{ "resourceType" : "Questionnaire", "id" : "88028-6", "meta" : { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/instance-name", "valueString" : "Tobacco Use Panel Questionnaire Example" }, { "url" : "http://hl7.org/fhir/StructureDefinition/instance-description", "valueMarkdown" : "LOINC 88028-6 *Tobacco use panel* rendered as a structured FHIR Questionnaire. Generated using the NIH SDC LHC-Forms application at . The paired QuestionnaireResponse captures the source data used to derive the *US Core Tobacco Use* panel Observation." }], "profile" : ["http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire"] }, "text" : { "status" : "extensions", "div" : "

Generated Narrative: Questionnaire 88028-6

Profile: SDCBaseQuestionnaire

Structure\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
LinkIDTextCardinalityTypeDescription & Constraints\"doco\"
\".\"\".\" TobaccoUsePanelQuestionnairehttp://hl7.org/fhir/us/core/Questionnaire/88028-6#0.1.0
\".\"\".\"\".\" /74011-8Lifetime tobacco use0..1decimal
\".\"\".\"\".\"\".\" /74011-8-helpTobacco use (e.g. by packs or cigarettes) per period of time (e.g. per year) over the patient's lifetime.0..1display
\".\"\".\"\".\" /11366-2History of Tobacco use Narrative0..1string
\".\"\".\"\".\" /88029-4Tobacco use duration0..1decimal
\".\"\".\"\".\"\".\" /88029-4-helpAmount of time (e.g. years) the patient has used smoking or smokeless tobacco products0..1display
\".\"\".\"\".\" /72166-2Tobacco smoking status0..1choiceOptions: 8 options
\".\"\".\"\".\" /88031-0Smokeless tobacco status0..1choiceOptions: 5 options
\".\"\".\"\".\" /82769-1Smoked or non-smoked tobacco0..1choiceOptions: 8 options
\".\"\".\"\".\" /81228-9Tobacco product0..*choiceOptions: 9 options
\".\"\".\"\".\"\".\" /81228-9-helpThe type(s) of tobacco used for known tobacco users. Examples include cigarettes, cigars, pipe tobacco and smokeless tobacco. This term was created for, but is not limited in use to, the Joint Commission's tobacco treatment eCQM, which uses separate OIDs for each recommended answer and associated SNOMED CT code rather than a single OID for the answer list as a whole. The answer OIDs that are available as of the date this term was created are specified in the description for each answer in the LOINC answer list, and new OIDs will be added as they become available and are reported to the LOINC development team.0..1display
\".\"\".\"\".\" /8663-7Cigarettes smoked current (pack per day) - Reported0..1decimal
\".\"\".\"\".\" /74010-0Date quit tobacco smoking0..1decimal
\".\"\".\"\".\" /88030-2Date quit smokeless tobacco0..1decimal
\".\"\".\"\".\" /48766-0Source of info0..1choice
\".\"\".\"\".\"\".\" /48766-0-helpThe information or data source may be a person, organization, information system, reference to some other data object, etc.0..1display

