| ENTRY SPECIFICATION |
questionnaire is also helpful for your primary care provider to determine the
level of pain and disability caused by your headaches and to find the best
treatment for you. <br /><br /><strong>INSTRUCTIONS</strong> <br /><br />Please answer the
following questions about ALL of the headaches you have had over the last 3
months. Enter your answer in the box beneath each question. Enter zero if you
did not have the activity in the last 3 months."
},
{"id": "q8947", "type": "IntegerQuestion", "required": true,
"text": "1. On how many days in the last 3 months did you miss work or school because of
your headaches?",
{"name": "MIDAS",
"intro": "The <strong>MIDAS</strong> (Migraine Disability Assessment) questionnaire was put together to help
you measure the impact your headaches have on your life. The information on this
questionnaire is also helpful for your primary care provider to determine the
level of pain and disability caused by your headaches and to find the best
treatment for you. <br /><br /><strong>INSTRUCTIONS</strong> <br /><br />Please answer the
following questions about ALL of the headaches you have had over the last 3
months. Enter your answer in the box beneath each question. Enter zero if you
did not have the activity in the last 3 months.",
"controlWidth": 70, "min": 0, "max": 92},
{"id": "q8948", "type": "IntegerQuestion", "required": true,
"copyright": "Innovative Medical Research 1997 and 2007, AstraZeneca Pharmaceuticals, LP. All Rights reserved.",
"text": "2. How many days in the last 3 months was your productivity at work or school
reduced by half or more because of your headaches? (Do not include days you
counted in question 1 where you missed work or school.)",
"intro": "The <strong>MIDAS</strong> (Migraine Disability Assessment) questionnaire was put together to help
you measure the impact your headaches have on your life. The information on this
questionnaire is also helpful for your primary care provider to determine the
level of pain and disability caused by your headaches and to find the best
treatment for you. <br /><br /><strong>INSTRUCTIONS</strong> <br /><br />Please answer the
following questions about ALL of the headaches you have had over the last 3
months. Enter your answer in the box beneath each question. Enter zero if you
"restartDays": 2,
did not have the activity in the last 3 months.",
"controlWidth": 70, "min": 0, "max": 92},
{"id": "q8949", "type": "IntegerQuestion", "required": true,
"text": "3. On how many days in the last 3 months did you not do household work (such as
housework, home repairs and maintenance, shopping, caring for children and
relatives) because of your headaches?",
"intro": "The <strong>MIDAS</strong> (Migraine Disability Assessment) questionnaire was put together to help
you measure the impact your headaches have on your life. The information on this
questionnaire is also helpful for your primary care provider to determine the
level of pain and disability caused by your headaches and to find the best
"printTitle": "Migraine Disability Assessment Test",
treatment for you. <br /><br /><strong>INSTRUCTIONS</strong> <br /><br />Please answer the
following questions about ALL of the headaches you have had over the last 3
months. Enter your answer in the box beneath each question. Enter zero if you
did not have the activity in the last 3 months.",
"controlWidth": 70, "min": 0, "max": 92},
{"id": "q8950", "type": "IntegerQuestion", "required": true,
"text": "4. How many days in the last 3 months was your productivity in household work
reduced by half of more because of your headaches? (Do not include days you
counted in question 3 where you did not do household work.)",
"intro": "The <strong>MIDAS</strong> (Migraine Disability Assessment) questionnaire was put together to help
"content":[
you measure the impact your headaches have on your life. The information on this
questionnaire is also helpful for your primary care provider to determine the
level of pain and disability caused by your headaches and to find the best
treatment for you. <br /><br /><strong>INSTRUCTIONS</strong> <br /><br />Please answer the
following questions about ALL of the headaches you have had over the last 3
months. Enter your answer in the box beneath each question. Enter zero if you
did not have the activity in the last 3 months.",
"controlWidth": 70, "min": 0, "max": 92},
{"id": "q8951", "type": "IntegerQuestion", "required": true,
"text": "5. On how many days in the last 3 months did you miss family, social or leisure
{"id": "i2488", "type": "IntroText",
activities because of your headaches?",
"intro": "The <strong>MIDAS</strong> (Migraine Disability Assessment) questionnaire was put together to help
you measure the impact your headaches have on your life. The information on this
questionnaire is also helpful for your primary care provider to determine the
level of pain and disability caused by your headaches and to find the best
treatment for you. <br /><br /><strong>INSTRUCTIONS</strong> <br /><br />Please answer the
following questions about ALL of the headaches you have had over the last 3
months. Enter your answer in the box beneath each question. Enter zero if you
did not have the activity in the last 3 months.",
"controlWidth": 70, "min": 0, "max": 92},
"text": "The <strong>MIDAS</strong> (Migraine Disability Assessment) questionnaire was put together to help
{"id": "i2489", "type": "IntroText",
"text": "<strong>What your Physician will need to know about your headache:</strong>"
},
{"id": "q8952", "type": "IntegerQuestion", "required": true,
"text": "A. On how many days in the last 3 months did you have a headache? (If a headache
lasted more than 1 day, count each day.)",
"intro": "<strong>What your Physician will need to know about your headache:</strong>",
"controlWidth": 70, "min": 0, "max": 92},
{"id": "q8953", "type": "SliderQuestion", "required": true,
"text": "B. On a scale of 0 - 10, on average how painful were these headaches? (where 0 =
you measure the impact your headaches have on your life. The information on this
no pain at all, and 10 = pain as bad as it can be.)",
"intro": "<strong>What your Physician will need to know about your headache:</strong>",
"min": 0, "max": 10,
"legend":["no pain at all", "pain as bad as it can be"]}]
}
|
