| SPECIFICATION |
{"test":[{"content":[{"choiceDisplay":114,"choiceTypeId":null,"designator":"1.","hint":null,"id":7258,"instrument":218,"introDisplay":113,"introId":null,"introText":null,"max":0,"min":0,"questionDisplay":112,"questionId":7313,"questionText"
ve you vomited?\" Observation:","required":false,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":40},{"choice":[{"choiceId":1366,"choiceText":"No tremor","ien":106571,"legacyValue":0,"sequence":1},{"choiceId":2444,"choiceText":"N
lood pressure:| <*Answer_7315*>| 4. NAUSEA AND VOMITING \r\n- Ask, \"Do you feel sick to your stomach? Have you vomited?\" Observation:| <*Answer_7316*>| 5. TREMOR - Arms extended and fingers spread apart. Observation:| <*Answer
_7318*>| 6. PAROXYSMAL \r\nSWEATS - Observation:| <*Answer_7320*>| 7. ANXIETY - Ask, \"Do you feel nervous?\" Observation:| <*Answer_7322*>| 8. AGITATION - Observation:| <*Answer_7324*>| 9. TACTILE DISTURBANCES -
\r\nAsk, \"Have you any itching, pins and needles sensations, any burning, any numbness, or do you feel bugs crawling on or under your skin?\" Observation:| <*Answer_7317*>| 10. AUDITORY DISTURBANCES - \r\nAsk, \"Are you more aware of s
ounds around you? Are they harsh? Do they frighten you? Are you hearing anything that is disturbing to you? Are you hearing things you know are not there?\" \r\nObservation: | <*Answer_7319*>| 11. VISUAL DISTURBANCES - Ask, \"Does th
e light appear to be too bright? Is its color different? Does it hurt your eyes? Are you seeing anything that is disturbing \r\nto you? Are you seeing things you know are not there?\" Observation: | <*Answer_7321*>| 12. HEADACHE, FUL
LNESS IN HEAD - Ask, \"Does your head feel different? Does it feel like there is a band \r\naround your head?\" Do not rate for dizziness or lightheadedness. Otherwise, rate severity:| <*Answer_7323*>| 13. ORIENTATION AND CLOUDING OF SE
NSORIUM - Ask, \"What day is this? Where are you? Who \r\nam I?\"| <*Answer_7325*>| | | Information contained in this note is based on a self-report assessment and is not sufficient to use alone for diagnostic purposes. Assessment resu
lts should be \r\nverified for accuracy and used in conjunction with other diagnostic activities and procedures.| $~"},"scaleGroup":[{"grid1":0,"grid2":10,"grid3":20,"id":244,"instrument":218,"name":"CIWA-AR","ordInc":10,"ordMax":67,"ordMi
n":0,"ordTitle":"Score","scale":[{"groupId":244,"id":980,"name":"Total Score","scoringKey":[{"id":9552,"questionId":7316,"scaleId":980,"targetText":"Intermittent nausea with dry heaves","value":4},{"id":9553,"questionId":7316,"scaleId":980,
"targetText":"Constant nausea, frequent dry heaves and vomiting","value":7},{"id":9555,"questionId":7317,"scaleId":980,"targetText":"Mild itching, pins and needles, burning or numbness","value":2},{"id":9556,"questionId":7317,"scaleId":980,
ot visible, but can be felt fingertip to fingertip","ien":106572,"legacyValue":1,"sequence":2},{"choiceId":2739,"choiceText":"Tremor 2","ien":106573,"legacyValue":2,"sequence":3},{"choiceId":2740,"choiceText":"Tremor 3","ien":106574,"legacy
"targetText":"Moderate itching, pins and needles, burning or numbness","value":3},{"id":9557,"questionId":7317,"scaleId":980,"targetText":"Moderately severe hallucinations","value":4},{"id":9558,"questionId":7317,"scaleId":980,"targetText":
"Severe hallucinations","value":5},{"id":9559,"questionId":7317,"scaleId":980,"targetText":"Extremely severe hallucinations","value":6},{"id":9560,"questionId":7317,"scaleId":980,"targetText":"Continuous hallucinations","value":7},{"id":956
1,"questionId":7318,"scaleId":980,"targetText":"Not visible, but can be felt fingertip to fingertip","value":1},{"id":9562,"questionId":7319,"scaleId":980,"targetText":"Very mild harshness or ability to frighten","value":1},{"id":9563,"ques
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:980,"targetText":"Moderately severe hallucinations","value":4},{"id":9566,"questionId":7319,"scaleId":980,"targetText":"Severe hallucinations","value":5},{"id":9567,"questionId":7319,"scaleId":980,"targetText":"Extremely severe hallucinati
