PASS-2 (158)    MH TEST/SURVEY SPEC (601.712)

Name Value
INSTRUMENT PASS-2
LAST UPDATE 2026-10-15 09:03:14
ENTRY CHECKSUM 2735295811
ENTRY SPECIFICATION
{"name": "PASS-2", 
    "intro": "A selection is required for all sections", 
    "columns": 1, 
    "choices":[
     {"id": "c5516", "text": " 2 Points - Minimal or none - Pain Score 0-4 or at tolerable level or at baseline"}, 
     {"id": "c5517", "text": " 1 Point - Moderate, requiring oral medication - Pain score 5-7 or 3 above
 baseline"}, 
     {"id": "c5518", "text": " 0 Points - Severe, requiring intravenous opioid treatment - Pain score 8-10"}
   ]}, 
   {"id": "q8961", "type": "ChoiceQuestion", "required": true, "inline": false, 
    "text": " Nausea/Vomiting", 
 "restartDays": 7, 
    "intro": "A selection is required for all sections", 
    "columns": 1, 
    "choices":[
     {"id": "c5519", "text": " 2 Points - Minimal or none"}, 
     {"id": "c5520", "text": " 1 Point - Moderate (requiring medication)"}, 
     {"id": "c5521", "text": " 0 Points - Severe"}
   ]}, 
   {"id": "q8962", "type": "ChoiceQuestion", "required": true, "inline": false, 
    "text": " Circulatory Status", 
    "intro": "A selection is required for all sections", 
 "printTitle": "Post Anesthesia and Sedation Score Phase 2", 
    "columns": 1, 
    "choices":[
     {"id": "c5522", "text": " 2 Points - BP/HR less than 20% or 20 mmHg of baseline"}, 
     {"id": "c5523", "text": " 1 Point - BP/HR 20 - 40% or 20-40 mmHg, no orthostasis"}, 
     {"id": "c5524", "text": " 0 Points - BP/HR greater than 40% or 40 mmHg, or orthostasis"}
   ]}, 
   {"id": "q8963", "type": "ChoiceQuestion", "required": true, "inline": false, 
    "text": " Activity and Mental Status", 
    "intro": "A selection is required for all sections", 
    "columns": 1, 
 "content":[
    "choices":[
     {"id": "c5525", "text": " 2 Points - Oriented x3 AND has steady gait (at baseline for non-ambulating
 patients)"}, 
     {"id": "c5526", "text": " 1 Point - Oriented x3 OR has steady gait (returning to baseline for
 non-ambulating patients)"}, 
     {"id": "c5527", "text": " 0 Points - Neither Oriented x3 or steady gait"}
   ]}, 
   {"id": "q8964", "type": "ChoiceQuestion", "required": true, "inline": false, 
    "text": " Surgical Site/Dressing", 
    "intro": "A selection is required for all sections", 
   {"id": "i2492", "type": "IntroText", 
    "columns": 1, 
    "choices":[
     {"id": "c5528", "text": " 2 Points - Dry and Clean or Not Applicable (for example, Endoscopy)"}, 
     {"id": "c5529", "text": " 1 Point - Wet but stationary and marked/minimal bleeding"}, 
     {"id": "c5530", "text": " 0 Points - Growing Area of wetness/active bleeding"}
   ]}]
}
    "text": "A selection is required for all sections"
    }, 
   {"id": "q8960", "type": "ChoiceQuestion", "required": true, "inline": false, 
    "text": " Pain",