Clinical response questionnaire at baseline - XML Representation

Smart Bear Implementation Guide - Local Development build (v3.4.1) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions
: Clinical response questionnaire at baseline - XML Representation

Draft as of 2024-09-17
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<Questionnaire xmlns="http://hl7.org/fhir">
  <id value="IADLQuestionnaire"/>
  <text>
    <status value="extensions"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: Questionnaire IADLQuestionnaire</b></p><a name="IADLQuestionnaire"> </a><a name="hcIADLQuestionnaire"> </a><a name="IADLQuestionnaire-en-US"> </a><b>Structure</b><table border="1" cellpadding="0" cellspacing="0" style="border: 1px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;"><tr style="border: 2px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top"><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="The linkID for the item">LinkID</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Text for the item">Text</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Minimum and Maximum # of times the item can appear in the instance">Cardinality</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="The type of the item">Type</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Additional information about the item">Description &amp; Constraints</a><span style="float: right"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="data:image/png;base64,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" alt="doco" style="background-color: inherit"/></a></span></th></tr><tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_q_root.gif" alt="." style="background-color: white; background-color: inherit" title="QuestionnaireRoot" class="hierarchy"/> IADLQuestionnaire</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Clinical response IADL questionnaire</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Questionnaire</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">https://smart-bear.eu/fhir/Questionnaire/IADLQuestionnaire#3.4.1</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.0" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> 0</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Ability to Use Telephone</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.0">4 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.1" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="coding" class="hierarchy"/> 1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Shopping</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.1">4 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.2" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> 2</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Food Preparation</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.2">4 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.3" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="coding" class="hierarchy"/> 3</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Housekeeping</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.3">5 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.4" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> 4</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Laundry</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.4">3 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.5" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="coding" class="hierarchy"/> 5</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Mode of Transportation</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.5">5 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.6" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> 6</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Responsibility for own medications</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.6">3 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.7" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="coding" class="hierarchy"/> 7</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Ability to Handle Finances</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.7">3 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.globalScore" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-integer.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="integer" class="hierarchy"/> globalScore</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">null</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-integer">integer</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck00.png)" id="item.ptScore" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-integer.png" alt="." style="background-color: white; background-color: inherit" title="integer" class="hierarchy"/> ptScore</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">null</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-integer">integer</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr><td colspan="5" class="hierarchy"><br/><a href="http://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="data:image/png;base64,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" alt="doco" style="background-color: inherit"/> Documentation for this format</a></td></tr></table><hr/><p><b>Options Sets</b></p><a name="opt-item.0"> </a><p><b>Answer options for 0 </b></p><ul><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/IADLTelephone#3 (&quot;Operates telephone on own initiative; looks up and dials numbers&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/IADLTelephone#2 (&quot;Dials a few well-known numbers&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/IADLTelephone#1 (&quot;Answers telephone, but does not dial&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/IADLTelephone#0 (&quot;Does not use telephone at all&quot;)</li></ul><a name="opt-item.1"> </a><p><b>Answer options for 1 </b></p><ul><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/IADLShopping#3 (&quot;Takes care of all shopping needs independent&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/IADLShopping#2 (&quot;Shops independently for small purchases&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/IADLShopping#1 (&quot;Needs to be accompanied on any shopping trip&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/IADLShopping#0 (&quot;Completely unable to shop&quot;)</li></ul><a