Release 5 Draft Ballot

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Questionnaireresponse-example-ussg-fht-answers

FHIR Infrastructure Work GroupMaturity Level: N/AStandards Status: InformativeCompartments: Device, Encounter, Patient, Practitioner, RelatedPerson

This is the narrative for the resource. See also the XML, JSON or Turtle format. This example conforms to the profile QuestionnaireResponse.


LinkIdTextDefinitionAnswerdoco
.. ussg-fht-answersQuestionnaireResponse
... 0
.... 0.1Date Done2008-01-17
... 1Your health information
.... 1.1
..... 1.1.1NameAnnie Proband
..... 1.1.2GenderLOINC LA3-6: Female
..... 1.1.3Date of Birth1966-04-04
..... 1.1.4Were you born a twin?LOINC LA32-8: No
..... 1.1.5Were you adopted?LOINC LA32-8: No
..... 1.1.6Are your parents related to each other in any way other than marriage?LOINC LA32-8: No
..... 1.1.7Height63
...... 1.1.7.1
....... 1.1.7.1.1UnitsUCUM [in_i]: inches
..... 1.1.8Weight127
...... 1.1.8.1
....... 1.1.8.1.1UnitsUCUM [lb_av]: pounds
..... 1.1.9Body mass index (BMI) [Ratio]22.5
..... 1.1.10RaceLOINC LA4457-3: White
..... 1.1.11Ethnicity
... 2Family member health information
.... 2.1
..... 2.1.1.1Relationship to youLOINC LA10405-1: Daughter
..... 2.1.1.2NameSusan
..... 2.1.1.3GenderLOINC LA3-6: Female
..... 2.1.1.4Living?LOINC LA33-6: Yes
...... 2.1.1.4.2
....... 2.1.1.4.2.2Age17
..... 2.1.1.5Was this person born a twin?LOINC LA32-8: No
..... 2.1.1.6Was this person adopted?LOINC LA32-8: No
.... 2.1
..... 2.1.1
...... 2.1.1.1Relationship to youLOINC LA10415-0: Brother
...... 2.1.1.2NameBrian
...... 2.1.1.3GenderLOINC LA2-8: Male
...... 2.1.1.4Living?LOINC LA33-6: Yes
....... 2.1.1.4.2
........ 2.1.1.4.2.2Age32
...... 2.1.1.5Was this person born a twin?LOINC LA32-8: No
...... 2.1.1.6Was this person adopted?LOINC LA32-8: No
..... 2.1.2This family member's history of disease
...... 2.1.2.1Disease or ConditionLOINC LA10550-4: -- Other Cancer
...... 2.1.2.2Age at DiagnosisLOINC LA10397-0: 30-39
.... 2.1
..... 2.1.1
...... 2.1.1.1Relationship to youLOINC LA10418-4: Sister
...... 2.1.1.2NameJanet
...... 2.1.1.3GenderLOINC LA3-6: Female
...... 2.1.1.4Living?LOINC LA33-6: Yes
....... 2.1.1.4.2
........ 2.1.1.4.2.2Age36
...... 2.1.1.5Was this person born a twin?LOINC LA32-8: No
...... 2.1.1.6Was this person adopted?LOINC LA32-8: No
..... 2.1.2This family member's history of disease
...... 2.1.2.1Disease or ConditionLOINC LA10536-3: -- Breast Cancer
...... 2.1.2.2Age at DiagnosisLOINC LA10397-0: 30-39
.... 2.1
..... 2.1.1
...... 2.1.1.1Relationship to youLOINC LA10419-2: Nephew
...... 2.1.1.2NameIan
...... 2.1.1.3GenderLOINC LA2-8: Male
...... 2.1.1.4Living?LOINC LA33-6: Yes
....... 2.1.1.4.2
........ 2.1.1.4.2.2Age16
...... 2.1.1.5Was this person born a twin?LOINC LA32-8: No
...... 2.1.1.6Was this person adopted?LOINC LA32-8: No
.... 2.1
..... 2.1.1
...... 2.1.1.1Relationship to youLOINC LA10420-0: Niece
...... 2.1.1.2NameHelen
...... 2.1.1.3GenderLOINC LA3-6: Female
...... 2.1.1.4Living?LOINC LA33-6: Yes
