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 |
{
"resourceType" : "Questionnaire",
"id" : "SHINNYNYSHRSNQuestionnaire",
"meta" : {
"lastUpdated" : "2024-01-01T00:00:00Z",
"profile" : [
🔗 "http://shinny.org/us/ny/hrsn/StructureDefinition/shinny-questionnaire"
]
},
"text" : {
"status" : "extensions",
"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p class=\"res-header-id\"><b>Generated Narrative: Questionnaire SHINNYNYSHRSNQuestionnaire</b></p><a name=\"SHINNYNYSHRSNQuestionnaire\"> </a><a name=\"hcSHINNYNYSHRSNQuestionnaire\"> </a><a name=\"SHINNYNYSHRSNQuestionnaire-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,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\" 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/SHINNYNYSHRSNQuestionnaire#1.5.3</td></tr>\r\n<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.nys-hrsn-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\"/> nys-hrsn-questionnaire</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">NYS Accountable Health Communities (AHC) Health-Related Social Needs Screening (HRSN) tool</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>\r\n<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.96777-8\" 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\"/> 96777-8</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Accountable health communities (AHC) health-related social needs screening (HRSN) tool</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>\r\n<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.71802-3\" 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\"/> 71802-3</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">What is your living situation today?</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.71802-3\">3 options</a></td></tr>\r\n<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.96778-6\" 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\"/> 96778-6</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Think about the place you live. Do you have problems with any of the following?</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.96778-6\">8 options</a></td></tr>\r\n<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.96779-4\" 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\"/> 96779-4</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">In the past 12 months has the electric, gas, oil, or water company threatened to shut off services in your home?</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.96779-4\">3 options</a></td></tr>\r\n<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.88122-7\" 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\"/> 88122-7</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Within the past 12 months, you worried that your food would run out before you got money to buy more.</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.88122-7\">3 options</a></td></tr>\r\n<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.88123-5\" 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\"/> 88123-5</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Within the past 12 months, the food you bought just didn't last and you didn't have money to get more.</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.88123-5\">3 options</a></td></tr>\r\n<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.93030-5\" 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\"/> 93030-5</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">In the past 12 months, has lack of reliable transportation kept you from medical appointments, meetings, work or from getting things needed for daily living?</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.93030-5\">2 options</a></td></tr>\r\n<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.96780-2\" 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\"/> 96780-2</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Do you want help finding or keeping work or a job?</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.96780-2\">3 options</a></td></tr>\r\n<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.96782-8\" 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\"/> 96782-8</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">Do you want help with school or training? For example, starting or completing job training or getting a high school diploma, GED or equivalent.</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.96782-8\">2 options</a></td></tr>\r\n<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.95618-5\" 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\"/> 95618-5</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">How often does anyone, including family and friends, physically hurt you?</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.95618-5\">5 options</a></td></tr>\r\n<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.95617-7\" 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\"/> 95617-7</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">How often does anyone, including family and friends, insult or talk down to you?