| SPECIFICATION |
{"test":[{"content":[{"choice":[{"choiceId":4915,"choiceText":"Yes","ien":90600,"legacyValue":1,"sequence":1},{"choiceId":4916,"choiceText":"No","ien":90601,"legacyValue":0,"sequence":2}],"choiceDisplay":91546,"choiceIdentifier":1,"choiceId
y enter your mind, such as:","max":0,"min":0,"questionDisplay":91547,"questionId":6815,"questionText":"Overconcern with keeping objects (clothing, tools, etc) in perfect order or arranged exactly?","required":false,"responseTypeId":1,"respo
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ar away from myself|\r\n <*Answer_7021*>|\r\n \r\n 23. I felt worthless|\r\n <*Answer_7022*>| | |\r\n \r\n Information contained in this note is based on a self-report assessment and is not sufficient to use alone for diagnostic p
urposes. Assessment results should be verified for accuracy and used in conjunction with other diagnostic activities and\r\n procedures.| $~"},"scaleGroup":[{"grid1":null,"grid2":null,"grid3":null,"id":315,"instrument":208,"name":"BSL 23"
,"ordInc":1,"ordMax":95,"ordMin":0,"ordTitle":"SCORE","scale":[{"groupId":315,"id":1351,"name":"BSL-23","sequence":1,"xLabel":"SCORE"}],"sequence":1}],"verify":["601.71:208","601.72:7000","601.72:7001","601.72:7002","601.72:7003","601.72:70
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"601.76:6967","601.86:315","601.87:1351","601.88:1443","601.88:1470","601.89:37752","601.89:37753","601.89:37754","601.89:37755","601.89:37756","601.89:37757","601.89:37758","601.89:37759","601.89:37760","601.89:37761","601.89:37762","601.8
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signs of item present. Patient is orientated to time place and person.","ien":109012,"legacyValue":0,"sequence":1},{"choiceId":5036,"choiceText":"Mild to moderate. Barely expressed and noticeable through to being present\/undeniable. Pt st
ill can provide some orientating information to time, place and\/or person.","ien":109013,"legacyValue":1,"sequence":3},{"choiceId":5037,"choiceText":"Moderate to severe. Pt not orientated to time\/place; i.e., not able to tell you the date
, month, day, year, season, floor, name of hospital, city, state, country.","ien":109014,"legacyValue":2,"sequence":4}],"choiceDisplay":59293,"choiceIdentifier":0,"choiceIdentifierIen":42242,"choiceTypeId":108962,"designator":1,"hint":null,
"id":8530,"instrument":263,"introDisplay":59293,"introId":2433,"introText":"This is an observational screening tool. Please use your best judgment as \r\nto what the patient is demonstrating. Each item contains 3 descriptors to \r\nchoose f
ed":false,"id":91557,"left":8,"mask":"646|||"},{"alignment":"L","columns":null,"component":null,"fontBold":false,"fontColor":"clWindowText","fontItalic":false,
rom.|","max":2,"min":0,"questionDisplay":59293,"questionId":8530,"questionText":
"DISORIENTATION. Verbal or behavioral manifestation of not being oriented to time or place or misperceiving persons in the environment.","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":1},{"choice":[{"choiceId":50
38,"choiceText":"Absent. No signs of item present.","ien":109015,"legacyValue":0,"sequence":1},{"choiceId":5039,"choiceText":"Mild to moderate. Hyperactivity is barely noticeable or appears as simple restlessness, to undeniable, subject mov
es frequently.","ien":109016,"legacyValue":1,"sequence":2},{"choiceId":5040,"choiceText":"Moderate to severe. Hyperactivity is severe; patient is constantly moving, overreacts to stimuli, requires surveillance and\/or restraint.","ien":1090
17,"legacyValue":2,"sequence":3}],"choiceDisplay":59293,"choiceIdentifier":0,"choiceIdentifierIen":42243,"choiceTypeId":108963,"designator":2,"hint":null,"id":8531,"instrument":263,"introDisplay":59293,"introId":2433,"introText":"This is an
observational screening tool. Please use your best judgment as \r\nto what the patient is demonstrating. Each item contains 3 descriptors to \r\nchoose from.|","max":2,"min":0,"questionDisplay":59293,"questionId":8531,"questionText":"INAPP
ROPRIATE BEHAVIOR. Behavior inappropriate to place and\/or for the person; e.g., pulling at tubes or dressings, attempting to get out of bed when it is contraindicated, and the like.","required":true,"responseTypeId":1,"responseTypeText":"M
CHOICE","sequence":2},{"choice":[{"choiceId":5041,"choiceText":"Absent. No sign of items present. Patient's speech is coherent and goal-directed.","ien":109018,"legacyValue":0,"sequence":1},{"choiceId":5042,"choiceText":"Mild to moderate. P
atient's speech is slightly difficult to follow; responses to questions are slightly off target, to disorganized speech being clearly present.","ien":109019,"legacyValue":1,"sequence":2},{"choiceId":5043,"choiceText":"Mod to severe. Convers
ation impossible due to disorganized thinking or speech (e.g., irrelevant, incoherent speech, or tangential, circumstantial, or faulty reasoning).","ien":109020,"legacyValue":2,"sequence":3}],"choiceDisplay":59293,"choiceIdentifier":0,"choi
"fontName":"MS Sans Serif","fontSize":10,"fontUnderlined":false,"id":91558,"left":8,"mask":null},{"alignment":"L","columns":2,"component":"RA","fontBold":false,"fontColor":"clWindowText","fontItalic":false,"fontName":"MS Sans Serif","fontSi
ceIdentifierIen":42244,"choiceTypeId":108964,"designator":3,"hint":null,"id":8532,"instrument":263,"introDisplay":59293,"introId":2433,"introText":"This is an observational screening tool. Please use your best judgment as \r\nto what the pa
tient is demonstrating. Each item contains 3 descriptors to \r\nchoose from.|","max":2,"min":0,"questionDisplay":59293,"questionId":8532,"questionText":"INAPPROPRIATE COMMUNICATION. Behavior inappropriate to place and\/or for the person; e.
g., incoherence, non-communicativeness, nonsensical or unintelligible speech.","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":3},{"choice":[{"choiceId":5044,"choiceText":"Absent. No sign of items present.","ien":
109021,"legacyValue":0,"sequence":1},{"choiceId":5045,"choiceText":"Mild to moderate. Misperceptions or illusions related to sleep, fleeting hallucinations.","ien":109022,"legacyValue":1,"sequence":2},{"choiceId":5046,"choiceText":"Moderate
to severe. Frequent or intense illusions or hallucinations that disrupts care, function or is associated with inappropriate behavior.","ien":109027,"legacyValue":2,"sequence":3}],"choiceDisplay":59293,"choiceIdentifier":0,"choiceIdentifier
Ien":42245,"choiceTypeId":108965,"designator":4,"hint":null,"id":8533,"instrument":263,"introDisplay":59293,"introId":2433,"introText":"This is an observational screening tool. Please use your best judgment as \r\nto what the patient is dem
onstrating. Each item contains 3 descriptors to \r\nchoose from.|","max":2,"min":0,"questionDisplay":59293,"questionId":8533,"questionText":"ILLUSIONS\/HALLUCINATIONS. Seeing or hearing things that are not there; \r\ndistortions of visual o
bjects.","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":4},{"choice":[{"choiceId":5047,"choiceText":
"Absent. No sign of items present.","ien":109023,"legacyValue":0,"sequence":1},{"choiceId":5048,"choiceText":"Mild to moderate. Hypoactivity is barely noticeable, expressed as slightly slowing of movement, to moderate slowing of movements."
