Preventive Care Guidelines IG
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: Prostate Cancer Screening Questionnaire - XML Representation

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<Questionnaire xmlns="http://hl7.org/fhir">
  <id value="mpc-prostate-cancer"/>
  <meta>
    <versionId value="0.1.0"/>
    <profile
             value="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire|2.7"/>
    <profile
             value="http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-shareablequestionnaire"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><b>Structure</b><table border="1" cellpadding="0" cellspacing="0" style="border: 1px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;"><tr style="border: 2px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top"><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="The linkId for the item">LinkId</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Text for the item">Text</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Minimum and Maximum # of times the the itemcan appear in the instance">Cardinality</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="The type of the item">Type</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Additional information about the item">Description &amp; Constraints</a><span style="float: right"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="http://hl7.org/fhir/R4/help16.png" alt="doco" style="background-color: inherit"/></a></span></th></tr><tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_q_root.gif" alt="." style="background-color: white; background-color: inherit" title="QuestionnaireRoot" class="hierarchy"/> </td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Questionnaire</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-display.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Display" class="hierarchy"/> learn-more-intro</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Learn More. What Tests Are Used to Screen for Prostate Cancer?&lt;br/&gt;&lt;br/&gt;Screening for prostate cancer is a blood test called the prostate-specific antigen or PSA test. A high PSA level can be a sign of prostate cancer. However, other things like an enlarged prostate or swelling of the prostate also cause a high PSA level. A biopsy of the prostate is necessary to make the diagnosis of cancer.</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-display">display</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-display.png" alt="." style="background-color: white; background-color: inherit" title="Display" class="hierarchy"/> learn-more-video</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Learn More. Watch a 3-minute video about the PSA testing. We’d like to suggest you watch the video to help you prepare for your upcoming visit. This video can help you prepare to ask questions that are important to you when you visit with your provider. &lt;br/&gt; &lt;br/&gt; &lt;a id=&quot;youtube&quot; value=&quot;YqticruOZ7U&quot;&gt;&lt;/a&gt;</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-display">display</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-display.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Display" class="hierarchy"/> learn-more-uspstf</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Learn More. See a picture of what happens to 1,000 men who chose to get a PSA test. It shows you how many men benefit from screening – don’t die from prostate cancer. And it shows you how many men are harmed – false positives and complications from treatment.&lt;br/&gt; &lt;br/&gt; &lt;img width=&quot;100%&quot; src=&quot;https://www.cdc.gov/cancer/prostate/images/prostate-decision-guide-300.jpg&quot;/&gt; &lt;a id=&quot;website&quot; value=&quot;https://www.uspreventiveservicestaskforce.org/Home/GetFileByID/3795&quot;&gt;&lt;/a&gt; </td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-display">display</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="Coding" class="hierarchy"/> 1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Next Steps. What do you want to do next?</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.1">3 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Group" class="hierarchy"/> 2</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Next Steps. How do you feel about your decision?</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group">group</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="Coding" class="hierarchy"/> 2.1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">I know the benefits of getting a PSA test.</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.2.1">5 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Coding" class="hierarchy"/> 2.2</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">I know the risks of getting a PSA test.