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</extension> </extension> <linkId value="1.1.2.1" /> <question> <linkId value="1.1.2.1.1" /> <text value="Please specify" /> <type value="string" /> </question> </group> </question> <question> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference"> <valueReference> <reference value="21112-8" /> </valueReference> </extension> <linkId value="1.1.3" /> <concept> <system value="http://loinc.org/" /> <code value="21112-8" /> <display value="Birth date" /> </concept> <text value="Date of Birth" /> <type value="date" /> </question> <question> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference"> <valueReference> <reference value="54132-6" /> </valueReference> </extension> <linkId value="1.1.4" /> <concept> <system value="http://loinc.org/" /> <code value="54132-6" /> <display value="Twin" /> </concept> <text value="Were you born a twin?" /> <type value="choice" /> <options> <reference value="http://details.loinc.org/AnswerList/LL623-0" /> <display value="USSG-FHT twin" /> </options> </question> <question> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference"> <valueReference> <reference value="54128-4" /> </valueReference> </extension> <linkId value="1.1.5" /> <concept> <system value="http://loinc.org/" /> <code value="54128-4" /> </concept> <text value="Were you adopted?" /> <type value="choice" /> <options> <reference value="http://details.loinc.org/AnswerList/LL361-7" /> <display value="Y/N1" /> </options> </question> <question> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference"> <valueReference> <reference value="54135-9" /> </valueReference> </extension> <linkId value="1.1.6" /> <concept> <system value="http://loinc.org/" /> <code value="54135-9" /> <display value="Parents related [USSG-FHT]" /> </concept> <text value="Are your parents related to each other in any way other than marriage?" /> <type value="choice" /> <options> <reference value="http://details.loinc.org/AnswerList/LL361-7" /> <display value="Y/N1" /> </options> </question> <question> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference"> <valueReference> <reference value="8302-2" /> </valueReference> </extension> <linkId value="1.1.7" /> <concept> <system value="http://loinc.org/" /> <code value="8302-2" /> <display value="Body height" /> </concept> <text value="Height" /> <type value="decimal" /> <required value="true" /> <group> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-enableWhen"> <extension url="question"> <valueString value="1.1.7" /> </extension> </extension> <linkId value="1.1.7.1" /> <question> <linkId value="1.1.7.1.1" /> <text value="Units" /> <type value="choice" /> <options> <reference value="#height" /> </options> </question> </group> <group> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-enableWhen"> <extension url="question"> <valueString value="1.1.7" /> </extension> <extension url="value"> <valueQuantity> <value value="10" /> <comparator value=">=" /> </valueQuantity> </extension> </extension> <linkId value="1.1.7.2" /> <question> <linkId value="1.1.7.2.1" /> <concept> <system value="http://loinc.org/" /> <code value="8302-2" /> </concept> <text value="Mock-up item: Shown when Height >= 10" /> <type value="string" /> </question> </group> </question> <question> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference"> <valueReference> <reference value="29463-7" /> </valueReference> </extension> <linkId value="1.1.8" /> <concept> <system value="http://loinc.org/" /> <code value="29463-7" /> <display value="Body weight" /> </concept> <text value="Weight" /> <type value="decimal" /> <group> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-enableWhen"> <extension url="question"> <valueString value="1.1.8" /> </extension> </extension> <linkId value="1.1.8.1" /> <question> <linkId value="1.1.8.1.1" /> <text value="Units" /> <type value="choice" /> <options> <reference value="#weight" /> </options> </question> </group> </question> <question> <linkId value="1.1.9" /> <concept> <system value="http://loinc.org/" /> <code value="39156-5" /> <display value="Body mass index" /> </concept> <text value="Body mass index (BMI) [Ratio]" /> <type value="decimal" /> </question> <question> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference"> <valueReference> <reference value="54134-2" /> </valueReference> </extension> <linkId value="1.1.10" /> <concept> <system value="http://loinc.org/" /> <code value="54134-2" /> <display value="Race [USSG-FHT]" /> </concept> <text value="Race" /> <type value="choice" /> <repeats value="true" /> <options> <reference value="http://details.loinc.org/AnswerList/LL629-7" /> <display value="USSG-FHT race" /> </options> </question> <question> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference"> <valueReference> <reference value="54133-4" /> </valueReference> </extension> <linkId value="1.1.11" /> <concept> <system value="http://loinc.org/" /> <code value="54133-4" /> <display value="Ethnicity [USSG-FHT]" /> </concept> <text value="Ethnicity" /> <type value="choice" /> <repeats value="true" /> <options> <reference value="http://details.loinc.org/AnswerList/LL628-9" /> <display value="USSG-FHT ethnicity" /> </options> </question> </group> <group> <linkId