PACIO Sample Data Depot, published by MITRE. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/paciowg/sample-data-fsh/ and changes regularly. See the Directory of published versions

• Narrative Content
• XML
• JSON

: PROMIS Pain Interference SF 6a QuestionnaireResponse - February 2026 - XML Representation

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<QuestionnaireResponse xmlns="http://hl7.org/fhir">
  <id value="PROMISPainInterferenceSFExample2"/>
  <meta>
    <profile
             value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-questionnaireresponse|6.1.0"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xml:lang="en" xmlns="http://www.w3.org/1999/xhtml" lang="en"><p>PROMIS Pain Interference (Short Form 6a) - February 2026. T-score: 54.9.</p></div>
  </text>
  <questionnaire
                 value="http://example.org/fhir/Questionnaire/PROMISPainInterferenceSFQuestionnaire"/>
  <status value="completed"/>
  <subject>🔗 
    <reference value="Patient/patient-john-doe-01"/>
  </subject>
  <authored value="2026-02-15T10:30:00Z"/>
  <author>🔗 
    <reference value="Patient/patient-john-doe-01"/>
  </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="2"/>
        </extension>
        <system value="http://loinc.org"/>
        <code value="LA13863-8"/>
        <display value="A little bit"/>
      </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="14"/>
    </answer>
  </item>
  <item>
    <linkId value="tscore"/>
    <answer>
      <valueDecimal value="54.9"/>
    </answer>
  </item>
</QuestionnaireResponse>