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

: Neck Disability Index QuestionnaireResponse Example

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<QuestionnaireResponse xmlns="http://hl7.org/fhir">
  <id value="NeckDisabilityIndexExample"/>
  <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>Neck Disability Index QuestionnaireResponse for John Doe. Total score: 40.</p></div>
  </text>
  <questionnaire
                 value="http://example.org/Questionnaire/NeckDisabilityIndexQuestionnaire"/>
  <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="ndi-1"/>
    <text value="Pain intensity"/>
    <answer>
      <valueCoding>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
          <valueDecimal value="2"/>
        </extension>
        <system value="http://loinc.org"/>
        <code value="LA25855-0"/>
        <display value="The pain is moderate at the moment."/>
      </valueCoding>
    </answer>
  </item>
  <item>
    <linkId value="ndi-2"/>
    <text value="Personal care (washing, dressing, etc.)"/>
    <answer>
      <valueCoding>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
          <valueDecimal value="1"/>
        </extension>
        <system value="http://loinc.org"/>
        <code value="LA25860-0"/>
        <display
                 value="I can look after myself normally but it causes extra pain."/>
      </valueCoding>
    </answer>
  </item>
  <item>
    <linkId value="ndi-3"/>
    <text value="Lifting"/>
    <answer>
      <valueCoding>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
          <valueDecimal value="2"/>
        </extension>
        <system value="http://loinc.org"/>
        <code value="LA25867-5"/>
        <display
                 value="Pain prevents me lifting heavy weights off the floor, but I can manage if they are conveniently placed, for example on a table."/>
      </valueCoding>
    </answer>
  </item>
  <item>
    <linkId value="ndi-4"/>
    <text value="Reading"/>
    <answer>
      <valueCoding>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
          <valueDecimal value="2"/>
        </extension>
        <system value="http://loinc.org"/>
        <code value="LA25873-3"/>
        <display
                 value="I can read as much as I want with moderate pain in my neck."/>
      </valueCoding>
    </answer>
  </item>
  <item>
    <linkId value="ndi-5"/>
    <text value="Headaches"/>
    <answer>
      <valueCoding>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
          <valueDecimal value="3"/>
        </extension>
        <system value="http://loinc.org"/>
        <code value="LA26367-5"/>
        <display value="I have moderate headaches, which come frequently."/>
      </valueCoding>
    </answer>
  </item>
  <item>
    <linkId value="ndi-6"/>
    <text value="Concentration"/>
    <answer>
      <valueCoding>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
          <valueDecimal value="2"/>
        </extension>
        <system value="http://loinc.org"/>
        <code value="LA25880-8"/>
        <display
                 value="I have a fair degree of difficulty in concentrating when I want to."/>
      </valueCoding>
    </answer>
  </item>
  <item>
    <linkId value="ndi-7"/>
    <text value="Work"/>
    <answer>
      <valueCoding>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
          <valueDecimal value="2"/>
        </extension>
        <system value="http://loinc.org"/>
        <code value="LA25886-5"/>
        <display value="I can do most of my usual work, but no more."/>
      </valueCoding>
    </answer>
  </item>
  <item>
    <linkId value="ndi-8"/>
    <text value="Driving"/>
    <answer>
      <valueCoding>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
          <valueDecimal value="2"/>
        </extension>
        <system value="http://loinc.org"/>
        <code value="LA25892-3"/>
        <display
                 value="I can drive my car as long as I want with moderate pain in my neck."/>
      </valueCoding>
    </answer>
  </item>
  <item>
    <linkId value="ndi-9"/>
    <text value="Sleeping"/>
    <answer>
      <valueCoding>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
          <valueDecimal value="2"/>
        </extension>
        <system value="http://loinc.org"/>
        <code value="LA25898-0"/>
        <display value="My sleep is mildly disturbed (1-2 hrs sleepless)."/>
      </valueCoding>
    </answer>
  </item>
  <item>
    <linkId value="ndi-10"/>
    <text value="Recreation"/>
    <answer>
      <valueCoding>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
          <valueDecimal value="2"/>
        </extension>
        <system value="http://loinc.org"/>
        <code value="LA25904-6"/>
        <display
                 value="I am able to engage in most, but not all of my usual recreation activities because of pain in my neck."/>
      </valueCoding>
    </answer>
  </item>
  <item>
    <linkId value="total-score"/>
    <answer>
      <valueDecimal value="40"/>
    </answer>
  </item>
</QuestionnaireResponse>