-2/67875-5\">5 options</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0110.png)\" id=\"item./93041-2/76437-3\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> /93041-2/76437-3</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Primary insurance</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item./93041-2/76437-3\">7 options</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0110.png)\" id=\"item./93041-2/63586-2\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-decimal.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"decimal\" class=\"hierarchy\"/> /93041-2/63586-2</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">What was your best estimate of the total income of all family members from all sources, before taxes, in last year?</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-decimal\">decimal</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0110.png)\" id=\"item./93041-2/93031-3\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> /93041-2/93031-3</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item./93041-2/93031-3\">8 options</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0100.png)\" id=\"item./93041-2/93030-5\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> /93041-2/93030-5</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living?</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..*</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item./93041-2/93030-5\">4 options</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck011.png)\" id=\"item./93040-4\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"group\" class=\"hierarchy\"/> /93040-4</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Social and emotional health</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0110.png)\" id=\"item./93040-4/93029-7\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> /93040-4/93029-7</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item./93040-4/93029-7\">5 options</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0100.png)\" id=\"item./93040-4/93038-8\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vline.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> /93040-4/93038-8</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Stress is when someone feels tense, nervous, anxious or can't sleep at night because their mind is troubled. How stressed are you?</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item./93040-4/93038-8\">6 options</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck001.png)\" id=\"item./93039-6\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-group.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"group\" class=\"hierarchy\"/> /93039-6</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Optional additional questions</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group\">group</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"/></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0010.png)\" id=\"item./93039-6/93028-9\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> /93039-6/93028-9</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item./93039-6/93028-9\">3 options</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0010.png)\" id=\"item./93039-6/93027-1\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> /93039-6/93027-1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Are you a refugee?</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item./93039-6/93027-1\">3 options</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0010.png)\" id=\"item./93039-6/93026-3\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> /93039-6/93026-3</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Do you feel physically and emotionally safe where you currently live?</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item./93039-6/93026-3\">4 options</a></td></tr>\r\n<tr style=\"border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white\"><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0000.png)\" id=\"item./93039-6/76501-6\" class=\"hierarchy\"><img src=\"tbl_spacer.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_blank.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"tbl_vjoin_end.png\" alt=\".\" style=\"background-color: inherit\" class=\"hierarchy\"/><img src=\"icon-q-coding.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> /93039-6/76501-6</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Within the last year, have you been afraid of your partner or ex-partner?</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">0..1</td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\"><a href=\"https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice\">choice</a></td><td style=\"vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Options: <a href=\"#opt-item./93039-6/76501-6\">2 options</a></td></tr>\r\n<tr><td colspan=\"5\" class=\"hierarchy\"><br/><a href=\"https://hl7.org/fhir/R4/formats.html#table\" title=\"Legend for this format\"><img src=\"data:image/png;base64, \" alt=\"doco\" style=\"background-color: inherit\"/> Documentation for this format</a></td></tr></table><hr/><p><b>Options Sets</b></p><a name=\"opt-item./93043-8/56051-6\"> </a><p><b>Answer options for /93043-8/56051-6 </b></p><ul><li style=\"font-size: 11px\">http://loinc.org#LA33-6 (&quot;Yes&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA32-8 (&quot;No&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA30122-8 (&quot;I choose not to answer this question&quot;)</li></ul><a name=\"opt-item./93043-8/32624-9\"> </a><p><b>Answer options for /93043-8/32624-9 </b></p><ul><li style=\"font-size: 11px\">http://loinc.org#LA6156-9 (&quot;Asian&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA14045-1 (&quot;Native Hawaiian&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA30187-1 (&quot;Pacific Islander&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA14042-8 (&quot;Black/African American&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA4457-3 (&quot;White&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA4-4 (&quot;American Indian/Alaskan Native&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA46-8 (&quot;Other&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA30122-8 (&quot;I choose not to answer this question&quot;)</li></ul><a name=\"opt-item./93043-8/93035-4\"> </a><p><b>Answer options for /93043-8/93035-4 </b></p><ul><li style=\"font-size: 11px\">http://loinc.org#LA33-6 (&quot;Yes&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA32-8 (&quot;No&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA30122-8 (&quot;I choose not to answer this question&quot;)</li></ul><a name=\"opt-item./93043-8/93034-7\"> </a><p><b>Answer options for /93043-8/93034-7 </b></p><ul><li style=\"font-size: 11px\">http://loinc.org#LA33-6 (&quot;Yes&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA32-8 (&quot;No&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA30122-8 (&quot;I choose not to answer this question&quot;)</li></ul><a name=\"opt-item./93043-8/54899-0\"> </a><p><b>Answer options for /93043-8/54899-0 </b></p><ul><li style=\"font-size: 