Name | Value |
---|---|
INSTRUMENT | C19-YRS |
LAST UPDATE | 2023-06-27 10:21:52 |
ENTRY CHECKSUM | 3733454678 |
ENTRY SPECIFICATION | {"name": "C19-YRS", <br />Rate the severity of each problem on a scale of 0-3:</i> "columns": 1, "choices":[ {"id": "c5544", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5545", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5546", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5547", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3}, {"id": "c5548", "text": "4. Don't know", "quickKey": 4} ]}, {"id": "q8985", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "1d. Breathlessness: On walking up a flight of stairs <i>[Now]</i>", <br /> <hr />1. Breathlessness" "intro": "<strong>SYMPTOM SEVERITY</strong> <br /> <br /><i>Please answer the questions below to the best of your knowledge. <br /><strong>[Now]</strong> refers to how you feel now/this week (last 7 days). <br /><strong>[Pre-COVID]</strong> refers to how you were feeling prior to contracting the illness. <br />If you are unable to recall this, just select </i>\u0022Don't know\u0022<i>. <br /> <br />Rate the severity of each problem on a scale of 0-3:</i> <br /> <hr />1. Breathlessness", "columns": 1, "choices":[ {"id": "c5540", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5541", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, }, {"id": "c5542", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5543", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3} ]}, {"id": "q8986", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "1d. Breathlessness: On walking up a flight of stairs <i>[Pre-COVID]</i>", "intro": "<strong>SYMPTOM SEVERITY</strong> <br /> <br /><i>Please answer the questions below to the best of your knowledge. <br /><strong>[Now]</strong> refers to how you feel now/this week (last 7 days). <br /><strong>[Pre-COVID]</strong> refers to how you were feeling prior to contracting the illness. <br />If you are unable to recall this, just select </i>\u0022Don't know\u0022<i>. <br /> <br />Rate the severity of each problem on a scale of 0-3:</i> {"id": "q8979", "type": "ChoiceQuestion", "required": false, "inline": false, <br /> <hr />1. Breathlessness", "columns": 1, "choices":[ {"id": "c5544", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5545", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5546", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5547", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3}, {"id": "c5548", "text": "4. Don't know", "quickKey": 4} ]}, {"id": "i2500", "type": "IntroText", "text": "1a. Breathlessness: At rest <i>[Now]</i>", "text": "2. Cough / throat sensitivity / voice change" }, {"id": "q8987", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "2a. Cough / throat sensitivity <i>[Now]</i>", "intro": "2. Cough / throat sensitivity / voice change", "columns": 1, "choices":[ {"id": "c5540", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5541", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5542", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, "intro": "<strong>SYMPTOM SEVERITY</strong> <br /> <br /><i>Please answer the questions below to the best of {"id": "c5543", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3} ]}, {"id": "q8988", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "2a. Cough / throat sensitivity <i>[Pre-COVID]</i>", "intro": "2. Cough / throat sensitivity / voice change", "columns": 1, "choices":[ {"id": "c5544", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5545", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5546", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, your knowledge. <br /><strong>[Now]</strong> refers to how you feel now/this week (last 7 days). {"id": "c5547", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3}, {"id": "c5548", "text": "4. Don't know", "quickKey": 4} ]}, {"id": "q8989", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "2b. Change of voice <i>[Now]</i>", "intro": "2. Cough / throat sensitivity / voice change", "columns": 1, "choices":[ {"id": "c5540", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5541", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, <br /><strong>[Pre-COVID]</strong> refers to how you were feeling prior to contracting the {"id": "c5542", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5543", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3} ]}, {"id": "q8990", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "2b. Change of voice <i>[Pre-COVID]</i>", "intro": "2. Cough / throat sensitivity / voice change", "columns": 1, "choices":[ {"id": "c5544", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5545", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, illness. <br />If you are unable to recall this, just select </i>\u0022Don't know\u0022<i>. <br /> {"id": "c5546", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5547", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3}, {"id": "c5548", "text": "4. Don't know", "quickKey": 4} ]}, {"id": "i2501", "type": "IntroText", "text": "3. Fatigue (tiredness not improved by rest)" }, {"id": "q8991", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "3. Fatigue levels in your usual activities <i>[Now]</i>", "intro": "3. Fatigue (tiredness not improved by rest)", <br />Rate the severity of each problem on a scale of 0-3:</i> "columns": 1, "choices":[ {"id": "c5540", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5541", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5542", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5543", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3} ]}, {"id": "q8992", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "3. Fatigue