| ENTRY SPECIFICATION |
{"name": "VR-12",
"
"intro": "4. 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)? ",
"columns": 3,
"choices":[
{"id": "c2991", "text": "1. No, none of the time", "quickKey": 1},
{"id": "c3001", "text": "2. Yes, a little of the time", "quickKey": 2},
{"id": "c2993", "text": "3. Yes, some of the time", "quickKey": 3},
{"id": "c2994", "text": "4. Yes, most of the time", "quickKey": 4},
{"id": "c2995", "text": "5. Yes, all of the time", "quickKey": 5}
},
]},
{"id": "q5607", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "5. During the past 4 weeks, how much did pain interfere with your normal work
(including both work outside the home and house work)?",
"intro": "4. 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)? ",
"columns": 3,
"choices":[
{"id": "c212", "text": "1. Not at all", "quickKey": 1},
{"id": "q5600", "type": "ChoiceQuestion", "required": false, "inline": true,
{"id": "c1007", "text": "2. A little bit", "quickKey": 2},
{"id": "c718", "text": "3. Moderately", "quickKey": 3},
{"id": "c719", "text": "4. Quite a bit", "quickKey": 4},
{"id": "c720", "text": "5. Extremely", "quickKey": 5}
]},
{"id": "i684", "type": "IntroText",
"text": "6. How much of the time during the past 4 weeks: "
},
{"id": "q5608", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "6A. Have you felt calm and peaceful?",
"text": "1. In general, would you say your health is:",
"intro": "6. How much of the time during the past 4 weeks: ",
"columns": 3,
"choices":[
{"id": "c3788", "text": "1. All of the time", "quickKey": 1},
{"id": "c3781", "text": "2. Most of the time", "quickKey": 2},
{"id": "c2996", "text": "3. A good bit of the time", "quickKey": 3},
{"id": "c3782", "text": "4. Some of the time", "quickKey": 4},
{"id": "c3787", "text": "5. A little of the time", "quickKey": 5},
{"id": "c3786", "text": "6. None of the time", "quickKey": 6}
]},
"intro": "Instructions: This questionnaire asks for your views about your health. This
{"id": "q5609", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "6B. Did you have a lot of energy?",
"intro": "6. How much of the time during the past 4 weeks: ",
"columns": 3,
"choices":[
{"id": "c3788", "text": "1. All of the time", "quickKey": 1},
{"id": "c3781", "text": "2. Most of the time", "quickKey": 2},
{"id": "c2996", "text": "3. A good bit of the time", "quickKey": 3},
{"id": "c3782", "text": "4. Some of the time", "quickKey": 4},
{"id": "c3787", "text": "5. A little of the time", "quickKey": 5},
information will help keep track of how you feel and how well you are able to do
{"id": "c3786", "text": "6. None of the time", "quickKey": 6}
]},
{"id": "q5610", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "6C. Have you felt downhearted and blue?",
"intro": "6. How much of the time during the past 4 weeks: ",
"columns": 3,
"choices":[
{"id": "c3788", "text": "1. All of the time", "quickKey": 1},
{"id": "c3781", "text": "2. Most of the time", "quickKey": 2},
{"id": "c2996", "text": "3. A good bit of the time", "quickKey": 3},
your usual activities. Answer every question by marking the answer as indicated.
{"id": "c3782", "text": "4. Some of the time", "quickKey": 4},
{"id": "c3787", "text": "5. A little of the time", "quickKey": 5},
{"id": "c3786", "text": "6. None of the time", "quickKey": 6}
]},
{"id": "q5611", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "7. 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.)?",
"intro": "6. How much of the time during the past 4 weeks: ",
"columns": 3,
If you are unsure how to answer a question, please give the best answer you can.
"choices":[
{"id": "c3788", "text": "1. All of the time", "quickKey": 1},
{"id": "c3781", "text": "2. Most of the time", "quickKey": 2},
{"id": "c3783", "text": "3. Some of the time", "quickKey": 3},
{"id": "c3784", "text": "4. A little of the time", "quickKey": 4},
{"id": "c3785", "text": "5. None of the time", "quickKey": 5}
]},
{"id": "i685", "type": "IntroText",
"text": "Now, we'd like to ask you some questions about how your health may have changed.
"
",
},
{"id": "q5612", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "8. Compared to one year ago, how would you rate your physical health in general
now?",
"intro": "Now, we'd like to ask you some questions about how your health may have changed.