....... 2.1.1.4.2
........ 2.1.1.4.2.2Age15
...... 2.1.1.5Was this person born a twin?LOINC LA32-8: No
...... 2.1.1.6Was this person adopted?LOINC LA32-8: No
.... 2.1
..... 2.1.1
...... 2.1.1.1Relationship to youLOINC LA10416-8: Father
...... 2.1.1.2NameDonald
...... 2.1.1.3GenderLOINC LA2-8: Male
...... 2.1.1.4Living?LOINC LA33-6: Yes
....... 2.1.1.4.2
........ 2.1.1.4.2.2Age52
...... 2.1.1.5Was this person born a twin?LOINC LA32-8: No
...... 2.1.1.6Was this person adopted?LOINC LA32-8: No
.... 2.1
..... 2.1.1
...... 2.1.1.1Relationship to youLOINC LA10425-9: Paternal Uncle
...... 2.1.1.2NameEric
...... 2.1.1.3GenderLOINC LA2-8: Male
...... 2.1.1.4Living?LOINC LA33-6: Yes
....... 2.1.1.4.2
........ 2.1.1.4.2.2Age56
...... 2.1.1.5Was this person born a twin?LOINC LA32-8: No
...... 2.1.1.6Was this person adopted?LOINC LA32-8: No
.... 2.1
..... 2.1.1
...... 2.1.1.1Relationship to youLOINC LA10421-8: Paternal Aunt
...... 2.1.1.2NameFiona
...... 2.1.1.3GenderLOINC LA3-6: Female
...... 2.1.1.4Living?LOINC LA33-6: Yes
....... 2.1.1.4.2
........ 2.1.1.4.2.2Age57
...... 2.1.1.5Was this person born a twin?LOINC LA32-8: No
...... 2.1.1.6Was this person adopted?LOINC LA32-8: No
..... 2.1.2This family member's history of disease
...... 2.1.2.1Disease or ConditionLOINC LA10543-9: -- Skin Cancer
.... 2.1
..... 2.1.1
...... 2.1.1.1Relationship to youLOINC LA10423-4: Paternal Grandfather
...... 2.1.1.2NameBob
...... 2.1.1.3GenderLOINC LA2-8: Male
...... 2.1.1.4Living?LOINC LA32-8: No
....... 2.1.1.4.1
........ 2.1.1.4.1.1Cause of DeathLOINC LA10537-1: -- Colon Cancer
........ 2.1.1.4.1.2Age at DeathLOINC LA10400-2: OVER 60
...... 2.1.1.5Was this person born a twin?LOINC LA32-8: No
...... 2.1.1.6Was this person adopted?LOINC LA32-8: No
..... 2.1.2This family member's history of disease
...... 2.1.2.1Disease or ConditionLOINC LA10537-1: -- Colon Cancer
...... 2.1.2.2Age at DiagnosisLOINC LA10400-2: OVER 60
.... 2.1
..... 2.1.1
...... 2.1.1.1Relationship to youLOINC LA10424-2: Paternal Grandmother
...... 2.1.1.2NameClaire
...... 2.1.1.3GenderLOINC LA3-6: Female
...... 2.1.1.4Living?LOINC LA32-8: No
....... 2.1.1.4.1
........ 2.1.1.4.1.1Cause of DeathLOINC LA10589-2: -- Other/Unexpected
......... 2.1.1.4.1.1.1Please specifyLou Gehrigs
........ 2.1.1.4.1.2Age at DeathLOINC LA10400-2: OVER 60
...... 2.1.1.5Was this person born a twin?LOINC LA32-8: No
...... 2.1.1.6Was this person adopted?LOINC LA32-8: No
.... 2.1
..... 2.1.1
...... 2.1.1.1Relationship to youLOINC LA10417-6: Mother
...... 2.1.1.2NameHarriet
...... 2.1.1.3GenderLOINC LA3-6: Female
...... 2.1.1.4Living?LOINC LA32-8: No
....... 2.1.1.4.1
........ 2.1.1.4.1.1Cause of DeathLOINC LA10539-7: -- Ovarian Cancer
........ 2.1.1.4.1.2Age at DeathLOINC LA10399-6: 50-59
...... 2.1.1.5Was this person born a twin?LOINC LA32-8: No
...... 2.1.1.6Was this person adopted?LOINC LA32-8: No
..... 2.1.2This family member's history of disease
...... 2.1.2.1Disease or ConditionLOINC LA10539-7: -- Ovarian Cancer
...... 2.1.2.2Age at DiagnosisLOINC LA10398-8: 40-49
