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
{
"resourceType" : "QuestionnaireResponse",
"id" : "PROMISPhysicalFunctionExample",
"meta" : {
"profile" : [
🔗 "http://hl7.org/fhir/us/core/StructureDefinition/us-core-questionnaireresponse|6.1.0"
]
},
"language" : "en",
"text" : {
"status" : "generated",
"div" : "<div xml:lang=\"en\" xmlns=\"http://www.w3.org/1999/xhtml\" lang=\"en\"><p>PROMIS Physical Function (Short Form 6b) QuestionnaireResponse for John Doe. T-score: 36.8.</p></div>"
},
"questionnaire" : "http://example.org/Questionnaire/PROMISPhysicalFunctionQuestionnaire",
"status" : "completed",
"subject" : {
🔗 "reference" : "Patient/PatientExample"
},
"authored" : "2026-01-15T10:30:00Z",
"author" : {
🔗 "reference" : "Patient/PatientExample"
},
"item" : [
{
"linkId" : "pf6b-1",
"text" : "Are you able to do chores such as vacuuming or yard work?",
"answer" : [
{
"valueCoding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal" : 4
}
],
"system" : "http://loinc.org",
"code" : "LA13918-0",
"display" : "With a little difficulty"
}
}
]
},
{
"linkId" : "pf6b-2",
"text" : "Are you able to go up and down stairs at a normal pace?",
"answer" : [
{
"valueCoding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal" : 3
}
],
"system" : "http://loinc.org",
"code" : "LA13920-6",
"display" : "With some difficulty"
}
}
]
},
{
"linkId" : "pf6b-3",
"text" : "Are you able to go for a walk of at least 15 minutes?",
"answer" : [
{
"valueCoding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal" : 3
}
],
"system" : "http://loinc.org",
"code" : "LA13920-6",
"display" : "With some difficulty"
}
}
]
},
{
"linkId" : "pf6b-4",
"text" : "Are you able to run errands and shop?",
"answer" : [
{
"valueCoding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal" : 4
}
],
"system" : "http://loinc.org",
"code" : "LA13918-0",
"display" : "With a little difficulty"
}
}
]
},
{
"linkId" : "pf6b-5",
"text" : "Does your health now limit you in doing two hours of physical labor?",
"answer" : [
{
"valueCoding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal" : 1
}
],
"system" : "http://loinc.org",
"code" : "LA13868-7",
"display" : "Cannot do"
}
}
]
},
{
"linkId" : "pf6b-6",
"text" : "Does your health now limit you in doing moderate work around the house like vacuuming, sweeping floors or carrying in groceries?",
"answer" : [
{
"valueCoding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal" : 2
}
],
"system" : "http://loinc.org",
"code" : "LA11911-7",
"display" : "Quite a lot"
}
}
]
},
{
"linkId" : "raw_score",
"answer" : [
{
"valueDecimal" : 17
}
]
},
{
"linkId" : "tscore",
"answer" : [
{
"valueDecimal" : 36.8
}
]
}
]
}