{ "resourceType": "Questionnaire", "id": "spark5", "meta": { "versionId": "spark5", "lastUpdated": "2015-10-02T14:04:25.466+00:00" }, "language": "en", "text": { "status": "generated", "div": "
Todo
" }, "contained": [ { "resourceType": "ValueSet", "id": "d1e9892-vs", "status": "active", "codeSystem": { "system": "http://nci.nih.gov/xml/owl/cadsr/form/form_design_identifier/2674812v4.0/question_identifier#3702892v4.0-cs", "caseSensitive": true, "concept": [ { "code": "Female", "display": "Female Gender", "definition": "An individual who reports belonging to the cultural gender role distinction of female." }, { "code": "Male", "display": "Male Gender", "definition": "An individual who reports belonging to the cultural gender role distinction of male." }, { "code": "Unknown", "display": "Unknown", "definition": "Not known, not observed, not recorded, or refused." }, { "code": "Unspecified", "display": "Unspecified", "definition": "Not stated explicitly or in detail." } ] } }, { "resourceType": "ValueSet", "id": "d1e10146-vs", "status": "active", "codeSystem": { "system": "http://nci.nih.gov/xml/owl/cadsr/form/form_design_identifier/2674812v4.0/question_identifier#3702904v4.0-cs", "caseSensitive": true, "concept": [ { "code": "American Indian or Alaska Native", "display": "American Indian or Alaska Native", "definition": "A person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment." }, { "code": "Asian", "display": "Asian", "definition": "A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam." }, { "code": "Black or African American", "display": "Black or African American", "definition": "A person having origins in any of the black racial groups of Africa. Terms such as \"Haitian\" or \"Negro\" can be used in addition to \"Black or African American.\"" }, { "code": "Native Hawaiian or other Pacific Islander", "display": "Native Hawaiian or Other Pacific Islander", "definition": "A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands." }, { "code": "Not Reported", "display": "Not Reported", "definition": "Not provided or available" }, { "code": "Unknown", "display": "Unknown", "definition": "Could not be determined or unsure" }, { "code": "White", "display": "White", "definition": "A person having origins in any of the original peoples of Europe, the Middle East, or North Africa." } ] } }, { "resourceType": "ValueSet", "id": "d1e10593-vs", "status": "active", "codeSystem": { "system": "http://nci.nih.gov/xml/owl/cadsr/form/form_design_identifier/2674812v4.0/question_identifier#3702898v4.0-cs", "caseSensitive": true, "concept": [ { "code": "Hispanic or Latino", "display": "Hispanic or Latino", "definition": "A person of Mexican, Puerto Rican, Cuban, Central or South American or other Spanish culture or origin, regardless of race." }, { "code": "Not Hispanic or Latino", "display": "Not Hispanic or Latino", "definition": "A person not meeting the definition for Hispanic or Latino." }, { "code": "Not reported", "display": "Not Reported", "definition": "Not provided or available" }, { "code": "Unknown", "display": "Unknown", "definition": "Could not be determined or unsure" } ] } }, { "resourceType": "ValueSet", "id": "d1e10923-vs", "status": "active", "codeSystem": { "system": "http://nci.nih.gov/xml/owl/cadsr/form/form_design_identifier/2674812v4.0/question_identifier#3702916v4.0-cs", "caseSensitive": true, "concept": [ { "code": "Managed Care/Medicare", "display": "Managed Care/Medicare", "definition": "An arrangement whereby a third-party payer (e.g., insurance company, federal government, or corporation) mediates between physicians and patients, negotiating fees for service and overseeing the types of treatment given. Managed care has virtually replaced unmanaged indemnity plans, where payment is automatic and oversight procedures are minimal. Whereas 96% of American workers had unmanaged indemnity in 1984, only 28% did in 1988. Typically, in managed care, the third-party payer requires second opinions and pre-certification review for patients requiring hospital admission. They obtain wholesale prices from doctors, and carry out cost-containment measures, including auditing hospitals and reviewing claims. Managed care has figured heavily in the national debate over health care.: A program under the U.S. Social Security Administration that reimburses hospitals and physicians for medical care provided to qualifying people over 65 years old." }, { "code": "Medicaid", "display": "Medicaid", "definition": "A jointly funded program of the United States federal and state governments that provides hospital expense and