This page is part of the ACCESS Model IG v0.9.8 DRAFT (v0.9.8: Releases Draft) based on FHIR (HL7® FHIR® Standard) R4. No current official version has been published yet. For a full list of available versions, see the Directory of published versions

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{
  "resourceType" : "QuestionnaireResponse",
  "id" : "PROMISCATExample",
  "meta" : {
    "profile" : [
      🔗 "http://hl7.org/fhir/us/core/StructureDefinition/us-core-questionnaireresponse|6.1.0"
    ]
  },
  "language" : "en",
  "text" : {
    "status" : "generated",
    "div" : "<div xml:lang=\"en\" xmlns=\"http://www.w3.org/1999/xhtml\" lang=\"en\"><p>PROMIS Physical Function (CAT) QuestionnaireResponse for John Doe. T-score: 38.</p></div>"
  },
  "questionnaire" : "http://example.org/Questionnaire/PROMISPhysicalFunctionCATQuestionnaire",
  "status" : "completed",
  "subject" : {
    🔗 "reference" : "Patient/PatientExample"
  },
  "authored" : "2026-01-15T10:30:00Z",
  "author" : {
    🔗 "reference" : "Patient/PatientExample"
  },
  "item" : [
    {
      "linkId" : "pf-cat-1",
      "text" : "Does your health now limit you in doing two hours of physical labor?",
      "answer" : [
        {
          "valueCoding" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                "valueDecimal" : 2
              }
            ],
            "system" : "http://loinc.org",
            "code" : "LA11911-7",
            "display" : "Quite a lot"
          }
        }
      ]
    },
    {
      "linkId" : "pf-cat-2",
      "text" : "Are you able to do chores such as vacuuming or yard work?",
      "answer" : [
        {
          "valueCoding" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                "valueDecimal" : 3
              }
            ],
            "system" : "http://loinc.org",
            "code" : "LA13920-6",
            "display" : "With some difficulty"
          }
        }
      ]
    },
    {
      "linkId" : "pf-cat-3",
      "text" : "To what extent are you able to carry out your everyday physical activities such as walking, climbing stairs, carrying groceries, or moving a chair?",
      "answer" : [
        {
          "valueCoding" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                "valueDecimal" : 3
              }
            ],
            "system" : "http://loinc.org",
            "code" : "LA13939-6",
            "display" : "Moderately"
          }
        }
      ]
    },
    {
      "linkId" : "pf-cat-4",
      "text" : "Does your health now limit you in walking more than a mile?",
      "answer" : [
        {
          "valueCoding" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                "valueDecimal" : 2
              }
            ],
            "system" : "http://loinc.org",
            "code" : "LA11911-7",
            "display" : "Quite a lot"
          }
        }
      ]
    },
    {
      "linkId" : "tscore",
      "answer" : [
        {
          "valueDecimal" : 38
        }
      ]
    }
  ]
}