| SPECIFICATION |
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me. Please do not attempt to score.","max":0,"min":0,"questionDisplay":81372,"questionId":9581,"questionText":"Difficulty making decisions","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":150},{"choice":[{"choiceI
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"Moderate - Often present, occasionally disrupts my activities; I can usually continue what I'm doing with some effort; I feel somewhat concerned.","ien":109860,"legacyValue":2,"sequence":3},{"choiceId":6178,"choiceText":"Severe - Frequentl
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7,"instrument":346,"introDisplay":81371,"introId":2617,"introText":"Symptom Report\r\n|Please rate the following symptoms with regard to how much they have disturbed you\r\nSINCE YOUR INJURY. The purpose of this inventory is to track sympt
oms over time. Please do not attempt to score.","max":0,"min":0,"questionDisplay":81372,"questionId":9582,"questionText":"Slowed thinking, difficulty getting organized, can't finish things","required":true,"responseTypeId":1,"responseTypeTe
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ally continue what I'm doing with some effort; I feel somewhat concerned.","ien":109860,"legacyValue":2,"sequence":3},{"choiceId":6178,"choiceText":"Severe - Frequently present and disrupts activities; I can only do things that are fairly s
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om Report\r\n|Please rate the following symptoms with regard to how much they have disturbed you\r\nSINCE YOUR INJURY. The purpose of this inventory is to track symptoms over time. Please do not attempt to score.","max":0,"min":0,"question
Display":81372,"questionId":9583,"questionText":"Fatigue, loss of energy, getting tired easily","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":170},{"choice":[{"choiceId":6175,"choiceText":"None - Rarely if ever
present; not a problem at all","ien":109858,"legacyValue":0,"sequence":1},{"choiceId":6176,"choiceText":"Mild - Occasionally present, but it does not disrupt my activities; I can usually continue what I'm doing; doesn't really concern me.",
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\r\n|Please rate the following symptoms with regard to how much they have disturbed you\r\nSINCE YOUR INJURY. The purpose of this inventory is to track symptoms over time. Please do not attempt to score.","max":0,"min":0,"questionDisplay":
81372,"questionId":9584,"questionText":"Difficulty falling or staying asleep","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":180},{"choice":[{"choiceId":6175,"choiceText":"None - Rarely if ever present; not a pro
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ceTypeId":15275,"designator":"19.","hint":null,"id":9650,"instrument":346,"introDisplay":81371,"introId":2617,"introText":"Symptom Report\r\n|Please rate the following symptoms with regard to how much they have disturbed you\r\nSINCE YOUR I
NJURY. The purpose of this inventory is to track symptoms over time. Please do not attempt to score.","max":0,"min":0,"questionDisplay":81372,"questionId":9585,"questionText":"Feeling anxious or tense","required":true,"responseTypeId":1,"r
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but it does not disrupt my activities; I can usually continue what I'm doing; doesn't really concern me.","ien":109859,"legacyValue":1,"sequence":2},{"choiceId":6177,"choiceText":"Moderate - Often present, occasionally disrupts my activiti
s inventory is to track symptoms over time. Please do not attempt to score.","max":0,"min":0,"questionDisplay":81372,"questionId":9568,"questionText":"Loss of balance","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","sequenc
es; I can usually continue what I'm doing with some effort; I feel somewhat concerned.","ien":109860,"legacyValue":2,"sequence":3},{"choiceId":6178,"choiceText":"Severe - Frequently present and disrupts activities; I can only do things that
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oText":"Symptom Report\r\n|Please rate the following symptoms with regard to how much they have disturbed you\r\nSINCE YOUR INJURY. The purpose of this inventory is to track symptoms over time. Please do not attempt to score.","max":0,"min
":0,"questionDisplay":81372,"questionId":9586,"questionText":"Feeling depressed or sad","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":200},{"choice":[{"choiceId":6175,"choiceText":"None - Rarely if ever present;
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"Moderate - Often present, occasionally disrupts my activities; I can usually continue what I'm doing with some effort; I feel somewhat concerned.","ien":109860,"legacyValue":2,"sequence":3},{"choiceId":6178,"choiceText":"Severe - Frequentl
y present and disrupts activities; I can only do things that are fairly simple or take little effort; I feel I need help.","ien":109861,"legacyValue":3,"sequence":4},{"choiceId":6179,"choiceText":"Very Severe - Almost always present and I h
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e":20},{"choice":[{"choiceId":6175,"choiceText":"None - Rarely if ever present; not a problem at all","ien":109858,"legacyValue":0,"sequence":1},{"choiceId":6176,"choiceText":"Mild - Occasionally present, but it does not disrupt my activiti
2,"instrument":346,"introDisplay":81371,"introId":2617,"introText":"Symptom Report\r\n|Please rate the following symptoms with regard to how much they have disturbed you\r\nSINCE YOUR INJURY. The purpose of this inventory is to track sympt
oms over time. Please do not attempt to score.","max":0,"min":0,"questionDisplay":81372,"questionId":9587,"questionText":"Irritability, easily annoyed","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":210},{"choice
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ly continue what I'm doing; doesn't really concern me.","ien":109859,"legacyValue":1,"sequence":2},{"choiceId":6177,"choiceText":"Moderate - Often present, occasionally disrupts my activities; I can usually continue what I'm doing with some
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g symptoms with regard to how much they have disturbed you\r\nSINCE YOUR INJURY. The purpose of this inventory is to track symptoms over time. Please do not attempt to score.","max":0,"min":0,"questionDisplay":81372,"questionId":9588,"ques
tionText":"Poor frustration tolerance, feeling easily overwhelmed by things","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":220}],"display":[{"alignment":"L","columns":1,"component":"RA","fontBold":false,"fontCol
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es; I can usually continue what I'm doing; doesn't really concern me.","ien":109859,"legacyValue":1,"sequence":2},{"choiceId":6177,"choiceText":"Moderate - Often present, occasionally disrupts my activities; I can usually continue what I'm
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fontSize":8,"fontUnderlined":false,"id":81372,"left":2,"mask":null}],"info":{"author":"Conaton E:DoD Policy Guidance for Management of Mild Traumatic Brain Injury\/concussion in the Deployed Setting. Department of Defense; 2012.","auxDate":
null,"auxVersion":null,"copyrightText":"Used with permission: Cicerone,KD: J Head Tr Rehabil 1995;10(3):1-17","copyrighted":true,"dllDate":null,"dllVersion":null,"enteredBy":null,"entryDate":"2025-03-08","fullText":true,"id":346,"interpreti
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"operational":"Y","printTitle":"Neurobehavioral Symptom Inventory for Traumatic Brain Injury","publicationDate":null,"publisher":null,"purpose":null,"reference":"Vanderploeg RD, Silva MA, Soble JR, Curtiss G, Belanger HG, Donnell AJ, Scott
SG The structure of post-concussion symptoms on the Neurobehavioral Symptom Inventory: A comparison of alternative models, Journal of Head Trauma Rehabilitation, 20 November 2013","requireSignature":false,"requiresLicense":"N","scoringRevis
ion":1,"scoringRoutine":"YTSNSI","scoringTag":"DLLSTR","staffOnly":null,"submitNational":true,"suicideriskRoutine":null,"suicideriskTag":null,"targetPopulation":null,"version":null,"wasOperational":true},"report":{"id":350,"instrument":346,
"template":"|Neurobehavioral Symptom Inventory for Traumatic Brain Injury (NSI FOR TBI)\r\n| \r\n| Date Given: <.Date_Given.>\r\n| Clinician: <.Staff_Ordered_By.>\r\n| Location: <.Location.>\r\n| \r\n| Veteran: <.Patient_Name_La
st_First.>\r\n| SSN: <.Patient_SSN.>\r\n| DOB: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)\r\n| Gender: <.Patient_Gender.>\r\n| \r\n| NSI Subscales\r\n| Cognitive subscale = <-Cognitive subscale->\r\n| Mood-Behavioral sub
scale = <-Mood-Behavioral subscale->\r\n| Vestibular - Sensory subscale = <-Vestibular - Sensory subscale->\r\n| \r\n| \r\n|Questions and Answers:\r\n| \r\n| 1. Feeling dizzy\r\n| <*Answer_7771*>\r\n| 2. Loss of balance\
doing with some effort; I feel somewhat concerned.","ien":109860,"legacyValue":2,"sequence":3},{"choiceId":6178,"choiceText":"Severe - Frequently present and disrupts activities; I can only do things that are fairly simple or take little ef
r\n| <*Answer_7772*>\r\n| 3. Poor coordination, clumsy\r\n| <*Answer_7773*>\r\n| 4. Headaches\r\n| <*Answer_7774*>\r\n| 5. Nausea\r\n| <*Answer_7775*>\r\n| 6. Vision problems, blurring, trouble seeing\r\n
| <*Answer_7776*>\r\n| 7. Sensitivity to light\r\n| <*Answer_7777*>\r\n| 8. Hearing difficulty\r\n| <*Answer_7778*>\r\n| 9. Sensitivity to noise\r\n| <*Answer_7779*>\r\n| 10. Numbness or tingling on parts
of my body\r\n| <*Answer_7780*>\r\n| 11. Change in taste and\/or smell\r\n| <*Answer_7781*>\r\n| 12. Loss of appetite or increased appetite\r\n| <*Answer_7782*>\r\n| 13. Poor concentration, can't pay attention, easil
y distracted\r\n| <*Answer_7783*>\r\n| 14. Forgetfulness, can't remember things\r\n| <*Answer_7784*>\r\n| 15. Difficulty making decisions\r\n| <*Answer_7785*>\r\n| 16. Slowed thinking, difficulty getting organized, c
an't finish things\r\n| <*Answer_7786*>\r\n| 17. Fatigue, loss of energy, getting tired easily\r\n| <*Answer_7787*>\r\n| 18. Difficulty falling or staying asleep\r\n| <*Answer_7788*>\r\n| 19. Feeling anxious or tense
\r\n| <*Answer_7789*>\r\n| 20. Feeling depressed or sad\r\n| <*Answer_7790*>\r\n| 21. Irritability, easily annoyed\r\n| <*Answer_7791*>\r\n| 22. Poor frustration tolerance, feeling easily overwhelmed by things\r\n|
<*Answer_7792*>\r\n| \r\n|Information 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 con
junction with \r\n|other diagnostic activities."},"scaleGroup":[{"grid1":0,"grid2":0,"grid3":0,"id":419,"instrument":346,"name":"NSI FOR TBI","ordInc":5,"ordMax":55,"ordMin":0,"ordTitle":"NSI FOR TBI","scale":[{"groupId":419,"id":1607,"name
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Text":"Mild - Occasionally present, but it does not disrupt my activities; I can usually continue what I'm doing; doesn't really concern me.","value":1},{"id":16356,"questionId":9581,"scaleId":1607,"targetText":"Moderate - Often present, oc
