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                "text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?"
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            "text": "Carbon Dioxide"
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                "text": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?"
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                "text": "How many family members, including yourself, do you currently live with?"
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                "text": "What language are you most comfortable speaking?"
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                ],
                "text": "Have you been discharged from the armed forces of the United States?"
              },
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                    "display": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?"
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                ],
                "text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?"
              },
              "valueCodeableConcept": {
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                "text": "No"
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            },
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                    "code": "32624-9",
                    "display": "Which race(s) are you?"
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                ],
                "text": "Which race(s) are you?"
              },
              "valueCodeableConcept": {
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                "text": "White"
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            },
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                    "code": "56051-6",
                    "display": "Are you Hispanic or Latino?"
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                ],
                "text": "Are you Hispanic or Latino?"
              },
              "valueCodeableConcept": {
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                "system": "http://loinc.org",
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                "system": "http://loinc.org",
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            "text": "Chloride"
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                "system": "http://loinc.org",
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            ],
            "text": "Carbon Dioxide"
          },
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            "text": "Tobacco smoking status"
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            "text": "Never smoked tobacco (finding)"
          },
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                "display": "Hemoglobin A1c/Hemoglobin.total in Blood"
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            ],
            "text": "Hemoglobin A1c/Hemoglobin.total in Blood"
          },
          "subject": {
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          "code": {
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                "code": "93025-5",
                "display": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]"
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            ],
            "text": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]"
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                "text": "In the past year, have you been afraid of your partner or ex-partner?"
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                "text": "In the past year, have you spent more than 2 nights in a row in a jail, prison, detention center, or juvenile correctional facility?"
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                ],
                "text": "Stress is when someone feels tense, nervous, anxious or can't sleep at night because their mind is troubled. How stressed are you?"
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                "text": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?"
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                "text": "During the past year, what was the total combined income for you and the family members you live with? This information will help us determine if you are eligible for any benefits."
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                "text": "What is your main insurance?"
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                "text": "What is your current work situation?"
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                "text": "What is the highest level of school that you have finished?"
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                "text": "More than high school"
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                "text": "What address do you live at?"
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                "text": "Are you worried about losing your housing?"
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                "text": "How many family members, including yourself, do you currently live with?"
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                ],
                "text": "What language are you most comfortable speaking?"
              },
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                ],
                "text": "Have you been discharged from the armed forces of the United States?"
              },
              "valueCodeableConcept": {
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                    "system": "http://loinc.org",
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                    "display": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?"
                  }
                ],
                "text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?"
              },
              "valueCodeableConcept": {
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            },
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                    "display": "Which race(s) are you?"
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                ],
                "text": "Which race(s) are you?"
              },
              "valueCodeableConcept": {
                "coding": [
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                ],
                "text": "Are you Hispanic or Latino?"
              },
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                "code": "70274-6",
                "display": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]"
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            ],
            "text": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]"
          },
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      },
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          ],
          "code": {
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                "system": "http://loinc.org",
                "code": "55758-7",
                "display": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]"
              }
            ],
            "text": "Patient Health Questionnaire 2 item (PHQ-2) total score [Reported]"
          },
          "subject": {
            "reference": "urn:uuid:69437c6f-772f-6aaf-34b9-b4d3f12d9eaf"
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            ],
            "text": "Carbon Dioxide"
          },
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            "text": "Tobacco smoking status"
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            ],
            "text": "Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences [PRAPARE]"
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                "text": "How often do you see or talk to people that you care about and feel close to (For example: talking to friends on the phone, visiting friends or family, going to church or club meetings)?"
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                "text": "During the past year, what was the total combined income for you and the family members you live with? This information will help us determine if you are eligible for any benefits."
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                "text": "What is your main insurance?"
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                "text": "None/uninsured"
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                "text": "What is your current work situation?"
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                "text": "Full-time work"
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                "text": "What is the highest level of school that you have finished?"
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                "text": "More than high school"
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                "text": "What address do you live at?"
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                "text": "Are you worried about losing your housing?"
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                "text": "How many family members, including yourself, do you currently live with?"
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                "text": "What language are you most comfortable speaking?"
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                ],
                "text": "Have you been discharged from the armed forces of the United States?"
              },
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            },
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                    "display": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?"
                  }
                ],
                "text": "At any point in the past 2 years, has season or migrant farm work been your or your family's main source of income?"
              },
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                "text": "No"
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            },
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                    "code": "32624-9",
                    "display": "Which race(s) are you?"
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                ],
                "text": "Which race(s) are you?"
              },
              "valueCodeableConcept": {
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                "text": "White"
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                    "code": "56051-6",
                    "display": "Are you Hispanic or Latino?"
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                ],
                "text": "Are you Hispanic or Latino?"
              },
              "valueCodeableConcept": {
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                "text": "No"
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                "code": "70274-6",
                "display": "Generalized anxiety disorder 7 item (GAD-7) total score [Reported.PHQ]"
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            ],
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      },
      {
        "fullUrl": "Procedure/4c9abdb0-b204-c24d-a123-eb8b5c910d61",
        "resource": {
          "resourceType": "Procedure",
          "id": "4c9abdb0-b204-c24d-a123-eb8b5c910d61",
          "meta": {
            "profile": [
              "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure"
            ]
          },
          "status": "completed",
          "code": {
            "coding": [
              {
                "system": "http://snomed.info/sct",
                "code": "713106006",
                "display": "Screening for drug abuse (procedure)"
              }
            ],
            "text": "Screening for drug abuse (procedure)"
          },
          "subject": {
            "reference": "urn:uuid:69437c6f-772f-6aaf-34b9-b4d3f12d9eaf"
          },
          "encounter": {
            "reference": "urn:uuid:4050a09d-7174-4f9e-64a2-c11cfe95b2eb"
          },
          "performedPeriod": {
            "start": "2022-02-26T00:18:52-06:00",
            "end": "2022-02-26T00:45:54-06:00"
          },
          "location": {
            "reference": "Location?identifier=https://github.com/synthetichealth/synthea|e2495d7e-a9ee-302e-88bc-581f792ef429",
            "display": "ROSELAND COMMUNITY HOSPITAL ASSOCIATION"
          },
          "_id": "2mp96qivmEczNi3yC"
        },
        "request": {
          "method": "PUT",
          "url": "Procedure/4c9abdb0-b204-c24d-a123-eb8b5c910d61"
        }
      },
      {
        "fullUrl": "Procedure/eacb2e05-bbc2-9a7b-7768-08738225b7ec",
        "resource": {
          "resourceType": "Procedure",
          "id": "eacb2e05-bbc2-9a7b-7768-08738225b7ec",
          "meta": {
            "profile": [
              "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure"
            ]
          },
          "status": "completed",
          "code": {
            "coding": [
              {
                "system": "http://snomed.info/sct",
                "code": "40701008",
                "display": "Echocardiography (procedure)"
              }
            ],
            "text": "Echocardiography (procedure)"
          },
          "subject": {
            "reference": "urn:uuid:69437c6f-772f-6aaf-34b9-b4d3f12d9eaf"
          },
          "encounter": {
            "reference": "urn:uuid:a35eeb54-dbdf-4f65-89fe-638beb6c312f"
          },
          "performedPeriod": {
            "start": "2022-07-16T01:11:05-05:00",
            "end": "2022-07-16T01:41:05-05:00"
          },
          "location": {
            "reference": "Location?identifier=https://github.com/synthetichealth/synthea|e2495d7e-a9ee-302e-88bc-581f792ef429",
            "display": "ROSELAND COMMUNITY HOSPITAL ASSOCIATION"
          },
          "_id": "phwmnwQpp5kuK82zP"
        },
        "request": {
          "method": "PUT",
          "url": "Procedure/eacb2e05-bbc2-9a7b-7768-08738225b7ec"
        }
      },
      {
        "fullUrl": "Procedure/7873c37e-b281-b18d-b4b8-11a1358a8195",
        "resource": {
          "resourceType": "Procedure",
          "id": "7873c37e-b281-b18d-b4b8-11a1358a8195",
          "meta": {
            "profile": [
              "http://hl7.org/fhir/us/core/StructureDefinition/us-core-procedure"
            ]
          },
          "status": "completed",
          "code": {
            "coding": [
              {
                "system": "http://snomed.info/sct",
                "code": "430193006",
                "display": "Medication Reconciliation (procedure)"
              }
            ],
            "text": "Medication Reconciliation (procedure)"
          },
          "subject": {
            "reference": "urn:uuid:69437c6f-772f-6aaf-34b9-b4d3f12d9eaf"
          },
          "encounter": {
            "reference": "urn:uuid:a35eeb54-dbdf-4f65-89fe-638beb6c312f"
          },
          "performedPeriod": {
            "start": "2022-07-16T01:11:05-05:00",
            "end": "2022-07-16T01:26:05-05:00"
          },
          "location": {
            "reference": "Location?identifier=https://github.com/synthetichealth/synthea|e2495d7e-a9ee-302e-88bc-581f792ef429",
            "display": "ROSELAND COMMUNITY HOSPITAL ASSOCIATION"
          },
          "_id": "XBM6NZ6m7EumXCeis"
        },
        "request": {
          "method": "PUT",
          "url": "Procedure/7873c37e-b281-b18d-b4b8-11a1358a8195"
        }
      },
      {
        "fullUrl": "QuestionnaireResponse/5770951-a",
        "resource": {
          "responseType": "QuestionnaireResponse",
          "id": "5770951-a",
          "questionnaire": "5770951",
          "title": "FAA 8500-8",
          "description": "Acceptable evidence of physical fitness on a form prescribed by the Administrator.",
          "status": "in-progress",
          "authored": "2024-04-01T01:20:41.893Z",
          "item": [
            {
              "type": "string",
              "linkId": "19264175569",
              "code": [
                {
                  "system": "https://www.faa.gov/pilots/medical_certification",
                  "code": "1",
                  "display": "Medical certificate type"
                }
              ],
              "text": "What is the patient applying for?",
              "required": true,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "form8500-8",
                    "code": "amc",
                    "display": "Airman Medical Certificate"
                  }
                },
                {
                  "valueCoding": {
                    "system": "form8500-8",
                    "code": "amspc",
                    "display": "Airman Medical Student Pilot Certificate"
                  }
                }
              ]
            },
            {
              "linkId": "7270595484463",
              "code": [
                {
                  "system": "https://www.faa.gov/pilots/medical_certification",
                  "code": "2",
                  "display": "Class of medical certificate"
                }
              ],
              "text": "What class of medical certificate does the patient have?",
              "type": "string",
              "required": true,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "form8500-8",
                    "code": "1",
                    "display": "1st"
                  }
                },
                {
                  "valueCoding": {
                    "system": "form8500-8",
                    "code": "2",
                    "display": "2nd"
                  }
                },
                {
                  "valueCoding": {
                    "system": "form8500-8",
                    "code": "3",
                    "display": "3rd"
                  }
                }
              ]
            },
            {
              "linkId": "2898049029846",
              "code": [
                {
                  "system": "https://www.faa.gov/pilots/medical_certification",
                  "code": "3.1",
                  "display": "Last name"
                }
              ],
              "text": "What is the patient's last name?",
              "type": "string"
            },
            {
              "linkId": "4564656421201",
              "code": [
                {
                  "system": "https://www.faa.gov/pilots/medical_certification",
                  "code": "3.2",
                  "display": "first name"
                }
              ],
              "text": "What is the patient's first name?",
              "type": "string"
            },
            {
              "linkId": "20315389196",
              "code": [
                {
                  "system": "https://www.faa.gov/pilots/medical_certification",
                  "code": "3.3",
                  "display": "middle name"
                }
              ],
              "text": "What is the patient's middle name?",
              "type": "string"
            },
            {
              "linkId": "3244638245409",
              "code": [
                {
                  "system": "https://www.faa.gov/pilots/medical_certification",
                  "code": "4",
                  "display": "Social Security number"
                }
              ],
              "text": "What is the patient's social security number?",
              "type": "string",
              "required": true
            },
            {
              "linkId": "3742489239981",
              "code": [
                {
                  "system": "https://www.faa.gov/pilots/medical_certification",
                  "code": "5",
                  "display": "Address and telephone number"
                }
              ],
              "text": "What is the patient's address and telephone number?",
              "type": "string"
            },
            {
              "linkId": "990063069213",
              "code": [
                {
                  "system": "http://loinc.org",
                  "code": "21112-8",
                  "display": "Birth date"
                }
              ],
              "text": "What is the patient's date of birth?",
              "type": "string",
              "required": true
            },
            {
              "linkId": "717842501763",
              "code": [
                {
                  "system": "https://www.faa.gov/pilots/medical_certification",
                  "code": "7",
                  "display": "Color of hair"
                }
              ],
              "text": "What is the color of the patient's hair?",
              "type": "string"
            },
            {
              "type": "choice",
              "linkId": "8636877002143",
              "code": [
                {
                  "system": "https://www.faa.gov/pilots/medical_certification",
                  "code": "10",
                  "display": "Item 10 - Occupation"
                }
              ],
              "text": "What is the patient's occupation?",
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "https://www.bls.gov/oes/current/oes_stru",
                    "code": "53-2011",
                    "display": "Airline Pilots, Copilots, and Flight Engineers"
                  }
                },
                {
                  "valueCoding": {
                    "system": "https://www.bls.gov/oes/current/oes_stru",
                    "code": "53-2012",
                    "display": "Commercial Pilots"
                  }
                }
              ]
            },
            {
              "type": "string",
              "linkId": "1408648142286",
              "code": [
                {
                  "system": "https://www.faa.gov/pilots/medical_certification",
                  "code": "12",
                  "display": "Item 12 - Employer name"
                }
              ],
              "text": "What is the name of the patient's employer?"
            },
            {
              "type": "choice",
              "linkId": "1835999511438",
              "code": [
                {
                  "system": "https://www.faa.gov/pilots/medical_certification",
                  "code": "13",
                  "display": "Item 13 - FAA Airman Medical Certificate Denied Suspended or Revoked"
                }
              ],
              "text": "Has the patient's FAA Airman Medical Certificate ever been denied, suspended, or revoked?",
              "required": true,
              "answerOption": [
                {
                  "valueCoding": {
                    "code": "1",
                    "display": "Yes"
                  }
                },
                {
                  "valueCoding": {
                    "code": "0",
                    "display": "No"
                  }
                }
              ]
            },
            {
              "type": "choice",
              "linkId": "2164571589013",
              "code": [
                {
                  "system": "https://www.faa.gov/pilots/medical_certification",
                  "code": "18",
                  "display": "Have you ever in your life been diagnosed with, had, or do you presently have any of the following?"
                }
              ],
              "text": "Has the patient ever in their life been diagnosed with, had, or do they presently have any of the following?",
              "required": true,
              "answerOption": [
                {
                  "valueCoding": {
                    "code": "a",
                    "display": "Frequent or severe headaches"
                  }
                },
                {
                  "valueCoding": {
                    "code": "b",
                    "display": "Dizziness or fainting spell"
                  }
                },
                {
                  "valueCoding": {
                    "code": "c",
                    "display": "Unconsciousness for any reason"
                  }
                },
                {
                  "valueCoding": {
                    "code": "d",
                    "display": "Eye or vision trouble except glasses"
                  }
                },
                {
                  "valueCoding": {
                    "code": "e",
                    "display": "Hay fever or allergy"
                  }
                },
                {
                  "valueCoding": {
                    "code": "f",
                    "display": "Asthma or lung disease"
                  }
                },
                {
                  "valueCoding": {
                    "code": "g",
                    "display": "Heart or vascular trouble"
                  }
                },
                {
                  "valueCoding": {
                    "code": "h",
                    "display": "High or low blood pressure"
                  }
                },
                {
                  "valueCoding": {
                    "code": "i",
                    "display": "Stomach, liver, or intestinal trouble"
                  }
                },
                {
                  "valueCoding": {
                    "code": "j",
                    "display": "Kidney stone or blood in urine"
                  }
                },
                {
                  "valueCoding": {
                    "code": "k",
                    "display": "Diabetes"
                  }
                },
                {
                  "valueCoding": {
                    "code": "l",
                    "display": "Neurlogical disorders; epilepsy, seizures, stroke, paralysis, etc"
                  }
                },
                {
                  "valueCoding": {
                    "code": "m",
                    "display": "Mental disorders of any sort; depression, anxiety, etc"
                  }
                },
                {
                  "valueCoding": {
                    "code": "n",
                    "display": "Substance dependence or failed a drug test ever; or substance abuse or use of illegal substance in the last 2 years."
                  }
                },
                {
                  "valueCoding": {
                    "code": "o",
                    "display": "Alcohol dependence or abuse"
                  }
                },
                {
                  "valueCoding": {
                    "code": "p",
                    "display": "Suicide attempt"
                  }
                },
                {
                  "valueCoding": {
                    "code": "q",
                    "display": "Motion sickness requiring medication"
                  }
                }
              ]
            },
            {
              "item": [
                {
                  "text": "The applicant should indicate the total number of civilian flight hours and whether those hours are logged (LOG) or estimated (EST).",
                  "type": "display",
                  "linkId": "8884801232461_helpText",
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept": {
                        "text": "Help-Button",
                        "coding": [
                          {
                            "code": "help",
                            "display": "Help-Button",
                            "system": "http://hl7.org/fhir/questionnaire-item-control"
                          }
                        ]
                      }
                    }
                  ]
                }
              ],
              "type": "integer",
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-unit",
                  "valueCoding": {
                    "system": "http://unitsofmeasure.org",
                    "code": "h",
                    "display": "hour"
                  }
                }
              ],
              "linkId": "8884801232461",
              "code": [
                {
                  "system": "https://www.faa.gov/pilots/medical_certification",
                  "code": "14",
                  "display": "Item 14 - Total Pilot Time to Date"
                }
              ],
              "text": "What is the patient's total pilot time to date?",
              "initial": [
                {
                  "valueInteger": 0
                }
              ]
            },
            {
              "type": "integer",
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-unit",
                  "valueCoding": {
                    "system": "http://unitsofmeasure.org",
                    "code": "h",
                    "display": "hour"
                  }
                }
              ],
              "linkId": "5125604165611",
              "code": [
                {
                  "system": "https://www.faa.gov/pilots/medical_certification",
                  "code": "15",
                  "display": "Total Pilot Time Past 6 Months"
                }
              ],
              "text": "How much total pilot time has the patient had in the past 6 months?"
            },
            {
              "type": "date",
              "linkId": "3625615065757",
              "code": [
                {
                  "system": "https://www.faa.gov/pilots/medical_certification",
                  "code": "16",
                  "display": "Date of Last FAA Medical Application"
                }
              ],
              "text": "When was the patient's last FAA Medical Application submitted?"
            },
            {
              "type": "choice",
              "linkId": "3764621580219",
              "code": [
                {
                  "system": "https://www.faa.gov/pilots/medical_certification",
                  "code": "17a",
                  "display": "Do You Currently Use Any Prescription of Non-prescription Medication?"
