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/PROMISPhysicalFunctionCATQuestionnaire#0.9.7
... pf-cat-1 Does your health now limit you in doing two hours of physical labor? 0..1 choice Value Set:
Options: 5 options
... pf-cat-2 Are you able to do chores such as vacuuming or yard work? 0..1 choice Value Set:
Options: 5 options
... pf-cat-3 To what extent are you able to carry out your everyday physical activities such as walking, climbing stairs, carrying groceries, or moving a chair? 0..1 choice Value Set:
Options: 5 options
... tscore PROMIS physical function - version 2.0 T-score 0..1 decimal iconicon Value Set:

doco Documentation for this format

Options Sets

Answer options for pf-cat-1

  • http://loinc.org#LA6568-5 ("Not at all")
  • http://loinc.org#LA13947-9 ("Very little")
  • http://loinc.org#LA13909-9 ("Somewhat")
  • http://loinc.org#LA11911-7 ("Quite a lot")
  • http://loinc.org#LA13868-7 ("Cannot do")

Answer options for pf-cat-2

  • http://loinc.org#LA13921-4 ("Without any difficulty")
  • http://loinc.org#LA13918-0 ("With a little difficulty")
  • http://loinc.org#LA13920-6 ("With some difficulty")
  • http://loinc.org#LA13919-8 ("With much difficulty")
  • http://loinc.org#LA13912-3 ("Unable to do")

Answer options for pf-cat-3

  • http://loinc.org#LA13937-0 ("Completely")
  • http://loinc.org#LA13938-8 ("Mostly")
  • http://loinc.org#LA13939-6 ("Moderately")
  • http://loinc.org#LA13940-4 ("A little")
  • http://loinc.org#LA6568-5 ("Not at all")

Answer options for pf-cat-4

  • http://loinc.org#LA6568-5 ("Not at all")
  • http://loinc.org#LA13947-9 ("Very little")
  • http://loinc.org#LA13909-9 ("Somewhat")
  • http://loinc.org#LA11911-7 ("Quite a lot")
  • http://loinc.org#LA13868-7 ("Cannot do")

Profile: SDCBaseQuestionnaire version: 3.0.0

Does your health now limit you in doing two hours of physical labor?

Are you able to do chores such as vacuuming or yard work?

To what extent are you able to carry out your everyday physical activities such as walking, climbing stairs, carrying groceries, or moving a chair?

Does your health now limit you in walking more than a mile?

PROMIS physical function - version 2.0 T-score

  • linkId: tscore
  • Answers:

Profile: SDCBaseQuestionnaire version: 3.0.0

LinkIDDescription & Constraintsdoco
.. pf-cat-1 Value Set:
Options: 5 options
.. pf-cat-2 Value Set:
Options: 5 options
.. pf-cat-3 Value Set:
Options: 5 options
.. pf-cat-4 Value Set:
Options: 5 options
.. tscore Value Set:

doco Documentation for this format

Test this Questionnaire

Try this questionnaire out:

Responses for this Questionnaire