| ENTRY SPECIFICATION |
{"name": "CIWA-AR-",
"controlWidth": 120, "min": 0, "max": 0},
disturbing to you? Are you hearing things you know are not there?\u0022
Observation: ",
"columns": 1,
"choices":[
{"id": "c614", "text": "0. Not present", "quickKey": 0},
{"id": "c2450", "text": "1. Very mild harshness or ability to frighten", "quickKey": 1},
{"id": "c2451", "text": "2. Mild harshness or ability to frighten", "quickKey": 2},
{"id": "c2452", "text": "3. Moderate harshness or ability to frighten", "quickKey": 3},
{"id": "c2440", "text": "4. Moderately severe hallucinations", "quickKey": 4},
{"id": "c2441", "text": "5. Severe hallucinations", "quickKey": 5},
{"id": "q7315", "type": "StringQuestion", "required": false,
{"id": "c2442", "text": "6. Extremely severe hallucinations", "quickKey": 6},
{"id": "c2443", "text": "7. Continuous hallucinations", "quickKey": 7}
]},
{"id": "q7321", "type": "ChoiceQuestion", "required": false, "inline": false,
"text": "11. VISUAL DISTURBANCES - Ask, \u0022Does the light appear to be too bright? Is
its color different? Does it hurt your eyes? Are you seeing anything that is
disturbing to you? Are you seeing things you know are not there?\u0022
Observation: ",
"columns": 1,
"choices":[
"text": "3. Blood pressure:",
{"id": "c614", "text": "0. Not present", "quickKey": 0},
{"id": "c2461", "text": "1. Very mild sensitivity", "quickKey": 1},
{"id": "c2462", "text": "2. Mild sensitivity", "quickKey": 2},
{"id": "c2463", "text": "3. Moderate sensitivity", "quickKey": 3},
{"id": "c2440", "text": "4. Moderately severe hallucinations", "quickKey": 4},
{"id": "c2441", "text": "5. Severe hallucinations", "quickKey": 5},
{"id": "c2442", "text": "6. Extremely severe hallucinations", "quickKey": 6},
{"id": "c2443", "text": "7. Continuous hallucinations", "quickKey": 7}
]},
{"id": "q7323", "type": "ChoiceQuestion", "required": false, "inline": false,
"controlWidth": 120, "min": 0, "max": 0},
"text": "12. HEADACHE, FULLNESS IN HEAD - Ask, \u0022Does your head feel different? Does
it feel like there is a band around your head?\u0022 Do not rate for dizziness
or lightheadedness. Otherwise, rate severity:",
"columns": 1,
"choices":[
{"id": "c614", "text": "0. Not present", "quickKey": 0},
{"id": "c615", "text": "1. Very mild", "quickKey": 1},
{"id": "c3", "text": "2. Mild", "quickKey": 2},
{"id": "c4", "text": "3. Moderate", "quickKey": 3},
{"id": "c618", "text": "4. Moderately severe", "quickKey": 4},
{"id": "q7316", "type": "ChoiceQuestion", "required": false, "inline": false,
{"id": "c5", "text": "5. Severe", "quickKey": 5},
{"id": "c1457", "text": "6. Very severe", "quickKey": 6},
{"id": "c620", "text": "7. Extremely severe", "quickKey": 7}
]},
{"id": "q7325", "type": "ChoiceQuestion", "required": false, "inline": false,
"text": "13. ORIENTATION AND CLOUDING OF SENSORIUM - Ask, \u0022What day is this? Where
are you? Who am I?\u0022",
"columns": 1,
"choices":[
{"id": "c2481", "text": "0. Oriented and can do serial additions", "quickKey": 0},
"text": "4. NAUSEA AND VOMITING - Ask, \u0022Do you feel sick to your stomach? Have you
{"id": "c2482", "text": "1. Cannot do serial additions or is uncertain about date", "quickKey": 1},
{"id": "c2483", "text": "2. Disoriented for date by no more than 2 calendar days", "quickKey": 2},
{"id": "c2484", "text": "3. Disoriented for date by more than 2 calendar days", "quickKey": 3},
{"id": "c2485", "text": "4. Disoriented for place/or person", "quickKey": 4}
]}]
}
vomited?\u0022 Observation:",
"columns": 1,
"choices":[
{"id": "c2429", "text": "0. No nausea and no vomiting", "quickKey": 0},
"restartDays": 2,
{"id": "c3608", "text": "1. Showing mild nausea and no vomiting", "quickKey": 1},
{"id": "c2735", "text": "2. Nausea 2", "quickKey": 2},
{"id": "c2736", "text": "3. Nausea 3", "quickKey": 3},
{"id": "c2433", "text": "4. Intermittent nausea with dry heaves", "quickKey": 4},
{"id": "c2737", "text": "5. Nausea 5", "quickKey": 5},
{"id": "c2738", "text": "6. Nausea 6", "quickKey": 6},
{"id": "c2436", "text": "7. Constant nausea, frequent dry heaves and vomiting", "quickKey": 7}
]},
{"id": "q7318", "type": "ChoiceQuestion", "required": false, "inline": false,
"text": "5. TREMOR - Arms extended and fingers spread apart. Observation:",
"printTitle": "Clinical Institute Withdrawal Assessment - Alcohol Revised",
