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

: Oswestry Disability Index QuestionnaireResponse Example

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<QuestionnaireResponse xmlns="http://hl7.org/fhir">
  <id value="OswestryDisabilityIndexExample"/>
  <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>Oswestry Disability Index QuestionnaireResponse for John Doe. Score: 36.</p></div>
  </text>
  <questionnaire
                 value="http://example.org/Questionnaire/OswestryDisabilityIndexQuestionnaire"/>
  <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="odi-1"/>
    <text value="Pain intensity"/>
    <answer>
      <valueCoding>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
          <valueDecimal value="2"/>
        </extension>
        <display value="The pain is moderate at the moment."/>
      </valueCoding>
    </answer>
  </item>
  <item>
    <linkId value="odi-2"/>
    <text value="Personal care (washing, dressing, etc.)"/>
    <answer>
      <valueCoding>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
          <valueDecimal value="1"/>
        </extension>
        <display
                 value="I can look after myself normally but it is very painful."/>
      </valueCoding>
    </answer>
  </item>
  <item>
    <linkId value="odi-3"/>
    <text value="Lifting"/>
    <answer>
      <valueCoding>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
          <valueDecimal value="3"/>
        </extension>
        <display
                 value="Pain prevents me lifting heavy weights off the floor, but I can manage if they are conveniently placed e.g. on a table."/>
      </valueCoding>
    </answer>
  </item>
  <item>
    <linkId value="odi-4"/>
    <text value="Walking"/>
    <answer>
      <valueCoding>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
          <valueDecimal value="1"/>
        </extension>
        <display value="Pain prevents me from walking more than one mile."/>
      </valueCoding>
    </answer>
  </item>
  <item>
    <linkId value="odi-5"/>
    <text value="Sitting"/>
    <answer>
      <valueCoding>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
          <valueDecimal value="2"/>
        </extension>
        <display
                 value="Pain prevents me from sitting for more than one hour."/>
      </valueCoding>
    </answer>
  </item>
  <item>
    <linkId value="odi-6"/>
    <text value="Standing"/>
    <answer>
      <valueCoding>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
          <valueDecimal value="2"/>
        </extension>
        <display
                 value="Pain prevents me from standing for more than 1 hour."/>
      </valueCoding>
    </answer>
  </item>
  <item>
    <linkId value="odi-7"/>
    <text value="Sleeping"/>
    <answer>
      <valueCoding>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
          <valueDecimal value="1"/>
        </extension>
        <display value="My sleep is occasionally interrupted by pain."/>
      </valueCoding>
    </answer>
  </item>
  <item>
    <linkId value="odi-8"/>
    <text value="Sex life (if applicable)"/>
    <answer>
      <valueCoding>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
          <valueDecimal value="2"/>
        </extension>
        <display value="My sex life is nearly normal but is very painful."/>
      </valueCoding>
    </answer>
  </item>
  <item>
    <linkId value="odi-9"/>
    <text value="Social life"/>
    <answer>
      <valueCoding>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
          <valueDecimal value="3"/>
        </extension>
        <display
                 value="Pain has restricted my social life and I do not go out as often."/>
      </valueCoding>
    </answer>
  </item>
  <item>
    <linkId value="odi-10"/>
    <text value="Traveling"/>
    <answer>
      <valueCoding>
        <extension
                   url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
          <valueDecimal value="2"/>
        </extension>
        <display
                 value="Pain is bad but I am able to manage trips over two hours."/>
      </valueCoding>
    </answer>
  </item>
  <item>
    <linkId value="score"/>
    <answer>
      <valueDecimal value="36"/>
    </answer>
  </item>
</QuestionnaireResponse>