medical expense coverage to some people with low-income and certain aged and disabled individuals." }, { "code": "Medicaid and Medicare", "display": "Medicare And Medicaid", "definition": "A program under the U.S. Social Security Administration that reimburses hospitals and physicians for medical care provided to qualifying people over 65 years old.: An article which expresses the relation of connection or addition. It is used to conjoin a word with a word, a clause with a clause, or a sentence with a sentence.: A jointly funded program of the United States federal and state governments that provides hospital expense and medical expense coverage to some people with low-income and certain aged and disabled individuals." }, { "code": "Medicare", "display": "Medicare", "definition": "A program under the U.S. Social Security Administration that reimburses hospitals and physicians for medical care provided to qualifying people over 65 years old." }, { "code": "Medicare and Private Insurance", "display": "Medicare And Private Insurance", "definition": "A program under the U.S. Social Security Administration that reimburses hospitals and physicians for medical care provided to qualifying people over 65 years old.: An article which expresses the relation of connection or addition. It is used to conjoin a word with a word, a clause with a clause, or a sentence with a sentence.: Not public; kept secret or restricted.: A mechanism for guarding against financial aspects of risk by making payments in the form of premiums to an insurance company, which pays an agreed-upon sum to the insured in the event of loss." }, { "code": "Military or Veterans Sponsored, NOS", "display": "Military Or Veterans Sponsored Insurance, Not Otherwise Specified", "definition": "The armed forces of a country.: Or; used to connect words, phrases, or clauses representing alternatives; used to connect alternative terms for the same thing; used in correlation; used to correct or rephrase what was previously said; otherwise.: A division of the Executive Branch of the United States government concerned with overall planning, promoting, and administering programs pertaining to veterans. The Department of Veterans Affairs (VA) was established March 15, 1989 as a Cabinet-level position.: A person or organization that supports or champions something.: Not characterized in any other way.: A mechanism for guarding against financial aspects of risk by making payments in the form of premiums to an insurance company, which pays an agreed-upon sum to the insured in the event of loss." }, { "code": "Military Sponsored (Including CHAMPUS & TriCare)", "display": "Military Insurance", "definition": "The armed forces of a country.: A mechanism for guarding against financial aspects of risk by making payments in the form of premiums to an insurance company, which pays an agreed-upon sum to the insured in the event of loss." }, { "code": "No Means of Payment (No Insurance)", "display": "No Insurance", "definition": "The non-affirmative response to a question.: A mechanism for guarding against financial aspects of risk by making payments in the form of premiums to an insurance company, which pays an agreed-upon sum to the insured in the event of loss." }, { "code": "Other", "display": "Other", "definition": "Not otherwise specified." }, { "code": "Private Insurance", "display": "Private Insurance", "definition": "Not public; kept secret or restricted.: A mechanism for guarding against financial aspects of risk by making payments in the form of premiums to an insurance company, which pays an agreed-upon sum to the insured in the event of loss." }, { "code": "Self-Pay (No Insurance)", "display": "Self Payment", "definition": "The individual as the object of his own reflective consciousness.: Payment; a sum of money paid." }, { "code": "State Supplemental Health Insurance", "display": "State Supplemental Health Insurance", "definition": "A U.S. State is any one of the fifty states which is a member of the federation known as the United States of America. Other US geographic areas, such as Puerto Rico and the District of Columbia, are essentially equivalent to State when used in an address. (from Wikipedia and NCI): Something added to complete a thing, make up for a deficiency, or extend or strengthen the whole; serving to complete or make an addition.: The state of the organism when it functions optimally without evidence of disease.: A mechanism for guarding against financial aspects of risk by making payments in the form of premiums to an insurance company, which pays an agreed-upon sum