levels in your usual activities <i>[Pre-COVID]</i>", "intro": "3. Fatigue (tiredness not improved by rest)", "restartDays": 2, <br /> <hr />1. Breathlessness", "columns": 1, "choices":[ {"id": "c5544", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5545", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5546", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5547", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3}, {"id": "c5548", "text": "4. Don't know", "quickKey": 4} ]}, {"id": "i2502", "type": "IntroText", "text": "4. Smell / taste" "columns": 1, }, {"id": "q8993", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "4a. Altered smell <i>[Now]</i>", "intro": "4. Smell / taste", "columns": 1, "choices":[ {"id": "c5540", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5541", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5542", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5543", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3} "choices":[ ]}, {"id": "q8994", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "4a. Altered smell <i>[Pre-COVID]</i>", "intro": "4. Smell / taste", "columns": 1, "choices":[ {"id": "c5544", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5545", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5546", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5547", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3}, {"id": "c5540", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5548", "text": "4. Don't know", "quickKey": 4} ]}, {"id": "q8995", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "4b. Altered taste <i>[Now]</i>", "intro": "4. Smell / taste", "columns": 1, "choices":[ {"id": "c5540", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5541", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5542", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5541", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5543", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3} ]}, {"id": "q8996", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "4b. Altered taste <i>[Pre-COVID]</i>", "intro": "4. Smell / taste", "columns": 1, "choices":[ {"id": "c5544", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5545", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5546", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5542", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5547", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3}, {"id": "c5548", "text": "4. Don't know", "quickKey": 4} ]}, {"id": "i2503", "type": "IntroText", "text": "5. Pain / discomfort" }, {"id": "q8997", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "5a. Chest pain <i>[Now]</i>", "intro": "5. Pain / discomfort", "columns": 1, {"id": "c5543", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3} "choices":[ {"id": "c5540", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5541", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5542", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5543", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3} ]}, {"id": "q8998", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "5a. Chest pain <i>[Pre-COVID]</i>", "intro": "5. Pain / discomfort", "columns": 1, ]}, "choices":[ {"id": "c5544", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5545", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5546", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5547", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3}, {"id": "c5548", "text": "4. Don't know", "quickKey": 4} ]}, {"id": "q8999", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "5b. Joint pain <i>[Now]</i>", "intro": "5. Pain / discomfort", {"id": "q8980", "type": "ChoiceQuestion", "required": false, "inline": false, "columns": 1, "choices":[ {"id": "c5540", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5541", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5542", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5543", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3} ]}, {"id": "q9000", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "5b. Joint Pain <i>[Pre-COVID]</i>", "intro": "5. Pain / discomfort", "text": "1a. Breathlessness: At rest <i>[Pre-COVID]</i>", "columns": 1, "choices":[ {"id": "c5544", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5545", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5546", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5547", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3}, {"id": "c5548", "text": "4. Don't know", "quickKey": 4} ]}, {"id": "q9001", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "5c. Muscle pain <i>[Now]</i>", "printTitle": "Modified COVID-19 Yorkshire Rehabilitation Screening (C19-YRS)", "intro": "<strong>SYMPTOM SEVERITY</strong> <br /> <br /><i>Please answer the questions below to the best of "intro": "5. Pain / discomfort", "columns": 1, "choices":[ {"id": "c5540", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5541", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5542", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5543", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3} ]}, {"id": "q9002", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "5c. Muscle pain <i>[Pre-COVID]</i>", your knowledge. <br /><strong>[Now]</strong> refers to how you feel now/this week (last 7 days). "intro": "5. Pain / discomfort", "columns": 1, "choices":[ {"id": "c5544", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5545", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5546", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5547", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3}, {"id": "c5548", "text": "4. Don't know", "quickKey": 