SDOH Assessment Error for 88123-5 b1_toc_amb sample 1

[ALICIA GARZA]

We are testing for B1_Toc_Amb sample 1 and have documented the Hunger Vital Signs (LOINC 88121-9) SDOH assessment from page 11 using 2 questions LOINC 88122-7 and LOINC 88123-5 with the answer "Often True" LOINC LA28397-0.  

We are receiving this error in the validator: 

this is the snippet of code for the 88123-5 question in our CCDA. 

And this is our overall social history entry for SDOH assessment in Social History.  We do currently have this in both Assessment & Plan and Social History.  Could the duplication be causing the error? 

<entry>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.69"/>
<templateId root="2.16.840.1.113883.10.20.22.4.69" extension="2022-06-01"/>
<id root="3875c524-4a24-4139-bcf1-523bc9d9a3f7"/>
<code code="88121-9" codeSystem="2.16.840.1.113883.6.1"/>
<text>Food Insecurity<reference value="#SocialHistoryRef-1070"/></text>
<statusCode code="completed"/>
<effectiveTime value="20250909102910-0800"/>
<value xsi:type="CD" nullFlavor="UNK"/>
<entryRelationship typeCode="COMP">
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.86"/>
<templateId root="2.16.840.1.113883.10.20.22.4.86" extension="2022-06-01"/>
<id root="7dbb7387-1312-49f9-a664-2dfa6ae9a500"/>
<code codeSystem="2.16.840.1.113883.6.1"/>
<text>TotalScore<reference value="#SocialHistoryRef-1070"/></text>
<statusCode code="completed"/>
<effectiveTime value="20250909102910-0800"/>
<value xsi:type="CD" nullFlavor="UNK">
<originalText>2 - Household is at risk for food insecurity.</originalText>
</value>
</observation>
</entryRelationship>
</observation>
</entry>
<entry>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.69"/>
<templateId root="2.16.840.1.113883.10.20.22.4.69" extension="2022-06-01"/>
<id root="266eb157-7170-4c37-b4d9-dc1fd646409c"/>
<code code="88121-9" codeSystem="2.16.840.1.113883.6.1"/>
<text>Food Insecurity<reference value="#SocialHistoryRef-1071"/></text>
<statusCode code="completed"/>
<effectiveTime value="20250909102910-0800"/>
<value xsi:type="CD" nullFlavor="UNK"/>
<entryRelationship typeCode="COMP">
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.86"/>
<templateId root="2.16.840.1.113883.10.20.22.4.86" extension="2022-06-01"/>
<id root="c00321a1-8150-40c9-9197-bd276865754c"/>
<code code="88123-5" codeSystem="2.16.840.1.113883.6.1"/>
<text>Within the past 12 months, the food we bought just didn't last and we didn't have money to get more.<reference value="#SocialHistoryRef-1071"/></text>
<statusCode code="completed"/>
<effectiveTime value="20250909102910-0800"/>
<value xsi:type="CD" code="LA28397-0" codeSystem="2.16.840.1.113883.6.1">
<originalText>Often true</originalText>
</value>
</observation>
</entryRelationship>
</observation>
</entry>
<entry>
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.69"/>
<templateId root="2.16.840.1.113883.10.20.22.4.69" extension="2022-06-01"/>
<id root="8dca048f-319b-47c2-9c72-6837903758b8"/>
<code code="88121-9" codeSystem="2.16.840.1.113883.6.1"/>
<text>Food Insecurity<reference value="#SocialHistoryRef-1072"/></text>
<statusCode code="completed"/>
<effectiveTime value="20250909102910-0800"/>
<value xsi:type="CD" nullFlavor="UNK"/>
<entryRelationship typeCode="COMP">
<observation classCode="OBS" moodCode="EVN">
<templateId root="2.16.840.1.113883.10.20.22.4.86"/>
<templateId root="2.16.840.1.113883.10.20.22.4.86" extension="2022-06-01"/>
<id root="5166a744-63ae-45c1-ab4f-ac49a9b334c9"/>
<code code="88122-7" codeSystem="2.16.840.1.113883.6.1"/>
<text>Within the past 12 months we worried whether our food would run out before we got money to buy more.<reference value="#SocialHistoryRef-1072"/></text>
<statusCode code="completed"/>
<effectiveTime value="20250909102910-0800"/>
<value xsi:type="CD" code="LA28397-0" codeSystem="2.16.840.1.113883.6.1">
<originalText>Often true</originalText>
</value>
</observation>
</entryRelationship>
</observation>
</entry>

Is anyone able to guide us on what we might be missing?  We checked template IDs and our code for the other question is passing...or its not being evaluated. 


Thank you in advance for any tips on this one. 

 

Alicia Garza

 

[Gulshan Dhiman]

Hi Alicia,

Under this entry section.

<entry>
            <observation classCode="OBS" moodCode="EVN">
              <templateId root="2.16.840.1.113883.10.20.22.4.69"/>
              <templateId root="2.16.840.1.113883.10.20.22.4.69" extension="2022-06-01"/>

              <id root="83799521-851c-43b7-a994-4c22d3370740"/>

              <code code="88121-9" codeSystem="2.16.840.1.113883.6.1"/>
              <text>Food Insecurity<reference value="#SocialHistoryRef-1071"/></text>
              <statusCode code="completed"/>
              <effectiveTime value="20250909102910-0800"/>
              <value xsi:type="CD" nullFlavor="UNK"/>
              <entryRelationship typeCode="COMP">
                <observation classCode="OBS" moodCode="EVN">
                  <templateId root="2.16.840.1.113883.10.20.22.4.86"/>
                  <templateId root="2.16.840.1.113883.10.20.22.4.86" extension="2022-06-01"/>

                  <id root="d4734a2b-c5bc-47bc-b287-51476ae9b0a3"/>

                  <code code="88123-5" codeSystem="2.16.840.1.113883.6.1"/>
                  <text>Within the past 12 months, the food we bought just didn't last and we didn't have money to get more.<reference value="#SocialHistoryRef-1071"/></text>
                  <statusCode code="completed"/>
                  <effectiveTime value="20250909102910-0800"/>
                  <value xsi:type="CD" code="LA28397-0" codeSystem="2.16.840.1.113883.6.1">
                    <originalText>Often true</originalText>
                  </value>
                </observation>
              </entryRelationship>
            </observation>
          </entry>

  Repeat the <entryRelationship> tag for each question/answer under category 88122, but do not repeat the category <entry> tag.
This will fix yours problem.