{ "resourceType" : "Bundle", "id" : "ussg-fht", "type" : "transaction", "entry" : [{ "fullUrl" : "http://hl7.org/fhir/us/sdc/Questionnaire/54127-6", "resource" : { "resourceType" : "Questionnaire", "id" : "54127-6", "meta" : { "profile" : ["http://hl7.org/fhir/us/sdc/StructureDefinition/sdc-questionnaire"] }, "text" : { "status" : "extensions", "div" : "
Generated Narrative: Questionnaire
Resource Questionnaire "54127-6"
Profile: http://hl7.org/fhir/us/sdc/StructureDefinition/sdc-questionnaire
StructureDefinition Work Group: fhir
url: http://hl7.org/fhir/us/sdc/Questionnaire/54127-6
identifier: http://example.org/panel-id
/54127-6
title: US Surgeon General - Family Health Portrait
status: active
experimental: true
subjectType: Patient
date: 2015
publisher: HL7 International / FHIR Infrastructure
contact: http://www.hl7.org/Special/committees/fiwg
description: This represents an implementation of the "US Surgeon General family health portrait" form found at https://lforms-demo.nlm.nih.gov
- | Code | Value[x] |
* | Species (Details: http://terminology.hl7.org/CodeSystem/usage-context-type code species = 'Species', stated as 'null') | Homo sapiens (SNOMED CT#337915000) |
jurisdiction: United States of America (ISO 3166-1 Codes for the representation of names of countries and their subdivisions — Part 1: Country code#US)
purpose: Captures basic family history information
copyright: (c) 2015 Regenstrief Institute
approvalDate: 2015-10-31
lastReviewDate: 2017-03-15
code: US Surgeon General family health portrait [USSG-FHT] (Details: LOINC code 54127-6 = 'US Surgeon General family health portrait [USSG-FHT]', stated as 'US Surgeon General family health portrait [USSG-FHT]')
item
linkId: 0
type: group
Items
- LinkId Text Type * 0.1 Date Done date * 0.2 Time Done time * 0.3 Where Done string * 0.4 Comment string
item
linkId: 1
definition: http://loinc.org/rdf#54126-8
text: Your health information
type: group
required: true
item
linkId: 1.1
type: group
item
item
item
item
item
item
item
item
item
item
item
item
linkId: 1.2
definition: http://loinc.org/rdf#54137-5
text: Your diseases history
type: group
repeats: true
item
item
item
linkId: 2
definition: http://loinc.org/rdf#54114-4
text: Family member health information
type: group
item
linkId: 2.1
type: group
repeats: true
item
item
item
item
item
item
item
item
item
item
Generated Narrative: ValueSet #length
name: Length Units
status: active
description: Length units
immutable: true
compose
include
system: Unified Code for Units of Measure (UCUM)
concept
code: [in_i]
display: inches
concept
code: cm
display: centimeters
Generated Narrative: ValueSet #weight
name: Weight Units
status: active
description: Weight units
immutable: true
compose
include
system: Unified Code for Units of Measure (UCUM)
concept
code: [lb_i]
display: pounds
concept
code: km
display: kilograms
Resource ValueSet "LL1-9"
Profile: http://hl7.org/fhir/us/sdc/StructureDefinition/sdc-valueset
StructureDefinition Work Group: fhir
url: http://details.loinc.org/AnswerList/LL1-9
name: Gender_M/F
status: active
publisher: HL7 International / FHIR Infrastructure
contact:
description: Male=1, Female=2
immutable: true
copyright: Refer to https://loinc.org/terms-of-use
compose
include
system: Logical Observation Identifiers, Names and Codes (LOINC)
concept
code: LA2-8
display: Male
concept
code: LA3-6
display: Female
concept
code: LA46-8
display: Other
Resource ValueSet "LL623-0"
Profile: http://hl7.org/fhir/us/sdc/StructureDefinition/sdc-valueset
StructureDefinition Work Group: fhir
url: http://details.loinc.org/AnswerList/LL623-0
name: USSG-FHT twin
