US Core Implementation Guide
9.0.0 - CI Build United States of America flag

US Core Implementation Guide, published by HL7 International / Cross-Group Projects. This guide is not an authorized publication; it is the continuous build for version 9.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/US-Core/ and changes regularly. See the Directory of published versions

Questionnaire: Questionnaire PRAPARE Example (Experimental)

Official URL: http://hl7.org/fhir/us/core/Questionnaire/prapare-example Version: 9.0.0
Standards status: Informative Computable Name: PRAPAREExample
Other Identifiers: OID:2.16.840.1.113883.4.642.40.2.35.6

Usage:Clinical Focus: SDOH

Copyright/Legal: This material contains content from LOINC® (http://loinc.org). LOINC is copyright © 1995-2024, Regenstrief Institute, Inc. and the LOINC Committee, and is available at no cost under the license at http://loinc.org/license. Copyright © 2019. This item comes from the national PRAPARE social determinants of health assessment protocol, developed and owned by the National Association of Community Health Centers (NACHC), in partnership with the Association of Asian Pacific Community Health Organization (AAPCHO), the Oregon Primary Care Association (OPCA), and the Institute for Alternative Futures (IAF). For more information, visit www.nachc.org/prapare. Used with permission.

Structure
LinkIDTextCardinalityTypeDescription & Constraintsdoco
.. PRAPAREExampleQuestionnairehttp://hl7.org/fhir/us/core/Questionnaire/prapare-example#9.0.0
... /93025-5Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]0..1groupValue Set:
.... /93043-8Personal characteristics0..1groupValue Set:
..... /93043-8/56051-6Hispanic or Latino0..1choiceValue Set:
Options: 3 options
..... /93043-8/32624-9Race0..*choiceValue Set:
Options: 8 options
..... /93043-8/93035-4Has season or migrant farm work been your or your family's main source of income at any point in past 2 years [PRAPARE]0..1choiceValue Set:
Options: 3 options
..... /93043-8/93034-7Discharged from the U.S. Armed Forces0..1choiceValue Set:
Options: 3 options
..... /93043-8/54899-0Preferred language0..1choiceValue Set:
Options: 3 options
.... /93042-0Family and home0..1groupValue Set:
..... /93042-0/63512-8How many people are living or staying at this address [#]0..1integerValue Set:
..... /93042-0/71802-3Housing status0..1choiceValue Set:
Options: 3 options
...... /93042-0/71802-3-helpDescribes patients living arrangement0..1displayValue Set:
..... /93042-0/93033-9Are you worried about losing your housing [PRAPARE]0..1choiceValue Set:
Options: 3 options
..... /93042-0/56799-0Address0..1stringValue Set:
.... /93041-2Money and resources0..1groupValue Set:
..... /93041-2/82589-3Highest level of educ0..1choiceValue Set:
Options: 4 options
..... /93041-2/67875-5Employment status current0..1choiceValue Set:
Options: 5 options
..... /93041-2/76437-3Primary insurance0..1choiceValue Set:
Options: 7 options
..... /93041-2/63586-2What was your best estimate of the total income of all family members from all sources, before taxes, in last year [PhenX]0..1decimalValue Set:
..... /93041-2/93031-3Have 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]0..*choiceValue Set:
Options: 8 options
..... /93041-2/93030-5Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living0..*choiceValue Set:
Options: 4 options
.... /93040-4Social and emotional health0..1groupValue Set:
..... /93040-4/93029-7How often do you see or talk to people that you care about and feel close to [PRAPARE]0..1choiceValue Set:
Options: 5 options
..... /93040-4/93038-8Stress is when someone feels tense, nervous, anxious or can't sleep at night because their mind is troubled. How stressed are you?0..1choiceValue Set:
Options: 6 options
.... /93039-6Optional additional questions0..1groupValue Set:
..... /93039-6/93028-9Have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility in past 1 year [PRAPARE]0..1choiceValue Set:
Options: 3 options
..... /93039-6/93027-1Are you a refugee0..1choiceValue Set:
Options: 3 options
..... /93039-6/93026-3Do you feel physically and emotionally safe where you currently live [PRAPARE]0..1choiceValue Set:
Options: 4 options
..... /93039-6/76501-6Within the last year, have you been afraid of your partner or ex-partner0..1choiceValue Set:
Options: 2 options

doco Documentation for this format

Options Sets

Answer options for /93043-8/56051-6

  • http://loinc.org#LA33-6 ("Yes")
  • http://loinc.org#LA32-8 ("No")
  • http://loinc.org#LA30122-8 ("I choose not to answer this question")

Answer options for /93043-8/32624-9

  • http://loinc.org#LA6156-9 ("Asian")
  • http://loinc.org#LA14045-1 ("Native Hawaiian")
  • http://loinc.org#LA30187-1 ("Pacific Islander")
  • http://loinc.org#LA14042-8 ("Black/African American")
  • http://loinc.org#LA4457-3 ("White")
  • http://loinc.org#LA4-4 ("American Indian/Alaskan Native")
  • http://loinc.org#LA46-8 ("Other")
  • http://loinc.org#LA30122-8 ("I choose not to answer this question")

