CMS ACCESS Model API
0.9.8 - draft US

This page is part of the ACCESS Model IG v0.9.8 DRAFT (v0.9.8: Releases Draft) based on FHIR (HL7® FHIR® Standard) R4. No current official version has been published yet. For a full list of available versions, see the Directory of published versions

Questionnaire:

Computable Name:

Profile: SDCBaseQuestionnaire version: 3.0.0

Structure
LinkIDTextCardinalityTypeFlagsDescription & Constraintsdoco
.. Questionnaire http://example.org/Questionnaire/NeckDisabilityIndexQuestionnaire#0.9.7
... ndi-1 Pain intensity 0..1 choice Value Set:
Options: 6 options
... ndi-2 Personal care (washing, dressing, etc.) 0..1 choice Value Set:
Options: 6 options
... ndi-3 Lifting 0..1 choice Value Set:
Options: 6 options
... ndi-5 Headaches 0..1 choice Value Set:
Options: 6 options
... ndi-6 Concentration 0..1 choice Value Set:
Options: 6 options
... ndi-7 Work 0..1 choice Value Set:
Options: 6 options
... ndi-8 Driving 0..1 choice Value Set:
Options: 6 options
... ndi-9 Sleeping 0..1 choice Value Set:
Options: 6 options
... ndi-10 Recreation 0..1 choice Value Set:
Options: 6 options
... total-score Total score [NDI] 0..1 decimal iconicon Value Set:

doco Documentation for this format

Options Sets

Answer options for ndi-1

  • http://loinc.org#LA25853-5 ("I have no pain at the moment.")
  • http://loinc.org#LA25854-3 ("The pain is very mild at the moment.")
  • http://loinc.org#LA25855-0 ("The pain is moderate at the moment.")
  • http://loinc.org#LA25856-8 ("The pain is fairly severe at the moment.")
  • http://loinc.org#LA25857-6 ("The pain is very severe at the moment.")
  • http://loinc.org#LA25858-4 ("The pain is the worst imaginable at the moment.")

Answer options for ndi-2

  • http://loinc.org#LA25859-2 ("I can look after myself normally without causing extra pain.")
  • http://loinc.org#LA25860-0 ("I can look after myself normally but it causes extra pain.")
  • http://loinc.org#LA25861-8 ("It is painful to look after myself and I am slow and careful.")
  • http://loinc.org#LA25862-6 ("I need some help but can manage most of my personal care.")
  • http://loinc.org#LA25863-4 ("I need help every day in most aspects of self-care.")
  • http://loinc.org#LA25864-2 ("I do not get dressed, I wash with difficulty and stay in bed.")

Answer options for ndi-3

  • http://loinc.org#LA25865-9 ("I can lift heavy weights without extra pain.")
  • http://loinc.org#LA25866-7 ("I can lift heavy weights but it gives extra pain.")
  • http://loinc.org#LA25867-5 ("Pain prevents me lifting heavy weights off the floor, but I can manage if they are conveniently placed, for example on a table.")
  • http://loinc.org#LA25868-3 ("Pain prevents me from lifting heavy weights but I can manage light to medium weights if they are conveniently positioned.")
  • http://loinc.org#LA25869-1 ("I can only lift very light weights.")
  • http://loinc.org#LA25870-9 ("I cannot lift or carry anything.")

Answer options for ndi-4

  • http://loinc.org#LA25871-7 ("I can read as much as I want to with no pain in my neck.")
  • http://loinc.org#LA25872-5 ("I can read as much as I want to with slight pain in my neck.")
  • http://loinc.org#LA25873-3 ("I can read as much as I want with moderate pain in my neck.")
  • http://loinc.org#LA25874-1 ("I can't read as much as I want because of moderate pain in my neck.")
  • http://loinc.org#LA25875-8 ("I can hardly read at all because of severe pain in my neck.")
  • http://loinc.org#LA25876-6 ("I can't read at all.")

Answer options for ndi-5

  • http://loinc.org#LA25877-4 ("I have no headaches at all.")
  • http://loinc.org#LA26365-9 ("I have slight headaches, which come infrequently.")
  • http://loinc.org#LA26366-7 ("I have moderate headaches, which come infrequently.")
  • http://loinc.org#LA26367-5 ("I have moderate headaches, which come frequently.")
  • http://loinc.org#LA26368-3 ("I have severe headaches, which come frequently.")
  • http://loinc.org#LA26369-1 ("I have headaches almost all the time.")