4} ]}, {"id": "q9003", "type": "ChoiceQuestion", "required": false, "inline": false, <br /><strong>[Pre-COVID]</strong> refers to how you were feeling prior to contracting the "text": "5d. Headache <i>[Now]</i>", "intro": "5. Pain / discomfort", "columns": 1, "choices":[ {"id": "c5540", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5541", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5542", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5543", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3} ]}, {"id": "q9004", "type": "ChoiceQuestion", "required": false, "inline": false, illness. <br />If you are unable to recall this, just select </i>\u0022Don't know\u0022<i>. <br /> "text": "5d. Headache <i>[Pre-COVID]</i>", "intro": "5. Pain / discomfort", "columns": 1, "choices":[ {"id": "c5544", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5545", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5546", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5547", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3}, {"id": "c5548", "text": "4. Don't know", "quickKey": 4} ]}, <br />Rate the severity of each problem on a scale of 0-3:</i> {"id": "q9005", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "5e. Abdominal pain <i>[Now]</i>", "intro": "5. Pain / discomfort", "columns": 1, "choices":[ {"id": "c5540", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5541", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5542", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5543", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3} ]}, <br /> <hr />1. Breathlessness", {"id": "q9006", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "5e. Abdominal pain <i>[Pre-COVID]</i>", "intro": "5. Pain / discomfort", "columns": 1, "choices":[ {"id": "c5544", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5545", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5546", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5547", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3}, {"id": "c5548", "text": "4. Don't know", "quickKey": 4} "columns": 1, ]}, {"id": "i2504", "type": "IntroText", "text": "6. Cognition" }, {"id": "q9007", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "6a. Problems with concentration <i>[Now]</i>", "intro": "6. Cognition", "columns": 1, "choices":[ {"id": "c5540", "text": "0. None; no problem", "quickKey": 0}, "choices":[ {"id": "c5541", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5542", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5543", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3} ]}, {"id": "q9008", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "6a. Problems with concentration <i>[Pre-COVID]</i>", "intro": "6. Cognition", "columns": 1, "choices":[ {"id": "c5544", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5544", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5545", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5546", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5547", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3}, {"id": "c5548", "text": "4. Don't know", "quickKey": 4} ]}, {"id": "q9009", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "6b. Problems with memory <i>[Now]</i>", "intro": "6. Cognition", "columns": 1, "choices":[ {"id": "c5545", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5540", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5541", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5542", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5543", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3} ]}, {"id": "q9010", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "6b. Problems with memory <i>[Pre-COVID]</i>", "intro": "6. Cognition", "columns": 1, "choices":[ "content":[ {"id": "c5546", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5544", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5545", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5546", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5547", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3}, {"id": "c5548", "text": "4. Don't know", "quickKey": 4} ]}, {"id": "q9011", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "6c. Problems with planning <i>[Now]</i>", "intro": "6. Cognition", "columns": 1, {"id": "c5547", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3}, "choices":[ {"id": "c5540", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5541", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5542", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5543", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3} ]}, {"id": "q9012", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "6c. Problems with planning <i>[Pre-COVID]</i>", "intro": "6. Cognition", "columns": 1, {"id": "c5548", "text": "4. Don't know", "quickKey": 4} "choices":[ {"id": "c5544", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5545", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5546", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5547", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3}, {"id": "c5548", "text": "4. Don't know", "quickKey": 4} ]}, {"id": "i2505", "type": "IntroText", "text": "7. Palpitations / dizziness" }, ]}, {"id": "q9013", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "7a. Palpitations in certain positions, activity or at rest <i>[Now]</i>", "intro": "7. Palpitations / dizziness", "columns": 1, "choices":[ {"id": "c5540", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5541", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5542", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5543", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3} ]}, {"id": "q8981", "type": "ChoiceQuestion", "required": false, "inline": false, {"id": "q9014", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "7a. Palpitations