                }
              ],
              "text": "Does the patient currently use any prescription or non-prescription medication?",
              "required": true,
              "answerOption": [
                {
                  "valueCoding": {
                    "code": "1",
                    "display": "Yes"
                  }
                },
                {
                  "valueCoding": {
                    "code": "0",
                    "display": "No"
                  }
                }
              ]
            },
            {
              "type": "string",
              "linkId": "282204433287",
              "code": [
                {
                  "system": "https://www.faa.gov/pilots/medical_certification",
                  "code": "17a1",
                  "display": "Enter in medication name"
                }
              ],
              "text": "What is the name of the medication that the patient is currently taking?",
              "enableWhen": [
                {
                  "question": "3764621580219",
                  "operator": "=",
                  "answerCoding": {
                    "code": "1",
                    "display": "Yes"
                  }
                }
              ],
              "repeats": true
            },
            null
          ],
          "_id": "bLBQNAkt72AHmrY5d"
        },
        "request": {
          "method": "PUT",
          "url": "QuestionnaireResponse/5770951-a"
        }
      },
      {
        "fullUrl": "QuestionnaireResponse/5770951-a",
        "resource": {
          "responseType": "QuestionnaireResponse",
          "id": "5770951-a",
          "questionnaire": "5770951",
          "title": "FAA 8500-8",
          "description": "Acceptable evidence of physical fitness on a form prescribed by the Administrator.",
          "status": "in-progress",
          "authored": "2024-04-01T01:20:41.893Z",
          "item": [
            {
              "type": "string",
              "linkId": "19264175569",
              "code": [
                {
                  "system": "https://www.faa.gov/pilots/medical_certification",
                  "code": "1",
                  "display": "Medical certificate type"
                }
              ],
              "text": "What is the patient applying for?",
              "required": true,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "form8500-8",
                    "code": "amc",
                    "display": "Airman Medical Certificate"
                  }
                },
                {
                  "valueCoding": {
                    "system": "form8500-8",
                    "code": "amspc",
                    "display": "Airman Medical Student Pilot Certificate"
                  }
                }
              ]
            },
            {
              "linkId": "7270595484463",
              "code": [
                {
                  "system": "https://www.faa.gov/pilots/medical_certification",
                  "code": "2",
                  "display": "Class of medical certificate"
                }
              ],
              "text": "What class of medical certificate does the patient have?",
              "type": "string",
              "required": true,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "form8500-8",
                    "code": "1",
                    "display": "1st"
                  }
                },
                {
                  "valueCoding": {
                    "system": "form8500-8",
                    "code": "2",
                    "display": "2nd"
                  }
                },
                {
                  "valueCoding": {
                    "system": "form8500-8",
                    "code": "3",
                    "display": "3rd"
                  }
                }
              ]
            },
            {
              "linkId": "2898049029846",
              "code": [
                {
                  "system": "https://www.faa.gov/pilots/medical_certification",
                  "code": "3.1",
                  "display": "Last name"
                }
              ],
              "text": "What is the patient's last name?",
              "type": "string"
            },
            {
              "linkId": "4564656421201",
              "code": [
                {
                  "system": "https://www.faa.gov/pilots/medical_certification",
                  "code": "3.2",
                  "display": "first name"
                }
              ],
              "text": "What is the patient's first name?",
              "type": "string"
            },
            {
              "linkId": "20315389196",
              "code": [
                {
                  "system": "https://www.faa.gov/pilots/medical_certification",
                  "code": "3.3",
                  "display": "middle name"
                }
              ],
              "text": "What is the patient's middle name?",
              "type": "string"
            },
            {
              "linkId": "3244638245409",
              "code": [
                {
                  "system": "https://www.faa.gov/pilots/medical_certification",
                  "code": "4",
                  "display": "Social Security number"
                }
              ],
              "text": "What is the patient's social security number?",
              "type": "string",
              "required": true
            },
            {
              "linkId": "3742489239981",
              "code": [
                {
                  "system": "https://www.faa.gov/pilots/medical_certification",
                  "code": "5",
                  "display": "Address and telephone number"
                }
              ],
              "text": "What is the patient's address and telephone number?",
              "type": "string"
            },
            {
              "linkId": "990063069213",
              "code": [
                {
                  "system": "http://loinc.org",
                  "code": "21112-8",
                  "display": "Birth date"
                }
              ],
              "text": "What is the patient's date of birth?",
              "type": "string",
              "required": true
            },
            {
              "linkId": "717842501763",
              "code": [
                {
                  "system": "https://www.faa.gov/pilots/medical_certification",
                  "code": "7",
                  "display": "Color of hair"
                }
              ],
              "text": "What is the color of the patient's hair?",
              "type": "string"
            },
            {
              "type": "choice",
              "linkId": "8636877002143",
              "code": [
                {
                  "system": "https://www.faa.gov/pilots/medical_certification",
                  "code": "10",
                  "display": "Item 10 - Occupation"
                }
              ],
              "text": "What is the patient's occupation?",
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "https://www.bls.gov/oes/current/oes_stru",
                    "code": "53-2011",
                    "display": "Airline Pilots, Copilots, and Flight Engineers"
                  }
                },
                {
                  "valueCoding": {
                    "system": "https://www.bls.gov/oes/current/oes_stru",
                    "code": "53-2012",
                    "display": "Commercial Pilots"
                  }
                }
              ]
            },
            {
              "type": "string",
              "linkId": "1408648142286",
              "code": [
                {
                  "system": "https://www.faa.gov/pilots/medical_certification",
                  "code": "12",
                  "display": "Item 12 - Employer name"
                }
              ],
              "text": "What is the name of the patient's employer?"
            },
            {
              "type": "choice",
              "linkId": "1835999511438",
              "code": [
                {
                  "system": "https://www.faa.gov/pilots/medical_certification",
                  "code": "13",
                  "display": "Item 13 - FAA Airman Medical Certificate Denied Suspended or Revoked"
                }
              ],
              "text": "Has the patient's FAA Airman Medical Certificate ever been denied, suspended, or revoked?",
              "required": true,
              "answerOption": [
                {
                  "valueCoding": {
                    "code": "1",
                    "display": "Yes"
                  }
                },
                {
                  "valueCoding": {
                    "code": "0",
                    "display": "No"
                  }
                }
              ]
            },
            {
              "type": "choice",
              "linkId": "2164571589013",
              "code": [
                {
                  "system": "https://www.faa.gov/pilots/medical_certification",
                  "code": "18",
                  "display": "Have you ever in your life been diagnosed with, had, or do you presently have any of the following?"
                }
              ],
              "text": "Has the patient ever in their life been diagnosed with, had, or do they presently have any of the following?",
              "required": true,
              "answerOption": [
                {
                  "valueCoding": {
                    "code": "a",
                    "display": "Frequent or severe headaches"
                  }
                },
                {
                  "valueCoding": {
                    "code": "b",
                    "display": "Dizziness or fainting spell"
                  }
                },
                {
                  "valueCoding": {
                    "code": "c",
                    "display": "Unconsciousness for any reason"
                  }
                },
                {
                  "valueCoding": {
                    "code": "d",
                    "display": "Eye or vision trouble except glasses"
                  }
                },
                {
                  "valueCoding": {
                    "code": "e",
                    "display": "Hay fever or allergy"
                  }
                },
                {
                  "valueCoding": {
                    "code": "f",
                    "display": "Asthma or lung disease"
                  }
                },
                {
                  "valueCoding": {
                    "code": "g",
                    "display": "Heart or vascular trouble"
                  }
                },
                {
                  "valueCoding": {
                    "code": "h",
                    "display": "High or low blood pressure"
                  }
                },
                {
                  "valueCoding": {
                    "code": "i",
                    "display": "Stomach, liver, or intestinal trouble"
                  }
                },
                {
                  "valueCoding": {
                    "code": "j",
                    "display": "Kidney stone or blood in urine"
                  }
                },
                {
                  "valueCoding": {
                    "code": "k",
                    "display": "Diabetes"
                  }
                },
                {
                  "valueCoding": {
                    "code": "l",
                    "display": "Neurlogical disorders; epilepsy, seizures, stroke, paralysis, etc"
                  }
                },
                {
                  "valueCoding": {
                    "code": "m",
                    "display": "Mental disorders of any sort; depression, anxiety, etc"
                  }
                },
                {
                  "valueCoding": {
                    "code": "n",
                    "display": "Substance dependence or failed a drug test ever; or substance abuse or use of illegal substance in the last 2 years."
                  }
                },
                {
                  "valueCoding": {
                    "code": "o",
                    "display": "Alcohol dependence or abuse"
                  }
                },
                {
                  "valueCoding": {
                    "code": "p",
                    "display": "Suicide attempt"
                  }
                },
                {
                  "valueCoding": {
                    "code": "q",
                    "display": "Motion sickness requiring medication"
                  }
                }
              ]
            },
            {
              "item": [
                {
                  "text": "The applicant should indicate the total number of civilian flight hours and whether those hours are logged (LOG) or estimated (EST).",
                  "type": "display",
                  "linkId": "8884801232461_helpText",
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept": {
                        "text": "Help-Button",
                        "coding": [
                          {
                            "code": "help",
                            "display": "Help-Button",
                            "system": "http://hl7.org/fhir/questionnaire-item-control"
                          }
                        ]
                      }
                    }
                  ]
                }
              ],
              "type": "integer",
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-unit",
                  "valueCoding": {
                    "system": "http://unitsofmeasure.org",
                    "code": "h",
                    "display": "hour"
                  }
                }
              ],
              "linkId": "8884801232461",
              "code": [
                {
                  "system": "https://www.faa.gov/pilots/medical_certification",
                  "code": "14",
                  "display": "Item 14 - Total Pilot Time to Date"
                }
              ],
              "text": "What is the patient's total pilot time to date?",
              "initial": [
                {
                  "valueInteger": 0
                }
              ]
            },
            {
              "type": "integer",
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-unit",
                  "valueCoding": {
                    "system": "http://unitsofmeasure.org",
                    "code": "h",
                    "display": "hour"
                  }
                }
              ],
              "linkId": "5125604165611",
              "code": [
                {
                  "system": "https://www.faa.gov/pilots/medical_certification",
                  "code": "15",
                  "display": "Total Pilot Time Past 6 Months"
                }
              ],
              "text": "How much total pilot time has the patient had in the past 6 months?"
            },
            {
              "type": "date",
              "linkId": "3625615065757",
              "code": [
                {
                  "system": "https://www.faa.gov/pilots/medical_certification",
                  "code": "16",
                  "display": "Date of Last FAA Medical Application"
                }
              ],
              "text": "When was the patient's last FAA Medical Application submitted?"
            },
            {
              "type": "choice",
              "linkId": "3764621580219",
              "code": [
                {
                  "system": "https://www.faa.gov/pilots/medical_certification",
                  "code": "17a",
                  "display": "Do You Currently Use Any Prescription of Non-prescription Medication?"
                }
              ],
              "text": "Does the patient currently use any prescription or non-prescription medication?",
              "required": true,
              "answerOption": [
                {
                  "valueCoding": {
                    "code": "1",
                    "display": "Yes"
                  }
                },
                {
                  "valueCoding": {
                    "code": "0",
                    "display": "No"
                  }
                }
              ]
            },
            {
              "type": "string",
              "linkId": "282204433287",
              "code": [
                {
                  "system": "https://www.faa.gov/pilots/medical_certification",
                  "code": "17a1",
                  "display": "Enter in medication name"
                }
              ],
              "text": "What is the name of the medication that the patient is currently taking?",
              "enableWhen": [
                {
                  "question": "3764621580219",
                  "operator": "=",
                  "answerCoding": {
                    "code": "1",
                    "display": "Yes"
                  }
                }
              ],
              "repeats": true
            },
            null
          ],
          "_id": "CXLfkdtxqSvKdng7h"
        },
        "request": {
          "method": "PUT",
          "url": "QuestionnaireResponse/5770951-a"
        }
      },
      {
        "fullUrl": "QuestionnaireResponse/5770951-a",
        "resource": {
          "responseType": "QuestionnaireResponse",
          "id": "5770951-a",
          "questionnaire": "5770951",
          "title": "FAA 8500-8",
          "description": "Acceptable evidence of physical fitness on a form prescribed by the Administrator.",
          "status": "in-progress",
          "authored": "2024-04-01T01:20:41.893Z",
          "item": [
            {
              "type": "string",
              "linkId": "19264175569",
              "code": [
                {
                  "system": "https://www.faa.gov/pilots/medical_certification",
                  "code": "1",
                  "display": "Medical certificate type"
                }
              ],
              "text": "What is the patient applying for?",
              "required": true,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "form8500-8",
                    "code": "amc",
                    "display": "Airman Medical Certificate"
                  }
                },
                {
                  "valueCoding": {
                    "system": "form8500-8",
                    "code": "amspc",
                    "display": "Airman Medical Student Pilot Certificate"
                  }
                }
              ]
            },
            {
              "linkId": "7270595484463",
              "code": [
                {
                  "system": "https://www.faa.gov/pilots/medical_certification",
                  "code": "2",
                  "display": "Class of medical certificate"
                }
              ],
              "text": "What class of medical certificate does the patient have?",
              "type": "string",
              "required": true,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "form8500-8",
                    "code": "1",
                    "display": "1st"
                  }
                },
                {
                  "valueCoding": {
                    "system": "form8500-8",
                    "code": "2",
                    "display": "2nd"
                  }
                },
                {
                  "valueCoding": {
                    "system": "form8500-8",
                    "code": "3",
                    "display": "3rd"
                  }
                }
              ]
            },
            {
              "linkId": "2898049029846",
              "code": [
                {
                  "system": "https://www.faa.gov/pilots/medical_certification",
                  "code": "3.1",
                  "display": "Last name"
                }
              ],
              "text": "What is the patient's last name?",
              "type": "string"
            },
            {
              "linkId": "4564656421201",
              "code": [
                {
                  "system": "https://www.faa.gov/pilots/medical_certification",
                  "code": "3.2",
                  "display": "first name"
                }
              ],
              "text": "What is the patient's first name?",
              "type": "string"
            },
            {
              "linkId": "20315389196",
              "code": [
                {
                  "system": "https://www.faa.gov/pilots/medical_certification",
                  "code": "3.3",
                  "display": "middle name"
                }
              ],
              "text": "What is the patient's middle name?",
              "type": "string"
            },
            {
              "linkId": "3244638245409",
              "code": [
                {
                  "system": "https://www.faa.gov/pilots/medical_certification",
                  "code": "4",
                  "display": "Social Security number"
                }
              ],
              "text": "What is the patient's social security number?",
              "type": "string",
              "required": true
            },
            {
              "linkId": "3742489239981",
              "code": [
                {
                  "system": "https://www.faa.gov/pilots/medical_certification",
                  "code": "5",
                  "display": "Address and telephone number"
                }
              ],
              "text": "What is the patient's address and telephone number?",
              "type": "string"
            },
            {
              "linkId": "990063069213",
              "code": [
                {
                  "system": "http://loinc.org",
                  "code": "21112-8",
                  "display": "Birth date"
                }
              ],
              "text": "What is the patient's date of birth?",
              "type": "string",
              "required": true
            },
            {
              "linkId": "717842501763",
              "code": [
                {
                  "system": "https://www.faa.gov/pilots/medical_certification",
                  "code": "7",
                  "display": "Color of hair"
                }
              ],
              "text": "What is the color of the patient's hair?",
              "type": "string"
            },
            {
              "type": "choice",
              "linkId": "8636877002143",
              "code": [
                {
                  "system": "https://www.faa.gov/pilots/medical_certification",
                  "code": "10",
                  "display": "Item 10 - Occupation"
                }
              ],
              "text": "What is the patient's occupation?",
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "https://www.bls.gov/oes/current/oes_stru",
                    "code": "53-2011",
                    "display": "Airline Pilots, Copilots, and Flight Engineers"
                  }
                },
                {
                  "valueCoding": {
                    "system": "https://www.bls.gov/oes/current/oes_stru",
                    "code": "53-2012",
                    "display": "Commercial Pilots"
                  }
                }
              ]
            },
            {
              "type": "string",
              "linkId": "1408648142286",
              "code": [
                {
                  "system": "https://www.faa.gov/pilots/medical_certification",
                  "code": "12",
                  "display": "Item 12 - Employer name"
                }
              ],
              "text": "What is the name of the patient's employer?"
            },
            {
              "type": "choice",
              "linkId": "1835999511438",
              "code": [
                {
                  "system": "https://www.faa.gov/pilots/medical_certification",
                  "code": "13",
                  "display": "Item 13 - FAA Airman Medical Certificate Denied Suspended or Revoked"
                }
              ],
              "text": "Has the patient's FAA Airman Medical Certificate ever been denied, suspended, or revoked?",
              "required": true,
              "answerOption": [
                {
                  "valueCoding": {
                    "code": "1",
                    "display": "Yes"
                  }
                },
                {
                  "valueCoding": {
                    "code": "0",
                    "display": "No"
                  }
                }
              ]
            },
            {
              "type": "choice",
              "linkId": "2164571589013",
              "code": [
                {
                  "system": "https://www.faa.gov/pilots/medical_certification",
                  "code": "18",
                  "display": "Have you ever in your life been diagnosed with, had, or do you presently have any of the following?"
                }
              ],
              "text": "Has the patient ever in their life been diagnosed with, had, or do they presently have any of the following?",
              "required": true,
              "answerOption": [
                {
                  "valueCoding": {
                    "code": "a",
                    "display": "Frequent or severe headaches"
                  }
                },
                {
                  "valueCoding": {
                    "code": "b",
                    "display": "Dizziness or fainting spell"
                  }
                },
                {
                  "valueCoding": {
                    "code": "c",
                    "display": "Unconsciousness for any reason"
                  }
                },
                {
                  "valueCoding": {
                    "code": "d",
                    "display": "Eye or vision trouble except glasses"
                  }
                },
                {
                  "valueCoding": {
                    "code": "e",
                    "display": "Hay fever or allergy"
                  }
                },
                {
                  "valueCoding": {
                    "code": "f",
                    "display": "Asthma or lung disease"
                  }
                },
                {
                  "valueCoding": {
                    "code": "g",
                    "display": "Heart or vascular trouble"
                  }
                },
                {
                  "valueCoding": {
                    "code": "h",
                    "display": "High or low blood pressure"
                  }
                },
                {
                  "valueCoding": {
                    "code": "i",
                    "display": "Stomach, liver, or intestinal trouble"
                  }
                },
                {
                  "valueCoding": {
                    "code": "j",
                    "display": "Kidney stone or blood in urine"
                  }
                },
                {
                  "valueCoding": {
                    "code": "k",
                    "display": "Diabetes"
                  }
                },
                {
                  "valueCoding": {
                    "code": "l",
                    "display": "Neurlogical disorders; epilepsy, seizures, stroke, paralysis, etc"
                  }
                },
                {
                  "valueCoding": {
                    "code": "m",
                    "display": "Mental disorders of any sort; depression, anxiety, etc"
                  }
                },
                {
                  "valueCoding": {
                    "code": "n",
                    "display": "Substance dependence or failed a drug test ever; or substance abuse or use of illegal substance in the last 2 years."
