| SPECIFICATION |
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he Q-LES-Q-SF is copyrighted by Jean Endicott, Ph.D. Permission granted to\r\n electronically reproduce for clinicians use and research in non-industry\r\n studies. For other uses, contact copyright holder.\", \r\n \"restartDays\": 2, \r\n
\"printTitle\": \"Quality of Life Enjoyment and Satisfaction Questionnaire - Short Form\", \r\n \"content\":[\r\n {\"id\": \"i2382\", \"type\": \"IntroText\", \r\n \"text\": \"INSTRUCTIONS: Read each question carefully and respond as i
nstructed. <br \/> <br\r\n \/> Taking everything into consideration, during the past week how satisfied have\r\n you been with:\"\r\n },
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/> <br\r\n \/> Taking everything into consideration, during the past week how satisfied have\r\n you been with:\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c3921\", \"text\": \"1. Very Poor\", \"quickKey\": 1}, \r\n
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"id\": \"q8212\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"2. Your mood?\", \r\n \"intro\": \" Taking everything into consideration, during the last week how satisfied have\r\n you been wit
h:\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c3921\", \"text\": \"1. Very Poor\", \"quickKey\": 1}, \r\n {\"id\": \"c3922\", \"text\": \"2. Poor\", \"quickKey\": 2}, \r\n {\"id\": \"c3923\", \"text\": \"3.
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\"text\": \"Taking everything into consideration, during the past week how satisfied have you\r\n been with:\"\r\n }, \r\n {\"id\": \"q8213\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"3.
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\r\n }, \r\n {\"id\": \"q8214\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"4. Your household activities?\", \r\n \"intro\": \" Taking everything into consideration, during the last week
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", \"type\": \"IntroText\", \r\n \"text\": \"Taking everything into consideration, during the past week how satisfied have you\r\n been with:\"\r\n }, \r\n {\"id\": \"q8215\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inli
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{\"id\": \"c3921\", \"text\": \"1. Very Poor\", \"quickKey\": 1}, \r\n {\"id\": \"c3922\", \"text\": \"2. Poor\", \"quickKey\": 2},
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\"i2388\", \"type\": \"IntroText\", \r\n \"text\": \" Taking everything into consideration, during the last week how satisfied have\r\n you been with:\"\r\n }, \r\n {\"id\": \"q8216\", \"type\": \"ChoiceQuestion\", \"required\": tru
e, \"inline\": false, \r\n \"text\": \"6. Your family relationships?\", \r\n \"intro\": \" Taking everything into consideration, during the last week how satisfied have\r\n you been with:\", \r\n \"columns\": 1, \r\n \"choices\"
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during the past week how satisfied have you\r\n been with:\"\r\n }, \r\n {\"id\": \"q8217\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"7. Your leisure time activities?\", \r\n \"intro\
": \"Taking everything into consideration, during the past week how satisfied have you\r\n been with:\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c3921\", \"text\": \"1. Very Poor\", \"quickKey\": 1}, \r\n {\"id\
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8218\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"8. Your ability to function in daily life?\", \r\n \"intro\": \" Taking everything into consideration, during the last week how satisfied ha
ve\r\n you been with:\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c3921\", \"text\": \"1. Very Poor\", \"quickKey\": 1}, \r\n {\"id\": \"c3922\", \"text\": \"2. Poor\", \"quickKey\": 2}, \r\n {\"id\": \"c3923
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\"text\": \"9. Your sexual drive, interest and\/or performance?\", \r\n \"intro\": \"Taking everything into consideration, during the past week how satisfied have you\r\n been with:\", \r\n \"columns\": 1, \r\n \"choices\":[\r\
n {\"id\": \"c3921\", \"text\": \"1. Very Poor\", \"quickKey\": 1}, \r\n {\"id\": \"c3922\", \"text\": \"2. Poor\", \"quickKey\": 2}, \r\n {\"id\": \"c3923\", \"text\": \"3. Fair\", \"quickKey\": 3}, \r\n {\"id\": \"c3924\",
\"text\": \"4. Good\", \"quickKey\": 4}, \r\n {\"id\": \"c3925\", \"text\": \"5. Very Good\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"i2388\", \"type\": \"IntroText\", \r\n \"text\": \" Taking everything into consideration, dur
ing the last week how satisfied have\r\n you been with:\"\r\n },
\r\n {\"id\": \"q8220\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"10. Your economic status?\", \r\n \"intro\": \" Taking everything into consideration, during the last week how satisfied