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nId":7320,"scaleId":980,"targetText":"Beads of sweat obvious on forehead","value":4},{"id":9571,"questionId":7320,"scaleId":980,"targetText":"Drenching sweats","value":7},{"id":9572,"questionId":7321,"scaleId":980,"targetText":"Very mild se
nsitivity","value":1},{"id":9573,"questionId":7321,"scaleId":980,"targetText":"Mild sensitivity","value":2},{"id":9574,"questionId":7321,"scaleId":980,"targetText":"Moderate sensitivity","value":3},{"id":9575,"questionId":7321,"scaleId":980
,"targetText":"Moderately severe hallucinations","value":4},{"id":9576,"questionId":7321,"scaleId":980,"targetText":"Severe hallucinations","value":5},{"id":
9577,"questionId":7321,"scaleId":980,"targetText":"Extremely severe hallucinations","value":6},{"id":9578,"questionId":7321,"scaleId":980,"targetText":"Continuous hallucinations","value":7},{"id":9579,"questionId":7322,"scaleId":980,"target
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Text":"Mildly anxious","value":1},{"id":9580,"questionId":7322,"scaleId":980,"targetText":"Moderately anxious, or guarded, so anxiety is inferred","value":4},{"id":9581,"questionId":7322,"scaleId":980,"targetText":"Equivalent to acute panic
states as seen in severe delirium or acute schizophrenic reactions","value":7},{"id":9582,"questionId":7323,"scaleId":980,"targetText":"Very mild","value":1},{"id":9583,"questionId":7323,"scaleId":980,"targetText":"Mild","value":2},{"id":9
584,"questionId":7323,"scaleId":980,"targetText":"Moderate","value":3},{"id":9585,"questionId":7323,"scaleId":980,"targetText":"Moderately severe","value":4},{"id":9586,"questionId":7323,"scaleId":980,"targetText":"Severe","value":5},{"id":
9587,"questionId":7323,"scaleId":980,"targetText":"Very severe","value":6},{"id":9588,"questionId":7323,"scaleId":980,"targetText":"Extremely severe","value":7},{"id":9589,"questionId":7324,"scaleId":980,"targetText":"Somewhat more than nor
mal activity","value":1},{"id":9590,"questionId":7324,"scaleId":980,"targetText":"Moderately fidgety and restless","value":4},{"id":9591,"questionId":7324,"scaleId":980,"targetText":"Paces back and forth during most of the interview, or con
stantly thrashes about","value":7},{"id":9592,"questionId":7325,"scaleId":980,"targetText":"Cannot do serial additions or is uncertain about date","value":1},{"id":9593,"questionId":7325,"scaleId":980,"targetText":"Disoriented for date by n
o more than 2 calendar days","value":2},{"id":9594,"questionId":7325,"scaleId":980,"targetText":"Disoriented for date by more than 2 calendar days","value":3},{"id":9595,"questionId":7325,"scaleId":980,"targetText":"Disoriented for place\/o
r person","value":4},{"id":9596,"questionId":7318,"scaleId":980,"targetText":"Moderate, with patient's arms extended","value":4},{"id":9597,"questionId":7318,"scaleId":980,"targetText":"Severe, even with arms not extended","value":7},{"id":
9599,"questionId":7316,"scaleId":980,"targetText":"Nausea 2","value":2},{"id":9600,"questionId":7316,"scaleId":980,"targetText":"Nausea 3","value":3},{"id":9601,"questionId":7316,"scaleId":980,"targetText":"Nausea 5","value":5},{"id":9602,"
questionId":7316,"scaleId":980,"targetText":"Nausea 6","value":6},{"id":9603,"questionId":7318,"scaleId":980,"targetText":"Tremor 2","value":2},{"id":9604,"questionId":7318,"scaleId":980,"targetText":"Tremor 3","value":3},{"id":9605,"questi
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onId":7318,"scaleId":980,"targetText":"Tremor 5","value":5},{"id":9606,"questionId":7318,"scaleId":980,"targetText":"Tremor 6","value":6},{"id":9607,"questionId":7320,"scaleId":980,"targetText":"Sweating 2","value":2},{"id":9608,"questionId
":7320,"scaleId":980,"targetText":"Sweating 3","value":3},{"id":9609,"questionId":7320,"scaleId":980,"targetText":"Sweating 5","value":5},{"id":9610,"questionId":7320,"scaleId":980,"targetText":"Sweating 6","value":6},{"id":9611,"questionId
":7322,"scaleId":980,"targetText":"Anxiety 2","value":2},{"id":9612,"questionId":7322,"scaleId":980,"targetText":"Anxiety 3","value":3},{"id":9613,"questionId":7322,"scaleId":980,"targetText":"Anxiety 5","value":5},{"id":9614,"questionId":7
