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="WHODASExample"/>
<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>WHODAS 2.0 (12-item) QuestionnaireResponse for John Doe. Total score: 26.</p></div>
</text>
<questionnaire
value="http://example.org/Questionnaire/WHODASQuestionnaire"/>
<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="whodas-s1"/>
<text value="Standing for long periods such as 30 minutes"/>
<answer>
<valueCoding>
<extension
url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="2"/>
</extension>
<display value="Mild"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="whodas-s2"/>
<text value="Taking care of household responsibilities"/>
<answer>
<valueCoding>
<extension
url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="3"/>
</extension>
<display value="Moderate"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="whodas-s3"/>
<text
value="Learning a new task, for example learning how to get to a new place"/>
<answer>
<valueCoding>
<extension
url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="2"/>
</extension>
<display value="Mild"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="whodas-s4"/>
<text
value="How much of a problem did you have joining in community activities (for example, festivities, religious or other activities) in the same way as anyone else can?"/>
<answer>
<valueCoding>
<extension
url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="2"/>
</extension>
<display value="Mild"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="whodas-s5"/>
<text
value="How much of a problem did you have with being emotionally affected by your health problems?"/>
<answer>
<valueCoding>
<extension
url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="3"/>
</extension>
<display value="Moderate"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="whodas-s6"/>
<text value="Concentrating on doing something for ten minutes?"/>
<answer>
<valueCoding>
<extension
url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="2"/>
</extension>
<display value="Mild"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="whodas-s7"/>
<text
value="Walking a long distance such as a kilometer [or equivalent]?"/>
<answer>
<valueCoding>
<extension
url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="3"/>
</extension>
<display value="Moderate"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="whodas-s8"/>
<text value="Washing your whole body?"/>
<answer>
<valueCoding>
<extension
url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="1"/>
</extension>
<display value="None"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="whodas-s9"/>
<text value="Getting dressed?"/>
<answer>
<valueCoding>
<extension
url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="1"/>
</extension>
<display value="None"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="whodas-s10"/>
<text value="Dealing with people you do not know"/>
<answer>
<valueCoding>
<extension
url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="2"/>
</extension>
<display value="Mild"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="whodas-s11"/>
<text value="Maintaining a friendship"/>
<answer>
<valueCoding>
<extension
url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="2"/>
</extension>
<display value="Mild"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="whodas-s12"/>
<text value="Your day-to-day work"/>
<answer>
<valueCoding>
<extension
url="http://hl7.org/fhir/StructureDefinition/ordinalValue">
<valueDecimal value="3"/>
</extension>
<display value="Moderate"/>
</valueCoding>
</answer>
</item>
<item>
<linkId value="whodas-h1"/>
<text
value="Overall, in the past 30 days, how many days were these difficulties present?"/>
<answer>
<valueDecimal value="3"/>
</answer>
</item>
<item>
<linkId value="whodas-h2"/>
<text
value="In the past 30 days, for how many days were you totally unable to carry out your usual activities or work because of any health condition?"/>
<answer>
<valueDecimal value="3"/>
</answer>
</item>
<item>
<linkId value="whodas-h3"/>
<text
value="In the past 30 days, not counting the days that you were totally unable, for how many days did you cut back or reduce your usual activities or work because of any health condition?"/>
<answer>
<valueDecimal value="3"/>
</answer>
</item>
<item>
<linkId value="total-score"/>
<answer>
<valueDecimal value="26"/>
</answer>
</item>
</QuestionnaireResponse>