226 (226)    MH REPORT (601.93)

|Headache Impact Test (HIT-6)
|   Gender: <.Patient_Gender.>
|
|  
|   HIT-6 Total Score = <-Total->
|
|   The HIT-6 total score ranges between 36 and 78, with larger scores
|   reflecting greater impact. Scores over 50 may indicate significant
|   impact on functioning.
|  
|  
|  
|Questions and Answers:
|  
|   1.  When you have headaches, how often is the pain severe?
|       <*Answer_8954*>
|   2.  How often do headaches limit your ability to do usual daily
|       activities including household work, work, school, or social 
|       activities?
|       <*Answer_8955*>
|   3.  When you have a headache, how often do you wish you could lie down?
|       <*Answer_8956*>
|   Date Given: <.Date_Given.>
|   4.  In the past 4 weeks, how often have you felt too tired to do work or
|       daily activities because of your headaches?
|       <*Answer_8957*>
|   5.  In the past 4 weeks, how often have you felt fed up or irritated 
|       because of your headaches?
|       <*Answer_8958*>
|   6.  In the past 4 weeks, how often did headaches limit your ability to
|       concentrate on work or daily activities?
|       <*Answer_8959*>
|  
|   Clinician: <.Staff_Ordered_By.>
|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.
||(c) 2001 QualityMetric, Inc. and GlaxoSmithKline Group of Companies.
|All rights reserved.
|   Location:  <.Location.>
|  
|   Veteran:  <.Patient_Name_Last_First.>
|   SSN: <.Patient_SSN.>
|   DOB: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)