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L., & Cella, D. (2009). Development of physical and mental health summary scores from the patient-reported outcomes measurement information system (PROMIS) global items. Quality of Life Research, 18(7), 873-880.","requireSignature":false,"r
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tient Reported Outcome Measurement Information System (PROMIS) 29 Profile v1.0 |\r\n | Date Given: <.Date_Given.>| Clinician: <.Staff_Ordered_By.>| \r\nLocation: <.Location.>| | Veteran: <.Patient_Name_Last_First.>| \r\nSSN:
<.Patient_SSN.>| DOB: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)\r\n| Gender: <.Patient_Gender.>| |\r\n \r\n \r\nTOTALS Raw Score T-Score| |\r\nPhysical Function <*Answer_7771*> <*Ans
wer_7778*>|\r\nAnxiety <*Answer_7772*> <*Answer_7779*>|\r\nDepression <*Answer_7773*> <*Answer_7780*>|\r\nFatigue <*Answer_7774*> <*Ans
wer_7781*>|\r\nSleep Disturbance <*Answer_7775*> <*Answer_7782*>|\r\nSatisfaction with Social Role <*Answer_7776*> <*Answer_7783*>|\r\nPain Interference <*Answer_7777*> <*Ans
wer_7784*>|\r\nPain Intensity <*Answer_8318*> N\/A | |\r\n \r\n \r\n \r\nQuestions and Answers| |1. Physical Functioning: Are you able to do\r\n chores such as vacuuming or yard work?|\r\n <*Answer_8290*>| |\
r\n2. Physical Functioning: Are you able to go up and down stairs at a normal pace?|\r\n <*Answer_8291*>| |\r\n3. Physical Functioning: Are you able to go for a walk of at least 15 minutes?|\r\n <*Answer_8292*>| |\r\n4. Physical Functio
ning: Are you able to run errands and shop?|\r\n <*Answer_8293*>| |\r\n5. Anxiety: IN THE PAST 7 DAYS I felt fearful.|\r\n <*Answer_8294*>| |\r\n6. Anxiety: IN THE PAST 7 DAYS I found it hard to focus on anything other than\r\n my anxie
east 15\r\nminutes?","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":3},{"choice":[{"choiceId":3937,"choiceText":"Without any difficulty","ien":108578,"legacyValue":5,"sequence":1},{"choiceId":3938,"choiceText":"W
ty.|\r\n <*Answer_8295*>| |\r\n7. Anxiety: IN THE PAST 7 DAYS my worries overwhelmed me.|\r\n <*Answer_8296*>| |\r\n8. Anxiety: IN THE PAST 7 DAYS I felt uneasy.| \r\n <*Answer_8297*>| |\r\n9. Depression: IN THE PAST 7 DAYS I felt wor
thless.|\r\n <*Answer_8298*>| |\r\n10. Depression: IN THE PAST 7 DAYS I felt helpless.|\r\n <*Answer_8299*>| |\r\n11. Depression: IN THE PAST 7 DAYS I felt depressed.|\r\n <*Answer_8300*>| |\r\n12. Depression: IN THE PAST 7 DAYS I f
elt hopeless.|\r\n <*Answer_8301*>| |\r\n13. Fatigue: DURING THE PAST 7 DAYS I feel fatigued.|\r\n <*Answer_8302*>| |\r\n14. Fatigue: DURING THE PAST 7 DAYS I have trouble STARTING things because I\r\n am tired.| \r\n <*Answer_8303*
>| |\r\n15. Fatigue: IN THE PAST 7 DAYS - How run down did you feel on average?|\r\n <*Answer_8304*>| |\r\n16. Fatigue: IN THE PAST 7 DAYS - How fatigued were you on average?|\r\n <*Answer_8305*>| |\r\n17. Sleep Disturbance: IN THE PA
ST 7 DAYS my sleep quality was,|\r\n <*Answer_8306*>| |\r\n18. Sleep Disturbance: IN THE PAST 7 DAYS my sleep was refreshing,|\r\n <*Answer_8307*>| |\r\n19. Sleep Disturbance: IN THE PAST 7 DAYS I had a problem with sleep,|\r\n <*A
nswer_8308*>| |\r\n20. Sleep Disturbance: IN THE PAST 7 DAYS I had difficulty falling asleep,|\r\n <*Answer_8309*>| |\r\n21. Satisfaction with Social Role: IN THE PAST 7 DAYS I am satisfied with how\r\n much work I can do (include work a
t home).|\r\n <*Answer_8310*>| |\r\n22. Satisfaction with Social Role: IN THE PAST 7 DAYS I am satisfied with my\r\n ability to work (include work at home).|
\r\n <*Answer_8311*>| |\r\n23. Satisfaction with Social Role: IN THE PAST 7 DAYS I am satisfied with my\r\n ability to do regular personal and household responsibilities.|\r\n <*Answer_8312*>| |\r\n24. Satisfaction with Social Role: I
N THE PAST 7 DAYS I am satisfied with my\r\n ability to perform my daily routines.|\r\n <*Answer_8313*>| |\r\n25. Pain Interference: IN THE PAST 7 DAYS - How much did pain interfere in your day to day \r\nactivities?|\r\n <*Answer_831
4*>| |\r\n26. Pain Interference: IN THE PAST 7 DAYS - How much did pain interfere \r\n with your work around the house?|\r\n <*Answer_8315*>| |\r\n27. Pain Interference: IN THE PAST 7 DAYS - How much did pain interfere with\r\n your abil
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ity to participate in social activities?|\r\n <*Answer_8316*>| |\r\n28. Pain Interference: IN THE PAST 7 DAYS - How much did pain interfere with\r\n your household chores?|\r\n <*Answer_8317*>| |\r\n29. Pain Intensity: How would you r
ate your pain on average?| \r\n <*Answer_8318*>| |\r\n \r\n \r\nInformation contained in this note is based on a self-report assessment \r\nand is not sufficient to use alone for diagnostic purposes. Assessment \r\nresults should be veri
fied for accuracy and used in conjunction with \r\nother diagnostic activities.| |\r\n \r\n 2008-2016 PROMIS Health Organization and PROMIS Cooperative Group\r\n \r\n$~"},"scaleGroup":[{"grid1":null,"grid2":null,"grid3":null,"id":296,"ins
