Generated Narrative: Questionnaire SDOHCC-QuestionnairePRAPARE Profile: Extractable Questionnaire - StructureMap Structure LinkID Text Cardinality Type Description & Constraints SDOHCCQuestionnairePRAPARE Questionnaire http://hl7.org/fhir/us/sdoh-clinicalcare/Questionnaire/SDOHCC-QuestionnairePRAPARE#3.0.0-ballot #xD; /93025-5 Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE] 0..1 group #xD; /93043-8 Personal characteristics 0..1 group #xD; /93043-8/56051-6 Hispanic or Latino 0..1 choice Options: 3 options #xD; /93043-8/32624-9 Race 0..* choice Options: 8 options #xD; /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? 0..1 choice Options: 3 options #xD; /93043-8/93034-7 Have you been discharged from the armed forces of the United States? 0..1 choice Options: 3 options #xD; /93043-8/54899-0 Preferred language 0..1 choice Options: 3 options #xD; /93042-0 Family and home 0..1 group #xD; /93042-0/63512-8 How many people are living or staying at this address? 0..1 integer #xD; /93042-0/71802-3 Housing status 0..1 choice Options: 3 options #xD; /93042-0/71802-3-help Describes patients living arrangement 0..1 display #xD; /93042-0/93033-9 Are you worried about losing your housing? 0..1 choice Options: 3 options #xD; /93042-0/56799-0 Address 0..1 string #xD; /93041-2 Money and resources 0..1 group #xD; /93041-2/82589-3 Highest level of educ 0..1 choice Options: 4 options #xD; /93041-2/67875-5 Employment status current 0..1 choice Options: 5 options #xD; /93041-2/76437-3 Primary insurance 0..1 choice Options: 7 options #xD; /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? 0..1 decimal #xD; /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? 0..* choice Options: 8 options #xD; /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 #xD; /93040-4 Social and emotional health 0..1 group #xD; /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)? 0..1 choice Options: 5 options #xD; /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 #xD; /93039-6 Optional additional questions 0..1 group #xD; /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? 0..1 choice Options: 3 options #xD; /93039-6/93027-1 Are you a refugee? 0..1 choice Options: 3 options #xD; /93039-6/93026-3 Do you feel physically and emotionally safe where you currently live? 0..1 choice Options: 4 options #xD; /93039-6/76501-6 Within the last year, have you been afraid of your partner or ex-partner? 0..1 choice Options: 2 options #xD; 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]
Has season or migrant farm work been your or your family's main source of income at any point in past 2 years [PRAPARE]
Has season or migrant farm work been your or your family's main source of income at any point in past 2 years?
Have you been discharged from the armed forces of the United States?
How many people are living or staying at this address [#]
How many people are living or staying at this address?
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)
Are you worried about losing your housing [PRAPARE]
Are you worried about losing your housing?
Otherwise unemployed but not seeking work (ex: student, retired, disabled, unpaid primary care giver)
What was your best estimate of the total income of all family members from all sources, before taxes, in last year [PhenX]
What was your best estimate of the total income of all family members from all sources, before taxes, in last year?
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]
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?
Medicine or Any Health Care (Medical, Dental, Mental Health, Vision)
Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living
Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living?
Yes, it has kept me from medical appointments or from getting my medications
Yes, it has kept me from non-medical meetings, appointments, work, or from getting things that I need
How often do you see or talk to people that you care about and feel close to [PRAPARE]
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)?
Stress is when someone feels tense, nervous, anxious or can't sleep at night because their mind is troubled. How stressed are you?
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]
In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?
Do you feel physically and emotionally safe where you currently live [PRAPARE]
Do you feel physically and emotionally safe where you currently live?
Within the last year, have you been afraid of your partner or ex-partner
Within the last year, have you been afraid of your partner or ex-partner?