,"ien":109028,"legacyValue":1,"sequence":2},{"choiceId":5049,"choiceText":"Moderate to severe. Hypoactivity is severe; patient does not move or speak without prodding or is catatonic.","ien":109029,"legacyValue":2,"sequence":3}],"choiceDisp
ze":10,"fontUnderlined":false,"id":91559,"left":8,"mask":"646|||"},{"alignment":"L","columns":null,"component":null,"fontBold":false,"fontColor":"clWindowText","fontItalic":false,"fontName":"MS Sans Serif","fontSize":10,"fontUnderlined":fal
lay":59293,"choiceIdentifier":0,"choiceIdentifierIen":42246,"choiceTypeId":108966,"designator":5,"hint":null,"id":8534,"instrument":263,"introDisplay":59293,"introId":null,"introText":null,"max":2,"min":0,"questionDisplay":59293,"questionId
":8534,"questionText":"PSYCHOMOTOR RETARDATION. Delayed responsiveness; few or no spontaneous \r\nactions\/words; e.g., when the patient is prodded, reaction is deferred \r\nand\/or the patient is unarousable.","required":true,"responseType
Id":1,"responseTypeText":"MCHOICE","sequence":5}],"display":[{"alignment":"L","columns":null,"component":null,"fontBold":false,"fontColor":"clWindowText","fontItalic":false,"fontName":"MS Sans Serif","fontSize":8,"fontUnderlined":false,"id"
:59293,"left":2,"mask":null}],"info":{"author":null,"auxDate":null,"auxVersion":null,"copyrightText":null,"copyrighted":false,"dllDate":null,"dllVersion":null,"enteredBy":"BARRY DELLINGER","entryDate":"2019-09-04","fullText":true,"id":263,"
lastEditDate":null,"lastEditedBy":"LEONARD BOSTWICK","legacy":false,"licenseCurrent":true,"name":"NUDESC","national":true,"normSample":null,"operational":"Y","printTitle":"Nursing Delirium Screening Scale - (NUDESC)","publicationDate":null,
"publisher":null,"purpose":null,"reference":"Gaudreau, J. D., Gagnon, P., Harel, F., Tremblay, A., & Roy, M. A. (2005). Fast, systematic, and continuous delirium assessment in hospitalized patients: The nursing delirium screening scale. Jou
rnal of Pain and Symptom Management 29 (4) 368-375.","requireSignature":false,"requiresLicense":"N","scoringRevision":1,"scoringRoutine":"YTSNUDEC","scoringTag":null,"submitNational":true,"targetPopulation":null,"version":null,"wasOperation
al":true},"report":{"id":186,"instrument":263,"template":"|.|.|Nursing Delirium Screening Scale - (NUDESC) |\r\n | Date Given: <.Date_Given.>| Clinician: <.Staff_Ordered_By.>|\r\n Location: <.Location.>| | Veteran: <.Patient_Na
me_Last_First.>|\r\n SSN: <.Patient_SSN.>| DOB: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)\r\n| Gender: <.Patient_Gender.>| |\r\n \r\nNuDESC score indicates a <*Answer_7771*> screen for delirium.| |\r\n \r\nTotal Score = <-TOTAL SCOR
E->| |\r\n \r\nMaximum total score is 10. Scores greater than\/equal to 2 are considered|\r\n postive.||\r\n \r\nQuestions and Answers| |\r\n \r\n1. DISORIENTATION. Verbal or behavioral manifestation of not being \r\noriented|\r\n to tim
se,"id":91560,"left":8,"mask":null},{"alignment":"L","columns":2,"component":"RA","fontBold":false,"fontColor":"clWindowText","fontItalic":false,"fontName":"MS Sans Serif","fontSize":10,"fontUnderlined":false,"id":91561,"left":8,"mask":"646
e or place or misperceiving persons in the environment.|\r\n <*Answer_7772*>||\r\n 2. INAPPROPRIATE BEHAVIOR. Behavior inappropriate to place and\/or for the|\r\n person; e.g., pulling at tubes or dressings, attempting to get out of b
ed|\r\n when it is contraindicated, and the like.|\r\n <*Answer_7773*>||\r\n 3. INAPPROPRIATE COMMUNICATION. Behavior inappropriate to place and\/or for the|\r\n person; e.g., incoherence, non-communicativeness, nonsensical or|\r\n
unintelligible speech.|\r\n <*Answer_7774*>||\r\n 4. ILLUSIONS\/HALLUCINATIONS. Seeing or hearing things that are not there;|\r\n distortions of visual objects.|\r\n <*Answer_7775*>||\r\n 5. PSYCHOMOTOR RETARDATION. Delayed res
ponsiveness; few or no spontaneous |\r\n actions\/words; e.g., when the patient is prodded, reaction is deferred |\r\n and\/or the patient is unarousable.|\r\n <*Answer_7776*>| |\r\n \r\nInformation contained in this note is based
on a self-report assessment and|\r\n is not sufficient to use alone for diagnostic purposes. Assessment results |
\r\n should be verified for accuracy and used in conjunction with other diagnostic|\r\n activities.||\r\n$~"},"scaleGroup":[{"grid1":null,"grid2":null,"grid3":null,"id":314,"instrument":263,"name":"NuDESC","ordInc":1,"ordMax":10,"ordMin":0,
"ordTitle":"Score","scale":[{"groupId":314,"id":1350,"name":"TOTAL SCORE","sequence":1,"xLabel":null}],"sequence":1}],"verify":["601.71:263","601.72:8530","601.72:8531","601.72:8532","601.72:8533","601.72:8534","601.73:2433","601.75:5035","
601.75:5036","601.75:5037","601.75:5038","601.75:5039","601.75:5040","601.75:5041","601.75:5042","601.75:5043","601.75:5044","601.75:5045","601.75:5046","601.75:5047","601.75:5048","601.75:5049","601.751:109012","601.751:109013","601.751:10
9014","601.751:109015","601.751:109016","601.751:109017","601.751:109018","601.751:109019","601.751:109020","601.751:109021","601.751:109022","601.751:109023","601.751:109027","601.751:109028","601.751:109029","601.76:8530","601.76:8531","6
01.76:8532","601.76:8533","601.76:8534","601.86:314","601.87:1350","601.88:59293","601.89:42242","601.89:42243","601.89:42244","601.89:42245","601.89:42246"]},{"content":[{"choice":[{"choiceId":3789,"choiceText":"YES, a change","ien":106538
|||"},{"alignment":"L","columns":null,"component":null,"fontBold":false,"fontColor":"clWindowText","fontItalic":false,"fontName":"MS Sans Serif","fontSize":10,"fontUnderlined":false,"id":91562,"left":8,"mask":null},{"alignment":"L","columns
,"legacyValue":null,"sequence":1},{"choiceId":3790,"choiceText":"NO, no change","ien":106539,"legacyValue":null,"sequence":2},{"choiceId":3791,"choiceText":"N\/A, don't know","ien":106540,"legacyValue":null,"sequence":3}],"choiceDisplay":14
43,"choiceIdentifier":1,"choiceIdentifierIen":42164,"choiceTypeId":106538,"designator":1,"hint":null,"id":7921,"instrument":238,"introDisplay":1470,"introId":2371,"introText":"The instrument may be self-administered or can be read aloud. It
is preferable to administer the AD8 to an informant, \r\nif available. If an informant is not available, the AD8 questionnaire may be administered to the patient. Rater should \r\nonly rate changes in the patient due to cognitive problems.
