# betsysmith-johnson01-qr-pt-assessment-snf-discharge-01 - PACIO Sample Data Depot v0.1.0

* [**Table of Contents**](toc.md)
* [**Artifacts Summary**](artifacts.md)
* **betsysmith-johnson01-qr-pt-assessment-snf-discharge-01**

## Example QuestionnaireResponse: betsysmith-johnson01-qr-pt-assessment-snf-discharge-01

* [LinkID](https://hl7.org/fhir/R4/formats.html#table): betsysmith-johnson01-qr-pt-assessment-snf-discharge-01
  * [Text](https://hl7.org/fhir/R4/formats.html#table): 
  * [Definition](https://hl7.org/fhir/R4/formats.html#table): 
  * [Answer](https://hl7.org/fhir/R4/formats.html#table)![](data:image/png;base64, ): Questionnaire:https://gw.interop.community/paciosandbox/open/Questionnaire/Questionnaire-MDS-Nursing-Home-Comprehensive-Item-Set
* [LinkID](https://hl7.org/fhir/R4/formats.html#table): ![](icon-q-string.png)/89398-2
  * [Text](https://hl7.org/fhir/R4/formats.html#table): Roll left and right
  * [Definition](https://hl7.org/fhir/R4/formats.html#table): 
  * [Answer](https://hl7.org/fhir/R4/formats.html#table)![](data:image/png;base64, ): [LOINC: LA27993-7](https://loinc.org/LA27993-7)(Independent - Resident completes the activity by themself with no assistance from a helper.)
* [LinkID](https://hl7.org/fhir/R4/formats.html#table): ![](icon-q-string.png)/89394-1
  * [Text](https://hl7.org/fhir/R4/formats.html#table): Sit to lying
  * [Definition](https://hl7.org/fhir/R4/formats.html#table): 
  * [Answer](https://hl7.org/fhir/R4/formats.html#table)![](data:image/png;base64, ): [LOINC: LA27993-7](https://loinc.org/LA27993-7)(Independent - Resident completes the activity by themself with no assistance from a helper.)
* [LinkID](https://hl7.org/fhir/R4/formats.html#table): ![](icon-q-string.png)/85927-2
  * [Text](https://hl7.org/fhir/R4/formats.html#table): Lying to sitting on side of bed
  * [Definition](https://hl7.org/fhir/R4/formats.html#table): 
  * [Answer](https://hl7.org/fhir/R4/formats.html#table)![](data:image/png;base64, ): [LOINC: LA27993-7](https://loinc.org/LA27993-7)(Independent - Resident completes the activity by themself with no assistance from a helper.)
* [LinkID](https://hl7.org/fhir/R4/formats.html#table): ![](icon-q-string.png)/89392-5
  * [Text](https://hl7.org/fhir/R4/formats.html#table): Sit to stand
  * [Definition](https://hl7.org/fhir/R4/formats.html#table): 
  * [Answer](https://hl7.org/fhir/R4/formats.html#table)![](data:image/png;base64, ): [LOINC: LA28870-6](https://loinc.org/LA28870-6)(Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently.)
* [LinkID](https://hl7.org/fhir/R4/formats.html#table): ![](icon-q-string.png)/89414-7
  * [Text](https://hl7.org/fhir/R4/formats.html#table): Chair/bed-to-chair transfer
  * [Definition](https://hl7.org/fhir/R4/formats.html#table): 
  * [Answer](https://hl7.org/fhir/R4/formats.html#table)![](data:image/png;base64, ): [LOINC: LA28870-6](https://loinc.org/LA28870-6)(Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently.)
* [LinkID](https://hl7.org/fhir/R4/formats.html#table): ![](icon-q-string.png)/89390-9
  * [Text](https://hl7.org/fhir/R4/formats.html#table): Toilet transfer
  * [Definition](https://hl7.org/fhir/R4/formats.html#table): 
  * [Answer](https://hl7.org/fhir/R4/formats.html#table)![](data:image/png;base64, ): [LOINC: LA28870-6](https://loinc.org/LA28870-6)(Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently.)
