| ENTRY SPECIFICATION |
{"name": "SF36",
are unsure about how to answer a question, please give the best answer you can."
"choices":[
{"id": "c1069", "text": "1. Yes, limited a lot.", "quickKey": 1},
{"id": "c1070", "text": "2. Yes, limited a little.", "quickKey": 2},
{"id": "c1071", "text": "3. No, not limited at all.", "quickKey": 3}
]},
{"id": "q3558", "type": "ChoiceQuestion", "required": false,
"text": "10. During a typical day, does YOUR HEALTH NOW LIMIT YOU in: Walking SEVERAL
BLOCKS. ",
"choices":[
},
{"id": "c1069", "text": "1. Yes, limited a lot.", "quickKey": 1},
{"id": "c1070", "text": "2. Yes, limited a little.", "quickKey": 2},
{"id": "c1071", "text": "3. No, not limited at all.", "quickKey": 3}
]},
{"id": "q3559", "type": "ChoiceQuestion", "required": false,
"text": "11. During a typical day, does YOUR HEALTH NOW LIMIT YOU in: Walking ONE BLOCK. ",
"choices":[
{"id": "c1069", "text": "1. Yes, limited a lot.", "quickKey": 1},
{"id": "c1070", "text": "2. Yes, limited a little.", "quickKey": 2},
{"id": "q3549", "type": "ChoiceQuestion", "required": false,
{"id": "c1071", "text": "3. No, not limited at all.", "quickKey": 3}
]},
{"id": "q3560", "type": "ChoiceQuestion", "required": false,
"text": "12. During a typical day, does YOUR HEALTH NOW LIMIT YOU in: Bathing or dressing
yourself. ",
"choices":[
{"id": "c1069", "text": "1. Yes, limited a lot.", "quickKey": 1},
{"id": "c1070", "text": "2. Yes, limited a little.", "quickKey": 2},
{"id": "c1071", "text": "3. No, not limited at all.", "quickKey": 3}
"text": "1. In general, would you say your health is: ",
]},
{"id": "i54", "type": "IntroText",
"text": "During the PAST 4 WEEKS, have you had any of the following problems with your
work or other regular daily activities AS A RESULT OF YOUR PHYSICAL HEALTH?"
},
{"id": "q3561", "type": "ChoiceQuestion", "required": false,
"text": "13. During the PAST 4 WEEKS, AS A RESULT OF YOUR PHYSICAL HEALTH have you: Cut
down on the AMOUNT OF TIME you spent on work or other activities. ",
"intro": "During the PAST 4 WEEKS, have you had any of the following problems with your
work or other regular daily activities AS A RESULT OF YOUR PHYSICAL HEALTH?",
"intro": "This survey asks for your views about your health. This information will help
"choices":[
{"id": "c1072", "text": "1. Yes.", "quickKey": 1},
{"id": "c1073", "text": "2. No.", "quickKey": 2}
]},
{"id": "q3562", "type": "ChoiceQuestion", "required": false,
"text": "14. During the PAST 4 WEEKS, AS A RESULT OF YOUR PHYSICAL HEALTH have you:
ACCOMPLISHED LESS than you would like. ",
"choices":[
keep track of how you feel and how well you are able to do your usual
{"id": "c1072", "text": "1. Yes.", "quickKey": 1},
{"id": "c1073", "text": "2. No.", "quickKey": 2}
]},
{"id": "q3563", "type": "ChoiceQuestion", "required": false,
"text": "15. During the PAST 4 WEEKS, AS A RESULT OF YOUR PHYSICAL HEALTH is it true that
you: Were limited in the KIND of work or other activities. ",
"choices":[
{"id": "c1072", "text": "1. Yes.", "quickKey": 1},
{"id": "c1073", "text": "2. No.", "quickKey": 2}
activities. Answer every question by making the appropriate selection. If you
]},
{"id": "q3564", "type": "ChoiceQuestion", "required": false,
"text": "16. During the PAST 4 WEEKS, AS A RESULT OF YOUR PHYSICAL HEALTH is it true that
you: Had DIFFICULTY performing the work or other activities. (for example, it
took extra effort) ",
"choices":[
{"id": "c1072", "text": "1. Yes.", "quickKey": 1},
{"id": "c1073", "text": "2. No.", "quickKey": 2}
]},
are unsure about how to answer a question, please give the best answer you can.",
{"id": "i55", "type": "IntroText",
"text": "During the PAST 4 WEEKS, have you had any of the following problems with your
work or other regular daily activities AS A RESULT OF ANY EMOTIONAL PROBLEMS
(such as feeling depressed or anxious)?"
