ussg-fht
type: Bundle
node role: treeRoot
id:
  v: ussg-fht
type:
  v: transaction
entry:
  full url:
    v: http://hl7.org/fhir/us/sdc/Questionnaire/54127-6
    l: http://hl7.org/fhir/us/sdc/Questionnaire/54127-6
  resource: http://hl7.org/fhir/us/sdc/Questionnaire/54127-6
  request:
    method:
      v: PUT
    url:
      v: http://hl7.org/fhir/us/sdc/Questionnaire/54127-6
      l: http://hl7.org/fhir/us/sdc/Questionnaire/54127-6

http://hl7.org/fhir/us/sdc/Questionnaire/54127-6
type: Questionnaire
id:
  v: 54127-6
meta:
  profile:
    v: http://hl7.org/fhir/us/sdc/StructureDefinition/sdc-questionnaire
    l: sdc-questionnaire
text:
  status:
    v: generated
  div:
    v: Generated Narrative: Questionnaire 54127-6 Profile: http://hl7.org/fhir/us/sdc/StructureDefinition/sdc-questionnaire LinkID Text Cardinality Type Flags Description & Constraints<img src="[binary]" alt="doco" style="background-color: inherit"/> This represents an implementation of the "US Surgeon General family health portrait" form found at https://lforms-demo.nlm.nih.gov Questionnaire http://hl7.org/fhir/us/sdc/Questionnaire/54127-6 0 null 0..1 group 0.1 Date Done 0..1 date 0.2 Time Done 0..1 time 0.3 Where Done 0..1 string 0.4 Comment 0..1 string 1 Your health information 1..1 group Definition: http://loinc.org/rdf#54126-8 1.1 null 0..1 group 1.1.1 Name 0..1 string Max Length: 200 Definition: http://loinc.org/rdf#54125-0 1.1.2 Gender 1..1 coding Definition: http://loinc.org/rdf#54131-8 Value Set: LOINC Answer Codes for LL1-9 1.1.2.1.1 Please specify 1..1 string 1.1.3 Date of Birth 0..1 date Definition: http://loinc.org/rdf#21112-8 1.1.4 Were you born a twin? 0..1 coding Definition: http://loinc.org/rdf#54132-6 Value Set: LOINC Answer Codes for LL623-0 Initial Value: Coding = LOINC#LA32-8 "No" 1.1.5 Were you adopted? 0..1 coding Definition: http://loinc.org/rdf#54128-4 Value Set: LOINC Answer Codes for LL361-7 1.1.6 Are your parents related to each other in any way other than marriage? 0..1 coding Definition: http://loinc.org/rdf#54135-9 Value Set: LOINC Answer Codes for LL361-7 1.1.7 Height 1..1 decimal Definition: http://loinc.org/rdf#8302-2 1.1.7.1.1 Units 0..1 coding Value Set: ValueSet Length Units 1.1.8 Weight 0..1 decimal Definition: http://loinc.org/rdf#29463-7 1.1.8.1.1 Units 0..1 coding Value Set: ValueSet Weight Units 1.1.9 Body mass index (BMI) [Ratio] 0..1 decimal Definition: http://loinc.org/rdf#39156-5 1.1.10 Race 1..1 coding Definition: http://loinc.org/rdf#54134-2 Value Set: LOINC Answer Codes for LL629-7 1.1.11 Ethnicity 0..* coding Definition: http://loinc.org/rdf#54133-4 Value Set: LOINC Answer Codes for LL628-9 1.2 Your diseases history 0..* gr…
contained: ValueSet
  id:
    v: length
  meta:
    profile:
      v: http://hl7.org/fhir/us/sdc/StructureDefinition/sdc-valueset
      l: sdc-valueset
  name:
    v: Length Units
  status:
    v: active
  description:
    v: Length units
  immutable:
    v: true
  compose:
    include:
      system:
        v: http://unitsofmeasure.org
        l: unitsofmeasure.org
contained: ValueSet
  id:
    v: weight
  meta:
