Form Context

We are interested in how people's lives changed during the pandemic up to now

Source: Charite - Universitatsmedizin Berlin

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

Long Common Name

Are you in a committed relationship

Basic Attributes

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

Normative Answer List LL6496-5

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

Member of these Panels

LOINCLong Common Name
104104-5Mental 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

Long Common Name

Which household type do you live in

Basic Attributes

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

Normative Answer List LL6388-4

AnswerCodeScoreAnswer ID
the same household

Same household

1LA33820-4
2. in a different household

In a different household

2LA33821-2
3. partly in the same household

Partly in the same household

3LA33822-0

Member of these Panels

LOINCLong Common Name
104104-5Mental 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?

Observation ID in Form

5.3

Form Context

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

Source: Charite - Universitatsmedizin Berlin

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

Long Common Name

What would you say how is the mental health of your partner is

Basic Attributes

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

Normative Answer List LL6389-2

AnswerCodeScoreAnswer ID
1 - ExcellentLA21636-8
2. very good

2 - very good

LA33824-6
3 - goodLA33825-3
4 - fairLA33826-1
5 - poorLA33827-9
6 - not applicableLA33828-7

Member of these Panels

LOINCLong Common Name
104104-5Mental 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

Long Common Name

What would you say is the quality of your partnership

Basic Attributes

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

Normative Answer List LL6389-2

AnswerCodeScoreAnswer ID
1 - ExcellentLA21636-8
2. very good

2 - very good

LA33824-6
3 - goodLA33825-3
4 - fairLA33826-1
5 - poorLA33827-9
6 - not applicableLA33828-7

Member of these Panels

LOINCLong Common Name
104104-5Mental 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

Long Common Name

Do you have underage persons in your household

Basic Attributes

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

Normative Answer List LL6496-5

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

Member of these Panels

LOINCLong Common Name
115559-7Children and work family balance
104104-5Mental 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

Long Common Name

Number of underage persons in household

Basic Attributes

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

Member of these Panels

LOINCLong Common Name
115559-7Children and work family balance
104084-9Children and work family balance panel
104104-5Mental Health Household Members panel

Example Units

UnitSource
{#}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

Long Common Name

For each underage person what would you say how is the mental health of underage person

Basic Attributes

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

Normative Answer List LL6389-2

AnswerCodeScoreAnswer ID
1 - ExcellentLA21636-8
2. very good

2 - very good

LA33824-6
3 - goodLA33825-3
4 - fairLA33826-1
5 - poorLA33827-9
6 - not applicableLA33828-7

Member of these Panels

LOINCLong Common Name
104104-5Mental 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

Long Common Name

Mental health of household members comments

Basic Attributes

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

Member of these Panels

LOINCLong Common Name
104104-5Mental Health Household Members panel