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="PROMISPhysicalFunctionExample"/>
<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>PROMIS Physical Function (Short Form 6b) QuestionnaireResponse for John Doe. T-score: 36.8.</p></div>
</text>
<questionnaire
value="http://example.org/Questionnaire/PROMISPhysicalFunctionQuestionnaire"/>
<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="pf6b-1"/>
<text value="Are you able to do chores such as vacuuming or yard work?"/>
<answer>
<valueCoding>
<extension
url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="4"/>
</extension>
<system value="http://loinc.org"/>
<code value="LA13918-0"/>
<display value="With a little difficulty"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="pf6b-2"/>
<text value="Are you able to go up and down stairs at a normal pace?"/>
<answer>
<valueCoding>
<extension
url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="3"/>
</extension>
<system value="http://loinc.org"/>
<code value="LA13920-6"/>
<display value="With some difficulty"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="pf6b-3"/>
<text value="Are you able to go for a walk of at least 15 minutes?"/>
<answer>
<valueCoding>
<extension
url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="3"/>
</extension>
<system value="http://loinc.org"/>
<code value="LA13920-6"/>
<display value="With some difficulty"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="pf6b-4"/>
<text value="Are you able to run errands and shop?"/>
<answer>
<valueCoding>
<extension
url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="4"/>
</extension>
<system value="http://loinc.org"/>
<code value="LA13918-0"/>
<display value="With a little difficulty"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="pf6b-5"/>
<text
value="Does your health now limit you in doing two hours of physical labor?"/>
<answer>
<valueCoding>
<extension
url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="1"/>
</extension>
<system value="http://loinc.org"/>
<code value="LA13868-7"/>
<display value="Cannot do"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="pf6b-6"/>
<text
value="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 value="2"/>
</extension>
<system value="http://loinc.org"/>
<code value="LA11911-7"/>
<display value="Quite a lot"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="raw_score"/>
<answer>
<valueDecimal value="17"/>
</answer>
</item>
<item>
<linkId value="tscore"/>
<answer>
<valueDecimal value="36.8"/>
</answer>
</item>
</QuestionnaireResponse>