| |\r\n \r\nRemember, \"Yes, a change\" indicates that there has been a change in the\r\nlast several years caused by cognitive (thinking and memory) problems.","max":1,"min":0,"questionDisplay":1470,"questionId":7926,"questionText":"Proble
ms with judgement (e.g., problems making decisions, bad financial \r\ndecisions, problems with thinking)","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":1},{"choice":[{"choiceId":3789,"choiceText":"YES, a change"
,"ien":106538,"legacyValue":null,"sequence":1},{"choiceId":3790,"choiceText":"NO, no change","ien":106539,"legacyValue":null,"sequence":2},{"choiceId":3791,"choiceText":"N\/A, don't know","ien":106540,"legacyValue":null,"sequence":3}],"choi
ceDisplay":1443,"choiceIdentifier":1,"choiceIdentifierIen":42164,"choiceTypeId":106538,"designator":2,"hint":null,"id":7922,"instrument":238,"introDisplay":1470,"introId":2371,"introText":"The instrument may be self-administered or can be r
ead aloud. It is preferable to administer the AD8 to an informant, \r\nif available. If an informant is not available, the AD8 questionnaire may be administered to the patient. Rater should \r\nonly rate changes in the patient due to cognit
ive problems.| |\r\n \r\nRemember, \"Yes, a change\" indicates that there has been a change in the\r\nlast several years caused by cognitive (thinking and memory) problems.","max":1,"min":0,"questionDisplay":1470,"questionId":7927,"question
Text":"Less interest in hobbies\/activities","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":2},{"choice":[{"choiceId":3789,"choiceText":"YES, a change","ien":106538,"legacyValue":null,"sequence":1},{"choiceId":37
":2,"component":"RA","fontBold":false,"fontColor":"clWindowText","fontItalic":false,"fontName":"MS Sans Serif","fontSize":10,"fontUnderlined":false,"id":91563,"left":8,"mask":"646|||"},{"alignment":"L","columns":null,"component":null,"fontB
90,"choiceText":"NO, no change","ien":106539,"legacyValue":null,"sequence":2},{"choiceId":3791,"choiceText":"N\/A, don't know","ien":106540,"legacyValue":null,"sequence":3}],"choiceDisplay":1443,"choiceIdentifier":1,"choiceIdentifierIen":42
164,"choiceTypeId":106538,"designator":3,"hint":null,"id":7923,"instrument":238,"introDisplay":1470,"introId":2371,"introText":
"The instrument may be self-administered or can be read aloud. It is preferable to administer the AD8 to an informant, \r\nif available. If an informant is not available, the AD8 questionnaire may be administered to the patient. Rater shoul
d \r\nonly rate changes in the patient due to cognitive problems.| |\r\n \r\nRemember, \"Yes, a change\" indicates that there has been a change in the\r\nlast several years caused by cognitive (thinking and memory) problems.","max":1,"min":
0,"questionDisplay":1470,"questionId":7928,"questionText":"Repeats the same things over and over (questions, stories, or statements)","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":3},{"choice":[{"choiceId":3789,
"choiceText":"YES, a change","ien":106538,"legacyValue":null,"sequence":1},{"choiceId":3790,"choiceText":"NO, no change","ien":106539,"legacyValue":null,"sequence":2},{"choiceId":3791,"choiceText":"N\/A, don't know","ien":106540,"legacyValu
e":null,"sequence":3}],"choiceDisplay":1443,"choiceIdentifier":1,"choiceIdentifierIen":42164,"choiceTypeId":106538,"designator":4,"hint":null,"id":7924,"instrument":238,"introDisplay":1470,"introId":2371,"introText":"The instrument may be s
elf-administered or can be read aloud. It is preferable to administer the AD8 to an informant, \r\nif available. If an informant is not available, the AD8 questionnaire may be administered to the patient. Rater should \r\nonly rate changes
in the patient due to cognitive problems.| |\r\n \r\nRemember, \"Yes, a change\" indicates that there has been a change in the\r\nlast several years caused by cognitive (thinking and memory) problems.","max":1,"min":0,"questionDisplay":1470
,"questionId":7929,"questionText":"Trouble learning how to use a tool, appliance, or gadget (e.g., VCR, computer, microwave, remote control)","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":4},{"choice":[{"choiceI
old":true,"fontColor":"clWindowText","fontItalic":false,"fontName":"MS Sans Serif","fontSize":10,"fontUnderlined":false,"id":91564,"left":3,"mask":null},{"alignment":"L","columns":null,"component":null,"fontBold":false,"fontColor":"clWindow
d":3789,"choiceText":"YES, a change","ien":106538,"legacyValue":null,"sequence":1},{"choiceId":3790,"choiceText":"NO, no change","ien":106539,"legacyValue":null,"sequence":2},{"choiceId":3791,"choiceText":"N\/A, don't know","ien":106540,"le
gacyValue":null,"sequence":3}],"choiceDisplay":1443,"choiceIdentifier":1,"choiceIdentifierIen":42164,"choiceTypeId":106538,"designator":5,"hint":null,"id":7925,"instrument":238,"introDisplay":1470,"introId":2371,"introText":"The instrument
may be self-administered or can be read aloud. It is preferable to administer the AD8 to an informant, \r\nif available. If an informant is not available, the AD8 questionnaire may be administered to the patient. Rater should \r\nonly rate
changes in the patient due to cognitive problems.| |\r\n \r\nRemember, \"Yes, a change\" indicates that there has been a change in the\r\nlast several years caused by cognitive (thinking and memory) problems.","max":1,"min":0,"questionDispl
ay":1470,"questionId":7930,"questionText":"Forgets correct month or year","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":5},{"choice":[{"choiceId":3789,"choiceText":"YES, a change","ien":106538,"legacyValue":null
,"sequence":1},{"choiceId":3790,"choiceText":"NO, no change","ien":106539,"legacyValue":null,"sequence":2},{"choiceId":3791,"choiceText":"N\/A, don't know","ien":106540,"legacyValue":null,"sequence":3}],"choiceDisplay":1443,"choiceIdentifie
r":1,"choiceIdentifierIen":42164,"choiceTypeId":106538,"designator":6,"hint":null,"id":7926,"instrument":238,"introDisplay":1470,"introId":2371,"introText":"The instrument may be self-administered or can be read aloud. It is preferable to a
dminister the AD8 to an informant, \r\nif available. If an informant is not available, the AD8 questionnaire may be administered to the patient. Rater should \r\nonly rate changes in the patient due to cognitive problems.| |\r\n \r\nRemembe
r, \"Yes, a change\" indicates that there has been a change in the\r\nlast several years caused by cognitive (thinking and memory) problems.","max":1,"min":0,
"questionDisplay":1470,"questionId":7931,"questionText":"Trouble handling complicated financial affairs (e.g., balancing checkbook, income taxes, paying bills)","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":6},{
Text","fontItalic":false,"fontName":"MS Sans Serif","fontSize":10,"fontUnderlined":false,"id":91565,"left":8,"mask":null},{"alignment":"L","columns":2,"component":"RA","fontBold":false,"fontColor":"clWindowText","fontItalic":false,"fontName
"choice":[{"choiceId":3789,"choiceText":"YES, a change","ien":106538,"legacyValue":null,"sequence":1},{"choiceId":3790,"choiceText":"NO, no change","ien":106539,"legacyValue":null,"sequence":2},{"choiceId":3791,"choiceText":"N\/A, don't kno
w","ien":106540,"legacyValue":null,"sequence":3}],"choiceDisplay":1443,"choiceIdentifier":1,"choiceIdentifierIen":42164,"choiceTypeId":106538,"designator":7,"hint":null,"id":7927,"instrument":238,"introDisplay":1470,"introId":2371,"introTex
