臺灣長期照顧實作指引(TW LTC IG), published by 經濟部產業發展署. This guide is not an authorized publication; it is the continuous build for version 1.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/Lorex/TWLongTermCare_IG_Build/ and changes regularly. See the Directory of published versions

• Narrative Content
• XML
• JSON
• TTL

: 工具性日常活動功能問卷 - XML Representation

Active as of 2026-03-01

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<Questionnaire xmlns="http://hl7.org/fhir">
  <id value="ltc-questionnaire-iadl"/>
  <meta>
    <profile
             value="http://ltc-ig.fhir.tw/StructureDefinition/LTCQuestionnaire"/>
  </meta>
  <text>
    <status value="extensions"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: Questionnaire ltc-questionnaire-iadl</b></p><a name="ltc-questionnaire-iadl"> </a><a name="hcltc-questionnaire-iadl"> </a><div style="display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%"><p style="margin-bottom: 0px"/><p style="margin-bottom: 0px">Profile: <a href="StructureDefinition-LTCQuestionnaire.html">長期照顧－問卷</a></p></div><b>Structure</b><table border="1" cellpadding="0" cellspacing="0" style="border: 1px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;"><tr style="border: 2px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top"><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="The linkID for the item">LinkID</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="Text for the item">Text</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="Minimum and Maximum # of times the item can appear in the instance">Cardinality</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="The type of the item">Type</a></th><th style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; padding-top: 3px; padding-bottom: 3px" class="hierarchy"><a href="https://hl7.org/fhir/R4/formats.html#table" title="Additional information about the item">Description &amp; Constraints</a><span style="float: right"><a href="https://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="data:image/png;base64,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" alt="doco" style="background-color: inherit"/></a></span></th></tr><tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_q_root.gif" alt="." style="background-color: white; background-color: inherit" title="QuestionnaireRoot" class="hierarchy"/> LTCQuestionnaireIADL</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Questionnaire</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">http://ltc-ig.fhir.tw/Questionnaire/ltc-questionnaire-iadl#1.0.0</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.F1" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> F1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">使用電話</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.F1">4 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.F2" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="coding" class="hierarchy"/> F2</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">購物</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.F2">4 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.F3" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> F3</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">備餐</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.F3">4 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.F4" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="coding" class="hierarchy"/> F4</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">處理家務</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.F4">4 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.F5" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> F5</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">洗衣服</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.F5">3 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.F6" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="coding" class="hierarchy"/> F6</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">外出</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.F6">5 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.F7" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="coding" class="hierarchy"/> F7</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">服用藥物</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.F7">3 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck00.png)" id="item.F8" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="coding" class="hierarchy"/> F8</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">處理財務的能力</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="https://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : var(--ig-left,left); background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.F8">3 options</a></td></tr>
<tr><td colspan="5" class="hierarchy"><br/><a href="https://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="data:image/png;base64,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" alt="doco" style="background-color: inherit"/> Documentation for this format</a></td></tr></table><hr/><p><b>Options Sets</b></p><a name="opt-item.F1"> </a><p><b>Answer options for F1 </b></p><ul><li style="font-size: 11px">4</li><li style="font-size: 11px">3</li><li style="font-size: 11px">2</li><li style="font-size: 11px">1</li></ul><a name="opt-item.F2"> </a><p><b>Answer options for F2 </b></p><ul><li style="font-size: 11px">4</li><li style="font-size: 11px">3</li><li style="font-size: 11px">2</li><li style="font-size: 11px">1</li></ul><a name="opt-item.F3"> </a><p><b>Answer options for F3 </b></p><ul><li style="font-size: 11px">4</li><li style="font-size: 11px">3</li><li style="font-size: 11px">2</li><li style="font-size: 11px">1</li></ul><a name="opt-item.F4"> </a><p><b>Answer options for F4 </b></p><ul><li style="font-size: 11px">4</li><li style="font-size: 11px">3</li><li style="font-size: 11px">2</li><li style="font-size: 11px">1</li></ul><a name="opt-item.F5"> </a><p><b>Answer options for F5 </b></p><ul><li style="font-size: 11px">3</li><li style="font-size: 11px">2</li><li style="font-size: 11px">1</li></ul><a name="opt-item.F6"> </a><p><b>Answer options for F6 </b></p><ul><li style="font-size: 11px">5</li><li style="font-size: 11px">4</li><li style="font-size: 11px">3</li><li style="font-size: 11px">2</li><li style="font-size: 11px">1</li></ul><a name="opt-item.F7"> </a><p><b>Answer options for F7 </b></p><ul><li style="font-size: 11px">3</li><li style="font-size: 11px">2</li><li style="font-size: 11px">1</li></ul><a name="opt-item.F8"> </a><p><b>Answer options for F8 </b></p><ul><li style="font-size: 11px">3</li><li style="font-size: 11px">2</li><li style="font-size: 11px">1</li></ul></div>