\"doco\" Documentation for this format

Options Sets

Answer options for /72166-2

Answer options for /88031-0

Answer options for /82769-1

Answer options for /81228-9

" }, "url" : "http://hl7.org/fhir/us/core/Questionnaire/88028-6", "identifier" : [{ "system" : "urn:ietf:rfc:3986", "value" : "urn:oid:2.16.840.1.113883.4.642.40.2.35.7" }], "version" : "0.1.0", "name" : "TobaccoUsePanel", "title" : "Tobacco use panel", "status" : "active", "experimental" : true, "subjectType" : ["Patient"], "date" : "2026-05-20", "publisher" : "HL7 International / Cross-Group Projects", "contact" : [{ "name" : "HL7 International / Cross-Group Projects", "telecom" : [{ "system" : "url", "value" : "http://www.hl7.org/Special/committees/cgp" }, { "system" : "email", "value" : "cgp@lists.HL7.org" }] }], "jurisdiction" : [{ "coding" : [{ "system" : "urn:iso:std:iso:3166", "code" : "US" }] }], "copyright" : "This material contains content from LOINC (http://loinc.org). LOINC is copyright 1995-2026, Regenstrief Institute, Inc. and the LOINC Committee, and is available at no cost under the license at http://loinc.org/license.", "code" : [{ "system" : "http://loinc.org", "code" : "88028-6", "display" : "Tobacco use panel" }], "item" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-unit", "valueCoding" : { "system" : "http://unitsofmeasure.org", "code" : "/a", "display" : "/a" } }], "linkId" : "/74011-8", "code" : [{ "system" : "http://loinc.org", "code" : "74011-8", "display" : "Lifetime tobacco use" }], "text" : "Lifetime tobacco use", "type" : "decimal", "item" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept" : { "coding" : [{ "system" : "http://hl7.org/fhir/questionnaire-item-control", "code" : "help", "display" : "Help-Button" }], "text" : "Help-Button" } }], "linkId" : "/74011-8-help", "text" : "Tobacco use (e.g. by packs or cigarettes) per period of time (e.g. per year) over the patient's lifetime.", "type" : "display" }] }, { "linkId" : "/11366-2", "code" : [{ "system" : "http://loinc.org", "code" : "11366-2", "display" : "History of Tobacco use Narrative" }], "text" : "History of Tobacco use Narrative", "type" : "string" }, { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-unit", "valueCoding" : { "system" : "http://unitsofmeasure.org", "code" : "a", "display" : "a" } }], "linkId" : "/88029-4", "code" : [{ "system" : "http://loinc.org", "code" : "88029-4", "display" : "Tobacco use duration" }], "text" : "Tobacco use duration", "type" : "decimal", "item" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept" : { "coding" : [{ "system" : "http://hl7.org/fhir/questionnaire-item-control", "code" : "help", "display" : "Help-Button" }], "text" : "Help-Button" } }], "linkId" : "/88029-4-help", "text" : "Amount of time (e.g. years) the patient has used smoking or smokeless tobacco products", "type" : "display" }] }, { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept" : { "coding" : [{ "system" : "http://hl7.org/fhir/questionnaire-item-control", "code" : "drop-down", "display" : "Drop down" }], "text" : "Drop down" } }], "linkId" : "/72166-2", "code" : [{ "system" : "http://loinc.org", "code" : "72166-2", "display" : "Tobacco smoking status" }], "text" : "Tobacco smoking status", "type" : "choice", "answerOption" : [{ "valueCoding" : { "system" : "http://loinc.org", "code" : "LA18976-3", "display" : "Current every day smoker" } }, { "valueCoding" : { "system" : "http://loinc.org", "code" : "LA18977-1", "display" : "Current some day smoker" } }, { "valueCoding" : { "system" : "http://loinc.org", "code" : "LA15920-4", "display" : "Former smoker" } }, { "valueCoding" : { "system" : "http://loinc.org", "code" : "LA18978-9", "display" : "Never smoker" } }, { "valueCoding" : { "system" : "http://loinc.org", "code" : "LA18979-7", "display" : "Smoker, current status unknown" } }, { "valueCoding" : { "system" : "http://loinc.org", "code" : "LA18980-5", "display" : "Unknown if ever smoked" } }, { "valueCoding" : { "system" : "http://loinc.org", "code" : "LA18981-3", "display" : "Heavy tobacco smoker" } }, { "valueCoding" : { "system" : "http://loinc.org", "code" : "LA18982-1", "display" : "Light tobacco smoker" } }] }, { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept" : { "coding" : [{ "system" : "http://hl7.org/fhir/questionnaire-item-control", "code" : "drop-down", "display" : "Drop down" }], "text" : "Drop down" } }], "linkId" : "/88031-0", "code" : [{ "system" : "http://loinc.org", "code" : "88031-0", "display" : "Smokeless tobacco status" }], "text" : "Smokeless tobacco status", "type" : "choice", "answerOption" : [{ "valueCoding" : { "system" : "http://loinc.org", "code" : "LA28391-3", "display" : "Current every day user" } }, { "valueCoding" : { "system" : "http://loinc.org", "code" : "LA28392-1", "display" : "Current some day user" } }, { "valueCoding" : { "system" : "http://loinc.org", "code" : "LA28393-9", "display" : "Former user" } }, { "valueCoding" : { "system" : "http://loinc.org", "code" : "LA4519-0", "display" : "Never used" } }, { "valueCoding" : { "system" : "http://loinc.org", "code" : "LA4489-6", "display" : "Unknown" } }] }, { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept" : { "coding" : [{ "system" : "http://hl7.org/fhir/questionnaire-item-control", "code" : "drop-down", "display" : "Drop down" }], "text" : "Drop down" } }], "linkId" : "/82769-1", "code" : [{ "system" : "http://loinc.org", "code" : "82769-1", "display" : "Smoked or non-smoked tobacco" }], "text" : "Smoked or non-smoked tobacco", "type" : "choice", "answerOption" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix", "valueString" : "01" }], "valueCoding" : { "system" : "http://loinc.org", "code" : "LA26671-0", "display" : "Smoked tobacco