                  }
                },
                {
                  "valueCoding": {
                    "code": "o",
                    "display": "Alcohol dependence or abuse"
                  }
                },
                {
                  "valueCoding": {
                    "code": "p",
                    "display": "Suicide attempt"
                  }
                },
                {
                  "valueCoding": {
                    "code": "q",
                    "display": "Motion sickness requiring medication"
                  }
                }
              ]
            },
            {
              "item": [
                {
                  "text": "The applicant should indicate the total number of civilian flight hours and whether those hours are logged (LOG) or estimated (EST).",
                  "type": "display",
                  "linkId": "8884801232461_helpText",
                  "extension": [
                    {
                      "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                      "valueCodeableConcept": {
                        "text": "Help-Button",
                        "coding": [
                          {
                            "code": "help",
                            "display": "Help-Button",
                            "system": "http://hl7.org/fhir/questionnaire-item-control"
                          }
                        ]
                      }
                    }
                  ]
                }
              ],
              "type": "integer",
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-unit",
                  "valueCoding": {
                    "system": "http://unitsofmeasure.org",
                    "code": "h",
                    "display": "hour"
                  }
                }
              ],
              "linkId": "8884801232461",
              "code": [
                {
                  "system": "https://www.faa.gov/pilots/medical_certification",
                  "code": "14",
                  "display": "Item 14 - Total Pilot Time to Date"
                }
              ],
              "text": "What is the patient's total pilot time to date?",
              "initial": [
                {
                  "valueInteger": 0
                }
              ]
            },
            {
              "type": "integer",
              "extension": [
                {
                  "url": "http://hl7.org/fhir/StructureDefinition/questionnaire-unit",
                  "valueCoding": {
                    "system": "http://unitsofmeasure.org",
                    "code": "h",
                    "display": "hour"
                  }
                }
              ],
              "linkId": "5125604165611",
              "code": [
                {
                  "system": "https://www.faa.gov/pilots/medical_certification",
                  "code": "15",
                  "display": "Total Pilot Time Past 6 Months"
                }
              ],
              "text": "How much total pilot time has the patient had in the past 6 months?"
            },
            {
              "type": "date",
              "linkId": "3625615065757",
              "code": [
                {
                  "system": "https://www.faa.gov/pilots/medical_certification",
                  "code": "16",
                  "display": "Date of Last FAA Medical Application"
                }
              ],
              "text": "When was the patient's last FAA Medical Application submitted?"
            },
            {
              "type": "choice",
              "linkId": "3764621580219",
              "code": [
                {
                  "system": "https://www.faa.gov/pilots/medical_certification",
                  "code": "17a",
                  "display": "Do You Currently Use Any Prescription of Non-prescription Medication?"
                }
              ],
              "text": "Does the patient currently use any prescription or non-prescription medication?",
              "required": true,
              "answerOption": [
                {
                  "valueCoding": {
                    "code": "1",
                    "display": "Yes"
                  }
                },
                {
                  "valueCoding": {
                    "code": "0",
                    "display": "No"
                  }
                }
              ]
            },
            {
              "type": "string",
              "linkId": "282204433287",
              "code": [
                {
                  "system": "https://www.faa.gov/pilots/medical_certification",
                  "code": "17a1",
                  "display": "Enter in medication name"
                }
              ],
              "text": "What is the name of the medication that the patient is currently taking?",
              "enableWhen": [
                {
                  "question": "3764621580219",
                  "operator": "=",
                  "answerCoding": {
                    "code": "1",
                    "display": "Yes"
                  }
                }
              ],
              "repeats": true
            },
            null
          ],
          "_id": "w8uB2QbcxtgyMGAjH"
        },
        "request": {
          "method": "PUT",
          "url": "QuestionnaireResponse/5770951-a"
        }
      },
      {
        "fullUrl": "QuestionnaireResponse/fasi",
        "resource": {
          "id": "fasi",
          "responseType": "QuestionnaireResponse",
          "status": "draft",
          "authored": "2024-04-27T18:21:32.181Z",
          "item": [
            {
              "linkId": "Section-37/GG0175A",
              "prefix": "GG0175A",
              "text": "Does the patient or resident use a manual wheelchair?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "0",
                    "display": "No"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA32-8",
                    "display": "No"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "1",
                    "display": "Yes"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA33-6",
                    "display": "Yes"
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0175F",
              "prefix": "GG0175F",
              "text": "Does the patient or resident use a motorized wheelchair and/or scooter?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "0",
                    "display": "No"
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                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA32-8",
                    "display": "No"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "1",
                    "display": "Yes"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA33-6",
                    "display": "Yes"
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125B1",
              "prefix": "GG0125B1",
              "text": "Does the patient use an assistive device such as a standard folding walker?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170HH",
              "prefix": "GG0170HH",
              "text": "Does the patient or resident have the ability to walk?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "0",
                    "display": "No, and walking goal is not indicated"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA31067-4",
                    "display": "No, and walking goal is not indicated"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "1",
                    "display": "No, and walking is indicated"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA31068-2",
                    "display": "No, and walking goal is indicated"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "2",
                    "display": "Yes"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA33-6",
                    "display": "Yes"
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0900A1",
              "prefix": "F0900A1",
              "text": "Please identify the usual living arrangement of the patient or resident during the past three days.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "{Patient/Resident} lives alone - no other residents in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30925-4",
                    "display": "Person lives alone - no other residents in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "{Patient/Resident} lives with others in the home - for example, family, friends, or paid caregiver."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30926-2",
                    "display": "Person lives with others in the home - for example, family, friends, or paid caregiver."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "{Patient/Resident} lives in congregate home - for example, assisted living, or residential care home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30927-0",
                    "display": "Person lives in congregate home - for example, assisted living, or residential care home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "{Patient/Resident} does not have a permanent home or is homeless."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30928-8",
                    "display": "Person does not have a permanent home or is homeless."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "{Patient/Resident} was in a medical facility."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30929-6",
                    "display": "Person was in a medical facility."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125B",
              "prefix": "GG0125B",
              "text": "Does the patient use an assistive device such as a walker?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125Z",
              "prefix": "GG0125Z",
              "text": "Does the patient use an assistive device other than the ones previously mentioned?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125A",
              "prefix": "GG0125A",
              "text": "The patient uses an assistive device, specifically a cane or a crutch.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125AA",
              "prefix": "GG0125AA",
              "text": "In the past month, has the patient used, or expressed or demonstrated a need for an assistive device?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "1",
                    "display": "Yes"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA33-6",
                    "display": "Yes"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "0",
                    "display": "No"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA32-8",
                    "display": "No"
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0910A",
              "prefix": "F0910A",
              "text": "Does the patient or resident have assistance in their home? The options are \"Yes\" or \"No\".",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "0",
                    "display": "No"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA32-8",
                    "display": "No"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "1",
                    "display": "Yes"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA33-6",
                    "display": "Yes"
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170X7",
              "prefix": "GG0170X7",
              "text": "The patient's usual performance indicates their ability to walk across a street before the light turns red.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170E7",
              "prefix": "GG0170E7",
              "text": "The form inquires about the patient's usual performance in terms of their ability to transfer to and from a bed to a chair or wheelchair.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170J7",
              "prefix": "GG0170J7",
              "text": "Does the patient have the ability, once standing, to walk at least 50 feet and make two turns as part of their usual performance?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0920E1",
              "prefix": "F0920E1",
              "text": "Has the patient paid for medical procedures or treatments, such as changing wound dressings or home exercise programs?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30938-7",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Caregiver(s) currently provide assistance - {Patient's/Resident's} usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30939-5",
                    "display": "Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30940-3",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Unclear is caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30941-1",
                    "display": "Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistance needed but no caregiver(s) available - {Patient/Resident} needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30942-9",
                    "display": "Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistance needed but {patient/resident} declines assistance - {Patient/Resident} needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30943-7",
                    "display": "Assistance needed but person declines assistance - Person needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30944-5",
                    "display": "Not applicable - Person does not do this activity."
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0920B2",
              "prefix": "F0920B2",
              "text": "Does the patient require mobility assistance, such as help with bed mobility, transfers, ambulating, or wheeling, and is this assistance unpaid?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30938-7",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Caregiver(s) currently provide assistance - {Patient's/Resident's} usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30939-5",
                    "display": "Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30940-3",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Unclear is caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30941-1",
                    "display": "Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistance needed but no caregiver(s) available - {Patient/Resident} needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30942-9",
                    "display": "Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistance needed but {patient/resident} declines assistance - {Patient/Resident} needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30943-7",
                    "display": "Assistance needed but person declines assistance - Person needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30944-5",
                    "display": "Not applicable - Person does not do this activity."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170K7",
              "prefix": "GG0170K7",
              "text": "Once the patient is standing, they should have the ability to walk at least 150 feet in a corridor or similar space. The usual performance is evaluated.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170F8",
              "prefix": "GG0170F8",
              "text": "The form inquires about the patient's ability to transfer to and from a toilet or commode, asking whether their performance is most dependent.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170D7",
              "prefix": "GG0170D7",
              "text": "Does the patient typically have the ability to come to a standing position from sitting in a chair, wheelchair, or on the side of the bed?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0920H1",
              "prefix": "F0920H1",
              "text": "Does the individual advocate or facilitate the patient's participation in appropriate medical care, for example, providing transportation to or from appointments? The options for this are either paid or unpaid.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30938-7",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Caregiver(s) currently provide assistance - {Patient's/Resident's} usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30939-5",
                    "display": "Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30940-3",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Unclear is caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30941-1",
                    "display": "Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistance needed but no caregiver(s) available - {Patient/Resident} needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30942-9",
                    "display": "Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistance needed but {patient/resident} declines assistance - {Patient/Resident} needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30943-7",
                    "display": "Assistance needed but person declines assistance - Person needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30944-5",
                    "display": "Not applicable - Person does not do this activity."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170M7",
              "prefix": "GG0170M7",
              "text": "The form asks about the patient's usual performance in the ability to go up and down a curb and/or up and down one step.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170W8",
              "prefix": "GG0170W8",
              "text": "The patient's ability to walk for 15 minutes without stopping or resting, like through a department store or supermarket, is the most dependent performance.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170B7",
              "prefix": "GG0170B7",
              "text": "The form asks about the patient's usual ability to move from sitting on the side of the bed to lying flat on the bed.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0130F7",
              "prefix": "GG0130F7",
              "text": "The form asks about the patient's usual performance in terms of their ability to dress and undress their upper body, including handling fasteners if applicable.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170X8",
              "prefix": "GG0170X8",
              "text": "The form asks the patient about their ability to walk across a street before the light turns red, with the most dependent performance as an answer choice.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170N7",
              "prefix": "GG0170N7",
              "text": "The form is asking about the patient's usual performance in regards to their ability to go up and down four steps, with or without using a rail.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0175B8",
              "prefix": "GG0175B8",
              "text": "Once seated in their manual wheelchair, the patient has the ability to wheel at least 50 feet and make two turns, indicating a most dependent performance level.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0920F1",
              "prefix": "F0920F1",
              "text": "Does the patient manage their equipment, for example, oxygen, IV/infusion equipment, enteral/parenteral nutrition, or ventilator therapy equipment and supplies, and is it paid for?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30938-7",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Caregiver(s) currently provide assistance - {Patient's/Resident's} usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30939-5",
                    "display": "Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30940-3",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Unclear is caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30941-1",
                    "display": "Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistance needed but no caregiver(s) available - {Patient/Resident} needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30942-9",
                    "display": "Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistance needed but {patient/resident} declines assistance - {Patient/Resident} needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30943-7",
                    "display": "Assistance needed but person declines assistance - Person needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30944-5",
                    "display": "Not applicable - Person does not do this activity."
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0920D2",
              "prefix": "F0920D2",
              "text": "Does the patient administer their medication themselves (for example, oral, inhaled, or injectable medications) without any paid assistance?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30938-7",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Caregiver(s) currently provide assistance - {Patient's/Resident's} usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30939-5",
                    "display": "Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30940-3",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Unclear is caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30941-1",
                    "display": "Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistance needed but no caregiver(s) available - {Patient/Resident} needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30942-9",
                    "display": "Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistance needed but {patient/resident} declines assistance - {Patient/Resident} needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30943-7",
                    "display": "Assistance needed but person declines assistance - Person needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30944-5",
                    "display": "Not applicable - Person does not do this activity."
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0910B2",
              "prefix": "F0910B2",
              "text": "Please indicate the level of both paid and unpaid assistance in the patient's or resident's home during the past month. The level of assistance was unpaid.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "No assistance received"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA12345-7",
                    "display": "No assistance received"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Occasional/short-term assistance"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30934-6",
                    "display": "Occasional/short term assistance"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Regular night-time"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30935-3",
                    "display": "Regular night-time"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Regular daytime"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA12164-2",
                    "display": "Regular daytime"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Around the clock"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA12163-4",
                    "display": "Around the clock"
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0130H7",
              "prefix": "GG0130H7",
              "text": "The form asks the patient to evaluate their usual performance in putting on and taking off socks, shoes, or other footwear appropriate for safe mobility. This includes handling fasteners, if applicable.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170O8",
              "prefix": "GG0170O8",
              "text": "The form asks the patient to assess their ability to go up and down 12 steps with or without a rail, with the most dependent performance being the possible response.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0130G7",
              "prefix": "GG0130G7",
              "text": "The form asks about the patient's usual performance in their ability to dress and undress below the waist, including fasteners, excluding footwear.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170M8",
              "prefix": "GG0170M8",
              "text": "The form asks about the patient's ability to go up and down a curb and/or up and down one step. The patient's performance is most dependent in this activity.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0175G8",
              "prefix": "GG0175G8",
              "text": "Once seated in their motorized wheelchair or scooter, the patient has the ability to wheel at least 50 feet and make two turns. However, their performance indicates that they are most dependent on this form of mobility.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0920H2",
              "prefix": "F0920H2",
              "text": "Does the person facilitate or advocate for the patient's participation in appropriate medical care, for instance, by transporting them to or from appointments, without any charge?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30938-7",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Caregiver(s) currently provide assistance - {Patient's/Resident's} usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30939-5",
                    "display": "Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30940-3",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Unclear is caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30941-1",
                    "display": "Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistance needed but no caregiver(s) available - {Patient/Resident} needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30942-9",
                    "display": "Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistance needed but {patient/resident} declines assistance - {Patient/Resident} needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30943-7",
                    "display": "Assistance needed but person declines assistance - Person needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30944-5",
                    "display": "Not applicable - Person does not do this activity."
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0910B1",
              "prefix": "F0910B1",
              "text": "Please indicate the level of both paid and unpaid assistance in the patient's or resident's home during the past month. The choices are \"Paid\", \"Unpaid\", or \"Both Paid and Unpaid\".",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "No assistance received"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA12345-7",
                    "display": "No assistance received"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Occasional/short-term assistance"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30934-6",
                    "display": "Occasional/short term assistance"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Regular night-time"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30935-3",
                    "display": "Regular night-time"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Regular daytime"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA12164-2",
                    "display": "Regular daytime"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Around the clock"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA12163-4",
                    "display": "Around the clock"
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0175B7",
              "prefix": "GG0175B7",
              "text": "The form asks about the patient's ability to wheel at least 50 feet and make two turns once seated in a manual wheelchair, assessing their usual performance.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170I7",
              "prefix": "GG0170I7",
              "text": "The form asks about the patient's usual performance in terms of their ability to walk at least 10 feet once standing, whether it be in a room, corridor, or similar space.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170L7",
              "prefix": "GG0170L7",
              "text": "The form asks about the patient's usual performance in the ability to walk 10 feet on uneven or sloping surfaces, such as turf or gravel, both indoors and outdoors.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170U8",
              "prefix": "GG0170U8",
              "text": "The form asks about the patient's ability to walk from one room to another, maneuver around furniture, and navigate other obstacles indoors. The label classifies the patient's performance as most dependent.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0175C8",
              "prefix": "GG0175C8",
              "text": "Once the patient is seated in the wheelchair, they should have the ability to wheel at least 150 feet in a corridor or similar space. The choices for this ability are with a manual wheelchair or indicating the most dependent performance.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185F8",
              "prefix": "GG0185F8",
              "text": "The form asks about the patient's ability to answer a telephone call in their customary manner and maintain it for 1 minute or longer. This does not include getting to the phone. The label for the most dependent performance is used.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185K7",
              "prefix": "GG0185K7",
              "text": "The patient's usual performance in simple financial management includes the ability to complete financial transactions such as counting coins, verifying change for a single item transaction, writing a check, online/mobile bill pay, banking, or shopping.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0175E7",
              "prefix": "GG0175E7",
              "text": "The form is asking about the patient's ability to wheel across a street using a manual wheelchair before the light turns red. The patient usually performs this task with their usual performance.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0130F8",
              "prefix": "GG0130F8",
              "text": "The form asks about the patient's ability to dress and undress above the waist, including dealing with fasteners if applicable, and the patient's most dependent performance is being evaluated.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0175H7",
              "prefix": "GG0175H7",
              "text": "Once the patient is seated in the wheelchair or scooter, does he or she have the ability to wheel at least 150 feet in a corridor or similar space? The options are: Motorized Wheelchair/Scooter or Usual Performance.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170C7",
              "prefix": "GG0170C7",
              "text": "The form asks about the patient's usual performance in the ability to move from lying on their back to sitting on the side of the bed with their feet flat on the floor, and without any back support.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0130G8",
              "prefix": "GG0130G8",
              "text": "The form asks about the patient's ability to dress and undress below the waist, including handling fasteners, but not including footwear. It indicates that the patient's performance in this area is mostly dependent.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0130D8",
              "prefix": "GG0130D8",
              "text": "The form asks about the patient's ability to wash, rinse, and dry their face, hands, chest, and arms while sitting in a chair or bed. The performance level indicated is \"Most Dependent Performance\".",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170K8",
              "prefix": "GG0170K8",
              "text": "The form asks if the patient, once standing, has the ability to walk at least 150 feet in a corridor or similar space. The performance level is gauged as 'Most Dependent Performance'.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185E8",
              "prefix": "GG0185E8",
              "text": "The patient's performance level in light shopping is at its most dependent. Once at the store, they can locate and select up to five needed goods, take them to the checkout, and complete the purchasing transaction.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170W7",
              "prefix": "GG0170W7",
              "text": "Does the patient have the ability to walk for 15 minutes without stopping or resting, such as through a department store or supermarket, as part of their usual performance?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170V7",
              "prefix": "GG0170V7",
              "text": "The form asks whether the patient has the ability to carry something in both hands, such as several dishes, a light laundry basket, or a tray with food, while walking indoors. The category for this question is 'Usual Performance.'",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170D8",
              "prefix": "GG0170D8",
              "text": "The form asks about the patient's ability to come to a standing position from sitting in a chair, wheelchair, or on the side of the bed. The patient's performance is most dependent in this regard.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0920A2",
              "prefix": "F0920A2",
              "text": "Does the patient require unpaid assistance with self-care tasks such as bathing, dressing, toileting, or eating/feeding?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30938-7",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Caregiver(s) currently provide assistance - {Patient's/Resident's} usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30939-5",
                    "display": "Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30940-3",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Unclear is caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30941-1",
                    "display": "Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistance needed but no caregiver(s) available - {Patient/Resident} needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30942-9",
                    "display": "Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistance needed but {patient/resident} declines assistance - {Patient/Resident} needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30943-7",
                    "display": "Assistance needed but person declines assistance - Person needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30944-5",
                    "display": "Not applicable - Person does not do this activity."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185G7",
              "prefix": "GG0185G7",
              "text": "The question on the form asks about the patient's or resident's usual performance in terms of the ability to place a call in their customary manner and maintain it for 1 minute or longer. Note that this does not include the act of getting to the phone.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185J7",
