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/PROMISPainInterferenceSFQuestionnaire#0.9.7
... pi6a-1 In the past 7 days: How much did pain interfere with your day to day activities? 0..1 choice Value Set:
Options: 5 options
... pi6a-2 In the past 7 days: How much did pain interfere with work around the home? 0..1 choice Value Set:
Options: 5 options
... pi6a-3 In the past 7 days: How much did pain interfere with your ability to participate in social activities? 0..1 choice Value Set:
Options: 5 options
... pi6a-5 In the past 7 days: How much did pain interfere with the things you usually do for fun? 0..1 choice Value Set:
Options: 5 options
... pi6a-6 In the past 7 days: How much did pain interfere with your enjoyment of social activities? 0..1 choice Value Set:
Options: 5 options
... raw_score PROMIS short form - pain interference 6a - version 1.0 raw score 0..1 decimal iconicon Value Set:
... tscore PROMIS pain interference - version 1.0 Tscore 0..1 decimal iconicon Value Set:

doco Documentation for this format

Options Sets

Answer options for pi6a-1

  • http://loinc.org#LA6568-5 ("Not at all")
  • http://loinc.org#LA13863-8 ("A little bit")
  • http://loinc.org#LA13909-9 ("Somewhat")
  • http://loinc.org#LA13902-4 ("Quite a bit")
  • http://loinc.org#LA13914-9 ("Very much")

Answer options for pi6a-2

  • http://loinc.org#LA6568-5 ("Not at all")
  • http://loinc.org#LA13863-8 ("A little bit")
  • http://loinc.org#LA13909-9 ("Somewhat")
  • http://loinc.org#LA13902-4 ("Quite a bit")
  • http://loinc.org#LA13914-9 ("Very much")

Answer options for pi6a-3

  • http://loinc.org#LA6568-5 ("Not at all")
  • http://loinc.org#LA13863-8 ("A little bit")
  • http://loinc.org#LA13909-9 ("Somewhat")
  • http://loinc.org#LA13902-4 ("Quite a bit")
  • http://loinc.org#LA13914-9 ("Very much")

Answer options for pi6a-4

  • http://loinc.org#LA6568-5 ("Not at all")
  • http://loinc.org#LA13863-8 ("A little bit")
  • http://loinc.org#LA13909-9 ("Somewhat")
  • http://loinc.org#LA13902-4 ("Quite a bit")
  • http://loinc.org#LA13914-9 ("Very much")

Answer options for pi6a-5

  • http://loinc.org#LA6568-5 ("Not at all")
  • http://loinc.org#LA13863-8 ("A little bit")
  • http://loinc.org#LA13909-9 ("Somewhat")
  • http://loinc.org#LA13902-4 ("Quite a bit")
  • http://loinc.org#LA13914-9 ("Very much")

Answer options for pi6a-6

  • http://loinc.org#LA6568-5 ("Not at all")
  • http://loinc.org#LA13863-8 ("A little bit")
  • http://loinc.org#LA13909-9 ("Somewhat")
  • http://loinc.org#LA13902-4 ("Quite a bit")
  • http://loinc.org#LA13914-9 ("Very much")

Profile: SDCBaseQuestionnaire version: 3.0.0

In the past 7 days: How much did pain interfere with your day to day activities?

In the past 7 days: How much did pain interfere with work around the home?

In the past 7 days: How much did pain interfere with your ability to participate in social activities?

In the past 7 days: How much did pain interfere with your household chores?

In the past 7 days: How much did pain interfere with the things you usually do for fun?

In the past 7 days: How much did pain interfere with your enjoyment of social activities?

PROMIS short form - pain interference 6a - version 1.0 raw score

  • linkId: raw_score
  • Answers:

PROMIS pain interference - version 1.0 Tscore

  • linkId: tscore
  • Answers:

Profile: SDCBaseQuestionnaire version: 3.0.0

LinkIDDescription & Constraintsdoco
.. pi6a-1 Value Set:
Options: 5 options
.. pi6a-2 Value Set:
Options: 5 options
.. pi6a-3 Value Set:
Options: 5 options
.. pi6a-4 Value Set:
Options: 5 options
.. pi6a-5 Value Set:
Options: 5 options
.. pi6a-6 Value Set:
Options: 5 options
.. raw_score Value Set:
.. tscore Value Set:

doco Documentation for this format

Test this Questionnaire

Try this questionnaire out:

Responses for this Questionnaire