</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.2.2">5 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="Coding" class="hierarchy"/> 2.3</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">I am clear about which benefits and risks matter most to me.</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.2.3">5 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Coding" class="hierarchy"/> 2.4</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">I have enough support and advice to make a decision about getting a PSA test.</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.2.4">5 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="Coding" class="hierarchy"/> 2.5</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">I feel sure about the best choice for me.</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.2.5">5 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-boolean.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Boolean" class="hierarchy"/> 3</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Next Steps. Would you like to discuss prostate cancer screening at your next appointment? MyPreventiveCare can let your provider know what you want.</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-boolean">boolean</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: white; background-color: inherit" title="Group" class="hierarchy"/> 15</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Feedback. Please indicate your level of agreement with the following statement:</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group">group</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Coding" class="hierarchy"/> 15.1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Using the MyPreventiveCare tool has helped me begin preparing for a conversation with my provider about making health decisions.</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.15.1">5 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck00.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-text.png" alt="." style="background-color: white; background-color: inherit" title="Text" class="hierarchy"/> 16</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Feedback. Do you have any other feedback or thoughts to share on your use of MyPreventiveCare?</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-text">text</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr><td colspan="5" class="hierarchy"><br/><a href="http://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="http://hl7.org/fhir/R4/help16.png" alt="doco" style="background-color: inherit"/> Documentation for this format</a></td></tr></table><hr/><p><b>Option Sets</b></p><a name="opt-item.1"> </a><p><b>Answer options for 1</b></p><ul><li style="font-size: 11px">http://fhir.org/guides/preventive-care/CodeSystem/mpc-questionnaire-codes#more-thought (&quot;I want to give it more thought&quot;)</li><li style="font-size: 11px">http://fhir.org/guides/preventive-care/CodeSystem/mpc-questionnaire-codes#get-test (&quot;I want to get a PSA test&quot;)</li><li style="font-size: 11px">http://fhir.org/guides/preventive-care/CodeSystem/mpc-questionnaire-codes#do-not-want-test (&quot;I do not want to get a PSA test&quot;)</li></ul><a name="opt-item.2.1"> </a><p><b>Answer options for 2.1</b></p><ul><li style="font-size: 11px"><a href="http://terminology.hl7.org/2.1.0/CodeSystem-v3-loinc.html">LOINC</a>: x (&quot;Strongly disagree&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/2.1.0/CodeSystem-v3-loinc.html">LOINC</a>: x (&quot;Disagree&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/2.1.0/CodeSystem-v3-loinc.html">LOINC</a>: x (&quot;Neutral&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/2.1.0/CodeSystem-v3-loinc.html">LOINC</a>: x (&quot;Agree&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/2.1.0/CodeSystem-v3-loinc.html">LOINC</a>: x (&quot;Strongly agree&quot;)</li></ul><a name="opt-item.2.2"> </a><p><b>Answer options for 2.2</b></p><ul><li style="font-size: 11px"><a href="http://terminology.hl7.org/2.1.0/CodeSystem-v3-loinc.html">LOINC</a>: x (&quot;Strongly disagree&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/2.1.0/CodeSystem-v3-loinc.html">LOINC</a>: x (&quot;Disagree&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/2.1.0/CodeSystem-v3-loinc.html">LOINC</a>: x (&quot;Neutral&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/2.1.0/CodeSystem-v3-loinc.html">LOINC</a>: x (&quot;Agree&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/2.1.0/CodeSystem-v3-loinc.html">LOINC</a>: x (&quot;Strongly agree&quot;)</li></ul><a name="opt-item.2.3"> </a><p><b>Answer options for 2.3</b></p><ul><li style="font-size: 11px"><a href="http://terminology.hl7.org/2.1.0/CodeSystem-v3-loinc.html">LOINC</a>: x (&quot;Strongly disagree&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/2.1.0/CodeSystem-v3-loinc.html">LOINC</a>: x (&quot;Disagree&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/2.1.0/CodeSystem-v3-loinc.html">LOINC</a>: x (&quot;Neutral&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/2.1.0/CodeSystem-v3-loinc.html">LOINC</a>: x (&quot;Agree&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/2.1.0/CodeSystem-v3-loinc.html">LOINC</a>: x (&quot;Strongly agree&quot;)</li></ul><a name="opt-item.2.4"> </a><p><b>Answer options for 2.4</b></p><ul><li style="font-size: 11px"><a href="http://terminology.hl7.org/2.1.0/CodeSystem-v3-loinc.html">LOINC</a>: x (&quot;Strongly disagree&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/2.1.0/CodeSystem-v3-loinc.html">LOINC</a>: x (&quot;Disagree&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/2.1.0/CodeSystem-v3-loinc.html">LOINC</a>: x (&quot;Neutral&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/2.1.0/CodeSystem-v3-loinc.html">LOINC</a>: x (&quot;Agree&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/2.1.0/CodeSystem-v3-loinc.html">LOINC</a>: x (&quot;Strongly agree&quot;)</li></ul><a name="opt-item.2.5"> </a><p><b>Answer options for 2.5</b></p><ul><li style="font-size: 11px"><a href="http://terminology.hl7.org/2.1.0/CodeSystem-v3-loinc.html">LOINC</a>: x (&quot;Strongly disagree&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/2.1.0/CodeSystem-v3-loinc.html">LOINC</a>: x (&quot;Disagree&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/2.1.0/CodeSystem-v3-loinc.html">LOINC</a>: x (&quot;Neutral&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/2.1.0/CodeSystem-v3-loinc.html">LOINC</a>: x (&quot;Agree&quot;)</li><li style="font-size: 11px"><a href="http://terminology.hl7.org/2.1.0/CodeSystem-v3-loinc.html">LOINC</a>: x (&quot;Strongly agree&quot;)</li></ul><a name="opt-item.15.1"> </a><p><b>Answer options for 15.1</b></p><ul><li style="font-size: 11px">https://loinc.org/LL1606-4/#LA15238-1 (&quot;Disagree a lot&quot;)</li><li style="font-size: 11px">https://loinc.org/LL1606-4/#LA15239-9 (&quot;Disagree a little&quot;)</li><li style="font-size: 11px">https://loinc.org/LL1606-4/#LA15240-7 (&quot;Neither agree nor disagree&quot;)</li><li style="font-size: 11px">https://loinc.org/LL1606-4/#LA15241-5 (&quot;Agree a little&quot;)</li><li style="font-size: 11px">https://loinc.org/LL1606-4/#LA15242-3 (&quot;Agree a lot&quot;)</li></ul></div>
  </text>
  <extension
             url="http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeCapability">
    <valueString value="shareable"/>
  </extension>
  <extension
             url="http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeCapability">
    <valueString value="publishable"/>
  </extension>
  <extension
             url="http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeRepresentationLevel">
    <valueString value="narrative"/>
  </extension>
  <extension
             url="http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeCapability">
    <valueString value="computable"/>
  </extension>
  <extension
             url="http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeRepresentationLevel">
    <valueString value="structured"/>
  </extension>
  <extension
             url="http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeCapability">
    <valueString value="executable"/>
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  <extension
             url="http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-knowledgeRepresentationLevel">
    <valueString value="executable"/>
  </extension>
  <url
       value="http://fhir.org/guides/preventive-care/Questionnaire/mpc-prostate-cancer"/>
  <version value="1.0.0"/>
  <title value="Prostate Cancer Screening Questionnaire"/>
  <status value="active"/>
  <date value="2021-09-03T16:48:06+00:00"/>
  <publisher value="U.S. Preventive Services Task Force (USPSTF)"/>
  <contact>
    <telecom>
      <system value="url"/>
      <value value="https://www.uspreventiveservicestaskforce.org/uspstf/"/>
    </telecom>
  </contact>
  <jurisdiction>
    <coding>
      <system value="http://unstats.un.org/unsd/methods/m49/m49.htm"/>
      <code value="001"/>
    </coding>
  </jurisdiction>
  <item>
    <linkId value="learn-more-intro"/>
    <prefix value="Learn More"/>
    <text
          value="What Tests Are Used to Screen for Prostate Cancer?&lt;br/&gt;&lt;br/&gt;Screening for prostate cancer is a blood test called the prostate-specific antigen or PSA test. A high PSA level can be a sign of prostate cancer. However, other things like an enlarged prostate or swelling of the prostate also cause a high PSA level. A biopsy of the prostate is necessary to make the diagnosis of cancer."/>
    <type value="display"/>
  </item>
  <item>
    <linkId value="learn-more-video"/>
    <prefix value="Learn More"/>
    <text
          value="Watch a 3-minute video about the PSA testing. We’d like to suggest you watch the video to help you prepare for your upcoming visit. This video can help you prepare to ask questions that are important to you when you visit with your provider. &lt;br/&gt; &lt;br/&gt; &lt;a id=&quot;youtube&quot; value=&quot;YqticruOZ7U&quot;&gt;&lt;/a&gt;"/>