value="1.2" /> <title value="Your diseases history" /> <concept> <system value="http://loinc.org/" /> <code value="54137-5" /> <display value="Diseases history panel [USSG-FHT]" /> </concept> <repeats value="true" /> <question> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference"> <valueReference> <reference value="54140-9" /> </valueReference> </extension> <linkId value="1.2.1" /> <concept> <system value="http://loinc.org/" /> <code value="54140-9" /> <display value="History of diseases [USSG-FHT]" /> </concept> <text value="Disease or Condition" /> <type value="choice" /> <options> <reference value="http://details.loinc.org/AnswerList/LL626-3" /> <display value="USSG-FHT diseases" /> </options> </question> <question> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference"> <valueReference> <reference value="54130-0" /> </valueReference> </extension> <linkId value="1.2.2" /> <concept> <system value="http://loinc.org/" /> <code value="54130-0" /> <display value="Age range at onset of disease [USSG-FHT]" /> </concept> <text value="Age at Diagnosis" /> <type value="choice" /> <options> <reference value="http://details.loinc.org/AnswerList/LL619-8" /> <display value="USSG-FHT age" /> </options> </question> </group> </group> <group> <linkId value="2" /> <title value="Family member health information" /> <concept> <system value="http://loinc.org/" /> <code value="54114-4" /> <display value="Family member health history [USSG-FHT] family member" /> </concept> <repeats value="true" /> <group> <linkId value="2.1" /> <group> <linkId value="2.1.1" /> <question> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference"> <valueReference> <reference value="54136-7" /> </valueReference> </extension> <linkId value="2.1.1.1" /> <concept> <system value="http://loinc.org/" /> <code value="54136-7" /> <display value="Relationship to patient family member [USSG-FHT]" /> </concept> <text value="Relationship to you" /> <type value="choice" /> <options> <reference value="http://details.loinc.org/AnswerList/LL621-4" /> <display value="USSG-FHT relationship" /> </options> </question> <question> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference"> <valueReference> <reference value="54138-3" /> </valueReference> </extension> <linkId value="2.1.1.2" /> <concept> <system value="http://loinc.org/" /> <code value="54138-3" /> <display value="Name family member" /> </concept> <text value="Name" /> <type value="string" /> </question> <question> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference"> <valueReference> <reference value="54123-5" /> </valueReference> </extension> <linkId value="2.1.1.3" /> <concept> <system value="http://loinc.org/" /> <code value="54123-5" /> <display value="Gender family member [USSG-FHT]" /> </concept> <text value="Gender" /> <type value="choice" /> <options> <reference value="http://details.loinc.org/AnswerList/LL1-9" /> <display value="Gender_M/F" /> </options> <group> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-enableWhen"> <extension url="question"> <valueString value="2.1.3" /> </extension> <extension url="value"> <valueCoding> <system value="http://loinc.org/" /> <code value="LA46-8" /> <display value="Other" /> </valueCoding> </extension> </extension> <linkId value="2.1.1.3.1" /> <question> <linkId value="2.1.1.3.1.1" /> <text value="Please specify" /> <type value="string" /> </question> </group> </question> <question> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference"> <valueReference> <reference value="54139-1" /> </valueReference> </extension> <linkId value="2.1.1.4" /> <concept> <system value="http://loinc.org/" /> <code value="54139-1" /> <display value="Living family member" /> </concept> <text value="Living?" /> <type value="choice" /> <options> <reference value="LL361-7" /> <display value="Y/N1" /> </options> <group> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-enableWhen"> <extension url="question"> <valueString value="2.1.3" /> </extension> <extension url="value"> <valueCoding> <system value="http://loinc.org/" /> <code value="LA33-6" /> <display value="Yes" /> </valueCoding> </extension> </extension> <linkId value="2.1.1.4.1" /> <question> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference"> <valueReference> <reference value="54112-8" /> </valueReference> </extension> <linkId value="2.1.1.4.1.1" /> <concept> <system value="http://loinc.org/" /> <code value="54112-8" /> <display value="Cause of death family member [USSG-FHT]" /> </concept> <text value="Cause of Death" /> <type value="choice" /> <options> <reference value="http://details.loinc.org/AnswerList/LL627-1" /> </options> <group> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-enableWhen"> <extension url="question"> <valueString value="2.1.1.4.1.1" /> </extension> <extension url="value"> <valueCoding> <system value="http://loinc.org/" /> <code value="LA10571-0" /> <display value="-- Other/Unknown" /> </valueCoding> </extension> </extension> <linkId value="2.1.1.4.1.1.1" /> <question> <text value="Please specify" /> <type value="string" /> </question> </group> </question> <question> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference"> <valueReference> <reference