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chool or home due to this.","value":4},{"id":16359,"questionId":9582,"scaleId":1607,"targetText":"None - Rarely if ever present; not a problem at all","value":0},{"id":16360,"questionId":9582,"scaleId":1607,"targetText":"Mild - Occasionally
present, but it does not disrupt my activities; I can usually continue what I'm doing; doesn't really concern me.","value":1},{"id":16361,"questionId":9582,"scaleId":1607,"targetText":"Moderate - Often present, occasionally disrupts my act
ivities; I can usually continue what I'm doing with some effort; I feel somewhat concerned.","value":2},{"id":16362,"questionId":9582,"scaleId":1607,"targetText":"Severe - Frequently present and disrupts activities; I can only do things tha
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","value":4}],"sequence":10,"xLabel":"Cognitive subscale"},{"groupId":419,"id":1608,"name":"Mood-Behavioral subscale","scoringKey":[{"id":16364,"questionId":9578,"scaleId":1608,"targetText":"None - Rarely if ever present; not a problem at a
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8,"targetText":"Severe - Frequently present and disrupts activities; I can only do things that are fairly simple or take little effort; I feel I need help.",
"value":3},{"id":16368,"questionId":9578,"scaleId":1608,"targetText":"Very Severe - Almost always present and I have been unable to perform at work, school or home due to this.","value":4},{"id":16369,"questionId":9583,"scaleId":1608,"targe
tText":"None - Rarely if ever present; not a problem at all","value":0},{"id":16370,"questionId":9583,"scaleId":1608,"targetText":"Mild - Occasionally present, but it does not disrupt my activities; I can usually continue what I'm doing; do
5275,"designator":"3.","hint":null,"id":9634,"instrument":346,"introDisplay":81371,"introId":2617,"introText":"Symptom Report\r\n|Please rate the following symptoms with regard to how much they have disturbed you\r\nSINCE YOUR INJURY. The
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.","value":2},{"id":16372,"questionId":9583,"scaleId":1608,"targetText":"Severe - Frequently present and disrupts activities; I can only do things that are fairly simple or take little effort; I feel I need help.","value":3},{"id":16373,"qu
estionId":9583,"scaleId":1608,"targetText":"Very Severe - Almost always present and I have been unable to perform at work, school or home due to this.","value":4},{"id":16374,"questionId":9584,"scaleId":1608,"targetText":"None - Rarely if e
ver present; not a problem at all","value":0},{"id":16375,"questionId":9584,"scaleId":1608,"targetText":"Mild - Occasionally present, but it does not disrupt my activities; I can usually continue what I'm doing; doesn't really concern me.",
"value":1},{"id":16376,"questionId":9584,"scaleId":1608,"targetText":"Moderate - Often present, occasionally disrupts my activities; I can usually continue what I'm doing with some effort; I feel somewhat concerned.","value":2},{"id":16377,
"questionId":9584,"scaleId":1608,"targetText":"Severe - Frequently present and disrupts activities; I can only do things that are fairly simple or take little effort; I feel I need help.","value":3},{"id":16378,"questionId":9584,"scaleId":1
608,"targetText":"Very Severe - Almost always present and I have been unable to perform at work, school or home due to this.","value":4},{"id":16379,"questionId":9585,"scaleId":1608,"targetText":"None - Rarely if ever present; not a problem
at all","value":0},{"id":16380,"questionId":9585,"scaleId":1608,"targetText":"Mild - Occasionally present, but it does not disrupt my activities; I can usually continue what I'm doing; doesn't really concern me.","value":1},{"id":16381,"qu
estionId":9585,"scaleId":1608,"targetText":"Moderate - Often present, occasionally disrupts my activities; I can usually continue what I'm doing with some effort; I feel somewhat concerned.","value":2},{"id":16382,"questionId":9585,"scaleId
":1608,"targetText":"Severe - Frequently present and disrupts activities; I can only do things that are fairly simple or take little effort; I feel I need help.","value":3},{"id":16383,"questionId":9585,"scaleId":1608,"targetText":"Very Sev
pt my activities; I can usually continue what I'm doing; doesn't really concern me.","ien":109859,"legacyValue":1,"sequence":2},{"choiceId":6177,"choiceText":"Moderate - Often present, occasionally disrupts my activities; I can usually cont
purpose of this inventory is to track symptoms over time. Please do not attempt to score.","max":0,"min":0,"questionDisplay":81372,"questionId":9569,"questionText":"Poor coordination, clumsy","required":true,"responseTypeId":1,"responseType
ere - Almost always present and I have been unable to perform at work, school or home due to this.","value":4},{"id":16384,"questionId":9586,"scaleId":1608,"targetText":"None - Rarely if ever present; not a problem at all","value":0},{"id":
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608,"targetText":"Moderate - Often present, occasionally disrupts my activities; I can usually continue what I'm doing with some effort; I feel somewhat concerned.","value":2},{"id":16387,"questionId":9586,"scaleId":1608,"targetText":"Sever
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"None - Rarely if ever present; not a problem at all","value":0},{"id":16390,"questionId":9587,"scaleId":1608,"targetText":"Mild - Occasionally present, but it does not disrupt my activities; I can usually continue what I'm doing; doesn't r
eally concern me.","value":1},{"id":16391,"questionId":9587,"scaleId":1608,"targetText":"Moderate - Often present, occasionally disrupts my activities; I can usually continue what I'm doing with some effort; I feel somewhat concerned.","val
ue":2},{"id":16392,"questionId":9587,"scaleId":1608,"targetText":"Severe - Frequently present and disrupts activities; I can only do things that are fairly simple or take little effort; I feel I need help.","value":3},{"id":16393,"questionI
d":9587,"scaleId":1608,"targetText":"Very Severe - Almost always present and I have been unable to perform at work, school or home due to this.","value":4},{"id":16394,"questionId":9588,"scaleId":1608,"targetText":"None - Rarely if ever pre
sent; not a problem at all","value":0},{"id":16395,"questionId":9588,"scaleId":1608,"targetText":"Mild - Occasionally present, but it does not disrupt my activities; I can usually continue what I'm doing; doesn't really concern me.","value"
Text":"MCHOICE","sequence":30},{"choice":[{"choiceId":6175,"choiceText":"None - Rarely if ever present; not a problem at all","ien":109858,"legacyValue":0,"sequence":1},{"choiceId":6176,"choiceText":"Mild - Occasionally present, but it does
:1},{"id":16396,"questionId":9588,"scaleId":1608,"targetText":"Moderate - Often present, occasionally disrupts my activities; I can usually continue what I'm doing with some effort; I feel somewhat concerned.","value":2},{"id":16397,"questi
onId":9588,"scaleId":1608,"targetText":"Severe - Frequently present and disrupts activities; I can only do things that are fairly simple or take little effort; I feel I need help.","value":3},{"id":16398,"questionId":9588,"scaleId":1608,"ta
rgetText":"Very Severe - Almost always present and I have been unable to perform at work, school or home due to this.","value":4}],"sequence":20,"xLabel":"Mood-Behavioral subscale"},{"groupId":419,"id":1609,"name":"Vestibular - Sensory subs
cale","scoringKey":[{"id":16399,"questionId":9567,"scaleId":1609,"targetText":"None - Rarely if ever present; not a problem at all","value":0},{"id":16400,"questionId":9567,"scaleId":1609,"targetText":"Mild - Occasionally present, but it do
es not disrupt my activities; I can usually continue what I'm doing; doesn't really concern me.","value":1},{"id":16401,"questionId":9567,"scaleId":1609,"targetText":"Moderate - Often present, occasionally disrupts my activities; I can usua
lly continue what I'm doing with some effort; I feel somewhat concerned.","value":2},{"id":16402,"questionId":9567,"scaleId":1609,"targetText":"Severe - Frequently present and disrupts activities; I can only do things that are fairly simple
or take little effort; I feel I need help.","value":3},{"id":16403,"questionId":9567,"scaleId":1609,"targetText":"Very Severe - Almost always present and I have been unable to perform at work, school or home due to this.","value":4},{"id":
16404,"questionId":9568,"scaleId":1609,"targetText":"None - Rarely if ever present; not a problem at all","value":0},{"id":16405,"questionId":9568,"scaleId":1609,"targetText":"Mild - Occasionally present, but it does not disrupt my activiti
es; I can usually continue what I'm doing; doesn't really concern me.","value":1},{"id":16406,"questionId":9568,"scaleId":1609,"targetText":"Moderate - Often present, occasionally disrupts my activities; I can usually continue what I'm doin
g with some effort; I feel somewhat concerned.","value":2},{"id":16407,"questionId":9568,"scaleId":1609,"targetText":"Severe - Frequently present and disrupts activities; I can only do things that are fairly simple or take little effort; I
not disrupt my activities; I can usually continue what I'm doing; doesn't really concern me.","ien":109859,"legacyValue":1,"sequence":2},{"choiceId":6177,"choiceText":"Moderate - Often present, occasionally disrupts my activities; I can us
feel I need help.","value":3},{"id":16408,"questionId":9568,"scaleId":1609,"targetText":"Very Severe - Almost always present and I have been unable to perform at work, school or home due to this.","value":4},{"id":16409,"questionId":9569,"s
caleId":1609,"targetText":"None - Rarely if ever present; not a problem at all","value":0},{"id":16410,"questionId":9569,"scaleId":1609,"targetText":
"Mild - Occasionally present, but it does not disrupt my activities; I can usually continue what I'm doing; doesn't really concern me.","value":1},{"id":16411,"questionId":9569,"scaleId":1609,"targetText":"Moderate - Often present, occasion
ally disrupts my activities; I can usually continue what I'm doing with some effort; I feel somewhat concerned.","value":2},{"id":16412,"questionId":9569,"scaleId":1609,"targetText":"Severe - Frequently present and disrupts activities; I ca
n only do things that are fairly simple or take little effort; I feel I need help.","value":3},{"id":16413,"questionId":9569,"scaleId":1609,"targetText":"Very Severe - Almost always present and I have been unable to perform at work, school
or home due to this.","value":4},{"id":16414,"questionId":9570,"scaleId":1609,"targetText":"None - Rarely if ever present; not a problem at all","value":0},{"id":16415,"questionId":9570,"scaleId":1609,"targetText":"Mild - Occasionally prese
nt, but it does not disrupt my activities; I can usually continue what I'm doing; doesn't really concern me.","value":1},{"id":16416,"questionId":9570,"scaleId":1609,"targetText":"Moderate - Often present, occasionally disrupts my activitie
s; I can usually continue what I'm doing with some effort; I feel somewhat concerned.","value":2},{"id":16417,"questionId":9570,"scaleId":1609,"targetText":"Severe - Frequently present and disrupts activities; I can only do things that are