"columns": 1,
"choices":[
{"id": "c1366", "text": "0. No tremor", "quickKey": 0},
{"id": "c2444", "text": "1. Not visible, but can be felt fingertip to fingertip", "quickKey": 1},
{"id": "c2739", "text": "2. Tremor 2", "quickKey": 2},
{"id": "c2740", "text": "3. Tremor 3", "quickKey": 3},
{"id": "c2446", "text": "4. Moderate, with patient's arms extended", "quickKey": 4},
{"id": "c2741", "text": "5. Tremor 5", "quickKey": 5},
{"id": "c2742", "text": "6. Tremor 6", "quickKey": 6},
{"id": "c2449", "text": "7. Severe, even with arms not extended", "quickKey": 7}
"content":[
]},
{"id": "q7320", "type": "ChoiceQuestion", "required": false, "inline": false,
"text": "6. PAROXYSMAL SWEATS - Observation:",
"columns": 1,
"choices":[
{"id": "c2453", "text": "0. No sweat visible", "quickKey": 0},
{"id": "c2454", "text": "1. Barely perceptible sweating, palms moist", "quickKey": 1},
{"id": "c2743", "text": "2. Sweating 2", "quickKey": 2},
{"id": "c2744", "text": "3. Sweating 3", "quickKey": 3},
{"id": "c2457", "text": "4. Beads of sweat obvious on forehead", "quickKey": 4},
{"id": "q7313", "type": "StringQuestion", "required": false,
{"id": "c2745", "text": "5. Sweating 5", "quickKey": 5},
{"id": "c2746", "text": "6. Sweating 6", "quickKey": 6},
{"id": "c2460", "text": "7. Drenching sweats", "quickKey": 7}
]},
{"id": "q7322", "type": "ChoiceQuestion", "required": false, "inline": false,
"text": "7. ANXIETY - Ask, \u0022Do you feel nervous?\u0022 Observation:",
"columns": 1,
"choices":[
{"id": "c2464", "text": "0. No anxiety, at ease", "quickKey": 0},
{"id": "c2465", "text": "1. Mildly anxious", "quickKey": 1},
"text": "1. Time (use 24 hour clock, midnight is 00:00):",
{"id": "c2747", "text": "2. Anxiety 2", "quickKey": 2},
{"id": "c2748", "text": "3. Anxiety 3", "quickKey": 3},
{"id": "c2468", "text": "4. Moderately anxious, or guarded, so anxiety is inferred", "quickKey": 4},
{"id": "c2749", "text": "5. Anxiety 5", "quickKey": 5},
{"id": "c2750", "text": "6. Anxiety 6", "quickKey": 6},
{"id": "c2471", "text": "7. Equivalent to acute panic states as seen in severe delirium or acute
schizophrenic reactions", "quickKey": 7}
]},
{"id": "q7324", "type": "ChoiceQuestion", "required": false, "inline": false,
"text": "8. AGITATION - Observation:",
"controlWidth": 120, "min": 0, "max": 0},
"columns": 1,
"choices":[
{"id": "c2473", "text": "0. Normal activity", "quickKey": 0},
{"id": "c2474", "text": "1. Somewhat more than normal activity", "quickKey": 1},
{"id": "c2751", "text": "2. Agitation 2", "quickKey": 2},
{"id": "c2752", "text": "3. Agitation 3", "quickKey": 3},
{"id": "c2477", "text": "4. Moderately fidgety and restless", "quickKey": 4},
{"id": "c2753", "text": "5. Agitation 5", "quickKey": 5},
{"id": "c2754", "text": "6. Agitation 6", "quickKey": 6},
{"id": "c2480", "text": "7. Paces back and forth during most of the interview, or constantly thrashes
{"id": "q7314", "type": "StringQuestion", "required": false,
about", "quickKey": 7}
]},
{"id": "q7317", "type": "ChoiceQuestion", "required": false, "inline": false,
"text": "9. TACTILE DISTURBANCES - Ask, \u0022Have you any itching, pins and needles
sensations, any burning, any numbness, or do you feel bugs crawling on or under
your skin?\u0022 Observation:",
"columns": 1,
"choices":[
{"id": "c1", "text": "0. None", "quickKey": 0},
{"id": "c2437", "text": "1. Very mild itching, pins and needles, burning or numbness", "quickKey": 1},
"text": "2. Pulse or heart rate (taken for one minute):",
{"id": "c2438", "text": "2. Mild itching, pins and needles, burning or numbness", "quickKey": 2},
{"id": "c2439", "text": "3. Moderate itching, pins and needles, burning or numbness", "quickKey": 3},
{"id": "c2440", "text": "4. Moderately severe hallucinations", "quickKey": 4},
{"id": "c2441", "text": "5. Severe hallucinations", "quickKey": 5},
{"id": "c2442", "text": "6. Extremely severe hallucinations", "quickKey": 6},
{"id": "c2443", "text": "7. Continuous hallucinations", "quickKey": 7}
]},
{"id": "q7319", "type": "ChoiceQuestion", "required": false, "inline": false,
"text": "10. AUDITORY DISTURBANCES - Ask, \u0022Are you more aware of sounds around you?
Are they harsh? Do they frighten you? Are you hearing anything that is
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