name="opt-item.2"> </a><p><b>Answer options for 2 </b></p><ul><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/IADLMeals#3 (&quot;Plans, prepares, and serves adequate meals independently&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/IADLMeals#2 (&quot;Prepares adequate meals if supplied with ingredients&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/IADLMeals#1 (&quot;Heats and serves prepared meals or prepares meals but does not maintain adequate diet&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/IADLMeals#0 (&quot;Needs to have meals prepared and served&quot;)</li></ul><a name="opt-item.3"> </a><p><b>Answer options for 3 </b></p><ul><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/IADLHouseKeeping#4 (&quot;Maintains house alone with occasion assistance (heavy work)&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/IADLHouseKeeping#3 (&quot;Performs light daily tasks such as dishwashing, bed making&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/IADLHouseKeeping#2 (&quot;Performs light daily tasks, but cannot maintain acceptable level of cleanliness&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/IADLHouseKeeping#1 (&quot;Needs help with all home maintenance tasks&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/IADLHouseKeeping#0 (&quot;Does not participate in any housekeeping tasks&quot;)</li></ul><a name="opt-item.4"> </a><p><b>Answer options for 4 </b></p><ul><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/IADLLaundry#2 (&quot;Does personal laundry completely.&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/IADLLaundry#1 (&quot;Launders small items, rinses socks, stockings, etc&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/IADLLaundry#0 (&quot;All laundry must be done by others&quot;)</li></ul><a name="opt-item.5"> </a><p><b>Answer options for 5 </b></p><ul><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/IADLTransportation#4 (&quot;Travels independently on public transportation or drives own car&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/IADLTransportation#3 (&quot;Arranges own travel via taxi, but does not otherwise use public transportation&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/IADLTransportation#2 (&quot;Travels on public transportation when assisted or accompanied by another&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/IADLTransportation#1 (&quot;Travel limited to taxi or automobile with assistance of another&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/IADLTransportation#0 (&quot;Does not travel at all&quot;)</li></ul><a name="opt-item.6"> </a><p><b>Answer options for 6 </b></p><ul><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/IADLMedications#2 (&quot;Is responsible for taking medication in correct dosages at correct time&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/IADLMedications#1 (&quot;Takes responsibility if medication is prepared in advance in separate dosages&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/IADLMedications#0 (&quot;Is not capable of dispensing own medication&quot;)</li></ul><a name="opt-item.7"> </a><p><b>Answer options for 7 </b></p><ul><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/IADLMoney#2 (&quot;Manages financial matters independently (budgets, writes checks, pays rent and bills, goes to bank); collects and keeps track of income&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/IADLMoney#1 (&quot;Manages day-to-day purchases, but needs help with banking, major purchases, etc&quot;)</li><li style="font-size: 11px">https://smart-bear.eu/fhir/CodeSystem/IADLMoney#0 (&quot;Incapable of handling money&quot;)</li></ul></div>
  </text>
  <url value="https://smart-bear.eu/fhir/Questionnaire/IADLQuestionnaire"/>
  <version value="3.4.1"/>
  <name value="IADLQuestionnaire"/>
  <title value="Clinical response questionnaire at baseline"/>
  <status value="draft"/>
  <date value="2024-09-17T08:57:54+02:00"/>
  <description value="Clinical response IADL questionnaire"/>
  <item>
    <linkId value="0"/>
    <text value="Ability to Use Telephone"/>
    <type value="choice"/>
    <required value="true"/>
    <answerOption>
      <valueCoding>
        <system value="https://smart-bear.eu/fhir/CodeSystem/IADLTelephone"/>
        <code value="3"/>
        <display
                 value="Operates telephone on own initiative; looks up and dials numbers"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system value="https://smart-bear.eu/fhir/CodeSystem/IADLTelephone"/>
        <code value="2"/>
        <display value="Dials a few well-known numbers"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system value="https://smart-bear.eu/fhir/CodeSystem/IADLTelephone"/>
        <code value="1"/>
        <display value="Answers telephone, but does not dial"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system value="https://smart-bear.eu/fhir/CodeSystem/IADLTelephone"/>
        <code value="0"/>
        <display value="Does not use telephone at all"/>
      </valueCoding>
      <initialSelected value="true"/>
    </answerOption>
  </item>
  <item>
    <linkId value="1"/>
    <text value="Shopping"/>
    <type value="choice"/>
    <required value="true"/>
    <answerOption>
      <valueCoding>
        <system value="https://smart-bear.eu/fhir/CodeSystem/IADLShopping"/>
        <code value="3"/>
        <display value="Takes care of all shopping needs independent"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system value="https://smart-bear.eu/fhir/CodeSystem/IADLShopping"/>
        <code value="2"/>
        <display value="Shops independently for small purchases"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system value="https://smart-bear.eu/fhir/CodeSystem/IADLShopping"/>
        <code value="1"/>
        <display value="Needs to be accompanied on any shopping trip"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system value="https://smart-bear.eu/fhir/CodeSystem/IADLShopping"/>
        <code value="0"/>
        <display value="Completely unable to shop"/>
      </valueCoding>
      <initialSelected value="true"/>
    </answerOption>
  </item>
  <item>
    <linkId value="2"/>
    <text value="Food Preparation"/>
    <type value="choice"/>
    <required value="true"/>
    <answerOption>
      <valueCoding>
