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nd Recovery Scales (IMRS) - Client Self-Rating|\r\n| Date Given: <.Date_Given.>\r\n| Clinician: <.Staff_Ordered_By.>\r\n| Location: <.Location.>|\r\n| Veteran: <.Patient_Name_Last_First.>\r\n| SSN: <.Patient_SSN.>\r\n| DOB: <.Patient_Date_
Of_Birth.> (<.Patient_Age.>)\r\n| Gender: <.Patient_Gender.>|\r\n|<*Answer_999999999999*>|\r\n| Questions and Answers|\r\n| 1. Progress towards personal goals: In the past 3 months, I have come up with. \r\n| <*Answer_8335*>\r\n| 2. Know
ledge: How much do you feel like you know about symptoms, treatment, coping strategies (coping methods), and medication? \r\n| <*Answer_8336*>\r\n| 3. Involvement of family and friends in my mental health treatment: How much are family me
mbers, friends, boyfriend\/girlfriend, and other people who are important to you (outside your mental health agency) involved in your mental health \r\ntreatment? \r\n| <*Answer_8337*>\r\n| 4. Contact with people outside of my family: In
a normal week, how many times do you talk to someone outside of your family (like a friend, co-worker, classmate, roommate, etc.) \r\n| <*Answer_8338*>\r\n| 5. Time in structured roles: How much time do you spend working, volunteering, be
ing a student, being a parent, taking care of someone else or someone else's house or apartment? That is, how much time do you spend in doing activities for or \r\nwith another person that are expected of you? (This would not include selfca
re or personal home maintenance.) \r\n| <*Answer_8339*>\r\n| 6. Symptom distress: How much do your symptoms bother you? \r\n| <*Answer_8340*>
\r\n| 7. Impairment of functioning: How much do your symptoms get in the way of you doing things that you would like to or need to do? \r\n| <*Answer_8341*>\r\n| 8. Relapse prevention planning: Which of the following would best describe w
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wer_8343*>\r\n| 10. Psychiatric hospitalizations: When is the last time you have been hospitalized for mental health or substance abuse reasons? \r\n| <*Answer_8344*>\r\n| 11. Coping: How well do feel like you are coping with your mental
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or emotional illness from day to day? \r\n| <*Answer_8345*>\r\n| 12. Involvement with self-help activities: How involved are you in consumer run services, peer support groups, Alcoholics Anonymous, drop-in centers, WRAP (Wellness Recovery
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appointments or paying attention during \r\nthem, or to increased symptoms. Over the past 3 months, how much did drinking get in the way of your functioning? \r\n| <*Answer_8348*>\r\n| 15. Functioning affected by drug use: Using street dr
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ttention during them, or to increased symptoms. Over the past 3 months, how much did drug use get in the way of your functioning? \r\n| <*Answer_8349*>|||\r\n|Information contained in this note is based on a self-report assessment and is
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"Bauer M, Crits-Christoph P, Ball W, Dewees E, McAllister T, Alahi P, Cacciola J, Whybrow P. Independent assessment of manic and depressive symptoms by self-rating: Scale characteristics and implications for the study of mania. Arch Gen Psy
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76*> mood state.| |\r\n \r\nNote: Though clinically relevant ranges or cut-off scores have not been \r\nestablished, Activation, Depression and Perceived Conflict subscales may\r\n be used to measure symptom severity within or across indivi
duals.| |\r\n \r\nQuestions and answers| |\r\n1. Today my mood is changeable.|\r\n <*Answer_8319*>| |\r\n2. Today I feel irritable.|\r\n <*Answer_8320*>| |\r\n3. Today I feel like a capable person.|\r\n <*Answer_8321*>| |\r\n4.
