qgenericdemographicsschema
type: Questionnaire
node role: treeRoot
id:
  v: qgenericdemographicsschema
text:
  status:
    v: generated
  div: Structure LinkID Text Cardinality Type Description & Constraints<img src="[binary]" alt="doco" style="background-color: inherit"/> Questionnaire https://kind-lab.github.io/vbai-fhir/Questionnaire-qgenericdemographicsschema#2.2.0 demographics_session_id Questionnaire - Metadata: Session ID 0..1 string demographics_started_at Questionnaire Started At 0..1 string demographics_completed_at Questionnaire Completed At 0..1 string demographics_duration Questionnaire Duration (seconds) 0..1 string demographics_completed_by Who is completing this survey? 0..1 string city Address Information: City 0..1 string state_province State/Province 0..1 string zipcode Zipcode 0..1 string country Country 0..1 choice Options: 2 options gender_identity Patient Demographics: What is your gender identity? 0..1 choice Options: 5 options other_gender_identity If you selected "other" for gender identity, please specify: 0..1 string Enable When: gender_identity = 'other' specify_gender_identity Please specify gender identity 0..1 choice Enable When: gender_identity = 'female' gender_identity = 'male' Options: 2 options sexual_orientation What is your sexual orientation? 0..1 choice Options: 5 options other_sex_orientation If you selected "other" for sexual orientation, please specify: 0..1 string Enable When: sexual_orientation = 'other' race Which race category best describes you? Choose all that apply 0..1 string native_american_race American Indian or Alaska Native 0..1 string Enable When: race = 1 asian_race Asian 0..1 string Enable When: race = 2 black_race Black or African American 0..1 string Enable When: race = 3 pacific_islander_race Native Hawaiian or other Pacific Islander 0..1 string Enable When: race = 4 white_race White 0..1 string Enable When: race = 5 canadian_race Canadian Indigenous or Aboriginal 0..1 string Enable When: race = 6 other_race_specify If race not listed above, please specify: 0..1 string Enable When: race = 7 ethnicity What is your ethnic or cultural origin? 0..1…
url:
  v: https://kind-lab.github.io/vbai-fhir/Questionnaire-qgenericdemographicsschema
version:
  v: 2.2.0
title:
  v: q_generic_demographics_schema
status:
  v: active
date:
  v: 2024-05-29T18:29:27Z
publisher:
  v: KinD Lab
contact:
  name:
    v: KinD Lab
  telecom:
    system:
      v: url
    value:
      v: http://fhir.kindlab.sickkids.ca
item:
  link id:
    v: demographics_session_id
  text:
    v: Questionnaire - Metadata: Session ID
  type:
    v: string
item:
  link id:
    v: demographics_started_at
  text:
    v: Questionnaire Started At
  type:
    v: string
item:
  link id:
    v: demographics_completed_at
  text:
    v: Questionnaire Completed At
  type:
    v: string
item:
  link id:
    v: demographics_duration
  text:
    v: Questionnaire Duration (seconds)
  type:
    v: string
item:
  link id:
    v: demographics_completed_by
  text:
    v: Who is completing this survey?
  type:
    v: string
item:
  link id:
    v: city
  text:
    v: Address Information: City
  type:
    v: string
item:
  link id:
    v: state_province
  text:
    v: State/Province
  type:
    v: string
item:
  link id:
    v: zipcode
  text:
    v: Zipcode
  type:
    v: string
item:
  link id:
    v: country
  text:
    v: Country
  type:
    v: choice
  answer option:
    value:
      v: USA
  answer option:
    value:
      v: Canada
item:
  link id:
    v: gender_identity
  text:
    v: Patient Demographics: What is your gender identity?
  type:
    v: choice
  answer option:
    value:
      v: Female gender identity
  answer option:
    value:
      v: Male gender identity
  answer option:
    value:
      v: Non-binary or genderqueer gender identity
  answer option:
    value:
      v: Other
  answer option:
    value:
      v: Prefer not to answer
item:
  link id:
    v: other_gender_identity
  text:
    v: If you selected "other" for gender identity, please specify:
  type:
    v: string
  enable when:
    question:
      v: gender_identity
    operator:
      v: =
    answer:
      v: 'other'
item:
  link id:
    v: specify_gender_identity
  text:
    v: Please specify gender identity
  type:
    v: choice
  enable when:
    question:
      v: gender_identity
    operator:
      v: =
    answer:
      v: 'female'
  enable when:
    question:
      v: gender_identity
    operator:
      v: =
    answer:
      v: 'male'
  enable behavior:
    v: any
  answer option:
    value:
      v: Cis: same gender as the sex assigned at birth
  answer option:
    value:
      v: Trans
item:
  link id:
    v: sexual_orientation
  text:
    v: What is your sexual orientation?
  type:
    v: choice
  answer option:
    value:
      v: Bisexual
  answer option:
    value:
      v: Heterosexual
  answer option:
    value:
      v: Homosexual
  answer option:
    value:
      v: Other (Please specify)
  answer option:
    value:
      v: Prefer not to answer
item:
  link id:
    v: other_sex_orientation
  text:
    v: If you selected "other" for sexual orientation, please specify:
  type:
    v: string
  enable when:
    question:
      v: sexual_orientation
    operator:
      v: =
    answer:
      v: 'other'
item:
  link id:
    v: race