value="54113-6" /> </valueReference> </extension> <linkId value="2.1.1.4.1.2" /> <concept> <system value="http://loinc.org/" /> <code value="54113-6" /> <display value="Age range at death family member [USSG-FHT]" /> </concept> <text value="Age at Death" /> <type value="choice" /> <options> <reference value="http://details.loinc.org/AnswerList/LL619-8" /> <display value="USSG-FHT age" /> </options> </question> </group> <group> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-enableWhen"> <extension url="question"> <valueString value="2.1.3" /> </extension> <extension url="value"> <valueCoding> <system value="http://loinc.org/" /> <code value="LA32-8" /> <display value="No" /> </valueCoding> </extension> </extension> <linkId value="2.1.1.4.2" /> <question> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference"> <valueReference> <reference value="54124-3" /> </valueReference> </extension> <linkId value="2.1.1.4.2.1" /> <concept> <system value="http://loinc.org/" /> <code value="54124-3" /> <display value="Birth date family member" /> </concept> <text value="Date of Birth" /> <type value="date" /> </question> <question> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference"> <valueReference> <reference value="54141-7" /> </valueReference> </extension> <linkId value="2.1.1.4.2.2" /> <concept> <system value="http://loinc.org/" /> <code value="54141-7" /> <display value="Current age family member [USSG-FHT]" /> </concept> <text value="Age" /> <type value="decimal" /> </question> </group> </question> <question> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference"> <valueReference> <reference value="54121-9" /> </valueReference> </extension> <linkId value="2.1.1.5" /> <concept> <system value="http://loinc.org/" /> <code value="54121-9" /> <display value="Twin family member" /> </concept> <text value="Was this person born a twin?" /> <type value="choice" /> <options> <reference value="http://details.loinc.org/AnswerList/LL623-0" /> </options> </question> <question> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference"> <valueReference> <reference value="54122-7" /> </valueReference> </extension> <linkId value="2.1.1.6" /> <concept> <system value="http://loinc.org/" /> <code value="54122-7" /> <display value="Adopted family member" /> </concept> <text value="Was this person adopted?" /> <type value="choice" /> <options> <reference value="http://details.loinc.org/AnswerList/LL623-0" /> </options> </question> <question> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference"> <valueReference> <reference value="54119-3" /> </valueReference> </extension> <linkId value="2.1.1.7" /> <concept> <system value="http://loinc.org/" /> <code value="54119-3" /> <display value="Race family member [USSG-FHT]" /> </concept> <text value="Race" /> <type value="choice" /> <repeats value="true" /> <options> <reference value="http://details.loinc.org/AnswerList/LL629-7" /> <display value="USSG-FHT race" /> </options> </question> <question> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference"> <valueReference> <reference value="54120-1" /> </valueReference> </extension> <linkId value="2.1.1.8" /> <concept> <system value="http://loinc.org/" /> <code value="54120-1" /> <display value="Ethnicity family member [USSG-FHT]" /> </concept> <text value="Ethnicity" /> <type value="choice" /> <repeats value="true" /> <options> <reference value="http://details.loinc.org/AnswerList/LL628-9" /> <display value="USSG-FHT ethnicity" /> </options> </question> </group> <group> <linkId value="2.1.2" /> <title value="This family member's history of disease" /> <concept> <system value="http://loinc.org/" /> <code value="54117-7" /> <display value="Disease history panel [USSG-FHT]" /> </concept> <repeats value="true" /> <question> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference"> <valueReference> <reference value="54116-9" /> </valueReference> </extension> <linkId value="2.1.2.1" /> <concept> <system value="http://loinc.org/" /> <code value="54116-9" /> <display value="History of diseases family member [USSG-FHT]" /> </concept> <text value="Disease or Condition" /> <type value="choice" /> <required value="true" /> <options> <reference value="http://details.loinc.org/AnswerList/LL626-3" /> <display value="USSG-FHT diseases" /> </options> </question> <question> <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference"> <valueReference> <reference value="54115-1" /> </valueReference> </extension> <linkId value="2.1.2.2" /> <concept> <system value="http://loinc.org/" /> <code value="54115-1" /> <display value="Age range at onset of disease family member [USSG-FHT]" /> </concept> <text value="Age at Diagnosis" /> <type value="choice" /> <options> <reference value="http://details.loinc.org/AnswerList/LL619-8" /> <display value="USSG-FHT age" /> </options> </question> <question> <linkId value="2.1.2.3" /> <text value="Mock-up item: Height" /> <type value="decimal" /> </question> <question> <linkId value="2.1.2.4" /> <text value="Mock-up item: Weight" /> <type value="decimal" /> </question> <question> <linkId value="2.1.2.5" /> <text value="Mock-up item: BMI" /> <type value="decimal" /> </question> </group> </group> </group> </group> </Questionnaire>