},
{"id": "q3565", "type": "ChoiceQuestion", "required": false,
"text": "17. During the PAST 4 WEEKS, AS A RESULT OF ANY EMOTIONAL PROBLEMS have you: Cut
down the AMOUNT OF TIME you spent on work or other activities. ",
"intro": "During the PAST 4 WEEKS, have you had any of the following problems with your
work or other regular daily activities AS A RESULT OF ANY EMOTIONAL PROBLEMS
(such as feeling depressed or anxious)?",
"choices":[
{"id": "c1072", "text": "1. Yes.", "quickKey": 1},
{"id": "c1073", "text": "2. No.", "quickKey": 2}
]},
{"id": "q3566", "type": "ChoiceQuestion", "required": false,
"text": "18. During the PAST 4 WEEKS, AS A RESULT OF ANY EMOTIONAL PROBLEMS is it true
that you: ACCOMPLISHED LESS than you would like. ",
"choices":[
"choices":[
{"id": "c1072", "text": "1. Yes.", "quickKey": 1},
{"id": "c1073", "text": "2. No.", "quickKey": 2}
]},
{"id": "q3567", "type": "ChoiceQuestion", "required": false,
"text": "19. During the PAST 4 WEEKS, AS A RESULT OF ANY EMOTIONAL PROBLEMS is it true
that you: Didn't do work or other activities as CAREFULLY as usual. ",
"choices":[
{"id": "c1072", "text": "1. Yes.", "quickKey": 1},
"copyright": "Medical Outcomes Trust",
{"id": "c1059", "text": "1. Excellent", "quickKey": 1},
{"id": "c1073", "text": "2. No.", "quickKey": 2}
]},
{"id": "q3568", "type": "ChoiceQuestion", "required": false,
"text": "20. During the PAST 4 WEEKS, to what extent has your physical health or emotional
problems interfered with your normal social activities with family, friends,
neighbors, or groups? ",
"choices":[
{"id": "c1074", "text": "1. Not at all.", "quickKey": 1},
{"id": "c1075", "text": "2. Slightly.", "quickKey": 2},
{"id": "c1060", "text": "2. Very good", "quickKey": 2},
{"id": "c1076", "text": "3. Moderately.", "quickKey": 3},
{"id": "c1077", "text": "4. Quite a bit.", "quickKey": 4},
{"id": "c1078", "text": "5. Extremely.", "quickKey": 5}
]},
{"id": "q3569", "type": "ChoiceQuestion", "required": false,
"text": "21. How much BODILY pain have you had during the PAST 4 WEEKS? ",
"choices":[
{"id": "c1079", "text": "1. None.", "quickKey": 1},
{"id": "c1080", "text": "2. Very mild.", "quickKey": 2},
{"id": "c1061", "text": "3. Good", "quickKey": 3},
{"id": "c1081", "text": "3. Mild.", "quickKey": 3},
{"id": "c1082", "text": "4. Moderate.", "quickKey": 4},
{"id": "c1083", "text": "5. Severe.", "quickKey": 5},
{"id": "c1084", "text": "6. Very severe.", "quickKey": 6}
]},
{"id": "q3570", "type": "ChoiceQuestion", "required": false,
"text": "22. During the PAST 4 WEEKS, how much did PAIN interfere with your normal work
(including both work outside the home and housework)? ",
"choices":[
{"id": "c1062", "text": "4. Fair", "quickKey": 4},
{"id": "c1074", "text": "1. Not at all.", "quickKey": 1},
{"id": "c1085", "text": "2. A little bit.", "quickKey": 2},
{"id": "c1076", "text": "3. Moderately.", "quickKey": 3},
{"id": "c1077", "text": "4. Quite a bit.", "quickKey": 4},
{"id": "c1078", "text": "5. Extremely.", "quickKey": 5}
]},
{"id": "i56", "type": "IntroText",
"text": "These questions are about how you feel and how things have been with you DURING
THE PAST 4 WEEKS. For each question, please give the one answer that comes
closest to the way you have been feeling. How much of the time during the PAST 4
{"id": "c1063", "text": "5. Poor", "quickKey": 5}
WEEKS:"
},
{"id": "q3571", "type": "ChoiceQuestion", "required": false,
"text": "23. DURING THE PAST 4 WEEKS: Did you feel full of pep? ",
"intro": "These questions are about how you feel and how things have been with you DURING
THE PAST 4 WEEKS. For each question, please give the one answer that comes