",
"columns": 3,
"choices":[
{"id": "c2997", "text": "1. Much better", "quickKey": 1},
{"id": "c2998", "text": "2. Slightly better", "quickKey": 2},
"columns": 5,
{"id": "c1523", "text": "3. About the same", "quickKey": 3},
{"id": "c2999", "text": "4. Slightly worse", "quickKey": 4},
{"id": "c3000", "text": "5. Much worse", "quickKey": 5}
]},
{"id": "q5613", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "9. Compared to one year ago, how would you rate your emotional problems (such as
feeling anxious, depressed or irritable) now?",
"intro": "Now, we'd like to ask you some questions about how your health may have changed.
",
"columns": 3,
"restartDays": 2,
"choices":[
"choices":[
{"id": "c2997", "text": "1. Much better", "quickKey": 1},
{"id": "c2998", "text": "2. Slightly better", "quickKey": 2},
{"id": "c1523", "text": "3. About the same", "quickKey": 3},
{"id": "c2999", "text": "4. Slightly worse", "quickKey": 4},
{"id": "c3000", "text": "5. Much worse", "quickKey": 5}
]}]
}
{"id": "c3776", "text": "1. Excellent", "quickKey": 1},
{"id": "c3777", "text": "2. Very good", "quickKey": 2},
{"id": "c3778", "text": "3. Good", "quickKey": 3},
{"id": "c3779", "text": "4. Fair", "quickKey": 4},
{"id": "c3780", "text": "5. Poor", "quickKey": 5}
]},
{"id": "i681", "type": "IntroText",
"text": "2. The following questions are about activities you might do during a typical
day. Does your health now limit you in these activities? If so, how much? "
"printTitle": "Veterans RAND 12 Item Health Survey",
},
{"id": "q5601", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "2A. Moderate activities, such as moving a table, pushing a vacuum cleaner,
bowling, or playing golf?",
"intro": "2. The following questions are about activities you might do during a typical
day. Does your health now limit you in these activities? If so, how much? ",
"columns": 3,
"choices":[
{"id": "c2988", "text": "1. Yes, limited a lot", "quickKey": 1},
{"id": "c2989", "text": "2. Yes, limited a little", "quickKey": 2},
"content":[
{"id": "c2990", "text": "3. No, not limited at all", "quickKey": 3}
]},
{"id": "q5602", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "2B. Climbing several flights of stairs?",
"intro": "2. The following questions are about activities you might do during a typical
day. Does your health now limit you in these activities? If so, how much? ",
"columns": 3,
"choices":[
{"id": "c2988", "text": "1. Yes, limited a lot", "quickKey": 1},
{"id": "c2989", "text": "2. Yes, limited a little", "quickKey": 2},
{"id": "i680", "type": "IntroText",
{"id": "c2990", "text": "3. No, not limited at all", "quickKey": 3}
]},
{"id": "i682", "type": "IntroText",
"text": "3. 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": "q5603", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "3A. Accomplished less than you would like.",
"intro": "3. 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? ",
"text": "Instructions: This questionnaire asks for your views about your health. This
"columns": 3,
"choices":[
{"id": "c2991", "text": "1. No, none of the time", "quickKey": 1},
{"id": "c3001", "text": "2. Yes, a little of the time", "quickKey": 2},
{"id": "c2993", "text": "3. Yes, some of the time", "quickKey": 3},
{"id": "c2994", "text": "4. Yes, most of the time", "quickKey": 4},
{"id": "c2995", "text": "5. Yes, all of the time", "quickKey": 5}
]},
{"id": "q5604", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "3B. Were limited in the kind of work or other activities.",
information will help keep track of how you feel and how well you are able to do
"intro": "3. 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? ",
"columns": 3,
"choices":[
{"id": "c2991", "text": "1. No, none of the time", "quickKey": 1},
{"id": "c3001", "text": "2. Yes, a little of the time", "quickKey": 2},
{"id": "c2993", "text": "3. Yes, some of the time", "quickKey": 3},
{"id": "c2994", "text": "4. Yes, most of the time", "quickKey": 4},
{"id": "c2995", "text": "5. Yes, all of the time", "quickKey": 5}
]},
your usual activities. Answer every question by marking the answer as indicated.
{"id": "i683", "type": "IntroText",
"text": "4. 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": "q5605", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "4A. Accomplished less than you would like.",
"intro": "4. 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)? ",
If you are unsure how to answer a question, please give the best answer you can.
"columns": 3,
"choices":[
{"id": "c2991", "text": "1. No, none of the time", "quickKey": 1},
{"id": "c3001", "text": "2. Yes, a little of the time", "quickKey": 2},
{"id": "c2993", "text": "3. Yes, some of the time", "quickKey": 3},
{"id": "c2994", "text": "4. Yes, most of the time", "quickKey": 4},
{"id": "c2995", "text": "5. Yes, all of the time", "quickKey": 5}
]},
{"id": "q5606", "type": "ChoiceQuestion", "required": false, "inline": true,
"text": "4B. Didn't do work or other activities as carefully as usual.",
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