to the insured in the event of loss." }, { "code": "Unknown", "display": "Unknown", "definition": "Not known, not observed, not recorded, or refused." }, { "code": "Veterans Sponsored", "display": "Veterans Administration Sponsor Insurance", "definition": "A division of the Executive Branch of the United States government concerned with overall planning, promoting, and administering programs pertaining to veterans. The Department of Veterans Affairs (VA) was established March 15, 1989 as a Cabinet-level position.: A person or organization that supports or champions something.: A mechanism for guarding against financial aspects of risk by making payments in the form of premiums to an insurance company, which pays an agreed-upon sum to the insured in the event of loss." } ] } }, { "resourceType": "ValueSet", "id": "d1e11887-vs", "status": "active", "codeSystem": { "system": "http://nci.nih.gov/xml/owl/cadsr/form/form_design_identifier/2674812v4.0/question_identifier#3702942v4.0-cs", "caseSensitive": true, "concept": [ { "code": "Bachelor's Degree", "display": "Bachelor's Degree", "definition": "Bachelor's degree is an award (baccalaureate or equivalent degree, as determined by the Secretary of the U.S. Department of Education) conferred by a college, university, or other postsecondary education institution as official recognition for the successful completion of a program of studies, that normally requires at least four years of full-time equivalent college-level work. This includes bachelor's degrees conferred in a five-year cooperative program." }, { "code": "Doctoral degree or professional degree", "display": "Professional Doctorate or Doctorate Degree", "definition": "A doctorate awarded in certain fields where most holders of the degree are not engaged primarily in scholarly research and academic activities, but rather in a profession, such as law, medicine, music, or ministry.: Or; used to connect words, phrases, or clauses representing alternatives; used to connect alternative terms for the same thing; used in correlation; used to correct or rephrase what was previously said; otherwise.: The Doctor's Degree is the highest award a student can earn for graduate study. The doctor's degree classification includes such degrees in any field." }, { "code": "Grade School", "display": "Grade School", "definition": "A school for young children; usually the first 6 or 8 grades." }, { "code": "Graduate or professional degree", "display": "Graduation Or Professional Degree", "definition": "Conferral or receipt of an academic degree or diploma marking the completion of a defined set of coursework.: Or; used to connect words, phrases, or clauses representing alternatives; used to connect alternative terms for the same thing; used in correlation; used to correct or rephrase what was previously said; otherwise.: An occupation requiring special education, especially in the liberal arts or sciences.: An academic degree is an award conferred by a college, university, or other postsecondary education institution as official recognition for the successful completion of a program of studies." }, { "code": "High school graduate (including equivalency)", "display": "High School Completion or General Equivalency Diploma (GED) Completion", "definition": "Indicates that a person has attended high school and has received a high school diploma.: Or; used to connect words, phrases, or clauses representing alternatives; used to connect alternative terms for the same thing; used in correlation; used to correct or rephrase what was previously said; otherwise.: Indicates that a person has received a General Equivalency Diploma in lieu of a high school diploma." }, { "code": "Master's Degree", "display": "Master's Degree", "definition": "The Master's Degree is an award that requires the successful completion of a program of study of at least the full-time equivalent of 1 but not more than two academic years of work beyond the bachelor's degree." }, { "code": "No formal education", "display": "No Formal Schooling", "definition": "Indicates that a person has never attended an educational program or formal schooling." }, { "code": "Not high school graduate", "display": "Not High School Graduate", "definition": "Indicates a person has attended high school but did not complete high school and did not receive a high school diploma." }, { "code": "Some college or associate degree", "display": "Some College or Associates Degree", "definition": "An institution of higher education created to educate and grant degrees; often a part of a university.: At least a