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" : "QuickDASHExample",
"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>QuickDASH QuestionnaireResponse for John Doe. Score: 50.</p></div>"
},
"questionnaire" : "http://example.org/Questionnaire/QuickDASHQuestionnaire",
"status" : "completed",
"subject" : {
🔗 "reference" : "Patient/PatientExample"
},
"authored" : "2026-01-15T10:30:00Z",
"author" : {
🔗 "reference" : "Patient/PatientExample"
},
"item" : [
{
"linkId" : "qd-1",
"text" : "Open a tight or new jar.",
"answer" : [
{
"valueCoding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal" : 3
}
],
"display" : "Moderate difficulty"
}
}
]
},
{
"linkId" : "qd-2",
"text" : "Do heavy household chores (e.g., wash walls, wash floors).",
"answer" : [
{
"valueCoding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal" : 4
}
],
"display" : "Severe difficulty"
}
}
]
},
{
"linkId" : "qd-3",
"text" : "Carry a shopping bag or briefcase.",
"answer" : [
{
"valueCoding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal" : 3
}
],
"display" : "Moderate difficulty"
}
}
]
},
{
"linkId" : "qd-4",
"text" : "Wash your back.",
"answer" : [
{
"valueCoding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal" : 2
}
],
"display" : "Mild difficulty"
}
}
]
},
{
"linkId" : "qd-5",
"text" : "Use a knife to cut food.",
"answer" : [
{
"valueCoding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal" : 2
}
],
"display" : "Mild difficulty"
}
}
]
},
{
"linkId" : "qd-6",
"text" : "Recreational activities in which you take some force or impact through your arm, shoulder, or hand (e.g., golf, hammering, tennis, etc.).",
"answer" : [
{
"valueCoding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal" : 4
}
],
"display" : "Severe difficulty"
}
}
]
},
{
"linkId" : "qd-7",
"text" : "During the past week, to what extent has your arm, shoulder, or hand problem interfered with your normal social activities with family, friends, neighbors, or groups?",
"answer" : [
{
"valueCoding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal" : 3
}
],
"display" : "Moderately"
}
}
]
},
{
"linkId" : "qd-8",
"text" : "During the past week, were you limited in your work or other regular daily activities as a result of your arm, shoulder, or hand problem?",
"answer" : [
{
"valueCoding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal" : 4
}
],
"display" : "Very limited"
}
}
]
},
{
"linkId" : "qd-9",
"text" : "Arm, shoulder, or hand pain",
"answer" : [
{
"valueCoding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal" : 3
}
],
"display" : "Moderate"
}
}
]
},
{
"linkId" : "qd-10",
"text" : "Tingling (pins and needles) in your arm, shoulder, or hand",
"answer" : [
{
"valueCoding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal" : 2
}
],
"display" : "Mild"
}
}
]
},
{
"linkId" : "qd-11",
"text" : "During the past week, how much difficulty have you had sleeping because of the pain in your arm, shoulder, or hand?",
"answer" : [
{
"valueCoding" : {
"extension" : [
{
"url" : "http://hl7.org/fhir/StructureDefinition/ordinalValue",
"valueDecimal" : 3
}
],
"display" : "Moderate difficulty"
}
}
]
},
{
"linkId" : "score",
"answer" : [
{
"valueDecimal" : 50
}
]
}
]
}