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<*Answer_8325*>| |\r\n8. Today my thoughts are going fast.|\r\n <*Answer_8326*>| |\r\n9. Today it seems like nothing will ever work out for me.|\r\n <*Answer_8327*>| |\r\n10. Today I feel overactive.|\r\n <*Answer_8328*>| |\r\n11
. Today I feel as if the world is against me.|\r\n <*Answer_8329*>| |\r\n12. Today I feel \"sped up\" inside.|\r\n <*Answer_8330*>| |\r\n13. Today I feel restless.|\r\n <*Answer_8331*>| |\r\n14. Today I feel argumentative.|\r\n
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3},{"choiceId":4048,"choiceText":"Very much","ien":92578,"legacyValue":2,"sequence":4},{"choiceId":4049,"choiceText":"An extreme amount","ien":92579,"legacyValue":
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Quality of Life Enjoyment and Satisfaction Questionnaire: A New Measure. Psychopharmacology Bulletin 1993; 29:321-326.","requireSignature":false,"requiresLicense":"N","scoringRevision":1,"scoringRoutine":"YTSQLES","scoringTag":null,"submitN
ational":true,"targetPopulation":null,"version":null,"wasOperational":true},"report":{"id":171,"instrument":248,"template":" |.|.|Quality of Life Enjoyment and Satisfaction Questionnaire - Short\r\n Form (Q-LES-Q-SF) |\r\n | Date Given:
<.Date_Given.>| Clinician: <.Staff_Ordered_By.>|\r\n Location: <.Location.>| | Veteran: <.Patient_Name_Last_First.>|\r\n SSN: <.Patient_SSN.>|\r\n DOB: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)|\r\n Gender: <.Patient_Gende
r.>| |\r\nQuality of Life\/Life Enjoyment Percent of Max Score*: <*Answer_7779*>%|\r\nSatisfaction with Medications (Item 15)*: <*Answer_7771*> |\r\nSelf-Rating of Overall Satisfaction (Item 16)*: <*Answer_7772*>| |\r\nCritical Items*: <*An
swer_7778*>|\r\n<*Answer_7773*>|\r\n <*Answer_7774*>| |\r\n<*Answer_7775*>|\r\n <*Answer_7780*>| |\r\n<*Answer_7776*>|\r\n <*Answer_7781*>| |\r\n<*Answer_7777*>|\r\n <*Answer_7782*>| |\r\n*Note: All scores reflect re
spondent satisfaction ratings for \"during the \r\npast week.\"| |\r\nQuestions and Answers | |\r\nTaking everything into consideration, during the past week how satisfied \r\nhave you been with:|\r\n1. Your physical health?|\r\n <*Answer
_8211*>| |\r\nTaking everything into consideration, during the last week how satisfied \r\nhave you been with:|\r\n2. Your mood?|\r\n <*Answer_8212*>| |\r\nTaking everything into consideration, during the past week how satisfied \r\nhave
you been with:|\r\n3. Your work?|\r\n <*Answer_8213*>| |\r\nTaking everything into consideration, during the last week how satisfied \r\nhave you been with:|\r\n4. Your household activities?|\r\n <*Answer_8214*>| |\r\nTaking everything
"wasOperational":true},"report":{"id":101,"instrument":198,"template":".| .| World Health Organization: Quality of Life - BREF (WHOQOL-BREF)| | Date Given: <.Date_Given.>| Clinician: <.Staff_Ordered_By.>| Location: <.Location.>| | Veteran:
into consideration, during the past week how satisfied \r\nhave you been with:|\r\n5. Your social relationships?|\r\n <*Answer_8215*>| |\r\nTaking everything into consideration, during the last week how satisfied \r\nhave you been with:|\
r\n6. Your family relationships?|\r\n <*Answer_8216*>| |\r\nTaking everything into consideration, during the past week how satisfied \r\nhave you been with:|\r\n7. Your leisure time activities?|\r\n <*Answer_8217*>| |\r\nTaking everythi
ng into consideration, during the last week how satisfied \r\nhave you been with:|\r\n8. Your ability to function in daily life?|\r\n <*Answer_8218*>| |\r\nTaking everything into consideration, during the past week how satisfied \r\nhave
you been with:|\r\n9. Your sexual drive, interest and\/or performance?|\r\n <*Answer_8219*>| |\r\nTaking everything into consideration, during the last week how satisfied\r\nhave you been with:|\r\n10. Your economic status?|\r\n <*Answ
