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The SDOH needs of a patient are usually determined by assessments. Based on the needs that were determined, the referral request should contain the relevant questions and answers from the assessment.

Currently the 360X-SD specification states:

Data ElelmentMessage FieldRequirementDescriptions
Order Specific Questions

OBX-3

OBX-5

R2

The OBX segment is used to convey any existing assessments that are in the form of questionnaires. OBX-3 contains the coded question, and OBX-5 contains the recorded response.

OBX-3 SHOULD be using codes from the value sets defined by the Gravity Project, as described at https://confluence.hl7.org/display/GRAV/Social+Risk+Terminology+Value+Sets – the ones that contain questions.

An important part of the assessment is the interpretation of the answers. For this, we will add the use of OBX-8 and OBX-10, Interpretation Codes and Nature of Abnormal Test respectively.

(Add guidance for how the combination of question/response order specific questions and the diagnoses Z-codes correspond to the the FHIR Observation.interpretation). In the cases where additional assessments are done at the intermediary/consolidator or at the service provider, that information will available via the Referral Status Query.

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