Generated Narrative: Questionnaire questionnaire-sdc-profile-example-ussg-fht Profiles: Populatable Questionnaire - Observation, Search Questionnaire LinkID Text Cardinality Type Flags Description & Constraints 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 Relationship to you 0..1 choice Value Set: LOINC Answer Codes for LL621-4 #xD; 2.1.1.2 Name 0..1 string #xD; 2.1.1.3 Gender 0..1 choice Value Set: LOINC Answer Codes for LL1-9 #xD; 2.1.1.3.1.1 Please specify 1..1 string Enable When: 2.1.1.3 = #xD; 2.1.1.4 Living? 0..1 choice Value Set: LOINC Answer Codes for LL361-7 #xD; 2.1.1.4.1 null 0..1 group #xD; 2.1.1.4.1.1 Cause of Death 0..1 choice Value Set: LOINC Answer Codes for LL627-1 #xD; 2.1.1.4.1.1.1 Please specify 0..1 string Enable When: 2.1.1.4.1.1 = #xD; 2.1.1.4.1.2 Age at Death 0..1 choice Value Set: LOINC Answer Codes for LL619-8 #xD; 2.1.1.4.2 null 0..1 group #xD; 2.1.1.4.2.1 Date of Birth 0..1 date #xD; 2.1.1.4.2.2 Age 0..1 decimal #xD; 2.1.1.5 Was this person born a twin? 0..1 choice Value Set: LOINC Answer Codes for LL623-0 #xD; 2.1.1.6 Was this person adopted? 0..1 choice Value Set: LOINC Answer Codes for LL623-0 #xD; 2.1.1.7 Race 0..* choice Value Set: LOINC Answer Codes for LL629-7 #xD; 2.1.1.8 Ethnicity 0..* choice Value Set: LOINC Answer Codes for LL628-9 #xD; 2.1.2 This family member's history of disease 0..* group #xD; 2.1.2.1 Disease or Condition 1..1 choice Value Set: LOINC Answer Codes for LL626-3 #xD; 2.1.2.2 Age at Diagnosis 0..1 choice Value Set: LOINC Answer Codes for LL619-8 #xD; 2.1.2.3 Mock-up item: Height 0..1 decimal #xD; 2.1.2.4 Mock-up item: Weight 0..1 decimal #xD; 2.1.2.5 Mock-up item: BMI 0..1 decimal #xD; Documentation for this format Contained Resources ValueSet #length Include these codes as defined in http://unitsofmeasure.org version Not Stated (use latest from terminology server) Code Display [in_i] inch (international) cm centimeters ValueSet #weight Include these codes as defined in http://unitsofmeasure.org version Not Stated (use latest from terminology server) Code Display [lb_av] pound (US and British) kg kilograms
US Surgeon General - Family Health Portrait
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
US Surgeon General family health portrait [USSG-FHT]
Are your parents related to each other in any way other than marriage?