v: Which race category best describes you? Choose all that apply

v: string

link id:
  v: native_american_race
text:
  v: American Indian or Alaska Native
type:
  v: string
enable when:
  question:
    v: race
  operator:
    v: =
  answer:
    v: 1

link id:
  v: asian_race
text:
  v: Asian
type:
  v: string
enable when:
  question:
    v: race
  operator:
    v: =
  answer:
    v: 2

link id:
  v: black_race
text:
  v: Black or African American
type:
  v: string
enable when:
  question:
    v: race
  operator:
    v: =
  answer:
    v: 3

link id:
  v: pacific_islander_race
text:
  v: Native Hawaiian or other Pacific Islander
type:
  v: string
enable when:
  question:
    v: race
  operator:
    v: =
  answer:
    v: 4

link id:
  v: white_race
text:
  v: White
type:
  v: string
enable when:
  question:
    v: race
  operator:
    v: =
  answer:
    v: 5

link id:
  v: canadian_race
text:
  v: Canadian Indigenous or Aboriginal
type:
  v: string
enable when:
  question:
    v: race
  operator:
    v: =
  answer:
    v: 6

link id:
  v: other_race_specify
text:
  v: If race not listed above, please specify:
type:
  v: string
enable when:
  question:
    v: race
  operator:
    v: =
  answer:
    v: 7

link id:
  v: ethnicity
text:
  v: What is your ethnic or cultural origin?
type:
  v: choice
answer option:
  value:
    v: Hispanic or Latino
answer option:
  value:
    v: Not Hispanic or Latino
answer option:
  value:
    v: Prefer not to answer

link id:
  v: hispanic_latino_selection
text:
  v: Check all that apply
type:
  v: string
enable when:
  question:
    v: ethnicity
  operator:
    v: =
  answer:
    v: 'yes'

link id:
  v: edu_level
text:
  v: Education: What is your highest level of education?
type:
  v: choice
answer option:
  value:
    v: No formal education
answer option:
  value:
    v: Some elementary school
answer option:
  value:
    v: Some secondary or high school education
answer option:
  value:
    v: High School or secondary school degree complete
answer option:
  value:
    v: Some college education
answer option:
  value:
    v: Associate's or technical degree complete
answer option:
  value:
    v: College or baccalaureate degree complete
answer option:
  value:
    v: Some post-baccalaureate education
answer option:
  value:
    v: Graduate or professional degree complete
answer option:
  value:
    v: Doctoral or post graduate education
answer option:
  value:
    v: Other
answer option:
  value:
    v: Prefer not to answer

link id:
  v: other_edu_level
text:
  v: If you selected "other" level of education, please specify:
type:
  v: string
enable when:
  question:
    v: edu_level
  operator:
    v: =
  answer:
    v: '11'

link id:
  v: hearing
text:
  v: Disability Questions: Are you deaf or do you have serious difficulty hearing?
type:
  v: choice
answer option:
  value:
    v: No
answer option:
  value:
    v: Yes
answer option:
  value:
    v: Prefer not to answer

