CMS ACCESS Model API
0.9.8 - draft US

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

: PROMIS Pain Interference CAT QuestionnaireResponse Example

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<QuestionnaireResponse xmlns="http://hl7.org/fhir">
  <id value="PROMISPainInterferenceCATExample"/>
  <meta>
    <profile
             value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-questionnaireresponse|6.1.0"/>
  </meta>
  <language value="en"/>
  <text>
    <status value="generated"/>
    <div xml:lang="en" xmlns="http://www.w3.org/1999/xhtml" lang="en"><p>PROMIS Pain Interference (CAT) QuestionnaireResponse for John Doe. T-score: 70.</p></div>
  </text>
  <questionnaire
                 value="http://example.org/Questionnaire/PROMISPainInterferenceCATQuestionnaire"/>
  <status value="completed"/>
  <subject>🔗 
    <reference value="Patient/PatientExample"/>
  </subject>
  <authored value="2026-01-15T10:30:00Z"/>
  <author>🔗 
    <reference value="Patient/PatientExample"/>
  </author>
  <item>
    <linkId value="pi-cat-1"/>
    <text
          value="In the past 7 days: How much did pain interfere with your day to day activities?"/>
    <answer>
      <valueCoding>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
          <valueDecimal value="4"/>
        </extension>
        <system value="http://loinc.org"/>
        <code value="LA13902-4"/>
        <display value="Quite a bit"/>
      </valueCoding>
    </answer>
  </item>
  <item>
    <linkId value="pi-cat-2"/>
    <text
          value="In the past 7 days: How much did pain interfere with your ability to participate in social activities?"/>
    <answer>
      <valueCoding>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
          <valueDecimal value="5"/>
        </extension>
        <system value="http://loinc.org"/>
        <code value="LA13914-9"/>
        <display value="Very much"/>
      </valueCoding>
    </answer>
  </item>
  <item>
    <linkId value="pi-cat-3"/>
    <text
          value="In the past 7 days: How much did pain interfere with your enjoyment of social activities?"/>
    <answer>
      <valueCoding>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
          <valueDecimal value="4"/>
        </extension>
        <system value="http://loinc.org"/>
        <code value="LA13902-4"/>
        <display value="Quite a bit"/>
      </valueCoding>
    </answer>
  </item>
  <item>
    <linkId value="pi-cat-4"/>
    <text
          value="In the past 7 days: How much did pain interfere with work around the home?"/>
    <answer>
      <valueCoding>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
          <valueDecimal value="5"/>
        </extension>
        <system value="http://loinc.org"/>
        <code value="LA13914-9"/>
        <display value="Very much"/>
      </valueCoding>
    </answer>
  </item>
  <item>
    <linkId value="tscore"/>
    <answer>
      <valueDecimal value="70"/>
    </answer>
  </item>
</QuestionnaireResponse>