    <type value="display"/>
  </item>
  <item>
    <linkId value="learn-more-uspstf"/>
    <prefix value="Learn More"/>
    <text
          value="See a picture of what happens to 1,000 men who chose to get a PSA test. It shows you how many men benefit from screening – don’t die from prostate cancer. And it shows you how many men are harmed – false positives and complications from treatment.&lt;br/&gt; &lt;br/&gt; &lt;img width=&quot;100%&quot; src=&quot;https://www.cdc.gov/cancer/prostate/images/prostate-decision-guide-300.jpg&quot;/&gt; &lt;a id=&quot;website&quot; value=&quot;https://www.uspreventiveservicestaskforce.org/Home/GetFileByID/3795&quot;&gt;&lt;/a&gt; "/>
    <type value="display"/>
  </item>
  <item>
    <extension
               url="http://hl7.org/fhir/uv/StructureDefinition/cpg-answerValueSetSource">
      <valueCanonical
                      value="http://fhir.org/guides/preventive-care/ValueSet/next-step-types"/>
    </extension>
    <linkId value="1"/>
    <code>
      <system
              value="http://fhir.org/guides/preventive-care/CodeSystem/mpc-questionnaire-codes"/>
      <code value="mpc-do-next"/>
      <display value="What do you want to do next?"/>
    </code>
    <prefix value="Next Steps"/>
    <text value="What do you want to do next?"/>
    <type value="choice"/>
    <required value="true"/>
    <answerOption>
      <valueCoding>
        <system
                value="http://fhir.org/guides/preventive-care/CodeSystem/mpc-questionnaire-codes"/>
        <code value="more-thought"/>
        <display value="I want to give it more thought"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system
                value="http://fhir.org/guides/preventive-care/CodeSystem/mpc-questionnaire-codes"/>
        <code value="get-test"/>
        <display value="I want to get a PSA test"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system
                value="http://fhir.org/guides/preventive-care/CodeSystem/mpc-questionnaire-codes"/>
        <code value="do-not-want-test"/>
        <display value="I do not want to get a PSA test"/>
      </valueCoding>
    </answerOption>
  </item>
  <item>
    <linkId value="2"/>
    <code>
      <system
              value="http://fhir.org/guides/preventive-care/CodeSystem/mpc-questionnaire-codes"/>
      <code value="next-step"/>
      <display value="What do you want to do next?"/>
    </code>
    <prefix value="Next Steps"/>
    <text value="How do you feel about your decision?"/>
    <type value="group"/>
    <required value="false"/>
    <item>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
        <valueCodeableConcept>
          <coding>
            <system value="http://hl7.org/fhir/questionnaire-item-control"/>
            <code value="drop-down"/>
            <display value="Drop down"/>
          </coding>
          <text value="Drop down"/>
        </valueCodeableConcept>
      </extension>
      <extension
                 url="http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-answerValueSetSource">
        <valueCanonical value="http://loinc.org/vs/LL2949-7"/>
      </extension>
      <linkId value="2.1"/>
      <code>
        <system value="mpc codesystem"/>
        <code value="x"/>
        <display value="Know benefits"/>
      </code>
      <text value="I know the benefits of getting a PSA test."/>
      <type value="choice"/>
      <required value="false"/>
      <answerOption>
        <valueCoding>
          <system value="http://loinc.org"/>
          <code value="x"/>
          <display value="Strongly disagree"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://loinc.org"/>
          <code value="x"/>
          <display value="Disagree"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://loinc.org"/>
          <code value="x"/>
          <display value="Neutral"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://loinc.org"/>
          <code value="x"/>
          <display value="Agree"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://loinc.org"/>
          <code value="x"/>
          <display value="Strongly agree"/>
        </valueCoding>
      </answerOption>
    </item>
    <item>
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        <valueCodeableConcept>
          <coding>
            <system value="http://hl7.org/fhir/questionnaire-item-control"/>
            <code value="drop-down"/>
            <display value="Drop down"/>
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          <text value="Drop down"/>
        </valueCodeableConcept>
      </extension>
      <extension
                 url="http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-answerValueSetSource">
        <valueCanonical value="http://loinc.org/vs/LL2949-7"/>
      </extension>
      <linkId value="2.2"/>
      <code>
        <system value="mpc codesystem"/>
        <code value="x"/>
        <display value="Know risks"/>
      </code>
