| RPT |
|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.>)
|
