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/QuickDASHQuestionnaire#0.9.7
... qd-1 Open a tight or new jar. 0..1 choice Value Set:
Options: 5 options
... qd-2 Do heavy household chores (e.g., wash walls, wash floors). 0..1 choice Value Set:
Options: 5 options
... qd-3 Carry a shopping bag or briefcase. 0..1 choice Value Set:
Options: 5 options
... qd-5 Use a knife to cut food. 0..1 choice Value Set:
Options: 5 options
... qd-6 Recreational activities in which you take some force or impact through your arm, shoulder, or hand (e.g., golf, hammering, tennis, etc.). 0..1 choice Value Set:
Options: 5 options
... qd-7 During the past week, to what extent has your arm, shoulder, or hand problem interfered with your normal social activities with family, friends, neighbors, or groups? 0..1 choice Value Set:
Options: 5 options
... qd-8 During the past week, were you limited in your work or other regular daily activities as a result of your arm, shoulder, or hand problem? 0..1 choice Value Set:
Options: 5 options
... qd-9 Arm, shoulder, or hand pain 0..1 choice Value Set:
Options: 5 options
... qd-10 Tingling (pins and needles) in your arm, shoulder, or hand 0..1 choice Value Set:
Options: 5 options
... qd-11 During the past week, how much difficulty have you had sleeping because of the pain in your arm, shoulder, or hand? 0..1 choice Value Set:
Options: 5 options
... score QuickDASH Score 0..1 decimal iconicon Value Set:

doco Documentation for this format

Options Sets

Answer options for qd-1

  • No difficulty
  • Mild difficulty
  • Moderate difficulty
  • Severe difficulty
  • Unable

Answer options for qd-2

  • No difficulty
  • Mild difficulty
  • Moderate difficulty
  • Severe difficulty
  • Unable

Answer options for qd-3

  • No difficulty
  • Mild difficulty
  • Moderate difficulty
  • Severe difficulty
  • Unable

Answer options for qd-4

  • No difficulty
  • Mild difficulty
  • Moderate difficulty
  • Severe difficulty
  • Unable

Answer options for qd-5

  • No difficulty
  • Mild difficulty
  • Moderate difficulty
  • Severe difficulty
  • Unable

Answer options for qd-6

  • No difficulty
  • Mild difficulty
  • Moderate difficulty
  • Severe difficulty
  • Unable

Answer options for qd-7

  • Not at all
  • Slightly
  • Moderately
  • Quite a bit
  • Extremely

Answer options for qd-8

  • Not limted at all
  • Slightly limited
  • Moderately limited
  • Very limited
  • Unable

Answer options for qd-9

  • None
  • Mild
  • Moderate
  • Severe
  • Extreme

Answer options for qd-10

  • None
  • Mild
  • Moderate
  • Severe
  • Extreme

Answer options for qd-11

  • No difficulty
  • Mild difficulty
  • Moderate difficulty
  • Severe difficulty
  • Unable

Profile: SDCBaseQuestionnaire version: 3.0.0

Open a tight or new jar.

Do heavy household chores (e.g., wash walls, wash floors).

Carry a shopping bag or briefcase.

Wash your back.

Use a knife to cut food.

Recreational activities in which you take some force or impact through your arm, shoulder, or hand (e.g., golf, hammering, tennis, etc.).

During the past week, to what extent has your arm, shoulder, or hand problem interfered with your normal social activities with family, friends, neighbors, or groups?

During the past week, were you limited in your work or other regular daily activities as a result of your arm, shoulder, or hand problem?

Arm, shoulder, or hand pain

Tingling (pins and needles) in your arm, shoulder, or hand

During the past week, how much difficulty have you had sleeping because of the pain in your arm, shoulder, or hand?

QuickDASH Score

  • linkId: score
  • Answers:

Profile: SDCBaseQuestionnaire version: 3.0.0

LinkIDDescription & Constraintsdoco
.. qd-1 Value Set:
Options: 5 options
.. qd-2 Value Set:
Options: 5 options
.. qd-3 Value Set:
Options: 5 options
.. qd-4 Value Set:
Options: 5 options
.. qd-5 Value Set:
Options: 5 options
.. qd-6 Value Set:
Options: 5 options
.. qd-7 Value Set:
Options: 5 options
.. qd-8 Value Set:
Options: 5 options
.. qd-9 Value Set:
Options: 5 options
.. qd-10 Value Set:
Options: 5 options
.. qd-11 Value Set:
Options: 5 options
.. score Value Set:

doco Documentation for this format

Test this Questionnaire

Try this questionnaire out:

Responses for this Questionnaire