have\r\n you been with:\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c3921\", \"text\": \"1. Very Poor\", \"quickKey\": 1}, \r\n {\"id\": \"c3922\", \"text\": \"2. Poor\", \"quickKey\": 2}, \r\n {\"id\": \"c39
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IntroText\", \r\n \"text\": \"Taking everything into consideration, during the past week how satisfied have you\r\n been with:\"\r\n }, \r\n {\"id\": \"q8221\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r
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\"c3921\", \"text\": \"1. Very Poor\", \"quickKey\": 1}, \r\n {\"id\": \"c3922\", \"text\": \"2. Poor\", \"quickKey\": 2}, \r\n {\"id\": \"c3923\", \"text\": \"3. Fair\", \"quickKey\": 3}, \r\n {\"id\": \"c3924\", \"text\": \"4
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eek how satisfied have\r\n you been with:\"\r\n }, \r\n {\"id\": \"q8222\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"12. Your ability to get around physically without feeling dizzy or uns
teady or\r\n falling?\", \r\n \"intro\": \" Taking everything into consideration, during the last week how satisfied have\r\n you been with:\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c3921\", \"text\": \"1. Very
Poor\", \"quickKey\": 1}, \r\n {\"id\": \"c3922\", \"text\": \"2. Poor\", \"quickKey\": 2}, \r\n {\"id\": \"c3923\", \"text\": \"3. Fair\", \"quickKey\": 3}, \r\n {\"id\": \"c3924\", \"text\": \"4. Good\", \"quickKey\": 4}, \r\
n {\"id\": \"c3925\", \"text\": \"5. Very Good\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"i2387\", \"type\": \"IntroText\", \r\n \"text\": \"Taking everything into consideration, during the past week how satisfied have you\r\n b
een with:\"\r\n }, \r\n {\"id\": \"q8223\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"13. Your vision in terms of ability to do work or hobbies?\", \r\n \"intro\": \"Taking everything i
nto consideration, during the past week how satisfied have you\r\n been with:\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c3921\", \"text\": \"1. Very Poor\", \"quickKey\": 1}, \r\n {\"id\": \"c3922\", \"text\":
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ceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"14. Your overall sense of well-being?\", \r\n \"intro\": \" Taking everything into consideration, during the last week how satisfied have\r\n you been with:\", \r\n
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{\"id\": \"q8225\", \"type\": \"ChoiceQuestion\", \"required\": false, \"inline\": false, \r\n \"text\": \"15. Your medication?\", \r\n \"intro\": \"Taking everything into consideration, during the past week how satisfied have you\r
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:\"\r\n }, \r\n {\"id\": \"q8226\", \"type\": \"ChoiceQuestion\", \"required\": false, \"inline\": false, \r\n \"text\": \"16. How would you rate your overall life satisfaction and contentment during the\r\n past week?\", \r\n \"
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tisfaction 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 D
OB: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)|\r\n Gender: <.Patient_Gender.>| |\r\nQuality of Life\/Life Enjoyment Percent of Max Score*: <*Answer_7779*>%|\r\nSatisfaction with Medications (Item 15)*: <*Answer_7771*> |\r\nSelf-Rating o
f Overall Satisfaction (Item 16)*: <*Answer_7772*>| |\r\n \r\n*Note: All scores reflect respondent satisfaction ratings for \"during the \r\npast week.\"| |\r\nQuestions and Answers | |\r\nTaking everything into consideration, during the pa
st 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*
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en with:|\r\n4. Your household activities?|\r\n <*Answer_8214*>| |\r\nTaking everything into consideration, during the past week how satisfied \r\nhave you been with:|\r\n5. Your social relationships?|\r\n <*Answer_8215*>| |\r\nTaking e
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en with:|\r\n7. Your leisure time activities?|\r\n <*Answer_8217*>| |\r\nTaking everything 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*
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ast week how satisfied \r\nhave you been with:|\r\n10. Your economic status?|\r\n <*Answer_8220*>| |\r\nTaking everything into consideration, during the past week how satisfied \r\nhave you been with:|\r\n11. Your living\/housing situati
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*Answer_8222*>| |\r\nTaking everything into consideration, during the past week how satisfied \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 consid
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\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 alon
e for diagnostic purposes. Assessment|\r\nresults should be 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 electroni
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