              "prefix": "GG0185J7",
              "text": "The patient's usual performance in medication management of injectable medications assesses their ability to prepare and take all prescribed injectable medications reliably and safely. This includes the administration of the correct dosage at the appropriate times or intervals.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170C8",
              "prefix": "GG0170C8",
              "text": "The form is asking about the patient's ability to move from lying on their back to sitting on the side of the bed with their feet flat on the floor, without any back support. The patient's performance in this task is categorized as 'Most Dependent'.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0175J7",
              "prefix": "GG0175J7",
              "text": "The form asks the patient about their ability to wheel across a street before the light turns red once they are seated in a wheelchair or scooter. The options for response are 'Motorized Wheelchair/Scooter' and 'Usual Performance'.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185D7",
              "prefix": "GG0185D7",
              "text": "The patient's usual performance in the ability to complete heavier periodic housework, such as doing laundry, vacuuming, and cleaning the bathroom, is evaluated to ensure they can maintain a safe home environment and not be at risk for harm within their home.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185A8",
              "prefix": "GG0185A8",
              "text": "The form inquires about the patient's ability to plan and prepare all aspects of a light cold meal, such as a bowl of cereal, sandwich and cold drink. The patient's performance in this area is marked as 'Most Dependent'.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0175G7",
              "prefix": "GG0175G7",
              "text": "Once the patient is seated in a wheelchair or scooter, they should have the ability to wheel at least 50 feet and make two turns. The options are either using a motorized wheelchair/scooter or executing their usual performance.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170O7",
              "prefix": "GG0170O7",
              "text": "The patient's usual performance is their ability to go up and down 12 steps with or without a rail.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0175D8",
              "prefix": "GG0175D8",
              "text": "The patient's ability to wheel for 15 minutes once seated in a manual wheelchair, without stopping or resting, for example, through a department store or supermarket, is evaluated as the most dependent performance.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185H8",
              "prefix": "GG0185H8",
              "text": "The form is asking about the patient's ability to manage their oral medications. This involves the preparation and safely taking all prescribed oral medications, including the administration of the correct dosage at the appropriate times/intervals. The level of performance is marked as \"most dependent\".",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125F",
              "prefix": "GG0125F",
              "text": "Does the patient use an assistive device such as a mechanical lift?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0175D7",
              "prefix": "GG0175D7",
              "text": "The form asks if the patient has the ability to wheel without stopping or resting for 15 minutes once seated in a manual wheelchair, such as when navigating through a department store or supermarket. The question is about their usual performance.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170G8",
              "prefix": "GG0170G8",
              "text": "The form asks about the patient's ability to transfer in and out of a car or van on the passenger side. This does not include the ability to open or close the door or fasten the seat belt. The patient's performance in this area is most dependent.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170I8",
              "prefix": "GG0170I8",
              "text": "The form asks about the patient's ability to walk at least 10 feet once they are standing, whether it be in a room, corridor, or a similar space. The patient's performance is rated as \"Most Dependent\".",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0180B",
              "prefix": "GG0180B",
              "text": "Please ask the patient to describe at least one or two personal priorities in the area of mobility for the next six months. If the patient does not express any personal priorities in this area, please note this below.",
              "type": "text",
              "repeats": false,
              "readOnly": false,
              "maxLength": 1500
            },
            {
              "linkId": "Section-37/GG0130A7",
              "prefix": "GG0130A7",
              "text": "The form is asking about the patient's usual performance in eating. It refers to their ability to use suitable utensils to bring food and/or liquid to their mouth and swallow food and/or liquid once the meal is placed before them.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185G8",
              "prefix": "GG0185G8",
              "text": "The form asks about the patient's or resident's ability to place a call in their customary manner and maintain it for 1 minute or longer. It does not include getting to the phone. The patient's performance in this area is classified as 'Most Dependent'.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0175E8",
              "prefix": "GG0175E8",
              "text": "The form asks about the patient's ability to wheel across a street once seated in a wheelchair before the light turns red. The options are from most dependent to a manual wheelchair performance.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185B7",
              "prefix": "GG0185B7",
              "text": "The form asks whether the patient has the ability to plan and prepare all aspects of a light hot meal, such as heating a bowl of soup and reheating a prepared meal. The label for this question is referring to the patient's usual performance.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125L",
              "prefix": "GG0125L",
              "text": "Does the patient use an assistive device such as grab bars?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0905B",
              "prefix": "F0905B",
              "text": "Please ask the patient to describe at least one or two personal priorities in the area of living arrangements for the next six months. If the patient does not express any personal priorities in this area, kindly note this down.",
              "type": "text",
              "repeats": false,
              "readOnly": false,
              "maxLength": 1500
            },
            {
              "linkId": "Section-37/GG0170U7",
              "prefix": "GG0170U7",
              "text": "The form asks about the patient's usual performance in their ability to walk indoors, specifically from room to room, and around furniture and other obstacles.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185E7",
              "prefix": "GG0185E7",
              "text": "The form asks about the patient's usual performance in light shopping tasks. Specifically, it asks if the patient can once at the store locate and select up to five needed goods, take them to the checkout, and complete the purchasing transaction.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170P8",
              "prefix": "GG0170P8",
              "text": "The form inquires about the patient's ability to bend or stoop from a standing position to pick up a small object, such as a spoon, from the floor. The performance level selected for the patient is \"Most Dependent Performance\".",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185B8",
              "prefix": "GG0185B8",
              "text": "The form asks about the patient's ability to plan and prepare all aspects of a light hot meal, such as heating a bowl of soup and reheating a prepared meal. It is noted that the patient's performance in this area is most dependent.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125Q",
              "prefix": "GG0125Q",
              "text": "Does the patient use an assistive device such as a hearing aid?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125ZZ",
              "prefix": "GG0125ZZ",
              "text": "The patient has indicated all the assistive devices they needed.",
              "type": "text",
              "repeats": false,
              "readOnly": false,
              "maxLength": 1
            },
            {
              "linkId": "Section-37/GG0170N8",
              "prefix": "GG0170N8",
              "text": "The form inquires about the patient's ability to go up and down four steps, with or without the assistance of a rail. The performance level was noted as \"most dependent\".",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0900A2",
              "prefix": "F0900A2",
              "text": "Please identify the patient's or resident's usual living arrangement during the past month.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "{Patient/Resident} lives alone - no other residents in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30925-4",
                    "display": "Person lives alone - no other residents in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "{Patient/Resident} lives with others in the home - for example, family, friends, or paid caregiver."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30926-2",
                    "display": "Person lives with others in the home - for example, family, friends, or paid caregiver."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "{Patient/Resident} lives in congregate home - for example, assisted living, or residential care home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30927-0",
                    "display": "Person lives in congregate home - for example, assisted living, or residential care home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "{Patient/Resident} does not have a permanent home or is homeless."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30928-8",
                    "display": "Person does not have a permanent home or is homeless."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "{Patient/Resident} was in a medical facility."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30929-6",
                    "display": "Person was in a medical facility."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170J8",
              "prefix": "GG0170J8",
              "text": "Once the patient is standing, they will be assessed on their ability to walk at least 50 feet and make two turns. The potential ratings for performance in this task range from 'Most Dependent' to 'Independent'.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0130EE7",
              "prefix": "GG0130EE7",
              "text": "The form inquires about the patient's usual performance regarding the ability to shower or bathe themselves, including tasks such as washing, rinsing, and drying themselves. It should be noted that this does not include the act of transferring in or out of the tub or shower.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185C7",
              "prefix": "GG0185C7",
              "text": "The form is asking about the patient's usual performance in terms of their ability to complete light daily housework. This entails maintaining a safe home environment so that the patient is not at risk from harm within their home. Examples of such housework include tasks like wiping counter tops or doing dishes.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0130EE8",
              "prefix": "GG0130EE8",
              "text": "The form is asking about the patient's level of ability to bathe themselves, including washing, rinsing, and drying. The question does not include the process of transferring in and out of a tub or shower. The performance level designated is \"Most Dependent\".",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0920A1",
              "prefix": "F0920A1",
              "text": "Does the patient require paid assistance for self-care activities such as bathing, dressing, toileting, or eating/feeding?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30938-7",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Caregiver(s) currently provide assistance - {Patient's/Resident's} usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30939-5",
                    "display": "Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30940-3",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Unclear is caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30941-1",
                    "display": "Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistance needed but no caregiver(s) available - {Patient/Resident} needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30942-9",
                    "display": "Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistance needed but {patient/resident} declines assistance - {Patient/Resident} needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30943-7",
                    "display": "Assistance needed but person declines assistance - Person needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30944-5",
                    "display": "Not applicable - Person does not do this activity."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170E8",
              "prefix": "GG0170E8",
              "text": "The form asks about the patient's ability to transfer from a bed to a chair or wheelchair. It is labeled \"Most Dependent Performance\", indicating the need for assistance with this task.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125M",
              "prefix": "GG0125M",
              "text": "Does the patient use an assistive device such as a transfer board?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0130B8",
              "prefix": "GG0130B8",
              "text": "The form asks about the patient's ability to maintain oral hygiene by using suitable items to clean their teeth and, if applicable, their ability to insert and remove dentures into and from their mouth, as well as manage denture soaking and rinsing with the use of equipment. The response category for their performance is \"Most Dependent\".",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125S",
              "prefix": "GG0125S",
              "text": "The patient uses an assistive device, specifically stair rails.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0135B",
              "prefix": "GG0135B",
              "text": "Please ask the patient to describe at least one or two personal priorities in the area of self-care for the next six months. If the patient does not express any personal priorities in this area, please record this information below.",
              "type": "text",
              "repeats": false,
              "readOnly": false,
              "maxLength": 1500
            },
            {
              "linkId": "Section-37/GG0170P7",
              "prefix": "GG0170P7",
              "text": "The form asks about the patient's usual performance in the ability to bend or stoop from a standing position to pick up a small object, such as a spoon, from the floor.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0175C7",
              "prefix": "GG0175C7",
              "text": "Once the patient is seated in their manual wheelchair, their usual performance indicates their ability to wheel at least 150 feet in a corridor or similar space.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0920E2",
              "prefix": "F0920E2",
              "text": "The patient has undergone medical procedures/treatments such as changing a wound dressing or a home exercise program, for which they have not paid.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30938-7",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Caregiver(s) currently provide assistance - {Patient's/Resident's} usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30939-5",
                    "display": "Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30940-3",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Unclear is caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30941-1",
                    "display": "Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistance needed but no caregiver(s) available - {Patient/Resident} needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30942-9",
                    "display": "Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistance needed but {patient/resident} declines assistance - {Patient/Resident} needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30943-7",
                    "display": "Assistance needed but person declines assistance - Person needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30944-5",
                    "display": "Not applicable - Person does not do this activity."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185K8",
              "prefix": "GG0185K8",
              "text": "The form asks about the patient's simple financial management skills, such as their ability to complete financial transactions, counting coins, verifying change for a single item transaction, writing a check, using online/mobile bill pay, banking, or shopping. The patient's performance is most dependent in these areas.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125C",
              "prefix": "GG0125C",
              "text": "Does the patient use an assistive device such as a wheelchair?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185H7",
              "prefix": "GG0185H7",
              "text": "The patient's usual performance in medication management, specifically for oral medications, refers to their ability to prepare and take all prescribed oral medications reliably and safely. This includes administering the correct dosage at the appropriate times or intervals.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125P",
              "prefix": "GG0125P",
              "text": "Does the patient use an assistive device such as glasses or contact lenses?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0175I7",
              "prefix": "GG0175I7",
              "text": "The form asks about the patient's ability to wheel for 15 minutes without stopping or resting, such as through a department store or supermarket, while seated in a wheelchair or scooter. Does the patient typically use a motorized wheelchair or scooter for this task?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125W",
              "prefix": "GG0125W",
              "text": "Does the patient use an assistive device such as a glucometer?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125T",
              "prefix": "GG0125T",
              "text": "Does the patient use an assistive device such as a lift chair?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125D",
              "prefix": "GG0125D",
              "text": "Does the patient use an assistive device such as a limb prosthesis?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185J8",
              "prefix": "GG0185J8",
              "text": "The form asks about the patient's ability to manage injectable medications. It specifically addresses whether the patient can reliably and safely prepare and take all prescribed injectable medications, including the administration of the correct dosage at the correct times/intervals. The patient's performance in this area is marked as \"Most Dependent\".",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125V",
              "prefix": "GG0125V",
              "text": "Does the patient use an assistive device such as a raised toilet seat?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125Y",
              "prefix": "GG0125Y",
              "text": "Does the patient use an assistive device such as an oxygen concentrator?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0175J8",
              "prefix": "GG0175J8",
              "text": "The question on the form is asking about the patient's ability, once seated in a wheelchair or scooter, to wheel across a street before the traffic light turns red. The answer choices are 'Motorized Wheelchair/Scooter' and 'Most Dependent Performance.'",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185I7",
              "prefix": "GG0185I7",
              "text": "The form asks about the patient's ability to manage their medication, specifically regarding inhalant or mist medications. It wants to know if the patient can prepare and take all prescribed inhalant or mist medications reliably and safely, including the correct dosage at the appropriate times or intervals. It asks for information about their usual performance.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125U",
              "prefix": "GG0125U",
              "text": "Does the patient use an assistive device such as ramps?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0180A",
              "prefix": "GG0180A",
              "text": "Please ask the patient to describe at least one or two personal priorities in the area of mobility for the next six months. If the patient does not express any personal priorities in this area, please note this below. The answer options would be: A) Improvement in walking, B) Ability to climb stairs, C) Independence in moving, or D) No personal priorities.",
              "type": "text",
              "repeats": false,
              "readOnly": false,
              "maxLength": 1500
            },
            {
              "linkId": "Section-37/GG0135A",
              "prefix": "GG0135A",
              "text": "Please ask the patient to describe at least one or two personal priorities in the area of self-care for the next six months. If the patient does not express any personal priorities in this area, please note this in their record.",
              "type": "text",
              "repeats": false,
              "readOnly": false,
              "maxLength": 1500
            },
            {
              "linkId": "Section-37/GG0125K",
              "prefix": "GG0125K",
              "text": "Does the patient use an assistive device such as an electronic bed?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125H",
              "prefix": "GG0125H",
              "text": "Does the patient use an assistive device such as a sock aid?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0920C2",
              "prefix": "F0920C2",
              "text": "The patient requires assistance with Instrumental Activities of Daily Living (IADL), such as making meals, housekeeping, telephone, shopping, or finances, which is currently unpaid.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30938-7",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Caregiver(s) currently provide assistance - {Patient's/Resident's} usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30939-5",
                    "display": "Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30940-3",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Unclear is caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30941-1",
                    "display": "Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistance needed but no caregiver(s) available - {Patient/Resident} needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30942-9",
                    "display": "Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistance needed but {patient/resident} declines assistance - {Patient/Resident} needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30943-7",
                    "display": "Assistance needed but person declines assistance - Person needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30944-5",
                    "display": "Not applicable - Person does not do this activity."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0130A8",
              "prefix": "GG0130A8",
              "text": "The question on the form assesses the patient's ability to use suitable utensils to bring food and/or liquid to their mouth and swallow food and/or liquid once the meal is placed before them. The performance options range from independent to most dependent.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125J",
              "prefix": "GG0125J",
              "text": "Does the patient use an assistive device such as a bed rail?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0920G1",
              "prefix": "F0920G1",
              "text": "Does the patient require supervision, for example due to safety concerns, and is this supervision paid?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30938-7",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Caregiver(s) currently provide assistance - {Patient's/Resident's} usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30939-5",
                    "display": "Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30940-3",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Unclear is caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30941-1",
                    "display": "Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistance needed but no caregiver(s) available - {Patient/Resident} needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30942-9",
                    "display": "Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistance needed but {patient/resident} declines assistance - {Patient/Resident} needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30943-7",
                    "display": "Assistance needed but person declines assistance - Person needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30944-5",
                    "display": "Not applicable - Person does not do this activity."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125O",
              "prefix": "GG0125O",
              "text": "Does the patient use an assistive device such as a walk-in or wheel-in shower?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125B3",
              "prefix": "GG0125B3",
              "text": "Does the patient use an assistive device, specifically a walker with wheels?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125G",
              "prefix": "GG0125G",
              "text": "Does the patient use an assistive device such as a reacher or grabber?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170F7",
              "prefix": "GG0170F7",
              "text": "The form asks about the patient's usual performance in terms of their ability to get on and off a toilet or commode.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125N",
              "prefix": "GG0125N",
              "text": "Does the patient require an assistive device such as a shower or commode chair?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125X",
              "prefix": "GG0125X",
              "text": "Does the patient use an assistive device such as a Continuous Positive Airway Pressure (CPAP) machine?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125C1",
              "prefix": "GG0125C1",
              "text": "Does the patient use an assistive device such as a manual wheelchair?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170G7",
              "prefix": "GG0170G7",
              "text": "The patient's usual performance indicates their ability to transfer in and out of a car or van on the passenger side. This does not include their ability to open/close the door or fasten the seat belt.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125B2",
              "prefix": "GG0125B2",
              "text": "Does the patient use an assistive device such as a walker with a seat?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185I8",
              "prefix": "GG0185I8",
              "text": "The form asks about the patient's ability to manage medication, specifically inhalant or mist medications. It wants to know if the patient can reliably and safely prepare and take all prescribed inhalant/mist medications, including the administration of the correct dosage at the appropriate times and intervals. The answer choices include 'Most Dependent Performance'.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0130B7",
              "prefix": "GG0130B7",
              "text": "The form asks about the patient's oral hygiene, specifically their ability to use suitable items to clean their teeth. It also inquires about their use of dentures, if applicable, including their ability to insert and remove the dentures from their mouth, and manage denture soaking and rinsing with the use of equipment. The section is labeled \"Usual Performance.\"",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125I",
              "prefix": "GG0125I",
              "text": "Does the patient use an assistive device such as orthotics or a brace?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125Z_specify",
              "prefix": "GG0125Z_specify",
              "text": "Does the patient use any other type of assistive device? If so, please specify.",
              "type": "text",
              "repeats": false,
              "readOnly": false,
              "maxLength": 1500
            },
            {
              "linkId": "Section-37/GG0170A8",
              "prefix": "GG0170A8",
              "text": "The patient's ability to roll from lying on their back to their left and right side, and return to lying on their back is most dependent on performance.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0130CC7",
              "prefix": "GG0130CC7",
              "text": "The form asks about the patient's usual performance in maintaining toileting hygiene, specifically their ability to maintain perineal/menstrual hygiene and adjust clothing before and after voiding or having a bowel movement. If the patient manages an ostomy, it also includes wiping the opening but does not include managing equipment.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0920D1",
              "prefix": "F0920D1",
              "text": "The form asks about the patient's method of medication administration, with options that include oral, inhaled, or injectable medications. The medication administration for the patient is paid.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30938-7",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Caregiver(s) currently provide assistance - {Patient's/Resident's} usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30939-5",
                    "display": "Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30940-3",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Unclear is caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30941-1",
                    "display": "Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistance needed but no caregiver(s) available - {Patient/Resident} needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30942-9",
                    "display": "Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistance needed but {patient/resident} declines assistance - {Patient/Resident} needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30943-7",
                    "display": "Assistance needed but person declines assistance - Person needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30944-5",
                    "display": "Not applicable - Person does not do this activity."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125E",
              "prefix": "GG0125E",
              "text": "Does the patient use an assistive device, such as a specialized seating pad (for example, an air-filled, gel, or shaped form pad)?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125C2",
              "prefix": "GG0125C2",
              "text": "Does the patient use an assistive device such as a motorized wheelchair and/or scooter?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170L8",
              "prefix": "GG0170L8",
              "text": "The form asks whether the patient has the ability to walk 10 feet on uneven or sloping surfaces, such as turf or gravel, indoors or outdoors. The answer choices for the patient's performance are: Most Independent Performance, Modified Independent, Supervision or Setup, Minimal Assistance, Moderate Assistance, Maximal Assistance, and Most Dependent Performance.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0130CC8",
              "prefix": "GG0130CC8",
              "text": "The form asks the patient about their toileting hygiene, specifically their ability to maintain perineal/menstrual hygiene and adjust their clothes before and after voiding or having a bowel movement. If they are managing an ostomy, they should include their ability to wipe the opening, although managing the equipment is not necessary. The performance rating is either \"Most Dependent Performance\".",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185A7",
              "prefix": "GG0185A7",
              "text": "The patient's usual performance demonstrates the ability to plan and prepare all aspects of a light, cold meal such as a bowl of cereal, sandwich, and cold drink.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0920G2",
              "prefix": "F0920G2",
              "text": "The form asks if the patient requires supervision due to safety concerns, and specifies if this supervision is unpaid.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30938-7",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Caregiver(s) currently provide assistance - {Patient's/Resident's} usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30939-5",
                    "display": "Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30940-3",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Unclear is caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30941-1",
                    "display": "Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistance needed but no caregiver(s) available - {Patient/Resident} needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30942-9",
                    "display": "Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistance needed but {patient/resident} declines assistance - {Patient/Resident} needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30943-7",
                    "display": "Assistance needed but person declines assistance - Person needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30944-5",
                    "display": "Not applicable - Person does not do this activity."