  </text>
  <url value="http://ltc-ig.fhir.tw/Questionnaire/ltc-questionnaire-iadl"/>
  <version value="1.0.0"/>
  <name value="LTCQuestionnaireIADL"/>
  <status value="active"/>
  <date value="2026-03-01T18:36:01+00:00"/>
  <publisher value="經濟部產業發展署"/>
  <contact>
    <name value="經濟部產業發展署"/>
    <telecom>
      <system value="url"/>
      <value value="https://www.ida.gov.tw/"/>
    </telecom>
  </contact>
  <item>
    <linkId value="F1"/>
    <text value="使用電話"/>
    <type value="choice"/>
    <answerOption>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="能獨立使用電話，含查電話簿、撥號等"/>
      </extension>
      <valueInteger value="4"/>
      <initialSelected value="true"/>
    </answerOption>
    <answerOption>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="僅能撥熟悉的電話號碼"/>
      </extension>
      <valueInteger value="3"/>
    </answerOption>
    <answerOption>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="僅能接電話，但不能撥電話"/>
      </extension>
      <valueInteger value="2"/>
    </answerOption>
    <answerOption>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="完全不能使用電話"/>
      </extension>
      <valueInteger value="1"/>
    </answerOption>
  </item>
  <item>
    <linkId value="F2"/>
    <text value="購物"/>
    <type value="choice"/>
    <answerOption>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="能獨立完成所有購物需求"/>
      </extension>
      <valueInteger value="4"/>
    </answerOption>
    <answerOption>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="只能獨立購買日常生活用品"/>
      </extension>
      <valueInteger value="3"/>
    </answerOption>
    <answerOption>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="每一次購物都需要有人陪"/>
      </extension>
      <valueInteger value="2"/>
    </answerOption>
    <answerOption>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="完全不能獨自購物"/>
      </extension>
      <valueInteger value="1"/>
    </answerOption>
  </item>
  <item>
    <linkId value="F3"/>
    <text value="備餐"/>
    <type value="choice"/>
    <answerOption>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="能獨立計畫、準備食材及佐料、烹煮和擺設一頓飯菜"/>
      </extension>
      <valueInteger value="4"/>
    </answerOption>
    <answerOption>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="如果準備好一切食材及佐料，能做一頓飯菜"/>
      </extension>
      <valueInteger value="3"/>
    </answerOption>
    <answerOption>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="能將已做好的飯菜加熱"/>
      </extension>
      <valueInteger value="2"/>
    </answerOption>
    <answerOption>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="需要別人把飯菜煮好、擺好"/>
      </extension>
      <valueInteger value="1"/>
    </answerOption>
  </item>
  <item>
    <linkId value="F4"/>
    <text value="處理家務"/>
    <type value="choice"/>
    <answerOption>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="能單獨處理家事，或偶爾需要協助較繁重的家事"/>
      </extension>
      <valueInteger value="4"/>
    </answerOption>
    <answerOption>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="能做較簡單的家事，如洗碗、擦桌子"/>
      </extension>
      <valueInteger value="3"/>
    </answerOption>
    <answerOption>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="能做較簡單的家事，但不能達到可接受的清潔程度"/>
      </extension>
      <valueInteger value="2"/>
    </answerOption>
    <answerOption>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="所有的家事都需要別人協助方能完成"/>
      </extension>
      <valueInteger value="1"/>
    </answerOption>
  </item>
  <item>
    <linkId value="F5"/>
    <text value="洗衣服"/>
    <type value="choice"/>
    <answerOption>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="自己清洗所有衣物"/>
      </extension>
      <valueInteger value="3"/>
    </answerOption>
    <answerOption>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="需部份協助"/>
      </extension>
      <valueInteger value="2"/>
    </answerOption>
    <answerOption>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="需完全協助"/>
      </extension>
      <valueInteger value="1"/>
    </answerOption>
  </item>
  <item>
    <linkId value="F6"/>
    <text value="外出"/>
    <type value="choice"/>
    <answerOption>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="能夠自己開車、騎車或自己搭乘大眾運輸工具"/>
      </extension>
      <valueInteger value="5"/>
    </answerOption>
    <answerOption>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="能夠自己搭乘計程車，但不能搭乘大眾運輸工具"/>
      </extension>
      <valueInteger value="4"/>
    </answerOption>
    <answerOption>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="當有人陪同時，可搭乘大眾運輸工具"/>
      </extension>
      <valueInteger value="3"/>
    </answerOption>
    <answerOption>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="只能在有人協助或陪同時，可搭乘計程車或自用車"/>
      </extension>
      <valueInteger value="2"/>
    </answerOption>
    <answerOption>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="完全不能出門"/>
      </extension>
      <valueInteger value="1"/>
    </answerOption>
  </item>
  <item>
    <linkId value="F7"/>
    <text value="服用藥物"/>
    <type value="choice"/>
    <answerOption>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="能自己負責在正確的時間用正確的藥物"/>
      </extension>
      <valueInteger value="3"/>
    </answerOption>
    <answerOption>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="如果事先準備好服用的藥物份量，可自行服用"/>
      </extension>
      <valueInteger value="2"/>
    </answerOption>
    <answerOption>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="完全不能自己服用藥物"/>
      </extension>
      <valueInteger value="1"/>
    </answerOption>
  </item>
  <item>
    <linkId value="F8"/>
    <text value="處理財務的能力"/>
    <type value="choice"/>
    <answerOption>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="可以獨立處理財務"/>
      </extension>
      <valueInteger value="3"/>
    </answerOption>
    <answerOption>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="可以處理日常的購買，但需別人協助與銀行往來或大宗買賣"/>
      </extension>
      <valueInteger value="2"/>
    </answerOption>
    <answerOption>
      <extension
                 url="http://hl7.org/fhir/StructureDefinition/rendering-style">
        <valueString value="完全不能處理錢財"/>
      </extension>
      <valueInteger value="1"/>
    </answerOption>
  </item>
</Questionnaire>