PASS-1 (150)    MH TEST/SURVEY SPEC (601.712)

Name Value
INSTRUMENT PASS-1
LAST UPDATE 2026-10-15 09:03:11
ENTRY CHECKSUM 1490031957
ENTRY SPECIFICATION
{"name": "PASS-1", 
    "intro": "A selection is required for all sections<br />", 
    "columns": 1, 
    "choices":[
     {"id": "c5469", "text": " 2 Points - SpO2 greater than or equal to 94% or baseline on room air"}, 
     {"id": "c5470", "text": " 1 Point - SpO2 greater than or equal to 94% or baseline minus 2% with oxygen"}, 
     {"id": "c5471", "text": " 0 Points - SpO2 less than 94% or baseline minus 2% with oxygen"}
   ]}, 
   {"id": "q8916", "type": "ChoiceQuestion", "required": true, "inline": false, 
    "text": " PACU Respiratory Status", 
    "intro": "A selection is required for all sections<br />", 
 "restartDays": 7, 
    "columns": 1, 
    "choices":[
     {"id": "c5472", "text": " 2 Points - Normal breathing and  deep cough on command"}, 
     {"id": "c5473", "text": " 1 Point - Inadequate coughing or coughing without command"}, 
     {"id": "c5474", "text": " 0 Points - Tachypneic or Dyspneic -  requires assisted ventilation or airway
 device"}
   ]}, 
   {"id": "q8917", "type": "ChoiceQuestion", "required": true, "inline": false, 
    "text": " Circulatory Status", 
    "intro": "A selection is required for all sections<br />", 
 "printTitle": "Post Anesthesia Sedation Score Phase 1", 
    "columns": 1, 
    "choices":[
     {"id": "c5475", "text": " 2 Points - BP/HR less than 20% or 20 mmHg of baseline"}, 
     {"id": "c5476", "text": " 1 Point - BP/HR 20 - 40% or 20-40 mmHg with no orthostasis"}, 
     {"id": "c5477", "text": " 0 Points - BP/HR greater than 40% or 40 mmHg or orthostasis"}
   ]}, 
   {"id": "q8918", "type": "ChoiceQuestion", "required": true, "inline": false, 
    "text": " Level of Consciousness", 
    "intro": "A selection is required for all sections<br />", 
    "columns": 1, 
 "content":[
    "choices":[
     {"id": "c5478", "text": " 2 Points - Fully awake or easily awakened"}, 
     {"id": "c5479", "text": " 1 Point - Arousable but delayed"}, 
     {"id": "c5480", "text": " 0 Points - Not responding or responding only with tactile stimulation"}
   ]}, 
   {"id": "q8919", "type": "ChoiceQuestion", "required": true, "inline": false, 
    "text": " Pain", 
    "intro": "A selection is required for all sections<br />", 
    "columns": 1, 
    "choices":[
   {"id": "i2484", "type": "IntroText", 
     {"id": "c5481", "text": " 2 Points - Minimal or none - Pain Score 0-4 or at tolerable level or at baseline"}, 
     {"id": "c5482", "text": " 1 Point - Moderate requiring oral medication - Pain Score 5-7 or 3 above
 baseline"}, 
     {"id": "c5483", "text": " 0 Points - Severe requiring intravenous opioid treatment - Pain Score 8-10"}
   ]}, 
   {"id": "q8920", "type": "ChoiceQuestion", "required": true, "inline": false, 
    "text": " Nausea/Vomiting", 
    "intro": "A selection is required for all sections<br />", 
    "columns": 1, 
    "choices":[
    "text": "A selection is required for all sections<br />"
     {"id": "c5484", "text": " 2 Points - Minimal or none"}, 
     {"id": "c5485", "text": " 1 Point - Moderate requiring medication"}, 
     {"id": "c5486", "text": " 0 Points - Severe"}
   ]}, 
   {"id": "q8921", "type": "ChoiceQuestion", "required": true, "inline": false, 
    "text": " Level of Activity", 
    "intro": "A selection is required for all sections<br />", 
    "columns": 1, 
    "choices":[
     {"id": "c5487", "text": " 2 Points - Able to move all extremities voluntarily or on command or moves all
    }, 
 extremities with the exception of extremity treated with peripheral nerve block
 or patient baseline"}, 
     {"id": "c5488", "text": " 1 Point - Moves at least two extremities or baseline moving less than all
 extremities"}, 
     {"id": "c5489", "text": " 0 Points - Unable to voluntarily move extremities on command"}
   ]}]
}
   {"id": "q8915", "type": "ChoiceQuestion", "required": true, "inline": false, 
    "text": " Oxygenation",