    profile:
      v: http://hl7.org/fhir/us/sdc/StructureDefinition/sdc-valueset
      l: sdc-valueset
  name:
    v: Weight Units
  status:
    v: active
  description:
    v: Weight units
  immutable:
    v: true
  compose:
    include:
      system:
        v: http://unitsofmeasure.org
        l: unitsofmeasure.org
extension:
  url:
    v: http://hl7.org/fhir/StructureDefinition/structuredefinition-wg
    l: structuredefinition-wg
  value: Code
    v: fhir
url:
  v: http://hl7.org/fhir/us/sdc/Questionnaire/54127-6
  l: http://hl7.org/fhir/us/sdc/Questionnaire/54127-6
identifier:
  system:
    v: http://example.org/panel-id
    l: panel-id
  value:
    v: 54127-6
title:
  v: US Surgeon General - Family Health Portrait
status:
  v: active
experimental:
  v: true
subject type:
  v: Patient
date:
  v: 2015
publisher:
  v: HL7 International / FHIR Infrastructure
contact:
  telecom:
    system:
      v: url
    value:
      v: http://www.hl7.org/Special/committees/fiwg
description:
  v: This represents an implementation of the "US Surgeon General family health portrait" form found at https://lforms-demo.nlm.nih.gov
use context:
  code:
    system:
      v: http://terminology.hl7.org/CodeSystem/usage-context-type
      l: usage-context-type
    code:
      v: species
  value: CodeableConcept
    type: http://snomed.info/id/337915000
    coding:
      system:
        v: http://snomed.info/sct
        l: sct
      code:
        v: 337915000
      display:
        v: Homo sapiens
jurisdiction:
  coding:
    system:
      v: urn:iso:std:iso:3166
      l: 3166
    code:
      v: US
purpose:
  v: Captures basic family history information
copyright:
  v: (c) 2015 Regenstrief Institute
approval date:
  v: 2015-10-31
last review date:
  v: 2017-03-15
code:
  system:
    v: http://loinc.org
    l: loinc.org
  code:
    v: 54127-6
  display:
    v: US Surgeon General family health portrait [USSG-FHT]
item:
  link id:
    v: 0
  type:
    v: group
  item:
    link id:
      v: 0.1
    text:
      v: Date Done
    type:
      v: date
  item:
    link id:
      v: 0.2
    text:
      v: Time Done
    type:
      v: time
  item:
    link id:
      v: 0.3
    text:
      v: Where Done
    type:
      v: string
  item:
    link id:
      v: 0.4
    text:
      v: Comment
    type:
      v: string
item:
  link id:
    v: 1
  definition:
    v: http://loinc.org/rdf#54126-8
    l: http://loinc.org/rdf#54126-8
  text:
    v: Your health information
  type:
    v: group
  required:
    v: true
  item:
    link id:
      v: 1.1
    type:
      v: group
    item:
      link id:
        v: 1.1.1
      definition:
        v: http://loinc.org/rdf#54125-0
        l: http://loinc.org/rdf#54125-0
      text:
        v: Name
      type:
        v: string
      max length:
        v: 200
    item:
      link id:
        v: 1.1.2
      definition:
        v: http://loinc.org/rdf#54131-8
        l: http://loinc.org/rdf#54131-8
      text:
        v: Gender
      type:
        v: coding
      required:
        v: true
      answer value set:
        v: http://loinc.org/vs/LL1-9
        l: LL1-9

