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

: QuickDASH QuestionnaireResponse Example

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<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>