Version 2.78

103935-3 Are you in a committed relationship?

Fully-Specified Name

Component
Are you in a committed relationship
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Basic Attributes

Class
SURVEY.COVID
Type
Surveys
First Released
Version 2.77
Last Updated
Version 2.77
Order vs. Observation
Observation

Survey Question

Text
Are you in a committed relationship?

Normative Answer List LL6496-5

Answer Code Score Answer ID
Yes Copyright http://snomed.info/sct ID:373066001 Yes (qualifier value) 1 LA33-6
No Copyright http://snomed.info/sct ID:373067005 No (qualifier value) 2 LA32-8

Member of these Panels

LOINC Long Common Name
104104-5 Mental Health Household Members panel

103936-1 If you selected 'Yes' in question 1, which household type do you live in?

Observation ID in Form

5.2

Fully-Specified Name

Component
Which household type do you live in
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Basic Attributes

Class
SURVEY.COVID
Type
Surveys
First Released
Version 2.77
Last Updated
Version 2.77
Order vs. Observation
Observation

Survey Question

Text
If you selected 'Yes' in question 1, which household type do you live in?

Normative Answer List LL6388-4

Answer Code Score Answer ID
the same household 1 LA33820-4
2. in a different household 2 LA33821-2
3. partly in the same household 3 LA33822-0

Member of these Panels

LOINC Long Common Name
104104-5 Mental Health Household Members panel

103937-9 If you selected 'Yes' in question 1, what would you say how is the mental health of your partner?

Reference Information

Type Source Reference
Form Context Charite - Universitatsmedizin Berlin Note: Mental health commonly is a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community

Observation ID in Form

5.3

Fully-Specified Name

Component
What would you say how is the mental health of your partner is
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Basic Attributes

Class
SURVEY.COVID
Type
Surveys
First Released
Version 2.77
Last Updated
Version 2.77
Order vs. Observation
Observation

Survey Question

Text
If you selected 'Yes' in question 1, what would you say how is the mental health of your partner?
Source
Orchestra

Normative Answer List LL6389-2

Answer Code Score Answer ID
1 - Excellent LA21636-8
2. very good LA33824-6
3 - good LA33825-3
4 - fair LA33826-1
5 - poor LA33827-9
6 - not applicable LA33828-7

Member of these Panels

LOINC Long Common Name
104104-5 Mental Health Household Members panel

103938-7 If you selected 'Yes' in question 1, what would you say is the quality of your partnership?

Observation ID in Form

5.4

Fully-Specified Name

Component
What would you say is the quality of your partnership
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Basic Attributes

Class
SURVEY.COVID
Type
Surveys
First Released
Version 2.77
Last Updated
Version 2.77
Order vs. Observation
Observation

Survey Question

Text
If you selected 'Yes' in question 1, what would you say is the quality of your partnership?

Normative Answer List LL6389-2

Answer Code Score Answer ID
1 - Excellent LA21636-8
2. very good LA33824-6
3 - good LA33825-3
4 - fair LA33826-1
5 - poor LA33827-9
6 - not applicable LA33828-7

Member of these Panels

LOINC Long Common Name
104104-5 Mental Health Household Members panel

103939-5 Do you have underage persons in your household?

Fully-Specified Name

Component
Do you have underage persons in your household
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Basic Attributes

Class
SURVEY.COVID
Type
Surveys
First Released
Version 2.77
Last Updated
Version 2.77
Order vs. Observation
Observation

Survey Question

Text
Do you have underage persons in your household?

Normative Answer List LL6496-5

Answer Code Score Answer ID
Yes Copyright http://snomed.info/sct ID:373066001 Yes (qualifier value) 1 LA33-6
No Copyright http://snomed.info/sct ID:373067005 No (qualifier value) 2 LA32-8

Member of these Panels

LOINC Long Common Name
104104-5 Mental Health Household Members panel

104078-1 If you selected 'Yes' in question 5, what is the number of underage persons?

Fully-Specified Name

Component
Number of underage persons in household
Property
Num
Time
Pt
System
^Patient
Scale
Qn
Method

Basic Attributes

Class
SURVEY.COVID
Type
Surveys
First Released
Version 2.77
Last Updated
Version 2.78
Order vs. Observation
Observation

Survey Question

Text
If you selected 'Yes' in question 1, what is the number of underage persons?

Member of these Panels

LOINC Long Common Name
104084-9 Children and work family balance panel
104104-5 Mental Health Household Members panel

Example Units

Unit Source
{#} Example UCUM Units

103941-1 If you selected 'Yes' in question 5, for each underage person. What would you say how is the mental health of underage person?

Fully-Specified Name

Component
For each underage person what would you say how is the mental health of underage person
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Basic Attributes

Class
SURVEY.COVID
Type
Surveys
First Released
Version 2.77
Last Updated
Version 2.77
Order vs. Observation
Observation

Survey Question

Text
If you selected 'Yes' in question 5, for each underage person. What would you say how is the mental health of underage person?

Normative Answer List LL6389-2

Answer Code Score Answer ID
1 - Excellent LA21636-8
2. very good LA33824-6
3 - good LA33825-3
4 - fair LA33826-1
5 - poor LA33827-9
6 - not applicable LA33828-7

Member of these Panels

LOINC Long Common Name
104104-5 Mental Health Household Members panel

103942-9 Do you have comments?

Fully-Specified Name

Component
Mental health of household members comments
Property
Imp
Time
Pt
System
^Patient
Scale
Nar
Method

Basic Attributes

Class
SURVEY.COVID
Type
Surveys
First Released
Version 2.77
Last Updated
Version 2.77
Order vs. Observation
Observation

Survey Question

Text
Do you have comments?

Member of these Panels

LOINC Long Common Name
104104-5 Mental Health Household Members panel