small amount or number of.: Or; used to connect words, phrases, or clauses representing alternatives; used to connect alternative terms for the same thing; used in correlation; used to correct or rephrase what was previously said; otherwise.: A degree granted by a two-year college on successful completion of the undergraduates course of studies." } ] } }, { "resourceType": "ValueSet", "id": "d1e12384-vs", "status": "active", "codeSystem": { "system": "http://nci.nih.gov/xml/owl/cadsr/form/form_design_identifier/2674812v4.0/question_identifier#3702952v4.0-cs", "caseSensitive": true, "concept": [ { "code": "Other country", "display": "Other country", "definition": "Other country of birth." }, { "code": "Other country, specify", "display": "OTHER COUNTRY, SPECIFY", "definition": "OTHER COUNTRY, SPECIFY" }, { "code": "USA", "display": "USA", "definition": "USA" }, { "code": "USA, specify the 2 letter State code, eg NY", "display": "USA, SPECIFY THE 2 LETTER STATE CODE, EG NY", "definition": "USA, SPECIFY THE 2 LETTER STATE CODE, EG NY" } ] } }, { "resourceType": "ValueSet", "id": "d1e12630-vs", "status": "active", "codeSystem": { "system": "http://nci.nih.gov/xml/owl/cadsr/form/form_design_identifier/2674812v4.0/question_identifier#3702957v4.0-cs", "caseSensitive": true, "concept": [ { "code": "10th Grade", "display": "10th Grade", "definition": "Indicates that 10th grade is the highest level of educational achievement" }, { "code": "11th Grade", "display": "11th Grade", "definition": "Indicates that 11th grade is the highest level of educational achievement" }, { "code": "12th Grade No Diploma", "display": "12th Grade", "definition": "Indicates that a person was in school through 12th grade but that they did not receive a high school diploma." }, { "code": "1st Grade", "display": "1st Grade", "definition": "Indicates that 1st grade is the highest level of educational achievement." }, { "code": "2nd Grade", "display": "2nd Grade", "definition": "Indicates that 2nd grade is the highest level of educational achievement." }, { "code": "3rd Grade", "display": "3rd Grade", "definition": "Indicates that 3rd grade is the highest level of educational achievement." }, { "code": "4th Grade", "display": "4th Grade", "definition": "Indicates that 4th grade is the highest level of educational achievement." }, { "code": "5th Grade", "display": "5th Grade", "definition": "Indicates that 5th grade is the highest level of educational achievement." }, { "code": "6th Grade", "display": "6th Grade", "definition": "Indicates that 6th grade is the highest level of educational achievement." }, { "code": "7th Grade", "display": "7th Grade", "definition": "Indicates that 7th grade is the highest level of educational achievement" }, { "code": "8th Grade", "display": "8th Grade", "definition": "Indicates that 8th grade is the highest level of educational achievement" }, { "code": "9th Grade", "display": "9th Grade", "definition": "Indicates that 9th grade is the highest level of educational achievement" }, { "code": "Academic Doctorate Degree", "display": "Academic Doctorate Degree Completion", "definition": "Indicates that a person has received a degree the highest award earned for graduate study." }, { "code": "Associate Degree", "display": "Associate Degree", "definition": "Indicates that a person has received a degree from a 2 year college program." }, { "code": "Bachelor Degree", "display": "Bachelor's Degree Completion", "definition": "Indicates that a person has received a degree for successful completion of a program of studies that normally requires at least 4-5 years of full-time equivalent college-level work." }, { "code": "Don't Know", "display": "Does Not Know", "definition": "The answer is not known by the person answering." }, { "code": "General Equivalency Diploma", "display": "General Equivalency Diploma", "definition": "Indicates that a person has received a General Equivalency Diploma in lieu of a high school diploma." }, { "code": "High School Graduate", "display": "High School Graduate", "definition": "Indicates that a person has attended high school and has received a high school diploma." }, { "code": "Kindergarten", "display": "Kindergarten Completion", "definition": "Indicates that kindergarten is the highest level of education achievement." }, { "code": "Master's Degree", "display": "Master's Degree Completion", "definition": "Indicates that a person has received a degree for completion of at least one year of prescribed study beyond the bachelor's degree." }, { "code": "No Formal Schooling", "display": "Never Attended", "definition": "Indicates