PACIO Functional Status Implementation Guide
1.0.0 - STU 1

This page is part of the PACIO Functional Status Implementation Guide (v1.0.0: STU 1) based on FHIR R4. This is the current published version. For a full list of available versions, see the Directory of published versions

: QResponse-Hospital-Admission-Mobility-1 - XML Representation

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<QuestionnaireResponse xmlns="http://hl7.org/fhir">
  <id value="QResponse-Hospital-Admission-Mobility-1"/>
  <meta>
    <profile
             value="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaireresponse"/>
  </meta>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p><b>Generated Narrative</b></p><p><b>questionnaire</b>: <a href="http://example.org/Questionnaire/MDS3.0-NC-1.17">http://example.org/Questionnaire/MDS3.0-NC-1.17</a></p><p><b>status</b>: completed</p><p><b>subject</b>: <a href="Patient-patientBSJ1.html">Generated Summary: Betsy Smith-Johnson </a></p><p><b>authored</b>: Jul 8, 2020 9:00:00 PM</p><p><b>author</b>: <a href="PractitionerRole-Role-PT-SallySmith.html">Generated Summary: active: true; <span title="Codes: {http://snomed.info/sct 36682004}">Physiotherapist</span></a></p><blockquote><p><b>item</b></p><p><b>linkId</b>: Section-37</p><p><b>text</b>: Functional abilities and goals - admission [CMS Assessment]</p><blockquote><p><b>item</b></p><p><b>linkId</b>: Section-37/GG0170_1</p><p><b>text</b>: Mobility - admission performance during 3 day assessment period [CMS Assessment]</p></blockquote></blockquote></div>
  </text>
  <questionnaire value="http://example.org/Questionnaire/MDS3.0-NC-1.17">
    <extension url="http://hl7.org/fhir/StructureDefinition/display">
      <valueString
                   value="Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.17.1 [CMS Assessment]"/>
    </extension>
  </questionnaire>
  <status value="completed"/>
  <subject>
    <reference value="Patient/patientBSJ1"/>
  </subject>
  <authored value="2020-07-08T16:00:00-05:00"/>
  <author>
    <reference value="PractitionerRole/Role-PT-SallySmith"/>
  </author>
  <item>
    <linkId value="Section-37"/>
    <text value="Functional abilities and goals - admission [CMS Assessment]"/>
    <item>
      <linkId value="Section-37/GG0170_1"/>
      <text
            value="Mobility - admission performance during 3 day assessment period [CMS Assessment]"/>
      <item>
        <linkId value="Section-37/GG0170A1"/>
        <text
              value="Roll left and right - functional ability during 3 day assessment period [CMS Assessment]"/>
        <answer>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA11759-0"/>
            <display
                     value="Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."/>
          </valueCoding>
        </answer>
      </item>
      <item>
        <linkId value="Section-37/GG0170B1"/>
        <text
              value="Sit to lying - functional ability during 3 day assessment period [CMS Assessment]"/>
        <answer>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA11759-0"/>
            <display
                     value="Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."/>
          </valueCoding>
        </answer>
      </item>
      <item>
        <linkId value="Section-37/GG0170C1"/>
        <text
              value="Lying to sitting on side of bed - functional ability during 3 day assessment period [CMS Assessment]"/>
        <answer>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA11759-0"/>
            <display
                     value="Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."/>
          </valueCoding>
        </answer>
      </item>
      <item>
        <linkId value="Section-37/GG0170D1"/>
        <text
              value="Sit to stand - functional ability during 3 day assessment period [CMS Assessment]"/>
        <answer>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA11759-0"/>
            <display
                     value="Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."/>
          </valueCoding>
        </answer>
      </item>
      <item>
        <linkId value="Section-37/GG0170E1"/>
        <text
              value="Chair/bed-to-chair transfer - functional ability during 3 day assessment period [CMS Assessment]"/>
        <answer>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA27665-1"/>
            <display
                     value="Dependent - Helper does all of the effort. Patient does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the patient to complete the activity."/>
          </valueCoding>
        </answer>
      </item>
      <item>
        <linkId value="Section-37/GG0170F1"/>
        <text
              value="Toilet transfer - functional ability during 3 day assessment period [CMS Assessment]"/>
        <answer>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA26735-3"/>
            <display