link id:
  v: vision
text:
  v: Are you blind or do you have serious difficulty seeing, even when wearing glasses?
type:
  v: choice
answer option:
  value:
    v: No
answer option:
  value:
    v: Yes
answer option:
  value:
    v: Prefer not to answer

link id:
  v: cognition
text:
  v: Because of a physical, mental, or emotional condition, do you have serious difficulty concentrating, remembering, or making decisions?
type:
  v: choice
answer option:
  value:
    v: No
answer option:
  value:
    v: Yes
answer option:
  value:
    v: Prefer not to answer

link id:
  v: mobility
text:
  v: Do you have serious difficulty walking or climbing stairs?
type:
  v: choice
answer option:
  value:
    v: No
answer option:
  value:
    v: Yes
answer option:
  value:
    v: Prefer not to answer

link id:
  v: self_care
text:
  v: Do you have difficulty dressing or bathing?
type:
  v: choice
answer option:
  value:
    v: No
answer option:
  value:
    v: Yes
answer option:
  value:
    v: Prefer not to answer

link id:
  v: independent_living
text:
  v: Because of a physical, mental, or emotional condition, do you have difficulty doing errands alone such as visiting a doctor's office or shopping?
type:
  v: choice
answer option:
  value:
    v: No
answer option:
  value:
    v: Yes
answer option:
  value:
    v: Prefer not to answer

link id:
  v: employ_status
text:
  v: Employment Status: What is your employment status? Choose all that apply
type:
  v: string

link id:
  v: other_employ_specify
text:
  v: If you selected "other" employment status, please specify.
type:
  v: string
enable when:
  question:
    v: employ_status
  operator:
    v: =
  answer:
    v: 9

link id:
  v: occupation
text:
  v: What is your occupation?
type:
  v: string

link id:
  v: veteran
text:
  v: Are you a veteran?
type:
  v: choice
answer option:
  value:
    v: Yes
answer option:
  value:
    v: No

link id:
  v: household_income_usa
text:
  v: Demographics - Optional: What was your total household income last year (USD)? Please include all sources of income, including pensions, dividends, alimony, child support, etc.
type:
  v: choice
enable when:
  question:
    v: country
  operator:
    v: =
  answer:
    v: '1'
answer option:
  value:
    v: < $15,000
answer option:
  value:
    v: $15,000 to $29,999
answer option:
  value:
    v: $30,000 to $$49,999
answer option:
  value:
    v: $50,000 to $99,999
answer option:
  value:
    v: $100,000 to $149,999
answer option:
  value:
    v: $150,000 to $199,999
answer option:
  value:
    v: $200,000 to $249,999
answer option:
  value:
    v: >$250,000
answer option:
  value:
    v: Prefer not to answer

link id:
  v: financial_assistance_usa
text:
  v: Do you receive a significant portion (>20%) of your income through federally-funded income assistance programs? Some examples of these programs are listed in the question below.
type:
  v: choice
enable when:
  question:
    v: country
  operator:
    v: =
  answer:
    v: '1'
answer option:
  value:
    v: No
answer option:
  value:
    v: Yes
answer option:
  value:
    v: Prefer not to answer

link id:
  v: assistance_programs_usa
text:
  v: Do you take advantage of any of the following programs? Choose all that apply
type:
  v: string
enable when:
  question:
    v: country
  operator:
    v: =
  answer:
    v: '1'

link id:
  v: household_income_ca
text:
  v: What was your total household income last year (CAD)? Please include all sources of income, including pensions, dividends, alimony, child support, etc.
type:
  v: choice
enable when:
  question:
    v: country
  operator:
    v: =
  answer:
    v: '2'
answer option:
  value:
    v: < $15,000
answer option:
  value:
    v: $15,000 to $29,999
answer option:
  value:
    v: $30,000 to $$49,999
answer option:
  value:
    v: $50,000 to $99,999
answer option:
  value:
    v: $100,000 to $149,999
answer option:
  value:
    v: $150,000 to $199,999
answer option:
  value:
    v: $200,000 to $249,999
answer option:
  value:
    v: >$250,000
answer option:
  value:
    v: Prefer not to answer