fairly simple or take little effort; I feel I need help.","value":3},{"id":16418,"questionId":9570,"scaleId":1609,"targetText":"Very Severe - Almost always present and I have been unable to perform at work, school or home due to this.","val
ue":4},{"id":16419,"questionId":9571,"scaleId":1609,"targetText":"None - Rarely if ever present; not a problem at all","value":0},{"id":16420,"questionId":9571,"scaleId":1609,"targetText":"Mild - Occasionally present, but it does not disrup
ually continue what I'm doing with some effort; I feel somewhat concerned.","ien":109860,"legacyValue":2,"sequence":3},{"choiceId":6178,"choiceText":"Severe - Frequently present and disrupts activities; I can only do things that are fairly
t my activities; I can usually continue what I'm doing; doesn't really concern me.","value":1},{"id":16421,"questionId":9571,"scaleId":1609,"targetText":"Moderate - Often present, occasionally disrupts my activities; I can usually continue
what I'm doing with some effort; I feel somewhat concerned.","value":2},{"id":16422,"questionId":9571,"scaleId":1609,"targetText":"Severe - Frequently present and disrupts activities; I can only do things that are fairly simple or take litt
le effort; I feel I need help.","value":3},{"id":16423,"questionId":9571,"scaleId":1609,"targetText":"Very Severe - Almost always present and I have been unable to perform at work, school or home due to this.","value":4},{"id":16424,"questi
onId":9572,"scaleId":1609,"targetText":"None - Rarely if ever present; not a problem at all","value":0},{"id":16425,"questionId":9572,"scaleId":1609,"targetText":"Mild - Occasionally present, but it does not disrupt my activities; I can usu
ally continue what I'm doing; doesn't really concern me.","value":1},{"id":16426,"questionId":9572,"scaleId":1609,"targetText":"Moderate - Often present, occasionally disrupts my activities; I can usually continue what I'm doing with some e
ffort; I feel somewhat concerned.","value":2},{"id":16427,"questionId":9572,"scaleId":1609,"targetText":"Severe - Frequently present and disrupts activities; I can only do things that are fairly simple or take little effort; I feel I need h
elp.","value":3},{"id":16428,"questionId":9572,"scaleId":1609,"targetText":"Very Severe - Almost always present and I have been unable to perform at work, school or home due to this.","value":4},{"id":16429,"questionId":9573,"scaleId":1609,
"targetText":"None - Rarely if ever present; not a problem at all","value":0},{"id":16430,"questionId":9573,"scaleId":1609,"targetText":"Mild - Occasionally present, but it does not disrupt my activities; I can usually continue what I'm doi
ng; doesn't really concern me.","value":1},{"id":16431,"questionId":9573,"scaleId":1609,"targetText":
"Moderate - Often present, occasionally disrupts my activities; I can usually continue what I'm doing with some effort; I feel somewhat concerned.","value":2},{"id":16432,"questionId":9573,"scaleId":1609,"targetText":"Severe - Frequently pr
simple or take little effort; I feel I need help.","ien":109861,"legacyValue":3,"sequence":4},{"choiceId":6179,"choiceText":"Very Severe - Almost always present and I have been unable to perform at work, school or home due to this.","ien":1
esent and disrupts activities; I can only do things that are fairly simple or take little effort; I feel I need help.","value":3},{"id":16433,"questionId":9573,"scaleId":1609,"targetText":"Very Severe - Almost always present and I have been
unable to perform at work, school or home due to this.","value":4},{"id":16434,"questionId":9574,"scaleId":1609,"targetText":"None - Rarely if ever present; not a problem at all","value":0},{"id":16435,"questionId":9574,"scaleId":1609,"tar
getText":"Mild - Occasionally present, but it does not disrupt my activities; I can usually continue what I'm doing; doesn't really concern me.","value":1},{"id":16436,"questionId":9574,"scaleId":1609,"targetText":"Moderate - Often present,
occasionally disrupts my activities; I can usually continue what I'm doing with some effort; I feel somewhat concerned.","value":2},{"id":16437,"questionId":9574,"scaleId":1609,"targetText":"Severe - Frequently present and disrupts activit
ies; I can only do things that are fairly simple or take little effort; I feel I need help.","value":3},{"id":16438,"questionId":9574,"scaleId":1609,"targetText":"Very Severe - Almost always present and I have been unable to perform at work
, school or home due to this.","value":4},{"id":16439,"questionId":9575,"scaleId":1609,"targetText":"None - Rarely if ever present; not a problem at all","value":0},{"id":16440,"questionId":9575,"scaleId":1609,"targetText":"Mild - Occasiona
lly present, but it does not disrupt my activities; I can usually continue what I'm doing; doesn't really concern me.","value":1},{"id":16441,"questionId":9575,"scaleId":1609,"targetText":"Moderate - Often present, occasionally disrupts my
activities; I can usually continue what I'm doing with some effort; I feel somewhat concerned.","value":2},{"id":16442,"questionId":9575,"scaleId":1609,"targetText":"Severe - Frequently present and disrupts activities; I can only do things
that are fairly simple or take little effort; I feel I need help.","value":3},{"id":16443,"questionId":9575,"scaleId":1609,"targetText":"Very Severe - Almost always present and I have been unable to perform at work, school or home due to th
is.","value":4},{"id":16444,"questionId":9576,"scaleId":1609,"targetText":"None - Rarely if ever present; not a problem at all","value":0},{"id":16445,"questionId":9576,"scaleId":1609,"targetText":"Mild - Occasionally present, but it does n
09862,"legacyValue":4,"sequence":5}],"choiceDisplay":81351,"choiceIdentifier":0,"choiceIdentifierIen":42509,"choiceTypeId":15275,"designator":"4.","hint":null,"id":9635,"instrument":346,"introDisplay":81371,"introId":2617,"introText":"Sympt
ot disrupt my activities; I can usually continue what I'm doing; doesn't really concern me.","value":1},{"id":16446,"questionId":9576,"scaleId":1609,"targetText":"Moderate - Often present, occasionally disrupts my activities; I can usually
continue what I'm doing with some effort; I feel somewhat concerned.","value":2},{"id":16447,"questionId":9576,"scaleId":1609,"targetText":"Severe - Frequently present and disrupts activities; I can only do things that are fairly simple or
take little effort; I feel I need help.","value":3},{"id":16448,"questionId":9576,"scaleId":1609,"targetText":"Very Severe - Almost always present and I have been unable to perform at work, school or home due to this.","value":4},{"id":1644
9,"questionId":9577,"scaleId":1609,"targetText":"None - Rarely if ever present; not a problem at all","value":0},{"id":16450,"questionId":9577,"scaleId":1609,"targetText":"Mild - Occasionally present, but it does not disrupt my activities;
I can usually continue what I'm doing; doesn't really concern me.","value":1},{"id":16451,"questionId":9577,"scaleId":1609,"targetText":"Moderate - Often present, occasionally disrupts my activities; I can usually continue what I'm doing wi
th some effort; I feel somewhat concerned.","value":2},{"id":16452,"questionId":9577,"scaleId":1609,"targetText":
"Severe - Frequently present and disrupts activities; I can only do things that are fairly simple or take little effort; I feel I need help.","value":3},{"id":16453,"questionId":9577,"scaleId":1609,"targetText":"Very Severe - Almost always
present and I have been unable to perform at work, school or home due to this.","value":4}],"sequence":30,"xLabel":"Vestibular - Sensory subscale"}],"sequence":10}],"spec":{"entryChecksum":3564078360,"entrySpec":"{\"name\": \"NSI FOR TBI\",
\r\n \"copyright\": \"Used with permission: Cicerone,KD: J Head Tr Rehabil 1995;10(3):1-17\", \r\n \"restartDays\": 2, \r\n \"printTitle\": \"Neurobehavioral Symptom Inventory for Traumatic Brain Injury\", \r\n \"content\":[\r\n {\"id\":
\"i2617\", \"type\": \"IntroText\", \r\n \"text\": \"Symptom Report <br \/>Please rate the following symptoms with regard to how much\r\n they have disturbed you SINCE YOUR INJURY. The purpose of this inventory is to\r\n track symptoms
om Report\r\n|Please rate the following symptoms with regard to how much they have disturbed you\r\nSINCE YOUR INJURY. The purpose of this inventory is to track symptoms over time. Please do not attempt to score.","max":0,"min":0,"question
over time. Please do not attempt to score.\"\r\n }, \r\n {\"id\": \"q9567\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"1. Feeling dizzy\", \r\n \"intro\": \"Symptom Report <br \/>Pleas
e rate the following symptoms with regard to how much\r\n they have disturbed you SINCE YOUR INJURY. The purpose of this inventory is to\r\n track symptoms over time. Please do not attempt to score.\", \r\n \"columns\": 1, \r\n \"cho
ices\":[\r\n {\"id\": \"c6175\", \"text\": \"0. None - Rarely if ever present; not a problem at all\", \"quickKey\": 0}, \r\n {\"id\": \"c6176\", \"text\": \"1. Mild - Occasionally present, but it does not disrupt my activities; I c
an\r\n usually continue what I'm doing; doesn't really concern me.\", \"quickKey\": 1}, \r\n {\"id\": \"c6177\", \"text\": \"2. Moderate - Often present, occasionally disrupts my activities; I can usually\r\n continue what I'm doing wit
h some effort; I feel somewhat concerned.\", \"quickKey\": 2}, \r\n {\"id\": \"c6178\", \"text\": \"3. Severe - Frequently present and disrupts activities; I can only do things\r\n that are fairly simple or take little effort; I feel I
need help.\", \"quickKey\": 3}, \r\n {\"id\": \"c6179\", \"text\": \"4. Very Severe - Almost always present and I have been unable to perform at work,\r\n school or home due to this.\", \"quickKey\": 4}\r\n ]}, \r\n {\"id\": \"q956
8\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"2. Loss of balance\", \r\n \"intro\": \"Symptom Report <br \/>Please rate the following symptoms with regard to how much\r\n they have disturbe
d you SINCE YOUR INJURY. The purpose of this inventory is to\r\n track symptoms over time. Please do not attempt to score.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c6175\", \"text\": \"0. None - Rarely if ever pr
esent; not a problem at all\", \"quickKey\": 0}, \r\n {\"id\": \"c6176\", \"text\": \"1. Mild - Occasionally present, but it does not disrupt my activities; I can\r\n usually continue what I'm doing; doesn't really concern me.\", \"quic
kKey\": 1}, \r\n {\"id\": \"c6177\", \"text\": \"2. Moderate - Often present, occasionally disrupts my activities; I can usually\r\n continue what I'm doing with some effort; I feel somewhat concerned.\", \"quickKey\": 2}, \r\n {\"i
Display":81372,"questionId":9570,"questionText":"Headaches","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":40},{"choice":[{"choiceId":6175,"choiceText":"None - Rarely if ever present; not a problem at all","ien":
d\": \"c6178\", \"text\": \"3. Severe - Frequently present and disrupts activities; I can only do things\r\n that are fairly simple or take little effort; I feel I need help.\", \"quickKey\": 3}, \r\n {\"id\": \"c6179\", \"text\": \"4.
