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
| Active as of 2026-05-20 |
<Questionnaire xmlns="http://hl7.org/fhir">
<id value="QuickDASHQuestionnaireExample"/>
<meta>
<profile
value="http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire|3.0.0"/>
</meta>
<language value="en"/>
<text>
<status value="extensions"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: Questionnaire QuickDASHQuestionnaireExample</b></p><a name="QuickDASHQuestionnaireExample"> </a><a name="hcQuickDASHQuestionnaireExample"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Profile: <a href="http://hl7.org/fhir/uv/sdc/STU3/StructureDefinition-sdc-questionnaire.html">SDCBaseQuestionnaireversion: null3.0.0)</a></p></div><b>Structure</b><table border="1" cellpadding="0" cellspacing="0" style="border: 1px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;"><tr style="border: 2px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top"><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="The linkID for the item">LinkID</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="Text for the item">Text</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="Minimum and Maximum # of times the item can appear in the instance">Cardinality</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="The type of the item">Type</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="Additional information about the item">Description & Constraints</a><span style="float: right"><a href="https://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="data:image/png;base64,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" alt="doco" style="background-color: inherit"/></a></span></th></tr><tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_q_root.gif" alt="." style="background-color: white; background-color: inherit" title="QuestionnaireRoot" class="hierarchy"/> </td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Questionnaire</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">http://example.org/Questionnaire/QuickDASHQuestionnaire#0.9.8</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.qd-1" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> qd-1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Open a tight or new jar.</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.qd-1">5 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.qd-2" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="coding" class="hierarchy"/> qd-2</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Do heavy household chores (e.g., wash walls, wash floors).</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.qd-2">5 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.qd-3" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> qd-3</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Carry a shopping bag or briefcase.</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.qd-3">5 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.qd-4" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="coding" class="hierarchy"/> qd-4</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Wash your back.</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.qd-4">5 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.qd-5" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> qd-5</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Use a knife to cut food.</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.qd-5">5 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.qd-6" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="coding" class="hierarchy"/> qd-6</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Recreational activities in which you take some force or impact through your arm, shoulder, or hand (e.g., golf, hammering, tennis, etc.).</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.qd-6">5 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.qd-7" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> qd-7</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">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?</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.qd-7">5 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.qd-8" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="coding" class="hierarchy"/> qd-8</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">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?</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.qd-8">5 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.qd-9" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> qd-9</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Arm, shoulder, or hand pain</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.qd-9">5 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.qd-10" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="coding" class="hierarchy"/> qd-10</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Tingling (pins and needles) in your arm, shoulder, or hand</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.qd-10">5 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.qd-11" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> qd-11</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">During the past week, how much difficulty have you had sleeping because of the pain in your arm, shoulder, or hand?