questionnaire-sdc-profile-example-ussg-fht
type: Questionnaire
node role: treeRoot
id:
  v: questionnaire-sdc-profile-example-ussg-fht
meta:
  profile:
    v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-pop-obsn
    link: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-pop-obsn
  profile:
    v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-search
    link: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-search
language:
  v: en
text:
  status:
    v: extensions
  div: Generated Narrative: Questionnaire questionnaire-sdc-profile-example-ussg-fht Profiles: Populatable Questionnaire - Observation, Search Questionnaire LinkID Text Cardinality Type Flags Description & Constraints<img src="[binary]" alt="doco" style="background-color: inherit"/> USSurgeonGeneralFamilyHealthPortrait 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/uv/sdc/Questionnaire/questionnaire-sdc-profile-example-ussg-fht#4.0.0 #xD; 0 null 0..1 group #xD; 0.1 Date Done 0..1 date #xD; 0.2 Time Done 0..1 time #xD; 0.3 Where Done 0..1 string #xD; 0.4 Comment 0..1 string #xD; 1 Your health information 1..1 group #xD; 1.1 null 0..1 group #xD; 1.1.1 Name 0..1 string Max Length: 200 #xD; 1.1.2 Gender 1..1 choice Value Set: LOINC Answer Codes for LL1-9 #xD; 1.1.2.1.1 Please specify 1..1 string Enable When: 1.1.2 = #xD; 1.1.3 Date of Birth 0..1 date #xD; 1.1.4 Were you born a twin? 0..1 choice Value Set: LOINC Answer Codes for LL623-0 Initial Value: Coding = LOINC#LA32-8 "No" #xD; 1.1.5 Were you adopted? 0..1 choice Value Set: LOINC Answer Codes for LL361-7 #xD; 1.1.6 Are your parents related to each other in any way other than marriage? 0..1 choice Value Set: LOINC Answer Codes for LL361-7 #xD; 1.1.7 Height 1..1 decimal #xD; 1.1.7.1.1 Units 0..1 choice Value Set: Length Units #xD; 1.1.8 Weight 0..1 decimal #xD; 1.1.8.1.1 Units 0..1 choice Value Set: Weight Units #xD; 1.1.9 Body mass index (BMI) [Ratio] 0..1 decimal #xD; 1.1.10 Race 1..1 choice Value Set: LOINC Answer Codes for LL629-7 #xD; 1.1.11 Ethnicity 0..* choice Value Set: LOINC Answer Codes for LL628-9 #xD; 1.2 Your diseases history 0..* group #xD; 1.2.1 Disease or Condition 0..1 choice Value Set: LOINC Answer Codes for LL626-3 #xD; 1.2.2 Age at Diagnosis 0..1 choice Value Set: LOINC Answer Codes for LL619-8 #xD; 2 Family member health information 0..* group #xD; 2.1.1 null 0..1 group #xD; 2.1.1.1 Rela…
contained: ValueSet
  id:
    v: length
  name:
    v: LengthUnits
  title:
    v: Length Units
  status:
    v: active
  description:
    v: Length units
  immutable:
    v: true
  compose:
    include:
      system:
        v: http://unitsofmeasure.org
contained: ValueSet
  id:
    v: weight
  name:
    v: WeightUnits
  title:
    v: Weight Units
  status:
    v: active
  description:
    v: Weight units
  immutable:
    v: true
  compose:
    include:
      system:
        v: http://unitsofmeasure.org
extension:
  url:
    v: http://hl7.org/fhir/5.0/StructureDefinition/extension-Questionnaire.versionAlgorithm%5Bx%5D
  value: Coding
    system:
      v: http://hl7.org/fhir/version-algorithm
    code:
      v: date
url:
  v: http://hl7.org/fhir/uv/sdc/Questionnaire/questionnaire-sdc-profile-example-ussg-fht
identifier:
  system:
    v: http://example.org/panel-id
  value:
    v: 54127-6
identifier:
  system:
    v: urn:ietf:rfc:3986
  value:
    v: urn:oid:2.16.840.1.113883.4.642.40.17.35.17
version:
  v: 4.0.0
name:
  v: USSurgeonGeneralFamilyHealthPortrait
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:
  name:
    v: HL7 International / FHIR Infrastructure
  telecom:
    system:
      v: url
    value:
      v: http://www.hl7.org/Special/committees/fiwg
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
    code:
      v: species
  value: CodeableConcept
    coding: http://snomed.info/id/337915000
      system:
        v: http://snomed.info/sct
      code:
        v: 337915000
      display:
        v: Homo sapiens
jurisdiction:
  coding:
    system:
      v: http://unstats.un.org/unsd/methods/m49/m49.htm
    code:
      v: 001
    display:
      v: World
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: https://loinc.org/rdf/54127-6
  system:
    v: http://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
  code: https://loinc.org/rdf/54126-8
    system:
      v: http://loinc.org
    code:
      v: 54126-8
  text:
    v: Your health information
  type:
    v: group
  required:
    v: true
  item:
    link id:
      v: 1.1
    type:
      v: group
    item:
      extension:
        value: Duration
      link id:
        v: 1.1.1
      code: https://loinc.org/rdf/54125-0
      text:
        v: Name
      type:
        v: string
      max length:
        v: 200

