1.5.3 - release
SHINNYHRSN - Local Development build (v1.5.3) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
| Active as of 2025-07-23 |
<Questionnaire xmlns="http://hl7.org/fhir">
<id value="SHINNYAdministrativeQuestionnaire"/>
<meta>
<lastUpdated value="2024-01-01T00:00:00Z"/>
<profile
value="http://shinny.org/us/ny/hrsn/StructureDefinition/shinny-questionnaire"/>
</meta>
<text>
<status value="extensions"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: Questionnaire SHINNYAdministrativeQuestionnaire</b></p><a name="SHINNYAdministrativeQuestionnaire"> </a><a name="hcSHINNYAdministrativeQuestionnaire"> </a><a name="SHINNYAdministrativeQuestionnaire-en-US"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px">Last updated: 2024-01-01 00:00:00+0000</p><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-shinny-questionnaire.html">SHINNY Questionnaire Profile</a></p></div><b>Structure</b><table border="1" cellpadding="0" cellspacing="0" style="border: 1px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;"><tr style="border: 2px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top"><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="The linkID for the item">LinkID</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="Text for the item">Text</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="Minimum and Maximum # of times the item can appear in the instance">Cardinality</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="The type of the item">Type</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="Additional information about the item">Description & Constraints</a><span style="float: right"><a href="https://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAABAAAAAQCAYAAAAf8/9hAAAABmJLR0QA/wD/AP+gvaeTAAAACXBIWXMAAAsTAAALEwEAmpwYAAAAB3RJTUUH3goXBCwdPqAP0wAAAldJREFUOMuNk0tIlFEYhp9z/vE2jHkhxXA0zJCMitrUQlq4lnSltEqCFhFG2MJFhIvIFpkEWaTQqjaWZRkp0g26URZkTpbaaOJkDqk10szoODP//7XIMUe0elcfnPd9zsfLOYplGrpRwZaqTtw3K7PtGem7Q6FoidbGgqHVy/HRb669R+56zx7eRV1L31JGxYbBtjKK93cxeqfyQHbehkZbUkK20goELEuIzEd+dHS+qz/Y8PTSif0FnGkbiwcAjHaU1+QWOptFiyCLp/LnKptpqIuXHx6rbR26kJcBX3yLgBfnd7CxwJmflpP2wUg0HIAoUUpZBmKzELGWcN8nAr6Gpu7tLU/CkwAaoKTWRSQyt89Q8w6J+oVQkKnBoblH7V0PPvUOvDYXfopE/SJmALsxnVm6LbkotrUtNowMeIrVrBcBpaMmdS0j9df7abpSuy7HWehwJdt1lhVwi/J58U5beXGAF6c3UXLycw1wdFklArBn87xdh0ZsZtArghBdAA3+OEDVubG4UEzP6x1FOWneHh2VDAHBAt80IbdXDcesNoCvs3E5AFyNSU5nbrDPZpcUEQQTFZiEVx+51fxMhhyJEAgvlriadIJZZksRuwBYMOPBbO3hePVVqgEJhFeUuFLhIPkRP6BQLIBrmMenujm/3g4zc398awIe90Zb5A1vREALqneMcYgP/xVQWlG+Ncu5vgwwlaUNx+3799rfe96u9K0JSDXcOzOTJg4B6IgmXfsygc7/Bvg9g9E58/cDVmGIBOP/zT8Bz1zqWqpbXIsd0O9hajXfL6u4BaOS6SeWAAAAAElFTkSuQmCC" alt="doco" style="background-color: inherit"/></a></span></th></tr><tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_q_root.gif" alt="." style="background-color: white; background-color: inherit" title="QuestionnaireRoot" class="hierarchy"/> </td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Questionnaire</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">http://shinny.org/us/ny/hrsn/Questionnaire/SHINNYAdministrativeQuestionnaire#1.5.3</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck01.png)" id="item.administrative-questionnaire" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="group" class="hierarchy"/> administrative-questionnaire</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Administrative questions that capture information about the patient's population categorization, specific services needed and/or medical necessities.</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group">group</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck001.png)" id="item.administrative-questions" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: white; background-color: inherit" title="group" class="hierarchy"/> administrative-questions</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Administrative quesitons that verify information about the patient.</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group">group</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0010.png)" id="item.enhanced-population-check" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> enhanced-population-check</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Check populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, resulting in SCN request to update covered population categorization with MCO.</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.enhanced-population-check">8 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0010.png)" id="item.service-duplication-check" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="coding" class="hierarchy"/> service-duplication-check</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Check populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient currently receives services that would inhibit ability to deliver any or all NYHER services.</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.service-duplication-check">11 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck0000.png)" id="item.clinical-criteria-check" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_blank.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> clinical-criteria-check</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Check populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient has the required medical necessity that would satisfy requirement to deliver NYHER service.</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.clinical-criteria-check">7 options</a></td></tr>