t":"The instrument may be self-administered or can be read aloud. It is preferable to administer the AD8 to an informant, \r\nif available. If an informant is not available, the AD8 questionnaire may be administered to the patient. Rater sh
ould \r\nonly rate changes in the patient due to cognitive problems.| |\r\n \r\nRemember, \"Yes, a change\" indicates that there has been a change in the\r\nlast several years caused by cognitive (thinking and memory) problems.","max":1,"mi
n":0,"questionDisplay":1470,"questionId":7932,"questionText":"Trouble remembering appointments","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":7},{"choice":[{"choiceId":3789,"choiceText":"YES, a change","ien":106
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ms.| |\r\n \r\nRemember, \"Yes, a change\" indicates that there has been a change in the\r\nlast several years caused by cognitive (thinking and memory) problems.","max":1,"min":0,"questionDisplay":1470,"questionId":7933,"questionText":"Dai
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,"fontSize":10,"fontUnderlined":false,"id":1470,"left":2,"mask":null}],"info":{"author":null,"auxDate":null,"auxVersion":null,"copyrightText":"Copyright 2005. The AD8 is a copyrighted instrument of the Knight Alzheimer Disease Research Cent
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"|.|Ascertain Dementia 8-item Informant Questionnaire (AD8)| |\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 \r\n|AD8 Dementia Rating Score: <-AD8 TOTAL->, suggesting <*Answer_7771*>|\r\n|AD8 Screening scores range from 0-8, with score
s in the 0-1 range suggesting\r\n|\"NORMAL COGNITION\" and scores 2 or greater suggesting \"COGNITIVE IMPAIRMENT IS\r\n|LIKELY TO BE PRESENT.\"\r\n||Note: Scores in the impaired range indicate a need for further\r\n diagnostic\r\n|assessmen
t. Scores in the \"normal\" range suggest that a dementing disorder\r\n|is unlikely, but a very early disease process cannot be ruled out.|\r\n|Question and Answers:|\r\n| 1. Problems with judgement (e.g., problems making decisions, bad fi
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nancial\r\n| decisions, problems with thinking)| <*Answer_7926*>\r\n| 2. Less interest in hobbies\/activities| <*Answer_7927*>\r\n| 3. Repeats the same things over and over (questions, stories, or statements)| <*Answer_792
8*>\r\n| 4. Trouble learning how to use a tool, appliance, or gadget (e.g., VCR,\r\n| computer, microwave, remote control)| <*Answer_7929*>\r\n| 5. Forgets correct month or year| <*Answer_7930*>\r\n| 6. Trouble handling compl
icated financial affairs (e.g., balancing\r\n| checkbook, income taxes, paying bills)| <*Answer_7931*>\r\n| 7. Trouble remembering appointments| <*Answer_7932*>\r\n| 8. Daily problems with thinking and\/or memory| <*Answer
_7933*>\r\n \r\n| |\r\nCopyright 2005. The AD8 is a copyrighted instrument of the Knight Alzheimer |\r\nDisease Research Center, Washington University, St. Louis, Missouri. |\r\nAll Rights Reserved. Reproduced with permission\r\n \r\n| |\
r\nInformation contained in this note is based on a self-report assessment and is |\r\nnot sufficient to use alone for diagnostic purposes. Assessment results should |\r\nbe verified for accuracy and used in conjunction with other diagnosti
c |\r\nactivities.\r\n$~"},"scaleGroup":[{"grid1":null,"grid2":null,"grid3":null,"id":261,"instrument":238,"name":"AD8","ordInc":1,"ordMax":8,"ordMin":0,"ordTitle":"AD8","scale":[{"groupId":261,"id":1098,"name":"AD8 TOTAL","scoringKey":[{"i
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onId":7929,"scaleId":1098,"targetText":"N\/A, don't know","value":0},{"id":10621,"questionId":7930,"scaleId":1098,"targetText":"YES, a change","value":1},{"id":10622,"questionId":7930,"scaleId":1098,"targetText":"NO, no change","value":0},{
"id":10623,"questionId":7930,"scaleId":1098,"targetText":"N\/A, don't know","value":0},{"id":10624,"questionId":7931,"scaleId":1098,"targetText":"YES, a change","value":1},{"id":10625,"questionId":7931,"scaleId":1098,"targetText":"NO, no ch
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"YES, a change","value":1},{"id":10628,"questionId":7932,"scaleId":1098,"targetText":"NO, no change","value":0},{"id":10629,"questionId":7932,"scaleId":1098,"targetText":"N\/A, don't know","value":0},{"id":10630,"questionId":7933,"scaleId":
1098,"targetText":"YES, a change","value":1},{"id":10631,"questionId":7933,"scaleId":1098,"targetText":"NO, no change","value":0},{"id":10632,"questionId":7933,"scaleId":1098,"targetText":"N\/A, don't know","value":0}],"sequence":1,"xLabel"
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ed":false,"id":91578,"left":8,"mask":null},{"alignment":"L","columns":2,"component":"RA","fontBold":false,"fontColor":"clWindowText","fontItalic":false,"fontName":"MS Sans Serif","fontSize":10,"fontUnderlined":false,"id":91579,"left":8,"mas
k":"646|||"},{"alignment":"L","columns":null,"component":null,"fontBold":false,"fontColor":"clWindowText","fontItalic":false,"fontName":"MS Sans Serif","fontSize":10,"fontUnderlined":false,"id":91580,"left":8,"mask":null},{"alignment":"L","
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,"fontBold":false,"fontColor":"clWindowText","fontItalic":false,"fontName":"MS Sans Serif","fontSize":10,"fontUnderlined":false,"id":91582,"left":8,"mask":null},{"alignment":"L","columns":2,"component":"RA","fontBold":false,"fontColor":"clW
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false,"id":91586,"left":8,"mask":null},{"alignment":"L","columns":2,"component":"RA","fontBold":false,"fontColor":"clWindowText","fontItalic":false,"fontName":"MS Sans Serif","fontSize":10,"fontUnderlined":false,"id":91587,"left":8,"mask":"
646|||"},{"alignment":"L","columns":null,"component":null,"fontBold":true,"fontColor":"clWindowText","fontItalic":false,"fontName":"MS Sans Serif","fontSize":10,"fontUnderlined":false,"id":91588,"left":8,"mask":null},{"alignment":"L","colum
"Images of death or horrible events?","required":false,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":40},{"choice":[{"choiceId":4915,"choiceText":"Yes","ien":90606,"legacyValue":1,"sequence":1},{"choiceId":4916,"choiceText":"No
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:91597,"left":8,"mask":null},{"alignment":"L","columns":2,"component":"RA","fontBold":false,"fontColor":"clWindowText","fontItalic":false,"fontName":"MS Sans Serif","fontSize":10,"fontUnderlined":false,"id":91598,"left":8,"mask":"646|||"}],
"info":{"author":"Wayne K. Goodman","auxDate":null,"auxVersion":null,"copyrightText":null,"copyrighted":false,"dllDate":null,"dllVersion":null,"enteredBy":"DELLINGER,BARRY","entryDate":"2019-04-15","fullText":true,"id":147,"lastEditDate":31
","ien":90607,"legacyValue":0,"sequence":2}],"choiceDisplay":91552,"choiceIdentifier":1,"choiceIdentifierIen":37626,"choiceTypeId":46636,"designator":"4.","hint":null,"id":6762,"instrument":147,"introDisplay":91544,"introId":null,"introText
90927.1119,"lastEditedBy":"DELLINGER,BARRY","legacy":false,"licenseCurrent":false,"name":"FOCI","national":true,"normSample":null,"operational":"Y","printTitle":"Florida Obsessive Compulsive Inventory (FOCI)","publicationDate":1994,"publish