er_8220*>| |\r\nTaking everything into consideration, during the past week how satisfied \r\nhave you been with:|\r\n11. Your living\/housing situation?|\r\n <*Answer_8221*>| |\r\nTaking everything into consideration, during the last wee
k how satisfied \r\nhave you been with:|\r\n12. Your ability to get around physically without feeling dizzy or|\r\n unsteady or falling?|\r\n <*Answer_8222*>| |\r\nTaking everything into consideration, during the past week how satisfi
ed \r\nhave you been with:|\r\n13. Your vision in terms of ability to do work or hobbies?|\r\n <*Answer_8223*>| |
\r\nTaking everything into consideration, during the last week how satisfied \r\nhave you been with:|\r\n14. Your overall sense of well-being?|\r\n <*Answer_8224*>| |\r\nTaking everything into consideration, during the past week how sati
sfied \r\nhave you been with:|\r\n15. Your medication?|\r\n <*Answer_8225*>| |\r\nTaking everything into consideration, during the last week how satisfied \r\nhave you been with:|\r\n16. How would you rate your overall life satisfaction
and contentment\r\nduring the past week?|\r\n <*Answer_8226*>| |\r\n Information contained in this note is based on a self-report assessment|\r\nand is not sufficient to use alone for diagnostic purposes. Assessment|\r\nresults should be
<.Patient_Name_Last_First.>| SSN: \r\n<.Patient_SSN.>| DOB: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)| Gender: <.Patient_Gender.>| | |\r\nHigher scores indicate higher quality of life.||\r\nItem\/Domain Veteran's Raw
verified for accuracy and used in conjunction with|\r\nother diagnostic activities.| |\r\n The Q-LES-Q-SF is copyrighted by Jean Endicott, Ph.D. Permission granted|\r\nto electronically reproduce for clinicians use and research in|\r\nnon-
industry studies. For other uses, contact copyright holder.| |\r\n \r\n$~"},"scaleGroup":[{"grid1":null,"grid2":null,"grid3":null,"id":292,"instrument":248,"name":"Q-LES-Q-SF","ordInc":1,"ordMax":100,"ordMin":1,"ordTitle":"Q-LES-Q-SF","scal
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wer_7773*>|\r\nDomain 2: Psychological <*Answer_7774*>|\r\nDomain 3: Social relationships <*Answer_7775*>|\r\nDomain 4: Environment <*Answer_7776*>|\r\n||\r\n| | | | Questions and Answers| | 1. How would you rate you
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11413,"questionId":8225,"scaleId":1224,"targetText":"Click here if the patient is not taking any medication.","value":0},{"id":11414,"questionId":8226,"scaleId":1224,"targetText":"Very Poor","value":1},{"id":11415,"questionId":8226,"scaleId
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r quality of life?|\r\n <*Answer_6605*>| 2. How satisfied are you with your health?| <*Answer_6606*>| 3. To what extent do you feel that physical pain prevents you from doing what you need to do?| <*Answer_6607*>| \r\n4. How muc
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re you able to concentrate?| <*Answer_6611*>| 8. How safe do you feel in your daily life?| <*Answer_6612*>| 9. How healthy is your physical \r\nenvironment?| <*Answer_6613*>| 10. Do you have enough energy for everyday life?|
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<*Answer_6614*>| 11. Are you able to accept your bodily appearance?| <*Answer_6615*>| 12. Have you enough \r\nmoney to meet your needs?| <*Answer_6616*>| 13. How available to you is the information that you need in your day-to-day
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r_7771*> <*Answer_7778*>|\r\nAnxiety <*Answer_7772*> <*Answer_7779*>|\r\nDepression <*Answer_7773*> <*Answer_7780*>|\r\nFatigue <*Answe
r_7774*> <*Answer_7781*>|\r\nSleep Disturbance <*Answer_7775*> <*Answer_7782*>|\r\nSatisfaction with Social Role <*Answer_7776*> <*Answer_7783*>|\r\nPain Interference <*Answe