v: [in_i]

v: inch (international)

v: cm

v: centimeters

v: [lb_av]

v: pound (US and British)

v: kg

v: kilograms

Duration
value:
  v: 200
system:
  v: http://unitsofmeasure.org
code:
  v: a

v: 54125-0

extension:
  url:
    v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-observationLinkPeriod
  value: Duration
    value:
      v: 200
    system:
      v: http://unitsofmeasure.org
    code:
      v: a
link id:
  v: 1.1.2
code: https://loinc.org/rdf/54131-8
  system:
    v: http://loinc.org
  code:
    v: 54131-8
text:
  v: Gender
type:
  v: choice
required:
  v: true
answer value set:
  v: http://loinc.org/vs/LL1-9
  link: http://loinc.org/vs/LL1-9
item:
  link id:
    v: 1.1.2.1.1
  text:
    v: Please specify
  type:
    v: string
  enable when:
    question:
      v: 1.1.2
    operator:
      v: =
    answer: Coding
      type: LA46-8
      system:
        v: http://loinc.org
      code:
        v: LA46-8
  required:
    v: true

extension:
  url:
    v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-observationLinkPeriod
  value: Duration
    value:
      v: 200
    system:
      v: http://unitsofmeasure.org
    code:
      v: a
link id:
  v: 1.1.3
code: https://loinc.org/rdf/21112-8
  system:
    v: http://loinc.org
  code:
    v: 21112-8
text:
  v: Date of Birth
type:
  v: date

extension:
  url:
    v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-observationLinkPeriod
  value: Duration
    value:
      v: 200
    system:
      v: http://unitsofmeasure.org
    code:
      v: a
link id:
  v: 1.1.4
code: https://loinc.org/rdf/54132-6
  system:
    v: http://loinc.org
  code:
    v: 54132-6
text:
  v: Were you born a twin?
type:
  v: choice
answer value set:
  v: http://loinc.org/vs/LL623-0
  link: http://loinc.org/vs/LL623-0
initial:
  value: Coding
    type: LA32-8
    system:
      v: http://loinc.org
    code:
      v: LA32-8
    display:
      v: No

extension:
  url:
    v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-observationLinkPeriod
  value: Duration
    value:
      v: 200
    system:
      v: http://unitsofmeasure.org
    code:
      v: a
link id:
  v: 1.1.5
code: https://loinc.org/rdf/54128-4
  system:
    v: http://loinc.org
  code:
    v: 54128-4
text:
  v: Were you adopted?
type:
  v: choice
answer value set:
  v: http://loinc.org/vs/LL361-7
  link: http://loinc.org/vs/LL361-7

extension:
  url:
    v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-observationLinkPeriod
  value: Duration
    value:
      v: 200
    system:
      v: http://unitsofmeasure.org
    code:
      v: a
link id:
  v: 1.1.6
code: https://loinc.org/rdf/54135-9
  system:
    v: http://loinc.org
  code:
    v: 54135-9
text:
  v: Are your parents related to each other in any way other than marriage?
type:
  v: choice
answer value set:
  v: http://loinc.org/vs/LL361-7
  link: http://loinc.org/vs/LL361-7

extension:
  url:
    v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-observationLinkPeriod
  value: Duration
    value:
      v: 200
    system:
      v: http://unitsofmeasure.org
    code:
      v: a
link id:
  v: 1.1.7
code: https://loinc.org/rdf/8302-2
  system:
    v: http://loinc.org
  code:
    v: 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: choice
  answer value set:
    v: #length

extension:
  url:
    v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-observationLinkPeriod
  value: Duration
    value:
      v: 200
    system:
      v: http://unitsofmeasure.org
    code:
      v: a
link id:
  v: 1.1.8
code: https://loinc.org/rdf/29463-7
  system:
    v: http://loinc.org
  code:
    v: 29463-7
text:
  v: Weight
type:
  v: decimal
item:
  link id:
    v: 1.1.8.1.1
  text:
    v: Units
  type:
    v: choice
  answer value set:
    v: #weight

