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

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

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

* [LinkID](https://hl7.org/fhir/R4/formats.html#table): betsysmith-johnson01-qr-pt-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)/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: LA27994-5](https://loinc.org/LA27994-5) (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)/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: 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)/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: 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)/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: 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)/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: 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)/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: 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)/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: LA27996-0](https://loinc.org/LA27996-0) (Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.)
* [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: 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)/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: 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)/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: 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)/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: LA27996-0](https://loinc.org/LA27996-0) (Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort.)
* [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: 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)/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: 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)/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: 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)/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-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" : "2025-05-05T09:00:00.000Z",
  "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" : 5
        }],
        "system" : "http://loinc.org",
        "code" : "LA27994-5",
        "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" : "/89392-5",
    "text" : "Sit to stand",
    "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" : "/89414-7",
    "text" : "Chair/bed-to-chair transfer",
    "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" : "/89390-9",
    "text" : "Toilet transfer",
    "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" : "/101325-9",
    "text" : "Tub/shower transfer",
    "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" : "/89412-1",
    "text" : "Car transfer",
    "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" : "/89385-9",
    "text" : "Walk 10 feet",
    "answer" : [{
      "valueCoding" : {
        "extension" : [{
          "url" : "http://hl7.org/fhir/StructureDefinition/ordinalValue",
          "valueDecimal" : 3
        }],
        "system" : "http://loinc.org",
        "code" : "LA27996-0",
        "display" : "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort."
      }
    }]
  },
  {
    "linkId" : "/89381-8",
    "text" : "Walk 50 feet with two turns",
    "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" : "/89383-4",
    "text" : "Walk 150 feet",
    "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" : "/89379-2",
    "text" : "Walking 10 feet on uneven surfaces",
    "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" : "/89420-4",
    "text" : "1 step (curb)",
    "answer" : [{
      "valueCoding" : {
        "extension" : [{
          "url" : "http://hl7.org/fhir/StructureDefinition/ordinalValue",
          "valueDecimal" : 3
        }],
        "system" : "http://loinc.org",
        "code" : "LA27996-0",
        "display" : "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds, or supports trunk or limbs, but provides less than half the effort."
      }
    }]
  },
  {
    "linkId" : "/89416-2",
    "text" : "4 steps",
    "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" : "/89418-8",
    "text" : "12 steps",
    "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" : "/89402-2",
    "text" : "Picking up object",
    "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" : "/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"
      }
    }]
  }]
}

```
