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

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: QResponse-SNF-PHQ9-1 - XML Representation

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<QuestionnaireResponse xmlns="http://hl7.org/fhir">
  <id value="QResponse-SNF-PHQ9-1"/>
  <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-LunaBaskins.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-4</p><p><b>text</b>: MDS v3.0 - RAI v1.18.1 - Mood - OSA [CMS Assessment]</p><blockquote><p><b>item</b></p><p><b>linkId</b>: Section-4/D0200</p><p><b>text</b>: Resident mood interview (PHQ-9) [Reported PHQ-9 CMS]</p></blockquote><blockquote><p><b>item</b></p><p><b>linkId</b>: Section-4/D0300</p><p><b>text</b>: PHQ-9 Total Score</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-LunaBaskins"/>
  </author>
  <item>
    <linkId value="Section-4"/>
    <text value="MDS v3.0 - RAI v1.18.1 - Mood - OSA [CMS Assessment]"/>
    <item>
      <linkId value="Section-4/D0200"/>
      <text value="Resident mood interview (PHQ-9) [Reported PHQ-9 CMS]"/>
      <item>
        <linkId value="Section-4/D0200_1"/>
        <text
              value="Resident mood interview (PHQ-9) - symptom presence in the last 2 weeks [CMS Assessment]"/>
        <item>
          <linkId value="Section-4/D0200A1"/>
          <text value="Little interest or pleasure in doing things"/>
          <answer>
            <valueCoding>
              <system value="http://loinc.org"/>
              <code value="LA33-6"/>
              <display value="Yes"/>
            </valueCoding>
          </answer>
        </item>
        <item>
          <linkId value="Section-4/D0200B1"/>
          <text value="Feeling down"/>
          <answer>
            <valueCoding>
              <system value="http://loinc.org"/>
              <code value="LA33-6"/>
              <display value="Yes"/>
            </valueCoding>
          </answer>
        </item>
        <item>
          <linkId value="Section-4/D0200C1"/>
          <text value="Trouble falling or staying asleep"/>
          <answer>
            <valueCoding>
              <system value="http://loinc.org"/>
              <code value="LA33-6"/>
              <display value="Yes"/>
            </valueCoding>
          </answer>
        </item>
        <item>
          <linkId value="Section-4/D0200D1"/>
          <text value="Feeling tired or having little energy"/>
          <answer>
            <valueCoding>
              <system value="http://loinc.org"/>
              <code value="LA32-8"/>
              <display value="No"/>
            </valueCoding>
          </answer>
        </item>
        <item>
          <linkId value="Section-4/D0200E1"/>
          <text value="Poor appetite or overeating"/>
          <answer>
            <valueCoding>
              <system value="http://loinc.org"/>
              <code value="LA32-8"/>
              <display value="No"/>
            </valueCoding>
          </answer>
        </item>
        <item>
          <linkId value="Section-4/D0200F1"/>
          <text
                value="Feeling bad about yourself - or that you are a failure or have let yourself or your family down"/>
          <answer>
            <valueCoding>
              <system value="http://loinc.org"/>
              <code value="LA32-8"/>
              <display value="No"/>
            </valueCoding>
          </answer>
        </item>
        <item>
          <linkId value="Section-4/D0200G1"/>
          <text value="Trouble concentrating on things"/>
          <answer>
            <valueCoding>
              <system value="http://loinc.org"/>
              <code value="LA32-8"/>
              <display value="No"/>
            </valueCoding>
          </answer>
        </item>
        <item>
          <linkId value="Section-4/D0200H1"/>
          <text
                value="Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual"/>
          <answer>
            <valueCoding>
              <system value="http://loinc.org"/>
              <code value="LA32-8"/>
              <display value="No"/>
            </valueCoding>
          </answer>
        </item>
        <item>
          <linkId value="Section-4/D0200I1"/>
          <text value="Thoughts that you would be better off dead"/>
          <answer>
            <valueCoding>
              <system value="http://loinc.org"/>
              <code value="LA10996-9"/>
              <display value="No response"/>
            </valueCoding>
          </answer>
        </item>
      </item>
      <item>
        <linkId value="Section-4/D0200_2"/>
        <text
              value="Resident mood interview (PHQ-9) - symptom frequency in the last 2 weeks [CMS Assessment]"/>
        <item>
          <linkId value="Section-4/D0200A2"/>
          <text value="Little interest or pleasure in doing things"/>
          <answer>
            <valueCoding>
              <system value="http://loinc.org"/>
              <code value="LA10998-5"/>
              <display value="2-6 days (several days)"/>
            </valueCoding>
          </answer>
        </item>
        <item>
          <linkId value="Section-4/D0200B2"/>
          <text value="Feeling down"/>
          <answer>
            <valueCoding>
              <system value="http://loinc.org"/>
              <code value="LA10998-5"/>
              <display value="2-6 days (several days)"/>
            </valueCoding>
          </answer>
        </item>
        <item>
          <linkId value="Section-4/D0200C2"/>
          <text value="Trouble falling or staying asleep"/>
          <answer>
            <valueCoding>
              <system value="http://loinc.org"/>
              <code value="LA10998-5"/>
              <display value="2-6 days (several days)"/>
            </valueCoding>
          </answer>
        </item>
        <item>
          <linkId value="Section-4/D0200D2"/>
          <text value="Feeling tired or having little energy"/>
          <answer>
            <valueCoding>
              <system value="http://loinc.org"/>
              <code value="LA10997-7"/>
              <display value="Never or 1 day"/>
            </valueCoding>
          </answer>
        </item>
        <item>
          <linkId value="Section-4/D0200E2"/>
          <text value="Poor appetite or overeating"/>
          <answer>
            <valueCoding>
              <system value="http://loinc.org"/>
              <code value="LA10997-7"/>
              <display value="Never or 1 day"/>
            </valueCoding>
          </answer>
        </item>
        <item>
          <linkId value="Section-4/D0200F2"/>
          <text
                value="Feeling bad about yourself - or that you are a failure or have let yourself or your family down"/>
          <answer>
            <valueCoding>
              <system value="http://loinc.org"/>
              <code value="LA10997-7"/>
              <display value="Never or 1 day"/>
            </valueCoding>
          </answer>
        </item>
        <item>
          <linkId value="Section-4/D0200G2"/>
          <text value="Trouble concentrating on things"/>
          <answer>
            <valueCoding>
              <system value="http://loinc.org"/>
              <code value="LA10997-7"/>
              <display value="Never or 1 day"/>
            </valueCoding>
          </answer>
        </item>
        <item>
          <linkId value="Section-4/D0200H2"/>
          <text
                value="Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual"/>
          <answer>
            <valueCoding>
              <system value="http://loinc.org"/>
              <code value="LA10997-7"/>
              <display value="Never or 1 day"/>
            </valueCoding>
          </answer>
        </item>
        <item>
          <linkId value="Section-4/D0200I2"/>
          <text value="Thoughts that you would be better off dead"/>
        </item>
      </item>
    </item>
    <item>
      <linkId value="Section-4/D0300"/>
      <text value="PHQ-9 Total Score"/>
      <answer>
        <valueQuantity>
          <value value="3"/>
          <system value="http://unitsofmeasure.org"/>
          <code value="{score}"/>
        </valueQuantity>
      </answer>
    </item>
  </item>
</QuestionnaireResponse>