</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.95617-7\">5 options</a></td></tr>\r\n<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.95616-9\" 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\"/> 95616-9</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">How often does anyone, including family and friends, threaten you with harm?</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.95616-9\">5 options</a></td></tr>\r\n<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_bck0000.png)\" id=\"item.95615-1\" 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: white; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> 95615-1</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">How often does anyone, including family and friends, scream or curse at you?</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.95615-1\">5 options</a></td></tr>\r\n<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.71802-3\"> </a><p><b>Answer options for 71802-3 </b></p><ul><li style=\"font-size: 11px\">http://loinc.org#LA31993-1 ("I have a steady place to live")</li><li style=\"font-size: 11px\">http://loinc.org#LA31994-9 ("I have a place to live today, but I am worried about losing it in the future")</li><li style=\"font-size: 11px\">http://loinc.org#LA31995-6 ("I do not have a steady place to live (I am temporarily 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)")</li></ul><a name=\"opt-item.96778-6\"> </a><p><b>Answer options for 96778-6 </b></p><ul><li style=\"font-size: 11px\">http://loinc.org#LA31996-4 ("Pests such as bugs, ants, or mice")</li><li style=\"font-size: 11px\">http://loinc.org#LA28580-1 ("Mold")</li><li style=\"font-size: 11px\">http://loinc.org#LA31997-2 ("Lead paint or pipes")</li><li style=\"font-size: 11px\">http://loinc.org#LA31998-0 ("Lack of heat")</li><li style=\"font-size: 11px\">http://loinc.org#LA31999-8 ("Oven or stove not working")</li><li style=\"font-size: 11px\">http://loinc.org#LA32000-4 ("Smoke detectors missing or not working")</li><li style=\"font-size: 11px\">http://loinc.org#LA32001-2 ("Water leaks")</li><li style=\"font-size: 11px\">http://loinc.org#LA9-3 ("None of the above")</li></ul><a name=\"opt-item.96779-4\"> </a><p><b>Answer options for 96779-4 </b></p><ul><li style=\"font-size: 11px\">http://loinc.org#LA33-6 ("Yes")</li><li style=\"font-size: 11px\">http://loinc.org#LA32-8 ("No")</li><li style=\"font-size: 11px\">http://loinc.org#LA32002-0 ("Already shut off")</li></ul><a name=\"opt-item.88122-7\"> </a><p><b>Answer options for 88122-7 </b></p><ul><li style=\"font-size: 11px\">http://loinc.org#LA28397-0 ("Often true")</li><li style=\"font-size: 11px\">http://loinc.org#LA6729-3 ("Sometimes true")</li><li style=\"font-size: 11px\">http://loinc.org#LA28398-8 ("Never true")</li></ul><a name=\"opt-item.88123-5\"> </a><p><b>Answer options for 88123-5 </b></p><ul><li style=\"font-size: 11px\">http://loinc.org#LA28397-0 ("Often true")</li><li style=\"font-size: 11px\">http://loinc.org#LA6729-3 ("Sometimes true")</li><li style=\"font-size: 11px\">http://loinc.org#LA28398-8 ("Never true")</li></ul><a name=\"opt-item.93030-5\"> </a><p><b>Answer options for 93030-5 </b></p><ul><li style=\"font-size: 11px\">http://loinc.org#LA33-6 ("Yes")</li><li style=\"font-size: 11px\">http://loinc.org#LA32-8 ("No")</li></ul><a name=\"opt-item.96780-2\"> </a><p><b>Answer options for 96780-2 </b></p><ul><li style=\"font-size: 11px\">http://loinc.org#LA31981-6 ("Yes, help finding work")</li><li style=\"font-size: 11px\">http://loinc.org#LA31982-4 ("Yes, help keeping work")</li><li style=\"font-size: 11px\">http://loinc.org#LA31983-2 ("I do not need or want help")</li></ul><a name=\"opt-item.96782-8\"> </a><p><b>Answer options for 96782-8 </b></p><ul><li style=\"font-size: 11px\">http://loinc.org#LA33-6 ("Yes")</li><li style=\"font-size: 11px\">http://loinc.org#LA32-8 ("No")</li></ul><a name=\"opt-item.95618-5\"> </a><p><b>Answer options for 95618-5 </b></p><ul><li style=\"font-size: 11px\">http://loinc.org#LA6270-8 ("Never")</li><li style=\"font-size: 11px\">http://loinc.org#LA10066-1 ("Rarely")</li><li style=\"font-size: 11px\">http://loinc.org#LA10082-8 ("Sometimes")</li><li style=\"font-size: 11px\">http://loinc.org#LA16644-9 ("Fairly often")</li><li style=\"font-size: 11px\">http://loinc.org#LA6482-9 ("Frequently")</li></ul><a name=\"opt-item.95617-7\"> </a><p><b>Answer options for 95617-7 </b></p><ul><li style=\"font-size: 11px\">http://loinc.org#LA6270-8 ("Never")</li><li style=\"font-size: 11px\">http://loinc.org#LA10066-1 ("Rarely")</li><li style=\"font-size: 11px\">http://loinc.org#LA10082-8 ("Sometimes")</li><li style=\"font-size: 11px\">http://loinc.org#LA16644-9 ("Fairly often")</li><li style=\"font-size: 11px\">http://loinc.org#LA6482-9 ("Frequently")</li></ul><a name=\"opt-item.95616-9\"> </a><p><b>Answer options for 95616-9 </b></p><ul><li style=\"font-size: 