* [LinkID](https://hl7.org/fhir/R4/formats.html#table): ![](icon-q-string.png)/101325-9
  * [Text](https://hl7.org/fhir/R4/formats.html#table): Tub/shower transfer
  * [Definition](https://hl7.org/fhir/R4/formats.html#table): 
  * [Answer](https://hl7.org/fhir/R4/formats.html#table)![](data:image/png;base64, ): [LOINC: LA28870-6](https://loinc.org/LA28870-6)(Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently.)
* [LinkID](https://hl7.org/fhir/R4/formats.html#table): ![](icon-q-string.png)/89412-1
  * [Text](https://hl7.org/fhir/R4/formats.html#table): Car transfer
  * [Definition](https://hl7.org/fhir/R4/formats.html#table): 
  * [Answer](https://hl7.org/fhir/R4/formats.html#table)![](data:image/png;base64, ): [LOINC: LA28870-6](https://loinc.org/LA28870-6)(Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently.)
* [LinkID](https://hl7.org/fhir/R4/formats.html#table): ![](icon-q-string.png)/89385-9
  * [Text](https://hl7.org/fhir/R4/formats.html#table): Walk 10 feet
  * [Definition](https://hl7.org/fhir/R4/formats.html#table): 
  * [Answer](https://hl7.org/fhir/R4/formats.html#table)![](data:image/png;base64, ): [LOINC: LA27993-7](https://loinc.org/LA27993-7)(Independent - Resident completes the activity by themself with no assistance from a helper.)
* [LinkID](https://hl7.org/fhir/R4/formats.html#table): ![](icon-q-string.png)/89381-8
  * [Text](https://hl7.org/fhir/R4/formats.html#table): Walk 50 feet with two turns
  * [Definition](https://hl7.org/fhir/R4/formats.html#table): 
  * [Answer](https://hl7.org/fhir/R4/formats.html#table)![](data:image/png;base64, ): [LOINC: LA28870-6](https://loinc.org/LA28870-6)(Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently.)
* [LinkID](https://hl7.org/fhir/R4/formats.html#table): ![](icon-q-string.png)/89383-4
  * [Text](https://hl7.org/fhir/R4/formats.html#table): Walk 150 feet
  * [Definition](https://hl7.org/fhir/R4/formats.html#table): 
  * [Answer](https://hl7.org/fhir/R4/formats.html#table)![](data:image/png;base64, ): [LOINC: LA28870-6](https://loinc.org/LA28870-6)(Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently.)
* [LinkID](https://hl7.org/fhir/R4/formats.html#table): ![](icon-q-string.png)/89379-2
  * [Text](https://hl7.org/fhir/R4/formats.html#table): Walking 10 feet on uneven surfaces
  * [Definition](https://hl7.org/fhir/R4/formats.html#table): 
  * [Answer](https://hl7.org/fhir/R4/formats.html#table)![](data:image/png;base64, ): [LOINC: LA28870-6](https://loinc.org/LA28870-6)(Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently.)
* [LinkID](https://hl7.org/fhir/R4/formats.html#table): ![](icon-q-string.png)/89420-4
  * [Text](https://hl7.org/fhir/R4/formats.html#table): 1 step (curb)
  * [Definition](https://hl7.org/fhir/R4/formats.html#table): 
  * [Answer](https://hl7.org/fhir/R4/formats.html#table)![](data:image/png;base64, ): [LOINC: LA28870-6](https://loinc.org/LA28870-6)(Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently.)
* [LinkID](https://hl7.org/fhir/R4/formats.html#table): ![](icon-q-string.png)/89416-2
  * [Text](https://hl7.org/fhir/R4/formats.html#table): 4 steps
  * [Definition](https://hl7.org/fhir/R4/formats.html#table): 
  * [Answer](https://hl7.org/fhir/R4/formats.html#table)![](data:image/png;base64, ): [LOINC: LA28870-6](https://loinc.org/LA28870-6)(Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently.)
