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="SHINNYServiceDuplicationQuestionnaire"/>
<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 SHINNYServiceDuplicationQuestionnaire</b></p><a name="SHINNYServiceDuplicationQuestionnaire"> </a><a name="hcSHINNYServiceDuplicationQuestionnaire"> </a><a name="SHINNYServiceDuplicationQuestionnaire-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/SHINNYServiceDuplicationQuestionnaire#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.service-duplication-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"/> service-duplication-questionnaire</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Indicator questions recording whether the patient receives assistance from a variety of programs, as well as other social and healthcare needs.</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.service-duplication-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"/> service-duplication-questions</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Questions regarding service duplication.</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.housing-program" 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"/> housing-program</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Indicator, populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient currently receives or is on any housing waitlists (e.g., HUD. Section 8, local housing authority, or other voucher programs).</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.housing-program">3 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.nutritional-education-program" 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"/> nutritional-education-program</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Indicator, populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient currently receives nutritional counseling or education.</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.nutritional-education-program">3 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_bck0010.png)" id="item.nutritional-services-program" 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"/> nutritional-services-program</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Indicator, populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient is actively engaged in a nutrition program.</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.nutritional-services-program">3 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.food-service-program" 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"/> food-service-program</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Indicator, populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient currently receives any home-delivered meals or food 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.food-service-program">3 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_bck0010.png)" id="item.snapp-program" 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"/> snapp-program</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Indicator, populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient is currently engaged in SNAP.</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.snapp-program">3 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.wic-program" 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"/> wic-program</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Indicator, populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient is currently engaged in WIC.</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.wic-program">3 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_bck0010.png)" id="item.tanf-program" 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"/> tanf-program</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Indicator, populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient is currently engaged in TANF.</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.tanf-program">3 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.transportation-program" 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"/> transportation-program</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Indicator, populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient is currently engaged in Transportation 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.transportation-program">3 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_bck0010.png)" id="item.medication-requiring-refrigeration" 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"/> medication-requiring-refrigeration</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Indicator, populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient is currently prescribed medication, requiring refrigeration for the management of a chronic condition.</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.medication-requiring-refrigeration">3 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.breast-milk-requiring-refrigeration" 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"/> breast-milk-requiring-refrigeration</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Indicator, populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient is a pregnant/postpartum persons that require a refrigeration for breast milk.</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.breast-milk-requiring-refrigeration">3 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_bck0010.png)" id="item.adls-iadls" 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"/> adls-iadls</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Indicator, populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient currently has Activities of Daily Living (ADLs) & Instrumental Activities of Daily Living (IADLs) needs.</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.adls-iadls">3 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.medical-respite" 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"/> medical-respite</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Indicator, populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient meets the qualifications for medical respite (see notes).</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.medical-respite">3 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.childcare-assistance" 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"/> childcare-assistance</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Indicator, populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient needs assistance with childcare.