PACIO Sample Data Depot
0.1.0 - draft

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-september

version: 1; Last updated: 2025-09-25 11:22:40+0000

LinkID | Text | Definition | Answer
--- | --- | --- | ---
promis-10-assessment-betsy-september |  |  | Questionnaire:PROMIS-10
mbi | What is this patient's Medicare Beneficiary Identifier (MBI)? |  | 7A34C75DE12
assessment_date | Please report the date this assessment was completed. |  | 2025-09-25
health | In general, would you say your health is... |  | LOINC: LA13913-1 (Very Good)
quality_of_life | In general, would you say your quality of life is... |  | LOINC: LA8967-7 (Good)
physical_health | In general, how would you rate your physical health? |  | LOINC: LA8967-7 (Good)
mental_health | In general, how would you rate your mental health, including your mood and your ability to think? |  | LOINC: LA8967-7 (Good)
satisfaction_social | In general, how would you rate your satisfaction with your social activities and relationships? |  | LOINC: LA8967-7 (Good)
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: LA13913-1 (Very 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: LA13937-0 (Completely)
emotional | In the past 7 days, how often have you been bothered by emotional problems such as feeling anxious, depressed or irritable? |  | LOINC: LA10082-8 (Sometimes)
fatigue | In the past 7 days, how would you rate your fatigue on average? |  | LOINC: LA6752-5 (Mild)
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: LA6115-5 (4)
physical_health_score | Physical Health Score (Raw Score) |  | 15
mental_health_score | Mental Health Score (Raw Score) |  | 12
physical_health_tscore | PROMIS Global Physical Health v1.2 T-Score |  | 47.7
mental_health_tscore | PROMIS Global Mental Health v1.2 T-Score |  | 43.5
Documentation for this format