v: [in_i]

v: inches

v: cm

v: centimeters

v: [lb_av]

v: pounds

v: km

v: kilograms

link id:
  v: 1.1.2.1.1
text:
  v: Please specify
type:
  v: string
required:
  v: true

link id:
  v: 1.1.3
definition:
  v: http://loinc.org/rdf#21112-8
  l: http://loinc.org/rdf#21112-8
text:
  v: Date of Birth
type:
  v: date

link id:
  v: 1.1.4
definition:
  v: http://loinc.org/rdf#54132-6
  l: http://loinc.org/rdf#54132-6
text:
  v: Were you born a twin?
type:
  v: coding
answer value set:
  v: http://loinc.org/vs/LL623-0
  l: LL623-0
initial:
  value: Coding
    system:
      v: http://loinc.org
      l: loinc.org
    code:
      v: LA32-8
    display:
      v: No

link id:
  v: 1.1.5
definition:
  v: http://loinc.org/rdf#54128-4
  l: http://loinc.org/rdf#54128-4
text:
  v: Were you adopted?
type:
  v: coding
answer value set:
  v: http://loinc.org/vs/LL361-7
  l: LL361-7

link id:
  v: 1.1.6
definition:
  v: http://loinc.org/rdf#54135-9
  l: http://loinc.org/rdf#54135-9
text:
  v: Are your parents related to each other in any way other than marriage?
type:
  v: coding
answer value set:
  v: http://loinc.org/vs/LL361-7
  l: LL361-7

link id:
  v: 1.1.7
definition:
  v: http://loinc.org/rdf#8302-2
  l: http://loinc.org/rdf#8302-2
text:
  v: Height
type:
  v: decimal
required:
  v: true
item:
  link id:
    v: 1.1.7.1.1
  text:
    v: Units
  type:
    v: coding
  answer value set:
    v: #length
    l: length

link id:
  v: 1.1.8
definition:
  v: http://loinc.org/rdf#29463-7
  l: http://loinc.org/rdf#29463-7
text:
  v: Weight
type:
  v: decimal
item:
  link id:
    v: 1.1.8.1.1
  text:
    v: Units
  type:
    v: coding
  answer value set:
    v: #weight
    l: weight

link id:
  v: 1.1.9
definition:
  v: http://loinc.org/rdf#39156-5
  l: http://loinc.org/rdf#39156-5
text:
  v: Body mass index (BMI) [Ratio]
type:
  v: decimal
read only:
  v: true

link id:
  v: 1.1.10
definition:
  v: http://loinc.org/rdf#54134-2
  l: http://loinc.org/rdf#54134-2
text:
  v: Race
type:
  v: coding
required:
  v: true
answer value set:
  v: http://loinc.org/vs/LL629-7
  l: LL629-7

link id:
  v: 1.1.11
definition:
  v: http://loinc.org/rdf#54133-4
  l: http://loinc.org/rdf#54133-4
text:
  v: Ethnicity
type:
  v: coding
repeats:
  v: true
answer value set:
  v: http://loinc.org/vs/LL628-9
  l: LL628-9

link id:
  v: 1.2
definition:
  v: http://loinc.org/rdf#54137-5
  l: http://loinc.org/rdf#54137-5
text:
  v: Your diseases history
type:
  v: group
repeats:
  v: true
item:
  link id:
    v: 1.2.1
  definition:
    v: http://loinc.org/rdf#54140-9
    l: http://loinc.org/rdf#54140-9
  text:
    v: Disease or Condition
  type:
    v: coding
  answer value set:
    v: http://loinc.org/vs/LL626-3
    l: LL626-3
item:
  link id:
    v: 1.2.2
  definition:
    v: http://loinc.org/rdf#54130-0
    l: http://loinc.org/rdf#54130-0
  text:
    v: Age at Diagnosis
  type:
    v: coding
  answer value set:
    v: http://loinc.org/vs/LL619-8
    l: LL619-8

