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

## Example QuestionnaireResponse: SDOHCC QuestionnaireResponse PRAPARE Example

Page standards status: Informative

Language: en

Profile: SDC Questionnaire Response

LinkID | Text | Definition | Answer
--- | --- | --- | ---
SDOHCC-QuestionnaireResponsePRAPAREExample |  |  | Questionnaire:SDOHCC Questionnaire PRAPARE
/93025-5 | Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE] |  |
/93043-8 | Personal characteristics |  |
/93043-8/56051-6 | Hispanic or Latino |  | LOINC: LA32-8 (No)
/93043-8/32624-9 | Race |  |
/93043-8/93035-4 | Has season or migrant farm work been your or your family's main source of income at any point in past 2 years? |  | LOINC: LA33-6 (Yes)
/93043-8/93034-7 | Have you been discharged from the armed forces of the United States? |  | LOINC: LA32-8 (No)
/93043-8/54899-0 | Preferred language |  | LOINC: LA43-5 (English)
/93042-0 | Family and home |  |
/93042-0/63512-8 | How many people are living or staying at this address? |  | 6
/93042-0/71802-3 | Housing status |  | LOINC: LA30190-5 (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))
/93042-0/93033-9 | Are you worried about losing your housing? |  | LOINC: LA30122-8 (I choose not to answer this question)
/93042-0/56799-0 | Address |  | Broadway
/93041-2 | Money and resources |  |
/93041-2/82589-3 | Highest level of educ |  | LOINC: LA30191-3 (Less than high school degree)
/93041-2/67875-5 | Employment status current |  | LOINC: LA17956-6 (Unemployed)
/93041-2/76437-3 | Primary insurance |  | LOINC: LA17849-3 (Medicaid)
/93041-2/63586-2 | What was your best estimate of the total income of all family members from all sources, before taxes, in last year? |  | 25000
/93041-2/93031-3 | 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? |  |
/93041-2/93030-5 | Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living? |  |
/93040-4 | Social and emotional health |  |
/93040-4/93029-7 | 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)? |  | LOINC: LA30130-1 (1 or 2 times a week)
/93040-4/93038-8 | Stress is when someone feels tense, nervous, anxious or can't sleep at night because their mind is troubled. How stressed are you? |  | LOINC: LA13909-9 (Somewhat)
/93039-6 | Optional additional questions |  |
/93039-6/93028-9 | In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility? |  | LOINC: LA32-8 (No)
/93039-6/93027-1 | Are you a refugee? |  | LOINC: LA32-8 (No)
/93039-6/93026-3 | Do you feel physically and emotionally safe where you currently live? |  | LOINC: LA32-8 (No)
/93039-6/76501-6 | Within the last year, have you been afraid of your partner or ex-partner? |  | LOINC: LA32-8 (No)
Documentation for this format