US Core Implementation Guide
​9.0.0-ballot - 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-ballot 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: Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE] (Experimental)

Official URL: http://hl7.org/fhir/us/core/Questionnaire/prapare-example Version: 9.0.0-ballot
Standards status: Informative Active as of 2023-03-31 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
.. PRAPAREExample Questionnaire http://hl7.org/fhir/us/core/Questionnaire/prapare-example#9.0.0-ballot
... /93025-5 Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE] 0..1 group
.... /93043-8 Personal characteristics 0..1 group
..... /93043-8/56051-6 Hispanic or Latino 0..1 choice Options: 3 options
..... /93043-8/32624-9 Race 0..* choice Options: 8 options
..... /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 [PRAPARE] 0..1 choice Options: 3 options
..... /93043-8/93034-7 Discharged from the U.S. Armed Forces 0..1 choice Options: 3 options
..... /93043-8/54899-0 Preferred language 0..1 choice Options: 3 options
.... /93042-0 Family and home 0..1 group
..... /93042-0/63512-8 How many people are living or staying at this address [#] 0..1 integer
..... /93042-0/71802-3 Housing status 0..1 choice Options: 3 options
...... /93042-0/71802-3-help Describes patients living arrangement 0..1 display
..... /93042-0/93033-9 Are you worried about losing your housing [PRAPARE] 0..1 choice Options: 3 options
..... /93042-0/56799-0 Address 0..1 string
.... /93041-2 Money and resources 0..1 group
..... /93041-2/82589-3 Highest level of educ 0..1 choice Options: 4 options
..... /93041-2/67875-5 Employment status current 0..1 choice Options: 5 options
..... /93041-2/76437-3 Primary insurance 0..1 choice Options: 7 options
..... /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 [PhenX] 0..1 decimal
..... /93041-2/93031-3 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] 0..* choice Options: 8 options
..... /93041-2/93030-5 Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living 0..* choice Options: 4 options
.... /93040-4 Social and emotional health 0..1 group
..... /93040-4/93029-7 How often do you see or talk to people that you care about and feel close to [PRAPARE] 0..1 choice Options: 5 options
..... /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? 0..1 choice Options: 6 options
.... /93039-6 Optional additional questions 0..1 group
..... /93039-6/93028-9 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] 0..1 choice Options: 3 options
..... /93039-6/93027-1 Are you a refugee 0..1 choice Options: 3 options
..... /93039-6/93026-3 Do you feel physically and emotionally safe where you currently live [PRAPARE] 0..1 choice Options: 4 options
..... /93039-6/76501-6 Within the last year, have you been afraid of your partner or ex-partner 0..1 choice 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")

Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]

  • linkId: /93025-5

Personal characteristics

  • linkId: /93043-8

Hispanic or Latino

Race

Has season or migrant farm work been your or your family's main source of income at any point in past 2 years [PRAPARE]

Discharged from the U.S. Armed Forces

Preferred language

Family and home

  • linkId: /93042-0

How many people are living or staying at this address [#]

  • linkId: /93042-0/63512-8

Housing status

Describes patients living arrangement

  • linkId: /93042-0/71802-3-help

Are you worried about losing your housing [PRAPARE]

Address

  • linkId: /93042-0/56799-0

Money and resources

  • linkId: /93041-2

Highest level of educ

Employment status current

Primary insurance

What was your best estimate of the total income of all family members from all sources, before taxes, in last year [PhenX]

  • linkId: /93041-2/63586-2

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]

Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living

Social and emotional health

  • linkId: /93040-4

How often do you see or talk to people that you care about and feel close to [PRAPARE]

Stress is when someone feels tense, nervous, anxious or can't sleep at night because their mind is troubled. How stressed are you?

Optional additional questions

  • linkId: /93039-6

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]

Are you a refugee

Do you feel physically and emotionally safe where you currently live [PRAPARE]

Within the last year, have you been afraid of your partner or ex-partner

LinkIDDescription & Constraintsdoco
.. /93025-5
... /93043-8
.... /93043-8/56051-6 Options: 3 options
.... /93043-8/32624-9 Options: 8 options
.... /93043-8/93035-4 Options: 3 options
.... /93043-8/93034-7 Options: 3 options
.... /93043-8/54899-0 Options: 3 options
... /93042-0
.... /93042-0/63512-8
.... /93042-0/71802-3 Options: 3 options
..... /93042-0/71802-3-help
.... /93042-0/93033-9 Options: 3 options
.... /93042-0/56799-0
... /93041-2
.... /93041-2/82589-3 Options: 4 options
.... /93041-2/67875-5 Options: 5 options
.... /93041-2/76437-3 Options: 7 options
.... /93041-2/63586-2
.... /93041-2/93031-3 Options: 8 options
.... /93041-2/93030-5 Options: 4 options
... /93040-4
.... /93040-4/93029-7 Options: 5 options
.... /93040-4/93038-8 Options: 6 options
... /93039-6
.... /93039-6/93028-9 Options: 3 options
.... /93039-6/93027-1 Options: 3 options
.... /93039-6/93026-3 Options: 4 options
.... /93039-6/76501-6 Options: 2 options

doco Documentation for this format

Test this Questionnaire

Try this questionnaire out:

    Responses for this Questionnaire