This page is part of the Argonaut Questionnaire Implementation Guide (v1.0.0: Release) based on FHIR R3. This is the current published version in it's permanent home (it will always be available at this URL). For a full list of available versions, see the Directory of published versions
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Health-Related Social Needs in Clinical Settings - The Accountable Health Communities Screening Tool,“ https://nam.edu/wp-content/uploads/2017/05/Standardized-Screening-for-Health-Related-Social-Needs-in-Clinical-Settings.pdf </p></div> </text> <url value="http://fhir.org/guides/argonaut/questionnaire/Questionnaire/questionnaire-example-housing"/> <identifier> <system value="http://acme.org/q-identifiers"/> <value value="business-identifier4"/> </identifier> <version value="0.0.0"/> <title value="Housing Questions"/> <status value="draft"/> <date value="2018-07-26"/> <publisher value="Argonaut Project"/> <useContext> <code> <system value="http://hl7.org/fhir/usage-context-type"/> <code value="task"/> <display value="Workflow Task"/> </code> <valueCodeableConcept> <coding> <system value="http://acme.org"/> <code value="example"/> <display value="Example of Use"/> </coding> </valueCodeableConcept> </useContext> <jurisdiction> <coding> <system value="urn:iso:std:iso:3166"/> <code value="US"/> <display value="United States of America"/> </coding> </jurisdiction> <contact> <telecom> <system value="url"/> <value value="http://argonautwiki.hl7.org"/> </telecom> </contact> <copyright value="Billioux, Alexander, MD, Dphil; Verlander, Katherine, MPH; Anthony, Susan, DrPH; Alley, Dawn, PhD; National Academy of Sciences, “Standardized Screening for Health-Related Social Needs in Clinical Settings - The Accountable Health Communities Screening Tool,“ https://nam.edu/wp-content/uploads/2017/05/Standardized-Screening-for-Health-Related-Social-Needs-in-Clinical-Settings.pdf "/> <code> <system value="http://acme.org/codes"/> <code value="housing"/> <display value="Housing Questions"/> </code> <subjectType value="Patient"/> <item> <linkId value="g1"/> <type value="group"/> <item> <extension url="http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder"> <valueInteger value="0"/> </extension> <linkId value="g1.d"/> <text value="Accountable Health Communities Core Health-Related Social Needs Screening Questions Underlined answer options indicate positive responses for the associated health-related social need. A value greater than 10 when the numerical values for answers to questions 7-10 are summed indicates a positive screen for interpersonal safety."/> <type value="display"/> </item> <item> <extension url="http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder"> <valueInteger value="1"/> </extension> <linkId value="g1.1"/> <prefix value="1"/> <text value="What is your housing situation today?"/> <type value="choice"/> <required value="true"/> <repeats value="false"/> <option> <extension url="http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder"> <valueInteger value="0"/> </extension> <valueString value="I do not have housing (I am staying with others, in a hotel, in a shelter, living outside on the street, on a beach, in a car, abandoned building, bus or train station, or in a park)"/> </option> <option> <extension url="http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder"> <valueInteger value="1"/> </extension> <valueString value="I have housing today, but I am worried about losing housing in the future"/> </option> <option> <extension url="http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder"> <valueInteger value="2"/> </extension> <valueString value="I have housing"/> </option> </item> <item> <extension url="http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder"> <valueInteger value="2"/> </extension> <linkId value="g1.2"/> <prefix value="2"/> <text value="Think about the place you live. 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(check all that apply)"/> <type value="choice"/> <required value="true"/> <repeats value="true"/> <option> <extension url="http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder"> <valueInteger value="0"/> </extension> <valueString value="Bug infestation"/> </option> <option> <extension url="http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder"> <valueInteger value="1"/> </extension> <valueString value="Mold"/> </option> <option> <extension url="http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder"> <valueInteger value="2"/> </extension> <valueString value="Lead paint or pipes"/> </option> <option> <extension url="http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder"> <valueInteger value="3"/> </extension> <valueString value="Inadequate heat"/> </option> <option> <extension url="http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder"> <valueInteger value="4"/> </extension> <valueString value="Oven or stove not working"/> </option> <option> <extension url="http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder"> <valueInteger value="5"/> </extension> <valueString value="No or not working smoke detectors"/> </option> <option> <extension url="http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder"> <valueInteger value="6"/> </extension> <valueString value="Water leaks"/> </option> <option> <extension url="http://fhir.org/guides/argonaut/questionnaire/StructureDefinition/extension-itemOrder"> <valueInteger value="7"/> </extension> <modifierExtension url="http://hl7.org/fhir/StructureDefinition/questionnaire-optionExclusive"> <valueBoolean value="true"/> </modifierExtension> <valueString value="None of the above"/> </option> </item> </item> </Questionnaire>