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0920C1",
              "prefix": "F0920C1",
              "text": "Does the patient require paid assistance for Instrumental Activities of Daily Living (IADL), such as making meals, housekeeping, using the telephone, shopping, or managing finances?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30938-7",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Caregiver(s) currently provide assistance - {Patient's/Resident's} usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30939-5",
                    "display": "Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30940-3",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Unclear is caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30941-1",
                    "display": "Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistance needed but no caregiver(s) available - {Patient/Resident} needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30942-9",
                    "display": "Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistance needed but {patient/resident} declines assistance - {Patient/Resident} needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30943-7",
                    "display": "Assistance needed but person declines assistance - Person needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30944-5",
                    "display": "Not applicable - Person does not do this activity."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185L7",
              "prefix": "GG0185L7",
              "text": "The patient's usual performance in complex financial management involves the ability to complete financial decision-making tasks such as budgeting and remembering to pay bills.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185C8",
              "prefix": "GG0185C8",
              "text": "The form inquires about the patient's ability to perform light daily housework in order to maintain a safe home environment such that they are not at risk from harm within their own home. Examples of this housework might include tasks like wiping countertops or doing dishes. The patient's performance is labeled as \"Most Dependent\".",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125R",
              "prefix": "GG0125R",
              "text": "Does the patient use an assistive device such as a communication device?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0920F2",
              "prefix": "F0920F2",
              "text": "Does the patient manage their own equipment, such as oxygen, IV/infusion equipment, enteral/parenteral nutrition, or ventilator therapy equipment and supplies, without any payment?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30938-7",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Caregiver(s) currently provide assistance - {Patient's/Resident's} usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30939-5",
                    "display": "Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30940-3",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Unclear is caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30941-1",
                    "display": "Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistance needed but no caregiver(s) available - {Patient/Resident} needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30942-9",
                    "display": "Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistance needed but {patient/resident} declines assistance - {Patient/Resident} needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30943-7",
                    "display": "Assistance needed but person declines assistance - Person needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30944-5",
                    "display": "Not applicable - Person does not do this activity."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185D8",
              "prefix": "GG0185D8",
              "text": "The form asks about the patient's ability to complete heavier periodic housework, like doing laundry, vacuuming, and cleaning the bathroom, in order to maintain a safe home environment. It also ensures the patient is not at risk for harm within their home. The category marked is 'Most Dependent Performance'.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170B8",
              "prefix": "GG0170B8",
              "text": "The form for the patient includes a question labeled \"Sit to lying\". This refers to the patient's ability to move from sitting on the side of the bed to lying flat on the bed. The performance is categorized as \"Most Dependent\", meaning the patient requires substantial assistance in this task.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0130D7",
              "prefix": "GG0130D7",
              "text": "Does the patient have the ability to wash, rinse, and dry their face, hands, chest, and arms while sitting in a chair or bed? Please rate their usual performance.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0190A",
              "prefix": "GG0190A",
              "text": "Please ask the patient to describe at least one or two personal priorities in the area of instrumental activities of daily living for the next six months. If the patient does not express any personal priorities in this area, please note this below. Answer: A",
              "type": "text",
              "repeats": false,
              "readOnly": false,
              "maxLength": 1500
            },
            {
              "linkId": "Section-6/F0905A",
              "prefix": "F0905A",
              "text": "Please ask the patient to describe at least one or two personal priorities in the area of their living arrangements for the next six months. If the patient does not express any personal priorities in this area, please note this below. The options are - A.",
              "type": "text",
              "repeats": false,
              "readOnly": false,
              "maxLength": 1500
            },
            {
              "linkId": "Section-6/F0920B1",
              "prefix": "F0920B1",
              "text": "Does the patient require mobility assistance, such as assistance with bed mobility, transfers, ambulating, or wheeling? If yes, is this assistance paid?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30938-7",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Caregiver(s) currently provide assistance - {Patient's/Resident's} usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30939-5",
                    "display": "Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30940-3",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Unclear is caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30941-1",
                    "display": "Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistance needed but no caregiver(s) available - {Patient/Resident} needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30942-9",
                    "display": "Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistance needed but {patient/resident} declines assistance - {Patient/Resident} needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30943-7",
                    "display": "Assistance needed but person declines assistance - Person needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30944-5",
                    "display": "Not applicable - Person does not do this activity."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185L8",
              "prefix": "GG0185L8",
              "text": "The form indicates the patient's level of ability in complex financial management, such as completing financial decision-making tasks including budgeting and remembering to pay bills. The patient's performance is recorded as mostly dependent.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0130H8",
              "prefix": "GG0130H8",
              "text": "The form asks about the patient's ability to put on and take off socks, shoes, or other appropriate footwear that is necessary for safe mobility, which includes dealing with fasteners, if applicable. The patient's performance in this aspect has been rated as most dependent.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0175H8",
              "prefix": "GG0175H8",
              "text": "The form is asking about the patient's ability to wheel at least 150 feet in a corridor or similar space once they are seated in a wheelchair or scooter. The answer choices include 'Motorized Wheelchair/Scooter' and 'Most Dependent Performance'.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170A7",
              "prefix": "GG0170A7",
              "text": "The form asks about the patient's usual performance when it comes to their ability to roll from lying on their back to their left and right side, and then return to lying on their back.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185F7",
              "prefix": "GG0185F7",
              "text": "The form asks about the patient's ability to answer a telephone call in their customary manner and maintain the call for one minute or longer. It does not include getting to the phone. The question refers to the patient's usual performance.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0175I8",
              "prefix": "GG0175I8",
              "text": "The patient questionnaire asked, \"Once the patient is seated in a wheelchair or scooter, do they have the ability to wheel without stopping or resting for 15 minutes (for example, through a department store or supermarket)?\" The answer choices include \"Motorized Wheelchair/Scooter\" and \"Most Dependent Performance.\"",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0190B",
              "prefix": "GG0190B",
              "text": "Please ask the patient to describe at least one or two personal priorities in the area of instrumental activities of daily living for the next six months. If the patient does not express any personal priorities in this area, note it below.",
              "type": "text",
              "repeats": false,
              "readOnly": false,
              "maxLength": 1500
            },
            {
              "linkId": "Section-6/F0925A",
              "prefix": "F0925A",
              "text": "Please ask the patient to describe at least one or two personal priorities for their caregiving arrangement in the next six months. If the patient does not express any personal priorities in this area, please note this below.",
              "type": "text",
              "repeats": false,
              "readOnly": false,
              "maxLength": 1500
            },
            {
              "linkId": "Section-6/F0925B",
              "prefix": "F0925B",
              "text": "Please ask the patient or resident to describe at least one or two personal priorities in the area of caregiving for the next six months. If the patient or resident does not express any personal priorities in this area, please note this below. The options are:\n\nA. The patient expresses personal priorities in the area of caregiving.\nB. The patient does not express any personal priorities in the area of caregiving.",
              "type": "text",
              "repeats": false,
              "readOnly": false,
              "maxLength": 1500
            },
            {
              "linkId": "Section-37/GG0170V8",
              "prefix": "GG0170V8",
              "text": "The form for the patient asks about his or her ability to carry something in both hands while walking indoors, such as several dishes, a light laundry basket, or a tray with food. The patient's performance in this area is identified as most dependent.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            }
          ],
          "_id": "txPFJmJMcwAwYSuNu"
        },
        "request": {
          "method": "PUT",
          "url": "QuestionnaireResponse/fasi"
        }
      },
      {
        "fullUrl": "QuestionnaireResponse/fasi",
        "resource": {
          "id": "fasi",
          "responseType": "QuestionnaireResponse",
          "status": "draft",
          "authored": "2024-04-27T18:21:32.181Z",
          "item": [
            {
              "linkId": "Section-37/GG0175A",
              "prefix": "GG0175A",
              "text": "Does the patient or resident use a manual wheelchair?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "0",
                    "display": "No"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA32-8",
                    "display": "No"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "1",
                    "display": "Yes"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA33-6",
                    "display": "Yes"
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0175F",
              "prefix": "GG0175F",
              "text": "Does the patient or resident use a motorized wheelchair and/or scooter?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "0",
                    "display": "No"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA32-8",
                    "display": "No"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "1",
                    "display": "Yes"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA33-6",
                    "display": "Yes"
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125B1",
              "prefix": "GG0125B1",
              "text": "Does the patient use an assistive device such as a standard folding walker?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170HH",
              "prefix": "GG0170HH",
              "text": "Does the patient or resident have the ability to walk?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "0",
                    "display": "No, and walking goal is not indicated"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA31067-4",
                    "display": "No, and walking goal is not indicated"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "1",
                    "display": "No, and walking is indicated"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA31068-2",
                    "display": "No, and walking goal is indicated"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "2",
                    "display": "Yes"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA33-6",
                    "display": "Yes"
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0900A1",
              "prefix": "F0900A1",
              "text": "Please identify the usual living arrangement of the patient or resident during the past three days.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "{Patient/Resident} lives alone - no other residents in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30925-4",
                    "display": "Person lives alone - no other residents in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "{Patient/Resident} lives with others in the home - for example, family, friends, or paid caregiver."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30926-2",
                    "display": "Person lives with others in the home - for example, family, friends, or paid caregiver."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "{Patient/Resident} lives in congregate home - for example, assisted living, or residential care home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30927-0",
                    "display": "Person lives in congregate home - for example, assisted living, or residential care home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "{Patient/Resident} does not have a permanent home or is homeless."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30928-8",
                    "display": "Person does not have a permanent home or is homeless."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "{Patient/Resident} was in a medical facility."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30929-6",
                    "display": "Person was in a medical facility."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125B",
              "prefix": "GG0125B",
              "text": "Does the patient use an assistive device such as a walker?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125Z",
              "prefix": "GG0125Z",
              "text": "Does the patient use an assistive device other than the ones previously mentioned?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125A",
              "prefix": "GG0125A",
              "text": "The patient uses an assistive device, specifically a cane or a crutch.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125AA",
              "prefix": "GG0125AA",
              "text": "In the past month, has the patient used, or expressed or demonstrated a need for an assistive device?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "1",
                    "display": "Yes"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA33-6",
                    "display": "Yes"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "0",
                    "display": "No"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA32-8",
                    "display": "No"
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0910A",
              "prefix": "F0910A",
              "text": "Does the patient or resident have assistance in their home? The options are \"Yes\" or \"No\".",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "0",
                    "display": "No"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA32-8",
                    "display": "No"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "1",
                    "display": "Yes"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA33-6",
                    "display": "Yes"
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170X7",
              "prefix": "GG0170X7",
              "text": "The patient's usual performance indicates their ability to walk across a street before the light turns red.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170E7",
              "prefix": "GG0170E7",
              "text": "The form inquires about the patient's usual performance in terms of their ability to transfer to and from a bed to a chair or wheelchair.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170J7",
              "prefix": "GG0170J7",
              "text": "Does the patient have the ability, once standing, to walk at least 50 feet and make two turns as part of their usual performance?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0920E1",
              "prefix": "F0920E1",
              "text": "Has the patient paid for medical procedures or treatments, such as changing wound dressings or home exercise programs?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30938-7",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Caregiver(s) currently provide assistance - {Patient's/Resident's} usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30939-5",
                    "display": "Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30940-3",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Unclear is caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30941-1",
                    "display": "Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistance needed but no caregiver(s) available - {Patient/Resident} needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30942-9",
                    "display": "Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistance needed but {patient/resident} declines assistance - {Patient/Resident} needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30943-7",
                    "display": "Assistance needed but person declines assistance - Person needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30944-5",
                    "display": "Not applicable - Person does not do this activity."
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0920B2",
              "prefix": "F0920B2",
              "text": "Does the patient require mobility assistance, such as help with bed mobility, transfers, ambulating, or wheeling, and is this assistance unpaid?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30938-7",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Caregiver(s) currently provide assistance - {Patient's/Resident's} usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30939-5",
                    "display": "Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30940-3",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Unclear is caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30941-1",
                    "display": "Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistance needed but no caregiver(s) available - {Patient/Resident} needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30942-9",
                    "display": "Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistance needed but {patient/resident} declines assistance - {Patient/Resident} needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30943-7",
                    "display": "Assistance needed but person declines assistance - Person needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30944-5",
                    "display": "Not applicable - Person does not do this activity."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170K7",
              "prefix": "GG0170K7",
              "text": "Once the patient is standing, they should have the ability to walk at least 150 feet in a corridor or similar space. The usual performance is evaluated.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170F8",
              "prefix": "GG0170F8",
              "text": "The form inquires about the patient's ability to transfer to and from a toilet or commode, asking whether their performance is most dependent.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170D7",
              "prefix": "GG0170D7",
              "text": "Does the patient typically have the ability to come to a standing position from sitting in a chair, wheelchair, or on the side of the bed?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0920H1",
              "prefix": "F0920H1",
              "text": "Does the individual advocate or facilitate the patient's participation in appropriate medical care, for example, providing transportation to or from appointments? The options for this are either paid or unpaid.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30938-7",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Caregiver(s) currently provide assistance - {Patient's/Resident's} usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30939-5",
                    "display": "Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30940-3",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Unclear is caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30941-1",
                    "display": "Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistance needed but no caregiver(s) available - {Patient/Resident} needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30942-9",
                    "display": "Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistance needed but {patient/resident} declines assistance - {Patient/Resident} needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30943-7",
                    "display": "Assistance needed but person declines assistance - Person needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30944-5",
                    "display": "Not applicable - Person does not do this activity."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170M7",
              "prefix": "GG0170M7",
              "text": "The form asks about the patient's usual performance in the ability to go up and down a curb and/or up and down one step.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170W8",
              "prefix": "GG0170W8",
              "text": "The patient's ability to walk for 15 minutes without stopping or resting, like through a department store or supermarket, is the most dependent performance.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170B7",
              "prefix": "GG0170B7",
              "text": "The form asks about the patient's usual ability to move from sitting on the side of the bed to lying flat on the bed.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0130F7",
              "prefix": "GG0130F7",
              "text": "The form asks about the patient's usual performance in terms of their ability to dress and undress their upper body, including handling fasteners if applicable.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170X8",
              "prefix": "GG0170X8",
              "text": "The form asks the patient about their ability to walk across a street before the light turns red, with the most dependent performance as an answer choice.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170N7",
              "prefix": "GG0170N7",
              "text": "The form is asking about the patient's usual performance in regards to their ability to go up and down four steps, with or without using a rail.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0175B8",
              "prefix": "GG0175B8",
              "text": "Once seated in their manual wheelchair, the patient has the ability to wheel at least 50 feet and make two turns, indicating a most dependent performance level.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0920F1",
              "prefix": "F0920F1",
              "text": "Does the patient manage their equipment, for example, oxygen, IV/infusion equipment, enteral/parenteral nutrition, or ventilator therapy equipment and supplies, and is it paid for?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30938-7",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Caregiver(s) currently provide assistance - {Patient's/Resident's} usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30939-5",
                    "display": "Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30940-3",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Unclear is caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30941-1",
                    "display": "Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistance needed but no caregiver(s) available - {Patient/Resident} needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30942-9",
                    "display": "Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistance needed but {patient/resident} declines assistance - {Patient/Resident} needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30943-7",
                    "display": "Assistance needed but person declines assistance - Person needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30944-5",
                    "display": "Not applicable - Person does not do this activity."
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0920D2",
              "prefix": "F0920D2",
              "text": "Does the patient administer their medication themselves (for example, oral, inhaled, or injectable medications) without any paid assistance?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30938-7",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Caregiver(s) currently provide assistance - {Patient's/Resident's} usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30939-5",
                    "display": "Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30940-3",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Unclear is caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30941-1",
                    "display": "Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistance needed but no caregiver(s) available - {Patient/Resident} needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30942-9",
                    "display": "Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistance needed but {patient/resident} declines assistance - {Patient/Resident} needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30943-7",
                    "display": "Assistance needed but person declines assistance - Person needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30944-5",
                    "display": "Not applicable - Person does not do this activity."
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0910B2",
              "prefix": "F0910B2",
              "text": "Please indicate the level of both paid and unpaid assistance in the patient's or resident's home during the past month. The level of assistance was unpaid.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "No assistance received"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA12345-7",
                    "display": "No assistance received"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Occasional/short-term assistance"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30934-6",
                    "display": "Occasional/short term assistance"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Regular night-time"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30935-3",
                    "display": "Regular night-time"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Regular daytime"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA12164-2",
                    "display": "Regular daytime"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Around the clock"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA12163-4",
                    "display": "Around the clock"
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0130H7",
              "prefix": "GG0130H7",
              "text": "The form asks the patient to evaluate their usual performance in putting on and taking off socks, shoes, or other footwear appropriate for safe mobility. This includes handling fasteners, if applicable.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170O8",
              "prefix": "GG0170O8",
              "text": "The form asks the patient to assess their ability to go up and down 12 steps with or without a rail, with the most dependent performance being the possible response.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0130G7",
              "prefix": "GG0130G7",
              "text": "The form asks about the patient's usual performance in their ability to dress and undress below the waist, including fasteners, excluding footwear.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170M8",
              "prefix": "GG0170M8",
              "text": "The form asks about the patient's ability to go up and down a curb and/or up and down one step. The patient's performance is most dependent in this activity.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0175G8",
              "prefix": "GG0175G8",
              "text": "Once seated in their motorized wheelchair or scooter, the patient has the ability to wheel at least 50 feet and make two turns. However, their performance indicates that they are most dependent on this form of mobility.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0920H2",
              "prefix": "F0920H2",
              "text": "Does the person facilitate or advocate for the patient's participation in appropriate medical care, for instance, by transporting them to or from appointments, without any charge?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30938-7",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Caregiver(s) currently provide assistance - {Patient's/Resident's} usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30939-5",
                    "display": "Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30940-3",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Unclear is caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30941-1",
                    "display": "Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistance needed but no caregiver(s) available - {Patient/Resident} needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30942-9",
                    "display": "Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistance needed but {patient/resident} declines assistance - {Patient/Resident} needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30943-7",
                    "display": "Assistance needed but person declines assistance - Person needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30944-5",
                    "display": "Not applicable - Person does not do this activity."