                     value="Not attempted due to medical condition or safety concerns"/>
          </valueCoding>
        </answer>
      </item>
      <item>
        <linkId value="Section-37/GG0170G1"/>
        <text
              value="Car transfer - functional ability during 3 day assessment period [CMS Assessment]"/>
        <answer>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA26735-3"/>
            <display
                     value="Not attempted due to medical condition or safety concerns"/>
          </valueCoding>
        </answer>
      </item>
      <item>
        <linkId value="Section-37/GG0170I1"/>
        <text
              value="Walk 10 feet - functional ability during 3 day assessment period [CMS Assessment]"/>
        <answer>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA26735-3"/>
            <display
                     value="Not attempted due to medical condition or safety concerns"/>
          </valueCoding>
        </answer>
      </item>
      <item>
        <linkId value="Section-37/GG0170J1"/>
        <text
              value="Walk 50 feet with two turns - functional ability during 3 day assessment period [CMS Assessment]"/>
        <answer>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA26735-3"/>
            <display
                     value="Not attempted due to medical condition or safety concerns"/>
          </valueCoding>
        </answer>
      </item>
      <item>
        <linkId value="Section-37/GG0170K1"/>
        <text
              value="Walk 150 feet - functional ability during 3 day assessment period [CMS Assessment]"/>
        <answer>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA26735-3"/>
            <display
                     value="Not attempted due to medical condition or safety concerns"/>
          </valueCoding>
        </answer>
      </item>
      <item>
        <linkId value="Section-37/GG0170L1"/>
        <text
              value="Walking 10 feet on uneven surfaces - functional ability during 3 day assessment period [CMS Assessment]"/>
        <answer>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA26735-3"/>
            <display
                     value="Not attempted due to medical condition or safety concerns"/>
          </valueCoding>
        </answer>
      </item>
      <item>
        <linkId value="Section-37/GG0170M1"/>
        <text
              value="1 step (curb) - functional ability during 3 day assessment period [CMS Assessment]"/>
        <answer>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA26735-3"/>
            <display
                     value="Not attempted due to medical condition or safety concerns"/>
          </valueCoding>
        </answer>
      </item>
      <item>
        <linkId value="Section-37/GG0170N1"/>
        <text
              value="4 steps - functional ability during 3 day assessment period [CMS Assessment]"/>
        <answer>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA26735-3"/>
            <display
                     value="Not attempted due to medical condition or safety concerns"/>
          </valueCoding>
        </answer>
      </item>
      <item>
        <linkId value="Section-37/GG0170O1"/>
        <text
              value="12 steps - functional ability during 3 day assessment period [CMS Assessment]"/>
        <answer>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA26735-3"/>
            <display
                     value="Not attempted due to medical condition or safety concerns"/>
          </valueCoding>
        </answer>
      </item>
      <item>
        <linkId value="Section-37/GG0170P1"/>
        <text
              value="Picking up object - functional ability during 3 day assessment period [CMS Assessment]"/>
        <answer>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA26735-3"/>
            <display
                     value="Not attempted due to medical condition or safety concerns"/>
          </valueCoding>
        </answer>
      </item>
      <item>
        <linkId value="Section-37/GG0170R1"/>
        <text
              value="Wheel 50 feet with two turns - functional ability during 3 day assessment period [CMS Assessment]"/>
        <answer>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA26735-3"/>
            <display
                     value="Not attempted due to medical condition or safety concerns"/>
          </valueCoding>
        </answer>
      </item>
      <item>
        <linkId value="Section-37/GG0170S1"/>
        <text
              value="Wheel 150 feet - functional ability during 3 day assessment period [CMS Assessment]"/>
        <answer>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA26735-3"/>
            <display
                     value="Not attempted due to medical condition or safety concerns"/>
          </valueCoding>
        </answer>
      </item>
    </item>
  </item>
</QuestionnaireResponse>