<tr><td colspan="5" class="hierarchy"><br/><a href="https://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="data:image/png;base64,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" alt="doco" style="background-color: inherit"/> Documentation for this format</a></td></tr></table><hr/><p><b>Options Sets</b></p><a name="opt-item.enhanced-population-check"> </a><p><b>Answer options for enhanced-population-check </b></p><ul><li style="font-size: 11px">http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires#medicaid-high-utilizer ("Medicaid High Utilizer")</li><li style="font-size: 11px">http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires#nys-health-home ("Individuals Enrolled in a NYS Health Home")</li><li style="font-size: 11px">http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires#pregnant-postpartum ("Pregnant and Postpartum Persons")</li><li style="font-size: 11px">http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires#children-high-risk ("High-Risk Children Under 18 Years Old")</li><li style="font-size: 11px">http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires#released-chronic-condition ("Individuals with a Chronic Condition Released from Incarceration in the Past 90 Days")</li><li style="font-size: 11px">http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires#other-eligible-population ("Other Eligible Population")</li><li style="font-size: 11px">http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires#high-risk-nutrition ("High Risk Children Under 18 Nutrition Only")</li><li style="font-size: 11px">http://loinc.org#LA9-3 ("None of the above")</li></ul><a name="opt-item.service-duplication-check"> </a><p><b>Answer options for service-duplication-check </b></p><ul><li style="font-size: 11px">http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires#healthy-homes ("Healthy Homes")</li><li style="font-size: 11px">http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires#nutritional-counseling ("Nutritional Counseling")</li><li style="font-size: 11px">http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires#medical-tailored-meals ("Medically Tailored Meals (MTM) In-lieu of Services (ILOS)")</li><li style="font-size: 11px">http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires#health-home-enrollment ("Health Home Enrollment (under Enhanced Populations)")</li><li style="font-size: 11px">http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires#opwdd-waiver ("Office for Persons with Developmental Disabilities (OPWDD) Waiver")</li><li style="font-size: 11px">http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires#tbi-waiver ("Traumatic Brain Injury (TBI) Waiver")</li><li style="font-size: 11px">http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires#nhtd-waiver ("Nursing Home Transition Diversion (NHTD) Waiver")</li><li style="font-size: 11px">http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires#childrens-waiver ("Childrens Waiver")</li><li style="font-size: 11px">http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires#medicaid-advantage-program ("Medicaid Advantage Program (MAP)")</li><li style="font-size: 11px">http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires#mltcp ("Partial Capitation Managed Long-Term Care (MLTCP)")</li><li style="font-size: 11px">http://loinc.org#LA9-3 ("None of the above")</li></ul><a name="opt-item.clinical-criteria-check"> </a><p><b>Answer options for clinical-criteria-check </b></p><ul><li style="font-size: 11px">http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires#chronic-condition ("Chronic Condition")</li><li style="font-size: 11px">http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires#uncontrolled-asthma ("Uncontrolled Asthma")</li><li style="font-size: 11px">http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires#nutrition-therapy ("Enteral or Parenteral Nutrition Therapy")</li><li style="font-size: 11px">http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires#heat-related-illness ("Heat-Related Illness Requiring an ER or UC Visit")</li><li style="font-size: 11px">http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires#cold-related-illness ("Cold-Related Illness Requiring an ER or UC Visit")</li><li style="font-size: 11px">http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires#thermoregulation-interference ("Conditions and Medications Interfering with Thermoregulation")</li><li style="font-size: 11px">http://loinc.org#LA9-3 ("None of the above")</li></ul></div>
</text>
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<version value="1.5.3"/>
<status value="active"/>
<date value="2025-07-23T17:01:14-04:00"/>
<publisher value="shinny"/>
<contact>
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<value value="https://shinny.org/us/ny/hrsn/index.html"/>
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<linkId value="administrative-questionnaire"/>
<code>
<system
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<code value="administrative-questionnaire"/>
<display value="Administrative Questionnaire"/>
</code>
<text
value="Administrative questions that capture information about the patient's population categorization, specific services needed and/or medical necessities."/>
<type value="group"/>
<required value="false"/>
<item>
<linkId value="administrative-questions"/>
<code>
<system
value="http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires"/>
<code value="administrative-questions"/>
<display value="Administrative Questions"/>
</code>
<text
value="Administrative quesitons that verify information about the patient."/>
<type value="group"/>
<required value="false"/>
<item>
<linkId value="enhanced-population-check"/>
<code>
<system
value="http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires"/>
<code value="enhanced-population-check"/>
<display value="Enhanced Population Check"/>
</code>
<text
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<type value="choice"/>
<required value="false"/>
<answerOption>
<valueCoding>
<system
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<code value="medicaid-high-utilizer"/>
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<answerOption>
<valueCoding>
<system
value="http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires"/>
<code value="nys-health-home"/>
<display value="Individuals Enrolled in a NYS Health Home"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system