status: active
publisher: HL7 International / FHIR Infrastructure
contact:
description: Family history tool twin
immutable: true
copyright: Refer to https://loinc.org/terms-of-use
compose
include
system: Logical Observation Identifiers, Names and Codes (LOINC)
concept
code: LA10427-5
display: Yes - Identical (Same)
concept
code: LA10428-3
display: Yes - Fraternal (Different)
concept
code: LA32-8
display: No
Resource ValueSet "LL361-7"
Profile: http://hl7.org/fhir/us/sdc/StructureDefinition/sdc-valueset
StructureDefinition Work Group: fhir
url: http://details.loinc.org/AnswerList/LL361-7
name: Y/N1
status: active
publisher: HL7 International / FHIR Infrastructure
contact:
description: Yes/No
immutable: true
copyright: Refer to https://loinc.org/terms-of-use
compose
include
system: Logical Observation Identifiers, Names and Codes (LOINC)
concept
code: LA33-6
display: Yes
concept
code: LA32-8
display: No
Resource ValueSet "LL629-7"
Profile: http://hl7.org/fhir/us/sdc/StructureDefinition/sdc-valueset
StructureDefinition Work Group: fhir
url: http://details.loinc.org/AnswerList/LL629-7
name: USSG-FHT race
status: active
publisher: HL7 International / FHIR Infrastructure
contact:
description: Family history tool race
immutable: true
copyright: Refer to https://loinc.org/terms-of-use
compose
include
system: Logical Observation Identifiers, Names and Codes (LOINC)
concept
code: LA10608-0
display: American Indian or Alaska Native
concept
code: LA6156-9
display: Asian
concept
code: LA10614-8
display: -- Asian Indian
concept
code: LA10615-5
display: -- Chinese
concept
code: LA10616-3
display: -- Filipino
concept
code: LA10617-1
display: -- Japanese
concept
code: LA10618-9
display: -- Korean
concept
code: LA10620-5
display: -- Vietnamese
concept
code: LA10619-7
display: -- Other Asian
concept
code: LA10610-6
display: Black or African American
concept
code: LA10611-4
display: Native Hawaiian or Other Pacific Islander
concept
code: LA10623-9
display: -- Native Hawaiian
concept
code: LA10622-1
display: -- Guamanian
concept
code: LA10621-3
display: -- Chamorro
concept
code: LA10625-4
display: -- Samoan
concept
code: LA10624-7
display: -- Other Pacific Islander
concept
code: LA4457-3
display: White
concept
code: LA10613-0
display: Other/Unknown/Refuse To Answer
Resource ValueSet "LL628-9"
Profile: http://hl7.org/fhir/us/sdc/StructureDefinition/sdc-valueset
StructureDefinition Work Group: fhir
url: http://details.loinc.org/AnswerList/LL628-9
name: USSG-FHT ethnicity
status: active
publisher: HL7 International / FHIR Infrastructure
contact:
description: Family history tool ethnicity
immutable: true
copyright: Refer to https://loinc.org/terms-of-use
compose
include
system: Logical Observation Identifiers, Names and Codes (LOINC)
concept
code: LA6214-6
display: Hispanic or Latino
concept
code: LA10599-1
display: -- Central American
concept
code: LA10600-7
display: -- Cuban
concept
code: LA10601-5
display: -- Dominican(Republic)
concept
code: LA10602-3
display: -- Mexican
concept
code: LA10605-6
display: -- Puerto Rican
concept
code: LA10606-4
display: -- South American
concept
code: LA10604-9
display: -- Other Latin American
concept
code: LA10603-1
display: -- Other Hispanic/Latino/Spanish
concept
code: LA10597-5
display: Non-Hispanic or Latino
concept
code: LA10598-3
display: Ashkenazi Jewish
concept
code: LA10607-2
display: Unknown/No answer
Resource ValueSet "LL626-3"
Profile: http://hl7.org/fhir/us/sdc/StructureDefinition/sdc-valueset
StructureDefinition Work Group: fhir
url: http://details.loinc.org/AnswerList/LL626-3
name: USSG-FHT diseases