</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.childcare-assistance">3 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.housing-program"> </a><p><b>Answer options for housing-program </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#LA30226-7 ("Not applicable (N/A)")</li></ul><a name="opt-item.nutritional-education-program"> </a><p><b>Answer options for nutritional-education-program </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#LA30226-7 ("Not applicable (N/A)")</li></ul><a name="opt-item.nutritional-services-program"> </a><p><b>Answer options for nutritional-services-program </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#LA30226-7 ("Not applicable (N/A)")</li></ul><a name="opt-item.food-service-program"> </a><p><b>Answer options for food-service-program </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#LA30226-7 ("Not applicable (N/A)")</li></ul><a name="opt-item.snapp-program"> </a><p><b>Answer options for snapp-program </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#LA30226-7 ("Not applicable (N/A)")</li></ul><a name="opt-item.wic-program"> </a><p><b>Answer options for wic-program </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#LA30226-7 ("Not applicable (N/A)")</li></ul><a name="opt-item.tanf-program"> </a><p><b>Answer options for tanf-program </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#LA30226-7 ("Not applicable (N/A)")</li></ul><a name="opt-item.transportation-program"> </a><p><b>Answer options for transportation-program </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#LA30226-7 ("Not applicable (N/A)")</li></ul><a name="opt-item.medication-requiring-refrigeration"> </a><p><b>Answer options for medication-requiring-refrigeration </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#LA30226-7 ("Not applicable (N/A)")</li></ul><a name="opt-item.breast-milk-requiring-refrigeration"> </a><p><b>Answer options for breast-milk-requiring-refrigeration </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#LA30226-7 ("Not applicable (N/A)")</li></ul><a name="opt-item.adls-iadls"> </a><p><b>Answer options for adls-iadls </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#LA30226-7 ("Not applicable (N/A)")</li></ul><a name="opt-item.medical-respite"> </a><p><b>Answer options for medical-respite </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#LA30226-7 ("Not applicable (N/A)")</li></ul><a name="opt-item.childcare-assistance"> </a><p><b>Answer options for childcare-assistance </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#LA30226-7 ("Not applicable (N/A)")</li></ul></div>
</text>
<url
value="http://shinny.org/us/ny/hrsn/Questionnaire/SHINNYServiceDuplicationQuestionnaire"/>
<version value="1.5.3"/>
<status value="active"/>
<date value="2025-07-23T17:01:14-04:00"/>
<publisher value="shinny"/>
<contact>
<name value="shinny"/>
<telecom>
<system value="url"/>
<value value="https://shinny.org/us/ny/hrsn/index.html"/>
</telecom>
</contact>
<item>
<linkId value="service-duplication-questionnaire"/>
<code>
<system
value="http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires"/>
<code value="service-duplication-questionnaire"/>
<display value="Service Duplication Questionnaire"/>
</code>
<text
value="Indicator questions recording whether the patient receives assistance from a variety of programs, as well as other social and healthcare needs."/>
<type value="group"/>
<required value="false"/>
<item>
<linkId value="service-duplication-questions"/>
<code>
<system
value="http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires"/>
<code value="service-duplication-questions"/>
<display value="Service Duplication Questions"/>
</code>
<text value="Questions regarding service duplication."/>
<type value="group"/>
<required value="false"/>
<item>
<linkId value="housing-program"/>
<code>
<system
value="http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires"/>
<code value="housing-program"/>
<display value="Housing Program"/>
</code>
<text
value="Indicator, populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient currently receives or is on any housing waitlists (e.g., HUD. Section 8, local housing authority, or other voucher programs)."/>
<type value="choice"/>
<required value="false"/>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA33-6"/>
<display value="Yes"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA32-8"/>
<display value="No"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30226-7"/>
<display value="Not applicable (N/A)"/>
</valueCoding>
</answerOption>
</item>
<item>
<linkId value="nutritional-education-program"/>
<code>
<system
value="http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires"/>
<code value="nutritional-education-program"/>
<display value="Nutritional Education Program"/>
</code>
<text
value="Indicator, populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient currently receives nutritional counseling or education."/>
<type value="choice"/>
<required value="false"/>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA33-6"/>
<display value="Yes"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA32-8"/>
<display value="No"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30226-7"/>
<display value="Not applicable (N/A)"/>
</valueCoding>
</answerOption>
</item>
<item>
<linkId value="nutritional-services-program"/>
<code>
<system
value="http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires"/>
<code value="nutritional-services-program"/>
<display value="Nutritional Services Program"/>
</code>
<text
value="Indicator, populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient is actively engaged in a nutrition program."/>
<type value="choice"/>
<required value="false"/>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA33-6"/>
<display value="Yes"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA32-8"/>
<display value="No"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30226-7"/>
<display value="Not applicable (N/A)"/>
</valueCoding>
</answerOption>
</item>
<item>
<linkId value="food-service-program"/>
<code>
<system
value="http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires"/>
<code value="food-service-program"/>
<display value="Food Service Program"/>
</code>
<text
value="Indicator, populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient currently receives any home-delivered meals or food services."/>
<type value="choice"/>
<required value="false"/>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA33-6"/>
<display value="Yes"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA32-8"/>
<display value="No"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30226-7"/>
<display value="Not applicable (N/A)"/>
