| RPT |
.| |COPD Assessment Test (CAT)||
<*Answer_7772*>||
3. Rate the tightness of your chest: 0 - My chest does not feel tight at all TO 5 - My chest feels very tight|
<*Answer_7773*>||
4. Rate your breathlessness: 0 - When I walk up a hill or one flight of stairs I am not breathless TO 5 - When I walk up a hill or one flight of stairs I am very breathless|
<*Answer_7774*>||
5. Rate your activity limitation: 0 - I am not limited doing any activities at home TO 5 - I am very limited doing activities at home|
<*Answer_7775*>||
6. Rate your confidence: 0 - I am confident leaving my home despite my lung condition TO 5 - I am not at all confident leaving my home because of my lung condition|
<*Answer_7776*>||
7. Rate your sleep: 0 - I sleep soundly TO 5 - I don't sleep soundly because of my lung condition|
Date Given: <.Date_Given.>| Clinician: <.Staff_Ordered_By.>| Location: <.Location.>||
<*Answer_7777*>||
8. Rate your energy: 0 - I have lots of energy TO 5 - I have no energy at all|
<*Answer_7778*>||
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.||
Copyright 2009 GlaxoSmithKline group of companies.||
| $~
Veteran: <.Patient_Name_Last_First.>| SSN: <.Patient_SSN.>| DOB: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)| Gender: <.Patient_Gender.>| |
CAT TOTAL SCORE = <*Answer_7779*>||
Total scores range from 0-40. Higher scores indicate a more severe impact of COPD on a patient's life. Scores <10 have a low impact, 10-20 medium, 21-30 high and >30 very high impact, requiring gradually more interventions.|||
Questions and Answers||
1. Rate your cough: 0 - I never cough TO 5 - I cough all the time|
<*Answer_7771*>||
2. Rate your phlegm: 0 - I have no phlegm (mucus) in my chest at all TO 5 - My chest is completely fully of phlegm (mucus)|
|