status: active
publisher: HL7 International / FHIR Infrastructure
contact:
description: Family history tool diseases
immutable: true
copyright: Refer to https://loinc.org/terms-of-use
compose
include
system: Logical Observation Identifiers, Names and Codes (LOINC)
concept
code: LA10533-0
display: Blood Clots
concept
code: LA10572-8
display: -- Blood Clot in Leg
concept
code: LA10573-6
display: -- Blood Clot in Lungs
concept
code: LA10524-9
display: Cancer
concept
code: LA10549-6
display: -- Bone
concept
code: LA10536-3
display: -- Breast Cancer
concept
code: LA10537-1
display: -- Colon Cancer
concept
code: LA10548-8
display: -- Esophageal Cancer
concept
code: LA10547-0
display: -- Gastric Cancer
concept
code: LA10541-3
display: -- Kidney Cancer
concept
code: LA10545-4
display: -- Leukemia
concept
code: LA10542-1
display: -- Lung Cancer
concept
code: LA10546-2
display: -- Muscle Cancer
concept
code: LA10539-7
display: -- Ovarian Cancer
concept
code: LA10538-9
display: -- Prostate Cancer
concept
code: LA10543-9
display: -- Skin Cancer
concept
code: LA10540-5
display: -- Thyroid Cancer
concept
code: LA10544-7
display: -- Uterine Cancer
concept
code: LA10550-4
display: -- Other Cancer
concept
code: LA10529-8
display: Diabetes
concept
code: LA10551-2
display: -- Diabetes Type 1
concept
code: LA10552-0
display: -- Diabetes Type 2
concept
code: LA10553-8
display: -- Gestational Diabetes
concept
code: LA10532-2
display: Gastrointestinal Disease
concept
code: LA10554-6
display: -- Crohn's Disease
concept
code: LA10555-3
display: -- Irritable Bowel Syndrome
concept
code: LA10556-1
display: -- Ulceritive Colitis
concept
code: LA10557-9
display: -- Colon Polyps
concept
code: LA10523-1
display: Heart Disease
concept
code: LA10558-7
display: -- Heart Attack
concept
code: LA10526-4
display: High Cholesterol/Hyperlipidemia
concept
code: LA7444-8
display: Hypertension
concept
code: LA10528-0
display: Kidney Disease
concept
code: LA10565-2
display: -- Cystic Kidney Disease
concept
code: LA10566-0
display: -- Kidney Disease Present From Birth
concept
code: LA10567-8
display: -- Nephrosis
concept
code: LA10568-6
display: -- Nephritis
concept
code: LA10569-4
display: -- Nephrotic Syndrome
concept
code: LA10570-2
display: -- Diabetic Kidney Disease
concept
code: LA10571-0
display: -- Other/Unknown
concept
code: LA10531-4
display: Lung Disease
concept
code: LA10559-5
display: -- COPD
concept
code: LA10560-3
display: -- Chronic Bronchitis
concept
code: LA10561-1
display: -- Emphysema
concept
code: LA10562-9
display: -- Chronic Lower Respiratory Disease
concept
code: LA10563-7
display: -- Influenza/Pneumonia
concept
code: LA10564-5
display: -- Asthma
concept
code: LA10590-0
display: Neurological Disorders
concept
code: LA10527-2
display: Osteoporosis
concept
code: LA10535-5
display: Psychological Disorders
concept
code: LA10574-4
display: -- Anxiety
concept
code: LA10575-1
display: -- Bipolar/Manic Depressive Disorder
concept
code: LA10576-9
display: -- Depression
concept
code: LA10577-7
display: -- Attention Deficit Hyper Activity
concept
code: LA10578-5
display: -- Autism
concept
code: LA10579-3
display: -- Personality Disorder
concept
code: LA10580-1
display: -- Eating Disorder
concept
code: LA10581-9
display: -- Obsessive Compulsive Disorder
concept
code: LA10582-7
display: -- Panic Disorder
concept
code: LA10583-5
display: -- Post Traumatic Stress Disorder
concept
code: LA10584-3
display: -- Schizophrenia
concept
code: LA10585-0
display: -- Social Phobia
concept
code: LA10586-8
display: -- Dementia
concept
code: LA10591-8
display: Septicemia
concept
code: LA10522-3