Very Severe - Almost always present and I have been unable to perform at work,\r\n school or home due to this.\", \"quickKey\": 4}\r\n ]}, \r\n {\"id\": \"q9569\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r
\n \"text\": \"3. Poor coordination, clumsy\", \r\n \"intro\": \"Symptom Report <br \/>Please rate the following symptoms with regard to how much
\r\n they have disturbed you SINCE YOUR INJURY. The purpose of this inventory is to\r\n track symptoms over time. Please do not attempt to score.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c6175\", \"text\": \"0. N
one - Rarely if ever present; not a problem at all\", \"quickKey\": 0}, \r\n {\"id\": \"c6176\", \"text\": \"1. Mild - Occasionally present, but it does not disrupt my activities; I can\r\n usually continue what I'm doing; doesn't reall
y concern me.\", \"quickKey\": 1}, \r\n {\"id\": \"c6177\", \"text\": \"2. Moderate - Often present, occasionally disrupts my activities; I can usually\r\n continue what I'm doing with some effort; I feel somewhat concerned.\", \"quickK
ey\": 2}, \r\n {\"id\": \"c6178\", \"text\": \"3. Severe - Frequently present and disrupts activities; I can only do things\r\n that are fairly simple or take little effort; I feel I need help.\", \"quickKey\": 3}, \r\n {\"id\": \"
c6179\", \"text\": \"4. Very Severe - Almost always present and I have been unable to perform at work,\r\n school or home due to this.\", \"quickKey\": 4}\r\n ]}, \r\n {\"id\": \"q9570\", \"type\": \"ChoiceQuestion\", \"required\": true
, \"inline\": false, \r\n \"text\": \"4. Headaches\", \r\n \"intro\": \"Symptom Report <br \/>Please rate the following symptoms with regard to how much\r\n they have disturbed you SINCE YOUR INJURY. The purpose of this inventory is
to\r\n track symptoms over time. Please do not attempt to score.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c6175\", \"text\": \"0. None - Rarely if ever present; not a problem at all\", \"quickKey\": 0}, \r\n {
109858,"legacyValue":0,"sequence":1},{"choiceId":6176,"choiceText":"Mild - Occasionally present, but it does not disrupt my activities; I can usually continue what I'm doing; doesn't really concern me.","ien":109859,"legacyValue":1,"sequenc
\"id\": \"c6176\", \"text\": \"1. Mild - Occasionally present, but it does not disrupt my activities; I can\r\n usually continue what I'm doing; doesn't really concern me.\", \"quickKey\": 1}, \r\n {\"id\": \"c6177\", \"text\": \"2. Mod
erate - Often present, occasionally disrupts my activities; I can usually\r\n continue what I'm doing with some effort; I feel somewhat concerned.\", \"quickKey\": 2}, \r\n {\"id\": \"c6178\", \"text\": \"3. Severe - Frequently present
and disrupts activities; I can only do things\r\n that are fairly simple or take little effort; I feel I need help.\", \"quickKey\": 3}, \r\n {\"id\": \"c6179\", \"text\": \"4. Very Severe - Almost always present and I have been unable
to perform at work,\r\n school or home due to this.\", \"quickKey\": 4}\r\n ]}, \r\n {\"id\": \"q9571\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"5. Nausea\", \r\n \"intro\": \"Symptom
Report <br \/>Please rate the following symptoms with regard to how much\r\n they have disturbed you SINCE YOUR INJURY. The purpose of this inventory is to\r\n track symptoms over time. Please do not attempt to score.\", \r\n \"columns
\": 1, \r\n \"choices\":[\r\n {\"id\": \"c6175\", \"text\": \"0. None - Rarely if ever present; not a problem at all\", \"quickKey\": 0}, \r\n {\"id\": \"c6176\", \"text\": \"1. Mild - Occasionally present, but it does not disrup
t my activities; I can\r\n usually continue what I'm doing; doesn't really concern me.\", \"quickKey\": 1}, \r\n {\"id\": \"c6177\", \"text\": \"2. Moderate - Often present, occasionally disrupts my activities; I can usually\r\n continu
e what I'm doing with some effort; I feel somewhat concerned.\", \"quickKey\": 2}, \r\n {\"id\": \"c6178\", \"text\": \"3. Severe - Frequently present and disrupts activities; I can only do things\r\n that are fairly simple or take lit
tle effort; I feel I need help.\", \"quickKey\": 3}, \r\n {\"id\": \"c6179\", \"text\": \"4. Very Severe - Almost always present and I have been unable to perform at work,\r\n school or home due to this.\", \"quickKey\": 4}\r\n ]}, \r
\n {\"id\": \"q9572\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false,
e":2},{"choiceId":6177,"choiceText":"Moderate - Often present, occasionally disrupts my activities; I can usually continue what I'm doing with some effort; I feel somewhat concerned.","ien":109860,"legacyValue":2,"sequence":3},{"choiceId":6
\r\n \"text\": \"6. Vision problems, blurring, trouble seeing\", \r\n \"intro\": \"Symptom Report <br \/>Please rate the following symptoms with regard to how much\r\n they have disturbed you SINCE YOUR INJURY. The purpose of this in
ventory is to\r\n track symptoms over time. Please do not attempt to score.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c6175\", \"text\": \"0. None - Rarely if ever present; not a problem at all\", \"quickKey\": 0},
\r\n {\"id\": \"c6176\", \"text\": \"1. Mild - Occasionally present, but it does not disrupt my activities; I can\r\n usually continue what I'm doing; doesn't really concern me.\", \"quickKey\": 1}, \r\n {\"id\": \"c6177\", \"text\
": \"2. Moderate - Often present, occasionally disrupts my activities; I can usually\r\n continue what I'm doing with some effort; I feel somewhat concerned.\", \"quickKey\": 2}, \r\n {\"id\": \"c6178\", \"text\": \"3. Severe - Frequen
tly present and disrupts activities; I can only do things\r\n that are fairly simple or take little effort; I feel I need help.\", \"quickKey\": 3}, \r\n {\"id\": \"c6179\", \"text\": \"4. Very Severe - Almost always present and I have
been unable to perform at work,\r\n school or home due to this.\", \"quickKey\": 4}\r\n ]}, \r\n {\"id\": \"q9573\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"7. Sensitivity to light\", \r\
n \"intro\": \"Symptom Report <br \/>Please rate the following symptoms with regard to how much\r\n they have disturbed you SINCE YOUR INJURY. The purpose of this inventory is to\r\n track symptoms over time. Please do not attempt to sc
ore.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c6175\", \"text\": \"0. None - Rarely if ever present; not a problem at all\", \"quickKey\": 0}, \r\n {\"id\": \"c6176\", \"text\": \"1. Mild - Occasionally presen
t, but it does not disrupt my activities; I can\r\n usually continue what I'm doing; doesn't really concern me.\", \"quickKey\": 1}, \r\n {\"id\": \"c6177\", \"text\": \"2. Moderate - Often present, occasionally disrupts my activities;
I can usually\r\n continue what I'm doing with some effort; I feel somewhat concerned.\", \"quickKey\": 2}, \r\n {\"id\": \"c6178\", \"text\": \"3. Severe - Frequently present and disrupts activities; I can only do things\r\n that are
inue what I'm doing with some effort; I feel somewhat concerned.","ien":109860,"legacyValue":2,"sequence":3},{"choiceId":6178,"choiceText":"Severe - Frequently present and disrupts activities; I can only do things that are fairly simple or
178,"choiceText":"Severe - Frequently present and disrupts activities; I can only do things that are fairly simple or take little effort; I feel I need help.","ien":109861,"legacyValue":3,"sequence":4},{"choiceId":6179,"choiceText":"Very Se
fairly simple or take little effort; I feel I need help.\", \"quickKey\": 3}, \r\n {\"id\": \"c6179\", \"text\": \"4. Very Severe - Almost always present and I have been unable to perform at work,\r\n school or home due to this.\", \"qu
ickKey\": 4}\r\n ]}, \r\n {\"id\": \"q9574\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"8. Hearing difficulty\", \r\n \"intro\": \"Symptom Report <br \/>Please rate the following symptom
s with regard to how much\r\n they have disturbed you SINCE YOUR INJURY. The purpose of this inventory is to\r\n track symptoms over time. Please do not attempt to score.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"
c6175\", \"text\": \"0. None - Rarely if ever present; not a problem at all\", \"quickKey\": 0}, \r\n {\"id\": \"c6176\", \"text\": \"1. Mild - Occasionally present, but it does not disrupt my activities; I can\r\n usually continue what
I'm doing; doesn't really concern me.\", \"quickKey\": 1}, \r\n {\"id\": \"c6177\", \"text\": \"2. Moderate - Often present, occasionally disrupts my activities; I can usually\r\n continue what I'm doing with some effort; I feel somewh
at concerned.\", \"quickKey\": 2}, \r\n {\"id\": \"c6178\", \"text\": \"3. Severe - Frequently present and disrupts activities; I can only do things\r\n that are fairly simple or take little effort; I feel I need help.\", \"quickKey\":
3}, \r\n {\"id\": \"c6179\", \"text\": \"4. Very Severe - Almost always present and I have been unable to perform at work,
\r\n school or home due to this.\", \"quickKey\": 4}\r\n ]}, \r\n {\"id\": \"q9575\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"9. Sensitivity to noise\", \r\n \"intro\": \"Symptom Repor
t <br \/>Please rate the following symptoms with regard to how much\r\n they have disturbed you SINCE YOUR INJURY. The purpose of this inventory is to\r\n track symptoms over time. Please do not attempt to score.\", \r\n \"columns\": 1,
