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
<QuestionnaireResponse xmlns="http://hl7.org/fhir">
<id value="KOOSJRExample"/>
<meta>
<profile
value="http://hl7.org/fhir/us/core/StructureDefinition/us-core-questionnaireresponse|6.1.0"/>
</meta>
<language value="en"/>
<text>
<status value="generated"/>
<div xml:lang="en" xmlns="http://www.w3.org/1999/xhtml" lang="en"><p>KOOS JR QuestionnaireResponse for John Doe. Total interval score: 50.012.</p></div>
</text>
<questionnaire
value="http://example.org/Questionnaire/KOOSJRQuestionnaire"/>
<status value="completed"/>
<subject>🔗
<reference value="Patient/PatientExample"/>
</subject>
<authored value="2026-01-15T10:30:00Z"/>
<author>🔗
<reference value="Patient/PatientExample"/>
</author>
<item>
<linkId value="koosjr-1"/>
<text
value="How severe is your knee stiffness after first wakening in the morning?"/>
<answer>
<valueCoding>
<extension
url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="2"/>
</extension>
<system value="http://loinc.org"/>
<code value="LA6751-7"/>
<display value="Moderate"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="koosjr-2"/>
<text value="Twisting/pivoting on your knee"/>
<answer>
<valueCoding>
<extension
url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="2"/>
</extension>
<system value="http://loinc.org"/>
<code value="LA6751-7"/>
<display value="Moderate"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="koosjr-3"/>
<text value="Straightening knee fully"/>
<answer>
<valueCoding>
<extension
url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="1"/>
</extension>
<system value="http://loinc.org"/>
<code value="LA6752-5"/>
<display value="Mild"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="koosjr-4"/>
<text value="Going up or down stairs"/>
<answer>
<valueCoding>
<extension
url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="3"/>
</extension>
<system value="http://loinc.org"/>
<code value="LA6750-9"/>
<display value="Severe"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="koosjr-5"/>
<text value="Standing upright"/>
<answer>
<valueCoding>
<extension
url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="2"/>
</extension>
<system value="http://loinc.org"/>
<code value="LA6751-7"/>
<display value="Moderate"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="koosjr-6"/>
<text value="Rising from sitting"/>
<answer>
<valueCoding>
<extension
url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="2"/>
</extension>
<system value="http://loinc.org"/>
<code value="LA6751-7"/>
<display value="Moderate"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="koosjr-7"/>
<text value="Bending to floor/picking up an object"/>
<answer>
<valueCoding>
<extension
url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="3"/>
</extension>
<system value="http://loinc.org"/>
<code value="LA6750-9"/>
<display value="Severe"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="total-interval-score"/>
<answer>
<valueDecimal value="50.012"/>
</answer>
</item>
</QuestionnaireResponse>