      <text value="I know the risks of getting a PSA test."/>
      <type value="choice"/>
      <required value="false"/>
      <answerOption>
        <valueCoding>
          <system value="http://loinc.org"/>
          <code value="x"/>
          <display value="Strongly disagree"/>
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      <answerOption>
        <valueCoding>
          <system value="http://loinc.org"/>
          <code value="x"/>
          <display value="Disagree"/>
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      <answerOption>
        <valueCoding>
          <system value="http://loinc.org"/>
          <code value="x"/>
          <display value="Neutral"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://loinc.org"/>
          <code value="x"/>
          <display value="Agree"/>
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      <answerOption>
        <valueCoding>
          <system value="http://loinc.org"/>
          <code value="x"/>
          <display value="Strongly agree"/>
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      </answerOption>
    </item>
    <item>
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        <valueCodeableConcept>
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            <code value="drop-down"/>
            <display value="Drop down"/>
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          <text value="Drop down"/>
        </valueCodeableConcept>
      </extension>
      <extension
                 url="http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-answerValueSetSource">
        <valueCanonical value="http://loinc.org/vs/LL2949-7"/>
      </extension>
      <linkId value="2.3"/>
      <code>
        <system value="mpc codesystem"/>
        <code value="x"/>
        <display value="Clear on what matters to me"/>
      </code>
      <text value="I am clear about which benefits and risks matter most to me."/>
      <type value="choice"/>
      <required value="false"/>
      <answerOption>
        <valueCoding>
          <system value="http://loinc.org"/>
          <code value="x"/>
          <display value="Strongly disagree"/>
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      <answerOption>
        <valueCoding>
          <system value="http://loinc.org"/>
          <code value="x"/>
          <display value="Disagree"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://loinc.org"/>
          <code value="x"/>
          <display value="Neutral"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://loinc.org"/>
          <code value="x"/>
          <display value="Agree"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://loinc.org"/>
          <code value="x"/>
          <display value="Strongly agree"/>
        </valueCoding>
      </answerOption>
    </item>
    <item>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
        <valueCodeableConcept>
          <coding>
            <system value="http://hl7.org/fhir/questionnaire-item-control"/>
            <code value="drop-down"/>
            <display value="Drop down"/>
          </coding>
          <text value="Drop down"/>
        </valueCodeableConcept>
      </extension>
      <extension
                 url="http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-answerValueSetSource">
        <valueCanonical value="http://loinc.org/vs/LL2949-7"/>
      </extension>
      <linkId value="2.4"/>
      <code>
        <system value="mpc codesystem"/>
        <code value="x"/>
        <display value="Have support"/>
      </code>
      <text
            value="I have enough support and advice to make a decision about getting a PSA test."/>
      <type value="choice"/>
      <required value="false"/>
      <answerOption>
        <valueCoding>
          <system value="http://loinc.org"/>
          <code value="x"/>
          <display value="Strongly disagree"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://loinc.org"/>
          <code value="x"/>
          <display value="Disagree"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://loinc.org"/>
          <code value="x"/>
          <display value="Neutral"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://loinc.org"/>
          <code value="x"/>
          <display value="Agree"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://loinc.org"/>
          <code value="x"/>
          <display value="Strongly agree"/>
        </valueCoding>
      </answerOption>
    </item>
    <item>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
        <valueCodeableConcept>
          <coding>
            <system value="http://hl7.org/fhir/questionnaire-item-control"/>
            <code value="drop-down"/>
            <display value="Drop down"/>
          </coding>
          <text value="Drop down"/>
        </valueCodeableConcept>
      </extension>
      <extension
                 url="http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-answerValueSetSource">