closest to the way you have been feeling. How much of the time during the PAST 4
WEEKS:",
"choices":[
]},
{"id": "c1086", "text": "1. All of the time.", "quickKey": 1},
{"id": "c1087", "text": "2. Most of the time.", "quickKey": 2},
{"id": "c1088", "text": "3. A good bit of the time.", "quickKey": 3},
{"id": "c1089", "text": "4. Some of the time.", "quickKey": 4},
{"id": "c1090", "text": "5. A little of the time.", "quickKey": 5},
{"id": "c1091", "text": "6. None of the time.", "quickKey": 6}
]},
{"id": "q3572", "type": "ChoiceQuestion", "required": false,
"text": "24. DURING THE PAST 4 WEEKS: Have you been a very nervous person? ",
{"id": "q3550", "type": "ChoiceQuestion", "required": false,
"choices":[
{"id": "c1086", "text": "1. All of the time.", "quickKey": 1},
{"id": "c1087", "text": "2. Most of the time.", "quickKey": 2},
{"id": "c1088", "text": "3. A good bit of the time.", "quickKey": 3},
{"id": "c1089", "text": "4. Some of the time.", "quickKey": 4},
{"id": "c1090", "text": "5. A little of the time.", "quickKey": 5},
{"id": "c1091", "text": "6. None of the time.", "quickKey": 6}
]},
{"id": "q3573", "type": "ChoiceQuestion", "required": false,
"text": "25. DURING THE PAST 4 WEEKS: Have you felt so down in the dumps that nothing
"text": "2. COMPARED TO ONE YEAR AGO, how would you rate your health in general now? ",
could cheer you up? ",
"choices":[
{"id": "c1086", "text": "1. All of the time.", "quickKey": 1},
{"id": "c1087", "text": "2. Most of the time.", "quickKey": 2},
{"id": "c1088", "text": "3. A good bit of the time.", "quickKey": 3},
{"id": "c1089", "text": "4. Some of the time.", "quickKey": 4},
{"id": "c1090", "text": "5. A little of the time.", "quickKey": 5},
{"id": "c1091", "text": "6. None of the time.", "quickKey": 6}
]},
{"id": "q3574", "type": "ChoiceQuestion", "required": false,
"text": "26. DURING THE PAST 4 WEEKS: Have you felt calm and peaceful? ",
"choices":[
{"id": "c1086", "text": "1. All of the time.", "quickKey": 1},
{"id": "c1087", "text": "2. Most of the time.", "quickKey": 2},
{"id": "c1088", "text": "3. A good bit of the time.", "quickKey": 3},
{"id": "c1089", "text": "4. Some of the time.", "quickKey": 4},
{"id": "c1090", "text": "5. A little of the time.", "quickKey": 5},
{"id": "c1091", "text": "6. None of the time.", "quickKey": 6}
"choices":[
]},
{"id": "q3575", "type": "ChoiceQuestion", "required": false,
"text": "27. DURING THE PAST 4 WEEKS: Did you have a lot of energy? ",
"choices":[
{"id": "c1086", "text": "1. All of the time.", "quickKey": 1},
{"id": "c1087", "text": "2. Most of the time.", "quickKey": 2},
{"id": "c1088", "text": "3. A good bit of the time.", "quickKey": 3},
{"id": "c1089", "text": "4. Some of the time.", "quickKey": 4},
{"id": "c1090", "text": "5. A little of the time.", "quickKey": 5},
"restartDays": 2,
{"id": "c1064", "text": "1. Much better now than one year ago", "quickKey": 1},
{"id": "c1091", "text": "6. None of the time.", "quickKey": 6}
]},
{"id": "q3576", "type": "ChoiceQuestion", "required": false,
"text": "28. DURING THE PAST 4 WEEKS: Have you felt downhearted and blue? ",
"choices":[
{"id": "c1086", "text": "1. All of the time.", "quickKey": 1},
{"id": "c1087", "text": "2. Most of the time.", "quickKey": 2},
{"id": "c1088", "text": "3. A good bit of the time.", "quickKey": 3},
{"id": "c1089", "text": "4. Some of the time.", "quickKey": 4},
{"id": "c1065", "text": "2. Somewhat better now than one year ago", "quickKey": 2},
{"id": "c1090", "text": "5. A little of the time.", "quickKey": 5},
{"id": "c1091", "text": "6. None of the time.", "quickKey": 6}
]},