link id:
  v: 2
definition:
  v: http://loinc.org/rdf#54114-4
  l: http://loinc.org/rdf#54114-4
text:
  v: Family member health information
type:
  v: group
item:
  link id:
    v: 2.1
  type:
    v: group
  repeats:
    v: true
  item:
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/questionnaire-referenceResource
        l: questionnaire-referenceResource
      value: Code
        v: Patient
    link id:
      v: 2.1.1.0
    text:
      v: Family Member identity
    type:
      v: reference
  item:
    link id:
      v: 2.1.1.1
    definition:
      v: http://loinc.org/rdf#54136-7
      l: http://loinc.org/rdf#54136-7
    text:
      v: Relationship to you
    type:
      v: coding
    answer value set:
      v: http://loinc.org/vs/LL621-4
      l: LL621-4
  item:
    link id:
      v: 2.1.1.2
    definition:
      v: http://loinc.org/rdf#54138-3
      l: http://loinc.org/rdf#54138-3
    text:
      v: Name
    type:
      v: string
  item:
    link id:
      v: 2.1.1.3
    definition:
      v: http://loinc.org/rdf#54123-5
      l: http://loinc.org/rdf#54123-5
    text:
      v: Gender
    type:
      v: coding
    answer value set:
      v: http://loinc.org/vs/LL1-9
      l: LL1-9
    item:
      link id:
        v: 2.1.1.3.1.1
      text:
        v: Please specify
      type:
        v: string
      required:
        v: true
  item:
    link id:
      v: 2.1.1.4
    definition:
      v: http://loinc.org/rdf#54139-1
      l: http://loinc.org/rdf#54139-1
    text:
      v: Living?
    type:
      v: coding
    answer value set:
      v: http://loinc.org/vs/LL361-7
      l: LL361-7
    item:
      link id:
        v: 2.1.1.4.1
      type:
        v: group
    item:
      link id:
        v: 2.1.1.4.2
      type:
        v: group
  item:
    link id:
      v: 2.1.1.5
    definition:
      v: http://loinc.org/rdf#54121-9
      l: http://loinc.org/rdf#54121-9
    text:
      v: Was this person born a twin?
    type:
      v: coding
    answer value set:
      v: http://loinc.org/vs/LL623-0
      l: LL623-0
  item:
    link id:
      v: 2.1.1.6
    definition:
      v: http://loinc.org/rdf#54122-7
      l: http://loinc.org/rdf#54122-7
    text:
      v: Was this person adopted?
    type:
      v: coding
    answer value set:
      v: http://loinc.org/vs/LL623-0
      l: LL623-0
  item:
    link id:
      v: 2.1.1.7
    definition:
      v: http://loinc.org/rdf#54119-3
      l: http://loinc.org/rdf#54119-3
    text:
      v: Race
    type:
      v: coding
    repeats:
      v: true
    answer value set:
      v: http://loinc.org/vs/LL629-7
      l: LL629-7
  item:
    link id:
      v: 2.1.1.8
    definition:
      v: http://loinc.org/rdf#54120-1
      l: http://loinc.org/rdf#54120-1
    text:
      v: Ethnicity
    type:
      v: coding
    repeats:
      v: true
    answer value set:
      v: http://loinc.org/vs/LL628-9
      l: LL628-9
  item:
    link id:
      v: 2.1.2
    definition:
      v: http://loinc.org/rdf#54117-7
      l: http://loinc.org/rdf#54117-7
    text:
      v: This family member's history of disease
    type:
      v: group
    repeats:
      v: true
    item:
      link id:
        v: 2.1.2.1
      definition:
        v: http://loinc.org/rdf#54116-9
        l: http://loinc.org/rdf#54116-9
      text:
        v: Disease or Condition
      type:
        v: coding
      required:
        v: true
      answer value set:
        v: http://loinc.org/vs/LL626-3
        l: LL626-3
    item:
      link id:
        v: 2.1.2.2
      definition:
        v: http://loinc.org/rdf#54115-1
        l: http://loinc.org/rdf#54115-1
      text:
        v: Age at Diagnosis
      type:
        v: coding
      answer value set:
        v: http://loinc.org/vs/LL619-8
        l: LL619-8
    item:
      link id:
        v: 2.1.2.3
      text:
        v: Mock-up item: Height
      type:
        v: decimal
    item:
      link id:
        v: 2.1.2.4

v: 2.1.1.4.1.1

v: Cause of Death

v: coding

link id:
  v: 2.1.1.4.1.1.1
text:
  v: Please specify
type:
  v: string

v: 2.1.1.4.1.2

v: Age at Death

v: coding

v: 2.1.1.4.2.1

v: Date of Birth

v: date

v: 2.1.1.4.2.2

v: Age

v: decimal

v: Mock-up item: Weight

v: decimal

link id:
  v: 2.1.2.5
text:
  v: Mock-up item: BMI
type:
  v: decimal