in certain positions, activity or at rest <i>[Pre-COVID]</i>", "intro": "7. Palpitations / dizziness", "columns": 1, "choices":[ {"id": "c5544", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5545", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5546", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5547", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3}, {"id": "c5548", "text": "4. Don't know", "quickKey": 4} "text": "1b. Breathlessness: Changing position e.g. from lying to sitting or sitting to ]}, {"id": "q9015", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "7b. Dizziness in certain positions, activity or at rest <i>[Now]</i>", "intro": "7. Palpitations / dizziness", "columns": 1, "choices":[ {"id": "c5540", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5541", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5542", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5543", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3} lying <i>[Now]</i>", ]}, {"id": "q9016", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "7b. Dizziness in certain positions, activity or at rest <i>[Pre-COVID]</i>", "intro": "7. Palpitations / dizziness", "columns": 1, "choices":[ {"id": "c5544", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5545", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5546", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5547", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3}, "intro": "<strong>SYMPTOM SEVERITY</strong> <br /> <br /><i>Please answer the questions below to the best of {"id": "c5548", "text": "4. Don't know", "quickKey": 4} ]}, {"id": "i2506", "type": "IntroText", "text": "8. Post-exertional malaise (worsening of symptoms)" }, {"id": "q9017", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "8. Crashing or relapse hours or days after physical, cognitive or emotional exertion <i>[Now]</i>", "intro": "8. Post-exertional malaise (worsening of symptoms)", "columns": 1, your knowledge. <br /><strong>[Now]</strong> refers to how you feel now/this week (last 7 days). "choices":[ {"id": "c5540", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5541", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5542", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5543", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3} ]}, {"id": "q9018", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "8. Crashing or relapse hours or days after physical, cognitive or emotional exertion <i>[Pre-COVID]</i>", "intro": "8. Post-exertional malaise (worsening of symptoms)", <br /><strong>[Pre-COVID]</strong> refers to how you were feeling prior to contracting the "columns": 1, "choices":[ {"id": "c5544", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5545", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5546", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5547", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3}, {"id": "c5548", "text": "4. Don't know", "quickKey": 4} ]}, {"id": "i2507", "type": "IntroText", "text": "9. Anxiety / mood" {"id": "i2499", "type": "IntroText", illness. <br />If you are unable to recall this, just select </i>\u0022Don't know\u0022<i>. <br /> }, {"id": "q9019", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "9a. Feeling anxious <i>[Now]</i>", "intro": "9. Anxiety / mood", "columns": 1, "choices":[ {"id": "c5540", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5541", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5542", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5543", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3} <br />Rate the severity of each problem on a scale of 0-3:</i> ]}, {"id": "q9020", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "9a. Feeling anxious <i>[Pre-COVID]</i>", "intro": "9. Anxiety / mood", "columns": 1, "choices":[ {"id": "c5544", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5545", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5546", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5547", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3}, <br /> <hr />1. Breathlessness", {"id": "c5548", "text": "4. Don't know", "quickKey": 4} ]}, {"id": "q9021", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "9b. Feeling depressed <i>[Now]</i>", "intro": "9. Anxiety / mood", "columns": 1, "choices":[ {"id": "c5540", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5541", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5542", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, "columns": 1, {"id": "c5543", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3} ]}, {"id": "q9022", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "9b. Feeling depressed <i>[Pre-COVID]</i>", "intro": "9. Anxiety / mood", "columns": 1, "choices":[ {"id": "c5544", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5545", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5546", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, "choices":[ {"id": "c5547", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3}, {"id": "c5548", "text": "4. Don't know", "quickKey": 4} ]}, {"id": "q9023", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "9c. Having unwanted memories of your illness or time in hospital <i>[Now]</i>", "intro": "9. Anxiety / mood", "columns": 1, "choices":[ {"id": "c5540", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5541", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5540", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5542", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5543", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3} ]}, {"id": "q9024", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "9c. Having