\r\n \"choices\":[\r\n {\"id\": \"c6175\", \"text\": \"0. None - Rarely if ever present; not a problem at all\", \"quickKey\": 0}, \r\n {\"id\": \"c6176\", \"text\": \"1. Mild - Occasionally present, but it does not disrupt my a
vere - Almost always present and I have been unable to perform at work, school or home due to this.","ien":109862,"legacyValue":4,"sequence":5}],"choiceDisplay":81351,"choiceIdentifier":0,"choiceIdentifierIen":42509,"choiceTypeId":15275,"de
ctivities; I can\r\n usually continue what I'm doing; doesn't really concern me.\", \"quickKey\": 1}, \r\n {\"id\": \"c6177\", \"text\": \"2. Moderate - Often present, occasionally disrupts my activities; I can usually\r\n continue what
I'm doing with some effort; I feel somewhat concerned.\", \"quickKey\": 2}, \r\n {\"id\": \"c6178\", \"text\": \"3. Severe - Frequently present and disrupts activities; I can only do things\r\n that are fairly simple or take little ef
fort; I feel I need help.\", \"quickKey\": 3}, \r\n {\"id\": \"c6179\", \"text\": \"4. Very Severe - Almost always present and I have been unable to perform at work,\r\n school or home due to this.\", \"quickKey\": 4}\r\n ]}, \r\n {
\"id\": \"q9576\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"10. Numbness or tingling on parts of my body\", \r\n \"intro\": \"Symptom Report <br \/>Please rate the following symptoms with r
egard to how much\r\n they have disturbed you SINCE YOUR INJURY. The purpose of this inventory is to\r\n track symptoms over time. Please do not attempt to score.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c6175\",
\"text\": \"0. None - Rarely if ever present; not a problem at all\", \"quickKey\": 0}, \r\n {\"id\": \"c6176\", \"text\": \"1. Mild - Occasionally present, but it does not disrupt my activities; I can\r\n usually continue what I'm doi
ng; doesn't really concern me.\", \"quickKey\": 1}, \r\n {\"id\": \"c6177\", \"text\": \"2. Moderate - Often present, occasionally disrupts my activities; I can usually\r\n continue what I'm doing with some effort; I feel somewhat conce
rned.\", \"quickKey\": 2}, \r\n {\"id\": \"c6178\", \"text\": \"3. Severe - Frequently present and disrupts activities; I can only do things\r\n that are fairly simple or take little effort; I feel I need help.\", \"quickKey\": 3}, \r\
n {\"id\": \"c6179\", \"text\": \"4. Very Severe - Almost always present and I have been unable to perform at work,\r\n school or home due to this.\", \"quickKey\": 4}\r\n ]}, \r\n {\"id\": \"q9577\", \"type\": \"ChoiceQuestion\", \
"required\": true, \"inline\": false, \r\n \"text\": \"11. Change in taste and\/or smell\", \r\n \"intro\": \"Symptom Report <br \/>Please rate the following symptoms with regard to how much\r\n they have disturbed you SINCE YOUR INJU
signator":"5.","hint":null,"id":9636,"instrument":346,"introDisplay":81371,"introId":2617,"introText":"Symptom Report\r\n|Please rate the following symptoms with regard to how much they have disturbed you\r\nSINCE YOUR INJURY. The purpose
RY. The purpose of this inventory is to\r\n track symptoms over time. Please do not attempt to score.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c6175\", \"text\": \"0. None - Rarely if ever present; not a problem
at all\", \"quickKey\": 0}, \r\n {\"id\": \"c6176\", \"text\": \"1. Mild - Occasionally present, but it does not disrupt my activities; I can\r\n usually continue what I'm doing; doesn't really concern me.\", \"quickKey\": 1}, \r\n
{\"id\": \"c6177\", \"text\": \"2. Moderate - Often present, occasionally disrupts my activities; I can usually\r\n continue what I'm doing with some effort; I feel somewhat concerned.\", \"quickKey\": 2}, \r\n {\"id\": \"c6178\", \"tex
t\": \"3. Severe - Frequently present and disrupts activities; I can only do things
\r\n that are fairly simple or take little effort; I feel I need help.\", \"quickKey\": 3}, \r\n {\"id\": \"c6179\", \"text\": \"4. Very Severe - Almost always present and I have been unable to perform at work,\r\n school or home due to
this.\", \"quickKey\": 4}\r\n ]}, \r\n {\"id\": \"q9578\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"12. Loss of appetite or increased appetite\", \r\n \"intro\": \"Symptom Report <br \
/>Please rate the following symptoms with regard to how much\r\n they have disturbed you SINCE YOUR INJURY. The purpose of this inventory is to\r\n track symptoms over time. Please do not attempt to score.\", \r\n \"columns\": 1, \r\n
\"choices\":[\r\n {\"id\": \"c6175\", \"text\": \"0. None - Rarely if ever present; not a problem at all\", \"quickKey\": 0}, \r\n {\"id\": \"c6176\", \"text\": \"1. Mild - Occasionally present, but it does not disrupt my activiti
es; I can\r\n usually continue what I'm doing; doesn't really concern me.\", \"quickKey\": 1}, \r\n {\"id\": \"c6177\", \"text\": \"2. Moderate - Often present, occasionally disrupts my activities; I can usually\r\n continue what I'm do
ing with some effort; I feel somewhat concerned.\", \"quickKey\": 2}, \r\n {\"id\": \"c6178\", \"text\": \"3. Severe - Frequently present and disrupts activities; I can only do things\r\n that are fairly simple or take little effort; I
of this inventory is to track symptoms over time. Please do not attempt to score.","max":0,"min":0,"questionDisplay":81372,"questionId":9571,"questionText":"Nausea","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":
feel I need help.\", \"quickKey\": 3}, \r\n {\"id\": \"c6179\", \"text\": \"4. Very Severe - Almost always present and I have been unable to perform at work,\r\n school or home due to this.\", \"quickKey\": 4}\r\n ]}, \r\n {\"id\":
\"q9579\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"13. Poor concentration, can't pay attention, easily distracted\", \r\n \"intro\": \"Symptom Report <br \/>Please rate the following symp
toms with regard to how much\r\n they have disturbed you SINCE YOUR INJURY. The purpose of this inventory is to\r\n track symptoms over time. Please do not attempt to score.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\":
\"c6175\", \"text\": \"0. None - Rarely if ever present; not a problem at all\", \"quickKey\": 0}, \r\n {\"id\": \"c6176\", \"text\": \"1. Mild - Occasionally present, but it does not disrupt my activities; I can\r\n usually continue w
hat I'm doing; doesn't really concern me.\", \"quickKey\": 1}, \r\n {\"id\": \"c6177\", \"text\": \"2. Moderate - Often present, occasionally disrupts my activities; I can usually\r\n continue what I'm doing with some effort; I feel som
ewhat concerned.\", \"quickKey\": 2}, \r\n {\"id\": \"c6178\", \"text\": \"3. Severe - Frequently present and disrupts activities; I can only do things\r\n that are fairly simple or take little effort; I feel I need help.\", \"quickKey
\": 3}, \r\n {\"id\": \"c6179\", \"text\": \"4. Very Severe - Almost always present and I have been unable to perform at work,\r\n school or home due to this.\", \"quickKey\": 4}\r\n ]}, \r\n {\"id\": \"q9580\", \"type\": \"ChoiceQu
estion\", \"required\": true, \"inline\": false, \r\n \"text\": \"14. Forgetfulness, can't remember things\", \r\n \"intro\": \"Symptom Report <br \/>Please rate the following symptoms with regard to how much\r\n they have disturbed y
ou SINCE YOUR INJURY. The purpose of this inventory is to\r\n track symptoms over time. Please do not attempt to score.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c6175\", \"text\": \"0. None - Rarely if ever prese
nt; not a problem at all\", \"quickKey\": 0}, \r\n {\"id\": \"c6176\", \"text\": \"1. Mild - Occasionally present, but it does not disrupt my activities; I can\r\n usually continue what I'm doing; doesn't really concern me.\", \"quickKe
50},{"choice":[{"choiceId":6175,"choiceText":"None - Rarely if ever present; not a problem at all","ien":109858,"legacyValue":0,"sequence":1},{"choiceId":6176,
y\": 1}, \r\n {\"id\": \"c6177\", \"text\": \"2. Moderate - Often present, occasionally disrupts my activities; I can usually
\r\n continue what I'm doing with some effort; I feel somewhat concerned.\", \"quickKey\": 2}, \r\n {\"id\": \"c6178\", \"text\": \"3. Severe - Frequently present and disrupts activities; I can only do things\r\n that are fairly simple
or take little effort; I feel I need help.\", \"quickKey\": 3}, \r\n {\"id\": \"c6179\", \"text\": \"4. Very Severe - Almost always present and I have been unable to perform at work,\r\n school or home due to this.\", \"quickKey\": 4}\
r\n ]}, \r\n {\"id\": \"q9581\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"15. Difficulty making decisions\", \r\n \"intro\": \"Symptom Report <br \/>Please rate the following symptoms w
ith regard to how much\r\n they have disturbed you SINCE YOUR INJURY. The purpose of this inventory is to\r\n track symptoms over time. Please do not attempt to score.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c61
75\", \"text\": \"0. None - Rarely if ever present; not a problem at all\", \"quickKey\": 0}, \r\n {\"id\": \"c6176\", \"text\": \"1. Mild - Occasionally present, but it does not disrupt my activities; I can\r\n usually continue what I'
m doing; doesn't really concern me.\", \"quickKey\": 1}, \r\n {\"id\": \"c6177\", \"text\": \"2. Moderate - Often present, occasionally disrupts my activities; I can usually\r\n continue what I'm doing with some effort; I feel somewhat
concerned.\", \"quickKey\": 2}, \r\n {\"id\": \"c6178\", \"text\": \"3. Severe - Frequently present and disrupts activities; I can only do things\r\n that are fairly simple or take little effort; I feel I need help.\", \"quickKey\": 3}