{"id": "q3577", "type": "ChoiceQuestion", "required": false,
"text": "29. DURING THE PAST 4 WEEKS: Did you feel worn out? ",
"choices":[
{"id": "c1086", "text": "1. All of the time.", "quickKey": 1},
{"id": "c1087", "text": "2. Most of the time.", "quickKey": 2},
{"id": "c1088", "text": "3. A good bit of the time.", "quickKey": 3},
{"id": "c1066", "text": "3. About the same as one year ago", "quickKey": 3},
{"id": "c1089", "text": "4. Some of the time.", "quickKey": 4},
{"id": "c1090", "text": "5. A little of the time.", "quickKey": 5},
{"id": "c1091", "text": "6. None of the time.", "quickKey": 6}
]},
{"id": "q3578", "type": "ChoiceQuestion", "required": false,
"text": "30. DURING THE PAST 4 WEEKS: Have you been a happy person? ",
"choices":[
{"id": "c1086", "text": "1. All of the time.", "quickKey": 1},
{"id": "c1087", "text": "2. Most of the time.", "quickKey": 2},
{"id": "c1067", "text": "4. Somewhat worse now than one year ago", "quickKey": 4},
{"id": "c1088", "text": "3. A good bit of the time.", "quickKey": 3},
{"id": "c1089", "text": "4. Some of the time.", "quickKey": 4},
{"id": "c1090", "text": "5. A little of the time.", "quickKey": 5},
{"id": "c1091", "text": "6. None of the time.", "quickKey": 6}
]},
{"id": "q3579", "type": "ChoiceQuestion", "required": false,
"text": "31. DURING THE PAST 4 WEEKS: Did you feel tired? ",
"choices":[
{"id": "c1086", "text": "1. All of the time.", "quickKey": 1},
{"id": "c1068", "text": "5. Much worse now than one year ago", "quickKey": 5}
{"id": "c1087", "text": "2. Most of the time.", "quickKey": 2},
{"id": "c1088", "text": "3. A good bit of the time.", "quickKey": 3},
{"id": "c1089", "text": "4. Some of the time.", "quickKey": 4},
{"id": "c1090", "text": "5. A little of the time.", "quickKey": 5},
{"id": "c1091", "text": "6. None of the time.", "quickKey": 6}
]},
{"id": "q3580", "type": "ChoiceQuestion", "required": false,
"text": "32. During the PAST 4 WEEKS, how much of the time has your PHYSICAL HEALTH OR
EMOTIONAL PROBLEMS interfered with your social activities (like visiting with
friends, relatives, etc.)?",
]},
"choices":[
{"id": "c1086", "text": "1. All of the time.", "quickKey": 1},
{"id": "c1087", "text": "2. Most of the time.", "quickKey": 2},
{"id": "c1092", "text": "3. Some of the time.", "quickKey": 3},
{"id": "c1093", "text": "4. A little of the time.", "quickKey": 4},
{"id": "c1094", "text": "5. None of the time.", "quickKey": 5}
]},
{"id": "i57", "type": "IntroText",
"text": "How TRUE or FALSE is each of the following statements for you?"
{"id": "i53", "type": "IntroText",
},
{"id": "q3581", "type": "ChoiceQuestion", "required": false,
"text": "33. How TRUE or FALSE is this for you? I seem to get sick a little easier than
other people. ",
"intro": "How TRUE or FALSE is each of the following statements for you?",
"choices":[
{"id": "c1095", "text": "1. Definitely true.", "quickKey": 1},
{"id": "c1096", "text": "2. Mostly true.", "quickKey": 2},
{"id": "c1097", "text": "3. Don't know.", "quickKey": 3},
"text": "The following items are about activities you might do during a typical day. Does
{"id": "c1098", "text": "4. Mostly false.", "quickKey": 4},
{"id": "c1099", "text": "5. Definitely false.", "quickKey": 5}
]},
{"id": "q3582", "type": "ChoiceQuestion", "required": false,
"text": "34. How TRUE or FALSE is this for you? I am as healthy as anybody I know. ",
"choices":[
{"id": "c1095", "text": "1. Definitely true.", "quickKey": 1},
{"id": "c1096", "text": "2. Mostly true.", "quickKey": 2},
{"id": "c1097", "text": "3. Don't know.", "quickKey": 3},
YOUR HEALTH NOW LIMIT YOU in the activities? If so, how much?"