that a person never attended school or only attended kindergarten." }, { "code": "Preschool", "display": "Preschool Completion", "definition": "Indicates that preschool is the highest level of education achievement." }, { "code": "Professional Doctorate Degree", "display": "Professional Doctorate Degree Completion", "definition": "Indicates that a person has received a degree allowing them to practice a profession, such as law, medicine, music, or ministry." }, { "code": "Refused", "display": "Refuse", "definition": "To decline to do, accept, give, or allow something." }, { "code": "Some College, No Degree", "display": "Some College", "definition": "Indicates that a person has attended college but that they did not receive any degree." }, { "code": "VoTech Program", "display": "Vocational Degree", "definition": "Indicates that a person has received a degree from a occupational, technical, or vocational program." } ] } }, { "resourceType": "ValueSet", "id": "d1e14027-vs", "status": "active", "codeSystem": { "system": "http://nci.nih.gov/xml/owl/cadsr/form/form_design_identifier/2674812v4.0/question_identifier#3702985v4.0-cs", "caseSensitive": true, "concept": [ { "code": "Divorced", "display": "Divorced: C51776", "definition": "A person whose marriage has been legally dissolved and has not remarried." }, { "code": "Domestic Partnership", "display": "Domestic Partner", "definition": "A person who is a member of an unmarried couple, including same sex couples, living together in longstanding relationships, that are registered or unregistered." }, { "code": "Married", "display": "Married: C51773", "definition": "A person currently joined in matrimony. Classify common law marriage as married. Includes married couples living together and not living together." }, { "code": "Never Married", "display": "Never married", "definition": "A person who has never been married or whose only marriages have been annulled." }, { "code": "Separated", "display": "SEPARATED", "definition": "A person living apart from his/her spouse by legal arrangement." }, { "code": "Widowed", "display": "WIDOWED", "definition": "A person who is no longer married because of the death of his/her spouse and who has not remarried." } ] } } ], "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-category", "valueCodeableConcept": { "coding": [ { "code": "CRF" } ] } }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-category", "valueCodeableConcept": { "coding": [ { "code": "Demographic" } ] } } ], "identifier": [ { "system": "http://nci.nih.gov/xml/owl/cadsr/form/form_design_identifier", "value": "2674812v4.0/" } ], "status": "published", "date": "2013-03-22", "publisher": "National Cancer Institute (NCI)", "group": { "linkId": "root", "title": "Demography NCI Standard Template", "required": true, "group": [ { "linkId": "3702891v4.0", "title": "Mandatory Demography Questions", "text": "These items must be included when this data is collected for reporting", "required": true, "question": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/minLength", "valueInteger": 4 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxLength", "valueInteger": 13 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-deReference", "valueReference": { "reference": "http://nci.nih.gov/xml/owl/cadsr/data_element_scoped_identifier#2200604v3.0" } } ], "linkId": "3702892v4.0", "text": "Gender", "type": "open-choice", "options": { "reference": "#d1e9892-vs" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/minLength", "valueInteger": 5 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxLength", "valueInteger": 41 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-deReference", "valueReference": { "reference": "http://nci.nih.gov/xml/owl/cadsr/data_element_scoped_identifier#2192199v1.0" } } ], "linkId": "3702904v4.0", "text": "Race", "type": "open-choice", "options": { "reference": "#d1e10146-vs" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-deReference", "valueReference": { "reference": "http://nci.nih.gov/xml/owl/cadsr/data_element_scoped_identifier#793v5.1" } } ], "linkId": "3702903v4.0", "text": "Patient's Date of Birth", "type": "string" }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/minLength", "valueInteger": 7 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxLength", "valueInteger": 22 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-deReference", "valueReference": { "reference": "http://nci.nih.gov/xml/owl/cadsr/data_element_scoped_identifier#2192217v2.0" } } ], "linkId": "3702898v4.0", "text": "Ethnicity", "type": "open-choice", "options": { "reference": "#d1e10593-vs" } } ] }, { "linkId": "3702912v4.0", "title": "Conditional