, \r\n {\"id\": \"c6179\", \"text\": \"4. Very Severe - Almost always present and I have been unable to perform at work,\r\n school or home due to this.\", \"quickKey\": 4}\r\n ]}, \r\n {\"id\": \"q9582\", \"type\": \"ChoiceQuestion
\", \"required\": true, \"inline\": false, \r\n \"text\": \"16. Slowed thinking, difficulty getting organized, can't finish things\", \r\n \"intro\": \"Symptom Report <br \/>Please rate the following symptoms with regard to how much\r
"choiceText":"Mild - Occasionally present, but it does not disrupt my activities; I can usually continue what I'm doing; doesn't really concern me.","ien":109859,"legacyValue":1,"sequence":2},{"choiceId":6177,"choiceText":"Moderate - Often
\n they have disturbed you SINCE YOUR INJURY. The purpose of this inventory is to\r\n track symptoms over time. Please do not attempt to score.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c6175\", \"text\": \"0. Non
e - Rarely if ever present; not a problem at all\", \"quickKey\": 0}, \r\n {\"id\": \"c6176\", \"text\": \"1. Mild - Occasionally present, but it does not disrupt my activities; I can\r\n usually continue what I'm doing; doesn't really
concern me.\", \"quickKey\": 1}, \r\n {\"id\": \"c6177\", \"text\": \"2. Moderate - Often present, occasionally disrupts my activities; I can usually\r\n continue what I'm doing with some effort; I feel somewhat concerned.\", \"quickKey
\": 2}, \r\n {\"id\": \"c6178\", \"text\": \"3. Severe - Frequently present and disrupts activities; I can only do things\r\n that are fairly simple or take little effort; I feel I need help.\", \"quickKey\": 3}, \r\n {\"id\": \"c6
179\", \"text\": \"4. Very Severe - Almost always present and I have been unable to perform at work,\r\n school or home due to this.\", \"quickKey\": 4}\r\n ]}, \r\n {\"id\": \"q9583\", \"type\": \"ChoiceQuestion\", \"required\": true,
\"inline\": false, \r\n \"text\": \"17. Fatigue, loss of energy, getting tired easily\", \r\n \"intro\": \"Symptom Report <br \/>Please rate the following symptoms with regard to how much\r\n they have disturbed you SINCE YOUR INJURY.
The purpose of this inventory is to\r\n track symptoms over time. Please do not attempt to score.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c6175\", \"text\": \"0. None - Rarely if ever present; not a problem at
all\", \"quickKey\": 0}, \r\n {\"id\": \"c6176\", \"text\": \"1. Mild - Occasionally present, but it does not disrupt my activities; I can
\r\n usually continue what I'm doing; doesn't really concern me.\", \"quickKey\": 1}, \r\n {\"id\": \"c6177\", \"text\": \"2. Moderate - Often present, occasionally disrupts my activities; I can usually\r\n continue what I'm doing with
some effort; I feel somewhat concerned.\", \"quickKey\": 2}, \r\n {\"id\": \"c6178\", \"text\": \"3. Severe - Frequently present and disrupts activities; I can only do things\r\n that are fairly simple or take little effort; I feel I n
present, occasionally disrupts my activities; I can usually continue what I'm doing with some effort; I feel somewhat concerned.","ien":109860,"legacyValue":2,"sequence":3},{"choiceId":6178,"choiceText":"Severe - Frequently present and disr
eed help.\", \"quickKey\": 3}, \r\n {\"id\": \"c6179\", \"text\": \"4. Very Severe - Almost always present and I have been unable to perform at work,\r\n school or home due to this.\", \"quickKey\": 4}\r\n ]}, \r\n {\"id\": \"q9584\
", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"18. Difficulty falling or staying asleep\", \r\n \"intro\": \"Symptom Report <br \/>Please rate the following symptoms with regard to how much\r\
n they have disturbed you SINCE YOUR INJURY. The purpose of this inventory is to\r\n track symptoms over time. Please do not attempt to score.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c6175\", \"text\": \"0. None
- Rarely if ever present; not a problem at all\", \"quickKey\": 0}, \r\n {\"id\": \"c6176\", \"text\": \"1. Mild - Occasionally present, but it does not disrupt my activities; I can\r\n usually continue what I'm doing; doesn't really c
oncern me.\", \"quickKey\": 1}, \r\n {\"id\": \"c6177\", \"text\": \"2. Moderate - Often present, occasionally disrupts my activities; I can usually\r\n continue what I'm doing with some effort; I feel somewhat concerned.\", \"quickKey\
": 2}, \r\n {\"id\": \"c6178\", \"text\": \"3. Severe - Frequently present and disrupts activities; I can only do things\r\n that are fairly simple or take little effort; I feel I need help.\", \"quickKey\": 3}, \r\n {\"id\": \"c61
79\", \"text\": \"4. Very Severe - Almost always present and I have been unable to perform at work,\r\n school or home due to this.\", \"quickKey\": 4}\r\n ]}, \r\n {\"id\": \"q9585\", \"type\": \"ChoiceQuestion\", \"required\": true, \
"inline\": false, \r\n \"text\": \"19. Feeling anxious or tense\", \r\n \"intro\": \"Symptom Report <br \/>Please rate the following symptoms with regard to how much\r\n they have disturbed you SINCE YOUR INJURY. The purpose of this
inventory is to\r\n track symptoms over time. Please do not attempt to score.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c6175\", \"text\": \"0. None - Rarely if ever present; not a problem at all\", \"quickKey\": 0
}, \r\n {\"id\": \"c6176\", \"text\": \"1. Mild - Occasionally present, but it does not disrupt my activities; I can\r\n usually continue what I'm doing; doesn't really concern me.\", \"quickKey\": 1}, \r\n {\"id\": \"c6177\", \"tex
upts activities; I can only do things that are fairly simple or take little effort; I feel I need help.","ien":109861,"legacyValue":3,"sequence":4},{"choiceId":6179,"choiceText":"Very Severe - Almost always present and I have been unable to
t\": \"2. Moderate - Often present, occasionally disrupts my activities; I can usually\r\n continue what I'm doing with some effort; I feel somewhat concerned.\", \"quickKey\": 2}, \r\n {\"id\": \"c6178\", \"text\": \"3. Severe - Frequ
ently present and disrupts activities; I can only do things\r\n that are fairly simple or take little effort; I feel I need help.\", \"quickKey\": 3}, \r\n {\"id\": \"c6179\", \"text\": \"4. Very Severe - Almost always present and I hav
e been unable to perform at work,\r\n school or home due to this.\", \"quickKey\": 4}\r\n ]}, \r\n {\"id\": \"q9586\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"20. Feeling depressed or sad
\", \r\n \"intro\": \"Symptom Report <br \/>Please rate the following symptoms with regard to how much\r\n they have disturbed you SINCE YOUR INJURY. The purpose of this inventory is to\r\n track symptoms over time. Please do not attemp
t to score.\", \r\n \"columns\": 1, \r\n \"choices\":[
\r\n {\"id\": \"c6175\", \"text\": \"0. None - Rarely if ever present; not a problem at all\", \"quickKey\": 0}, \r\n {\"id\": \"c6176\", \"text\": \"1. Mild - Occasionally present, but it does not disrupt my activities; I can\r\n u
sually continue what I'm doing; doesn't really concern me.\", \"quickKey\": 1}, \r\n {\"id\": \"c6177\", \"text\": \"2. Moderate - Often present, occasionally disrupts my activities; I can usually\r\n continue what I'm doing with some e
ffort; I feel somewhat concerned.\", \"quickKey\": 2}, \r\n {\"id\": \"c6178\", \"text\": \"3. Severe - Frequently present and disrupts activities; I can only do things\r\n that are fairly simple or take little effort; I feel I need he
lp.\", \"quickKey\": 3}, \r\n {\"id\": \"c6179\", \"text\": \"4. Very Severe - Almost always present and I have been unable to perform at work,\r\n school or home due to this.\", \"quickKey\": 4}\r\n ]}, \r\n {\"id\": \"q9587\", \"t
ype\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"21. Irritability, easily annoyed\", \r\n \"intro\": \"Symptom Report <br \/>Please rate the following symptoms with regard to how much\r\n they have di
perform at work, school or home due to this.","ien":109862,"legacyValue":4,"sequence":5}],"choiceDisplay":81351,"choiceIdentifier":0,"choiceIdentifierIen":42509,"choiceTypeId":15275,"designator":"6.","hint":null,"id":9637,"instrument":346,
sturbed you SINCE YOUR INJURY. The purpose of this inventory is to\r\n track symptoms over time. Please do not attempt to score.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c6175\", \"text\": \"0. None - Rarely if e
ver present; not a problem at all\", \"quickKey\": 0}, \r\n {\"id\": \"c6176\", \"text\": \"1. Mild - Occasionally present, but it does not disrupt my activities; I can\r\n usually continue what I'm doing; doesn't really concern me.\",
\"quickKey\": 1}, \r\n {\"id\": \"c6177\", \"text\": \"2. Moderate - Often present, occasionally disrupts my activities; I can usually\r\n continue what I'm doing with some effort; I feel somewhat concerned.\", \"quickKey\": 2}, \r\n
{\"id\": \"c6178\", \"text\": \"3. Severe - Frequently present and disrupts activities; I can only do things\r\n that are fairly simple or take little effort; I feel I need help.\", \"quickKey\": 3}, \r\n {\"id\": \"c6179\", \"text\"
: \"4. Very Severe - Almost always present and I have been unable to perform at work,\r\n school or home due to this.\", \"quickKey\": 4}\r\n ]}, \r\n {\"id\": \"q9588\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": fal