Generated Narrative with Details

id: 54127-6

contained: ,

status: published

publisher: Regenstrief Institute, Inc and the LOINC Committee

group

linkId: root

title: US Surgeon General - Family Health Portrait

concept: US Surgeon General family health portrait [USSG-FHT] (Details: [not stated] code 54127-6H = '??', stated as 'US Surgeon General family health portrait [USSG-FHT]')

required: true

Groups

-

*

*

*


  
    
      
      
      
        
          
          
            
            
          
          
            
            
          
        
      
    
  
  
  
  
    
    
    <concept>
      <code value="54127-6H" />
      <display value="US Surgeon General family health portrait [USSG-FHT]" />
    </concept>
    <required value="true" />
    <group>
      <linkId value="0" />
      <question>
        <linkId value="0.1" />
        <text value="Date Done" />
        <type value="date" />
      </question>
      <question>
        <linkId value="0.2" />
        <text value="Time Done" />
        <type value="time" />
      </question>
      <question>
        <linkId value="0.3" />
        <text value="Where Done" />
        <type value="string" />
      </question>
      <question>
        <linkId value="0.4" />
        <text value="Comment" />
        <type value="string" />
      </question>
    </group>
    <group>
      <linkId value="1" />
      <title value="Your health information" />
      <concept>
        <system value="http://loinc.org/" />
        <code value="54126-8" />
        <display value="My health history [USSG-FHT]" />
      </concept>
      <required value="true" />
      <group>
        <linkId value="1.1" />
        <question>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference">
            <valueReference>
              <reference value="54125-0" />
            </valueReference>
          </extension>
          <linkId value="1.1.1" />
          <concept>
            <system value="http://loinc.org/" />
            <code value="54125-0" />
            <display value="Name" />
          </concept>
          <text value="Name" />
          <type value="string" />
        </question>
        <question>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference">
            <valueReference>
              <reference value="54131-8" />
            </valueReference>
          </extension>
          <linkId value="1.1.2" />
          <concept>
            <system value="http://loinc.org/" />
            <code value="54131-8" />
            <display value="Gender [USSG-FHT]" />
          </concept>
          <text value="Gender" />
          <type value="choice" />
          <required value="true" />
          <options>
            <reference value="http://details.loinc.org/AnswerList/LL1-9" />
            <display value="Gender_M/F" />
          </options>
          <group>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-enableWhen">
              <extension url="question">
                <valueString value="1.2.1" />
              </extension>
              <extension url="value">
                <valueCoding>
                  <system value="http://loinc.org/" />
                  <code value="LL46-8" />
                  <display value="Other" />
                </valueCoding>
              </extension>
            </extension>
            <linkId value="1.1.2.1" />
            <question>
              <linkId value="1.1.2.1.1" />
              <text value="Please specify" />
              <type value="string" />
            </question>
          </group>
        </question>
        <question>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference">
            <valueReference>
              <reference value="21112-8" />
            </valueReference>
          </extension>
          <linkId value="1.1.3" />
          <concept>
            <system value="http://loinc.org/" />
            <code value="21112-8" />
            <display value="Birth date" />
          </concept>
          <text value="Date of Birth" />
          <type value="date" />
        </question>
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          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference">
            <valueReference>
              <reference value="54132-6" />
            </valueReference>
          </extension>
          <linkId value="1.1.4" />
          <concept>
            <system value="http://loinc.org/" />
            <code value="54132-6" />
            <display value="Twin" />
          </concept>
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          <type value="choice" />
          <options>
            <reference value="http://details.loinc.org/AnswerList/LL623-0" />
            <display value="USSG-FHT twin" />
          </options>
        </question>
        <question>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference">
            <valueReference>
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            </valueReference>
          </extension>
          <linkId value="1.1.5" />
          <concept>
            <system value="http://loinc.org/" />
            <code value="54128-4" />
          </concept>
          <text value="Were you adopted?" />
          <type value="choice" />
          <options>
            <reference value="http://details.loinc.org/AnswerList/LL361-7" />