* [LinkID](https://hl7.org/fhir/R4/formats.html#table): ![](icon-q-string.png)/89418-8
  * [Text](https://hl7.org/fhir/R4/formats.html#table): 12 steps
  * [Definition](https://hl7.org/fhir/R4/formats.html#table): 
  * [Answer](https://hl7.org/fhir/R4/formats.html#table)![](data:image/png;base64, ): [LOINC: LA28870-6](https://loinc.org/LA28870-6)(Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity.)
* [LinkID](https://hl7.org/fhir/R4/formats.html#table): ![](icon-q-string.png)/89402-2
  * [Text](https://hl7.org/fhir/R4/formats.html#table): Picking up object
  * [Definition](https://hl7.org/fhir/R4/formats.html#table): 
  * [Answer](https://hl7.org/fhir/R4/formats.html#table)![](data:image/png;base64, ): [LOINC: LA27994-5](https://loinc.org/LA27994-5)(Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity.)
* [LinkID](https://hl7.org/fhir/R4/formats.html#table): ![](icon-q-string.png)/95738-1
  * [Text](https://hl7.org/fhir/R4/formats.html#table): Does the resident use a wheelchair and/or scooter?
  * [Definition](https://hl7.org/fhir/R4/formats.html#table): 
  * [Answer](https://hl7.org/fhir/R4/formats.html#table)![](data:image/png;base64, ): [LOINC: LA32-8](https://loinc.org/LA32-8)(No)
* [LinkID](https://hl7.org/fhir/R4/formats.html#table): ![](data:image/png;base64, )Documentation for this format



## Resource Content

```json
{
  "resourceType" : "QuestionnaireResponse",
  "id" : "betsysmith-johnson01-qr-pt-assessment-snf-discharge-01",
  "questionnaire" : "https://gw.interop.community/paciosandbox/open/Questionnaire/Questionnaire-MDS-Nursing-Home-Comprehensive-Item-Set",
  "status" : "completed",
  "subject" : {
    "reference" : "Patient/patient-betsysmith-johnson01"
  },
  "authored" : "2025-06-30T09:00:00.000Z",
  "author" : {
    "reference" : "PractitionerRole/PractitionerRole-PT-DeyonteDarden"
  },
  "item" : [
    {
      "linkId" : "/89398-2",
      "text" : "Roll left and right",
      "answer" : [
        {
          "valueCoding" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                "valueDecimal" : 6
              }
            ],
            "system" : "http://loinc.org",
            "code" : "LA27993-7",
            "display" : "Independent - Resident completes the activity by themself with no assistance from a helper."
          }
        }
      ]
    },
    {
      "linkId" : "/89394-1",
      "text" : "Sit to lying",
      "answer" : [
        {
          "valueCoding" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                "valueDecimal" : 6
              }
            ],
            "system" : "http://loinc.org",
            "code" : "LA27993-7",
            "display" : "Independent - Resident completes the activity by themself with no assistance from a helper."
          }
        }
      ]
    },
    {
      "linkId" : "/85927-2",
      "text" : "Lying to sitting on side of bed",
      "answer" : [
        {
          "valueCoding" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                "valueDecimal" : 6
              }
            ],
            "system" : "http://loinc.org",
            "code" : "LA27993-7",
            "display" : "Independent - Resident completes the activity by themself with no assistance from a helper."
          }
        }
      ]
    },
    {
      "linkId" : "/89392-5",
      "text" : "Sit to stand",
      "answer" : [
        {
          "valueCoding" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                "valueDecimal" : 4
              }
            ],
            "system" : "http://loinc.org",
            "code" : "LA28870-6",
            "display" : "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently."
          }
        }
      ]
    },
    {
      "linkId" : "/89414-7",
      "text" : "Chair/bed-to-chair transfer",
      "answer" : [
        {
          "valueCoding" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                "valueDecimal" : 4
              }
            ],
            "system" : "http://loinc.org",
            "code" : "LA28870-6",
            "display" : "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently."