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onal":true},"report":{"id":126,"instrument":147,"template":" \r\n|\r\n .| Florida Obsessive Compulsive Inventory (FOCI)|\r\n | Date Given: <.Date_Given.>| Clinician: <.Staff_Ordered_By.>| Location: <.Location.>| | Veteran: <.Patient_N
ame_Last_First.>| SSN:\r\n<.Patient_SSN.>| DOB: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)| Gender: <.Patient_Gender.>| | | |\r\n \r\n FOCI Symptom Checklist Total Score: <-Part A->| |\r\n \r\n Total Scores range from a minimum of
0 to a maximum of 20, with higher scores indicating greater symptomatology.| |\r\n \r\n FOCI Symptom Severity Total Score: <-Part B->| |\r\n \r\n Total Scores range from a minimum of 0 to a maximum of 20, with higher scores indicating gr
eater symptom serverity.| |\r\n \r\n \r\n Questions and Answers| |\r\n \r\n Part A:\r\n Have you been bothered by unpleasant thoughts or images that repeatedly enter your mind, such as:| |\r\n 1. Concerns with contamination (dirt, ge
rms, chemicals, radiation) or acquiring a serious illness such as AIDS?|\r\n <*Answer_6814*>|\r\n 2. Overconcern with keeping objects (clothing, tools, etc) in perfect order or arranged exactly?|\r\n <*Answer_6815*>|\r\n 3
. Images of death or other horrible events?|\r\n <*Answer_6816*>|\r\n 4. Personally unacceptable religious or sexual thoughts?|\r\n <*Answer_6817*>| |\r\n \r\n Have you worried a lot about terrible things happening, such as
:| |\r\n \r\n 5. Fire, burglary or flooding of the house?|\r\n <*Answer_6818*>|\r\n 6. Accidentally hitting a pedestrian with your car or letting it roll down a hill?|\r\n <*Answer_6819*>|\r\n 7. Spreading an illness (gi
ving someone AIDS)?|\r\n <*Answer_6820*>|\r\n 8. Losing something valuable?|\r\n <*Answer_6821*>|\r\n 9. Harm coming to a loved one because you weren't careful enough?|\r\n <*Answer_6822*>| |\r\n \r\n Have you worr
":null,"max":0,"min":0,"questionDisplay":91551,"questionId":6817,"questionText":"Personally unacceptable religious or sexual thoughts?","required":false,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":50},{"choice":[{"choiceId":4
ied about acting on an unwanted and senseless urge or impulse, such as:| |\r\n 10. Physically harming a loved one, pushing a stranger in front of a bus, steering your car into oncoming traffic;|\r\n inappropriate sexual contact; o
r poisoning dinner guests?|\r\n <*Answer_6823*>| |\r\n \r\n Have you felt driven to perform certain acts over and over again, such as:| |\r\n 11. Excessive or ritualized washing, cleaning or grooming?|\r\n <*Answer_6824*>
|\r\n 12. Checking light switches, water faucets, the stove, door locks or the emergency brake?|\r\n <*Answer_6825*>|\r\n 13. Counting, arranging; evening-up behaviors (making sure socks are at same height)?|\r\n <*Answe
r_6826*>|\r\n 14. Collecting useless objects or inspecting the garbage before it is thrown out?|\r\n <*Answer_6827*>|
\r\n 15. Repeating routine actions (in\/out of chair, going through doorway, relighting cigarette) a certain number of times|\r\n or until it feels just right?|\r\n <*Answer_6828*>|\r\n 16. Needing to touch objects or pe
ople?|\r\n <*Answer_6829*>|\r\n 17. Unnecessary rereading or rewriting; reopening envelopes before they are mailed?|\r\n <*Answer_6830*>|\r\n 18. Examining your body for signs of illness?|\r\n <*Answer_6831*>|\r\n
19. Avoiding colors (\"red\" means blood), numbers (\"13\" is unlucky) or names (those that start with \"D\" signify death) |\r\n that are associated with dreaded events or unpleasant thoughts?|\r\n <*Answer_6832*>|\r\n
20. Needing to \"confess\" or repeatedly asking for reassurance that you said or did something correctly?|\r\n <*Answer_6833*>| |\r\n \r\n PART B: In the past month...|\r\n \r\n 1. On average, how much time is occupied by these t
houghts or behaviors each day?|\r\n <*Answer_6834*>|\r\n 2. How much distress do they cause you?|\r\n <*Answer_6835*>|\r\n 3. How hard is it for you to control them?|\r\n <*Answer_6836*>|\r\n 4. How much do they cause y
ou to avoid doing anything, going anyplace or being with anyone?|\r\n <*Answer_6837*>|\r\n 5. How much do they interfere with school work or your social or family life?|\r\n <*Answer_6838*>| | |\r\n Information contained in
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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.\r\n| $~"},"rule":[{"
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"Instructions: Below are some statements about feelings and thoughts.\r\n|Please select the response that best describes your experience of each over the last 2 weeks.","max":5,"min":1,"questionDisplay":1470,"questionId":8403,"questionText"
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ician: <.Staff_Ordered_By.>| \r\nLocation: <.Location.>| | Veteran: <.Patient_Name_Last_First.>| \r\nSSN: <.Patient_SSN.>| DOB: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)\r\n| Gender: <.Patient_Gender.>| | \r\n \r\nSWEMWB
S Total Metric Score: <-METRIC SCORE->| |\r\n \r\nTotal scores range from a minimum of 7 to a maximum of 35, with higher scores | \r\nindicating greater overall mental well-being.| |\r\n \r\nQuestions and Answers:| |\r\n1. I've been felling
optimistic about the future.|\r\n <*Answer_8403*> ||\r\n2. I've been feeling useful.|\r\n <*Answer_8404*> ||\r\n3. I've been feeling relaxed.|\r\n <*Answer_8405*> ||\r\n4. I've been dealing with problems well.|\r\n <*Answer_8406*>
||\r\n5. I've been thinking clearly.|\r\n <*Answer_8407*> ||\r\n6. I've been feeling close to other people.|\r\n <*Answer_8408*> ||\r\n7. I've been able to make up my own mind about things.|\r\n <*Answer_8409*> |||\r\n \r\nShort Warwi
ck-Edinburgh Mental Well-being Scale (SWEMWBS) NHS Health Scotland, | \r\nUniversity of Warwick and University of Edinburgh, 2007, all rights reserved.| |
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\r\n \r\nInformation contained in this note is based on a self-report assessment and is not | \r\nsufficient to use alone for diagnostic purposes. Assessment results should be verified| \r\nfor accuracy and used in conjunction with other di
agnostic activities.| |\r\n$~"},"scaleGroup":[{"grid1":null,"grid2":null,"grid3":null,"id":305,"instrument":256,"name":"SWEMWBS","ordInc":1,"ordMax":35,"ordMin":0,"ordTitle":"SCORE","scale":[{"groupId":305,"id":1325,"name":"Ques1","sequence
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anxiety symptoms. Keep in mind, a high score on this questionnaire does| not necessarily mean you have an anxiety disorder- only an evaluation by a\r\n health professional can make this determination. Answer these questions as accurately
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al. There are no right or wrong answers. Please read each statement \r\ncarefully, with regard to your own current recovery process, and indicate how much you agree or disagree with each item by selecting the appropriate response.","max":4,
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"The MHRM-10 is a brief version of the MHRM, adapted by Panasci (Armstrong), NP, Cohen, AN, Hellemann, G, Reist, C, & Young, AS (2014), with support from the Dept. of Veterans Affairs (VA), Veterans Health Administration (VHA), Health Serv
ices Research & Development (HSR&D) Quality Enhancement Research Initiative (QUERI) (MNT 03-213), and the VA Desert Pacific Mental Illness Research, Education, & Clinical Center (MIRECC).","requireSignature":false,"requiresLicense":"N","sco