display: Stroke/Brain Attack
concept
code: LA10530-6
display: Sudden Infant Death Syndrome
Resource ValueSet "LL619-8"
Profile: http://hl7.org/fhir/us/sdc/StructureDefinition/sdc-valueset
StructureDefinition Work Group: fhir
url: http://details.loinc.org/AnswerList/LL619-8
name: USSG-FHT age
status: active
publisher: HL7 International / FHIR Infrastructure
contact:
description: Family history tool age range
immutable: true
copyright: Refer to https://loinc.org/terms-of-use
compose
include
system: Logical Observation Identifiers, Names and Codes (LOINC)
concept
code: LA10402-8
display: Pre-Birth
concept
code: LA10403-6
display: Newborn
concept
code: LA10394-7
display: Infancy
concept
code: LA10395-4
display: Childhood
concept
code: LA10404-4
display: Adolescence
concept
code: LA10396-2
display: 20-29
concept
code: LA10397-0
display: 30-39
concept
code: LA10398-8
display: 40-49
concept
code: LA10399-6
display: 50-59
concept
code: LA10400-2
display: OVER 60
concept
code: LA4489-6
display: Unknown
Resource ValueSet "LL621-4"
Profile: http://hl7.org/fhir/us/sdc/StructureDefinition/sdc-valueset
StructureDefinition Work Group: fhir
url: http://details.loinc.org/AnswerList/LL621-4
name: USSG-FHT relationship
status: active
publisher: HL7 International / FHIR Infrastructure
contact:
description: Family history tool relationship to patient
immutable: true
copyright: Refer to https://loinc.org/terms-of-use
compose
include
system: Logical Observation Identifiers, Names and Codes (LOINC)
concept
code: LA10405-1
display: Daughter
concept
code: LA10406-9
display: Granddaughter
concept
code: LA10407-7
display: Grandson
concept
code: LA10408-5
display: Half-brother
concept
code: LA10409-3
display: Half-sister
concept
code: LA10410-1
display: Maternal Aunt
concept
code: LA10411-9
display: Maternal Cousin
concept
code: LA10412-7
display: Maternal Grandfather
concept
code: LA10413-5
display: Maternal Grandmother
concept
code: LA10414-3
display: Maternal Uncle
concept
code: LA10415-0
display: Brother
concept
code: LA10416-8
display: Father
concept
code: LA10417-6
display: Mother
concept
code: LA10418-4
display: Sister
concept
code: LA10419-2
display: Nephew
concept
code: LA10420-0
display: Niece
concept
code: LA10421-8
display: Paternal Aunt
concept
code: LA10422-6
display: Paternal Cousin
concept
code: LA10423-4
display: Paternal Grandfather
concept
code: LA10424-2
display: Paternal Grandmother
concept
code: LA10425-9
display: Paternal Uncle
concept
code: LA10426-7
display: Son
Resource ValueSet "LL624-8"
Profile: http://hl7.org/fhir/us/sdc/StructureDefinition/sdc-valueset
StructureDefinition Work Group: fhir
url: http://details.loinc.org/AnswerList/LL624-8
name: USSG-FHT living
status: active
publisher: HL7 International / FHIR Infrastructure
contact:
description: Family history tool living
immutable: true
copyright: Refer to https://loinc.org/terms-of-use
compose
include
system: Logical Observation Identifiers, Names and Codes (LOINC)
concept
code: LA33-6
display: Yes
concept
code: LA32-8
display: No
concept
code: LA4489-6
display: Unknown
Resource ValueSet "LL627-1"
Profile: http://hl7.org/fhir/us/sdc/StructureDefinition/sdc-valueset
StructureDefinition Work Group: fhir
url: http://details.loinc.org/AnswerList/LL627-1
name: USSG-FHT diseases & cause of death
status: active
publisher: HL7 International / FHIR Infrastructure
contact:
description: Family history tool diseases and cause of death
immutable: true
copyright: Refer to https://loinc.org/terms-of-use
compose
include
system: Logical Observation Identifiers, Names and Codes (LOINC)
concept
code: LA10533-0