unwanted memories of your illness or time in hospital <i>[Pre-COVID]</i>", "intro": "9. Anxiety / mood", "columns": 1, "choices":[ {"id": "c5544", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5545", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5541", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5546", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5547", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3}, {"id": "c5548", "text": "4. Don't know", "quickKey": 4} ]}, {"id": "q9025", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "9d. Having unpleasant dreams about your illness or time in hospital <i>[Now]</i>", "intro": "9. Anxiety / mood", "columns": 1, "choices":[ {"id": "c5540", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5542", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5541", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5542", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5543", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3} ]}, {"id": "q9026", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "9d. Having unpleasant dreams about your illness or time in hospital <i>[Pre-COVID]</i>", "intro": "9. Anxiety / mood", "columns": 1, "choices":[ {"id": "c5544", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5543", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3} {"id": "c5545", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5546", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5547", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3}, {"id": "c5548", "text": "4. Don't know", "quickKey": 4} ]}, {"id": "q9027", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "9e. Trying to avoid thoughts or feelings about your illness or time in hospital <i>[Now]</i>", "intro": "9. Anxiety / mood", "columns": 1, ]}, "choices":[ {"id": "c5540", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5541", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5542", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5543", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3} ]}, {"id": "q9028", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "9e. Trying to avoid thoughts or feelings about your illness or time in hospital <i>[Pre-COVID]</i>", "intro": "9. Anxiety / mood", "text": "<strong>SYMPTOM SEVERITY</strong> <br /> <br /><i>Please answer the questions below to the best of {"id": "q8982", "type": "ChoiceQuestion", "required": false, "inline": false, "columns": 1, "choices":[ {"id": "c5544", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5545", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5546", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5547", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3}, {"id": "c5548", "text": "4. Don't know", "quickKey": 4} ]}, {"id": "i2508", "type": "IntroText", "text": "10. Sleep" "text": "1b. Breathlessness: Changing position e.g. from lying to sitting or sitting to }, {"id": "q9029", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "10. Sleep problems, such as difficulty falling asleep, staying asleep or oversleeping <i>[Now]</i>", "intro": "10. Sleep", "columns": 1, "choices":[ {"id": "c5540", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5541", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5542", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, lying <i>[Pre-COVID]</i>", {"id": "c5543", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3} ]}, {"id": "q9030", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "10. Sleep problems, such as difficulty falling asleep, staying asleep or oversleeping <i>[Pre-COVID]</i>", "intro": "10. Sleep", "columns": 1, "choices":[ {"id": "c5544", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5545", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, "intro": "<strong>SYMPTOM SEVERITY</strong> <br /> <br /><i>Please answer the questions below to the best of {"id": "c5546", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5547", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3}, {"id": "c5548", "text": "4. Don't know", "quickKey": 4} ]}, {"id": "i2509", "type": "IntroText", "text": "<strong>FUNCTIONAL ABILITY</strong> <br /><br />11. Communication" }, {"id": "q9031", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "11. Difficulty with communication / word finding difficulty / understanding others <i>[Now]</i>", your knowledge. <br /><strong>[Now]</strong> refers to how you feel now/this week (last 7 days). "intro": "<strong>FUNCTIONAL ABILITY</strong> <br /><br />11. Communication", "columns": 1, "choices":[ {"id": "c5540", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5541", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5542", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5543", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3} ]}, {"id": "q9032", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "11. Difficulty with communication/word finding difficulty/understanding others <br /><strong>[Pre-COVID]</strong> refers to how you were feeling prior to contracting the <i>[Pre-COVID]</i>", "intro": "<strong>FUNCTIONAL ABILITY</strong> <br /><br />11. Communication", "columns": 1, "choices":[ {"id": "c5544", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5545", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5546", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5547", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3}, {"id": "c5548", "text": "4. Don't know", "quickKey": 4} ]}, illness. <br />If you are unable to recall this, just select </i>\u0022Don't know\u0022<i>. <br /> {"id": "i2510", "type": "IntroText", "text": "12. Walking or moving around" }, {"id": "q9033", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "12. Difficulties with walking or moving around <i>[Now]</i>", "intro": "12. Walking or moving around", "columns": 1, "choices":[ {"id": "c5540", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5541", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, <br />Rate the severity of each problem on a scale of 0-3:</i> {"id": "c5542", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5543", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3} ]}, {"id": "q9034", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "12. Difficulties with walking or moving around <i>[Pre-COVID]</i>", "intro": "12. Walking or moving around", "columns": 1, "choices":[ {"id": "c5544", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5545", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, <br /> <hr />1. Breathlessness", {"id": "c5546", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5547", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3}, {"id": "c5548", "text": "4. Don't know", "quickKey": 4} ]}, {"id": "i2511", "type": "IntroText", "text": "13. Personal Care" }, {"id": "q9035", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "13. Difficulties with personal tasks such as using the toilet or getting washed and dressed <i>[Now]</i>", "columns": 1, "intro": "13. Personal Care", "columns": 1, "choices":[ {"id": "c5540", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5541", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5542", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5543", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3} ]}, {"id": "q9036", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "13. Difficulties with personal tasks such as using the toilet or getting washed your knowledge. <br /><strong>[Now]</strong> refers to how you feel now/this week (last 7 days). "choices":[ and dressed <i>[Pre-COVID]</i>", "intro": "13. Personal Care", "columns": 1, "choices":[ {"id": "c5544", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5545", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5546", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5547", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3}, {"id": "c5548", "text": "4. Don't know", "quickKey": 4} ]}, {"id": "c5544", "text": "0. None; no problem", "quickKey": 0}, {"id": "i2512", "type": "IntroText", "text": "14. Other activities of Daily Living" }, {"id": "q9037", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "14. Difficulty doing wider activities, such as household work, leisure/sporting activities, paid/unpaid work, study or shopping <i>[Now]</i>", "intro": "14. Other activities of Daily Living", "columns": 1, "choices":[ {"id": "c5540", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5545", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5541", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5542", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5543", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3} ]}, {"id": "q9038", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "14. Difficulty doing wider activities, such as household work, leisure/sporting activities, paid/unpaid work, study or shopping <i>[Pre-COVID]</i>", "intro": "14. Other activities of Daily Living", "columns": 1, "choices":[ {"id": "c5546", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5544", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5545", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5546", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5547", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3}, {"id": "c5548", "text": "4. Don't know", "quickKey": 4} ]}, {"id": "i2513", "type": "IntroText", "text": "15. Social role" }, {"id": "q9039", "type": "ChoiceQuestion", "required": false, "inline": false, {"id": "c5547", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3}, "text": "15. Problems with socializing / interacting with friends* or caring for dependants <i>[Now]</i><br />* related to your illness and not due to social distancing / lockdown measures", "intro": "15. Social role", "columns": 1, "choices":[ {"id": "c5540", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5541", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5542", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5543", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3} {"id": "c5548", "text": "4. Don't know", "quickKey": 4} ]}, {"id": "q9040", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "15. Problems with socializing / interacting with friends* or caring for dependants <i>[Pre-COVID]</i><br />* related to your illness and not due to social distancing / lockdown measures", "intro": "15. Social role", "columns": 1, "choices":[ {"id": "c5544", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5545", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, ]}, {"id": "c5546", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, {"id": "c5547", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3}, {"id": "c5548", "text": "4. Don't know", "quickKey": 4} ]}, {"id": "i2514", "type": "IntroText", "text": "<strong>OTHER SYMPTOMS</strong>" }, {"id": "q9041", "type": "CheckQuestion", "required": false, "inline": false, "text": "16a. Please select any of the following symptoms you have experienced since your illness in the last 7 days. Please also select any previous problems that have {"id": "q8983", "type": "ChoiceQuestion", "required": false, "inline": false, worsened for you following your illness.", "intro": "<strong>OTHER SYMPTOMS</strong>", "columns": 1, "choices":[ {"id": "c5549", "text": " Fever"}, {"id": "c5550", "text": " Skin rash / discoloration of skin"}, {"id": "c5551", "text": " New allergy such as medication, food etc."