141 (141)    MH REPORT (601.93)

.| .| Quality of Life in Epilespy - QOLIE-31| | Date Given: <.Date_Given.>| Clinician: <.Staff_Ordered_By.>| Location: <.Location.>| | Veteran: <.Patient_Name_Last_First.>| SSN: <.Patient_SSN.>| DOB: 
Driving?|     <*Answer_7203*>| 21. How fearful are you of having a seizure during the next month?|     <*Answer_7204*>| 22. Do you worry about hurting yourself during a seizure?|     <*Answer_7205*>| 
23. How worried are you about embarrassment or other social problems resulting from having a seizure during the next month?|     <*Answer_7206*>| 24. How worried are you that medications you are 
taking will be bad for you if taken for a long time?|     <*Answer_7207*>| 25. Seizures|     <*Answer_7208*>| 26. Memory difficulties|     <*Answer_7209*>| 27. Work limitations|     <*Answer_7210*>| 
28. Social limitations|     <*Answer_7211*>| 29. Physical effects of antiepileptic medication|     <*Answer_7212*>| 30. Mental effects of antiepileptic medication|     <*Answer_7213*>| 31. How good 
or bad do you think your health is?|     <*Answer_7214*>| 32. Comments (if any)|     <*Answer_7215*>| |   Copyright 1993, RAND. All Rights reserved.  The QOLIE-31 was developed in cooperation with 
Professional Postgraduate Services, a division of Phys World Comm Group, and the QOLIE Development Group.| | | Information contained in this note is based on a self-report assessment and is not 
sufficient to use alone for diagnostic purposes.  Assessment results should be verified for accuracy and used in conjunction with other diagnostic activities and procedures.|  $~
<.Patient_Date_Of_Birth.> (<.Patient_Age.>)| Gender: <.Patient_Gender.>| | | <.DLL_String.>| | Questions and Answers| | 1. Overall, how would you rate your quality of life?|     <*Answer_7184*>| 2. 
Did you feel full of pep?|     <*Answer_7185*>| 3. Have you been a very nervous person?|     <*Answer_7186*>| 4. Have you felt so down in the dumps that nothing could cheer you up?|     
<*Answer_7187*>| 5. Have you felt calm and peaceful?|     <*Answer_7188*>| 6. Did you have a lot of energy?|     <*Answer_7189*>| 7. Have you felt downhearted and blue?|     <*Answer_7190*>| 8. Did 
you feel worn out?|     <*Answer_7191*>| 9. Have you been a happy person?|     <*Answer_7192*>| 10. Did you feel tired?|     <*Answer_7193*>| 11. Have you worried about having another seizure?|     
<*Answer_7194*>| 12. Did you have difficulty reasoning and solving problems (such as making plans, making decisions, learning new things)?|     <*Answer_7195*>| 13. Has your health limited your 
social activities (such as visiting with friends or close relatives)?|     <*Answer_7196*>| 14. How has the QUALITY OF YOUR LIFE been during the past 4 weeks (that is, how have things been going for 
you)?|     <*Answer_7197*>| 15. In the past 4 weeks, have you had any trouble with your memory?|     <*Answer_7198*>| 16. Trouble remembering things people tell you?|     <*Answer_7199*>| 17. Trouble 
concentrating or reading?|     <*Answer_7200*>| 18. Trouble concentrating or doing one thing at a time?|     <*Answer_7201*>| 19. Leisure time (such as hobbies, going out)?|     <*Answer_7202*>| 20.