{
  "type": "smart-health-checkin-request",
  "version": "1",
  "id": "replace-with-a-unique-id",
  "purpose": "Pre-visit check-in",
  "fhirVersions": [
    "4.0.1"
  ],
  "items": [
    {
      "id": "phq2",
      "title": "Two questions about your mood",
      "required": true,
      "content": {
        "kind": "form.fhir",
        "questionnaireCanonical": "https://smart-health-checkin.org/connectathon/Questionnaire/phq-2.json|1",
        "questionnaire": {
          "resourceType": "Questionnaire",
          "text": {
            "status": "generated",
            "div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><p><b>PHQ-2 depression screen</b></p><ol><li>Little interest or pleasure in doing things</li><li>Feeling down, depressed, or hopeless</li></ol></div>"
          },
          "url": "https://smart-health-checkin.org/connectathon/Questionnaire/phq-2.json",
          "version": "1",
          "name": "PHQ2",
          "title": "PHQ-2 depression screen",
          "status": "draft",
          "subjectType": [
            "Patient"
          ],
          "date": "2026-09-25",
          "publisher": "SMART Health IT (connectathon example)",
          "description": "The two-question PHQ-2 depression screen, for the KTC SMART Health Check-in connectathon. Answers carry scores 0 to 3 in the ordinalValue extension; the total (LOINC 55758-7) is the sum and is computed by the receiver, not entered by the patient.",
          "copyright": "This material contains content from LOINC (http://loinc.org). LOINC is copyright © Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee and is available at no cost under the license at http://loinc.org/license. PHQ-2: Developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke and colleagues, with an educational grant from Pfizer Inc. No permission required to reproduce, translate, display or distribute.",
          "code": [
            {
              "system": "http://loinc.org",
              "code": "55757-9",
              "display": "Patient Health Questionnaire 2 item (PHQ-2) [Reported]"
            }
          ],
          "item": [
            {
              "linkId": "stem",
              "type": "display",
              "text": "Over the last 2 weeks, how often have you been bothered by the following problems?"
            },
            {
              "linkId": "phq2-1",
              "code": [
                {
                  "system": "http://loinc.org",
                  "code": "44250-9",
                  "display": "Little interest or pleasure in doing things in last 2 weeks"
                }
              ],
              "prefix": "1.",
              "text": "Little interest or pleasure in doing things",
              "type": "choice",
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA6568-5",
                    "display": "Not at all"
                  },
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                      "valueDecimal": 0
                    }
                  ]
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA6569-3",
                    "display": "Several days"
                  },
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                      "valueDecimal": 1
                    }
                  ]
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA6570-1",
                    "display": "More than half the days"
                  },
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                      "valueDecimal": 2
                    }
                  ]
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA6571-9",
                    "display": "Nearly every day"
                  },
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                      "valueDecimal": 3
                    }
                  ]
                }
              ]
            },
            {
              "linkId": "phq2-2",
              "code": [
                {
                  "system": "http://loinc.org",
                  "code": "44255-8",
                  "display": "Feeling down, depressed, or hopeless in last 2 weeks"
                }
              ],
              "prefix": "2.",
              "text": "Feeling down, depressed, or hopeless",
              "type": "choice",
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA6568-5",
                    "display": "Not at all"
                  },
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                      "valueDecimal": 0
                    }
                  ]
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA6569-3",
                    "display": "Several days"
                  },
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                      "valueDecimal": 1
                    }
                  ]
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA6570-1",
                    "display": "More than half the days"
                  },
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                      "valueDecimal": 2
                    }
                  ]
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA6571-9",
                    "display": "Nearly every day"
                  },
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                      "valueDecimal": 3
                    }
                  ]
                }
              ]
            }
          ]
        }
      },
      "accept": [
        "application/fhir+json"
      ]
    }
  ]
}