FHIR IG Statistics: Questionnaire/questionnaire-example-housing

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Narrative

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Housing Questions

Billioux, Alexander, MD, Dphil; Verlander, Katherine, MPH; Anthony, Susan, DrPH; Alley, Dawn, PhD; National Academy of Sciences, “Standardized Screening for Health-Related Social Needs in Clinical Settings - The Accountable Health Communities Screening Tool,“ https://nam.edu/wp-content/uploads/2017/05/Standardized-Screening-for-Health-Related-Social-Needs-in-Clinical-Settings.pdf

Source

{
  "resourceType": "Questionnaire",
  "id": "questionnaire-example-housing",
  "meta": {
    "profile": [
      "http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/argo-questionnaire"
    ]
  },
  "text": {
    "status": "additional",
    "div": "<!-- snip (see above) -->"
  },
  "url": "http://fhir.org/guides/argonaut/questionnaire/Questionnaire/questionnaire-example-housing",
  "identifier": [
    {
      "system": "http://acme.org/q-identifiers",
      "value": "business-identifier4"
    }
  ],
  "version": "0.0.0",
  "title": "Housing Questions",
  "status": "draft",
  "date": "2018-07-26",
  "publisher": "Argonaut Project",
  "useContext": [
    {
      "code": {
        "system": "http://hl7.org/fhir/usage-context-type",
        "code": "task",
        "display": "Workflow Task"
      },
      "valueCodeableConcept": {
        "coding": [
          {
            "system": "http://acme.org",
            "code": "example",
            "display": "Example of Use"
          }
        ]
      }
    }
  ],
  "jurisdiction": [
    {
      "coding": [
        {
          "system": "urn:iso:std:iso:3166",
          "code": "US",
          "display": "United States of America"
        }
      ]
    }
  ],
  "contact": [
    {
      "telecom": [
        {
          "system": "url",
          "value": "http://argonautwiki.hl7.org"
        }
      ]
    }
  ],
  "copyright": "Billioux, Alexander, MD, Dphil; Verlander, Katherine, MPH; Anthony, Susan, DrPH; Alley, Dawn, PhD; National Academy of Sciences, “Standardized Screening for Health-Related Social Needs in Clinical Settings - The Accountable Health Communities Screening Tool,“ https://nam.edu/wp-content/uploads/2017/05/Standardized-Screening-for-Health-Related-Social-Needs-in-Clinical-Settings.pdf  \n",
  "code": [
    {
      "system": "http://acme.org/codes",
      "code": "housing",
      "display": "Housing Questions"
    }
  ],
  "subjectType": [
    "Patient"
  ],
  "item": [
    {
      "linkId": "g1",
      "type": "group",
      "item": [
        {
          "extension": [
            {
              "url": "http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder",
              "valueInteger": 0
            }
          ],
          "linkId": "g1.d",
          "text": "Accountable Health Communities Core Health-Related Social Needs Screening Questions \nUnderlined answer options indicate positive responses for the associated health-related social need. \nA value greater than 10 when the numerical values for answers to questions 7-10 are summed indicates a positive screen for interpersonal safety.",
          "type": "display"
        },
        {
          "extension": [
            {
              "url": "http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder",
              "valueInteger": 1
            }
          ],
          "linkId": "g1.1",
          "prefix": "1",
          "text": "What is your housing situation today?",
          "type": "choice",
          "required": true,
          "repeats": false,
          "option": [
            {
              "extension": [
                {
                  "url": "http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder",
                  "valueInteger": 0
                }
              ],
              "valueString": "I do not have housing (I am staying with others, in a hotel, in a shelter, living outside on the street, on a beach, in a car, abandoned building, bus or train station, or in a park)"
            },
            {
              "extension": [
                {
                  "url": "http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder",
                  "valueInteger": 1
                }
              ],
              "valueString": "I have housing today, but I am worried about losing housing in the future"
            },
            {
              "extension": [
                {
                  "url": "http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder",
                  "valueInteger": 2
                }
              ],
              "valueString": "I have housing"
            }
          ]
        },
        {
          "extension": [
            {
              "url": "http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder",
              "valueInteger": 2
            }
          ],
          "linkId": "g1.2",
          "prefix": "2",
          "text": "Think about the place you live. Do you have problems with any of the following? (check all that apply)",
          "type": "choice",
          "required": true,
          "repeats": true,
          "option": [
            {
              "extension": [
                {
                  "url": "http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder",
                  "valueInteger": 0
                }
              ],
              "valueString": "Bug infestation"
            },
            {
              "extension": [
                {
                  "url": "http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder",
                  "valueInteger": 1
                }
              ],
              "valueString": "Mold"
            },
            {
              "extension": [
                {
                  "url": "http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder",
                  "valueInteger": 2
                }
              ],
              "valueString": "Lead paint or pipes"
            },
            {
              "extension": [
                {
                  "url": "http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder",
                  "valueInteger": 3
                }
              ],
              "valueString": "Inadequate heat"
            },
            {
              "extension": [
                {
                  "url": "http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder",
                  "valueInteger": 4
                }
              ],
              "valueString": "Oven or stove not working"
            },
            {
              "extension": [
                {
                  "url": "http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder",
                  "valueInteger": 5
                }
              ],
              "valueString": "No or not working smoke detectors"
            },
            {
              "extension": [
                {
                  "url": "http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder",
                  "valueInteger": 6
                }
              ],
              "valueString": "Water leaks"
            },
            {
              "extension": [
                {
                  "url": "http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder",
                  "valueInteger": 7
                }
              ],
              "modifierExtension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-optionExclusive",
                  "valueBoolean": true
                }
              ],
              "valueString": "None of the above"
            }
          ]
        }
      ]
    }
  ]
}