.... 2.1
..... 2.1.1
...... 2.1.1.1Relationship to youLOINC LA10414-3: Maternal Uncle
...... 2.1.1.2NameRudy
...... 2.1.1.3GenderLOINC LA2-8: Male
...... 2.1.1.4Living?LOINC LA33-6: Yes
....... 2.1.1.4.2
........ 2.1.1.4.2.2Age60
...... 2.1.1.5Was this person born a twin?LOINC LA32-8: No
...... 2.1.1.6Was this person adopted?LOINC LA32-8: No
.... 2.1
..... 2.1.1
...... 2.1.1.1Relationship to youLOINC LA10410-1: Maternal Aunt
...... 2.1.1.2NameJulie
...... 2.1.1.3GenderLOINC LA3-6: Female
...... 2.1.1.4Living?LOINC LA33-6: Yes
....... 2.1.1.4.2
........ 2.1.1.4.2.2Age57
...... 2.1.1.5Was this person born a twin?LOINC LA32-8: No
...... 2.1.1.6Was this person adopted?LOINC LA32-8: No
.... 2.1
..... 2.1.1
...... 2.1.1.1Relationship to youLOINC LA10412-7: Maternal Grandfather
...... 2.1.1.2NameIan
...... 2.1.1.3GenderLOINC LA2-8: Male
...... 2.1.1.4Living?LOINC LA32-8: No
....... 2.1.1.4.1
........ 2.1.1.4.1.1Cause of DeathLOINC LA10558-7: -- Heart Attack
........ 2.1.1.4.1.2Age at DeathLOINC LA10400-2: OVER 60
...... 2.1.1.5Was this person born a twin?LOINC LA32-8: No
...... 2.1.1.6Was this person adopted?LOINC LA32-8: No
.... 2.1
..... 2.1.1
...... 2.1.1.1Relationship to youLOINC LA10413-5: Maternal Grandmother
...... 2.1.1.2NameGladys
...... 2.1.1.3GenderLOINC LA3-6: Female
...... 2.1.1.4Living?LOINC LA32-8: No
....... 2.1.1.4.1
........ 2.1.1.4.1.1Cause of DeathLOINC LA10571-0: -- Other/Unknown
........ 2.1.1.4.1.2Age at DeathLOINC LA10400-2: OVER 60
...... 2.1.1.5Was this person born a twin?LOINC LA32-8: No
...... 2.1.1.6Was this person adopted?LOINC LA32-8: No
..... 2.1.2This family member's history of disease
...... 2.1.2.1Disease or ConditionLOINC LA10536-3: -- Breast Cancer
...... 2.1.2.2Age at DiagnosisLOINC LA10399-6: 50-59
..... 2.1.2This family member's history of disease
...... 2.1.2.1Disease or ConditionLOINC LA10564-5: -- Asthma
...... 2.1.2.2Age at DiagnosisLOINC LA10395-4: Childhood
.... 2.1
..... 2.1.1
...... 2.1.1.1Relationship to youLOINC LA10411-9: Maternal Cousin
...... 2.1.1.2NameKarren
...... 2.1.1.3GenderLOINC LA3-6: Female
...... 2.1.1.4Living?LOINC LA33-6: Yes
....... 2.1.1.4.2
........ 2.1.1.4.2.2Age30
...... 2.1.1.5Was this person born a twin?LOINC LA32-8: No
...... 2.1.1.6Was this person adopted?LOINC LA32-8: No
..... 2.1.2This family member's history of disease
...... 2.1.2.1Disease or ConditionLOINC LA10536-3: -- Breast Cancer
...... 2.1.2.2Age at DiagnosisLOINC LA10397-0: 30-39
.... 2.1
..... 2.1.1
...... 2.1.1.1Relationship to youLOINC LA10411-9: Maternal Cousin
...... 2.1.1.2NameMary
...... 2.1.1.3GenderLOINC LA3-6: Female
...... 2.1.1.4Living?LOINC LA33-6: Yes
....... 2.1.1.4.2
........ 2.1.1.4.2.2Age31
...... 2.1.1.5Was this person born a twin?LOINC LA32-8: No
...... 2.1.1.6Was this person adopted?LOINC LA32-8: No

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Usage note: every effort has been made to ensure that the examples are correct and useful, but they are not a normative part of the specification.