| RPT |
|Patient-Reported Outcomes Measurement Information System (PROMIS-10)
| DOB: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)
| Gender: <.Patient_Gender.>
|
|<*Answer_7771*>
|
|The PROMIS-10 measures patients' perceptions of their own physical and
|mental health. It can assess the outcomes of many different types of
|patient-centered innovations. It does this by assessing overall "global"
|health.
|
|Global Health Scale
|The mean (average) T-score of PROMIS-10 among the general U.S. population
|is 50, with a standard deviation (SD) of 10. This applies to the Mental
|Health and Physical Health subscales. Higher scores are better, so a score
|above the mean of 50 is better than average and a score below the mean of
|50 is worse than average.
|
|
|Questions and Answers:
|
| 1) In general, would you say your health is:
|
| <*Answer_8789*>
| 2) In general, would you say your quality of life is:
| <*Answer_8790*>
| 3) In general, how would you rate your physical health?
| <*Answer_8791*>
| 4) In general, how would you rate your mental health, including your
| mood and your ability to think?
| <*Answer_8792*>
| 5) In general, how would you rate your satisfaction with your social
| activities and relationships?
| Date Given: <.Date_Given.>
| <*Answer_8793*>
| 6) In general, please rate how well you carry out your usual social
| activities and roles. (This includes activities at home, at work
| and in your community, and responsibilities as a parent, child,
| spouse, employee, friend, etc.)
| <*Answer_8794*>
| 7) To what extent are you able to carry out your everyday physical
| activities such as walking, climbing stairs, carrying groceries,
| or moving a chair?
| <*Answer_8795*>
| Clinician: <.Staff_Ordered_By.>
| 8) In the past 7 days... How often have you been bothered by emotional
| problems such as feeling anxious, depressed or irritable?
| <*Answer_8796*>
| 9) How would you rate your fatigue on average?
| <*Answer_8797*>
| 10) How would you rate your pain on average?
| <*Answer_8798*>
|
|Information contained in this note is based on a self-report assessment
|and is not sufficient to use alone for diagnostic purposes. Assessment
| Location: <.Location.>
|results should be verified for accuracy and used in conjunction with
|other diagnostic activities.
|
| Veteran: <.Patient_Name_Last_First.>
| SSN: <.Patient_SSN.>
|
