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/PROMISPhysicalFunctionQuestionnaire#0.9.7
... pf6b-1 Are you able to do chores such as vacuuming or yard work? 0..1 choice Value Set:
Options: 5 options
... pf6b-2 Are you able to go up and down stairs at a normal pace? 0..1 choice Value Set:
Options: 5 options
... pf6b-3 Are you able to go for a walk of at least 15 minutes? 0..1 choice Value Set:
Options: 5 options
... pf6b-5 Does your health now limit you in doing two hours of physical labor? 0..1 choice Value Set:
Options: 5 options
... pf6b-6 Does your health now limit you in doing moderate work around the house like vacuuming, sweeping floors or carrying in groceries? 0..1 choice Value Set:
Options: 5 options
... raw_score PROMIS short form - physical function 6b - version 1.2 raw score 0..1 decimal iconicon Value Set:
... tscore PROMIS physical function - version 1.0 Tscore 0..1 decimal iconicon Value Set:

doco Documentation for this format

Options Sets

Answer options for pf6b-1

  • 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 pf6b-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 pf6b-3

  • 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 pf6b-4

  • 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 pf6b-5

  • 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 pf6b-6

  • 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")

Profile: SDCBaseQuestionnaire version: 3.0.0

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

Are you able to go up and down stairs at a normal pace?

Are you able to go for a walk of at least 15 minutes?

Are you able to run errands and shop?

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

Does your health now limit you in doing moderate work around the house like vacuuming, sweeping floors or carrying in groceries?

PROMIS short form - physical function 6b - version 1.2 raw score

  • linkId: raw_score
  • Answers:

PROMIS physical function - version 1.0 Tscore

  • linkId: tscore
  • Answers:

Profile: SDCBaseQuestionnaire version: 3.0.0

LinkIDDescription & Constraintsdoco
.. pf6b-1 Value Set:
Options: 5 options
.. pf6b-2 Value Set:
Options: 5 options
.. pf6b-3 Value Set:
Options: 5 options
.. pf6b-4 Value Set:
Options: 5 options
.. pf6b-5 Value Set:
Options: 5 options
.. pf6b-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