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)|\r\n | Date Given: <.Date_Given.>| Clinician: <.Staff_Ordered_By.>| \r\nLocation: <.Location.>| | Veteran: <.Patient_Name_Last_First.>| \r\nSSN: <.Patient_SSN.>| DOB: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)\r\n| Gen
der: <.Patient_Gender.>| |\r\n \r\nMHRM-10 Total Score: <-TOTAL SCORE->|\r\n MHRM-10 scores range from 0 to 40, with higher scores indicating higher perceived mental health recovery.| |\r\n \r\nQuestions and Answers:| |\r\n \r\n 1. I still
grow and change in positive ways despite my mental health problem.|\r\n <*Answer_8410*>| |\r\n \r\n 2. Even though I may still have problems, I value myself as a person of worth.|\r\n <*Answer_8411*>| |\r\n \r\n 3. I understand myse
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Edwards V., Koss M.P., et al. (1998). The relationship of adult health status to childhood abuse and household dysfunction. American Journal of Preventive Medicine, 14, 245-258","requireSignature":false,"requiresLicense":"N","scoringRevisi
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en: <.Date_Given.>| Clinician: <.Staff_Ordered_By.>| \r\nLocation: <.Location.>| | Veteran: <.Patient_Name_Last_First.>| \r\nSSN: <.Patient_SSN.>| DOB: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)\r\n| Gender: <.Patient_Gende
r.>| |\r\n \r\nACE Total Score = <-Total Score->| | \r\n \r\nTotal scores range from 0 - 10. The higher the score, the higher the| \r\nprevalence of physical and mental health risks.| |\r\n \r\n \r\nQuestions and Answers:|\r\n 1. Did a pa
rent or other adult in the household often or very often...Swear|\r\n at you, insult you, put you down, or humiliate you? or Act in a way that|\r\n made you afraid that you might be physically hurt?| <*Answer_8460*>| |\r\n 2. Did a
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parent or other adult in the household often or very often...Push,|\r\n grab, slap, or throw something at you? or Ever hit you so hard that you|\r\n had marks or were injured?| <*Answer_8461*>| |\r\n 3. Did an adult person at leas
t 5 years older than you ever...Touch or |\r\n fondle you or have you touch their body in a sexual way? or Attempt|\r\n or actually have oral, anal, or vaginal intercourse with you?| <*Answer_8462*>| |\r\n 4. Did you often or very
often feel that...No one in your family loved|\r\n you or thought you were important or special? or Your family didn't|\r\n look out for each other, feel close to each other, or support each|\r\n other?| <*Answer_8463*>| |\r\n 5
. Did you often or very often feel that...You didn't have enough to |\r\n eat, had to wear dirty clothes, and had no one to protect you? or|\r\n Your parents were too drunk or high to take care of you or take |\r\n you to the docto
r if you needed it?| <*Answer_8464*>| |\r\n 6. Were your parents ever separated or divorced?| <*Answer_8465*>| |\r\n 7. Was your mother or stepmother: Often or very often pushed, grabbed,|\r\n slapped, or had something thrown at he
r? or Sometimes, often, or |\r\n very often kicked, bitten, hit with a fist, or hit with something|\r\n hard? or Ever repeatedly hit at least a few minutes or threatened|\r\n with a gun or knife?| <*Answer_8466*>| |\r\n 8. Did
you live with anyone who was a problem drinker or alcoholic or|\r\n who used street drugs?| <*Answer_8467*>| |\r\n 9. Was a household member depressed or mentally ill, or did a house-|\r\n hold member attempt suicide?| <*Answer_
8467*>| |\r\n10. Did a household member go to prison?| <*Answer_8469*>| |\r\n \r\nInformation contained in this note is based on a self-report assessment |\r\n and is not sufficient to use alone for diagnostic purposes. Assessment |\r\n
results should be verified for accuracy and used in conjunction with |\r\n other diagnostic activities.| |\r\n$~"},"scaleGroup":[{"grid1":null,"grid2":null,
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g, how \r\ntired to you feel?","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":5},{"choice":[{"choiceId":4982,"choiceText":"Would be in good form","ien":108969,"legacyValue":4,"sequence":1},{"choiceId":4983,"choic
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,"max":4,"min":1,"questionDisplay":1470,"questionId":8475,"questionText":"You have decided to engage in some physical exercise. A friend suggests \r\nthat you do this one hour twice a week and the best time for him is \r\n7:00-8:00 a.m. B
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e":1},{"choiceId":5004,"choiceText":"Rather difficult and unpleasant","ien":108991,"legacyValue":2,"sequence":2},{"choiceId":5005,"choiceText":"A little unpleasant but no great problem","ien":108993,"legacyValue":3,"sequence":3},{"choiceId"
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e before you \"recover your senses\" in \r\nthe morning after rising from a night's sleep?","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":12},{"choice":[{"choiceId":5011,"choiceText":"Pronounced morning active (
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n":1,"questionDisplay":1470,"questionId":8482,"questionText":"Please indicate to what extend you are a morning or evening active \r\nindividual.","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":13}],"display":[{"a
lignment":"L","columns":4,"component":"LI","fontBold":false,"fontColor":"clRed","fontItalic":false,"fontName":"Verdana","fontSize":12,"fontUnderlined":false,"id":1,"left":0,"mask":null},{"alignment":"L","columns":1,"component":"RA","fontBol
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dowText","fontItalic":false,"fontName":"MS Sans Serif","fontSize":10,"fontUnderlined":false,"id":1470,"left":2,"mask":null}],"info":{"author":null,"auxDate":null,"auxVersion":null,"copyrightText":"Copyright [1989] by the American Psycholo
gical Association. Reproduced with permission. The official citation that should be used in referencing this material is [Smith CS, Reilly C, Midkiff K. Evaluation of three circadian rhythm questionnaires with suggestions for an improved m
easure of morningness. J Appl Psychol. Oct 1989;74(5):728-738]. The use of APA information does not imply endorsement by APA.","copyrighted":true,"dllDate":null,"dllVersion":null,"enteredBy":"BARRY DELLINGER","entryDate":"2019-07-01","fullT
ext":true,"id":260,"lastEditDate":3190927.1119,"lastEditedBy":"DELLINGER,BARRY","legacy":false,"licenseCurrent":true,"name":"CMQ","national":true,"normSample":null,"operational":"Y","printTitle":" Composite Morningness Questionnaire (CMQ)",
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emplate":"|.|.|Composite Morningness Questionnaire (CMQ) |\r\n | Date Given: <.Date_Given.>| Clinician: <.Staff_Ordered_By.>| \r\nLocation: <.Location.>| | Veteran: <.Patient_Name_Last_First.>| \r\nSSN: <.Patient_SSN.>| DOB
: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)\r\n| Gender: <.Patient_Gender.>| |\r\n \r\nCMQ Total Score = <-CMQ Total Score->| |\r\n \r\nA score of 22 or below indicates an evening type, a score above 44 indicates |\r\n a morning type, a
nd scores in between receive a classification of|\r\n intermediate.| |\r\n \r\nQuestions and Answers:| |\r\n \r\n1. Considering only your own \"feeling best\" rhythm, at what time would you get|\r\n up if you were entirely free to plan y