11px\">http://loinc.org#LA43-5 (&quot;English&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA30188-9 (&quot;Language other than English&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA30122-8 (&quot;I choose not to answer this question&quot;)</li></ul><a name=\"opt-item./93042-0/71802-3\"> </a><p><b>Answer options for /93042-0/71802-3 </b></p><ul><li style=\"font-size: 11px\">http://loinc.org#LA30189-7 (&quot;I have housing&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA30190-5 (&quot;I do not have housing (staying with others, in a hotel, in a shelter, living outside on the street, on a beach, in a car, or in a park)&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA30122-8 (&quot;I choose not to answer this question&quot;)</li></ul><a name=\"opt-item./93042-0/93033-9\"> </a><p><b>Answer options for /93042-0/93033-9 </b></p><ul><li style=\"font-size: 11px\">http://loinc.org#LA33-6 (&quot;Yes&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA32-8 (&quot;No&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA30122-8 (&quot;I choose not to answer this question&quot;)</li></ul><a name=\"opt-item./93041-2/82589-3\"> </a><p><b>Answer options for /93041-2/82589-3 </b></p><ul><li style=\"font-size: 11px\">http://loinc.org#LA30191-3 (&quot;Less than high school degree&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA30192-1 (&quot;High school diploma or GED&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA30193-9 (&quot;More than high school&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA30122-8 (&quot;I choose not to answer this question&quot;)</li></ul><a name=\"opt-item./93041-2/67875-5\"> </a><p><b>Answer options for /93041-2/67875-5 </b></p><ul><li style=\"font-size: 11px\">http://loinc.org#LA17956-6 (&quot;Unemployed&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA30138-4 (&quot;Part-time or temporary work&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA30136-8 (&quot;Full-time work&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA30137-6 (&quot;Otherwise unemployed but not seeking work (ex: student, retired, disabled, unpaid primary care giver)&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA30122-8 (&quot;I choose not to answer this question&quot;)</li></ul><a name=\"opt-item./93041-2/76437-3\"> </a><p><b>Answer options for /93041-2/76437-3 </b></p><ul><li style=\"font-size: 11px\">http://loinc.org#LA30194-7 (&quot;None/uninsured&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA17849-3 (&quot;Medicaid&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA30195-4 (&quot;CHIP Medicaid&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA15652-3 (&quot;Medicare&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA30196-2 (&quot;Other public insurance (not CHIP)&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA30197-0 (&quot;Other public insurance (CHIP)&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA6350-8 (&quot;Private insurance&quot;)</li></ul><a name=\"opt-item./93041-2/93031-3\"> </a><p><b>Answer options for /93041-2/93031-3 </b></p><ul><li style=\"font-size: 11px\">http://loinc.org#LA30125-1 (&quot;Food&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA30126-9 (&quot;Clothing&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA30124-4 (&quot;Utilities&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA30127-7 (&quot;Child care&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA30128-5 (&quot;Medicine or Any Health Care (Medical, Dental, Mental Health, Vision)&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA30129-3 (&quot;Phone&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA46-8 (&quot;Other&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA30122-8 (&quot;I choose not to answer this question&quot;)</li></ul><a name=\"opt-item./93041-2/93030-5\"> </a><p><b>Answer options for /93041-2/93030-5 </b></p><ul><li style=\"font-size: 11px\">http://loinc.org#LA30133-5 (&quot;Yes, it has kept me from medical appointments or from getting my medications&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA30134-3 (&quot;Yes, it has kept me from non-medical meetings, appointments, work, or from getting things that I need&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA32-8 (&quot;No&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA30257-2 (&quot;Patient unable to respond&quot;)</li></ul><a name=\"opt-item./93040-4/93029-7\"> </a><p><b>Answer options for /93040-4/93029-7 </b></p><ul><li style=\"font-size: 11px\">http://loinc.org#LA27722-0 (&quot;Less than once a week&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA30130-1 (&quot;1 or 2 times a week&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA30131-9 (&quot;3 to 5 times a week&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA30132-7 (&quot;5 or more times a week&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA30122-8 (&quot;I choose not to answer this question&quot;)</li></ul><a name=\"opt-item./93040-4/93038-8\"> </a><p><b>Answer options for /93040-4/93038-8 </b></p><ul><li style=\"font-size: 11px\">http://loinc.org#LA6568-5 (&quot;Not at all&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA13863-8 (&quot;A little bit&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA13909-9 (&quot;Somewhat&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA13902-4 (&quot;Quite a bit&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA13914-9 (&quot;Very much&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA30122-8 (&quot;I choose not to answer this question&quot;)</li></ul><a name=\"opt-item./93039-6/93028-9\"> </a><p><b>Answer options for /93039-6/93028-9 </b></p><ul><li style=\"font-size: 11px\">http://loinc.org#LA33-6 (&quot;Yes&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA32-8 (&quot;No&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA30122-8 (&quot;I choose not to answer this question&quot;)</li></ul><a name=\"opt-item./93039-6/93027-1\"> </a><p><b>Answer options for /93039-6/93027-1 </b></p><ul><li style=\"font-size: 11px\">http://loinc.org#LA33-6 (&quot;Yes&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA32-8 (&quot;No&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA30122-8 (&quot;I choose not to answer this question&quot;)</li></ul><a name=\"opt-item./93039-6/93026-3\"> </a><p><b>Answer options for /93039-6/93026-3 </b></p><ul><li style=\"font-size: 11px\">http://loinc.org#LA33-6 (&quot;Yes&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA32-8 (&quot;No&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA14072-5 (&quot;Unsure&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA30122-8 (&quot;I choose not to answer this question&quot;)</li></ul><a name=\"opt-item./93039-6/76501-6\"> </a><p><b>Answer options for /93039-6/76501-6 </b></p><ul><li style=\"font-size: 11px\">http://loinc.org#LA33-6 (&quot;Yes&quot;)</li><li style=\"font-size: 11px\">http://loinc.org#LA32-8 (&quot;No&quot;)</li></ul></div>"
      },
      "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"
                      }
                    }
                  ]
                }
              ]
            }
          ]
        }
      ]
    }