{"id": "c1098", "text": "4. Mostly false.", "quickKey": 4},
{"id": "c1099", "text": "5. Definitely false.", "quickKey": 5}
]},
{"id": "q3583", "type": "ChoiceQuestion", "required": false,
"text": "35. How TRUE or FALSE is this for you? I expect my health to get worse. ",
"choices":[
{"id": "c1095", "text": "1. Definitely true.", "quickKey": 1},
{"id": "c1096", "text": "2. Mostly true.", "quickKey": 2},
{"id": "c1097", "text": "3. Don't know.", "quickKey": 3},
},
{"id": "c1098", "text": "4. Mostly false.", "quickKey": 4},
{"id": "c1099", "text": "5. Definitely false.", "quickKey": 5}
]},
{"id": "q3584", "type": "ChoiceQuestion", "required": false,
"text": "36. How TRUE or FALSE is this for you? My health is excellent. ",
"choices":[
{"id": "c1095", "text": "1. Definitely true.", "quickKey": 1},
{"id": "c1096", "text": "2. Mostly true.", "quickKey": 2},
{"id": "c1097", "text": "3. Don't know.", "quickKey": 3},
"printTitle": "SF-36 Health Survey",
{"id": "q3551", "type": "ChoiceQuestion", "required": false,
{"id": "c1098", "text": "4. Mostly false.", "quickKey": 4},
{"id": "c1099", "text": "5. Definitely false.", "quickKey": 5}
]}]
}
"text": "3. During a typical day, does YOUR HEALTH NOW LIMIT YOU in: VIGOROUS ACTIVITIES,
such as running, lifting heavy objects, participating in strenuous sports. ",
"intro": "The following items are about activities you might do during a typical day. Does
YOUR HEALTH NOW LIMIT YOU in the activities? If so, how much?",
"choices":[
{"id": "c1069", "text": "1. Yes, limited a lot.", "quickKey": 1},
{"id": "c1070", "text": "2. Yes, limited a little.", "quickKey": 2},
{"id": "c1071", "text": "3. No, not limited at all.", "quickKey": 3}
"content":[
]},
{"id": "q3552", "type": "ChoiceQuestion", "required": false,
"text": "4. During a typical day, does YOUR HEALTH NOW LIMIT YOU in: MODERATE ACTIVITIES,
such as moving a table, pushing a vacuum cleaner, bowling, or playing golf. ",
"choices":[
{"id": "c1069", "text": "1. Yes, limited a lot.", "quickKey": 1},
{"id": "c1070", "text": "2. Yes, limited a little.", "quickKey": 2},
{"id": "c1071", "text": "3. No, not limited at all.", "quickKey": 3}
]},
{"id": "i52", "type": "IntroText",
{"id": "q3553", "type": "ChoiceQuestion", "required": false,
"text": "5. During a typical day, does YOUR HEALTH NOW LIMIT YOU in: Lifting or carrying
groceries. ",
"choices":[
{"id": "c1069", "text": "1. Yes, limited a lot.", "quickKey": 1},
{"id": "c1070", "text": "2. Yes, limited a little.", "quickKey": 2},
{"id": "c1071", "text": "3. No, not limited at all.", "quickKey": 3}
]},
{"id": "q3554", "type": "ChoiceQuestion", "required": false,
"text": "This survey asks for your views about your health. This information will help
"text": "6. During a typical day, does YOUR HEALTH NOW LIMIT YOU in: Climbing SEVERAL
flights of stairs. ",
"choices":[
{"id": "c1069", "text": "1. Yes, limited a lot.", "quickKey": 1},
{"id": "c1070", "text": "2. Yes, limited a little.", "quickKey": 2},
{"id": "c1071", "text": "3. No, not limited at all.", "quickKey": 3}
]},
{"id": "q3555", "type": "ChoiceQuestion", "required": false,
"text": "7. During a typical day, does YOUR HEALTH NOW LIMIT YOU in: Climbing ONE flight
keep track of how you feel and how well you are able to do your usual
of stairs. ",
"choices":[
{"id": "c1069", "text": "1. Yes, limited a lot.", "quickKey": 1},
{"id": "c1070", "text": "2. Yes, limited a little.", "quickKey": 2},
{"id": "c1071", "text": "3. No, not limited at all.", "quickKey": 3}
]},
{"id": "q3556", "type": "ChoiceQuestion", "required": false,
"text": "8. During a typical day, does YOUR HEALTH NOW LIMIT YOU in: Bending, kneeling, or
stooping. ",
activities. Answer every question by making the appropriate selection. If you
"choices":[
{"id": "c1069", "text": "1. Yes, limited a lot.", "quickKey": 1},
{"id": "c1070", "text": "2. Yes, limited a little.", "quickKey": 2},
{"id": "c1071", "text": "3. No, not limited at all.", "quickKey": 3}
]},
{"id": "q3557", "type": "ChoiceQuestion", "required": false,
"text": "9. During a typical day, does YOUR HEALTH NOW LIMIT YOU in: Walking MORE THAN A
MILE. ",
|