            <display value="Y/N1" />
          </options>
        </question>
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            <valueReference>
              <reference value="54135-9" />
            </valueReference>
          </extension>
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            <code value="54135-9" />
            <display value="Parents related [USSG-FHT]" />
          </concept>
          <text value="Are your parents related to each other in any way other than marriage?" />
          <type value="choice" />
          <options>
            <reference value="http://details.loinc.org/AnswerList/LL361-7" />
            <display value="Y/N1" />
          </options>
        </question>
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          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference">
            <valueReference>
              <reference value="8302-2" />
            </valueReference>
          </extension>
          <linkId value="1.1.7" />
          <concept>
            <system value="http://loinc.org/" />
            <code value="8302-2" />
            <display value="Body height" />
          </concept>
          <text value="Height" />
          <type value="decimal" />
          <required value="true" />
          <group>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-enableWhen">
              <extension url="question">
                <valueString value="1.1.7" />
              </extension>
            </extension>
            <linkId value="1.1.7.1" />
            <question>
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              <text value="Units" />
              <type value="choice" />
              <options>
                <reference value="#height" />
              </options>
            </question>
          </group>
          <group>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-enableWhen">
              <extension url="question">
                <valueString value="1.1.7" />
              </extension>
              <extension url="value">
                <valueQuantity>
                  <value value="10" />
                  <comparator value=">=" />
                </valueQuantity>
              </extension>
            </extension>
            <linkId value="1.1.7.2" />
            <question>
              <linkId value="1.1.7.2.1" />
              <concept>
                <system value="http://loinc.org/" />
                <code value="8302-2" />
              </concept>
              <text value="Mock-up item: Shown when Height >= 10" />
              <type value="string" />
            </question>
          </group>
        </question>
        <question>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference">
            <valueReference>
              <reference value="29463-7" />
            </valueReference>
          </extension>
          <linkId value="1.1.8" />
          <concept>
            <system value="http://loinc.org/" />
            <code value="29463-7" />
            <display value="Body weight" />
          </concept>
          <text value="Weight" />
          <type value="decimal" />
          <group>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-enableWhen">
              <extension url="question">
                <valueString value="1.1.8" />
              </extension>
            </extension>
            <linkId value="1.1.8.1" />
            <question>
              <linkId value="1.1.8.1.1" />
              <text value="Units" />
              <type value="choice" />
              <options>
                <reference value="#weight" />
              </options>
            </question>
          </group>
        </question>
        <question>
          <linkId value="1.1.9" />
          <concept>
            <system value="http://loinc.org/" />
            <code value="39156-5" />
            <display value="Body mass index" />
          </concept>
          <text value="Body mass index (BMI) [Ratio]" />
          <type value="decimal" />
        </question>
        <question>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference">
            <valueReference>
              <reference value="54134-2" />
            </valueReference>
          </extension>
          <linkId value="1.1.10" />
          <concept>
            <system value="http://loinc.org/" />
            <code value="54134-2" />
            <display value="Race [USSG-FHT]" />
          </concept>
          <text value="Race" />
          <type value="choice" />
          <repeats value="true" />
          <options>
            <reference value="http://details.loinc.org/AnswerList/LL629-7" />
            <display value="USSG-FHT race" />
          </options>
        </question>
        <question>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference">
            <valueReference>
              <reference value="54133-4" />
            </valueReference>
          </extension>
          <linkId value="1.1.11" />
          <concept>
            <system value="http://loinc.org/" />
            <code value="54133-4" />
            <display value="Ethnicity [USSG-FHT]" />
          </concept>
          <text value="Ethnicity" />
          <type value="choice" />
          <repeats value="true" />
          <options>
