# betsysmith-johnson01-qr-ot-assessment-snf-admission-01 - PACIO Sample Data Depot v0.1.0

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

## Example QuestionnaireResponse: betsysmith-johnson01-qr-ot-assessment-snf-admission-01

* [LinkID](https://hl7.org/fhir/R4/formats.html#table): betsysmith-johnson01-qr-ot-assessment-snf-admission-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)/95019-6
  * [Text](https://hl7.org/fhir/R4/formats.html#table): Eating
  * [Definition](https://hl7.org/fhir/R4/formats.html#table): 
  * [Answer](https://hl7.org/fhir/R4/formats.html#table)![](data:image/png;base64, ): [LOINC: LA11759-0](https://loinc.org/LA11759-0)(Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.)
* [LinkID](https://hl7.org/fhir/R4/formats.html#table): ![](icon-q-string.png)/95018-8
  * [Text](https://hl7.org/fhir/R4/formats.html#table): Oral hygiene
  * [Definition](https://hl7.org/fhir/R4/formats.html#table): 
  * [Answer](https://hl7.org/fhir/R4/formats.html#table)![](data:image/png;base64, ): [LOINC: LA11759-0](https://loinc.org/LA11759-0)(Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.)
* [LinkID](https://hl7.org/fhir/R4/formats.html#table): ![](icon-q-string.png)/95017-0
  * [Text](https://hl7.org/fhir/R4/formats.html#table): Toileting hygiene
  * [Definition](https://hl7.org/fhir/R4/formats.html#table): 
  * [Answer](https://hl7.org/fhir/R4/formats.html#table)![](data:image/png;base64, ): [LOINC: LA11759-0](https://loinc.org/LA11759-0)(Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.)
* [LinkID](https://hl7.org/fhir/R4/formats.html#table): ![](icon-q-string.png)/95015-4
  * [Text](https://hl7.org/fhir/R4/formats.html#table): Shower/bathe self
  * [Definition](https://hl7.org/fhir/R4/formats.html#table): 
  * [Answer](https://hl7.org/fhir/R4/formats.html#table)![](data:image/png;base64, ): [LOINC: LA27998-6](https://loinc.org/LA27998-6)(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)/95014-7
  * [Text](https://hl7.org/fhir/R4/formats.html#table): Upper body dressing
  * [Definition](https://hl7.org/fhir/R4/formats.html#table): 
  * [Answer](https://hl7.org/fhir/R4/formats.html#table)![](data:image/png;base64, ): [LOINC: LA27998-6](https://loinc.org/LA27998-6)(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)/95013-9
  * [Text](https://hl7.org/fhir/R4/formats.html#table): Lower body dressing
  * [Definition](https://hl7.org/fhir/R4/formats.html#table): 
  * [Answer](https://hl7.org/fhir/R4/formats.html#table)![](data:image/png;base64, ): [LOINC: LA27998-6](https://loinc.org/LA27998-6)(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)/95012-1
  * [Text](https://hl7.org/fhir/R4/formats.html#table): Putting on/taking off footwear
  * [Definition](https://hl7.org/fhir/R4/formats.html#table): 
  * [Answer](https://hl7.org/fhir/R4/formats.html#table)![](data:image/png;base64, ): [LOINC: LA27998-6](https://loinc.org/LA27998-6)(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)/45606-1
  * [Text](https://hl7.org/fhir/R4/formats.html#table): Personal hygiene
  * [Definition](https://hl7.org/fhir/R4/formats.html#table): 
  * [Answer](https://hl7.org/fhir/R4/formats.html#table)![](data:image/png;base64, ): [LOINC: LA11759-0](https://loinc.org/LA11759-0)(Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort.)
* [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-ot-assessment-snf-admission-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" : "2025-05-05T11:00:00.000Z",
  "author" : {
    "reference" : "PractitionerRole/PractitionerRole-OT-SonjaValdez"
  },
  "item" : [
    {
      "linkId" : "/95019-6",
      "text" : "Eating",
      "answer" : [
        {
          "valueCoding" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                "valueDecimal" : 2
              }
            ],
            "system" : "http://loinc.org",
            "code" : "LA11759-0",
            "display" : "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
          }
        }
      ]
    },
    {
      "linkId" : "/95018-8",
      "text" : "Oral hygiene",
      "answer" : [
        {
          "valueCoding" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                "valueDecimal" : 2
              }
            ],
            "system" : "http://loinc.org",
            "code" : "LA11759-0",
            "display" : "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
          }
        }
      ]
    },
    {
      "linkId" : "/95017-0",
      "text" : "Toileting hygiene",
      "answer" : [
        {
          "valueCoding" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                "valueDecimal" : 2
              }
            ],
            "system" : "http://loinc.org",
            "code" : "LA11759-0",
            "display" : "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
          }
        }
      ]
    },
    {
      "linkId" : "/95015-4",
      "text" : "Shower/bathe self",
      "answer" : [
        {
          "valueCoding" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                "valueDecimal" : 1
              }
            ],
            "system" : "http://loinc.org",
            "code" : "LA27998-6",
            "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" : "/95014-7",
      "text" : "Upper body dressing",
      "answer" : [
        {
          "valueCoding" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                "valueDecimal" : 1
              }
            ],
            "system" : "http://loinc.org",
            "code" : "LA27998-6",
            "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" : "/95013-9",
      "text" : "Lower body dressing",
      "answer" : [
        {
          "valueCoding" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                "valueDecimal" : 1
              }
            ],
            "system" : "http://loinc.org",
            "code" : "LA27998-6",
            "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" : "/95012-1",
      "text" : "Putting on/taking off footwear",
      "answer" : [
        {
          "valueCoding" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                "valueDecimal" : 1
              }
            ],
            "system" : "http://loinc.org",
            "code" : "LA27998-6",
            "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" : "/45606-1",
      "text" : "Personal hygiene",
      "answer" : [
        {
          "valueCoding" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/ordinalValue",
                "valueDecimal" : 2
              }
            ],
            "system" : "http://loinc.org",
            "code" : "LA11759-0",
            "display" : "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
          }
        }
      ]
    }
  ]
}

```