</valueCoding>
</answerOption>
</item>
<item>
<linkId value="snapp-program"/>
<code>
<system
value="http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires"/>
<code value="snapp-program"/>
<display value="SNAPP Program"/>
</code>
<text
value="Indicator, populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient is currently engaged in SNAP."/>
<type value="choice"/>
<required value="false"/>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA33-6"/>
<display value="Yes"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA32-8"/>
<display value="No"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30226-7"/>
<display value="Not applicable (N/A)"/>
</valueCoding>
</answerOption>
</item>
<item>
<linkId value="wic-program"/>
<code>
<system
value="http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires"/>
<code value="wic-program"/>
<display value="WIC Program"/>
</code>
<text
value="Indicator, populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient is currently engaged in WIC."/>
<type value="choice"/>
<required value="false"/>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA33-6"/>
<display value="Yes"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA32-8"/>
<display value="No"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30226-7"/>
<display value="Not applicable (N/A)"/>
</valueCoding>
</answerOption>
</item>
<item>
<linkId value="tanf-program"/>
<code>
<system
value="http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires"/>
<code value="tanf-program"/>
<display value="TANF Program"/>
</code>
<text
value="Indicator, populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient is currently engaged in TANF."/>
<type value="choice"/>
<required value="false"/>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA33-6"/>
<display value="Yes"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA32-8"/>
<display value="No"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30226-7"/>
<display value="Not applicable (N/A)"/>
</valueCoding>
</answerOption>
</item>
<item>
<linkId value="transportation-program"/>
<code>
<system
value="http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires"/>
<code value="transportation-program"/>
<display value="Transportation Program"/>
</code>
<text
value="Indicator, populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient is currently engaged in Transportation services."/>
<type value="choice"/>
<required value="false"/>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA33-6"/>
<display value="Yes"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA32-8"/>
<display value="No"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30226-7"/>
<display value="Not applicable (N/A)"/>
</valueCoding>
</answerOption>
</item>
<item>
<linkId value="medication-requiring-refrigeration"/>
<code>
<system
value="http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires"/>
<code value="medication-requiring-refrigeration"/>
<display value="Medication Requiring Refrigeration"/>
</code>
<text
value="Indicator, populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient is currently prescribed medication, requiring refrigeration for the management of a chronic condition."/>
<type value="choice"/>
<required value="false"/>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA33-6"/>
<display value="Yes"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA32-8"/>
<display value="No"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30226-7"/>
<display value="Not applicable (N/A)"/>
</valueCoding>
</answerOption>
</item>
<item>
<linkId value="breast-milk-requiring-refrigeration"/>
<code>
<system
value="http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires"/>
<code value="breast-milk-requiring-refrigeration"/>
<display value="Breast Milk Requiring Refrigeration"/>
</code>
<text
value="Indicator, populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient is a pregnant/postpartum persons that require a refrigeration for breast milk."/>
<type value="choice"/>
<required value="false"/>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA33-6"/>
<display value="Yes"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA32-8"/>
<display value="No"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30226-7"/>
<display value="Not applicable (N/A)"/>
</valueCoding>
</answerOption>
</item>
<item>
<linkId value="adls-iadls"/>
<code>
<system
value="http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires"/>
<code value="adls-iadls"/>
<display value="ADLS-IADLS"/>
</code>
<text
value="Indicator, populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient currently has Activities of Daily Living (ADLs) & Instrumental Activities of Daily Living (IADLs) needs."/>
<type value="choice"/>
<required value="false"/>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA33-6"/>
<display value="Yes"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA32-8"/>
<display value="No"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30226-7"/>
<display value="Not applicable (N/A)"/>
</valueCoding>
</answerOption>
</item>
<item>
<linkId value="medical-respite"/>
<code>
<system
value="http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires"/>
<code value="medical-respite"/>
<display value="Medical Respite"/>
</code>
<text
value="Indicator, populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient meets the qualifications for medical respite (see notes)."/>
<type value="choice"/>
<required value="false"/>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA33-6"/>
<display value="Yes"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA32-8"/>
<display value="No"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30226-7"/>
<display value="Not applicable (N/A)"/>
</valueCoding>
</answerOption>
</item>
<item>
<linkId value="childcare-assistance"/>
<code>
<system
value="http://shinny.org/us/ny/hrsn/CodeSystem/SHINNYQuestionnaires"/>
<code value="childcare-assistance"/>
<display value="Childcare Assistance"/>
</code>
<text
value="Indicator, populated by entity, conducting the assessment. Captures patient response during the HRSN assessment, identifying if patient needs assistance with childcare."/>
<type value="choice"/>
<required value="false"/>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA33-6"/>
<display value="Yes"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA32-8"/>
<display value="No"/>
</valueCoding>
</answerOption>
<answerOption>
<valueCoding>
<system value="http://loinc.org"/>
<code value="LA30226-7"/>
<display value="Not applicable (N/A)"/>
</valueCoding>
</answerOption>
</item>
</item>
</item>
</Questionnaire>