        <system value="https://smart-bear.eu/fhir/CodeSystem/IADLMeals"/>
        <code value="3"/>
        <display
                 value="Plans, prepares, and serves adequate meals independently"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system value="https://smart-bear.eu/fhir/CodeSystem/IADLMeals"/>
        <code value="2"/>
        <display
                 value="Prepares adequate meals if supplied with ingredients"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system value="https://smart-bear.eu/fhir/CodeSystem/IADLMeals"/>
        <code value="1"/>
        <display
                 value="Heats and serves prepared meals or prepares meals but does not maintain adequate diet"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system value="https://smart-bear.eu/fhir/CodeSystem/IADLMeals"/>
        <code value="0"/>
        <display value="Needs to have meals prepared and served"/>
      </valueCoding>
      <initialSelected value="true"/>
    </answerOption>
  </item>
  <item>
    <linkId value="3"/>
    <text value="Housekeeping"/>
    <type value="choice"/>
    <required value="true"/>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/IADLHouseKeeping"/>
        <code value="4"/>
        <display
                 value="Maintains house alone with occasion assistance (heavy work)"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/IADLHouseKeeping"/>
        <code value="3"/>
        <display
                 value="Performs light daily tasks such as dishwashing, bed making"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/IADLHouseKeeping"/>
        <code value="2"/>
        <display
                 value="Performs light daily tasks, but cannot maintain acceptable level of cleanliness"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/IADLHouseKeeping"/>
        <code value="1"/>
        <display value="Needs help with all home maintenance tasks"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/IADLHouseKeeping"/>
        <code value="0"/>
        <display value="Does not participate in any housekeeping tasks"/>
      </valueCoding>
      <initialSelected value="true"/>
    </answerOption>
  </item>
  <item>
    <linkId value="4"/>
    <text value="Laundry"/>
    <type value="choice"/>
    <required value="true"/>
    <answerOption>
      <valueCoding>
        <system value="https://smart-bear.eu/fhir/CodeSystem/IADLLaundry"/>
        <code value="2"/>
        <display value="Does personal laundry completely."/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system value="https://smart-bear.eu/fhir/CodeSystem/IADLLaundry"/>
        <code value="1"/>
        <display value="Launders small items, rinses socks, stockings, etc"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system value="https://smart-bear.eu/fhir/CodeSystem/IADLLaundry"/>
        <code value="0"/>
        <display value="All laundry must be done by others"/>
      </valueCoding>
      <initialSelected value="true"/>
    </answerOption>
  </item>
  <item>
    <linkId value="5"/>
    <text value="Mode of Transportation"/>
    <type value="choice"/>
    <required value="true"/>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/IADLTransportation"/>
        <code value="4"/>
        <display
                 value="Travels independently on public transportation or drives own car"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/IADLTransportation"/>
        <code value="3"/>
        <display
                 value="Arranges own travel via taxi, but does not otherwise use public transportation"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/IADLTransportation"/>
        <code value="2"/>
        <display
                 value="Travels on public transportation when assisted or accompanied by another"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/IADLTransportation"/>
        <code value="1"/>
        <display
                 value="Travel limited to taxi or automobile with assistance of another"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/IADLTransportation"/>
        <code value="0"/>
        <display value="Does not travel at all"/>
      </valueCoding>
      <initialSelected value="true"/>
    </answerOption>
  </item>
  <item>
    <linkId value="6"/>
    <text value="Responsibility for own medications"/>
    <type value="choice"/>
    <required value="true"/>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/IADLMedications"/>
        <code value="2"/>
        <display
                 value="Is responsible for taking medication in correct dosages at correct time"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/IADLMedications"/>
        <code value="1"/>
        <display
                 value="Takes responsibility if medication is prepared in advance in separate dosages"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system
                value="https://smart-bear.eu/fhir/CodeSystem/IADLMedications"/>
        <code value="0"/>
        <display value="Is not capable of dispensing own medication"/>
      </valueCoding>
      <initialSelected value="true"/>
    </answerOption>
  </item>
  <item>
    <linkId value="7"/>
    <text value="Ability to Handle Finances"/>
    <type value="choice"/>
    <required value="true"/>
    <answerOption>
      <valueCoding>
        <system value="https://smart-bear.eu/fhir/CodeSystem/IADLMoney"/>
        <code value="2"/>
        <display
                 value="Manages financial matters independently (budgets, writes checks, pays rent and bills, goes to bank); collects and keeps track of income"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system value="https://smart-bear.eu/fhir/CodeSystem/IADLMoney"/>
        <code value="1"/>
        <display
                 value="Manages day-to-day purchases, but needs help with banking, major purchases, etc"/>
      </valueCoding>
    </answerOption>
    <answerOption>
      <valueCoding>
        <system value="https://smart-bear.eu/fhir/CodeSystem/IADLMoney"/>
        <code value="0"/>
        <display value="Incapable of handling money"/>
      </valueCoding>
      <initialSelected value="true"/>
    </answerOption>
  </item>
  <item>
    <linkId value="globalScore"/>
    <type value="integer"/>
    <required value="true"/>
  </item>
  <item>
    <linkId value="ptScore"/>
    <type value="integer"/>
    <required value="true"/>
  </item>
</Questionnaire>