            <reference value="http://details.loinc.org/AnswerList/LL628-9" />
            <display value="USSG-FHT ethnicity" />
          </options>
        </question>
      </group>
      <group>
        <linkId value="1.2" />
        <title value="Your diseases history" />
        <concept>
          <system value="http://loinc.org/" />
          <code value="54137-5" />
          <display value="Diseases history panel [USSG-FHT]" />
        </concept>
        <repeats value="true" />
        <question>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference">
            <valueReference>
              <reference value="54140-9" />
            </valueReference>
          </extension>
          <linkId value="1.2.1" />
          <concept>
            <system value="http://loinc.org/" />
            <code value="54140-9" />
            <display value="History of diseases [USSG-FHT]" />
          </concept>
          <text value="Disease or Condition" />
          <type value="choice" />
          <options>
            <reference value="http://details.loinc.org/AnswerList/LL626-3" />
            <display value="USSG-FHT diseases" />
          </options>
        </question>
        <question>
          <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference">
            <valueReference>
              <reference value="54130-0" />
            </valueReference>
          </extension>
          <linkId value="1.2.2" />
          <concept>
            <system value="http://loinc.org/" />
            <code value="54130-0" />
            <display value="Age range at onset of disease [USSG-FHT]" />
          </concept>
          <text value="Age at Diagnosis" />
          <type value="choice" />
          <options>
            <reference value="http://details.loinc.org/AnswerList/LL619-8" />
            <display value="USSG-FHT age" />
          </options>
        </question>
      </group>
    </group>
    <group>
      <linkId value="2" />
      <title value="Family member health information" />
      <concept>
        <system value="http://loinc.org/" />
        <code value="54114-4" />
        <display value="Family member health history [USSG-FHT] family member" />
      </concept>
      <repeats value="true" />
      <group>
        <linkId value="2.1" />
        <group>
          <linkId value="2.1.1" />
          <question>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference">
              <valueReference>
                <reference value="54136-7" />
              </valueReference>
            </extension>
            <linkId value="2.1.1.1" />
            <concept>
              <system value="http://loinc.org/" />
              <code value="54136-7" />
              <display value="Relationship to patient family member [USSG-FHT]" />
            </concept>
            <text value="Relationship to you" />
            <type value="choice" />
            <options>
              <reference value="http://details.loinc.org/AnswerList/LL621-4" />
              <display value="USSG-FHT relationship" />
            </options>
          </question>
          <question>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference">
              <valueReference>
                <reference value="54138-3" />
              </valueReference>
            </extension>
            <linkId value="2.1.1.2" />
            <concept>
              <system value="http://loinc.org/" />
              <code value="54138-3" />
              <display value="Name family member" />
            </concept>
            <text value="Name" />
            <type value="string" />
          </question>
          <question>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference">
              <valueReference>
                <reference value="54123-5" />
              </valueReference>
            </extension>
            <linkId value="2.1.1.3" />
            <concept>
              <system value="http://loinc.org/" />
              <code value="54123-5" />
              <display value="Gender family member [USSG-FHT]" />
            </concept>
            <text value="Gender" />
            <type value="choice" />
            <options>
              <reference value="http://details.loinc.org/AnswerList/LL1-9" />
              <display value="Gender_M/F" />
            </options>
            <group>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-enableWhen">
                <extension url="question">
                  <valueString value="2.1.3" />
                </extension>
                <extension url="value">
                  <valueCoding>
                    <system value="http://loinc.org/" />
                    <code value="LA46-8" />
                    <display value="Other" />
                  </valueCoding>
                </extension>
              </extension>
              <linkId value="2.1.1.3.1" />
              <question>
                <linkId value="2.1.1.3.1.1" />
                <text value="Please specify" />
                <type value="string" />
              </question>
            </group>
          </question>
          <question>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference">
              <valueReference>
                <reference value="54139-1" />
              </valueReference>
            </extension>