value="http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires"/>
<code value="pregnant-postpartum"/>
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<answerOption>
<valueCoding>
<system
value="http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires"/>
<code value="children-high-risk"/>
<display value="High-Risk Children Under 18 Years Old"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system
value="http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires"/>
<code value="released-chronic-condition"/>
<display
value="Individuals with a Chronic Condition Released from Incarceration in the Past 90 Days"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system
value="http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires"/>
<code value="other-eligible-population"/>
<display value="Other Eligible Population"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system
value="http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires"/>
<code value="high-risk-nutrition"/>
<display value="High Risk Children Under 18 Nutrition Only"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA9-3"/>
<display value="None of the above"/>
</valueCoding>
</answerOption>
</item>
<item>
<linkId value="service-duplication-check"/>
<code>
<system
value="http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires"/>
<code value="service-duplication-check"/>
<display value="Service Duplication Check"/>
</code>
<text
value="Check populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient currently receives services that would inhibit ability to deliver any or all NYHER services."/>
<type value="choice"/>
<required value="false"/>
<answerOption>
<valueCoding>
<system
value="http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires"/>
<code value="healthy-homes"/>
<display value="Healthy Homes"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system
value="http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires"/>
<code value="nutritional-counseling"/>
<display value="Nutritional Counseling"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system
value="http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires"/>
<code value="medical-tailored-meals"/>
<display
value="Medically Tailored Meals (MTM) In-lieu of Services (ILOS)"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system
value="http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires"/>
<code value="health-home-enrollment"/>
<display
value="Health Home Enrollment (under Enhanced Populations)"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system
value="http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires"/>
<code value="opwdd-waiver"/>
<display
value="Office for Persons with Developmental Disabilities (OPWDD) Waiver"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system
value="http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires"/>
<code value="tbi-waiver"/>
<display value="Traumatic Brain Injury (TBI) Waiver"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system
value="http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires"/>
<code value="nhtd-waiver"/>
<display value="Nursing Home Transition Diversion (NHTD) Waiver"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system
value="http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires"/>
<code value="childrens-waiver"/>
<display value="Childrens Waiver"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system
value="http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires"/>
<code value="medicaid-advantage-program"/>
<display value="Medicaid Advantage Program (MAP)"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system
value="http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires"/>
<code value="mltcp"/>
<display
value="Partial Capitation Managed Long-Term Care (MLTCP)"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA9-3"/>
<display value="None of the above"/>
</valueCoding>
</answerOption>
</item>
<item>
<linkId value="clinical-criteria-check"/>
<code>
<system
value="http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires"/>
<code value="clinical-criteria-check"/>
<display value="Clinical Criteria Check"/>
</code>
<text
value="Check populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient has the required medical necessity that would satisfy requirement to deliver NYHER service."/>
<type value="choice"/>
<required value="false"/>
<answerOption>
<valueCoding>
<system
value="http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires"/>
<code value="chronic-condition"/>
<display value="Chronic Condition"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system
value="http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires"/>
<code value="uncontrolled-asthma"/>
<display value="Uncontrolled Asthma"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system
value="http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires"/>
<code value="nutrition-therapy"/>
<display value="Enteral or Parenteral Nutrition Therapy"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system
value="http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires"/>
<code value="heat-related-illness"/>
<display
value="Heat-Related Illness Requiring an ER or UC Visit"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system
value="http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires"/>
<code value="cold-related-illness"/>
<display
value="Cold-Related Illness Requiring an ER or UC Visit"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system
value="http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires"/>
<code value="thermoregulation-interference"/>
<display
value="Conditions and Medications Interfering with Thermoregulation"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA9-3"/>
<display value="None of the above"/>
</valueCoding>
</answerOption>
</item>
</item>
</item>
</Questionnaire>