Demography Questions", "text": "There are business rules to indicate situations under which these elements should be used on a case report form.", "question": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxLength", "valueInteger": 15 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-deReference", "valueReference": { "reference": "http://nci.nih.gov/xml/owl/cadsr/data_element_scoped_identifier#2179606v2.0" } } ], "linkId": "3702914v4.0", "text": "ZIP Code", "type": "string" }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxLength", "valueInteger": 50 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-deReference", "valueReference": { "reference": "http://nci.nih.gov/xml/owl/cadsr/data_element_scoped_identifier#2865130v1.0" } } ], "linkId": "3702916v4.0", "text": "Payment Method", "type": "open-choice", "options": { "reference": "#d1e10923-vs" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxLength", "valueInteger": 75 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-deReference", "valueReference": { "reference": "http://nci.nih.gov/xml/owl/cadsr/data_element_scoped_identifier#315v4.0" } } ], "linkId": "3702932v4.0", "text": "Country of Residence", "type": "string" }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-deReference", "valueReference": { "reference": "http://nci.nih.gov/xml/owl/cadsr/data_element_scoped_identifier#2003745v5.0" } } ], "linkId": "3702934v4.0", "text": "Date Completed", "type": "string" }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxLength", "valueInteger": 6 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-deReference", "valueReference": { "reference": "http://nci.nih.gov/xml/owl/cadsr/data_element_scoped_identifier#2200286v1.0" } } ], "linkId": "3702936v4.0", "text": "CDC Race Code", "type": "string" }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxLength", "valueInteger": 6 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-deReference", "valueReference": { "reference": "http://nci.nih.gov/xml/owl/cadsr/data_element_scoped_identifier#2200284v2.0" } } ], "linkId": "3702938v4.0", "text": "CDC Ethnicity Code", "type": "string" } ] }, { "linkId": "3702940v4.0", "title": "Optional Demography Questions", "text": "There is no requirement for inclusion of these elements on the case report form. If the design and scientific questions posed in the study dictate the need to collect this type of data, these elements should be included.", "question": [ { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxLength", "valueInteger": 44 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-deReference", "valueReference": { "reference": "http://nci.nih.gov/xml/owl/cadsr/data_element_scoped_identifier#2681552v1.0" } } ], "linkId": "3702942v4.0", "text": "Highest Education Level", "type": "open-choice", "options": { "reference": "#d1e11887-vs" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxLength", "valueInteger": 55 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-deReference", "valueReference": { "reference": "http://nci.nih.gov/xml/owl/cadsr/data_element_scoped_identifier#2001708v5.0" } } ], "linkId": "3702952v4.0", "text": "Country of Birth", "type": "open-choice", "options": { "reference": "#d1e12384-vs" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxLength", "valueInteger": 50 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-deReference", "valueReference": { "reference": "http://nci.nih.gov/xml/owl/cadsr/data_element_scoped_identifier#2674076v2.0" } } ], "linkId": "3702957v4.0", "text": "Highest Education Level", "type": "open-choice", "options": { "reference": "#d1e12630-vs" } }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxLength", "valueInteger": 6 }, { "url": "http://hl7.org/fhir/StructureDefinition/entryFormat", "valueString": "9999.99" }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-deReference", "valueReference": { "reference": "http://nci.nih.gov/xml/owl/cadsr/data_element_scoped_identifier#2943243v1.0" } } ], "linkId": "3702984v4.0", "text": "Census Tract Code at Enrollment", "type": "string" }, { "extension": [ { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-maxLength", "valueInteger": 25 }, { "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-deReference", "valueReference": { "reference": "http://nci.nih.gov/xml/owl/cadsr/data_element_scoped_identifier#2188083v2.0" } } ], "linkId": "3702985v4.0", "text": "Marital Status", "type": "open-choice", "options": { "reference": "#d1e14027-vs" } } ] } ] } }