Answer options for /93043-8/93035-4

  • http://loinc.org#LA33-6 ("Yes")
  • http://loinc.org#LA32-8 ("No")
  • http://loinc.org#LA30122-8 ("I choose not to answer this question")

Answer options for /93043-8/93034-7

  • http://loinc.org#LA33-6 ("Yes")
  • http://loinc.org#LA32-8 ("No")
  • http://loinc.org#LA30122-8 ("I choose not to answer this question")

Answer options for /93043-8/54899-0

  • http://loinc.org#LA43-5 ("English")
  • http://loinc.org#LA30188-9 ("Language other than English")
  • http://loinc.org#LA30122-8 ("I choose not to answer this question")

Answer options for /93042-0/71802-3

  • http://loinc.org#LA30189-7 ("I have housing")
  • http://loinc.org#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)")
  • http://loinc.org#LA30122-8 ("I choose not to answer this question")

Answer options for /93042-0/93033-9

  • http://loinc.org#LA33-6 ("Yes")
  • http://loinc.org#LA32-8 ("No")
  • http://loinc.org#LA30122-8 ("I choose not to answer this question")

Answer options for /93041-2/82589-3

  • http://loinc.org#LA30191-3 ("Less than high school degree")
  • http://loinc.org#LA30192-1 ("High school diploma or GED")
  • http://loinc.org#LA30193-9 ("More than high school")
  • http://loinc.org#LA30122-8 ("I choose not to answer this question")

Answer options for /93041-2/67875-5

  • http://loinc.org#LA17956-6 ("Unemployed")
  • http://loinc.org#LA30138-4 ("Part-time or temporary work")
  • http://loinc.org#LA30136-8 ("Full-time work")
  • http://loinc.org#LA30137-6 ("Otherwise unemployed but not seeking work (ex: student, retired, disabled, unpaid primary care giver)")
  • http://loinc.org#LA30122-8 ("I choose not to answer this question")

Answer options for /93041-2/76437-3

  • http://loinc.org#LA30194-7 ("None/uninsured")
  • http://loinc.org#LA17849-3 ("Medicaid")
  • http://loinc.org#LA30195-4 ("CHIP Medicaid")
  • http://loinc.org#LA15652-3 ("Medicare")
  • http://loinc.org#LA30196-2 ("Other public insurance (not CHIP)")
  • http://loinc.org#LA30197-0 ("Other public insurance (CHIP)")
  • http://loinc.org#LA6350-8 ("Private insurance")

Answer options for /93041-2/93031-3

  • http://loinc.org#LA30125-1 ("Food")
  • http://loinc.org#LA30126-9 ("Clothing")
  • http://loinc.org#LA30124-4 ("Utilities")
  • http://loinc.org#LA30127-7 ("Child care")
  • http://loinc.org#LA30128-5 ("Medicine or Any Health Care (Medical, Dental, Mental Health, Vision)")
  • http://loinc.org#LA30129-3 ("Phone")
  • http://loinc.org#LA46-8 ("Other")
  • http://loinc.org#LA30122-8 ("I choose not to answer this question")

Answer options for /93041-2/93030-5

  • http://loinc.org#LA30133-5 ("Yes, it has kept me from medical appointments or from getting my medications")
  • http://loinc.org#LA30134-3 ("Yes, it has kept me from non-medical meetings, appointments, work, or from getting things that I need")
  • http://loinc.org#LA32-8 ("No")
  • http://loinc.org#LA30257-2 ("Patient unable to respond")

Answer options for /93040-4/93029-7

  • http://loinc.org#LA27722-0 ("Less than once a week")
  • http://loinc.org#LA30130-1 ("1 or 2 times a week")
  • http://loinc.org#LA30131-9 ("3 to 5 times a week")
  • http://loinc.org#LA30132-7 ("5 or more times a week")
  • http://loinc.org#LA30122-8 ("I choose not to answer this question")

Answer options for /93040-4/93038-8

  • http://loinc.org#LA6568-5 ("Not at all")
  • http://loinc.org#LA13863-8 ("A little bit")
  • http://loinc.org#LA13909-9 ("Somewhat")
  • http://loinc.org#LA13902-4 ("Quite a bit")
  • http://loinc.org#LA13914-9 ("Very much")
  • http://loinc.org#LA30122-8 ("I choose not to answer this question")

Answer options for /93039-6/93028-9

  • http://loinc.org#LA33-6 ("Yes")
  • http://loinc.org#LA32-8 ("No")
  • http://loinc.org#LA30122-8 ("I choose not to answer this question")

Answer options for /93039-6/93027-1

  • http://loinc.org#LA33-6 ("Yes")
  • http://loinc.org#LA32-8 ("No")
  • http://loinc.org#LA30122-8 ("I choose not to answer this question")

Answer options for /93039-6/93026-3

  • http://loinc.org#LA33-6 ("Yes")
  • http://loinc.org#LA32-8 ("No")
  • http://loinc.org#LA14072-5 ("Unsure")
  • http://loinc.org#LA30122-8 ("I choose not to answer this question")

Answer options for /93039-6/76501-6

  • http://loinc.org#LA33-6 ("Yes")
  • http://loinc.org#LA32-8 ("No")