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

extension:
  url:
    v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-observationLinkPeriod
  value: Duration
    value:
      v: 200
    system:
      v: http://unitsofmeasure.org
    code:
      v: a
link id:
  v: 1.1.10
code: https://loinc.org/rdf/54134-2
  system:
    v: http://loinc.org
  code:
    v: 54134-2
text:
  v: Race
type:
  v: choice
required:
  v: true
answer value set:
  v: http://loinc.org/vs/LL629-7
  link: http://loinc.org/vs/LL629-7

extension:
  url:
    v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-observationLinkPeriod
  value: Duration
    value:
      v: 200
    system:
      v: http://unitsofmeasure.org
    code:
      v: a
link id:
  v: 1.1.11
code: https://loinc.org/rdf/54133-4
  system:
    v: http://loinc.org
  code:
    v: 54133-4
text:
  v: Ethnicity
type:
  v: choice
repeats:
  v: true
answer value set:
  v: http://loinc.org/vs/LL628-9
  link: http://loinc.org/vs/LL628-9

link id:
  v: 1.2
code: https://loinc.org/rdf/54137-5
  system:
    v: http://loinc.org
  code:
    v: 54137-5
text:
  v: Your diseases history
type:
  v: group
repeats:
  v: true
item:
  extension:
    url:
      v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-observationLinkPeriod
    value: Duration
      value:
        v: 200
      system:
        v: http://unitsofmeasure.org
      code:
        v: a
  link id:
    v: 1.2.1
  code: https://loinc.org/rdf/54140-9
    system:
      v: http://loinc.org
    code:
      v: 54140-9
  text:
    v: Disease or Condition
  type:
    v: choice
  answer value set:
    v: http://loinc.org/vs/LL626-3
    link: http://loinc.org/vs/LL626-3
item:
  extension:
    url:
      v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-observationLinkPeriod
    value: Duration
      value:
        v: 200
      system:
        v: http://unitsofmeasure.org
      code:
        v: a
  link id:
    v: 1.2.2
  code: https://loinc.org/rdf/54130-0
    system:
      v: http://loinc.org
    code:
      v: 54130-0
  text:
    v: Age at Diagnosis
  type:
    v: choice
  answer value set:
    v: http://loinc.org/vs/LL619-8
    link: http://loinc.org/vs/LL619-8

link id:
  v: 2
code: https://loinc.org/rdf/54114-4
  system:
    v: http://loinc.org
  code:
    v: 54114-4
text:
  v: Family member health information
type:
  v: group
repeats:
  v: true
item:
  link id:
    v: 2.1.1
  type:
    v: group
  item:
    extension:
      url:
        v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-observationLinkPeriod
      value: Duration
    link id:
      v: 2.1.1.1
    code: https://loinc.org/rdf/54136-7
      system:
        v: http://loinc.org
      code:
        v: 54136-7
    text:
      v: Relationship to you
    type:
      v: choice
    answer value set:
      v: http://loinc.org/vs/LL621-4
      link: http://loinc.org/vs/LL621-4
  item:
    extension:
      url:
        v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-observationLinkPeriod
      value: Duration
    link id:
      v: 2.1.1.2
    code: https://loinc.org/rdf/54138-3
      system:
        v: http://loinc.org
      code:
        v: 54138-3
    text:
      v: Name
    type:
      v: string
  item:
    extension:
      url:
        v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-observationLinkPeriod
      value: Duration
    link id:
      v: 2.1.1.3
    code: https://loinc.org/rdf/54123-5
      system:
        v: http://loinc.org
      code:
        v: 54123-5
    text:
      v: Gender
    type:
      v: choice
    answer value set:
      v: http://loinc.org/vs/LL1-9
      link: http://loinc.org/vs/LL1-9
    item:
      link id:
        v: 2.1.1.3.1.1
      text:
        v: Please specify
      type:
        v: string
      enable when:
        answer: Coding
      required:
        v: true
  item:
    extension:
      url:
        v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-observationLinkPeriod
      value: Duration
    link id:
      v: 2.1.1.4
    code: https://loinc.org/rdf/54139-1
      system:
        v: http://loinc.org
      code:
        v: 54139-1
    text:
      v: Living?
    type:
      v: choice
    answer value set:
      v: http://loinc.org/vs/LL361-7
      link: http://loinc.org/vs/LL361-7
    item:
      link id:
        v: 2.1.1.4.1
      type:
        v: group
      item:
        code: https://loinc.org/rdf/54112-8
      item:
        code: https://loinc.org/rdf/54113-6
    item:
      link id:
        v: 2.1.1.4.2
      type:
        v: group
      item:
        code: https://loinc.org/rdf/54124-3
      item:
        code: https://loinc.org/rdf/54141-7
  item:
    extension:
      url:
        v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-observationLinkPeriod
      value: Duration
    link id:
      v: 2.1.1.5
    code: https://loinc.org/rdf/54121-9
      system:
        v: http://loinc.org
      code:
        v: 54121-9
    text:
      v: Was this person born a twin?
    type:
      v: choice
    answer value set:
      v: http://loinc.org/vs/LL623-0
      link: http://loinc.org/vs/LL623-0
  item:
    extension:
      url:
        v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-observationLinkPeriod
      value: Duration
    link id:
      v: 2.1.1.6
    code: https://loinc.org/rdf/54122-7
      system:
        v: http://loinc.org
      code:
        v: 54122-7
    text:
      v: Was this person adopted?
    type:
      v: choice
    answer value set:
      v: http://loinc.org/vs/LL623-0
      link: http://loinc.org/vs/LL623-0
  item:
    extension:
      url:
        v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-observationLinkPeriod
      value: Duration
    link id:
      v: 2.1.1.7
    code: https://loinc.org/rdf/54119-3
      system:
        v: http://loinc.org
      code:
        v: 54119-3
    text:
      v: Race
    type:
      v: choice
    repeats:
      v: true
    answer value set:
      v: http://loinc.org/vs/LL629-7
      link: http://loinc.org/vs/LL629-7
  item:
    extension:
      url:
        v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-observationLinkPeriod
      value: Duration
    link id:
      v: 2.1.1.8
    code: https://loinc.org/rdf/54120-1
      system:
        v: http://loinc.org
      code:
        v: 54120-1
    text:
      v: Ethnicity
    type:
      v: choice
    repeats:
      v: true
    answer value set:
      v: http://loinc.org/vs/LL628-9
      link: http://loinc.org/vs/LL628-9

