SDC-Response to LOINC USSG Family History - Structured Data Capture v4.0.0

Structured Data Capture
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Structured Data Capture, published by HL7 International / FHIR Infrastructure. This guide is not an authorized publication; it is the continuous build for version 4.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/sdc/ and changes regularly. See the Directory of published versions

Example QuestionnaireResponse: SDC-Response to LOINC USSG Family History

Page standards status: Informative

Language: en

Profile: SDC Standard Questionnaire Response

LinkID	Text	Answer
questionnaireresponse-sdc-example-ussg-fht-answers		Questionnaire:US Surgeon General - Family Health Portrait
0
0.1	Date Done	2008-01-17
1	Your health information
1.1
1.1.1	Name	Annie Proband
1.1.2	Gender	LOINC: LA3-6 (Female)
1.1.3	Date of Birth	1966-04-04
1.1.4	Were you born a twin?	LOINC: LA32-8 (No)
1.1.5	Were you adopted?	LOINC: LA32-8 (No)
1.1.6	Are your parents related to each other in any way other than marriage?	LOINC: LA32-8 (No)
1.1.7	Height	63
1.1.7.1.1	Units	UCUM: [in_i] ([in_i])
1.1.8	Weight	127
1.1.8.1.1	Units	UCUM: [lb_av] ([lb_av])
1.1.9	Body mass index (BMI) [Ratio]	22.5
1.1.10	Race	LOINC: LA4457-3 (White)
1.1.11	Ethnicity
2	Family member health information
2.1.1
2.1.1.1	Relationship to you	LOINC: LA10405-1 (Daughter)
2.1.1.2	Name	Susan
2.1.1.3	Gender	LOINC: LA3-6 (Female)
2.1.1.4	Living?	LOINC: LA33-6 (Yes)
2.1.1.4.2
2.1.1.4.2.2	Age	17
2.1.1.5	Was this person born a twin?	LOINC: LA32-8 (No)
2.1.1.6	Was this person adopted?	LOINC: LA32-8 (No)
2	Family member health information
2.1.1
2.1.1.1	Relationship to you	LOINC: LA10415-0 (Brother)
2.1.1.2	Name	Brian
2.1.1.3	Gender	LOINC: LA2-8 (Male)
2.1.1.4	Living?	LOINC: LA33-6 (Yes)
2.1.1.4.2
2.1.1.4.2.2	Age	32
2.1.1.5	Was this person born a twin?	LOINC: LA32-8 (No)
2.1.1.6	Was this person adopted?	LOINC: LA32-8 (No)
2.1.2	This family member's history of disease
2.1.2.1	Disease or Condition	LOINC: LA14284-6 (Other Cancer)
2.1.2.2	Age at Diagnosis	LOINC: LA10397-0 (30-39)
2	Family member health information
2.1.1
2.1.1.1	Relationship to you	LOINC: LA10418-4 (Sister)
2.1.1.2	Name	Janet
2.1.1.3	Gender	LOINC: LA3-6 (Female)
2.1.1.4	Living?	LOINC: LA33-6 (Yes)
2.1.1.4.2
2.1.1.4.2.2	Age	36
2.1.1.5	Was this person born a twin?	LOINC: LA32-8 (No)
2.1.1.6	Was this person adopted?	LOINC: LA32-8 (No)
2.1.2	This family member's history of disease
2.1.2.1	Disease or Condition	LOINC: LA14283-8 (Breast Cancer)
2.1.2.2	Age at Diagnosis	LOINC: LA10397-0 (30-39)
2	Family member health information
2.1.1
2.1.1.1	Relationship to you	LOINC: LA10419-2 (Nephew)
2.1.1.2	Name	Ian
2.1.1.3	Gender	LOINC: LA2-8 (Male)
2.1.1.4	Living?	LOINC: LA33-6 (Yes)
2.1.1.4.2
2.1.1.4.2.2	Age	16
2.1.1.5	Was this person born a twin?	LOINC: LA32-8 (No)
2.1.1.6	Was this person adopted?	LOINC: LA32-8 (No)