display: Blood Clots
concept
code: LA10572-8
display: -- Blood Clot in Leg
concept
code: LA10573-6
display: -- Blood Clot in Lungs
concept
code: LA10524-9
display: Cancer
concept
code: LA10549-6
display: -- Bone
concept
code: LA10536-3
display: -- Breast Cancer
concept
code: LA10537-1
display: -- Colon Cancer
concept
code: LA10548-8
display: -- Esophageal Cancer
concept
code: LA10547-0
display: -- Gastric Cancer
concept
code: LA10541-3
display: -- Kidney Cancer
concept
code: LA10545-4
display: -- Leukemia
concept
code: LA10542-1
display: -- Lung Cancer
concept
code: LA10546-2
display: -- Muscle Cancer
concept
code: LA10539-7
display: -- Ovarian Cancer
concept
code: LA10538-9
display: -- Prostate Cancer
concept
code: LA10543-9
display: -- Skin Cancer
concept
code: LA10540-5
display: -- Thyroid Cancer
concept
code: LA10544-7
display: -- Uterine Cancer
concept
code: LA10550-4
display: -- Other Cancer
concept
code: LA10529-8
display: Diabetes
concept
code: LA10551-2
display: -- Diabetes Type 1
concept
code: LA10552-0
display: -- Diabetes Type 2
concept
code: LA10553-8
display: -- Gestational Diabetes
concept
code: LA10532-2
display: Gastrointestinal Disease
concept
code: LA10554-6
display: -- Crohn's Disease
concept
code: LA10555-3
display: -- Irritable Bowel Syndrome
concept
code: LA10556-1
display: -- Ulceritive Colitis
concept
code: LA10557-9
display: -- Colon Polyps
concept
code: LA10523-1
display: Heart Disease
concept
code: LA10558-7
display: -- Heart Attack
concept
code: LA10526-4
display: High Cholesterol/Hyperlipidemia
concept
code: LA7444-8
display: Hypertension
concept
code: LA10528-0
display: Kidney Disease
concept
code: LA10565-2
display: -- Cystic Kidney Disease
concept
code: LA10566-0
display: -- Kidney Disease Present From Birth
concept
code: LA10567-8
display: -- Nephrosis
concept
code: LA10568-6
display: -- Nephritis
concept
code: LA10569-4
display: -- Nephrotic Syndrome
concept
code: LA10570-2
display: -- Diabetic Kidney Disease
concept
code: LA10571-0
display: -- Other/Unknown
concept
code: LA10531-4
display: Lung Disease
concept
code: LA10559-5
display: -- COPD
concept
code: LA10560-3
display: -- Chronic Bronchitis
concept
code: LA10561-1
display: -- Emphysema
concept
code: LA10562-9
display: -- Chronic Lower Respiratory Disease
concept
code: LA10563-7
display: -- Influenza/Pneumonia
concept
code: LA10564-5
display: -- Asthma
concept
code: LA10590-0
display: Neurological Disorders
concept
code: LA10527-2
display: Osteoporosis
concept
code: LA10535-5
display: Psychological Disorders
concept
code: LA10574-4
display: -- Anxiety
concept
code: LA10575-1
display: -- Bipolar/Manic Depressive Disorder
concept
code: LA10576-9
display: -- Depression
concept
code: LA10577-7
display: -- Attention Deficit Hyper Activity
concept
code: LA10578-5
display: -- Autism
concept
code: LA10579-3
display: -- Personality Disorder
concept
code: LA10580-1
display: -- Eating Disorder
concept
code: LA10581-9
display: -- Obsessive Compulsive Disorder
concept
code: LA10582-7
display: -- Panic Disorder
concept
code: LA10583-5
display: -- Post Traumatic Stress Disorder
concept
code: LA10584-3
display: -- Schizophrenia
concept
code: LA10585-0
display: -- Social Phobia
concept
code: LA10586-8
display: -- Dementia
concept
code: LA10591-8
display: Septicemia
concept
code: LA10522-3
display: Stroke/Brain Attack
concept
code: LA10530-6
display: Sudden Infant Death Syndrome
concept
code: LA10595-9
display: Cause of Death
concept
code: LA10587-6
display: -- Suicide
concept
code: LA10588-4
display: -- Accidental Death
concept
code: LA10589-2
display: -- Other/Unexpected