228 (228)    MH REPORT (601.93)

|Medical Research Council Breathlessness Scale (MRC)
|   Gender: <.Patient_Gender.>
|  
|   MRC Grade <-Total->
|  
|  
|Questions and Answers:
|  
|   1.  Are you ever troubled by breathlessness except on strenuous 
|       exertion?
|       <*Answer_8974*>
|  
|   2.  Are you short of breath when hurrying on the level or walking up
|       a slight hill?
|       <*Answer_8975*>
|   3.  Do you have to walk slower than most people on the level? -or-
|       Do you have to stop after a mile or so (or after 1/4 hour) on the 
|       level at your own pace?
|       <*Answer_8976*>
|   4.  Do you have to stop for breath after walking about 100 yds. (or 
|       after a few minutes) on the level?
|       <*Answer_8977*>
|   Date Given: <.Date_Given.>
|   5.  Are you too breathless to leave the house, or breathless after 
|       undressing?
|       <*Answer_8978*>
|  
|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.
|   Clinician: <.Staff_Ordered_By.>
|   Location:  <.Location.>
|  
|   Veteran:  <.Patient_Name_Last_First.>
|   SSN: <.Patient_SSN.>
|   DOB: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)