2	Family member health information
2.1.1
2.1.1.1	Relationship to you	LOINC: LA10420-0 (Niece)
2.1.1.2	Name	Helen
2.1.1.3	Gender	LOINC: LA3-6 (Female)
2.1.1.4	Living?	LOINC: LA33-6 (Yes)
2.1.1.4.2
2.1.1.4.2.2	Age	15
2.1.1.5	Was this person born a twin?	LOINC: LA32-8 (No)
2.1.1.6	Was this person adopted?	LOINC: LA32-8 (No)
2	Family member health information
2.1.1
2.1.1.1	Relationship to you	LOINC: LA10416-8 (Father)
2.1.1.2	Name	Donald
2.1.1.3	Gender	LOINC: LA2-8 (Male)
2.1.1.4	Living?	LOINC: LA33-6 (Yes)
2.1.1.4.2
2.1.1.4.2.2	Age	52
2.1.1.5	Was this person born a twin?	LOINC: LA32-8 (No)
2.1.1.6	Was this person adopted?	LOINC: LA32-8 (No)
2	Family member health information
2.1.1
2.1.1.1	Relationship to you	LOINC: LA10425-9 (Paternal Uncle)
2.1.1.2	Name	Eric
2.1.1.3	Gender	LOINC: LA2-8 (Male)
2.1.1.4	Living?	LOINC: LA33-6 (Yes)
2.1.1.4.2
2.1.1.4.2.2	Age	56
2.1.1.5	Was this person born a twin?	LOINC: LA32-8 (No)
2.1.1.6	Was this person adopted?	LOINC: LA32-8 (No)
2	Family member health information
2.1.1
2.1.1.1	Relationship to you	LOINC: LA10421-8 (Paternal Aunt)
2.1.1.2	Name	Fiona
2.1.1.3	Gender	LOINC: LA3-6 (Female)
2.1.1.4	Living?	LOINC: LA33-6 (Yes)
2.1.1.4.2
2.1.1.4.2.2	Age	57
2.1.1.5	Was this person born a twin?	LOINC: LA32-8 (No)
2.1.1.6	Was this person adopted?	LOINC: LA32-8 (No)
2.1.2	This family member's history of disease
2.1.2.1	Disease or Condition	LOINC: LA10543-9 (Skin Cancer)
2	Family member health information
2.1.1
2.1.1.1	Relationship to you	LOINC: LA10423-4 (Paternal Grandfather)
2.1.1.2	Name	Bob
2.1.1.3	Gender	LOINC: LA2-8 (Male)
2.1.1.4	Living?	LOINC: LA32-8 (No)
2.1.1.4.1
2.1.1.4.1.1	Cause of Death	LOINC: LA10537-1 (Colon Cancer)
2.1.1.4.1.2	Age at Death	LOINC: LA10400-2 (OVER 60)
2.1.1.5	Was this person born a twin?	LOINC: LA32-8 (No)
2.1.1.6	Was this person adopted?	LOINC: LA32-8 (No)
2.1.2	This family member's history of disease
2.1.2.1	Disease or Condition	LOINC: LA10537-1 (Colon Cancer)
2.1.2.2	Age at Diagnosis	LOINC: LA10400-2 (OVER 60)
2	Family member health information
2.1.1
2.1.1.1	Relationship to you	LOINC: LA10424-2 (Paternal Grandmother)
2.1.1.2	Name	Claire
2.1.1.3	Gender	LOINC: LA3-6 (Female)
2.1.1.4	Living?	LOINC: LA32-8 (No)
2.1.1.4.1
2.1.1.4.1.1	Cause of Death	LOINC: LA10589-2 (Other/Unexpected)
2.1.1.4.1.1.1	Please specify	Lou Gehrigs
2.1.1.4.1.2	Age at Death	LOINC: LA10400-2 (OVER 60)
2.1.1.5	Was this person born a twin?	LOINC: LA32-8 (No)
2.1.1.6	Was this person adopted?	LOINC: LA32-8 (No)
2	Family member health information
2.1.1
2.1.1.1	Relationship to you	LOINC: LA10417-6 (Mother)
2.1.1.2	Name	Harriet
2.1.1.3	Gender	LOINC: LA3-6 (Female)
2.1.1.4	Living?	LOINC: LA32-8 (No)
2.1.1.4.1
2.1.1.4.1.1	Cause of Death	LOINC: LA15682-0 (Ovarian Cancer)
2.1.1.4.1.2	Age at Death	LOINC: LA10399-6 (50-59)
2.1.1.5	Was this person born a twin?	LOINC: LA32-8 (No)
2.1.1.6	Was this person adopted?	LOINC: LA32-8 (No)