11px\">http://loinc.org#LA6270-8 ("Never")</li><li style=\"font-size: 11px\">http://loinc.org#LA10066-1 ("Rarely")</li><li style=\"font-size: 11px\">http://loinc.org#LA10082-8 ("Sometimes")</li><li style=\"font-size: 11px\">http://loinc.org#LA16644-9 ("Fairly often")</li><li style=\"font-size: 11px\">http://loinc.org#LA6482-9 ("Frequently")</li></ul><a name=\"opt-item.95615-1\"> </a><p><b>Answer options for 95615-1 </b></p><ul><li style=\"font-size: 11px\">http://loinc.org#LA6270-8 ("Never")</li><li style=\"font-size: 11px\">http://loinc.org#LA10066-1 ("Rarely")</li><li style=\"font-size: 11px\">http://loinc.org#LA10082-8 ("Sometimes")</li><li style=\"font-size: 11px\">http://loinc.org#LA16644-9 ("Fairly often")</li><li style=\"font-size: 11px\">http://loinc.org#LA6482-9 ("Frequently")</li></ul></div>"
},
"url" : "http://shinny.org/us/ny/hrsn/Questionnaire/SHINNYNYSHRSNQuestionnaire",
"version" : "1.5.3",
"status" : "active",
"date" : "2025-07-23T17:01:14-04:00",
"publisher" : "shinny",
"contact" : [
{
"name" : "shinny",
"telecom" : [
{
"system" : "url",
"value" : "https://shinny.org/us/ny/hrsn/index.html"
}
]
}
],
"item" : [
{
"linkId" : "nys-hrsn-questionnaire",
"code" : [
{
"system" : "http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires",
"code" : "nys-hrsn-questionnaire",
"display" : "NYS HRSN Questionnaire"
}
],
"text" : "NYS Accountable Health Communities (AHC) Health-Related Social Needs Screening (HRSN) tool",
"type" : "group",
"required" : false,
"item" : [
{
"linkId" : "96777-8",
"code" : [
{
"system" : "http://loinc.org",
"code" : "96777-8",
"display" : "Accountable health communities (AHC) health-related social needs screening (HRSN) tool"
}
],
"text" : "Accountable health communities (AHC) health-related social needs screening (HRSN) tool",
"type" : "group",
"required" : false,
"item" : [
{
"linkId" : "71802-3",
"code" : [
{
"system" : "http://loinc.org",
"code" : "71802-3",
"display" : "Housing status"
}
],
"text" : "What is your living situation today?",
"type" : "choice",
"required" : false,
"answerOption" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA31993-1",
"display" : "I have a steady place to live"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA31994-9",
"display" : "I have a place to live today, but I am worried about losing it in the future"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA31995-6",
"display" : "I do not have a steady place to live (I am temporarily 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)"
}
}
]
},
{
"linkId" : "96778-6",
"code" : [
{
"system" : "http://loinc.org",
"code" : "96778-6",
"display" : "Problems with place where you live"
}
],
"text" : "Think about the place you live. Do you have problems with any of the following?",
"type" : "choice",
"required" : false,
"answerOption" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA31996-4",
"display" : "Pests such as bugs, ants, or mice"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA28580-1",
"display" : "Mold"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA31997-2",
"display" : "Lead paint or pipes"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA31998-0",
"display" : "Lack of heat"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA31999-8",
"display" : "Oven or stove not working"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32000-4",
"display" : "Smoke detectors missing or not working"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32001-2",
"display" : "Water leaks"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA9-3",
"display" : "None of the above"
}
}
]
},
{
"linkId" : "96779-4",
"code" : [
{
"system" : "http://loinc.org",
"code" : "96779-4",
"display" : "Has the electric, gas, oil, or water company threatened to shut off services in your home in past 12 months"
}
],
"text" : "In the past 12 months has the electric, gas, oil, or water company threatened to shut off services in your home?",
"type" : "choice",
"required" : false,
"answerOption" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA33-6",
"display" : "Yes"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32002-0",
"display" : "Already shut off"
}
}
]
},
{
"linkId" : "88122-7",
"code" : [
{
"system" : "http://loinc.org",
"code" : "88122-7",
"display" : "Within the past 12 months we worried whether our food would run out before we got money to buy more [U.S. FSS]"
}
],
"text" : "Within the past 12 months, you worried that your food would run out before you got money to buy more.",
"type" : "choice",
"required" : false,
"answerOption" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA28397-0",
"display" : "Often true"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA6729-3",
"display" : "Sometimes true"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA28398-8",
"display" : "Never true"
}
}
]
},
{
"linkId" : "88123-5",
"code" : [
{
"system" : "http://loinc.org",
"code" : "88123-5",
"display" : "Within the past 12 months the food we bought just didn't last and we didn't have money to get more [U.S. FSS]"
