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

## Questionnaire: PROMIS-10

Official URL: https://globalalliantinc.com/fhir/Questionnaire/questionnaire-PROMIS10 | Version: 0.1.0
Draft as of 2026-03-26 | Computable Name:

PROMIS Global-10

The PROMIS Global-10 is a 10-item patient-reported questionnaire used to gauge the patient’s overall physical and mental health.

Structure

LinkID | Text | Cardinality | Type | Flags | Description & Constraints
--- | --- | --- | --- | --- | ---
| PROMIS Global-10 |  | Questionnaire |  | https://globalalliantinc.com/fhir/Questionnaire/questionnaire-PROMIS10#0.1.0
mbi | What is this patient's Medicare Beneficiary Identifier (MBI)? | 1..1 | string |  | Value Set:
assessment_date | Please report the date this assessment was complete. | 1..1 | date |  | Value Set:
health | In general, would you say your health is... | 1..1 | choice |  | Value Set: Options: 5 options
quality_of_life | In general, would you say your quality of life is... | 1..1 | choice |  | Value Set: Options: 5 options
physical_health | In general, how would you rate your physical health? | 1..1 | choice |  | Value Set: Options: 5 options
mental_health | In general, how would you rate your mental health, including your mood and your ability to think? | 1..1 | choice |  | Value Set: Options: 5 options
satisfaction_social | In general, how would you rate your satisfaction with your social activities and relationships? | 1..1 | choice |  | Value Set: Options: 5 options
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.) | 1..1 | choice |  | Value Set: Options: 5 options
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? | 1..1 | choice |  | Value Set: Options: 5 options
emotional | In the past 7 days, how often have you been bothered by emotional problems such as feeling anxious, depressed or irritable? | 1..1 | choice |  | Value Set: Options: 5 options
fatigue | In the past 7 days, how would you rate your fatigue on average? | 1..1 | choice |  | Value Set: Options: 5 options
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? | 1..1 | choice |  | Value Set: Options: 11 options
physical_health_score | PROMIS-10 Global Health, GPH, raw score | 0..1 | decimal |  | Value Set:
mental_health_score | PROMIS-10 Global Health, GMH raw score | 0..1 | decimal |  | Value Set:
physical_health_tscore | PROMIS Global Physical Health v1.2 T-Score | 0..1 | decimal |  | Value Set:
mental_health_tscore | PROMIS Global Mental Health v1.2 T-Score | 0..1 | decimal |  | Value Set:
Documentation for this format

Options Sets

Answer options for health

- http://loinc.org#LA9206-9 ("Excellent")
- http://loinc.org#LA13913-1 ("Very Good")
- http://loinc.org#LA8967-7 ("Good")
- http://loinc.org#LA8968-5 ("Fair")
- http://loinc.org#LA8969-3 ("Poor")

Answer options for quality_of_life

- http://loinc.org#LA9206-9 ("Excellent")
- http://loinc.org#LA13913-1 ("Very Good")
- http://loinc.org#LA8967-7 ("Good")
- http://loinc.org#LA8968-5 ("Fair")
- http://loinc.org#LA8969-3 ("Poor")

Answer options for physical_health

- http://loinc.org#LA9206-9 ("Excellent")
- http://loinc.org#LA13913-1 ("Very Good")
- http://loinc.org#LA8967-7 ("Good")
- http://loinc.org#LA8968-5 ("Fair")
- http://loinc.org#LA8969-3 ("Poor")

Answer options for mental_health

- http://loinc.org#LA9206-9 ("Excellent")
- http://loinc.org#LA13913-1 ("Very Good")
- http://loinc.org#LA8967-7 ("Good")
- http://loinc.org#LA8968-5 ("Fair")
- http://loinc.org#LA8969-3 ("Poor")

Answer options for satisfaction_social

- http://loinc.org#LA9206-9 ("Excellent")
- http://loinc.org#LA13913-1 ("Very Good")
- http://loinc.org#LA8967-7 ("Good")
- http://loinc.org#LA8968-5 ("Fair")
- http://loinc.org#LA8969-3 ("Poor")

Answer options for social_activities

- http://loinc.org#LA9206-9 ("Excellent")
- http://loinc.org#LA13913-1 ("Very Good")
- http://loinc.org#LA8967-7 ("Good")
- http://loinc.org#LA8968-5 ("Fair")
- http://loinc.org#LA8969-3 ("Poor")

Answer options for physical_activities

- http://loinc.org#LA13937-0 ("Completely")
- http://loinc.org#LA13938-8 ("Mostly")
- http://loinc.org#LA13939-6 ("Moderately")
- http://loinc.org#LA13940-4 ("A little")
- http://loinc.org#LA6568-5 ("Not at all")

Answer options for emotional

- http://loinc.org#LA6270-8 ("Never")
- http://loinc.org#LA10066-1 ("Rarely")
- http://loinc.org#LA10082-8 ("Sometimes")
- http://loinc.org#LA10044-8 ("Often")
- http://loinc.org#LA9933-8 ("Always")

Answer options for fatigue

- http://loinc.org#LA137-2 ("None")
- http://loinc.org#LA6752-5 ("Mild")
- http://loinc.org#LA6751-7 ("Moderate")
- http://loinc.org#LA6750-9 ("Severe")
- http://loinc.org#LA13958-6 ("Very Severe")

Answer options for pain

- http://loinc.org#LA26951-6 ("0 - No Pain")
- http://loinc.org#LA6112-2 ("1")
- http://loinc.org#LA6113-0 ("2")
- http://loinc.org#LA6114-8 ("3")
- http://loinc.org#LA6115-5 ("4")
- http://loinc.org#LA10137-0 ("5")
- http://loinc.org#LA10138-8 ("6")
- http://loinc.org#LA10139-6 ("7")
- http://loinc.org#LA10140-4 ("8")
- http://loinc.org#LA10141-2 ("9")
- http://loinc.org#LA26952-4 ("10 - Worst Pain Imaginable")