322,"scaleId":980,"targetText":"Anxiety 6","value":6},{"id":9615,"questionId":7324,"scaleId":980,"targetText":"Agitation 2","value":2},{"id":9616,"questionId":7324,"scaleId":980,"targetText":"Agitation 3","value":3},{"id":9617,"questionId":
7324,"scaleId":980,"targetText":"Agitation 5","value":5},{"id":9618,"questionId":7324,"scaleId":980,"targetText":"Agitation 6","value":6},{"id":9631,"questionId":7316,"scaleId":980,"targetText":"Showing mild nausea and no vomiting","value":
1},{"id":9632,"questionId":7317,"scaleId":980,"targetText":"Very mild itching, pins and needles, burning or numbness","value":1}],"sequence":1,"xLabel":"Score"}],
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41842,"choiceTypeId":50852,"designator":"5.","hint":null,"id":7263,"instrument":218,"introDisplay":128,"introId":null,"introText":null,"max":0,"min":0,"questionDisplay":127,"questionId":7318,"questionText":"TREMOR - Arms extended and finger
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01.91:9556","601.91:9557","601.91:9558","601.91:9559","601.91:9560","601.91:9561","601.91:9562","601.91:9563","601.91:9564","601.91:9565","601.91:9566","601.91:9567","601.91:9568","601.91:9569","601.91:9570","601.91:9571","601.91:9572","601
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"601.91:9632"]}],"xchg":{"date":3200312.18144,"description":"(no description)","name":"YS*5.01*141 CIWA-AR REPORT","source":"MELDRUM@CAMP MASTER","version":1.02}}
t":"Barely perceptible sweating, palms moist","ien":106580,"legacyValue":1,"sequence":2},{"choiceId":2743,"choiceText":"Sweating 2","ien":106581,"legacyValue":2,"sequence":3},{"choiceId":2744,"choiceText":"Sweating 3","ien":106582,"legacyVa
lue":3,"sequence":4},{"choiceId":2457,"choiceText":"Beads of sweat obvious on forehead","ien":106583,"legacyValue":4,"sequence":5},{"choiceId":2745,"choiceText":
"Sweating 5","ien":106584,"legacyValue":5,"sequence":6},{"choiceId":2746,"choiceText":"Sweating 6","ien":106585,"legacyValue":6,"sequence":7},{"choiceId":2460,"choiceText":"Drenching sweats","ien":106586,"legacyValue":7,"sequence":8}],"choi
ceDisplay":135,"choiceIdentifier":0,"choiceIdentifierIen":41843,"choiceTypeId":50853,"designator":"6.","hint":null,"id":7265,"instrument":218,"introDisplay":134,"introId":null,"introText":null,"max":0,"min":0,"questionDisplay":133,"question
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Id":7320,"questionText":"PAROXYSMAL SWEATS - Observation:","required":false,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":60},{"choice":[{"choiceId":2464,"choiceText":"No anxiety, at ease","ien":106587,"legacyValue":0,"sequence
":1},{"choiceId":2465,"choiceText":"Mildly anxious","ien":106588,"legacyValue":1,"sequence":2},{"choiceId":2747,"choiceText":"Anxiety 2","ien":106589,"legacyValue":2,"sequence":3},{"choiceId":2748,"choiceText":"Anxiety 3","ien":106590,"lega
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{"choiceId":2750,"choiceText":"Anxiety 6","ien":106593,"legacyValue":6,"sequence":7},{"choiceId":2471,"choiceText":"Equivalent to acute panic states as seen in severe delirium or acute schizophrenic reactions","ien":106594,"legacyValue":7,"
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play":139,"questionId":7322,"questionText":"ANXIETY - Ask, \"Do you feel nervous?\" Observation:","required":false,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":70},{"choice":[{"choiceId":2473,"choiceText":"Normal activity","ie
n":106595,"legacyValue":0,"sequence":1},{"choiceId":2474,"choiceText":"Somewhat more than normal activity","ien":106596,"legacyValue":1,"sequence":2},{"choiceId":2751,"choiceText":"Agitation 2","ien":106597,"legacyValue":2,"sequence":3},{"c
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:106600,"legacyValue":5,"sequence":6},{"choiceId":2754,"choiceText":"Agitation 6","ien":106601,"legacyValue":6,"sequence":7},{"choiceId":2480,"choiceText":"Paces back and forth during most of the interview, or constantly thrashes about","ie
n":106602,"legacyValue":7,"sequence":8}],"choiceDisplay":147,"choiceIdentifier":0,"choiceIdentifierIen":41845,"choiceTypeId":50855,"designator":"8.","hint":null,"id":7269,"instrument":218,"introDisplay":146,"introId":null,"introText":null,"