}, {"id": "c5552", "text": " Hair loss"}, {"id": "c5553", "text": " Skin sensation (numbness / tingling / itching / nerve pain)"}, {"id": "c5554", "text": " Dry eyes / redness of eyes"}, "text": "1c. Breathlessness: On dressing yourself <i>[Now]</i>", {"id": "c5555", "text": " Swelling of feet / swelling of hands"}, {"id": "c5556", "text": " Easy bruising / bleeding"}, {"id": "c5557", "text": " Visual changes"}, {"id": "c5558", "text": " Difficulty swallowing solids"}, {"id": "c5559", "text": " Difficulty swallowing liquids"}, {"id": "c5560", "text": " Balance problems or falls"}, {"id": "c5561", "text": " Weakness or movement problems or coordination problems in limbs"}, {"id": "c5562", "text": " Tinnitus"}, {"id": "c5563", "text": " Nausea"}, {"id": "c5564", "text": " Dry mouth / mouth ulcers"}, "intro": "<strong>SYMPTOM SEVERITY</strong> <br /> <br /><i>Please answer the questions below to the best of {"id": "c5565", "text": " Acid Reflux / heartburn"}, {"id": "c5566", "text": " Change in appetite"}, {"id": "c5567", "text": " Unintentional weight loss"}, {"id": "c5568", "text": " Unintentional weight gain"}, {"id": "c5569", "text": " Bladder frequency, urgency or incontinence"}, {"id": "c5570", "text": " Constipation, diarrhea or bowel incontinence"}, {"id": "c5571", "text": " Change in menstrual cycles or flow"}, {"id": "c5572", "text": " Waking up at night gasping for air (also called sleep apnea)"}, {"id": "c5573", "text": " Thoughts about harming yourself"} ]}, <br /><strong>[Pre-COVID]</strong> refers to how you were feeling prior to contracting the your knowledge. <br /><strong>[Now]</strong> refers to how you feel now/this week (last 7 days). {"id": "q9042", "type": "MemoQuestion", "required": false, "text": "16b. Other symptoms - free text", "intro": "<strong>OTHER SYMPTOMS</strong>", "controlWidth": 662}, {"id": "i2515", "type": "IntroText", "text": "<strong>OVERALL HEALTH</strong> <br /><br />For this question, a score of 10 means the BEST health you can imagine. 0 means the WORST health you can imagine." }, {"id": "q9043", "type": "SliderQuestion", "required": false, "text": "17a. How good or bad is your health overall in the last 7 days? <i>[Now]</i>", <br /><strong>[Pre-COVID]</strong> refers to how you were feeling prior to contracting the "intro": "<strong>OVERALL HEALTH</strong> <br /><br />For this question, a score of 10 means the BEST health you can imagine. 0 means the WORST health you can imagine.", "min": 0, "max": 10, "legend":["WORST HEALTH", "BEST HEALTH"]}, {"id": "q9044", "type": "SliderQuestion", "required": false, "text": "17b. How good or bad is your health overall in the last 7 days? <i>[Pre-COVID]</i>", "intro": "<strong>OVERALL HEALTH</strong> <br /><br />For this question, a score of 10 means the BEST health you can imagine. 0 means the WORST health you can imagine.", "min": 0, "max": 10, "legend":["WORST HEALTH", "BEST HEALTH"]}, illness. <br />If you are unable to recall this, just select </i>\u0022Don't know\u0022<i>. <br /> {"id": "i2516", "type": "IntroText", "text": "<strong>EMPLOYMENT</strong>" }, {"id": "q9045", "type": "StringQuestion", "required": false, "text": "18a. Occupation", "intro": "<strong>EMPLOYMENT</strong>", "controlWidth": 662, "min": 0, "max": 0}, {"id": "q9046", "type": "CheckQuestion", "required": false, "inline": false, "text": "18b. Has your COVID-19 illness affected your work?", "intro": "<strong>EMPLOYMENT</strong>", <br />Rate the severity of each problem on a scale of 0-3:</i> "columns": 1, "choices":[ {"id": "c5576", "text": " No change"}, {"id": "c5577", "text": " On reduced working hours"}, {"id": "c5578", "text": " On sickness leave"}, {"id": "c5579", "text": " Changes made to role / working arrangements (such as working from home or lighter duties)"}, {"id": "c5580", "text": " Had to retire / change job"}, {"id": "c5581", "text": " Lost job"} ]}, <br /> <hr />1. Breathlessness", {"id": "q9047", "type": "MemoQuestion", "required": false, "text": "18c. Any other comments/concerns", "intro": "<strong>EMPLOYMENT</strong>", "controlWidth": 662}, {"id": "i2517", "type": "IntroText", "text": "<strong>PARTNER / FAMILY / CAREGIVER PERSPECTIVE</strong>" }, {"id": "q9048", "type": "MemoQuestion", "required": false, "text": "19. This is space for your partner, family or caregiver to add anything from their perspective", "columns": 1, "intro": "<strong>PARTNER / FAMILY / CAREGIVER PERSPECTIVE</strong>", "controlWidth": 662}] } "choices":[ {"id": "c5540", "text": "0. None; no problem", "quickKey": 0}, {"id": "c5541", "text": "1. Mild problem; does not affect daily life", "quickKey": 1}, {"id": "c5542", "text": "2. Moderate problem; affects daily life to a certain extent", "quickKey": 2}, illness. <br />If you are unable to recall this, just select </i>\u0022Don't know\u0022<i>. <br /> {"id": "c5543", "text": "3. Severe problem; affects all aspects of daily life; life-disturbing", "quickKey": 3} ]}, {"id": "q8984", "type": "ChoiceQuestion", "required": false, "inline": false, "text": "1c. Breathlessness: On dressing yourself <i>[Pre-COVID]</i>", "intro": "<strong>SYMPTOM SEVERITY</strong> <br /> <br /><i>Please answer the questions below to the best of your knowledge. <br /><strong>[Now]</strong> refers to how you feel now/this week (last 7 days). <br /><strong>[Pre-COVID]</strong> refers to how you were feeling prior to contracting the illness. <br />If you are unable to recall this, just select </i>\u0022Don't know\u0022<i>. <br /> <br />Rate the severity of each problem on a scale of 0-3:</i> <br /> <hr />1. Breathlessness", |