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
{
"resourceType" : "QuestionnaireResponse",
"id" : "PROMISPainInterferenceSFExample",
"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 Pain Interference (Short Form 6a) QuestionnaireResponse for John Doe. T-score: 58.6.</p></div>"
},
"questionnaire" : "http://example.org/Questionnaire/PROMISPainInterferenceSFQuestionnaire",
"status" : "completed",
"subject" : {
🔗 "reference" : "Patient/PatientExample"
},
"authored" : "2026-01-15T10:30:00Z",
"author" : {
🔗 "reference" : "Patient/PatientExample"
},
"item" : [
{
"linkId" : "pi6a-1",
"text" : "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" : 2
}
],
"system" : "http://loinc.org",
"code" : "LA13863-8",
"display" : "A little bit"
}
}
]
},
{
"linkId" : "pi6a-2",
"text" : "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" : 2
}
],
"system" : "http://loinc.org",
"code" : "LA13863-8",
"display" : "A little bit"
}
}
]
},
{
"linkId" : "pi6a-3",
"text" : "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" : 3
}
],
"system" : "http://loinc.org",
"code" : "LA13909-9",
"display" : "Somewhat"
}
}
]
},
{
"linkId" : "pi6a-4",
"text" : "In the past 7 days: How much did pain interfere with your household chores?",
"answer" : [
{
"valueCoding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal" : 2
}
],
"system" : "http://loinc.org",
"code" : "LA13863-8",
"display" : "A little bit"
}
}
]
},
{
"linkId" : "pi6a-5",
"text" : "In the past 7 days: How much did pain interfere with the things you usually do for fun?",
"answer" : [
{
"valueCoding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal" : 3
}
],
"system" : "http://loinc.org",
"code" : "LA13909-9",
"display" : "Somewhat"
}
}
]
},
{
"linkId" : "pi6a-6",
"text" : "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" : 3
}
],
"system" : "http://loinc.org",
"code" : "LA13909-9",
"display" : "Somewhat"
}
}
]
},
{
"linkId" : "raw_score",
"answer" : [
{
"valueDecimal" : 15
}
]
},
{
"linkId" : "tscore",
"answer" : [
{
"valueDecimal" : 58.6
}
]
}
]
}