our day?|\r\n <*Answer_8470*>||\r\n 2. Considering your only \"feeling best\" rhythm, at what time would you go to|\r\n bed if you were entirely free to plan your evening?|\r\n <*Answer_8471*>||\r\n 3. Assuming normal circumstance,
how easy do you find getting up in the |\r\n morning?|\r\n <*Answer_8472*>||\r\n 4. How alert do you feel during the first half hour after having awakened|\r\n in the morning?|\r\n <*Answer_8473*>||\r\n 5. During the first half
hour after having awakened in the morning, how |\r\n tired to you feel?|\r\n <*Answer_8474*>||\r\n 6. You have decided to engage in some physical exercise. A friend suggests|\r\n that you do this one hour twice a week and the bes
t time for him is |\r\n 7:00-8:00 a.m. Bearing in mind nothing else but your own \"feeling best\"|\r\n rhythm, how do you think you would perform?|
\r\n <*Answer_8475*>||\r\n 7. At what time in the evening do you feel tired and, as a result, in |\r\n need of sleep?|\r\n <*Answer_8476*>||\r\n 8. You wish to be at your peak performance for a test which you know is |\r\n going
to be mentally exhausting and lasting for two hours. You are|\r\n entirely free to plan your day, and considering only your own \"feeling|\r\n best\" rhythm, which ONE of the four testing times would you choose?|\r\n <*Answer_8477
*>||\r\n 9. One hears about \"morning\" and \"evening\" types of people. Which ONE |\r\n of these types do you consider yourself to be?|\r\n <*Answer_8478*>||\r\n10. When would you prefer to rise (provided you have a full day's work-
ll,"id":6779,"instrument":147,"introDisplay":91588,"introId":1716,"introText":"|\r\nIf you answered YES to one or more of these questions, please continue with Part B.| |\r\n \r\n| |PART B Instructions: The following questions refer to the
|\r\n 8 hours) if you were totally free to arrange your time?|\r\n <*Answer_8479*>||\r\n11. If you always had to rise at 6:00 a.m., what do you think it would |\r\n be like?|\r\n <*Answer_8480*>||\r\n12. How long a time does it
usually take before you \"recover your senses\"|\r\n in the morning after rising from a night's sleep?|\r\n <*Answer_8481*>||\r\n13. Please indicate to what extend you are a morning or evening active |\r\n individual.|\r\n <*An
swer_8482*>\r\n| | \r\nInformation contained in this note is based on a self-report assessment|\r\n and is not sufficient to use alone for diagnostic purposes. Assessment|\r\n results should be verified for accuracy and used in conjunction
with |\r\n other diagnostic activities.||\r\n \r\nCopyright [1989] by the American Psychological Association. Reproduced |\r\n with permission. The official citation that should be used in referencing|\r\n this material is [Smith CS, Reill
y C, Midkiff K. Evaluation of three |\r\n circadian rhythm questionnaires with suggestions for an improved measure|\r\n of morningness. J Appl Psychol. Oct 1989;74(5):728-738]. The use of APA|\r\n information does not imply endorsement by A
PA.\r\n$~"},"scaleGroup":[{"grid1":null,"grid2":null,"grid3":null,"id":309,"instrument":260,"name":"CMQ","ordInc":1,"ordMax":65,"ordMin":0,"ordTitle":"SCORE","scale":[{"groupId":309,"id":1335,"name":"CMQ Total Score","sequence":1,"xLabel":n
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repeated thoughts, images, urges or behaviors identified in Part A. Consider your experience during the past 30|\r\n days when selecting an answer. Select the most appropriate number from 0 to 4. | |\r\n \r\nIn the past month... ","max":0,
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instrument":261,"introDisplay":1470,"introId":2432,"introText":" Here are a number of events that people sometimes experience in relation to their use of alcohol and other drugs.\r\nRead each one carefully and then indicate how often each o
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"min":0,"questionDisplay":91589,"questionId":6834,"questionText":"On average, how much time is occupied by these thoughts or behaviors each day?","required":false,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":260},{"choice":[{"
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ull,"max":3,"min":0,"questionDisplay":1470,"questionId":8483,"questionText":"In the past 30 days, I have been unhappy because of my drinking or drug \r\nuse.","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":2},{"c
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r":2,"hint":null,"id":8484,"instrument":261,"introDisplay":1470,"introId":null,"introText":null,"max":3,"min":0,"questionDisplay":1470,"questionId":8484,"questionText":" In the past 30 days, because of my drinking or drug use I have not eat
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questionText":"In the past 30 days, I have failed to do what was expected of me because \r\nof my drinking or drug use.","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":4},{"choice":[{"choiceId":5015,"choiceText":
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30 days, I have felt guilty or ashamed because of my drinking \r\nor drug use.","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":5},{"choice":[{"choiceId":5015,"choiceText":"Never","ien":109002,"legacyValue":0,"se
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,"introText":null,"max":3,"min":0,"questionDisplay":1470,"questionId":8487,"questionText":"In the past 30 days, I have taken foolish risks when I have been drinking \r\nor using drugs.","required":true,"responseTypeId":1,"responseTypeText":
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ier":1,"choiceIdentifierIen":37624,"choiceTypeId":46634,"designator":"2.","hint":null,"id":6760,"instrument":147,"introDisplay":91544,"introId":1712,"introText":"General Instructions: The questions below are designed to help health profess
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to one or more of these questions, please continue with Part B.| |\r\n \r\n| |PART B Instructions: The following questions refer to the repeated thoughts, images, urges or behaviors identified in Part A. Consider your experience during the
\r\ngrowth as a person.","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":13},{"choice":[{"choiceId":5015,"choiceText":"Never","ien":109002,"legacyValue":0,"sequence":1},{"choiceId":5016,"choiceText":"Once or a fe
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Patient_SSN.>| DOB: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)\r\n| Gender: <.Patient_Gender.>| |\r\n \r\nSession number: <*Answer_8529*>| |\r\n \r\nSIP-AD PAST 30-DAY TOTAL SCORE = <-PAST 30 DAY TOTAL SCORE->||\r\n \r\nSubscale Scores
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scores range from 0-45. Higher scores indicate more |\r\n negative consequences associated with drinking or drug use within the |
\r\n past 30 days. Subscale scores range from 0-9.| |\r\n \r\n \r\nQuestions and Answers||\r\n \r\n 1. I have been unhappy because of my drinking or drug use.|\r\n <*Answer_8483*>| |\r\n \r\n 2. Because of my drinking or drug use I have
not eaten.|\r\n <*Answer_8484*>| |\r\n \r\n 3. I have failed to do what was expected of me because of my drinking or |\r\n drug use.|\r\n <*Answer_8485*>| |\r\n \r\n 4. I have felt guilty or ashamed because of my drinking or dr