            <linkId value="2.1.1.4" />
            <concept>
              <system value="http://loinc.org/" />
              <code value="54139-1" />
              <display value="Living family member" />
            </concept>
            <text value="Living?" />
            <type value="choice" />
            <options>
              <reference value="LL361-7" />
              <display value="Y/N1" />
            </options>
            <group>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-enableWhen">
                <extension url="question">
                  <valueString value="2.1.3" />
                </extension>
                <extension url="value">
                  <valueCoding>
                    <system value="http://loinc.org/" />
                    <code value="LA33-6" />
                    <display value="Yes" />
                  </valueCoding>
                </extension>
              </extension>
              <linkId value="2.1.1.4.1" />
              <question>
                <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference">
                  <valueReference>
                    <reference value="54112-8" />
                  </valueReference>
                </extension>
                <linkId value="2.1.1.4.1.1" />
                <concept>
                  <system value="http://loinc.org/" />
                  <code value="54112-8" />
                  <display value="Cause of death family member [USSG-FHT]" />
                </concept>
                <text value="Cause of Death" />
                <type value="choice" />
                <options>
                  <reference value="http://details.loinc.org/AnswerList/LL627-1" />
                </options>
                <group>
                  <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-enableWhen">
                    <extension url="question">
                      <valueString value="2.1.1.4.1.1" />
                    </extension>
                    <extension url="value">
                      <valueCoding>
                        <system value="http://loinc.org/" />
                        <code value="LA10571-0" />
                        <display value="-- Other/Unknown" />
                      </valueCoding>
                    </extension>
                  </extension>
                  <linkId value="2.1.1.4.1.1.1" />
                  <question>
                    <text value="Please specify" />
                    <type value="string" />
                  </question>
                </group>
              </question>
              <question>
                <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference">
                  <valueReference>
                    <reference value="54113-6" />
                  </valueReference>
                </extension>
                <linkId value="2.1.1.4.1.2" />
                <concept>
                  <system value="http://loinc.org/" />
                  <code value="54113-6" />
                  <display value="Age range at death family member [USSG-FHT]" />
                </concept>
                <text value="Age at Death" />
                <type value="choice" />
                <options>
                  <reference value="http://details.loinc.org/AnswerList/LL619-8" />
                  <display value="USSG-FHT age" />
                </options>
              </question>
            </group>
            <group>
              <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-enableWhen">
                <extension url="question">
                  <valueString value="2.1.3" />
                </extension>
                <extension url="value">
                  <valueCoding>
                    <system value="http://loinc.org/" />
                    <code value="LA32-8" />
                    <display value="No" />
                  </valueCoding>
                </extension>
              </extension>
              <linkId value="2.1.1.4.2" />
              <question>
                <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference">
                  <valueReference>
                    <reference value="54124-3" />
                  </valueReference>
                </extension>
                <linkId value="2.1.1.4.2.1" />
                <concept>
                  <system value="http://loinc.org/" />
                  <code value="54124-3" />
                  <display value="Birth date family member" />
                </concept>
                <text value="Date of Birth" />
                <type value="date" />
              </question>
              <question>
                <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference">
                  <valueReference>
                    <reference value="54141-7" />
                  </valueReference>
                </extension>
                <linkId value="2.1.1.4.2.2" />
                <concept>
                  <system value="http://loinc.org/" />
                  <code value="54141-7" />
                  <display value="Current age family member [USSG-FHT]" />
                </concept>
                <text value="Age" />
                <type value="decimal" />
              </question>
            </group>
          </question>
          <question>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference">
