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/WHODASQuestionnaire#0.9.7
... whodas-s1 Standing for long periods such as 30 minutes 0..1 choice Value Set:
Options: 5 options
... whodas-s2 Taking care of household responsibilities 0..1 choice Value Set:
Options: 5 options
... whodas-s3 Learning a new task, for example learning how to get to a new place 0..1 choice Value Set:
Options: 5 options
... whodas-s5 How much of a problem did you have with being emotionally affected by your health problems? 0..1 choice Value Set:
Options: 5 options
... whodas-s6 Concentrating on doing something for ten minutes? 0..1 choice Value Set:
Options: 5 options
... whodas-s7 Walking a long distance such as a kilometer [or equivalent]? 0..1 choice Value Set:
Options: 5 options
... whodas-s8 Washing your whole body? 0..1 choice Value Set:
Options: 5 options
... whodas-s9 Getting dressed? 0..1 choice Value Set:
Options: 5 options
... whodas-s10 Dealing with people you do not know 0..1 choice Value Set:
Options: 5 options
... whodas-s11 Maintaining a friendship 0..1 choice Value Set:
Options: 5 options
... whodas-s12 Your day-to-day work 0..1 choice Value Set:
Options: 5 options
... whodas-h1 Overall, in the past 30 days, how many days were these difficulties present? 0..1 decimal Value Set:
... whodas-h2 In the past 30 days, for how many days were you totally unable to carry out your usual activities or work because of any health condition? 0..1 decimal Value Set:
... whodas-h3 In the past 30 days, not counting the days that you were totally unable, for how many days did you cut back or reduce your usual activities or work because of any health condition? 0..1 decimal Value Set:
... total-score WHODAS total score 0..1 decimal iconicon Value Set:

doco Documentation for this format

Options Sets

Answer options for whodas-s1

  • None
  • Mild
  • Moderate
  • Severe
  • Extreme or cannot do

Answer options for whodas-s2

  • None
  • Mild
  • Moderate
  • Severe
  • Extreme or cannot do

Answer options for whodas-s3

  • None
  • Mild
  • Moderate
  • Severe
  • Extreme or cannot do

Answer options for whodas-s4

  • None
  • Mild
  • Moderate
  • Severe
  • Extreme or cannot do

Answer options for whodas-s5

  • None
  • Mild
  • Moderate
  • Severe
  • Extreme or cannot do

Answer options for whodas-s6

  • None
  • Mild
  • Moderate
  • Severe
  • Extreme or cannot do

Answer options for whodas-s7

  • None
  • Mild
  • Moderate
  • Severe
  • Extreme or cannot do

Answer options for whodas-s8

  • None
  • Mild
  • Moderate
  • Severe
  • Extreme or cannot do

Answer options for whodas-s9

  • None
  • Mild
  • Moderate
  • Severe
  • Extreme or cannot do

Answer options for whodas-s10

  • None
  • Mild
  • Moderate
  • Severe
  • Extreme or cannot do

Answer options for whodas-s11

  • None
  • Mild
  • Moderate
  • Severe
  • Extreme or cannot do

Answer options for whodas-s12

  • None
  • Mild
  • Moderate
  • Severe
  • Extreme or cannot do

Profile: SDCBaseQuestionnaire version: 3.0.0

Standing for long periods such as 30 minutes

Taking care of household responsibilities

Learning a new task, for example learning how to get to a new place

How much of a problem did you have joining in community activities (for example, festivities, religious or other activities) in the same way as anyone else can?

How much of a problem did you have with being emotionally affected by your health problems?

Concentrating on doing something for ten minutes?

Walking a long distance such as a kilometer [or equivalent]?

Washing your whole body?

Getting dressed?

Dealing with people you do not know

Maintaining a friendship

Your day-to-day work

Overall, in the past 30 days, how many days were these difficulties present?

  • linkId: whodas-h1
  • Answers:

In the past 30 days, for how many days were you totally unable to carry out your usual activities or work because of any health condition?

  • linkId: whodas-h2
  • Answers:

In the past 30 days, not counting the days that you were totally unable, for how many days did you cut back or reduce your usual activities or work because of any health condition?

  • linkId: whodas-h3
  • Answers:

WHODAS total score

  • linkId: total-score
  • Answers:

Profile: SDCBaseQuestionnaire version: 3.0.0

LinkIDDescription & Constraintsdoco
.. whodas-s1 Value Set:
Options: 5 options
.. whodas-s2 Value Set:
Options: 5 options
.. whodas-s3 Value Set:
Options: 5 options
.. whodas-s4 Value Set:
Options: 5 options
.. whodas-s5 Value Set:
Options: 5 options
.. whodas-s6 Value Set:
Options: 5 options
.. whodas-s7 Value Set:
Options: 5 options
.. whodas-s8 Value Set:
Options: 5 options
.. whodas-s9 Value Set:
Options: 5 options
.. whodas-s10 Value Set:
Options: 5 options
.. whodas-s11 Value Set:
Options: 5 options
.. whodas-s12 Value Set:
Options: 5 options
.. whodas-h1 Value Set:
.. whodas-h2 Value Set:
.. whodas-h3 Value Set:
.. total-score Value Set:

doco Documentation for this format

Test this Questionnaire

Try this questionnaire out:

Responses for this Questionnaire