}
],
"text" : "Within the past 12 months, the food you bought just didn't last and you didn't have money to get more.",
"type" : "choice",
"required" : false,
"answerOption" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA28397-0",
"display" : "Often true"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA6729-3",
"display" : "Sometimes true"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA28398-8",
"display" : "Never true"
}
}
]
},
{
"linkId" : "93030-5",
"code" : [
{
"system" : "http://loinc.org",
"code" : "93030-5",
"display" : "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living"
}
],
"text" : "In the past 12 months, has lack of reliable transportation kept you from medical appointments, meetings, work or from getting things needed for daily living?",
"type" : "choice",
"required" : false,
"answerOption" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA33-6",
"display" : "Yes"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
}
}
]
},
{
"linkId" : "96780-2",
"code" : [
{
"system" : "http://loinc.org",
"code" : "96780-2",
"display" : "Wants help finding or keeping work or a job"
}
],
"text" : "Do you want help finding or keeping work or a job?",
"type" : "choice",
"required" : false,
"answerOption" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA31981-6",
"display" : "Yes, help finding work"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA31982-4",
"display" : "Yes, help keeping work"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA31983-2",
"display" : "I do not need or want help"
}
}
]
},
{
"linkId" : "96782-8",
"code" : [
{
"system" : "http://loinc.org",
"code" : "96782-8",
"display" : "Wants help with school or training"
}
],
"text" : "Do you want help with school or training? For example, starting or completing job training or getting a high school diploma, GED or equivalent.",
"type" : "choice",
"required" : false,
"answerOption" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA33-6",
"display" : "Yes"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA32-8",
"display" : "No"
}
}
]
},
{
"linkId" : "95618-5",
"code" : [
{
"system" : "http://loinc.org",
"code" : "95618-5",
"display" : "Physically hurt you"
}
],
"text" : "How often does anyone, including family and friends, physically hurt you?",
"type" : "choice",
"required" : false,
"answerOption" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA6270-8",
"display" : "Never"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA10066-1",
"display" : "Rarely"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA10082-8",
"display" : "Sometimes"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA16644-9",
"display" : "Fairly often"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA6482-9",
"display" : "Frequently"
}
}
]
},
{
"linkId" : "95617-7",
"code" : [
{
"system" : "http://loinc.org",
"code" : "95617-7",
"display" : "Insult you or talk down to you"
}
],
"text" : "How often does anyone, including family and friends, insult or talk down to you?",
"type" : "choice",
"required" : false,
"answerOption" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA6270-8",
"display" : "Never"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA10066-1",
"display" : "Rarely"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA10082-8",
"display" : "Sometimes"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA16644-9",
"display" : "Fairly often"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA6482-9",
"display" : "Frequently"
}
}
]
},
{
"linkId" : "95616-9",
"code" : [
{
"system" : "http://loinc.org",
"code" : "95616-9",
"display" : "Threaten you with physical harm"
}
],
"text" : "How often does anyone, including family and friends, threaten you with harm?",
"type" : "choice",
"required" : false,
"answerOption" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA6270-8",
"display" : "Never"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA10066-1",
"display" : "Rarely"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA10082-8",
"display" : "Sometimes"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA16644-9",
"display" : "Fairly often"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA6482-9",
"display" : "Frequently"
}
}
]
},
{
"linkId" : "95615-1",
"code" : [
{
"system" : "http://loinc.org",
"code" : "95615-1",
"display" : "Scream or curse at you"
}
],
"text" : "How often does anyone, including family and friends, scream or curse at you?",
"type" : "choice",
"required" : false,
"answerOption" : [
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA6270-8",
"display" : "Never"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA10066-1",
"display" : "Rarely"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA10082-8",
"display" : "Sometimes"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA16644-9",
"display" : "Fairly often"
}
},
{
"valueCoding" : {
"system" : "http://loinc.org",
"code" : "LA6482-9",
"display" : "Frequently"
}
}
]
}
]
}
]
}
]
}