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-SNF-Admission-Mobility-SelfCare-1 - XML Representation

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<QuestionnaireResponse xmlns="http://hl7.org/fhir">
  <id value="QResponse-SNF-Admission-Mobility-SelfCare-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 11, 2020 9:32:00 PM</p><p><b>author</b>: <a href="PractitionerRole-Role-OT-JenCadbury.html">Generated Summary: active: true; <span title="Codes: {http://snomed.info/sct 80546007}">Occupational therapist</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/GG0130_1</p><p><b>text</b>: Self-care - admission performance [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="2020-07-11T16:32:00-05:00"/>
  <author>
    <reference value="PractitionerRole/Role-OT-JenCadbury"/>
  </author>
  <item>
    <linkId value="Section-37"/>
    <text value="Functional abilities and goals - admission [CMS Assessment]"/>
    <item>
      <linkId value="Section-37/GG0130_1"/>
      <text value="Self-care - admission performance [CMS Assessment]"/>
      <item>
        <linkId value="Section-37/GG0130A1"/>
        <text value="Eating"/>
        <answer>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA10055-4"/>
            <display
                     value="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."/>
          </valueCoding>
        </answer>
      </item>
      <item>
        <linkId value="Section-37/GG0130B1"/>
        <text value="Oral hygiene"/>
        <answer>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA10055-4"/>
            <display
                     value="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."/>
          </valueCoding>
        </answer>
      </item>
      <item>
        <linkId value="Section-37/GG0130C1"/>
        <text value="Toileting hygiene"/>
        <answer>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA10055-4"/>
            <display
                     value="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."/>
          </valueCoding>
        </answer>
      </item>
      <item>
        <linkId value="Section-37/GG0130E1"/>
        <text value="Shower/bathe self"/>
        <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/GG0130F1"/>
        <text value="Upper body dressing"/>
        <answer>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA10055-4"/>
            <display
                     value="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."/>
          </valueCoding>
        </answer>
      </item>
      <item>
        <linkId value="Section-37/GG0130G1"/>
        <text value="Lower body dressing"/>
        <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/GG0130H1"/>
        <text value="Putting on/taking off footwear"/>
        <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>
  </item>
</QuestionnaireResponse>