</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.qd-11">5 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck00.png)" id="item.score" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-decimal.png" alt="." style="background-color: white; background-color: inherit" title="decimal" class="hierarchy"/> score</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">QuickDASH Score</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-decimal">decimal</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr><td colspan="5" class="hierarchy"><br/><a href="https://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="data:image/png;base64,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" alt="doco" style="background-color: inherit"/> Documentation for this format</a></td></tr></table><hr/><p><b>Options Sets</b></p><a name="opt-item.qd-1"> </a><p><b>Answer options for qd-1 </b></p><ul><li style="font-size: 11px">null#null ("No difficulty")</li><li style="font-size: 11px">null#null ("Mild difficulty")</li><li style="font-size: 11px">null#null ("Moderate difficulty")</li><li style="font-size: 11px">null#null ("Severe difficulty")</li><li style="font-size: 11px">null#null ("Unable")</li></ul><a name="opt-item.qd-2"> </a><p><b>Answer options for qd-2 </b></p><ul><li style="font-size: 11px">null#null ("No difficulty")</li><li style="font-size: 11px">null#null ("Mild difficulty")</li><li style="font-size: 11px">null#null ("Moderate difficulty")</li><li style="font-size: 11px">null#null ("Severe difficulty")</li><li style="font-size: 11px">null#null ("Unable")</li></ul><a name="opt-item.qd-3"> </a><p><b>Answer options for qd-3 </b></p><ul><li style="font-size: 11px">null#null ("No difficulty")</li><li style="font-size: 11px">null#null ("Mild difficulty")</li><li style="font-size: 11px">null#null ("Moderate difficulty")</li><li style="font-size: 11px">null#null ("Severe difficulty")</li><li style="font-size: 11px">null#null ("Unable")</li></ul><a name="opt-item.qd-4"> </a><p><b>Answer options for qd-4 </b></p><ul><li style="font-size: 11px">null#null ("No difficulty")</li><li style="font-size: 11px">null#null ("Mild difficulty")</li><li style="font-size: 11px">null#null ("Moderate difficulty")</li><li style="font-size: 11px">null#null ("Severe difficulty")</li><li style="font-size: 11px">null#null ("Unable")</li></ul><a name="opt-item.qd-5"> </a><p><b>Answer options for qd-5 </b></p><ul><li style="font-size: 11px">null#null ("No difficulty")</li><li style="font-size: 11px">null#null ("Mild difficulty")</li><li style="font-size: 11px">null#null ("Moderate difficulty")</li><li style="font-size: 11px">null#null ("Severe difficulty")</li><li style="font-size: 11px">null#null ("Unable")</li></ul><a name="opt-item.qd-6"> </a><p><b>Answer options for qd-6 </b></p><ul><li style="font-size: 11px">null#null ("No difficulty")</li><li style="font-size: 11px">null#null ("Mild difficulty")</li><li style="font-size: 11px">null#null ("Moderate difficulty")</li><li style="font-size: 11px">null#null ("Severe difficulty")</li><li style="font-size: 11px">null#null ("Unable")</li></ul><a name="opt-item.qd-7"> </a><p><b>Answer options for qd-7 </b></p><ul><li style="font-size: 11px">null#null ("Not at all")</li><li style="font-size: 11px">null#null ("Slightly")</li><li style="font-size: 11px">null#null ("Moderately")</li><li style="font-size: 11px">null#null ("Quite a bit")</li><li style="font-size: 11px">null#null ("Extremely")</li></ul><a name="opt-item.qd-8"> </a><p><b>Answer options for qd-8 </b></p><ul><li style="font-size: 11px">null#null ("Not limted at all")</li><li style="font-size: 11px">null#null ("Slightly limited")</li><li style="font-size: 11px">null#null ("Moderately limited")</li><li style="font-size: 11px">null#null ("Very limited")</li><li style="font-size: 11px">null#null ("Unable")</li></ul><a name="opt-item.qd-9"> </a><p><b>Answer options for qd-9 </b></p><ul><li style="font-size: 11px">null#null ("None")</li><li style="font-size: 11px">null#null ("Mild")</li><li style="font-size: 11px">null#null ("Moderate")</li><li style="font-size: 11px">null#null ("Severe")</li><li style="font-size: 11px">null#null ("Extreme")</li></ul><a name="opt-item.qd-10"> </a><p><b>Answer options for qd-10 </b></p><ul><li style="font-size: 11px">null#null ("None")</li><li style="font-size: 11px">null#null ("Mild")</li><li style="font-size: 11px">null#null ("Moderate")</li><li style="font-size: 11px">null#null ("Severe")</li><li style="font-size: 11px">null#null ("Extreme")</li></ul><a name="opt-item.qd-11"> </a><p><b>Answer options for qd-11 </b></p><ul><li style="font-size: 11px">null#null ("No difficulty")</li><li style="font-size: 11px">null#null ("Mild difficulty")</li><li style="font-size: 11px">null#null ("Moderate difficulty")</li><li style="font-size: 11px">null#null ("Severe difficulty")</li><li style="font-size: 11px">null#null ("Unable")</li></ul></div>
</text>
<url value="http://example.org/Questionnaire/QuickDASHQuestionnaire"/>
<version value="0.9.8"/>
<status value="active"/>
<subjectType value="Patient"/>
<date value="2026-05-20T09:30:43-04:00"/>