              <valueReference>
                <reference value="54121-9" />
              </valueReference>
            </extension>
            <linkId value="2.1.1.5" />
            <concept>
              <system value="http://loinc.org/" />
              <code value="54121-9" />
              <display value="Twin family member" />
            </concept>
            <text value="Was this person born a twin?" />
            <type value="choice" />
            <options>
              <reference value="http://details.loinc.org/AnswerList/LL623-0" />
            </options>
          </question>
          <question>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference">
              <valueReference>
                <reference value="54122-7" />
              </valueReference>
            </extension>
            <linkId value="2.1.1.6" />
            <concept>
              <system value="http://loinc.org/" />
              <code value="54122-7" />
              <display value="Adopted family member" />
            </concept>
            <text value="Was this person adopted?" />
            <type value="choice" />
            <options>
              <reference value="http://details.loinc.org/AnswerList/LL623-0" />
            </options>
          </question>
          <question>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference">
              <valueReference>
                <reference value="54119-3" />
              </valueReference>
            </extension>
            <linkId value="2.1.1.7" />
            <concept>
              <system value="http://loinc.org/" />
              <code value="54119-3" />
              <display value="Race family member [USSG-FHT]" />
            </concept>
            <text value="Race" />
            <type value="choice" />
            <repeats value="true" />
            <options>
              <reference value="http://details.loinc.org/AnswerList/LL629-7" />
              <display value="USSG-FHT race" />
            </options>
          </question>
          <question>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference">
              <valueReference>
                <reference value="54120-1" />
              </valueReference>
            </extension>
            <linkId value="2.1.1.8" />
            <concept>
              <system value="http://loinc.org/" />
              <code value="54120-1" />
              <display value="Ethnicity family member [USSG-FHT]" />
            </concept>
            <text value="Ethnicity" />
            <type value="choice" />
            <repeats value="true" />
            <options>
              <reference value="http://details.loinc.org/AnswerList/LL628-9" />
              <display value="USSG-FHT ethnicity" />
            </options>
          </question>
        </group>
        <group>
          <linkId value="2.1.2" />
          <title value="This family member's history of disease" />
          <concept>
            <system value="http://loinc.org/" />
            <code value="54117-7" />
            <display value="Disease history panel [USSG-FHT]" />
          </concept>
          <repeats value="true" />
          <question>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference">
              <valueReference>
                <reference value="54116-9" />
              </valueReference>
            </extension>
            <linkId value="2.1.2.1" />
            <concept>
              <system value="http://loinc.org/" />
              <code value="54116-9" />
              <display value="History of diseases family member [USSG-FHT]" />
            </concept>
            <text value="Disease or Condition" />
            <type value="choice" />
            <required value="true" />
            <options>
              <reference value="http://details.loinc.org/AnswerList/LL626-3" />
              <display value="USSG-FHT diseases" />
            </options>
          </question>
          <question>
            <extension url="http://hl7.org/fhir/StructureDefinition/questionnaire-deReference">
              <valueReference>
                <reference value="54115-1" />
              </valueReference>
            </extension>
            <linkId value="2.1.2.2" />
            <concept>
              <system value="http://loinc.org/" />
              <code value="54115-1" />
              <display value="Age range at onset of disease family member [USSG-FHT]" />
            </concept>
            <text value="Age at Diagnosis" />
            <type value="choice" />
            <options>
              <reference value="http://details.loinc.org/AnswerList/LL619-8" />
              <display value="USSG-FHT age" />
            </options>
          </question>
          <question>
            <linkId value="2.1.2.3" />
            <text value="Mock-up item: Height" />
            <type value="decimal" />
          </question>
          <question>
            <linkId value="2.1.2.4" />
            <text value="Mock-up item: Weight" />
            <type value="decimal" />
          </question>
          <question>
            <linkId value="2.1.2.5" />
            <text value="Mock-up item: BMI" />
            <type value="decimal" />
          </question>
        </group>
      </group>
    </group>
  </group>
</Questionnaire>