link id:
  v: financial_assistance_ca
text:
  v: Do you receive a significant portion (>20%) of your income through federally-funded income assistance programs? Some examples of these programs are listed below.
type:
  v: choice
enable when:
  question:
    v: country
  operator:
    v: =
  answer:
    v: '2'
answer option:
  value:
    v: No
answer option:
  value:
    v: Yes
answer option:
  value:
    v: Prefer not to answer

link id:
  v: assistance_programs_ca
text:
  v: Do you take advantage of any of the following programs? Choose all that apply
type:
  v: string
enable when:
  question:
    v: country
  operator:
    v: =
  answer:
    v: '2'

link id:
  v: citizen
text:
  v: Citizenship: Citizen
type:
  v: choice
answer option:
  value:
    v: Citizen
answer option:
  value:
    v: Permanent resident (Green card holder)
answer option:
  value:
    v: Non-citizen US/Canadian national
answer option:
  value:
    v: Refugee
answer option:
  value:
    v: Asylum seeker
answer option:
  value:
    v: Non-immigrant student
answer option:
  value:
    v: Non-immigrant worker
answer option:
  value:
    v: Prefer not to answer

link id:
  v: marital_status
text:
  v: What is your marital status? Choose all that apply
type:
  v: string

link id:
  v: housing_status
text:
  v: What is your current housing status?
type:
  v: choice
answer option:
  value:
    v: Assisted living
answer option:
  value:
    v: Own home
answer option:
  value:
    v: Rent home
answer option:
  value:
    v: Skilled nursing facility/nursing home
answer option:
  value:
    v: Unhoused-temporarily
answer option:
  value:
    v: Unhoused-permanently

link id:
  v: household_count
text:
  v: How many people live in your household?Please specify a number
type:
  v: string

link id:
  v: spouse_partner_sig_other
text:
  v: Who lives with you? Choose all that apply: Spouse/partner/significant other
type:
  v: choice
enable when:
  question:
    v: household_count
  operator:
    v: >
  answer:
    v: 0
answer option:
  value:
    v: Yes
answer option:
  value:
    v: No

link id:
  v: children
text:
  v: One or more children
type:
  v: choice
enable when:
  question:
    v: household_count
  operator:
    v: >
  answer:
    v: 0
answer option:
  value:
    v: Yes
answer option:
  value:
    v: No

link id:
  v: parent
text:
  v: One or more parent
type:
  v: choice
enable when:
  question:
    v: household_count
  operator:
    v: >
  answer:
    v: 0
answer option:
  value:
    v: Yes
answer option:
  value:
    v: No

link id:
  v: grandparent
text:
  v: One or more grandparent
type:
  v: choice
enable when:
  question:
    v: household_count
  operator:
    v: >
  answer:
    v: 0
answer option:
  value:
    v: Yes
answer option:
  value:
    v: No

link id:
  v: other_live_with
text:
  v: Other
type:
  v: choice
enable when:
  question:
    v: household_count
  operator:
    v: >
  answer:
    v: 0
answer option:
  value:
    v: Yes
answer option:
  value:
    v: No

link id:
  v: others_household_specify
text:
  v: If "others" live in your household, please specify:
type:
  v: string
enable when:
  question:
    v: other_live_with
  operator:
    v: =
  answer:
    v: '1'

link id:
  v: transportation_yn
text:
  v: Do you have a reliable mode of transportation?
type:
  v: choice
answer option:
  value:
    v: Yes
answer option:
  value:
    v: No

link id:
  v: primary_transportation
text:
  v: What is your primary mode of transportation?
type:
  v: choice
enable when:
  question:
    v: transportation_yn
  operator:
    v: =
  answer:
    v: '1'
answer option:
  value:
    v: Personal vehicle
answer option:
  value:
    v: Shared vehicle
answer option:
  value:
    v: Public transportation
answer option:
  value:
    v: Ride with someone else
answer option:
  value:
    v: Ride service
answer option:
  value:
    v: Bicycle/Motorbike
answer option:
  value:
    v: Walking
answer option:
  value:
    v: Other (Please specify)

link id:
  v: other_transportation
text:
  v: If you selected "other" transportation, please specify.
type:
  v: string
enable when:
  question:
    v: primary_transportation
  operator:
    v: =
  answer:
    v: '8'