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0910B1",
              "prefix": "F0910B1",
              "text": "Please indicate the level of both paid and unpaid assistance in the patient's or resident's home during the past month. The choices are \"Paid\", \"Unpaid\", or \"Both Paid and Unpaid\".",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "No assistance received"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA12345-7",
                    "display": "No assistance received"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Occasional/short-term assistance"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30934-6",
                    "display": "Occasional/short term assistance"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Regular night-time"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30935-3",
                    "display": "Regular night-time"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Regular daytime"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA12164-2",
                    "display": "Regular daytime"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Around the clock"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA12163-4",
                    "display": "Around the clock"
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0175B7",
              "prefix": "GG0175B7",
              "text": "The form asks about the patient's ability to wheel at least 50 feet and make two turns once seated in a manual wheelchair, assessing their usual performance.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170I7",
              "prefix": "GG0170I7",
              "text": "The form asks about the patient's usual performance in terms of their ability to walk at least 10 feet once standing, whether it be in a room, corridor, or similar space.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170L7",
              "prefix": "GG0170L7",
              "text": "The form asks about the patient's usual performance in the ability to walk 10 feet on uneven or sloping surfaces, such as turf or gravel, both indoors and outdoors.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170U8",
              "prefix": "GG0170U8",
              "text": "The form asks about the patient's ability to walk from one room to another, maneuver around furniture, and navigate other obstacles indoors. The label classifies the patient's performance as most dependent.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0175C8",
              "prefix": "GG0175C8",
              "text": "Once the patient is seated in the wheelchair, they should have the ability to wheel at least 150 feet in a corridor or similar space. The choices for this ability are with a manual wheelchair or indicating the most dependent performance.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185F8",
              "prefix": "GG0185F8",
              "text": "The form asks about the patient's ability to answer a telephone call in their customary manner and maintain it for 1 minute or longer. This does not include getting to the phone. The label for the most dependent performance is used.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185K7",
              "prefix": "GG0185K7",
              "text": "The patient's usual performance in simple financial management includes the ability to complete financial transactions such as counting coins, verifying change for a single item transaction, writing a check, online/mobile bill pay, banking, or shopping.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0175E7",
              "prefix": "GG0175E7",
              "text": "The form is asking about the patient's ability to wheel across a street using a manual wheelchair before the light turns red. The patient usually performs this task with their usual performance.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0130F8",
              "prefix": "GG0130F8",
              "text": "The form asks about the patient's ability to dress and undress above the waist, including dealing with fasteners if applicable, and the patient's most dependent performance is being evaluated.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0175H7",
              "prefix": "GG0175H7",
              "text": "Once the patient is seated in the wheelchair or scooter, does he or she have the ability to wheel at least 150 feet in a corridor or similar space? The options are: Motorized Wheelchair/Scooter or Usual Performance.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170C7",
              "prefix": "GG0170C7",
              "text": "The form asks about the patient's usual performance in the ability to move from lying on their back to sitting on the side of the bed with their feet flat on the floor, and without any back support.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0130G8",
              "prefix": "GG0130G8",
              "text": "The form asks about the patient's ability to dress and undress below the waist, including handling fasteners, but not including footwear. It indicates that the patient's performance in this area is mostly dependent.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0130D8",
              "prefix": "GG0130D8",
              "text": "The form asks about the patient's ability to wash, rinse, and dry their face, hands, chest, and arms while sitting in a chair or bed. The performance level indicated is \"Most Dependent Performance\".",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170K8",
              "prefix": "GG0170K8",
              "text": "The form asks if the patient, once standing, has the ability to walk at least 150 feet in a corridor or similar space. The performance level is gauged as 'Most Dependent Performance'.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185E8",
              "prefix": "GG0185E8",
              "text": "The patient's performance level in light shopping is at its most dependent. Once at the store, they can locate and select up to five needed goods, take them to the checkout, and complete the purchasing transaction.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170W7",
              "prefix": "GG0170W7",
              "text": "Does the patient have the ability to walk for 15 minutes without stopping or resting, such as through a department store or supermarket, as part of their usual performance?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170V7",
              "prefix": "GG0170V7",
              "text": "The form asks whether the patient has the ability to carry something in both hands, such as several dishes, a light laundry basket, or a tray with food, while walking indoors. The category for this question is 'Usual Performance.'",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170D8",
              "prefix": "GG0170D8",
              "text": "The form asks about the patient's ability to come to a standing position from sitting in a chair, wheelchair, or on the side of the bed. The patient's performance is most dependent in this regard.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0920A2",
              "prefix": "F0920A2",
              "text": "Does the patient require unpaid assistance with self-care tasks such as bathing, dressing, toileting, or eating/feeding?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30938-7",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Caregiver(s) currently provide assistance - {Patient's/Resident's} usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30939-5",
                    "display": "Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30940-3",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Unclear is caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30941-1",
                    "display": "Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistance needed but no caregiver(s) available - {Patient/Resident} needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30942-9",
                    "display": "Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistance needed but {patient/resident} declines assistance - {Patient/Resident} needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30943-7",
                    "display": "Assistance needed but person declines assistance - Person needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30944-5",
                    "display": "Not applicable - Person does not do this activity."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185G7",
              "prefix": "GG0185G7",
              "text": "The question on the form asks about the patient's or resident's usual performance in terms of the ability to place a call in their customary manner and maintain it for 1 minute or longer. Note that this does not include the act of getting to the phone.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185J7",
              "prefix": "GG0185J7",
              "text": "The patient's usual performance in medication management of injectable medications assesses their ability to prepare and take all prescribed injectable medications reliably and safely. This includes the administration of the correct dosage at the appropriate times or intervals.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170C8",
              "prefix": "GG0170C8",
              "text": "The form is asking about the patient's ability to move from lying on their back to sitting on the side of the bed with their feet flat on the floor, without any back support. The patient's performance in this task is categorized as 'Most Dependent'.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0175J7",
              "prefix": "GG0175J7",
              "text": "The form asks the patient about their ability to wheel across a street before the light turns red once they are seated in a wheelchair or scooter. The options for response are 'Motorized Wheelchair/Scooter' and 'Usual Performance'.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185D7",
              "prefix": "GG0185D7",
              "text": "The patient's usual performance in the ability to complete heavier periodic housework, such as doing laundry, vacuuming, and cleaning the bathroom, is evaluated to ensure they can maintain a safe home environment and not be at risk for harm within their home.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185A8",
              "prefix": "GG0185A8",
              "text": "The form inquires about the patient's ability to plan and prepare all aspects of a light cold meal, such as a bowl of cereal, sandwich and cold drink. The patient's performance in this area is marked as 'Most Dependent'.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0175G7",
              "prefix": "GG0175G7",
              "text": "Once the patient is seated in a wheelchair or scooter, they should have the ability to wheel at least 50 feet and make two turns. The options are either using a motorized wheelchair/scooter or executing their usual performance.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170O7",
              "prefix": "GG0170O7",
              "text": "The patient's usual performance is their ability to go up and down 12 steps with or without a rail.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0175D8",
              "prefix": "GG0175D8",
              "text": "The patient's ability to wheel for 15 minutes once seated in a manual wheelchair, without stopping or resting, for example, through a department store or supermarket, is evaluated as the most dependent performance.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185H8",
              "prefix": "GG0185H8",
              "text": "The form is asking about the patient's ability to manage their oral medications. This involves the preparation and safely taking all prescribed oral medications, including the administration of the correct dosage at the appropriate times/intervals. The level of performance is marked as \"most dependent\".",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125F",
              "prefix": "GG0125F",
              "text": "Does the patient use an assistive device such as a mechanical lift?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0175D7",
              "prefix": "GG0175D7",
              "text": "The form asks if the patient has the ability to wheel without stopping or resting for 15 minutes once seated in a manual wheelchair, such as when navigating through a department store or supermarket. The question is about their usual performance.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170G8",
              "prefix": "GG0170G8",
              "text": "The form asks about the patient's ability to transfer in and out of a car or van on the passenger side. This does not include the ability to open or close the door or fasten the seat belt. The patient's performance in this area is most dependent.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170I8",
              "prefix": "GG0170I8",
              "text": "The form asks about the patient's ability to walk at least 10 feet once they are standing, whether it be in a room, corridor, or a similar space. The patient's performance is rated as \"Most Dependent\".",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0180B",
              "prefix": "GG0180B",
              "text": "Please ask the patient to describe at least one or two personal priorities in the area of mobility for the next six months. If the patient does not express any personal priorities in this area, please note this below.",
              "type": "text",
              "repeats": false,
              "readOnly": false,
              "maxLength": 1500
            },
            {
              "linkId": "Section-37/GG0130A7",
              "prefix": "GG0130A7",
              "text": "The form is asking about the patient's usual performance in eating. It refers to their ability to use suitable utensils to bring food and/or liquid to their mouth and swallow food and/or liquid once the meal is placed before them.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185G8",
              "prefix": "GG0185G8",
              "text": "The form asks about the patient's or resident's ability to place a call in their customary manner and maintain it for 1 minute or longer. It does not include getting to the phone. The patient's performance in this area is classified as 'Most Dependent'.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0175E8",
              "prefix": "GG0175E8",
              "text": "The form asks about the patient's ability to wheel across a street once seated in a wheelchair before the light turns red. The options are from most dependent to a manual wheelchair performance.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185B7",
              "prefix": "GG0185B7",
              "text": "The form asks whether the patient has the ability to plan and prepare all aspects of a light hot meal, such as heating a bowl of soup and reheating a prepared meal. The label for this question is referring to the patient's usual performance.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125L",
              "prefix": "GG0125L",
              "text": "Does the patient use an assistive device such as grab bars?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0905B",
              "prefix": "F0905B",
              "text": "Please ask the patient to describe at least one or two personal priorities in the area of living arrangements for the next six months. If the patient does not express any personal priorities in this area, kindly note this down.",
              "type": "text",
              "repeats": false,
              "readOnly": false,
              "maxLength": 1500
            },
            {
              "linkId": "Section-37/GG0170U7",
              "prefix": "GG0170U7",
              "text": "The form asks about the patient's usual performance in their ability to walk indoors, specifically from room to room, and around furniture and other obstacles.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185E7",
              "prefix": "GG0185E7",
              "text": "The form asks about the patient's usual performance in light shopping tasks. Specifically, it asks if the patient can once at the store locate and select up to five needed goods, take them to the checkout, and complete the purchasing transaction.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170P8",
              "prefix": "GG0170P8",
              "text": "The form inquires about the patient's ability to bend or stoop from a standing position to pick up a small object, such as a spoon, from the floor. The performance level selected for the patient is \"Most Dependent Performance\".",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185B8",
              "prefix": "GG0185B8",
              "text": "The form asks about the patient's ability to plan and prepare all aspects of a light hot meal, such as heating a bowl of soup and reheating a prepared meal. It is noted that the patient's performance in this area is most dependent.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125Q",
              "prefix": "GG0125Q",
              "text": "Does the patient use an assistive device such as a hearing aid?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125ZZ",
              "prefix": "GG0125ZZ",
              "text": "The patient has indicated all the assistive devices they needed.",
              "type": "text",
              "repeats": false,
              "readOnly": false,
              "maxLength": 1
            },
            {
              "linkId": "Section-37/GG0170N8",
              "prefix": "GG0170N8",
              "text": "The form inquires about the patient's ability to go up and down four steps, with or without the assistance of a rail. The performance level was noted as \"most dependent\".",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0900A2",
              "prefix": "F0900A2",
              "text": "Please identify the patient's or resident's usual living arrangement during the past month.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "{Patient/Resident} lives alone - no other residents in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30925-4",
                    "display": "Person lives alone - no other residents in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "{Patient/Resident} lives with others in the home - for example, family, friends, or paid caregiver."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30926-2",
                    "display": "Person lives with others in the home - for example, family, friends, or paid caregiver."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "{Patient/Resident} lives in congregate home - for example, assisted living, or residential care home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30927-0",
                    "display": "Person lives in congregate home - for example, assisted living, or residential care home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "{Patient/Resident} does not have a permanent home or is homeless."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30928-8",
                    "display": "Person does not have a permanent home or is homeless."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "{Patient/Resident} was in a medical facility."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30929-6",
                    "display": "Person was in a medical facility."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170J8",
              "prefix": "GG0170J8",
              "text": "Once the patient is standing, they will be assessed on their ability to walk at least 50 feet and make two turns. The potential ratings for performance in this task range from 'Most Dependent' to 'Independent'.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0130EE7",
              "prefix": "GG0130EE7",
              "text": "The form inquires about the patient's usual performance regarding the ability to shower or bathe themselves, including tasks such as washing, rinsing, and drying themselves. It should be noted that this does not include the act of transferring in or out of the tub or shower.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185C7",
              "prefix": "GG0185C7",
              "text": "The form is asking about the patient's usual performance in terms of their ability to complete light daily housework. This entails maintaining a safe home environment so that the patient is not at risk from harm within their home. Examples of such housework include tasks like wiping counter tops or doing dishes.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0130EE8",
              "prefix": "GG0130EE8",
              "text": "The form is asking about the patient's level of ability to bathe themselves, including washing, rinsing, and drying. The question does not include the process of transferring in and out of a tub or shower. The performance level designated is \"Most Dependent\".",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0920A1",
              "prefix": "F0920A1",
              "text": "Does the patient require paid assistance for self-care activities such as bathing, dressing, toileting, or eating/feeding?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30938-7",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Caregiver(s) currently provide assistance - {Patient's/Resident's} usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30939-5",
                    "display": "Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30940-3",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Unclear is caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30941-1",
                    "display": "Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistance needed but no caregiver(s) available - {Patient/Resident} needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30942-9",
                    "display": "Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistance needed but {patient/resident} declines assistance - {Patient/Resident} needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30943-7",
                    "display": "Assistance needed but person declines assistance - Person needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30944-5",
                    "display": "Not applicable - Person does not do this activity."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170E8",
              "prefix": "GG0170E8",
              "text": "The form asks about the patient's ability to transfer from a bed to a chair or wheelchair. It is labeled \"Most Dependent Performance\", indicating the need for assistance with this task.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125M",
              "prefix": "GG0125M",
              "text": "Does the patient use an assistive device such as a transfer board?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0130B8",
              "prefix": "GG0130B8",
              "text": "The form asks about the patient's ability to maintain oral hygiene by using suitable items to clean their teeth and, if applicable, their ability to insert and remove dentures into and from their mouth, as well as manage denture soaking and rinsing with the use of equipment. The response category for their performance is \"Most Dependent\".",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125S",
              "prefix": "GG0125S",
              "text": "The patient uses an assistive device, specifically stair rails.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0135B",
              "prefix": "GG0135B",
              "text": "Please ask the patient to describe at least one or two personal priorities in the area of self-care for the next six months. If the patient does not express any personal priorities in this area, please record this information below.",
              "type": "text",
              "repeats": false,
              "readOnly": false,
              "maxLength": 1500
            },
            {
              "linkId": "Section-37/GG0170P7",
              "prefix": "GG0170P7",
              "text": "The form asks about the patient's usual performance in the ability to bend or stoop from a standing position to pick up a small object, such as a spoon, from the floor.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0175C7",
              "prefix": "GG0175C7",
              "text": "Once the patient is seated in their manual wheelchair, their usual performance indicates their ability to wheel at least 150 feet in a corridor or similar space.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0920E2",
              "prefix": "F0920E2",
              "text": "The patient has undergone medical procedures/treatments such as changing a wound dressing or a home exercise program, for which they have not paid.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30938-7",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Caregiver(s) currently provide assistance - {Patient's/Resident's} usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30939-5",
                    "display": "Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30940-3",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Unclear is caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30941-1",
                    "display": "Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistance needed but no caregiver(s) available - {Patient/Resident} needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30942-9",
                    "display": "Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistance needed but {patient/resident} declines assistance - {Patient/Resident} needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30943-7",
                    "display": "Assistance needed but person declines assistance - Person needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30944-5",
                    "display": "Not applicable - Person does not do this activity."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185K8",
              "prefix": "GG0185K8",
              "text": "The form asks about the patient's simple financial management skills, such as their ability to complete financial transactions, counting coins, verifying change for a single item transaction, writing a check, using online/mobile bill pay, banking, or shopping. The patient's performance is most dependent in these areas.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125C",
              "prefix": "GG0125C",
              "text": "Does the patient use an assistive device such as a wheelchair?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185H7",
              "prefix": "GG0185H7",
              "text": "The patient's usual performance in medication management, specifically for oral medications, refers to their ability to prepare and take all prescribed oral medications reliably and safely. This includes administering the correct dosage at the appropriate times or intervals.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125P",
              "prefix": "GG0125P",
              "text": "Does the patient use an assistive device such as glasses or contact lenses?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0175I7",
              "prefix": "GG0175I7",
              "text": "The form asks about the patient's ability to wheel for 15 minutes without stopping or resting, such as through a department store or supermarket, while seated in a wheelchair or scooter. Does the patient typically use a motorized wheelchair or scooter for this task?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125W",
              "prefix": "GG0125W",
              "text": "Does the patient use an assistive device such as a glucometer?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125T",
              "prefix": "GG0125T",
              "text": "Does the patient use an assistive device such as a lift chair?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125D",
              "prefix": "GG0125D",
              "text": "Does the patient use an assistive device such as a limb prosthesis?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185J8",
              "prefix": "GG0185J8",
              "text": "The form asks about the patient's ability to manage injectable medications. It specifically addresses whether the patient can reliably and safely prepare and take all prescribed injectable medications, including the administration of the correct dosage at the correct times/intervals. The patient's performance in this area is marked as \"Most Dependent\".",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125V",
              "prefix": "GG0125V",
              "text": "Does the patient use an assistive device such as a raised toilet seat?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125Y",
              "prefix": "GG0125Y",
              "text": "Does the patient use an assistive device such as an oxygen concentrator?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0175J8",
              "prefix": "GG0175J8",
              "text": "The question on the form is asking about the patient's ability, once seated in a wheelchair or scooter, to wheel across a street before the traffic light turns red. The answer choices are 'Motorized Wheelchair/Scooter' and 'Most Dependent Performance.'",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185I7",
              "prefix": "GG0185I7",
              "text": "The form asks about the patient's ability to manage their medication, specifically regarding inhalant or mist medications. It wants to know if the patient can prepare and take all prescribed inhalant or mist medications reliably and safely, including the correct dosage at the appropriate times or intervals. It asks for information about their usual performance.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125U",
              "prefix": "GG0125U",
              "text": "Does the patient use an assistive device such as ramps?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0180A",
              "prefix": "GG0180A",
              "text": "Please ask the patient to describe at least one or two personal priorities in the area of mobility for the next six months. If the patient does not express any personal priorities in this area, please note this below. The answer options would be: A) Improvement in walking, B) Ability to climb stairs, C) Independence in moving, or D) No personal priorities.",
              "type": "text",
              "repeats": false,
              "readOnly": false,
              "maxLength": 1500
            },
            {
              "linkId": "Section-37/GG0135A",
              "prefix": "GG0135A",
              "text": "Please ask the patient to describe at least one or two personal priorities in the area of self-care for the next six months. If the patient does not express any personal priorities in this area, please note this in their record.",
              "type": "text",
              "repeats": false,
              "readOnly": false,
              "maxLength": 1500
            },
            {
              "linkId": "Section-37/GG0125K",
              "prefix": "GG0125K",
              "text": "Does the patient use an assistive device such as an electronic bed?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125H",
              "prefix": "GG0125H",
              "text": "Does the patient use an assistive device such as a sock aid?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0920C2",
              "prefix": "F0920C2",
