| RPT |
|Fatigue Severity Scale (FSS)
| Gender: <.Patient_Gender.>
|
| FSS Total Score = <-Total->
|
| Scores can range from 9-63, with higher scores indicative of more
| severe fatigue.
|
|
|Questions and Answers:
|
|
| 1. My motivation is lower when I am fatigued.
| <*Answer_8965*>
| 2. Exercise brings on my fatigue.
| <*Answer_8966*>
| 3. I am easily fatigued.
| <*Answer_8967*>
| 4. Fatigue interferes with my physical functioning.
| <*Answer_8968*>
| 5. Fatigue causes frequent problems for me.
| <*Answer_8969*>
| Date Given: <.Date_Given.>
| 6. My fatigue prevents sustained physical functioning.
| <*Answer_8970*>
| 7. Fatigue interferes with carrying out certain duties and
| responsibilities.
| <*Answer_8971*>
| 8. Fatigue is among my three most disabling symptoms.
| <*Answer_8972*>
| 9. Fatigue interferes with my work, family, or social life.
| <*Answer_8973*>
|
| 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.
|
|Copyright 1989 American Medical Association. All rights reserved.
| Location: <.Location.>
|
| Veteran: <.Patient_Name_Last_First.>
| SSN: <.Patient_SSN.>
| DOB: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)
|
