Structured Data Capture
3.0.0 - STU 3 International flag

Structured Data Capture, published by HL7 International - FHIR Infrastructure Work Group. This is not an authorized publication; it is the continuous build for version 3.0.0). This version is based on the current content of https://github.com/HL7/sdc/ and changes regularly. See the Directory of published versions

Questionnaire: SDC-LOINC USSG Family History (Experimental)

Official URL: http://hl7.org/fhir/uv/sdc/Questionnaire/questionnaire-sdc-profile-example-ussg-fht Version: 3.0.0
Standards status: Informative Computable Name: USSurgeonGeneralFamilyHealthPortrait
Other Identifiers: : 54127-6

Usage:Species: Homo sapiens

Copyright/Legal: (c) 2015 Regenstrief Institute

This represents an implementation of the “US Surgeon General family health portrait” form found at https://lforms-demo.nlm.nih.gov

Captures basic family history information

LinkIdTextCardinalityTypeFlagsDescription & Constraintsdoco
.. USSurgeonGeneralFamilyHealthPortraitThis represents an implementation of the "US Surgeon General family health portrait" form found at https://lforms-demo.nlm.nih.govQuestionnairehttp://hl7.org/fhir/uv/sdc/Questionnaire/questionnaire-sdc-profile-example-ussg-fht#3.0.0
... 0null0..1group
.... 0.1Date Done0..1date
.... 0.2Time Done0..1time
.... 0.3Where Done0..1string
.... 0.4Comment0..1string
... 1Your health information1..1groupDefinition: http://loinc.org/fhir/DataElement/54126-8
.... 1.1null0..1group
..... 1.1.1Name0..1stringMax Length: 200
Definition: http://loinc.org/fhir/DataElement/54125-0
..... 1.1.2Gender1..1choiceDefinition: http://loinc.org/fhir/DataElement/54131-8
Value Set: http://loinc.org/vs/LL1-9
...... 1.1.2.1.1Please specify1..1stringEnable When: 1.1.2 = Other (LOINC#LA46-8)
..... 1.1.3Date of Birth0..1dateDefinition: http://loinc.org/fhir/DataElement/21112-8
..... 1.1.4Were you born a twin?0..1choiceDefinition: http://loinc.org/fhir/DataElement/54132-6
Value Set: http://loinc.org/vs/LL623-0
Initial Value: Coding = LOINC#LA32-8 "No"
..... 1.1.5Were you adopted?0..1choiceDefinition: http://loinc.org/fhir/DataElement/54128-4
Value Set: http://loinc.org/vs/LL361-7
..... 1.1.6Are your parents related to each other in any way other than marriage?0..1choiceDefinition: http://loinc.org/fhir/DataElement/54135-9
Value Set: http://loinc.org/vs/LL361-7
..... 1.1.7Height1..1decimalDefinition: http://loinc.org/fhir/DataElement/8302-2
...... 1.1.7.1.1Units0..1choiceValue Set: Length Units
..... 1.1.8Weight0..1decimalDefinition: http://loinc.org/fhir/DataElement/29463-7
...... 1.1.8.1.1Units0..1choiceValue Set: Weight Units
..... 1.1.9Body mass index (BMI) [Ratio]0..1decimalDefinition: http://loinc.org/fhir/DataElement/39156-5
..... 1.1.10Race1..1choiceDefinition: http://loinc.org/fhir/DataElement/54134-2
Value Set: http://loinc.org/vs/LL629-7
..... 1.1.11Ethnicity0..*choiceDefinition: http://loinc.org/fhir/DataElement/54133-4
Value Set: http://loinc.org/vs/LL628-9
.... 1.2Your diseases history0..*groupDefinition: http://loinc.org/fhir/DataElement/54137-5
..... 1.2.1Disease or Condition0..1choiceDefinition: http://loinc.org/fhir/DataElement/54140-9
Value Set: http://loinc.org/vs/LL626-3
..... 1.2.2Age at Diagnosis0..1choiceDefinition: http://loinc.org/fhir/DataElement/54130-0
Value Set: http://loinc.org/vs/LL619-8
... 2Family member health information0..*groupDefinition: http://loinc.org/fhir/DataElement/54114-4
.... 2.1.1null0..1group
..... 2.1.1.1Relationship to you0..1choiceDefinition: http://loinc.org/fhir/DataElement/54136-7
Value Set: http://loinc.org/vs/LL621-4
..... 2.1.1.2Name0..1stringDefinition: http://loinc.org/fhir/DataElement/54138-3
..... 2.1.1.3Gender0..1choiceDefinition: http://loinc.org/fhir/DataElement/54123-5
Value Set: http://loinc.org/vs/LL1-9
...... 2.1.1.3.1.1Please specify1..1stringEnable When: 2.1.1.3 = Other (LOINC#LA46-8)
..... 2.1.1.4Living?0..1choiceDefinition: http://loinc.org/fhir/DataElement/54139-1
Value Set: http://loinc.org/vs/LL361-7
...... 2.1.1.4.1null0..1group
....... 2.1.1.4.1.1Cause of Death0..1choiceDefinition: http://loinc.org/fhir/DataElement/54112-8
Value Set: http://loinc.org/vs/LL627-1
........ 2.1.1.4.1.1.1Please specify0..1stringEnable When: 2.1.1.4.1.1 = Other/Unexpected (LOINC#LA10589-2)
....... 2.1.1.4.1.2Age at Death0..1choiceDefinition: http://loinc.org/fhir/DataElement/54113-6
Value Set: http://loinc.org/vs/LL619-8
...... 2.1.1.4.2null0..1group
....... 2.1.1.4.2.1Date of Birth0..1dateDefinition: http://loinc.org/fhir/DataElement/54124-3
....... 2.1.1.4.2.2Age0..1decimalDefinition: http://loinc.org/fhir/DataElement/54141-7
..... 2.1.1.5Was this person born a twin?0..1choiceDefinition: http://loinc.org/fhir/DataElement/54121-9
Value Set: http://loinc.org/vs/LL623-0
..... 2.1.1.6Was this person adopted?0..1choiceDefinition: http://loinc.org/fhir/DataElement/54122-7
Value Set: http://loinc.org/vs/LL623-0
..... 2.1.1.7Race0..*choiceDefinition: http://loinc.org/fhir/DataElement/54119-3
Value Set: http://loinc.org/vs/LL629-7
..... 2.1.1.8Ethnicity0..*choiceDefinition: http://loinc.org/fhir/DataElement/54120-1
Value Set: http://loinc.org/vs/LL628-9
.... 2.1.2This family member's history of disease0..*groupDefinition: http://loinc.org/fhir/DataElement/54117-7
..... 2.1.2.1Disease or Condition1..1choiceDefinition: http://loinc.org/fhir/DataElement/54116-9
Value Set: http://loinc.org/vs/LL626-3
..... 2.1.2.2Age at Diagnosis0..1choiceDefinition: http://loinc.org/fhir/DataElement/54115-1
Value Set: http://loinc.org/vs/LL619-8
..... 2.1.2.3Mock-up item: Height0..1decimal
..... 2.1.2.4Mock-up item: Weight0..1decimal
..... 2.1.2.5Mock-up item: BMI0..1decimal

doco Documentation for this format