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
<QuestionnaireResponse xmlns="http://hl7.org/fhir">
<id value="PROMISPainInterferenceSFExample"/>
<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 (Short Form 6a) QuestionnaireResponse for John Doe. T-score: 58.6.</p></div>
</text>
<questionnaire
value="http://example.org/Questionnaire/PROMISPainInterferenceSFQuestionnaire"/>
<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="pi6a-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="2"/>
</extension>
<system value="http://loinc.org"/>
<code value="LA13863-8"/>
<display value="A little bit"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="pi6a-2"/>
<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="2"/>
</extension>
<system value="http://loinc.org"/>
<code value="LA13863-8"/>
<display value="A little bit"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="pi6a-3"/>
<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="3"/>
</extension>
<system value="http://loinc.org"/>
<code value="LA13909-9"/>
<display value="Somewhat"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="pi6a-4"/>
<text
value="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 value="2"/>
</extension>
<system value="http://loinc.org"/>
<code value="LA13863-8"/>
<display value="A little bit"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="pi6a-5"/>
<text
value="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 value="3"/>
</extension>
<system value="http://loinc.org"/>
<code value="LA13909-9"/>
<display value="Somewhat"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="pi6a-6"/>
<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="3"/>
</extension>
<system value="http://loinc.org"/>
<code value="LA13909-9"/>
<display value="Somewhat"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="raw_score"/>
<answer>
<valueDecimal value="15"/>
</answer>
</item>
<item>
<linkId value="tscore"/>
<answer>
<valueDecimal value="58.6"/>
</answer>
</item>
</QuestionnaireResponse>