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="QuickDASHExample"/>
<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>QuickDASH QuestionnaireResponse for John Doe. Score: 50.</p></div>
</text>
<questionnaire
value="http://example.org/Questionnaire/QuickDASHQuestionnaire"/>
<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="qd-1"/>
<text value="Open a tight or new jar."/>
<answer>
<valueCoding>
<extension
url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="3"/>
</extension>
<display value="Moderate difficulty"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="qd-2"/>
<text value="Do heavy household chores (e.g., wash walls, wash floors)."/>
<answer>
<valueCoding>
<extension
url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="4"/>
</extension>
<display value="Severe difficulty"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="qd-3"/>
<text value="Carry a shopping bag or briefcase."/>
<answer>
<valueCoding>
<extension
url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="3"/>
</extension>
<display value="Moderate difficulty"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="qd-4"/>
<text value="Wash your back."/>
<answer>
<valueCoding>
<extension
url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="2"/>
</extension>
<display value="Mild difficulty"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="qd-5"/>
<text value="Use a knife to cut food."/>
<answer>
<valueCoding>
<extension
url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="2"/>
</extension>
<display value="Mild difficulty"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="qd-6"/>
<text
value="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 value="4"/>
</extension>
<display value="Severe difficulty"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="qd-7"/>
<text
value="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 value="3"/>
</extension>
<display value="Moderately"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="qd-8"/>
<text
value="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 value="4"/>
</extension>
<display value="Very limited"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="qd-9"/>
<text value="Arm, shoulder, or hand pain"/>
<answer>
<valueCoding>
<extension
url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="3"/>
</extension>
<display value="Moderate"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="qd-10"/>
<text value="Tingling (pins and needles) in your arm, shoulder, or hand"/>
<answer>
<valueCoding>
<extension
url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="2"/>
</extension>
<display value="Mild"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="qd-11"/>
<text
value="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 value="3"/>
</extension>
<display value="Moderate difficulty"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="score"/>
<answer>
<valueDecimal value="50"/>
</answer>
</item>
</QuestionnaireResponse>