v: 200

v: a

v: 200

v: a

v: 200

v: a

v: 2.1.1.3

v: =

Coding
type: LA46-8
system:
  v: http://loinc.org
code:
  v: LA46-8

v: 200

v: a

url:
  v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-observationLinkPeriod
value: Duration
  value:
    v: 200
  system:
    v: http://unitsofmeasure.org
  code:
    v: a

v: 2.1.1.4.1.1

https://loinc.org/rdf/54112-8
system:
  v: http://loinc.org
code:
  v: 54112-8

v: Cause of Death

v: choice

link id:
  v: 2.1.1.4.1.1.1
text:
  v: Please specify
type:
  v: string
enable when:
  question:
    v: 2.1.1.4.1.1
  operator:
    v: =
  answer: Coding
    type: LA10589-2
    system:
      v: http://loinc.org
    code:
      v: LA10589-2

url:
  v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-observationLinkPeriod
value: Duration
  value:
    v: 200
  system:
    v: http://unitsofmeasure.org
  code:
    v: a

v: 2.1.1.4.1.2

https://loinc.org/rdf/54113-6
system:
  v: http://loinc.org
code:
  v: 54113-6

v: Age at Death

v: choice

url:
  v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-observationLinkPeriod
value: Duration
  value:
    v: 200
  system:
    v: http://unitsofmeasure.org
  code:
    v: a

v: 2.1.1.4.2.1

https://loinc.org/rdf/54124-3
system:
  v: http://loinc.org
code:
  v: 54124-3

v: Date of Birth

v: date

url:
  v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-observationLinkPeriod
value: Duration
  value:
    v: 200
  system:
    v: http://unitsofmeasure.org
  code:
    v: a

v: 2.1.1.4.2.2

https://loinc.org/rdf/54141-7
system:
  v: http://loinc.org
code:
  v: 54141-7

v: Age

v: decimal

v: 200

v: a

v: 200

v: a

v: 200

v: a

v: 200

v: a

link id:
  v: 2.1.2
code: https://loinc.org/rdf/54117-7
  system:
    v: http://loinc.org
  code:
    v: 54117-7
text:
  v: This family member's history of disease
type:
  v: group
repeats:
  v: true
item:
  extension:
    url:
      v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-observationLinkPeriod
    value: Duration
      value:
        v: 200
      system:
        v: http://unitsofmeasure.org
      code:
        v: a
  link id:
    v: 2.1.2.1
  code: https://loinc.org/rdf/54116-9
    system:
      v: http://loinc.org
    code:
      v: 54116-9
  text:
    v: Disease or Condition
  type:
    v: choice
  required:
    v: true
  answer value set:
    v: http://loinc.org/vs/LL626-3
    link: http://loinc.org/vs/LL626-3
item:
  extension:
    url:
      v: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-observationLinkPeriod
    value: Duration
      value:
        v: 200
      system:
        v: http://unitsofmeasure.org
      code:
        v: a
  link id:
    v: 2.1.2.2
  code: https://loinc.org/rdf/54115-1
    system:
      v: http://loinc.org
    code:
      v: 54115-1
  text:
    v: Age at Diagnosis
  type:
    v: choice
  answer value set:
    v: http://loinc.org/vs/LL619-8
    link: http://loinc.org/vs/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
  text:
    v: Mock-up item: Weight
  type:
    v: decimal
item:
  link id:
    v: 2.1.2.5
  text:
    v: Mock-up item: BMI
  type:
    v: decimal