r_7777*> <*Answer_7784*>|\r\nPain Intensity <*Answer_8318*> N\/A | |\r\n \r\n \r\n \r\nQuestions and Answers| |1. Physical Functioning: Are you able to do\r\n chores such as vacuuming or yard work?|\r
\n <*Answer_8290*>| |\r\n2. Physical Functioning: Are you able to go up and down stairs at a normal pace?|\r\n <*Answer_8291*>| |\r\n3. Physical Functioning: Are you able to go for a walk of at least 15 minutes?|\r\n <*Answer_8292*>|
|\r\n4. Physical Functioning: Are you able to run errands and shop?|\r\n <*Answer_8293*>| |\r\n5. Anxiety: IN THE PAST 7 DAYS I felt fearful.|
\r\n <*Answer_8294*>| |\r\n6. Anxiety: IN THE PAST 7 DAYS I found it hard to focus on anything other than\r\n my anxiety.|\r\n <*Answer_8295*>| |\r\n7. Anxiety: IN THE PAST 7 DAYS my worries overwhelmed me.|\r\n <*Answer_8296*>| |\r\n
8. Anxiety: IN THE PAST 7 DAYS I felt uneasy.| \r\n <*Answer_8297*>| |\r\n9. Depression: IN THE PAST 7 DAYS I felt worthless.|\r\n <*Answer_8298*>| |\r\n10. Depression: IN THE PAST 7 DAYS I felt helpless.|\r\n <*Answer_8299*>| |\r\n1
1. Depression: IN THE PAST 7 DAYS I felt depressed.|\r\n <*Answer_8300*>| |\r\n12. Depression: IN THE PAST 7 DAYS I felt hopeless.|\r\n <*Answer_8301*>| |\r\n13. Fatigue: DURING THE PAST 7 DAYS I feel fatigued.|\r\n <*Answer_8302*>
isfied","value":1},{"id":13456,"questionId":6606,"scaleId":1308,"targetText":"Dissatisfied","value":2},{"id":13457,"questionId":6606,"scaleId":1308,"targetText":"Neither satisfied nor dissatisfied","value":3},{"id":13458,"questionId":6606,"
| |\r\n14. Fatigue: DURING THE PAST 7 DAYS I have trouble STARTING things because I\r\n am tired.| \r\n <*Answer_8303*>| |\r\n15. Fatigue: IN THE PAST 7 DAYS - How run down did you feel on average?|\r\n <*Answer_8304*>| |\r\n16. Fatigu
e: IN THE PAST 7 DAYS - How fatigued were you on average?|\r\n <*Answer_8305*>| |\r\n17. Sleep Disturbance: IN THE PAST 7 DAYS my sleep quality was,|\r\n <*Answer_8306*>| |\r\n18. Sleep Disturbance: IN THE PAST 7 DAYS my sleep was ref
reshing,|\r\n <*Answer_8307*>| |\r\n19. Sleep Disturbance: IN THE PAST 7 DAYS I had a problem with sleep,|\r\n <*Answer_8308*>| |\r\n20. Sleep Disturbance: IN THE PAST 7 DAYS I had difficulty falling asleep,|\r\n <*Answer_8309*>| |
\r\n21. Satisfaction with Social Role: IN THE PAST 7 DAYS I am satisfied with how\r\n much work I can do (include work at home).|\r\n <*Answer_8310*>| |\r\n22. Satisfaction with Social Role: IN THE PAST 7 DAYS I am satisfied with my\r\n
ability to work (include work at home).|\r\n <*Answer_8311*>| |\r\n23. Satisfaction with Social Role: IN THE PAST 7 DAYS I am satisfied with my\r\n ability to do regular personal and household responsibilities.|\r\n <*Answer_8312*>| |
\r\n24. Satisfaction with Social Role: IN THE PAST 7 DAYS I am satisfied with my\r\n ability to perform my daily routines.|\r\n <*Answer_8313*>| |\r\n25. Pain Interference: IN THE PAST 7 DAYS - How much did pain interfere in your day to
day \r\nactivities?|\r\n <*Answer_8314*>| |\r\n26. Pain Interference: IN THE PAST 7 DAYS - How much did pain interfere \r\n with your work around the house?|\r\n <*Answer_8315*>| |\r\n27. Pain Interference: IN THE PAST 7 DAYS - How mu
ch did pain interfere with\r\n your ability to participate in social activities?|\r\n <*Answer_8316*>| |\r\n28. Pain Interference: IN THE PAST 7 DAYS - How much did pain interfere with\r\n your household chores?|\r\n <*Answer_8317*>|
|\r\n29. Pain Intensity: How would you rate your pain on average?| \r\n <*Answer_8318*>| |\r\n \r\n \r\nInformation contained in this note is based on a self-report assessment \r\nand is not sufficient to use alone for diagnostic purpose
s. Assessment \r\nresults should be verified for accuracy and used in conjunction with \r\nother diagnostic activities.| |\r\n \r\n 2008-2016 PROMIS Health Organization and PROMIS Cooperative Group\r\n \r\n$~"},"scaleGroup":[{"grid1":null
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