PACIO Cognitive Status Implementation Guide
1.0.0 - STU 1

This page is part of the PACIO Cognitive 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-BIMS-1 - JSON Representation

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{
  "resourceType" : "QuestionnaireResponse",
  "id" : "QResponse-SNF-BIMS-1",
  "meta" : {
    "profile" : [
      "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaireresponse"
    ]
  },
  "text" : {
    "status" : "generated",
    "div" : "<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 4:30:00 PM</p><p><b>author</b>: <a href=\"PractitionerRole-Role-SLP-HoneyJones.html\">Generated Summary: active: true; <span title=\"Codes: {http://snomed.info/sct 159026005}\">Speech and language therapist</span></a></p><blockquote><p><b>item</b></p><p><b>linkId</b>: Section-3</p><p><b>text</b>: MDS v3.0 - RAI v1.17.2 - Cognitive patterns [CMS Assessment]</p><blockquote><p><b>item</b></p><p><b>linkId</b>: Section-3/C0200-C0500</p><p><b>text</b>: Brief interview for mental status [BIMS]</p></blockquote></blockquote></div>"
  },
  "questionnaire" : "http://example.org/Questionnaire/MDS3.0-NC-1.17",
  "_questionnaire" : {
    "extension" : [
      {
        "url" : "http://hl7.org/fhir/StructureDefinition/display",
        "valueString" : "Minimum Data Set (MDS) - version 3.0 - Resident Assessment Instrument (RAI) version 1.17.1 [CMS Assessment]"
      }
    ]
  },
  "status" : "completed",
  "subject" : {
    "reference" : "Patient/patientBSJ1"
  },
  "authored" : "2020-07-11T11:30:00-05:00",
  "author" : {
    "reference" : "PractitionerRole/Role-SLP-HoneyJones"
  },
  "item" : [
    {
      "linkId" : "Section-3",
      "text" : "MDS v3.0 - RAI v1.17.2 - Cognitive patterns [CMS Assessment]",
      "item" : [
        {
          "linkId" : "Section-3/C0200-C0500",
          "text" : "Brief interview for mental status [BIMS]",
          "item" : [
            {
              "linkId" : "Section-3/C0200",
              "text" : "Repetition of Three Words. Number of words repeated after first attempt",
              "answer" : [
                {
                  "valueCoding" : {
                    "system" : "http://loinc.org",
                    "code" : "LA6404-3",
                    "display" : "Two"
                  }
                }
              ]
            },
            {
              "linkId" : "Section-3/C0300",
              "text" : "Temporal orientation (orientation to year, month, and day) [BIMS]",
              "item" : [
                {
                  "linkId" : "Section-3/C0300A",
                  "text" : "Able to report correct year",
                  "answer" : [
                    {
                      "valueCoding" : {
                        "system" : "http://loinc.org",
                        "code" : "LA10008-3",
                        "display" : "Missed by 1 year"
                      }
                    }
                  ]
                },
                {
                  "linkId" : "Section-3/C0300B",
                  "text" : "Able to report correct month",
                  "answer" : [
                    {
                      "valueCoding" : {
                        "system" : "http://loinc.org",
                        "code" : "LA10010-9",
                        "display" : "Missed by 6 days to 1 month"
                      }
                    }
                  ]
                },
                {
                  "linkId" : "Section-3/C0300C",
                  "text" : "Able to report correct day of the week",
                  "answer" : [
                    {
                      "valueCoding" : {
                        "system" : "http://loinc.org",
                        "code" : "LA9960-1",
                        "display" : "Correct"
                      }
                    }
                  ]
                }
              ]
            },
            {
              "linkId" : "Section-3/C0400",
              "text" : "Recall [BIMS]",
              "item" : [
                {
                  "linkId" : "Section-3/C0400A",
                  "text" : "Able to recall \"sock\"",
                  "answer" : [
                    {
                      "valueCoding" : {
                        "system" : "http://loinc.org",
                        "code" : "LA10126-3",
                        "display" : "Yes, after cueing (\"something to wear\")"
                      }
                    }
                  ]
                },
                {
                  "linkId" : "Section-3/C0400B",
                  "text" : "Able to recall \"blue\"",
                  "answer" : [
                    {
                      "valueCoding" : {
                        "system" : "http://loinc.org",
                        "code" : "LA10978-7",
                        "display" : "Yes, after cueing (\"a color\")"
                      }
                    }
                  ]
                },
                {
                  "linkId" : "Section-3/C0400C",
                  "text" : "Able to recall \"bed\"",
                  "answer" : [
                    {
                      "valueCoding" : {
                        "system" : "http://loinc.org",
                        "code" : "LA10125-5",
                        "display" : "Yes, after cueing (\"a piece of furniture\")"
                      }
                    }
                  ]
                }
              ]
            },
            {
              "linkId" : "Section-3/C0500",
              "text" : "BIMS Summary Score",
              "answer" : [
                {
                  "valueQuantity" : {
                    "value" : 9,
                    "system" : "http://unitsofmeasure.org",
                    "code" : "{score}"
                  }
                }
              ]
            }
          ]
        }
      ]
    }
  ]
}