se, \r\n \"text\": \"22. Poor frustration tolerance, feeling easily overwhelmed by things\", \r\n \"intro\": \"Symptom Report <br \/>Please rate the following symptoms with regard to how much\r\n they have disturbed you SINCE YOUR INJ
URY. The purpose of this inventory is to\r\n track symptoms over time. Please do not attempt to score.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c6175\", \"text\": \"0. None - Rarely if ever present; not a problem
at all\", \"quickKey\": 0}, \r\n {\"id\": \"c6176\", \"text\": \"1. Mild - Occasionally present, but it does not disrupt my activities; I can\r\n usually continue what I'm doing; doesn't really concern me.\", \"quickKey\": 1}, \r\n
{\"id\": \"c6177\", \"text\": \"2. Moderate - Often present, occasionally disrupts my activities; I can usually\r\n continue what I'm doing with some effort; I feel somewhat concerned.\", \"quickKey\": 2}, \r\n {\"id\": \"c6178\", \"te
xt\": \"3. Severe - Frequently present and disrupts activities; I can only do things\r\n that are fairly simple or take little effort; I feel I need help.\", \"quickKey\": 3}, \r\n {\"id\": \"c6179\", \"text\": \"4. Very Severe - Almos
"introDisplay":81371,"introId":2617,"introText":"Symptom Report\r\n|Please rate the following symptoms with regard to how much they have disturbed you\r\nSINCE YOUR INJURY. The purpose of this inventory is to track symptoms over time. Plea
t always present and I have been unable to perform at work,\r\n school or home due to this.\", \"quickKey\": 4}\r\n ]}]\r\n}","instrument":346,"lastUpdate":"2025-03-27T10:44:17","specIen":198},"verify":["601.71:346","601.72:9567","601.72:
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"601.72:9580","601.72:9581","601.72:9582","601.72:9583","601.72:9584","601.72:9585","601.72:9586","601.72:9587","601.72:9588","601.73:2617","601.75:6175","601.75:6176","601.75:6177","601.75:6178","601.75:6179","601.751:109858","601.751:1098
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1.76:9645","601.76:9646","601.76:9647","601.76:9648","601.76:9649","601.76:9650","601.76:9651","601.76:9652","601.76:9653","601.86:419","601.87:1607","601.87:1608","601.87:1609","601.88:81351","601.88:81371","601.88:81372","601.89:42509","6
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01.91:16360","601.91:16361","601.91:16362","601.91:16363","601.91:16364","601.91:16365","601.91:16366","601.91:16367","601.91:16368","601.91:16369","601.91:16370","601.91:16371","601.91:16372","601.91:16373","601.91:16374","601.91:16375","6
01.91:16376","601.91:16377","601.91:16378","601.91:16379","601.91:16380","601.91:16381","601.91:16382","601.91:16383","601.91:16384","601.91:16385","601.91:16386","601.91:16387","601.91:16388","601.91:16389","601.91:16390","601.91:16391","6
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01.91:16408","601.91:16409","601.91:16410","601.91:16411","601.91:16412","601.91:16413","601.91:16414","601.91:16415","601.91:16416","601.91:16417","601.91:16418","601.91:16419","601.91:16420","601.91:16421","601.91:16422","601.91:16423","6
take little effort; I feel I need help.","ien":109861,"legacyValue":3,"sequence":4},{"choiceId":6179,"choiceText":"Very Severe - Almost always present and I have been unable to perform at work, school or home due to this.","ien":109862,"leg
se do not attempt to score.","max":0,"min":0,"questionDisplay":81372,"questionId":9572,"questionText":"Vision problems, blurring, trouble seeing","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":60},{"choice":[{"ch
01.91:16424","601.91:16425","601.91:16426","601.91:16427","601.91:16428","601.91:16429","601.91:16430","601.91:16431","601.91:16432","601.91:16433","601.91:16434","601.91:16435","601.91:16436","601.91:16437","601.91:16438","601.91:16439","6
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oiceId":6175,"choiceText":"None - Rarely if ever present; not a problem at all","ien":109858,"legacyValue":0,"sequence":1},{"choiceId":6176,"choiceText":"Mild - Occasionally present, but it does not disrupt my activities; I can usually cont
inue what I'm doing; doesn't really concern me.","ien":109859,"legacyValue":1,"sequence":2},{"choiceId":6177,"choiceText":"Moderate - Often present, occasionally disrupts my activities; I can usually continue what I'm doing with some effort
; I feel somewhat concerned.","ien":109860,"legacyValue":2,"sequence":3},{"choiceId":6178,"choiceText":"Severe - Frequently present and disrupts activities; I can only do things that are fairly simple or take little effort; I feel I need he
lp.","ien":109861,"legacyValue":3,"sequence":4},{"choiceId":6179,"choiceText":"Very Severe - Almost always present and I have been unable to perform at work, school or home due to this.","ien":109862,"legacyValue":4,"sequence":5}],"choiceDi
splay":81351,"choiceIdentifier":0,"choiceIdentifierIen":42509,"choiceTypeId":15275,"designator":"7.","hint":null,"id":9638,"instrument":346,"introDisplay":81371,"introId":2617,"introText":"Symptom Report\r\n|Please rate the following sympto
ms with regard to how much they have disturbed you\r\nSINCE YOUR INJURY. The purpose of this inventory is to track symptoms over time. Please do not attempt to score.","max":0,"min":0,"questionDisplay":81372,"questionId":9573,"questionText
":"Sensitivity to light","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":70},{"choice":[{"choiceId":6175,"choiceText":"None - Rarely if ever present; not a problem at all","ien":109858,"legacyValue":0,"sequence":1
},{"choiceId":6176,"choiceText":"Mild - Occasionally present, but it does not disrupt my activities; I can usually continue what I'm doing; doesn't really concern me.","ien":109859,"legacyValue":1,"sequence":2},{"choiceId":6177,"choiceText"
:"Moderate - Often present, occasionally disrupts my activities; I can usually continue what I'm doing with some effort; I feel somewhat concerned.","ien":109860,"legacyValue":2,"sequence":3},{"choiceId":6178,"choiceText":"Severe - Frequent
acyValue":4,"sequence":5}],"choiceDisplay":81351,"choiceIdentifier":0,"choiceIdentifierIen":42509,"choiceTypeId":15275,"designator":"1.","hint":null,"id":9632,"instrument":346,"introDisplay":81371,"introId":2617,"introText":"Symptom Report\
ly present and disrupts activities; I can only do things that are fairly simple or take little effort; I feel I need help.","ien":109861,"legacyValue":3,"sequence":4},{"choiceId":6179,"choiceText":"Very Severe - Almost always present and I
have been unable to perform at work, school or home due to this.","ien":109862,"legacyValue":4,"sequence":5}],"choiceDisplay":81351,"choiceIdentifier":0,
"choiceIdentifierIen":42509,"choiceTypeId":15275,"designator":"8.","hint":null,"id":9639,"instrument":346,"introDisplay":81371,"introId":2617,"introText":"Symptom Report\r\n|Please rate the following symptoms with regard to how much they ha
ve disturbed you\r\nSINCE YOUR INJURY. The purpose of this inventory is to track symptoms over time. Please do not attempt to score.","max":0,"min":0,"questionDisplay":81372,"questionId":9574,"questionText":"Hearing difficulty","required":
true,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":80},{"choice":[{"choiceId":6175,"choiceText":"None - Rarely if ever present; not a problem at all","ien":109858,"legacyValue":0,"sequence":1},{"choiceId":6176,"choiceText":"Mil
d - Occasionally present, but it does not disrupt my activities; I can usually continue what I'm doing; doesn't really concern me.","ien":109859,"legacyValue":1,"sequence":2},{"choiceId":6177,"choiceText":"Moderate - Often present, occasion
ally disrupts my activities; I can usually continue what I'm doing with some effort; I feel somewhat concerned.","ien":109860,"legacyValue":2,"sequence":3},{"choiceId":6178,"choiceText":"Severe - Frequently present and disrupts activities;
I can only do things that are fairly simple or take little effort; I feel I need help.","ien":109861,"legacyValue":3,"sequence":4},{"choiceId":6179,"choiceText":"Very Severe - Almost always present and I have been unable to perform at work,
school or home due to this.","ien":109862,"legacyValue":4,"sequence":5}],"choiceDisplay":81351,"choiceIdentifier":0,"choiceIdentifierIen":42509,"choiceTypeId":15275,"designator":"9.","hint":null,"id":9640,"instrument":346,"introDisplay":81
371,"introId":2617,"introText":"Symptom Report\r\n|Please rate the following symptoms with regard to how much they have disturbed you\r\nSINCE YOUR INJURY. The purpose of this inventory is to track symptoms over time. Please do not attempt
r\n|Please rate the following symptoms with regard to how much they have disturbed you\r\nSINCE YOUR INJURY. The purpose of this inventory is to track symptoms over time. Please do not attempt to score.","max":0,"min":0,"questionDisplay":8
to score.","max":0,"min":0,"questionDisplay":81372,"questionId":9575,"questionText":"Sensitivity to noise","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":90},{"choice":[{"choiceId":6175,"choiceText":"None - Rare
ly if ever present; not a problem at all","ien":109858,"legacyValue":0,"sequence":1},{"choiceId":6176,"choiceText":"Mild - Occasionally present, but it does not disrupt my activities; I can usually continue what I'm doing; doesn't really co
ncern me.","ien":109859,"legacyValue":1,"sequence":2},{"choiceId":6177,"choiceText":"Moderate - Often present, occasionally disrupts my activities; I can usually continue what I'm doing with some effort; I feel somewhat concerned.","ien":10