        <valueCanonical value="http://loinc.org/vs/LL2949-7"/>
      </extension>
      <linkId value="2.5"/>
      <code>
        <system value="mpc codesystem"/>
        <code value="x"/>
        <display value="Sure about choice"/>
      </code>
      <text value="I feel sure about the best choice for me."/>
      <type value="choice"/>
      <required value="false"/>
      <answerOption>
        <valueCoding>
          <system value="http://loinc.org"/>
          <code value="x"/>
          <display value="Strongly disagree"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://loinc.org"/>
          <code value="x"/>
          <display value="Disagree"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://loinc.org"/>
          <code value="x"/>
          <display value="Neutral"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://loinc.org"/>
          <code value="x"/>
          <display value="Agree"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://loinc.org"/>
          <code value="x"/>
          <display value="Strongly agree"/>
        </valueCoding>
      </answerOption>
    </item>
  </item>
  <item>
    <linkId value="3"/>
    <code>
      <system value="http://example.org/questionnaires"/>
      <code value="Discuss at next appointment"/>
    </code>
    <prefix value="Next Steps"/>
    <text
          value="Would you like to discuss prostate cancer screening at your next appointment? MyPreventiveCare can let your provider know what you want."/>
    <type value="boolean"/>
    <required value="true"/>
  </item>
  <item>
    <linkId value="15"/>
    <code>
      <system
              value="http://fhir.org/guides/preventive-care/CodeSystem/mpc-questionnaire-codes"/>
      <code value="mpc-feedback"/>
      <display value="Feedback about your use of MyPreventiveCare"/>
    </code>
    <prefix value="Feedback"/>
    <text
          value="Please indicate your level of agreement with the following statement:"/>
    <type value="group"/>
    <required value="false"/>
    <item>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl">
        <valueCodeableConcept>
          <coding>
            <system value="http://hl7.org/fhir/questionnaire-item-control"/>
            <code value="drop-down"/>
            <display value="Drop down"/>
          </coding>
          <text value="Drop down"/>
        </valueCodeableConcept>
      </extension>
      <extension
                 url="http://hl7.org/fhir/uv/cpg/StructureDefinition/cpg-answerValueSetSource">
        <valueCanonical value="http://loinc.org/vs/LL1606-4"/>
      </extension>
      <linkId value="15.1"/>
      <code>
        <system
                value="http://fhir.org/guides/preventive-care/CodeSystem/mpc-questionnaire-codes"/>
        <code value="mpq-1063"/>
        <display
                 value="Please indicate your level of agreement with the following statement: Using the MyPreventiveCare tool has helped me begin preparing for a conversation with my provider about making health decisions."/>
      </code>
      <text
            value="Using the MyPreventiveCare tool has helped me begin preparing for a conversation with my provider about making health decisions."/>
      <type value="choice"/>
      <required value="false"/>
      <answerOption>
        <valueCoding>
          <system value="https://loinc.org/LL1606-4/"/>
          <code value="LA15238-1"/>
          <display value="Disagree a lot"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="https://loinc.org/LL1606-4/"/>
          <code value="LA15239-9"/>
          <display value="Disagree a little"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="https://loinc.org/LL1606-4/"/>
          <code value="LA15240-7"/>
          <display value="Neither agree nor disagree"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="https://loinc.org/LL1606-4/"/>
          <code value="LA15241-5"/>
          <display value="Agree a little"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="https://loinc.org/LL1606-4/"/>
          <code value="LA15242-3"/>
          <display value="Agree a lot"/>
        </valueCoding>
      </answerOption>
    </item>
  </item>
  <item>
    <linkId value="16"/>
    <code>
      <system
              value="http://fhir.org/guides/preventive-care/CodeSystem/mpc-questionnaire-codes"/>
      <code value="mpq-1064"/>
      <display
               value="Do you have any other feedback or thoughts to share on your use of MyPreventiveCare?"/>
    </code>
    <code>
      <system
              value="http://fhir.org/guides/preventive-care/CodeSystem/mpc-questionnaire-codes"/>
      <code value="mpc-feedback"/>
      <display value="Feedback on your use of MyPreventiveCare"/>
    </code>
    <prefix value="Feedback"/>
    <text
          value="Do you have any other feedback or thoughts to share on your use of MyPreventiveCare?"/>
    <type value="text"/>
    <required value="false"/>
  </item>
</Questionnaire>