2.1.2	This family member's history of disease
2.1.2.1	Disease or Condition	LOINC: LA15682-0 (Ovarian Cancer)
2.1.2.2	Age at Diagnosis	LOINC: LA10398-8 (40-49)
2	Family member health information
2.1.1
2.1.1.1	Relationship to you	LOINC: LA10414-3 (Maternal Uncle)
2.1.1.2	Name	Rudy
2.1.1.3	Gender	LOINC: LA2-8 (Male)
2.1.1.4	Living?	LOINC: LA33-6 (Yes)
2.1.1.4.2
2.1.1.4.2.2	Age	60
2.1.1.5	Was this person born a twin?	LOINC: LA32-8 (No)
2.1.1.6	Was this person adopted?	LOINC: LA32-8 (No)
2	Family member health information
2.1.1
2.1.1.1	Relationship to you	LOINC: LA10410-1 (Maternal Aunt)
2.1.1.2	Name	Julie
2.1.1.3	Gender	LOINC: LA3-6 (Female)
2.1.1.4	Living?	LOINC: LA33-6 (Yes)
2.1.1.4.2
2.1.1.4.2.2	Age	57
2.1.1.5	Was this person born a twin?	LOINC: LA32-8 (No)
2.1.1.6	Was this person adopted?	LOINC: LA32-8 (No)
2	Family member health information
2.1.1
2.1.1.1	Relationship to you	LOINC: LA10412-7 (Maternal Grandfather)
2.1.1.2	Name	Ian
2.1.1.3	Gender	LOINC: LA2-8 (Male)
2.1.1.4	Living?	LOINC: LA32-8 (No)
2.1.1.4.1
2.1.1.4.1.1	Cause of Death	LOINC: LA16286-9 (Heart attack)
2.1.1.4.1.2	Age at Death	LOINC: LA10400-2 (OVER 60)
2.1.1.5	Was this person born a twin?	LOINC: LA32-8 (No)
2.1.1.6	Was this person adopted?	LOINC: LA32-8 (No)
2	Family member health information
2.1.1
2.1.1.1	Relationship to you	LOINC: LA10413-5 (Maternal Grandmother)
2.1.1.2	Name	Gladys
2.1.1.3	Gender	LOINC: LA3-6 (Female)
2.1.1.4	Living?	LOINC: LA32-8 (No)
2.1.1.4.1
2.1.1.4.1.1	Cause of Death	LOINC: LA10589-2 (Other/Unexpected)
2.1.1.4.1.2	Age at Death	LOINC: LA10400-2 (OVER 60)
2.1.1.5	Was this person born a twin?	LOINC: LA32-8 (No)
2.1.1.6	Was this person adopted?	LOINC: LA32-8 (No)
2.1.2	This family member's history of disease
2.1.2.1	Disease or Condition	LOINC: LA14283-8 (Breast Cancer)
2.1.2.2	Age at Diagnosis	LOINC: LA10399-6 (50-59)
2.1.2	This family member's history of disease
2.1.2.1	Disease or Condition	LOINC: LA16982-3 (Asthma)
2.1.2.2	Age at Diagnosis	LOINC: LA10395-4 (Childhood)
2	Family member health information
2.1.1
2.1.1.1	Relationship to you	LOINC: LA10411-9 (Maternal Cousin)
2.1.1.2	Name	Karren
2.1.1.3	Gender	LOINC: LA3-6 (Female)
2.1.1.4	Living?	LOINC: LA33-6 (Yes)
2.1.1.4.2
2.1.1.4.2.2	Age	30
2.1.1.5	Was this person born a twin?	LOINC: LA32-8 (No)
2.1.1.6	Was this person adopted?	LOINC: LA32-8 (No)
2.1.2	This family member's history of disease
2.1.2.1	Disease or Condition	LOINC: LA14283-8 (Breast Cancer)
2.1.2.2	Age at Diagnosis	LOINC: LA10397-0 (30-39)
2	Family member health information
2.1.1
2.1.1.1	Relationship to you	LOINC: LA10411-9 (Maternal Cousin)
2.1.1.2	Name	Mary
2.1.1.3	Gender	LOINC: LA3-6 (Female)
2.1.1.4	Living?	LOINC: LA33-6 (Yes)
2.1.1.4.2
2.1.1.4.2.2	Age	31
2.1.1.5	Was this person born a twin?	LOINC: LA32-8 (No)
2.1.1.6	Was this person adopted?	LOINC: LA32-8 (No)
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