9860,"legacyValue":2,"sequence":3},{"choiceId":6178,"choiceText":"Severe - Frequently present and disrupts activities; I can only do things that are fairly simple or take little effort; I feel I need help.","ien":109861,"legacyValue":3,"seq
uence":4},{"choiceId":6179,"choiceText":"Very Severe - Almost always present and I have been unable to perform at work, school or home due to this.","ien":109862,"legacyValue":4,"sequence":5}],"choiceDisplay":81351,"choiceIdentifier":0,"cho
iceIdentifierIen":42509,"choiceTypeId":15275,"designator":"10.","hint":null,"id":9641,"instrument":346,"introDisplay":81371,"introId":2617,"introText":"Symptom Report\r\n|Please rate the following symptoms with regard to how much they have
disturbed you\r\nSINCE YOUR INJURY. The purpose of this inventory is to track symptoms over time. Please do not attempt to score.","max":0,"min":0,"questionDisplay":81372,"questionId":9576,"questionText":"Numbness or tingling on parts of m
y body","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":100},{"choice":[{"choiceId":6175,"choiceText":"None - Rarely if ever present; not a problem at all","ien":109858,"legacyValue":0,"sequence":1},{"choiceId":61
76,"choiceText":"Mild - Occasionally present, but it does not disrupt my activities; I can usually continue what I'm doing; doesn't really concern me.","ien":
109859,"legacyValue":1,"sequence":2},{"choiceId":6177,"choiceText":"Moderate - Often present, occasionally disrupts my activities; I can usually continue what I'm doing with some effort; I feel somewhat concerned.","ien":109860,"legacyValue
1372,"questionId":9567,"questionText":"Feeling dizzy","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":10},{"choice":[{"choiceId":6175,"choiceText":"None - Rarely if ever present; not a problem at all","ien":109858
":2,"sequence":3},{"choiceId":6178,"choiceText":"Severe - Frequently present and disrupts activities; I can only do things that are fairly simple or take little effort; I feel I need help.","ien":109861,"legacyValue":3,"sequence":4},{"choic
eId":6179,"choiceText":"Very Severe - Almost always present and I have been unable to perform at work, school or home due to this.","ien":109862,"legacyValue":4,"sequence":5}],"choiceDisplay":81351,"choiceIdentifier":0,"choiceIdentifierIen"
:42509,"choiceTypeId":15275,"designator":"11.","hint":null,"id":9642,"instrument":346,"introDisplay":81371,"introId":2617,"introText":"Symptom Report\r\n|Please rate the following symptoms with regard to how much they have disturbed you\r\n
SINCE YOUR INJURY. The purpose of this inventory is to track symptoms over time. Please do not attempt to score.","max":0,"min":0,"questionDisplay":81372,"questionId":9577,"questionText":"Change in taste and\/or smell","required":true,"res
ponseTypeId":1,"responseTypeText":"MCHOICE","sequence":110},{"choice":[{"choiceId":6175,"choiceText":"None - Rarely if ever present; not a problem at all","ien":109858,"legacyValue":0,"sequence":1},{"choiceId":6176,"choiceText":"Mild - Occa
sionally present, but it does not disrupt my activities; I can usually continue what I'm doing; doesn't really concern me.","ien":109859,"legacyValue":1,"sequence":2},{"choiceId":6177,"choiceText":"Moderate - Often present, occasionally dis
rupts my activities; I can usually continue what I'm doing with some effort; I feel somewhat concerned.","ien":109860,"legacyValue":2,"sequence":3},{"choiceId":6178,"choiceText":"Severe - Frequently present and disrupts activities; I can on
ly do things that are fairly simple or take little effort; I feel I need help.","ien":109861,"legacyValue":3,"sequence":4},{"choiceId":6179,"choiceText":"Very Severe - Almost always present and I have been unable to perform at work, school
or home due to this.","ien":109862,"legacyValue":4,"sequence":5}],"choiceDisplay":81351,"choiceIdentifier":0,"choiceIdentifierIen":42509,"choiceTypeId":15275,"designator":"12.","hint":null,"id":9643,"instrument":346,"introDisplay":81371,"in
troId":2617,"introText":"Symptom Report\r\n|Please rate the following symptoms with regard to how much they have disturbed you\r\nSINCE YOUR INJURY. The purpose of this inventory is to track symptoms over time. Please do not attempt to sco
,"legacyValue":0,"sequence":1},{"choiceId":6176,"choiceText":"Mild - Occasionally present, but it does not disrupt my activities; I can usually continue what I'm doing; doesn't really concern me.","ien":109859,"legacyValue":1,"sequence":2},
re.","max":0,"min":0,"questionDisplay":81372,"questionId":9578,"questionText":"Loss of appetite or increased appetite","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":120},{"choice":[{"choiceId":6175,"choiceText":
"None - Rarely if ever present; not a problem at all","ien":109858,"legacyValue":0,"sequence":1},{"choiceId":6176,"choiceText":"Mild - Occasionally present, but it does not disrupt my activities; I can usually continue what I'm doing; doesn
't really concern me.","ien":109859,"legacyValue":1,"sequence":2},{"choiceId":6177,"choiceText":"Moderate - Often present, occasionally disrupts my activities; I can usually continue what I'm doing with some effort; I feel somewhat concerne
d.","ien":109860,"legacyValue":2,"sequence":3},{"choiceId":6178,"choiceText":"Severe - Frequently present and disrupts activities; I can only do things that are fairly simple or take little effort; I feel I need help.","ien":109861,"legacyV
alue":3,"sequence":4},{"choiceId":6179,"choiceText":"Very Severe - Almost always present and I have been unable to perform at work, school or home due to this.","ien":109862,"legacyValue":4,"sequence":5}],"choiceDisplay":81351,"choiceIdenti
fier":0,"choiceIdentifierIen":42509,"choiceTypeId":15275,"designator":"13.","hint":null,"id":9644,"instrument":346,"introDisplay":81371,"introId":2617,"introText":
"Symptom Report\r\n|Please rate the following symptoms with regard to how much they have disturbed you\r\nSINCE YOUR INJURY. The purpose of this inventory is to track symptoms over time. Please do not attempt to score.","max":0,"min":0,"qu
estionDisplay":81372,"questionId":9579,"questionText":"Poor concentration, can't pay attention, easily distracted","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":130},{"choice":[{"choiceId":6175,"choiceText":"Non
e - Rarely if ever present; not a problem at all","ien":109858,"legacyValue":0,"sequence":1},{"choiceId":6176,"choiceText":"Mild - Occasionally present, but it does not disrupt my activities; I can usually continue what I'm doing; doesn't r
eally concern me.","ien":109859,"legacyValue":1,"sequence":2},{"choiceId":6177,"choiceText":"Moderate - Often present, occasionally disrupts my activities; I can usually continue what I'm doing with some effort; I feel somewhat concerned.",
{"choiceId":6177,"choiceText":"Moderate - Often present, occasionally disrupts my activities; I can usually continue what I'm doing with some effort; I feel somewhat concerned.","ien":109860,"legacyValue":2,"sequence":3},{"choiceId":6178,"c
"ien":109860,"legacyValue":2,"sequence":3},{"choiceId":6178,"choiceText":"Severe - Frequently present and disrupts activities; I can only do things that are fairly simple or take little effort; I feel I need help.","ien":109861,"legacyValue
":3,"sequence":4},{"choiceId":6179,"choiceText":"Very Severe - Almost always present and I have been unable to perform at work, school or home due to this.","ien":109862,"legacyValue":4,"sequence":5}],"choiceDisplay":81351,"choiceIdentifier
":0,"choiceIdentifierIen":42509,"choiceTypeId":15275,"designator":"14.","hint":null,"id":9645,"instrument":346,"introDisplay":81371,"introId":2617,"introText":"Symptom Report\r\n|Please rate the following symptoms with regard to how much th
ey have disturbed you\r\nSINCE YOUR INJURY. The purpose of this inventory is to track symptoms over time. Please do not attempt to score.","max":0,"min":0,"questionDisplay":81372,"questionId":9580,"questionText":"Forgetfulness, can't remem
ber things","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":140},{"choice":[{"choiceId":6175,"choiceText":"None - Rarely if ever present; not a problem at all","ien":109858,"legacyValue":0,"sequence":1},{"choiceId
":6176,"choiceText":"Mild - Occasionally present, but it does not disrupt my activities; I can usually continue what I'm doing; doesn't really concern me.","ien":109859,"legacyValue":1,"sequence":2},{"choiceId":6177,"choiceText":"Moderate -
Often present, occasionally disrupts my activities; I can usually continue what I'm doing with some effort; I feel somewhat concerned.","ien":109860,"legacyValue":2,"sequence":3},{"choiceId":6178,"choiceText":"Severe - Frequently present a
nd disrupts activities; I can only do things that are fairly simple or take little effort; I feel I need help.","ien":109861,"legacyValue":3,"sequence":4},{"choiceId":6179,"choiceText":"Very Severe - Almost always present and I have been un
able to perform at work, school or home due to this.","ien":109862,"legacyValue":4,"sequence":5}],"choiceDisplay":81351,"choiceIdentifier":0,"choiceIdentifierIen":42509,"choiceTypeId":15275,"designator":"15.","hint":null,"id":9646,"instrume
nt":346,"introDisplay":81371,"introId":2617,"introText":"Symptom Report\r\n|Please rate the following symptoms with regard to how much they have disturbed you\r\nSINCE YOUR INJURY. The purpose of this inventory is to track symptoms over ti
|