<publisher value="Global Alliant, Inc."/>
<contact>
<name value="Global Alliant, Inc."/>
<telecom>
<system value="url"/>
<value value="https://globalalliantinc.com"/>
</telecom>
<telecom>
<system value="email"/>
<value value="david.h@globalalliantinc.org"/>
</telecom>
</contact>
<jurisdiction>
<coding>
<system value="urn:iso:std:iso:3166"/>
<code value="US"/>
<display value="United States of America"/>
</coding>
</jurisdiction>
<code>
<system
value="https://dsacms.github.io/cmmi-access-model/CodeSystem/ACCESSReportDataCompositionSectionCS"/>
<code value="QuickDASH"/>
<display
value="Quick Disabilities of the Arm, Shoulder and Hand [QuickDASH]"/>
</code>
<item>
<linkId value="qd-1"/>
<text value="Open a tight or new jar."/>
<type value="choice"/>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="1"/>
</extension>
<valueCoding>
<display value="No difficulty"/>
</valueCoding>
</answerOption>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="2"/>
</extension>
<valueCoding>
<display value="Mild difficulty"/>
</valueCoding>
</answerOption>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="3"/>
</extension>
<valueCoding>
<display value="Moderate difficulty"/>
</valueCoding>
</answerOption>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="4"/>
</extension>
<valueCoding>
<display value="Severe difficulty"/>
</valueCoding>
</answerOption>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="5"/>
</extension>
<valueCoding>
<display value="Unable"/>
</valueCoding>
</answerOption>
</item>
<item>
<linkId value="qd-2"/>
<text value="Do heavy household chores (e.g., wash walls, wash floors)."/>
<type value="choice"/>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="1"/>
</extension>
<valueCoding>
<display value="No difficulty"/>
</valueCoding>
</answerOption>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="2"/>
</extension>
<valueCoding>
<display value="Mild difficulty"/>
</valueCoding>
</answerOption>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="3"/>
</extension>
<valueCoding>
<display value="Moderate difficulty"/>
</valueCoding>
</answerOption>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="4"/>
</extension>
<valueCoding>
<display value="Severe difficulty"/>
</valueCoding>
</answerOption>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="5"/>
</extension>
<valueCoding>
<display value="Unable"/>
</valueCoding>
</answerOption>
</item>
<item>
<linkId value="qd-3"/>
<text value="Carry a shopping bag or briefcase."/>
<type value="choice"/>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="1"/>
</extension>
<valueCoding>
<display value="No difficulty"/>
</valueCoding>
</answerOption>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="2"/>
</extension>
<valueCoding>
<display value="Mild difficulty"/>
</valueCoding>
</answerOption>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="3"/>
</extension>
<valueCoding>
<display value="Moderate difficulty"/>
</valueCoding>
</answerOption>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="4"/>
</extension>
<valueCoding>
<display value="Severe difficulty"/>
</valueCoding>
</answerOption>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="5"/>
</extension>
<valueCoding>
<display value="Unable"/>
</valueCoding>
</answerOption>
</item>
<item>
<linkId value="qd-4"/>
<text value="Wash your back."/>
<type value="choice"/>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="1"/>
</extension>
<valueCoding>
<display value="No difficulty"/>
</valueCoding>
</answerOption>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="2"/>
</extension>
<valueCoding>
<display value="Mild difficulty"/>
</valueCoding>
</answerOption>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="3"/>
</extension>
<valueCoding>
<display value="Moderate difficulty"/>
</valueCoding>
</answerOption>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="4"/>
</extension>
<valueCoding>
<display value="Severe difficulty"/>
</valueCoding>
</answerOption>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="5"/>
</extension>
<valueCoding>
<display value="Unable"/>
</valueCoding>
</answerOption>
</item>
<item>
<linkId value="qd-5"/>
<text value="Use a knife to cut food."/>
<type value="choice"/>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="1"/>
</extension>
<valueCoding>
<display value="No difficulty"/>
</valueCoding>
</answerOption>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="2"/>
</extension>
<valueCoding>
<display value="Mild difficulty"/>
</valueCoding>
</answerOption>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="3"/>
</extension>
<valueCoding>
<display value="Moderate difficulty"/>
</valueCoding>
</answerOption>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="4"/>
</extension>
<valueCoding>
<display value="Severe difficulty"/>
</valueCoding>
</answerOption>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="5"/>
</extension>
<valueCoding>
<display value="Unable"/>
</valueCoding>
</answerOption>
</item>
<item>
<linkId value="qd-6"/>
<text
value="Recreational activities in which you take some force or impact through your arm, shoulder, or hand (e.g., golf, hammering, tennis, etc.)."/>
<type value="choice"/>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="1"/>