ug use.|\r\n <*Answer_8486*>| |\r\n \r\n 5. I have taken foolish risks when I have been drinking or using drugs.|\r\n <*Answer_8487*>| |\r\n \r\n 6. When drinking or using drugs, I have done impulsive things that I|\r\n regrette
d later.|\r\n <*Answer_8488*>| |\r\n \r\n 7. I have been harmed by my drinking or drug use.|\r\n <*Answer_8489*>| |\r\n \r\n 8. I have had money problems because of my drinking or drug use.|\r\n <*Answer_8490*>| |\r\n \r\n 9. My
physical appearance has been harmed by my drinking or drug use.|\r\n <*Answer_8491*>| |\r\n \r\n10. My family has been hurt by my drinking or drug use.|\r\n <*Answer_8492*>| |\r\n \r\n11. A friendship or close relationship has been
damaged by my drinking or |\r\n drug use.|\r\n <*Answer_8493*>| |\r\n \r\n12. My drinking or drug use has gotten in the way of my growth as a person.|\r\n <*Answer_8494*>| |\r\n \r\n13. My drinking or drug use has damaged my so
cial life, popularity, and |\r\n reputation.|\r\n <*Answer_8495*>| |\r\n \r\n14. I have spent too much or lost a lot of money because of my drinking or |\r\n drug use.|\r\n <*Answer_8496*>| |\r\n \r\n15. I have had an accide
nt while using or under the influence of alcohol or |\r\n drugs.|\r\n <*Answer_8497*>||\r\n \r\nInformation contained in this note is based on a self-report assessment and |\r\n is not sufficient to use alone for diagnostic purposes
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. Assessment results |\r\n should be verified for accuracy and used in conjunction with other diagnostic |\r\n activities.| |\r\n \r\n$~"},"scaleGroup":[{"grid1":null,"grid2":null,"grid3":null,"id":310,"instrument":261,"name":"SIP-AD-30","o
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l":true},"report":{"id":185,"instrument":262,"template":"|.|.|SHORT INVENTORY OF PROBLEMS - AD (SIP-AD-START) |\r\n | Date Given: <.Date_Given.>| Clinician: <.Staff_Ordered_By.>| \r\nLocation: <.Location.>| | Veteran: <.Patient
_Name_Last_First.>| \r\nSSN: <.Patient_SSN.>| DOB: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)\r\n| Gender: <.Patient_Gender.>| |\r\n \r\nSession number: <*Answer_8528*> | |\r\n \r\nSIP-AD-LIFETIME TOTAL SCORE = <-LIFETIME SCORE->||\r
\n \r\nLifetime Total scores range from 0-15. Higher scores indicate more negative|\r\n consequences associated with drinking or drug use across the lifetime.||\r\n \r\nSIP-AD PAST 30-DAY TOTAL SCORE = <-30-DAY TOTAL SCORE->||\r\n \r\nSubsc
ale Scores:||\r\n \r\nPhysical = <-Physical->|\r\n Interpersonal = <-Interpersonal->|\r\n Intrapersonal = <-Intrapersonal->|\r\n Impulse control = <-Impulse control->|\r\n Social Responsibility = <-Social Responsibility->||\r\n \r\nPast 30-
day total scores range from 0-45. Higher scores indicate more negative|\r\n consequences associated with drinking or drug use within the past 30 days.|\r\n Subscale scores range from 0-9.||\r\n \r\nQuestions and Answers||\r\n \r\nI have bee
n unhappy because of my drinking or drug use.|\r\n 1a. Ever: <*Answer_8498*>|\r\n 1b. In the past 30 days: <*Answer_8499*>| |\r\n \r\nBecause of my drinking or drug use I have not eaten.|\r\n 2a. Ever: <*Answer_8500*>|\r\n 2b. In th
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e past 30 days: <*Answer_8501*>| |\r\n \r\nI have failed to do what was expected of me because of my drinking or drug use.|\r\n 3a. Ever: <*Answer_8502*>|
\r\n 3b. In the past 30 days: <*Answer_8503*>| |\r\n \r\nI have felt guilty or ashamed because of my drinking or drug use.|\r\n 4a. Ever: <*Answer_8504*>|\r\n 4b. In the past 30 days: <*Answer_8505*>| |\r\n \r\nI have taken foolish ri
sks when I have been drinking or using drugs.|\r\n 5a. Ever: <*Answer_8506*>|\r\n 5b. In the past 30 days: <*Answer_8507*>| |\r\n \r\nWhen drinking or using drugs, I have done impulsive things that I regretted |\r\n later.|\r\n 6a. Ev
er: <*Answer_8508*>|\r\n 6b. In the past 30 days: <*Answer_8509*>| |\r\n \r\nI have been harmed by my drinking or drug use.|\r\n 7a. Ever: <*Answer_8510*>|\r\n 7b. In the past 30 days: <*Answer_8511*>| |\r\n \r\nI have had money probl
ems because of my drinking or drug use.|\r\n 8a. Ever: <*Answer_8512*>|\r\n 8b. In the past 30 days: <*Answer_8513*>| |\r\n \r\nMy physical appearance has been harmed by my drinking or drug use.|\r\n 9a. Ever: <*Answer_8514*>|\r\n 9
b. In the past 30 days: <*Answer_8515*>| |\r\n \r\nMy family has been hurt by my drinking or drug use.|\r\n 10a. Ever: <*Answer_8516*>|\r\n 10b. In the past 30 days: <*Answer_8517*>| |\r\n \r\nA friendship or close relationship has been
damaged by my drinking or drug use.|\r\n 11a. Ever: <*Answer_8518*>|\r\n 11b. In the past 30 days: <*Answer_8519*>| |\r\n \r\nMy drinking or drug use has gotten in the way of my growth as a person.|\r\n 12a. Ever: <*Answer_8520*>|\r\
n 12b. In the past 30 days: <*Answer_8521*>||\r\n \r\nMy drinking or drug use has damaged my social life, popularity, and |\r\n reputation.|\r\n 13a. Ever: <*Answer_8522*>|\r\n 13b. In the past 30 days: <*Answer_8523*>| |\r\n \r\nI ha
ve spent too much or lost a lot of money because of my drinking or |\r\n drug use.|\r\n 14a. Ever: <*Answer_8524*>|\r\n 14b. In the past 30 days: <*Answer_8525*>| |\r\n \r\nI have had an accident while using or under the influence of al
cohol or |\r\n drugs.|\r\n 15a. Ever: <*Answer_8526*>|\r\n 15b. In the past 30 days: <*Answer_8527*>| |\r\n \r\nInformation contained in this note is based on a self-report assessment and|\r\n is not sufficient to use alone for diagnost
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repeated thoughts, images, urges or behaviors identified in Part A. Consider your experience during the past 30|\r\n days when selecting an answer. Select the most appropriate number from 0 to 4. | |\r\n \r\nIn the past month... ","max":0
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0-92. Higher scores indicate more borderline symptoms.| |\r\n \r\n Questions and Answers| |\r\n 1. It was hard for me to concentrate|\r\n <*Answer_7000*>|\r\n \r\n 2. I felt helpless|\r\n <*Answer_7001*>|\r\n \r\n 3. I was ab
sent-minded and unable to remember what I was actually doing|\r\n <*Answer_7002*>|\r\n \r\n 4. I felt disgust|\r\n <*Answer_7003*>|\r\n \r\n 5. I thought of hurting myself|\r\n <*Answer_7004*>|\r\n \r\n 6. I didn't trust o
ther people|\r\n <*Answer_7005*>|\r\n \r\n 7. I didn't believe in my right to live|\r\n <*Answer_7006*>|\r\n \r\n 8. I was lonely|\r\n <*Answer_7007*>|\r\n \r\n 9. I experienced stressful inner tension|\r\n <*Answer_7
008*>|\r\n \r\n 10. I had images that I was very much afraid of|\r\n <*Answer_7009*>|\r\n \r\n 11. I hated myself|\r\n <*Answer_7010*>|\r\n \r\n 12. I wanted to punish myself|\r\n <*Answer_7011*>| \r\n \r\n13. I suffered from
shame|\r\n <*Answer_7012*>|\r\n \r\n 14. My mood rapidly cycled in terms of anxiety, anger, and depression|\r\n <*Answer_7013*>|\r\n \r\n 15. I suffered from voices and noises from inside or outside my head|\r\n <*Answer_701
4*>|\r\n \r\n 16. Criticism had a devastating effect on me|\r\n <*Answer_7015*>|\r\n \r\n 17. I felt vulnerable|\r\n <*Answer_7016*>|\r\n \r\n 18. The idea of death had a certain fascination for me|\r\n <*Answer_7017*>|\r\n \
r\n 19. Everything seemed senseless to me|\r\n <*Answer_7018*>|\r\n \r\n 20. I was afraid of losing control|\r\n <*Answer_7019*>|\r\n \r\n 21. I felt disgusted by myself|\r\n <*Answer_7020*>|\r\n \r\n 22. I felt as if I was f
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