              "text": "The patient requires assistance with Instrumental Activities of Daily Living (IADL), such as making meals, housekeeping, telephone, shopping, or finances, which is currently unpaid.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30938-7",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Caregiver(s) currently provide assistance - {Patient's/Resident's} usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30939-5",
                    "display": "Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30940-3",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Unclear is caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30941-1",
                    "display": "Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistance needed but no caregiver(s) available - {Patient/Resident} needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30942-9",
                    "display": "Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistance needed but {patient/resident} declines assistance - {Patient/Resident} needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30943-7",
                    "display": "Assistance needed but person declines assistance - Person needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30944-5",
                    "display": "Not applicable - Person does not do this activity."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0130A8",
              "prefix": "GG0130A8",
              "text": "The question on the form assesses the patient's ability to use suitable utensils to bring food and/or liquid to their mouth and swallow food and/or liquid once the meal is placed before them. The performance options range from independent to most dependent.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125J",
              "prefix": "GG0125J",
              "text": "Does the patient use an assistive device such as a bed rail?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0920G1",
              "prefix": "F0920G1",
              "text": "Does the patient require supervision, for example due to safety concerns, and is this supervision paid?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30938-7",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Caregiver(s) currently provide assistance - {Patient's/Resident's} usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30939-5",
                    "display": "Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30940-3",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Unclear is caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30941-1",
                    "display": "Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistance needed but no caregiver(s) available - {Patient/Resident} needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30942-9",
                    "display": "Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistance needed but {patient/resident} declines assistance - {Patient/Resident} needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30943-7",
                    "display": "Assistance needed but person declines assistance - Person needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30944-5",
                    "display": "Not applicable - Person does not do this activity."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125O",
              "prefix": "GG0125O",
              "text": "Does the patient use an assistive device such as a walk-in or wheel-in shower?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125B3",
              "prefix": "GG0125B3",
              "text": "Does the patient use an assistive device, specifically a walker with wheels?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125G",
              "prefix": "GG0125G",
              "text": "Does the patient use an assistive device such as a reacher or grabber?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170F7",
              "prefix": "GG0170F7",
              "text": "The form asks about the patient's usual performance in terms of their ability to get on and off a toilet or commode.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125N",
              "prefix": "GG0125N",
              "text": "Does the patient require an assistive device such as a shower or commode chair?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125X",
              "prefix": "GG0125X",
              "text": "Does the patient use an assistive device such as a Continuous Positive Airway Pressure (CPAP) machine?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125C1",
              "prefix": "GG0125C1",
              "text": "Does the patient use an assistive device such as a manual wheelchair?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170G7",
              "prefix": "GG0170G7",
              "text": "The patient's usual performance indicates their ability to transfer in and out of a car or van on the passenger side. This does not include their ability to open/close the door or fasten the seat belt.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125B2",
              "prefix": "GG0125B2",
              "text": "Does the patient use an assistive device such as a walker with a seat?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185I8",
              "prefix": "GG0185I8",
              "text": "The form asks about the patient's ability to manage medication, specifically inhalant or mist medications. It wants to know if the patient can reliably and safely prepare and take all prescribed inhalant/mist medications, including the administration of the correct dosage at the appropriate times and intervals. The answer choices include 'Most Dependent Performance'.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0130B7",
              "prefix": "GG0130B7",
              "text": "The form asks about the patient's oral hygiene, specifically their ability to use suitable items to clean their teeth. It also inquires about their use of dentures, if applicable, including their ability to insert and remove the dentures from their mouth, and manage denture soaking and rinsing with the use of equipment. The section is labeled \"Usual Performance.\"",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125I",
              "prefix": "GG0125I",
              "text": "Does the patient use an assistive device such as orthotics or a brace?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125Z_specify",
              "prefix": "GG0125Z_specify",
              "text": "Does the patient use any other type of assistive device? If so, please specify.",
              "type": "text",
              "repeats": false,
              "readOnly": false,
              "maxLength": 1500
            },
            {
              "linkId": "Section-37/GG0170A8",
              "prefix": "GG0170A8",
              "text": "The patient's ability to roll from lying on their back to their left and right side, and return to lying on their back is most dependent on performance.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0130CC7",
              "prefix": "GG0130CC7",
              "text": "The form asks about the patient's usual performance in maintaining toileting hygiene, specifically their ability to maintain perineal/menstrual hygiene and adjust clothing before and after voiding or having a bowel movement. If the patient manages an ostomy, it also includes wiping the opening but does not include managing equipment.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0920D1",
              "prefix": "F0920D1",
              "text": "The form asks about the patient's method of medication administration, with options that include oral, inhaled, or injectable medications. The medication administration for the patient is paid.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30938-7",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Caregiver(s) currently provide assistance - {Patient's/Resident's} usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30939-5",
                    "display": "Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30940-3",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Unclear is caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30941-1",
                    "display": "Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistance needed but no caregiver(s) available - {Patient/Resident} needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30942-9",
                    "display": "Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistance needed but {patient/resident} declines assistance - {Patient/Resident} needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30943-7",
                    "display": "Assistance needed but person declines assistance - Person needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30944-5",
                    "display": "Not applicable - Person does not do this activity."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125E",
              "prefix": "GG0125E",
              "text": "Does the patient use an assistive device, such as a specialized seating pad (for example, an air-filled, gel, or shaped form pad)?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125C2",
              "prefix": "GG0125C2",
              "text": "Does the patient use an assistive device such as a motorized wheelchair and/or scooter?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170L8",
              "prefix": "GG0170L8",
              "text": "The form asks whether the patient has the ability to walk 10 feet on uneven or sloping surfaces, such as turf or gravel, indoors or outdoors. The answer choices for the patient's performance are: Most Independent Performance, Modified Independent, Supervision or Setup, Minimal Assistance, Moderate Assistance, Maximal Assistance, and Most Dependent Performance.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0130CC8",
              "prefix": "GG0130CC8",
              "text": "The form asks the patient about their toileting hygiene, specifically their ability to maintain perineal/menstrual hygiene and adjust their clothes before and after voiding or having a bowel movement. If they are managing an ostomy, they should include their ability to wipe the opening, although managing the equipment is not necessary. The performance rating is either \"Most Dependent Performance\".",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185A7",
              "prefix": "GG0185A7",
              "text": "The patient's usual performance demonstrates the ability to plan and prepare all aspects of a light, cold meal such as a bowl of cereal, sandwich, and cold drink.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0920G2",
              "prefix": "F0920G2",
              "text": "The form asks if the patient requires supervision due to safety concerns, and specifies if this supervision is unpaid.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30938-7",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Caregiver(s) currently provide assistance - {Patient's/Resident's} usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30939-5",
                    "display": "Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30940-3",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Unclear is caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30941-1",
                    "display": "Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistance needed but no caregiver(s) available - {Patient/Resident} needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30942-9",
                    "display": "Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistance needed but {patient/resident} declines assistance - {Patient/Resident} needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30943-7",
                    "display": "Assistance needed but person declines assistance - Person needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30944-5",
                    "display": "Not applicable - Person does not do this activity."
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0920C1",
              "prefix": "F0920C1",
              "text": "Does the patient require paid assistance for Instrumental Activities of Daily Living (IADL), such as making meals, housekeeping, using the telephone, shopping, or managing finances?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30938-7",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Caregiver(s) currently provide assistance - {Patient's/Resident's} usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30939-5",
                    "display": "Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30940-3",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Unclear is caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30941-1",
                    "display": "Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistance needed but no caregiver(s) available - {Patient/Resident} needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30942-9",
                    "display": "Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistance needed but {patient/resident} declines assistance - {Patient/Resident} needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30943-7",
                    "display": "Assistance needed but person declines assistance - Person needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30944-5",
                    "display": "Not applicable - Person does not do this activity."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185L7",
              "prefix": "GG0185L7",
              "text": "The patient's usual performance in complex financial management involves the ability to complete financial decision-making tasks such as budgeting and remembering to pay bills.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185C8",
              "prefix": "GG0185C8",
              "text": "The form inquires about the patient's ability to perform light daily housework in order to maintain a safe home environment such that they are not at risk from harm within their own home. Examples of this housework might include tasks like wiping countertops or doing dishes. The patient's performance is labeled as \"Most Dependent\".",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125R",
              "prefix": "GG0125R",
              "text": "Does the patient use an assistive device such as a communication device?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0920F2",
              "prefix": "F0920F2",
              "text": "Does the patient manage their own equipment, such as oxygen, IV/infusion equipment, enteral/parenteral nutrition, or ventilator therapy equipment and supplies, without any payment?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30938-7",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Caregiver(s) currently provide assistance - {Patient's/Resident's} usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30939-5",
                    "display": "Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30940-3",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Unclear is caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30941-1",
                    "display": "Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistance needed but no caregiver(s) available - {Patient/Resident} needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30942-9",
                    "display": "Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistance needed but {patient/resident} declines assistance - {Patient/Resident} needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30943-7",
                    "display": "Assistance needed but person declines assistance - Person needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30944-5",
                    "display": "Not applicable - Person does not do this activity."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185D8",
              "prefix": "GG0185D8",
              "text": "The form asks about the patient's ability to complete heavier periodic housework, like doing laundry, vacuuming, and cleaning the bathroom, in order to maintain a safe home environment. It also ensures the patient is not at risk for harm within their home. The category marked is 'Most Dependent Performance'.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170B8",
              "prefix": "GG0170B8",
              "text": "The form for the patient includes a question labeled \"Sit to lying\". This refers to the patient's ability to move from sitting on the side of the bed to lying flat on the bed. The performance is categorized as \"Most Dependent\", meaning the patient requires substantial assistance in this task.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0130D7",
              "prefix": "GG0130D7",
              "text": "Does the patient have the ability to wash, rinse, and dry their face, hands, chest, and arms while sitting in a chair or bed? Please rate their usual performance.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0190A",
              "prefix": "GG0190A",
              "text": "Please ask the patient to describe at least one or two personal priorities in the area of instrumental activities of daily living for the next six months. If the patient does not express any personal priorities in this area, please note this below. Answer: A",
              "type": "text",
              "repeats": false,
              "readOnly": false,
              "maxLength": 1500
            },
            {
              "linkId": "Section-6/F0905A",
              "prefix": "F0905A",
              "text": "Please ask the patient to describe at least one or two personal priorities in the area of their living arrangements for the next six months. If the patient does not express any personal priorities in this area, please note this below. The options are - A.",
              "type": "text",
              "repeats": false,
              "readOnly": false,
              "maxLength": 1500
            },
            {
              "linkId": "Section-6/F0920B1",
              "prefix": "F0920B1",
              "text": "Does the patient require mobility assistance, such as assistance with bed mobility, transfers, ambulating, or wheeling? If yes, is this assistance paid?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30938-7",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Caregiver(s) currently provide assistance - {Patient's/Resident's} usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30939-5",
                    "display": "Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30940-3",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Unclear is caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30941-1",
                    "display": "Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistance needed but no caregiver(s) available - {Patient/Resident} needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30942-9",
                    "display": "Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistance needed but {patient/resident} declines assistance - {Patient/Resident} needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30943-7",
                    "display": "Assistance needed but person declines assistance - Person needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30944-5",
                    "display": "Not applicable - Person does not do this activity."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185L8",
              "prefix": "GG0185L8",
              "text": "The form indicates the patient's level of ability in complex financial management, such as completing financial decision-making tasks including budgeting and remembering to pay bills. The patient's performance is recorded as mostly dependent.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0130H8",
              "prefix": "GG0130H8",
              "text": "The form asks about the patient's ability to put on and take off socks, shoes, or other appropriate footwear that is necessary for safe mobility, which includes dealing with fasteners, if applicable. The patient's performance in this aspect has been rated as most dependent.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0175H8",
              "prefix": "GG0175H8",
              "text": "The form is asking about the patient's ability to wheel at least 150 feet in a corridor or similar space once they are seated in a wheelchair or scooter. The answer choices include 'Motorized Wheelchair/Scooter' and 'Most Dependent Performance'.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170A7",
              "prefix": "GG0170A7",
              "text": "The form asks about the patient's usual performance when it comes to their ability to roll from lying on their back to their left and right side, and then return to lying on their back.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185F7",
              "prefix": "GG0185F7",
              "text": "The form asks about the patient's ability to answer a telephone call in their customary manner and maintain the call for one minute or longer. It does not include getting to the phone. The question refers to the patient's usual performance.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0175I8",
              "prefix": "GG0175I8",
              "text": "The patient questionnaire asked, \"Once the patient is seated in a wheelchair or scooter, do they have the ability to wheel without stopping or resting for 15 minutes (for example, through a department store or supermarket)?\" The answer choices include \"Motorized Wheelchair/Scooter\" and \"Most Dependent Performance.\"",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0190B",
              "prefix": "GG0190B",
              "text": "Please ask the patient to describe at least one or two personal priorities in the area of instrumental activities of daily living for the next six months. If the patient does not express any personal priorities in this area, note it below.",
              "type": "text",
              "repeats": false,
              "readOnly": false,
              "maxLength": 1500
            },
            {
              "linkId": "Section-6/F0925A",
              "prefix": "F0925A",
              "text": "Please ask the patient to describe at least one or two personal priorities for their caregiving arrangement in the next six months. If the patient does not express any personal priorities in this area, please note this below.",
              "type": "text",
              "repeats": false,
              "readOnly": false,
              "maxLength": 1500
            },
            {
              "linkId": "Section-6/F0925B",
              "prefix": "F0925B",
              "text": "Please ask the patient or resident to describe at least one or two personal priorities in the area of caregiving for the next six months. If the patient or resident does not express any personal priorities in this area, please note this below. The options are:\n\nA. The patient expresses personal priorities in the area of caregiving.\nB. The patient does not express any personal priorities in the area of caregiving.",
              "type": "text",
              "repeats": false,
              "readOnly": false,
              "maxLength": 1500
            },
            {
              "linkId": "Section-37/GG0170V8",
              "prefix": "GG0170V8",
              "text": "The form for the patient asks about his or her ability to carry something in both hands while walking indoors, such as several dishes, a light laundry basket, or a tray with food. The patient's performance in this area is identified as most dependent.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            }
          ],
          "_id": "XqmDxb2J54dNKqnxo"
        },
        "request": {
          "method": "PUT",
          "url": "QuestionnaireResponse/fasi"
        }
      },
      {
        "fullUrl": "QuestionnaireResponse/fasi",
        "resource": {
          "id": "fasi",
          "responseType": "QuestionnaireResponse",
          "status": "draft",
          "authored": "2024-04-27T18:21:32.181Z",
          "item": [
            {
              "linkId": "Section-37/GG0175A",
              "prefix": "GG0175A",
              "text": "Does the patient or resident use a manual wheelchair?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "0",
                    "display": "No"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA32-8",
                    "display": "No"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "1",
                    "display": "Yes"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA33-6",
                    "display": "Yes"
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0175F",
              "prefix": "GG0175F",
              "text": "Does the patient or resident use a motorized wheelchair and/or scooter?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "0",
                    "display": "No"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA32-8",
                    "display": "No"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "1",
                    "display": "Yes"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA33-6",
                    "display": "Yes"
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125B1",
              "prefix": "GG0125B1",
              "text": "Does the patient use an assistive device such as a standard folding walker?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170HH",
              "prefix": "GG0170HH",
              "text": "Does the patient or resident have the ability to walk?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "0",
                    "display": "No, and walking goal is not indicated"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA31067-4",
                    "display": "No, and walking goal is not indicated"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "1",
                    "display": "No, and walking is indicated"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA31068-2",
                    "display": "No, and walking goal is indicated"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "2",
                    "display": "Yes"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA33-6",
                    "display": "Yes"
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0900A1",
              "prefix": "F0900A1",
              "text": "Please identify the usual living arrangement of the patient or resident during the past three days.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "{Patient/Resident} lives alone - no other residents in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30925-4",
                    "display": "Person lives alone - no other residents in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "{Patient/Resident} lives with others in the home - for example, family, friends, or paid caregiver."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30926-2",
                    "display": "Person lives with others in the home - for example, family, friends, or paid caregiver."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "{Patient/Resident} lives in congregate home - for example, assisted living, or residential care home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30927-0",
                    "display": "Person lives in congregate home - for example, assisted living, or residential care home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "{Patient/Resident} does not have a permanent home or is homeless."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30928-8",
                    "display": "Person does not have a permanent home or is homeless."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "{Patient/Resident} was in a medical facility."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30929-6",
                    "display": "Person was in a medical facility."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125B",
              "prefix": "GG0125B",
              "text": "Does the patient use an assistive device such as a walker?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125Z",
              "prefix": "GG0125Z",
              "text": "Does the patient use an assistive device other than the ones previously mentioned?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125A",
              "prefix": "GG0125A",
              "text": "The patient uses an assistive device, specifically a cane or a crutch.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125AA",
              "prefix": "GG0125AA",
              "text": "In the past month, has the patient used, or expressed or demonstrated a need for an assistive device?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "1",
                    "display": "Yes"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA33-6",
                    "display": "Yes"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "0",
                    "display": "No"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA32-8",
                    "display": "No"
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0910A",
              "prefix": "F0910A",
              "text": "Does the patient or resident have assistance in their home? The options are \"Yes\" or \"No\".",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "0",
                    "display": "No"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA32-8",
                    "display": "No"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "1",
                    "display": "Yes"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA33-6",
                    "display": "Yes"
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170X7",
              "prefix": "GG0170X7",
              "text": "The patient's usual performance indicates their ability to walk across a street before the light turns red.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170E7",
              "prefix": "GG0170E7",
              "text": "The form inquires about the patient's usual performance in terms of their ability to transfer to and from a bed to a chair or wheelchair.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170J7",
              "prefix": "GG0170J7",
              "text": "Does the patient have the ability, once standing, to walk at least 50 feet and make two turns as part of their usual performance?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0920E1",
              "prefix": "F0920E1",
              "text": "Has the patient paid for medical procedures or treatments, such as changing wound dressings or home exercise programs?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30938-7",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Caregiver(s) currently provide assistance - {Patient's/Resident's} usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30939-5",
                    "display": "Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30940-3",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Unclear is caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30941-1",
                    "display": "Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistance needed but no caregiver(s) available - {Patient/Resident} needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30942-9",
                    "display": "Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistance needed but {patient/resident} declines assistance - {Patient/Resident} needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30943-7",
                    "display": "Assistance needed but person declines assistance - Person needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30944-5",
                    "display": "Not applicable - Person does not do this activity."