</extension>
<valueCoding>
<display value="No difficulty"/>
</valueCoding>
</answerOption>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="2"/>
</extension>
<valueCoding>
<display value="Mild difficulty"/>
</valueCoding>
</answerOption>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="3"/>
</extension>
<valueCoding>
<display value="Moderate difficulty"/>
</valueCoding>
</answerOption>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="4"/>
</extension>
<valueCoding>
<display value="Severe difficulty"/>
</valueCoding>
</answerOption>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="5"/>
</extension>
<valueCoding>
<display value="Unable"/>
</valueCoding>
</answerOption>
</item>
<item>
<linkId value="qd-7"/>
<text
value="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?"/>
<type value="choice"/>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="1"/>
</extension>
<valueCoding>
<display value="Not at all"/>
</valueCoding>
</answerOption>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="2"/>
</extension>
<valueCoding>
<display value="Slightly"/>
</valueCoding>
</answerOption>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="3"/>
</extension>
<valueCoding>
<display value="Moderately"/>
</valueCoding>
</answerOption>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="4"/>
</extension>
<valueCoding>
<display value="Quite a bit"/>
</valueCoding>
</answerOption>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="5"/>
</extension>
<valueCoding>
<display value="Extremely"/>
</valueCoding>
</answerOption>
</item>
<item>
<linkId value="qd-8"/>
<text
value="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?"/>
<type value="choice"/>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="1"/>
</extension>
<valueCoding>
<display value="Not limted at all"/>
</valueCoding>
</answerOption>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="2"/>
</extension>
<valueCoding>
<display value="Slightly limited"/>
</valueCoding>
</answerOption>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="3"/>
</extension>
<valueCoding>
<display value="Moderately limited"/>
</valueCoding>
</answerOption>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="4"/>
</extension>
<valueCoding>
<display value="Very limited"/>
</valueCoding>
</answerOption>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="5"/>
</extension>
<valueCoding>
<display value="Unable"/>
</valueCoding>
</answerOption>
</item>
<item>
<linkId value="qd-9"/>
<text value="Arm, shoulder, or hand pain"/>
<type value="choice"/>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="1"/>
</extension>
<valueCoding>
<display value="None"/>
</valueCoding>
</answerOption>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="2"/>
</extension>
<valueCoding>
<display value="Mild"/>
</valueCoding>
</answerOption>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="3"/>
</extension>
<valueCoding>
<display value="Moderate"/>
</valueCoding>
</answerOption>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="4"/>
</extension>
<valueCoding>
<display value="Severe"/>
</valueCoding>
</answerOption>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="5"/>
</extension>
<valueCoding>
<display value="Extreme"/>
</valueCoding>
</answerOption>
</item>
<item>
<linkId value="qd-10"/>
<text value="Tingling (pins and needles) in your arm, shoulder, or hand"/>
<type value="choice"/>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="1"/>
</extension>
<valueCoding>
<display value="None"/>
</valueCoding>
</answerOption>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="2"/>
</extension>
<valueCoding>
<display value="Mild"/>
</valueCoding>
</answerOption>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="3"/>
</extension>
<valueCoding>
<display value="Moderate"/>
</valueCoding>
</answerOption>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="4"/>
</extension>
<valueCoding>
<display value="Severe"/>
</valueCoding>
</answerOption>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="5"/>
</extension>
<valueCoding>
<display value="Extreme"/>
</valueCoding>
</answerOption>
</item>
<item>
<linkId value="qd-11"/>
<text
value="During the past week, how much difficulty have you had sleeping because of the pain in your arm, shoulder, or hand?"/>
<type value="choice"/>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="1"/>
</extension>
<valueCoding>
<display value="No difficulty"/>
</valueCoding>
</answerOption>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="2"/>
</extension>
<valueCoding>
<display value="Mild difficulty"/>
</valueCoding>
</answerOption>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="3"/>
</extension>
<valueCoding>
<display value="Moderate difficulty"/>
</valueCoding>
</answerOption>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="4"/>
</extension>
<valueCoding>
<display value="Severe difficulty"/>
</valueCoding>
</answerOption>
<answerOption>
<extension url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="5"/>
</extension>
<valueCoding>
<display value="Unable"/>
</valueCoding>
</answerOption>
</item>
<item>
<linkId value="score"/>
<text value="QuickDASH Score"/>
<type value="decimal"/>
</item>
</Questionnaire>