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cyValue":0,"sequence":1},{"choiceId":2437,"choiceText":"Very mild itching, pins and needles, burning or numbness","ien":106604,"legacyValue":1,"sequence":2},{"choiceId":2438,"choiceText":"Mild itching, pins and needles, burning or numbness"
,"ien":106605,"legacyValue":2,"sequence":3},{"choiceId":2439,"choiceText":"Moderate itching, pins and needles, burning or numbness","ien":106606,"legacyValue":3,"sequence":4},{"choiceId":2440,"choiceText":"Moderately severe hallucinations",
"ien":106607,"legacyValue":4,"sequence":5},{"choiceId":2441,"choiceText":"Severe hallucinations","ien":106608,"legacyValue":5,"sequence":6},{"choiceId":2442,"choiceText":"Extremely severe hallucinations","ien":106609,"legacyValue":6,"sequen
ce":7},{"choiceId":2443,"choiceText":"Continuous hallucinations","ien":106610,"legacyValue":7,"sequence":8}],"choiceDisplay":126,"choiceIdentifier":0,
"choiceIdentifierIen":41846,"choiceTypeId":50856,"designator":"9.","hint":null,"id":7262,"instrument":218,"introDisplay":125,"introId":null,"introText":null,"max":0,"min":0,"questionDisplay":124,"questionId":7317,"questionText":"TACTILE DIS
TURBANCES - Ask, \"Have you any itching, pins and needles sensations, any burning, any numbness, or do you feel bugs crawling on or under your skin?\" Observation:","required":false,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence"
:90},{"choice":[{"choiceId":614,"choiceText":"Not present","ien":106611,"legacyValue":0,"sequence":1},{"choiceId":2450,"choiceText":"Very mild harshness or ability to frighten","ien":106612,"legacyValue":1,"sequence":2},{"choiceId":2451,"ch
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"Moderately severe hallucinations","ien":106615,"legacyValue":4,"sequence":5},{"choiceId":2441,"choiceText":"Severe hallucinations","ien":106616,"legacyValue":5,"sequence":6},{"choiceId":2442,"choiceText":"Extremely severe hallucinations","
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ien":106617,"legacyValue":6,"sequence":7},{"choiceId":2443,"choiceText":"Continuous hallucinations","ien":106618,"legacyValue":7,"sequence":8}],"choiceDisplay":132,"choiceIdentifier":0,"choiceIdentifierIen":41847,"choiceTypeId":50857,"desig
nator":"10.","hint":null,"id":7264,"instrument":218,"introDisplay":131,"introId":null,"introText":null,"max":0,"min":0,"questionDisplay":130,"questionId":7319,"questionText":"AUDITORY DISTURBANCES - Ask, \"Are you more aware of sounds aroun
d you? Are they harsh? Do they frighten you? Are you hearing anything that is disturbing to you? Are you hearing things you know are \r\nnot there?\" Observation:\r\n","required":false,"responseTypeId":1,"responseTypeText":"MCHOICE","sequen
ce":100},{"choice":[{"choiceId":614,"choiceText":"Not present","ien":106619,"legacyValue":0,"sequence":1},{"choiceId":2461,"choiceText":"Very mild sensitivity","ien":106620,"legacyValue":1,"sequence":2},{"choiceId":2462,"choiceText":"Mild s
ensitivity","ien":106621,"legacyValue":2,"sequence":3},{"choiceId":2463,"choiceText":"Moderate sensitivity","ien":106622,"legacyValue":3,"sequence":4},{"choiceId":2440,"choiceText":"Moderately severe hallucinations","ien":106623,"legacyValu
e":4,"sequence":5},{"choiceId":2441,"choiceText":"Severe hallucinations","ien":106624,"legacyValue":5,"sequence":6},{"choiceId":2442,"choiceText":"Extremely severe hallucinations","ien":106625,"legacyValue":6,"sequence":7},{"choiceId":2443,
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itute Withdrawal Assessment - Alcohol Revised| | Date Given: <.Date_Given.>| Clinician: <.Staff_Ordered_By.>| Location: <.Location.>| | Veteran: <.Patient_Name_Last_First.>| SSN: \r\n<.Patient_SSN.>| DOB: <.Patient_Date_Of_Birth.> (<.Patien
t_Age.>)| Gender: <.Patient_Gender.>| | | CIWA-AR| Total Score: <-Total Score->| | Scores of less than 8 indicate mild withdrawal, 8-15\r\n indicate moderate| withdrawal (marked autonomic arousal) and >15 indicate severe withdrawal| and
are also predictive of the development of seizures and delirium.| | Questions and Answers| | 1. \r\nTime (use 24 hour clock, midnight is 00:00):| <*Answer_7313*>| 2. Pulse or heart rate (taken for one minute):| <*Answer_7314*>| 3. B
|
