---
tags: USCDI v3
title: US Core Screenings and Assessments Examples
---

# US Core Screenings and Assessments Examples

These Examples are intended to demonstrate how both FHIR *Questionnaire and *US Core Screening and Assessment Observations* can be used to represent clinical screening tools and assessments in a structured and interoperable way.

- The "clinical judgement" Observation/Condition is out of scope for this sprint

1. Generate a FHIR Questionnaire
- No preconditions or assumptions regarding user presentation
- Standard Assessments will have LOINC codes assigned. (Customer defined forms/questionnaires may not, but each question will still need to be accessible in FHIR Questionnaire + Observation with an internal identifier/code)
<!-- 1. Generate a FHIR QuestionnaireResponse from Questionnaire
- When QuestionnaireResponse SHALL be used:
- If you are assuming user presentation, than Q/QR is a must
- If you are responding to a Data Consumer's Questionnaire (in other words - a form) and sharing the response to the form with the Data Consumer.
- Adaptive questionnaires
- Future Psychometric instruments?
- Unable to represent the Questionnaire's structure using a set of nested Observations becuase if the Questionniare's complexity (enableWhen, repeating questions, etc). (We think this is a corner case)
- When QuestionnaireResponse MAY be used:
- Anytime you have a Questionnaire
- Retrieval of QuestionnaireResponse with with pointer to that Questionnaire
1. Generate a set of FHIR Observations from the QuestionnaireResponse
- Option of using a StructureMap - not shown here or bespoke code to convert the *relevant* responses to *US Core Screening and Assessment Observations*.
- Retrieval of all relevant observations with pointer to that QuestionnaireResponse -->
2. Generate a set of FHIR Observations directly from the FHIR Questionnaire <!-- without an intermediary QuestionnaireResponse! -->
- Review using a *custom extension* to link an Observation to the FHIR Questionnaire source
- Demonstrate converting the *relevant* responses to *US Core Screening and Assessment Observations*.
3. Retrieval of relevant Observations with pointer to the FHIR Questionnaire
- Search by `patient` and `category`
- Search by `patient` and `code`

## [Example 1 PHQ-2](/hO6PsmoHTqycOZJ4tqhRbw)

The PHQ-2 is the ultra-brief depression measure (using first 2 items of PHQ-9) and ranges from 0-6. Most who use the short PHQ-2 use it for screening and not for monitoring depression

PHQ-2 is a simple questionnaire consisting of a panel of 3 items (2 questions and a score).

digraph hierarchy {

                nodesep=1.0 // increases the separation between nodes

                node [color=Red,fontname=Courier,shape=box] //All nodes will this shape and colour
                edge [color=Blue, style=dashed] //All the lines look like this

                "PHQ-2 Panel\n (LOINC 55757-9)"->{"Question 1\n (LOINC 44250-9)" "Question 2\n (LOINC 44255-8)" "Score\n (LOINC 55758-7)"} 
}

## [Example 2 Custom Form](/cx6xKg8hQGK1GosvccK1uA)

This Custom Form is a modified PHQ-2 with an extra custom question for demonstration purposes. Instead of standard LOINC codes it uses a *local code* for the panel and custom question.

digraph hierarchy {

                nodesep=1.0 // increases the separation between nodes

                node [color=Red,fontname=Courier,shape=box] //All nodes will this shape and colour
                edge [color=Blue, style=dashed] //All the lines look like this

                "My Customized PHQ-2 Panel\n (Local CUST-PNL)"->{"Question 1\n (LOINC 44250-9)" "Question 2\n (LOINC 44255-8)" "Score\n (LOINC 55758-7)" "My Custom Question\n (Local CUST-ITM)"} 
}

## [Example 3 AHC-HRSN](/Rmmv-rjWShKkXWLbnJ5KTA)

The Accountable Health Communities (AHC) Health-Related Social Needs (HRSN) Screening Tool is designed to assess the the health-related social needs of Medicare and Medicaid beneficiaries, in an effort to determine impact on health care costs and health outcomes. Five specific domains are addressed: housing instability, food insecurity, transportation problems, utility help needs, and interpersonal safety.

AHC-HRSN is a questionnaire consisting of a panel of 11 items (10 questions and a score) one of the questions is multiselect answer ("pick all that apply").

digraph hierarchy {

                nodesep=1.0 // increases the separation between nodes

                node [color=Red,fontname=Courier,shape=box] //All nodes will this shape and colour
                edge [color=Blue, style=dashed] //All the lines look like this

                "AHC-HRSN Panel\n (LOINC 96777-8)"->{"Question 1\n (LOINC 71802-3)" "Question 2\n (LOINC 96778-6)" "Questions 3-10...\n""Score\n (LOINC 95614-4)"} 
                "Question 2\n (LOINC 96778-6)"->{"Answer1\nMold","Answer2\nLead Paint", "Other Answers"}
}

## [Example 4 PRAPARE](/ePa5mdbpQyWNv1VhjTAMdg)

The Protocol for Responding to & Assessing Patients’ Assets, Risks & Experiences (PRAPARE) is designed to equip healthcare and their community partners to better understand and act on individuals’ social drivers of health (SDOH).

Prapare is a complex questionnaire consisting of a panel of 5 subpanel with several items each and several of the questions are multiselect answer ("pick all that apply").

digraph hierarchy {

                nodesep=1.0 // increases the separation between nodes

                node [color=Red,fontname=Courier,shape=box] //All nodes will this shape and colour
                edge [color=Blue, style=dashed] //All the lines look like this

                "PRAPARE Panel\n (LOINC 93025-5)"->{"Panel 1\n (LOINC 93043-8)" "Panel 2\n (LOINC 93042-0)" "Panels 3-5"} 

               "Panel 1\n (LOINC 93043-8)" -> {"Question 1\n (LOINC 56051-6)" "Question 2\n (LOINC 32624-9)" "Questions 3-5...\n"} 
                
                "Question 2\n (LOINC 32624-9)"->{"Answer1\nAsian","Answer2\nWhite", "Other Answers"}


"Panel 2\n (LOINC 93042-0)" -> {"Questions 1-4...\n"}

"Panels 3-5" -> {"Questions..."}

"Questions..." -> {"Multiple answer..."}

}