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
Example QuestionnaireResponse: promis-10-assessment-betsy-april
version: 1; Last updated: 2025-04-16 14:36:50+0000
| LinkID | Text | Definition | Answer |
|---|---|---|---|
  promis-10-assessment-betsy-april | Questionnaire:PROMIS-10 | ||
  mbi | What is this patient's Medicare Beneficiary Identifier (MBI)? | 1PA3D58WH16 | |
| assessment_date | Please report the date this assessment was completed. | 2025-04-16 | |
| health | In general, would you say your health is... | LOINC: LA8967-7 (Good) | |
| quality_of_life | In general, would you say your quality of life is... | LOINC: LA8968-5 (Fair) | |
| physical_health | In general, how would you rate your physical health? | LOINC: LA8968-5 (Fair) | |
| mental_health | In general, how would you rate your mental health, including your mood and your ability to think? | LOINC: LA8968-5 (Fair) | |
| satisfaction_social | In general, how would you rate your satisfaction with your social activities and relationships? | LOINC: LA8969-3 (Poor) | |
| social_activities | In general, please rate how well you carry out your usual social activities and roles. (This includes activities at home, at work and in your community, and responsibilities as a parent, child, spouse, employee, friend, etc.) | LOINC: LA8967-7 (Good) | |
| physical_activities | In the past 7 days, to what extent are you able to carry out your everyday physical activities such as walking, climbing stairs, carrying groceries, or moving a chair? | LOINC: LA13939-6 (Moderately) | |
| emotional | In the past 7 days, how often have you been bothered by emotional problems such as feeling anxious, depressed or irritable? | LOINC: LA10066-1 (Rarely) | |
| fatigue | In the past 7 days, how would you rate your fatigue on average? | LOINC: LA6750-9 (Severe) | |
| pain | On a scale of 0-10, with 10 being the worst pain imaginable and 0 being no pain, how would you rate your pain on average? | LOINC: LA10139-6 (7) | |
| physical_health_score | PROMIS-10 Global Physical Health (Raw Score) | 9 | |
| mental_health_score | PROMIS-10 Global Mental Health (Raw Score) | 9 | |
| physical_health_tscore | PROMIS Global Physical Health v1.2 T-Score | 32.4 | |
 mental_health_tscore | PROMIS Global Mental Health v1.2 T-Score | 36.3 | |
| Documentation for this format | |||