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 - XML Representation

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<QuestionnaireResponse xmlns="http://hl7.org/fhir">
  <id value="QResponse-SNF-BIMS-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 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>
  </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="2020-07-11T11:30:00-05:00"/>
  <author>
    <reference value="PractitionerRole/Role-SLP-HoneyJones"/>
  </author>
  <item>
    <linkId value="Section-3"/>
    <text value="MDS v3.0 - RAI v1.17.2 - Cognitive patterns [CMS Assessment]"/>
    <item>
      <linkId value="Section-3/C0200-C0500"/>
      <text value="Brief interview for mental status [BIMS]"/>
      <item>
        <linkId value="Section-3/C0200"/>
        <text
              value="Repetition of Three Words. Number of words repeated after first attempt"/>
        <answer>
          <valueCoding>
            <system value="http://loinc.org"/>
            <code value="LA6404-3"/>
            <display value="Two"/>
          </valueCoding>
        </answer>
      </item>
      <item>
        <linkId value="Section-3/C0300"/>
        <text
              value="Temporal orientation (orientation to year, month, and day) [BIMS]"/>
        <item>
          <linkId value="Section-3/C0300A"/>
          <text value="Able to report correct year"/>
          <answer>
            <valueCoding>
              <system value="http://loinc.org"/>
              <code value="LA10008-3"/>
              <display value="Missed by 1 year"/>
            </valueCoding>
          </answer>
        </item>
        <item>
          <linkId value="Section-3/C0300B"/>
          <text value="Able to report correct month"/>
          <answer>
            <valueCoding>
              <system value="http://loinc.org"/>
              <code value="LA10010-9"/>
              <display value="Missed by 6 days to 1 month"/>
            </valueCoding>
          </answer>
        </item>
        <item>
          <linkId value="Section-3/C0300C"/>
          <text value="Able to report correct day of the week"/>
          <answer>
            <valueCoding>
              <system value="http://loinc.org"/>
              <code value="LA9960-1"/>
              <display value="Correct"/>
            </valueCoding>
          </answer>
        </item>
      </item>
      <item>
        <linkId value="Section-3/C0400"/>
        <text value="Recall [BIMS]"/>
        <item>
          <linkId value="Section-3/C0400A"/>
          <text value="Able to recall &quot;sock&quot;"/>
          <answer>
            <valueCoding>
              <system value="http://loinc.org"/>
              <code value="LA10126-3"/>
              <display value="Yes, after cueing (&quot;something to wear&quot;)"/>
            </valueCoding>
          </answer>
        </item>
        <item>
          <linkId value="Section-3/C0400B"/>
          <text value="Able to recall &quot;blue&quot;"/>
          <answer>
            <valueCoding>
              <system value="http://loinc.org"/>
              <code value="LA10978-7"/>
              <display value="Yes, after cueing (&quot;a color&quot;)"/>
            </valueCoding>
          </answer>
        </item>
        <item>
          <linkId value="Section-3/C0400C"/>
          <text value="Able to recall &quot;bed&quot;"/>
          <answer>
            <valueCoding>
              <system value="http://loinc.org"/>
              <code value="LA10125-5"/>
              <display
                       value="Yes, after cueing (&quot;a piece of furniture&quot;)"/>
            </valueCoding>
          </answer>
        </item>
      </item>
      <item>
        <linkId value="Section-3/C0500"/>
        <text value="BIMS Summary Score"/>
        <answer>
          <valueQuantity>
            <value value="9"/>
            <system value="http://unitsofmeasure.org"/>
            <code value="{score}"/>
          </valueQuantity>
        </answer>
      </item>
    </item>
  </item>
</QuestionnaireResponse>