only" } }, { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix", "valueString" : "02" }], "valueCoding" : { "system" : "http://loinc.org", "code" : "LA26672-8", "display" : "Non-smoked tobacco only" } }, { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix", "valueString" : "03" }], "valueCoding" : { "system" : "http://loinc.org", "code" : "LA26673-6", "display" : "Use of both smoked and non-smoked tobacco products" } }, { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix", "valueString" : "04" }], "valueCoding" : { "system" : "http://loinc.org", "code" : "LA137-2", "display" : "None" } }, { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix", "valueString" : "05" }], "valueCoding" : { "system" : "http://loinc.org", "code" : "LA26674-4", "display" : "Use of smoked tobacco but no information about non-smoked tobacco use" } }, { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix", "valueString" : "NI" }], "valueCoding" : { "system" : "http://loinc.org", "code" : "LA21413-2", "display" : "No information" } }, { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix", "valueString" : "UN" }], "valueCoding" : { "system" : "http://loinc.org", "code" : "LA4489-6", "display" : "Unknown" } }, { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-optionPrefix", "valueString" : "OT" }], "valueCoding" : { "system" : "http://loinc.org", "code" : "LA46-8", "display" : "Other" } }] }, { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept" : { "coding" : [{ "system" : "http://hl7.org/fhir/questionnaire-item-control", "code" : "drop-down", "display" : "Drop down" }], "text" : "Drop down" } }], "linkId" : "/81228-9", "code" : [{ "system" : "http://loinc.org", "code" : "81228-9", "display" : "Tobacco product" }], "text" : "Tobacco product", "type" : "choice", "repeats" : true, "answerOption" : [{ "valueCoding" : { "system" : "http://loinc.org", "code" : "LA15332-2", "display" : "Cigarettes" } }, { "valueCoding" : { "system" : "http://loinc.org", "code" : "LA15333-0", "display" : "Cigars" } }, { "valueCoding" : { "system" : "http://loinc.org", "code" : "LA26091-1", "display" : "Pipe tobacco" } }, { "valueCoding" : { "system" : "http://loinc.org", "code" : "LA26092-9", "display" : "Smokeless tobacco" } }, { "valueCoding" : { "system" : "http://snomed.info/sct", "code" : "598111000005109", "display" : "Nicotine pouch (product)" } }, { "valueCoding" : { "system" : "http://snomed.info/sct", "code" : "698289004", "display" : "Hookah pipe smoker (finding)" } }, { "valueCoding" : { "system" : "http://snomed.info/sct", "code" : "81911001", "display" : "Chewing tobacco (substance)" } }, { "valueCoding" : { "system" : "http://snomed.info/sct", "code" : "39789004", "display" : "Snuff tobacco (substance)" } }, { "valueCoding" : { "system" : "http://snomed.info/sct", "code" : "1303239008", "display" : "Electronic cigarette liquid containing nicotine (substance)" } }], "item" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept" : { "coding" : [{ "system" : "http://hl7.org/fhir/questionnaire-item-control", "code" : "help", "display" : "Help-Button" }], "text" : "Help-Button" } }], "linkId" : "/81228-9-help", "text" : "The type(s) of tobacco used for known tobacco users. Examples include cigarettes, cigars, pipe tobacco and smokeless tobacco. This term was created for, but is not limited in use to, the Joint Commission's tobacco treatment eCQM, which uses separate OIDs for each recommended answer and associated SNOMED CT code rather than a single OID for the answer list as a whole. The answer OIDs that are available as of the date this term was created are specified in the description for each answer in the LOINC answer list, and new OIDs will be added as they become available and are reported to the LOINC development team.", "type" : "display" }] }, { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-unit", "valueCoding" : { "system" : "http://unitsofmeasure.org", "code" : "{#}/d", "display" : "{#}/d" } }], "linkId" : "/8663-7", "code" : [{ "system" : "http://loinc.org", "code" : "8663-7", "display" : "Cigarettes smoked current (pack per day) - Reported" }], "text" : "Cigarettes smoked current (pack per day) - Reported", "type" : "decimal" }, { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-unit", "valueCoding" : { "system" : "http://unitsofmeasure.org", "code" : "{mm/dd/yyyy}", "display" : "{mm/dd/yyyy}" } }], "linkId" : "/74010-0", "code" : [{ "system" : "http://loinc.org", "code" : "74010-0", "display" : "Date quit tobacco smoking" }], "text" : "Date quit tobacco smoking", "type" : "decimal" }, { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-unit", "valueCoding" : { "system" : "http://unitsofmeasure.org", "code" : "{mm/dd/yyyy}", "display" : "{mm/dd/yyyy}" } }], "linkId" : "/88030-2", "code" : [{ "system" : "http://loinc.org", "code" : "88030-2", "display" : "Date quit smokeless tobacco" }], "text" : "Date quit smokeless tobacco", "type" : "decimal" }, { "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept" : { "coding" : [{ "system" : "http://hl7.org/fhir/questionnaire-item-control", "code" : "drop-down", "display" : "Drop down" }], "text" : "Drop down" } }], "linkId" : "/48766-0", "code" : [{ "system" : "http://loinc.org", "code" : "48766-0", "display" : "Source of info" }], "text" : "Source of info", "type" : "choice", "item" : [{ "extension" : [{ "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl", "valueCodeableConcept" : { "coding" : [{ "system" : "http://hl7.org/fhir/questionnaire-item-control", "code" : "help", "display" : "Help-Button" }], "text" : "Help-Button" } }], "linkId" : "/48766-0-help", "text" : "The information or data source may be a person, organization, information system, reference to some other data object, etc.", "type" : "display" }] }] }