          }
        }
      ]
    },
    {
      "linkId" : "/89390-9",
      "text" : "Toilet transfer",
      "answer" : [
        {
          "valueCoding" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                "valueDecimal" : 4
              }
            ],
            "system" : "http://loinc.org",
            "code" : "LA28870-6",
            "display" : "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently."
          }
        }
      ]
    },
    {
      "linkId" : "/101325-9",
      "text" : "Tub/shower transfer",
      "answer" : [
        {
          "valueCoding" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                "valueDecimal" : 4
              }
            ],
            "system" : "http://loinc.org",
            "code" : "LA28870-6",
            "display" : "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently."
          }
        }
      ]
    },
    {
      "linkId" : "/89412-1",
      "text" : "Car transfer",
      "answer" : [
        {
          "valueCoding" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                "valueDecimal" : 4
              }
            ],
            "system" : "http://loinc.org",
            "code" : "LA28870-6",
            "display" : "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently."
          }
        }
      ]
    },
    {
      "linkId" : "/89385-9",
      "text" : "Walk 10 feet",
      "answer" : [
        {
          "valueCoding" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                "valueDecimal" : 6
              }
            ],
            "system" : "http://loinc.org",
            "code" : "LA27993-7",
            "display" : "Independent - Resident completes the activity by themself with no assistance from a helper."
          }
        }
      ]
    },
    {
      "linkId" : "/89381-8",
      "text" : "Walk 50 feet with two turns",
      "answer" : [
        {
          "valueCoding" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                "valueDecimal" : 4
              }
            ],
            "system" : "http://loinc.org",
            "code" : "LA28870-6",
            "display" : "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently."
          }
        }
      ]
    },
    {
      "linkId" : "/89383-4",
      "text" : "Walk 150 feet",
      "answer" : [
        {
          "valueCoding" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                "valueDecimal" : 4
              }
            ],
            "system" : "http://loinc.org",
            "code" : "LA28870-6",
            "display" : "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently."
          }
        }
      ]
    },
    {
      "linkId" : "/89379-2",
      "text" : "Walking 10 feet on uneven surfaces",
      "answer" : [
        {
          "valueCoding" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                "valueDecimal" : 4
              }
            ],
            "system" : "http://loinc.org",
            "code" : "LA28870-6",
            "display" : "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently."
          }
        }
      ]
    },
    {
      "linkId" : "/89420-4",
      "text" : "1 step (curb)",
      "answer" : [
        {
          "valueCoding" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                "valueDecimal" : 4
              }
            ],
            "system" : "http://loinc.org",
            "code" : "LA28870-6",
            "display" : "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently."
          }
        }
      ]
    },
    {
      "linkId" : "/89416-2",
      "text" : "4 steps",
      "answer" : [
        {
          "valueCoding" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                "valueDecimal" : 4
              }
            ],
            "system" : "http://loinc.org",
            "code" : "LA28870-6",
            "display" : "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as resident completes activity. Assistance may be provided throughout the activity or intermittently."
          }
        }
      ]
    },
    {
      "linkId" : "/89418-8",
      "text" : "12 steps",
      "answer" : [
        {
          "valueCoding" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                "valueDecimal" : 4
              }
            ],
            "system" : "http://loinc.org",
            "code" : "LA28870-6",
            "display" : "Setup or clean-up assistance - Helper sets up or cleans up; resident completes activity. Helper assists only prior to or following the activity."
          }
        }
      ]
    },
    {
      "linkId" : "/89402-2",
      "text" : "Picking up object",
      "answer" : [
        {
          "valueCoding" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                "valueDecimal" : 5
              }
            ],
            "system" : "http://loinc.org",
            "code" : "LA27994-5",
            "display" : "Dependent - Helper does all of the effort. Resident does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the resident to complete the activity."
          }
        }
      ]
    },
    {
      "linkId" : "/95738-1",
      "text" : "Does the resident use a wheelchair and/or scooter?",
      "answer" : [
        {
          "valueCoding" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                "valueDecimal" : 0
              }
            ],
            "system" : "http://loinc.org",
            "code" : "LA32-8",
            "display" : "No"
          }
        }
      ]
    }
  ]
}

```