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0920B2",
              "prefix": "F0920B2",
              "text": "Does the patient require mobility assistance, such as help with bed mobility, transfers, ambulating, or wheeling, and is this assistance unpaid?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30938-7",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Caregiver(s) currently provide assistance - {Patient's/Resident's} usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30939-5",
                    "display": "Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30940-3",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Unclear is caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30941-1",
                    "display": "Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistance needed but no caregiver(s) available - {Patient/Resident} needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30942-9",
                    "display": "Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistance needed but {patient/resident} declines assistance - {Patient/Resident} needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30943-7",
                    "display": "Assistance needed but person declines assistance - Person needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30944-5",
                    "display": "Not applicable - Person does not do this activity."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170K7",
              "prefix": "GG0170K7",
              "text": "Once the patient is standing, they should have the ability to walk at least 150 feet in a corridor or similar space. The usual performance is evaluated.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170F8",
              "prefix": "GG0170F8",
              "text": "The form inquires about the patient's ability to transfer to and from a toilet or commode, asking whether their performance is most dependent.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170D7",
              "prefix": "GG0170D7",
              "text": "Does the patient typically have the ability to come to a standing position from sitting in a chair, wheelchair, or on the side of the bed?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0920H1",
              "prefix": "F0920H1",
              "text": "Does the individual advocate or facilitate the patient's participation in appropriate medical care, for example, providing transportation to or from appointments? The options for this are either paid or unpaid.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30938-7",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Caregiver(s) currently provide assistance - {Patient's/Resident's} usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30939-5",
                    "display": "Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30940-3",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Unclear is caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30941-1",
                    "display": "Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistance needed but no caregiver(s) available - {Patient/Resident} needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30942-9",
                    "display": "Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistance needed but {patient/resident} declines assistance - {Patient/Resident} needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30943-7",
                    "display": "Assistance needed but person declines assistance - Person needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30944-5",
                    "display": "Not applicable - Person does not do this activity."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170M7",
              "prefix": "GG0170M7",
              "text": "The form asks about the patient's usual performance in the ability to go up and down a curb and/or up and down one step.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170W8",
              "prefix": "GG0170W8",
              "text": "The patient's ability to walk for 15 minutes without stopping or resting, like through a department store or supermarket, is the most dependent performance.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170B7",
              "prefix": "GG0170B7",
              "text": "The form asks about the patient's usual ability to move from sitting on the side of the bed to lying flat on the bed.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0130F7",
              "prefix": "GG0130F7",
              "text": "The form asks about the patient's usual performance in terms of their ability to dress and undress their upper body, including handling fasteners if applicable.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170X8",
              "prefix": "GG0170X8",
              "text": "The form asks the patient about their ability to walk across a street before the light turns red, with the most dependent performance as an answer choice.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170N7",
              "prefix": "GG0170N7",
              "text": "The form is asking about the patient's usual performance in regards to their ability to go up and down four steps, with or without using a rail.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0175B8",
              "prefix": "GG0175B8",
              "text": "Once seated in their manual wheelchair, the patient has the ability to wheel at least 50 feet and make two turns, indicating a most dependent performance level.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0920F1",
              "prefix": "F0920F1",
              "text": "Does the patient manage their equipment, for example, oxygen, IV/infusion equipment, enteral/parenteral nutrition, or ventilator therapy equipment and supplies, and is it paid for?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30938-7",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Caregiver(s) currently provide assistance - {Patient's/Resident's} usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30939-5",
                    "display": "Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30940-3",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Unclear is caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30941-1",
                    "display": "Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistance needed but no caregiver(s) available - {Patient/Resident} needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30942-9",
                    "display": "Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistance needed but {patient/resident} declines assistance - {Patient/Resident} needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30943-7",
                    "display": "Assistance needed but person declines assistance - Person needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30944-5",
                    "display": "Not applicable - Person does not do this activity."
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0920D2",
              "prefix": "F0920D2",
              "text": "Does the patient administer their medication themselves (for example, oral, inhaled, or injectable medications) without any paid assistance?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30938-7",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Caregiver(s) currently provide assistance - {Patient's/Resident's} usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30939-5",
                    "display": "Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30940-3",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Unclear is caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30941-1",
                    "display": "Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistance needed but no caregiver(s) available - {Patient/Resident} needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30942-9",
                    "display": "Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistance needed but {patient/resident} declines assistance - {Patient/Resident} needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30943-7",
                    "display": "Assistance needed but person declines assistance - Person needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30944-5",
                    "display": "Not applicable - Person does not do this activity."
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0910B2",
              "prefix": "F0910B2",
              "text": "Please indicate the level of both paid and unpaid assistance in the patient's or resident's home during the past month. The level of assistance was unpaid.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "No assistance received"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA12345-7",
                    "display": "No assistance received"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Occasional/short-term assistance"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30934-6",
                    "display": "Occasional/short term assistance"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Regular night-time"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30935-3",
                    "display": "Regular night-time"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Regular daytime"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA12164-2",
                    "display": "Regular daytime"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Around the clock"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA12163-4",
                    "display": "Around the clock"
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0130H7",
              "prefix": "GG0130H7",
              "text": "The form asks the patient to evaluate their usual performance in putting on and taking off socks, shoes, or other footwear appropriate for safe mobility. This includes handling fasteners, if applicable.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170O8",
              "prefix": "GG0170O8",
              "text": "The form asks the patient to assess their ability to go up and down 12 steps with or without a rail, with the most dependent performance being the possible response.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0130G7",
              "prefix": "GG0130G7",
              "text": "The form asks about the patient's usual performance in their ability to dress and undress below the waist, including fasteners, excluding footwear.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170M8",
              "prefix": "GG0170M8",
              "text": "The form asks about the patient's ability to go up and down a curb and/or up and down one step. The patient's performance is most dependent in this activity.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0175G8",
              "prefix": "GG0175G8",
              "text": "Once seated in their motorized wheelchair or scooter, the patient has the ability to wheel at least 50 feet and make two turns. However, their performance indicates that they are most dependent on this form of mobility.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0920H2",
              "prefix": "F0920H2",
              "text": "Does the person facilitate or advocate for the patient's participation in appropriate medical care, for instance, by transporting them to or from appointments, without any charge?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30938-7",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Caregiver(s) currently provide assistance - {Patient's/Resident's} usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30939-5",
                    "display": "Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30940-3",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Unclear is caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30941-1",
                    "display": "Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistance needed but no caregiver(s) available - {Patient/Resident} needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30942-9",
                    "display": "Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistance needed but {patient/resident} declines assistance - {Patient/Resident} needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30943-7",
                    "display": "Assistance needed but person declines assistance - Person needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30944-5",
                    "display": "Not applicable - Person does not do this activity."
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0910B1",
              "prefix": "F0910B1",
              "text": "Please indicate the level of both paid and unpaid assistance in the patient's or resident's home during the past month. The choices are \"Paid\", \"Unpaid\", or \"Both Paid and Unpaid\".",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "No assistance received"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA12345-7",
                    "display": "No assistance received"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Occasional/short-term assistance"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30934-6",
                    "display": "Occasional/short term assistance"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Regular night-time"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30935-3",
                    "display": "Regular night-time"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Regular daytime"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA12164-2",
                    "display": "Regular daytime"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Around the clock"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA12163-4",
                    "display": "Around the clock"
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0175B7",
              "prefix": "GG0175B7",
              "text": "The form asks about the patient's ability to wheel at least 50 feet and make two turns once seated in a manual wheelchair, assessing their usual performance.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170I7",
              "prefix": "GG0170I7",
              "text": "The form asks about the patient's usual performance in terms of their ability to walk at least 10 feet once standing, whether it be in a room, corridor, or similar space.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170L7",
              "prefix": "GG0170L7",
              "text": "The form asks about the patient's usual performance in the ability to walk 10 feet on uneven or sloping surfaces, such as turf or gravel, both indoors and outdoors.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170U8",
              "prefix": "GG0170U8",
              "text": "The form asks about the patient's ability to walk from one room to another, maneuver around furniture, and navigate other obstacles indoors. The label classifies the patient's performance as most dependent.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0175C8",
              "prefix": "GG0175C8",
              "text": "Once the patient is seated in the wheelchair, they should have the ability to wheel at least 150 feet in a corridor or similar space. The choices for this ability are with a manual wheelchair or indicating the most dependent performance.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185F8",
              "prefix": "GG0185F8",
              "text": "The form asks about the patient's ability to answer a telephone call in their customary manner and maintain it for 1 minute or longer. This does not include getting to the phone. The label for the most dependent performance is used.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185K7",
              "prefix": "GG0185K7",
              "text": "The patient's usual performance in simple financial management includes the ability to complete financial transactions such as counting coins, verifying change for a single item transaction, writing a check, online/mobile bill pay, banking, or shopping.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0175E7",
              "prefix": "GG0175E7",
              "text": "The form is asking about the patient's ability to wheel across a street using a manual wheelchair before the light turns red. The patient usually performs this task with their usual performance.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0130F8",
              "prefix": "GG0130F8",
              "text": "The form asks about the patient's ability to dress and undress above the waist, including dealing with fasteners if applicable, and the patient's most dependent performance is being evaluated.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0175H7",
              "prefix": "GG0175H7",
              "text": "Once the patient is seated in the wheelchair or scooter, does he or she have the ability to wheel at least 150 feet in a corridor or similar space? The options are: Motorized Wheelchair/Scooter or Usual Performance.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170C7",
              "prefix": "GG0170C7",
              "text": "The form asks about the patient's usual performance in the ability to move from lying on their back to sitting on the side of the bed with their feet flat on the floor, and without any back support.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0130G8",
              "prefix": "GG0130G8",
              "text": "The form asks about the patient's ability to dress and undress below the waist, including handling fasteners, but not including footwear. It indicates that the patient's performance in this area is mostly dependent.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0130D8",
              "prefix": "GG0130D8",
              "text": "The form asks about the patient's ability to wash, rinse, and dry their face, hands, chest, and arms while sitting in a chair or bed. The performance level indicated is \"Most Dependent Performance\".",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170K8",
              "prefix": "GG0170K8",
              "text": "The form asks if the patient, once standing, has the ability to walk at least 150 feet in a corridor or similar space. The performance level is gauged as 'Most Dependent Performance'.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185E8",
              "prefix": "GG0185E8",
              "text": "The patient's performance level in light shopping is at its most dependent. Once at the store, they can locate and select up to five needed goods, take them to the checkout, and complete the purchasing transaction.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170W7",
              "prefix": "GG0170W7",
              "text": "Does the patient have the ability to walk for 15 minutes without stopping or resting, such as through a department store or supermarket, as part of their usual performance?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170V7",
              "prefix": "GG0170V7",
              "text": "The form asks whether the patient has the ability to carry something in both hands, such as several dishes, a light laundry basket, or a tray with food, while walking indoors. The category for this question is 'Usual Performance.'",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170D8",
              "prefix": "GG0170D8",
              "text": "The form asks about the patient's ability to come to a standing position from sitting in a chair, wheelchair, or on the side of the bed. The patient's performance is most dependent in this regard.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0920A2",
              "prefix": "F0920A2",
              "text": "Does the patient require unpaid assistance with self-care tasks such as bathing, dressing, toileting, or eating/feeding?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30938-7",
                    "display": "Assistance not needed - No assistance needed."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Caregiver(s) currently provide assistance - {Patient's/Resident's} usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30939-5",
                    "display": "Caregiver(s) currently provide assistance - Person's usual caregiver(s) willing and able to provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30940-3",
                    "display": "Caregiver(s) need training/supportive services to provide assistance - Caregiver(s) available and need assistance to provide support."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Unclear is caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30941-1",
                    "display": "Unclear if caregiver(s) will provide assistance - Caregiver(s) available in the home but it is not clear if caregiver(s) will provide needed assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistance needed but no caregiver(s) available - {Patient/Resident} needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30942-9",
                    "display": "Assistance needed but no caregiver(s) available - Person needs assistance but no caregiver(s) available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistance needed but {patient/resident} declines assistance - {Patient/Resident} needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30943-7",
                    "display": "Assistance needed but person declines assistance - Person needs caregiving but declines this assistance."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30944-5",
                    "display": "Not applicable - Person does not do this activity."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185G7",
              "prefix": "GG0185G7",
              "text": "The question on the form asks about the patient's or resident's usual performance in terms of the ability to place a call in their customary manner and maintain it for 1 minute or longer. Note that this does not include the act of getting to the phone.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185J7",
              "prefix": "GG0185J7",
              "text": "The patient's usual performance in medication management of injectable medications assesses their ability to prepare and take all prescribed injectable medications reliably and safely. This includes the administration of the correct dosage at the appropriate times or intervals.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170C8",
              "prefix": "GG0170C8",
              "text": "The form is asking about the patient's ability to move from lying on their back to sitting on the side of the bed with their feet flat on the floor, without any back support. The patient's performance in this task is categorized as 'Most Dependent'.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0175J7",
              "prefix": "GG0175J7",
              "text": "The form asks the patient about their ability to wheel across a street before the light turns red once they are seated in a wheelchair or scooter. The options for response are 'Motorized Wheelchair/Scooter' and 'Usual Performance'.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185D7",
              "prefix": "GG0185D7",
              "text": "The patient's usual performance in the ability to complete heavier periodic housework, such as doing laundry, vacuuming, and cleaning the bathroom, is evaluated to ensure they can maintain a safe home environment and not be at risk for harm within their home.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185A8",
              "prefix": "GG0185A8",
              "text": "The form inquires about the patient's ability to plan and prepare all aspects of a light cold meal, such as a bowl of cereal, sandwich and cold drink. The patient's performance in this area is marked as 'Most Dependent'.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0175G7",
              "prefix": "GG0175G7",
              "text": "Once the patient is seated in a wheelchair or scooter, they should have the ability to wheel at least 50 feet and make two turns. The options are either using a motorized wheelchair/scooter or executing their usual performance.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170O7",
              "prefix": "GG0170O7",
              "text": "The patient's usual performance is their ability to go up and down 12 steps with or without a rail.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0175D8",
              "prefix": "GG0175D8",
              "text": "The patient's ability to wheel for 15 minutes once seated in a manual wheelchair, without stopping or resting, for example, through a department store or supermarket, is evaluated as the most dependent performance.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185H8",
              "prefix": "GG0185H8",
              "text": "The form is asking about the patient's ability to manage their oral medications. This involves the preparation and safely taking all prescribed oral medications, including the administration of the correct dosage at the appropriate times/intervals. The level of performance is marked as \"most dependent\".",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125F",
              "prefix": "GG0125F",
              "text": "Does the patient use an assistive device such as a mechanical lift?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0175D7",
              "prefix": "GG0175D7",
              "text": "The form asks if the patient has the ability to wheel without stopping or resting for 15 minutes once seated in a manual wheelchair, such as when navigating through a department store or supermarket. The question is about their usual performance.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170G8",
              "prefix": "GG0170G8",
              "text": "The form asks about the patient's ability to transfer in and out of a car or van on the passenger side. This does not include the ability to open or close the door or fasten the seat belt. The patient's performance in this area is most dependent.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170I8",
              "prefix": "GG0170I8",
              "text": "The form asks about the patient's ability to walk at least 10 feet once they are standing, whether it be in a room, corridor, or a similar space. The patient's performance is rated as \"Most Dependent\".",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0180B",
              "prefix": "GG0180B",
              "text": "Please ask the patient to describe at least one or two personal priorities in the area of mobility for the next six months. If the patient does not express any personal priorities in this area, please note this below.",
              "type": "text",
              "repeats": false,
              "readOnly": false,
              "maxLength": 1500
            },
            {
              "linkId": "Section-37/GG0130A7",
              "prefix": "GG0130A7",
              "text": "The form is asking about the patient's usual performance in eating. It refers to their ability to use suitable utensils to bring food and/or liquid to their mouth and swallow food and/or liquid once the meal is placed before them.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185G8",
              "prefix": "GG0185G8",
              "text": "The form asks about the patient's or resident's ability to place a call in their customary manner and maintain it for 1 minute or longer. It does not include getting to the phone. The patient's performance in this area is classified as 'Most Dependent'.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0175E8",
              "prefix": "GG0175E8",
              "text": "The form asks about the patient's ability to wheel across a street once seated in a wheelchair before the light turns red. The options are from most dependent to a manual wheelchair performance.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185B7",
              "prefix": "GG0185B7",
              "text": "The form asks whether the patient has the ability to plan and prepare all aspects of a light hot meal, such as heating a bowl of soup and reheating a prepared meal. The label for this question is referring to the patient's usual performance.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125L",
              "prefix": "GG0125L",
              "text": "Does the patient use an assistive device such as grab bars?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-6/F0905B",
              "prefix": "F0905B",
              "text": "Please ask the patient to describe at least one or two personal priorities in the area of living arrangements for the next six months. If the patient does not express any personal priorities in this area, kindly note this down.",
              "type": "text",
              "repeats": false,
              "readOnly": false,
              "maxLength": 1500
            },
            {
              "linkId": "Section-37/GG0170U7",
              "prefix": "GG0170U7",
              "text": "The form asks about the patient's usual performance in their ability to walk indoors, specifically from room to room, and around furniture and other obstacles.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185E7",
              "prefix": "GG0185E7",
              "text": "The form asks about the patient's usual performance in light shopping tasks. Specifically, it asks if the patient can once at the store locate and select up to five needed goods, take them to the checkout, and complete the purchasing transaction.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0170P8",
              "prefix": "GG0170P8",
              "text": "The form inquires about the patient's ability to bend or stoop from a standing position to pick up a small object, such as a spoon, from the floor. The performance level selected for the patient is \"Most Dependent Performance\".",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0185B8",
              "prefix": "GG0185B8",
              "text": "The form asks about the patient's ability to plan and prepare all aspects of a light hot meal, such as heating a bowl of soup and reheating a prepared meal. It is noted that the patient's performance in this area is most dependent.",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper sets up or cleans up; {patient/resident} completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30910-6",
                    "display": "Setup or cleanup assistance - Helper sets up or cleans up; person completes activity. Helper assists only prior to or following the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "04",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as {patient/resident} completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30911-4",
                    "display": "Supervision or touching assistance - Helper provides verbal cues and/or touching/steadying and/or contact guard assistance as person completes activity. Assistance may be provided throughout the activity or intermittently."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "03",
                    "display": "Partial/moderate assistance - Helper does LESS THAN HALF the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA10055-4",
                    "display": "Partial/moderate assistance - Helper does less than half the effort. Helper lifts, holds or supports trunk or limbs, but provides less than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Substantial/maximal assistance - Helper does MORE THAN HALF the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA11759-0",
                    "display": "Substantial/maximal assistance - Helper does more than half the effort. Helper lifts or holds trunk or limbs and provides more than half the effort."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Dependent - Helper does ALL of the effort. {Patient/Resident} does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the {patient/resident} to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30914-8",
                    "display": "Dependent - Helper does all of the effort. Person does none of the effort to complete the activity. Or, the assistance of 2 or more helpers is required for the person to complete the activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused"
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30915-5",
                    "display": "Person refused."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30916-3",
                    "display": "Not applicable - Person does not usually do this activity."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "90",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30917-1",
                    "display": "Not attempted due to short-term medical condition or safety concerns."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125Q",
              "prefix": "GG0125Q",
              "text": "Does the patient use an assistive device such as a hearing aid?",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "02",
                    "display": "Assistive device needed and available - {Patient/Resident} needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30918-9",
                    "display": "Assistive device needed and available - Person needs this device to complete daily activities and has the device in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "01",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets {patient's/resident's} needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30919-7",
                    "display": "Assistive device needed but current device unsuitable - Device is in home but no longer meets person's needs."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "00",
                    "display": "Assistive device needed but not available - {Patient/Resident} needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30920-5",
                    "display": "Assistive device needed but not available - Person needs the device but it is not available in the home."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "07",
                    "display": "{Patient/Resident} refused - {Patient/Resident} chooses not to use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30921-3",
                    "display": "Person refused - Person chooses to not use needed device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "11",
                    "display": "Not applicable - {Patient/Resident} does not need this device."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30922-1",
                    "display": "Not applicable - Person does not need this device."
                  }
                }
              ]
            },
            {
              "linkId": "Section-37/GG0125ZZ",
              "prefix": "GG0125ZZ",
              "text": "The patient has indicated all the assistive devices they needed.",
              "type": "text",
              "repeats": false,
              "readOnly": false,
              "maxLength": 1
            },
            {
              "linkId": "Section-37/GG0170N8",
              "prefix": "GG0170N8",
              "text": "The form inquires about the patient's ability to go up and down four steps, with or without the assistance of a rail. The performance level was noted as \"most dependent\".",
              "type": "choice",
              "repeats": false,
              "readOnly": false,
              "answerOption": [
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "06",
                    "display": "Independent - {Patient/Resident} completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://loinc.org",
                    "code": "LA30909-8",
                    "display": "Independent - Person completes the activity by him/herself with no assistance from a helper."
                  }
                },
                {
                  "valueCoding": {
                    "system": "http://del.cms.gov",
                    "code": "05",
                    "display": "Setup or clean-up assistance - Helper