Form Context

When you were growing up, during your first 18 years of life:

Source: University of Denver

112475-9 Did you have at least one caregiver with whom you felt safe?

Observation ID in Form

Q1

Observation Required in Panel

Required

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
Did you have at least one caregiver with whom you felt safe
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Long Common Name

Did you have at least one caregiver with whom you felt safe

Basic Attributes

Class
SURVEY.SDOH
Type
Surveys
First Released
Version 2.82
Last Updated
Version 2.82 (ADD)
Order vs. Observation
Observation

Example Answer List LL5955-1

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)0LA32-8

Member of these Panels

LOINCLong Common Name
112464-3Benevolent Childhood Experiences Scale [BCEs Scale]

112474-2 Did you have at least one good friend?

Observation ID in Form

Q2

Observation Required in Panel

Required

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
Did you have at least one good friend
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Long Common Name

Did you have at least one good friend

Basic Attributes

Class
SURVEY.SDOH
Type
Surveys
First Released
Version 2.82
Last Updated
Version 2.82 (ADD)
Order vs. Observation
Observation

Example Answer List LL5955-1

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)0LA32-8

Member of these Panels

LOINCLong Common Name
112464-3Benevolent Childhood Experiences Scale [BCEs Scale]

112473-4 Did you have beliefs that gave you comfort?

Observation ID in Form

Q3

Observation Required in Panel

Required

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
Did you have beliefs that gave you comfort
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Long Common Name

Did you have beliefs that gave you comfort

Basic Attributes

Class
SURVEY.SDOH
Type
Surveys
First Released
Version 2.82
Last Updated
Version 2.82 (ADD)
Order vs. Observation
Observation

Example Answer List LL5955-1

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)0LA32-8

Member of these Panels

LOINCLong Common Name
112464-3Benevolent Childhood Experiences Scale [BCEs Scale]

112472-6 Did you like school?

Observation ID in Form

Q4

Observation Required in Panel

Required

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
Did you like school
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Long Common Name

Did you like school

Basic Attributes

Class
SURVEY.SDOH
Type
Surveys
First Released
Version 2.82
Last Updated
Version 2.82 (ADD)
Order vs. Observation
Observation

Example Answer List LL5955-1

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)0LA32-8

Member of these Panels

LOINCLong Common Name
112464-3Benevolent Childhood Experiences Scale [BCEs Scale]

112471-8 Did you have at least one teacher who cared about you?

Observation ID in Form

Q5

Observation Required in Panel

Required

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
Did you have at least one teacher who cared about you
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Long Common Name

Did you have at least one teacher who cared about you

Basic Attributes

Class
SURVEY.SDOH
Type
Surveys
First Released
Version 2.82
Last Updated
Version 2.82 (ADD)
Order vs. Observation
Observation

Example Answer List LL5955-1

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)0LA32-8

Member of these Panels

LOINCLong Common Name
112464-3Benevolent Childhood Experiences Scale [BCEs Scale]

112470-0 Did you have good neighbors?

Observation ID in Form

Q6

Observation Required in Panel

Required

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
Did you have good neighbors
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Long Common Name

Did you have good neighbors

Basic Attributes

Class
SURVEY.SDOH
Type
Surveys
First Released
Version 2.82
Last Updated
Version 2.82 (ADD)
Order vs. Observation
Observation

Example Answer List LL5955-1

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)0LA32-8

Member of these Panels

LOINCLong Common Name
112464-3Benevolent Childhood Experiences Scale [BCEs Scale]

112469-2 Was there an adult who could provide you with support or advice?

Observation ID in Form

Q7

Observation Required in Panel

Required

Type of Entry

Question expects user entry - requires response [Q]

Form Coding Instructions

not a parent/caregiver or the person from #1

Source: University of Denver

Fully-Specified Name

Component
Was there an adult who could provide you with support or advice
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Long Common Name

Was there an adult who could provide you with support or advice

Basic Attributes

Class
SURVEY.SDOH
Type
Surveys
First Released
Version 2.82
Last Updated
Version 2.82 (ADD)
Order vs. Observation
Observation

Example Answer List LL5955-1

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)0LA32-8

Member of these Panels

LOINCLong Common Name
112464-3Benevolent Childhood Experiences Scale [BCEs Scale]

112468-4 Did you have opportunities to have a good time?

Observation ID in Form

Q8

Observation Required in Panel

Required

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
Did you have opportunities to have a good time
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Long Common Name

Did you have opportunities to have a good time

Basic Attributes

Class
SURVEY.SDOH
Type
Surveys
First Released
Version 2.82
Last Updated
Version 2.82 (ADD)
Order vs. Observation
Observation

Example Answer List LL5955-1

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)0LA32-8

Member of these Panels

LOINCLong Common Name
112464-3Benevolent Childhood Experiences Scale [BCEs Scale]

112467-6 Did you like yourself or feel comfortable with yourself?

Observation ID in Form

Q9

Observation Required in Panel

Required

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
Did you like yourself or feel comfortable with yourself
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Long Common Name

Did you like yourself or feel comfortable with yourself

Basic Attributes

Class
SURVEY.SDOH
Type
Surveys
First Released
Version 2.82
Last Updated
Version 2.82 (ADD)
Order vs. Observation
Observation

Example Answer List LL5955-1

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)0LA32-8

Member of these Panels

LOINCLong Common Name
112464-3Benevolent Childhood Experiences Scale [BCEs Scale]

112466-8 Did you have a predictable home routine, like regular meals and a regular bedtime?

Observation ID in Form

Q10

Observation Required in Panel

Required

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
Did you have a predictable home routine, like regular meals and a regular bedtime
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Long Common Name

Did you have a predictable home routine, like regular meals and a regular bedtime

Basic Attributes

Class
SURVEY.SDOH
Type
Surveys
First Released
Version 2.82
Last Updated
Version 2.82 (ADD)
Order vs. Observation
Observation

Example Answer List LL5955-1

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)0LA32-8

Member of these Panels

LOINCLong Common Name
112464-3Benevolent Childhood Experiences Scale [BCEs Scale]

112465-0 Total score [BCEs Scale]

Term Description

Add together the individual scores for all ten items. The total score should be between 0 and 10.

Observation Required in Panel

Required

Type of Entry

Question - computer calculates response [C]

Form Coding Instructions

Each item contributes to a BCEs score (range: 0-10).

Source: University of Denver

Fully-Specified Name

Component
Total score
Property
Score
Time
Pt
System
^Patient
Scale
Qn
Method
BCEs Scale

Basic Attributes

Class
SURVEY.SDOH
Type
Surveys
First Released
Version 2.82
Last Updated
Version 2.82 (ADD)
Order vs. Observation
Observation

Member of these Panels

LOINCLong Common Name
112464-3Benevolent Childhood Experiences Scale [BCEs Scale]

Example Units

UnitSource
{score}Example UCUM Units