Answer options for ndi-6

  • http://loinc.org#LA25878-2 ("I can concentrate fully when I want to with no difficulty.")
  • http://loinc.org#LA25879-0 ("I can concentrate fully when I want to with slight difficulty.")
  • http://loinc.org#LA25880-8 ("I have a fair degree of difficulty in concentrating when I want to.")
  • http://loinc.org#LA25881-6 ("I have a lot of difficulty in concentrating when I want to.")
  • http://loinc.org#LA25882-4 ("I have a great deal of difficulty in concentrating when I want to.")
  • http://loinc.org#LA25883-2 ("I can't concentrate at all.")

Answer options for ndi-7

  • http://loinc.org#LA25884-0 ("I can do as much work as I want to.")
  • http://loinc.org#LA25885-7 ("I can only do my usual work, but no more.")
  • http://loinc.org#LA25886-5 ("I can do most of my usual work, but no more.")
  • http://loinc.org#LA25887-3 ("I cannot do my usual work.")
  • http://loinc.org#LA25888-1 ("I can hardly do any work at all.")
  • http://loinc.org#LA25889-9 ("I can't do any work at all.")

Answer options for ndi-8

  • http://loinc.org#LA25890-7 ("I can drive my car without any neck pain.")
  • http://loinc.org#LA25891-5 ("I can drive my car as long as I want with slight pain in my neck.")
  • http://loinc.org#LA25892-3 ("I can drive my car as long as I want with moderate pain in my neck.")
  • http://loinc.org#LA25893-1 ("I can't drive my car as long as I want because of moderate pain in my neck.")
  • http://loinc.org#LA25894-9 ("I can hardly drive at all because of severe pain in my neck.")
  • http://loinc.org#LA25895-6 ("I can't drive my car at all.")

Answer options for ndi-9

  • http://loinc.org#LA25896-4 ("I have no trouble sleeping.")
  • http://loinc.org#LA25897-2 ("My sleep is slightly disturbed (less than 1 hr sleepless).")
  • http://loinc.org#LA25898-0 ("My sleep is mildly disturbed (1-2 hrs sleepless).")
  • http://loinc.org#LA25899-8 ("My sleep is moderately disturbed (2-3 hrs sleepless).")
  • http://loinc.org#LA25900-4 ("My sleep is greatly disturbed (3-5 hrs sleepless).")
  • http://loinc.org#LA25901-2 ("My sleep is completely disturbed (5-7 hrs sleepless).")

Answer options for ndi-10

  • http://loinc.org#LA25902-0 ("I am able to engage in all my recreation activities with no neck pain at all.")
  • http://loinc.org#LA25903-8 ("I am able to engage in all my recreation activities, with some pain in my neck.")
  • http://loinc.org#LA25904-6 ("I am able to engage in most, but not all of my usual recreation activities because of pain in my neck.")
  • http://loinc.org#LA25905-3 ("I am able to engage in a few of my usual recreation activities because of pain in my neck.")
  • http://loinc.org#LA25906-1 ("I can hardly do any recreation activities because of pain in my neck.")
  • http://loinc.org#LA25907-9 ("I can't do any recreation activities due at all.")

Profile: SDCBaseQuestionnaire version: 3.0.0

Pain intensity

Personal care (washing, dressing, etc.)

Lifting

Reading

Headaches

Concentration

Work

Driving

Sleeping

Recreation

Total score [NDI]

  • linkId: total-score
  • Answers:

Profile: SDCBaseQuestionnaire version: 3.0.0

LinkIDDescription & Constraintsdoco
.. ndi-1 Value Set:
Options: 6 options
.. ndi-2 Value Set:
Options: 6 options
.. ndi-3 Value Set:
Options: 6 options
.. ndi-4 Value Set:
Options: 6 options
.. ndi-5 Value Set:
Options: 6 options
.. ndi-6 Value Set:
Options: 6 options
.. ndi-7 Value Set:
Options: 6 options
.. ndi-8 Value Set:
Options: 6 options
.. ndi-9 Value Set:
Options: 6 options
.. ndi-10 Value Set:
Options: 6 options
.. total-score Value Set:

doco Documentation for this format

Test this Questionnaire

Try this questionnaire out:

Responses for this Questionnaire