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"choices\":[\r\n {\"id\": \"c3937\", \"text\": \"1. Without any difficulty\", \"quickKey\": 1}, \r\n {\"id\": \"c3938\", \"text\": \"2. With a little difficulty\", \"quickKey\": 2}, \r\n {\"id\": \"c3939\", \"text\": \"3. With s
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\"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c3942\", \"text\": \"1. Never\", \"quickKey\": 1}, \r\n {\"id\": \"c3943\", \"text\": \"2. Rarely\", \"quickKey\": 2}, \r\n {\"id\": \"c3944\", \"text\": \"3. Sometimes\",
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true, \"inline\": false, \r\n \"text\": \"7. Anxiety: IN THE PAST 7 DAYS my worries overwhelmed me.\", \r\n \"intro\": \"For each question or statement below, please mark one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r
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: \"8. Anxiety: IN THE PAST 7 DAYS I felt uneasy.\", \r\n \"intro\": \"For each question or statement below, please mark one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c3942\", \"text\": \"1. Never\", \"q
n":108586,"legacyValue":2,"sequence":2},{"choiceId":3944,"choiceText":"Sometimes","ien":108587,"legacyValue":3,"sequence":3},{"choiceId":3945,"choiceText":"Often","ien":108588,"legacyValue":4,"sequence":4},{"choiceId":3946,"choiceText":"Alw
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{\"id\": \"c3946\", \"text\": \"5. Always\", \"quickKey\": 5}\r\n ]},
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k one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c3942\", \"text\": \"1. Never\", \"quickKey\": 1}, \r\n {\"id\": \"c3943\", \"text\": \"2. Rarely\", \"quickKey\": 2}, \r\n {\"id\": \"c3944\", \"text
\": \"3. Sometimes\", \"quickKey\": 3}, \r\n {\"id\": \"c3945\", \"text\": \"4. Often\", \"quickKey\": 4}, \r\n {\"id\": \"c3946\", \"text\": \"5. Always\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8299\", \"type\": \"ChoiceQue
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\"choices\":[\r\n {\"id\": \"c3942\", \"text\": \"1. Never\", \"quickKey\": 1}, \r\n {\"id\": \"c3943\", \"text\": \"2. Rarely\", \"quickKey\": 2}, \r\n {\"id\": \"c3944\", \"text\": \"3. Sometimes\", \"quickKey\": 3}, \r\n
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xt\": \"1. Never\", \"quickKey\": 1}, \r\n {\"id\": \"c3943\", \"text\": \"2. Rarely\", \"quickKey\": 2}, \r\n {\"id\": \"c3944\", \"text\": \"3. Sometimes\", \"quickKey\": 3}, \r\n {\"id\": \"c3945\", \"text\": \"4. Often\", \"
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quickKey\": 4}, \r\n {\"id\": \"c3946\", \"text\": \"5. Always\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8301\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"12. Depression: IN THE PAST
7 DAYS I felt hopeless.\", \r\n \"intro\": \"For each question or statement below, please mark one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c3942\", \"text\": \"1. Never\", \"quickKey\": 1}, \r\n {
\"id\": \"c3943\", \"text\": \"2. Rarely\", \"quickKey\": 2}, \r\n {\"id\": \"c3944\", \"text\": \"3. Sometimes\", \"quickKey\": 3}, \r\n {\"id\": \"c3945\", \"text\": \"4. Often\", \"quickKey\": 4}, \r\n {\"id\": \"c3946\", \"t
ext\": \"5. Always\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8302\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"13. Fatigue: DURING THE PAST 7 DAYS I feel fatigued.\", \r\n \"intro\":
\"For each question or statement below, please mark one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c3947\", \"text\": \"1. Not at all\", \"quickKey\": 1}, \r\n {\"id\": \"c3948\", \"text\": \"2. A little
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kKey\": 5}\r\n ]}, \r\n {\"id\": \"q8303\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"14. Fatigue: DURING THE PAST 7 DAYS I have trouble STARTING things because I am\r\n tired.\", \r\n \
"intro\": \"For each question or statement below, please mark one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c3947\", \"text\": \"1. Not at all\", \"quickKey\": 1}, \r\n {\"id\": \"c3948\", \"text\": \"2
. A little bit\", \"quickKey\": 2}, \r\n {\"id\": \"c3949\", \"text\": \"3. Somewhat\", \"quickKey\": 3},
\r\n {\"id\": \"c3950\", \"text\": \"4. Quite a bit\", \"quickKey\": 4}, \r\n {\"id\": \"c3951\", \"text\": \"5. Very much\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8304\", \"type\": \"ChoiceQuestion\", \"required\": true, \"
:"For each question or statement below, please mark one answer.","max":null,"min":null,"questionDisplay":1470,"questionId":8295,"questionText":"Anxiety: IN THE PAST 7 DAYS I found it hard to focus on anything other\r\nthan my anxiety.","req
inline\": false, \r\n \"text\": \"15. Fatigue: IN THE PAST 7 DAYS - How run down did you feel on average?\", \r\n \"intro\": \"For each question or statement below, please mark one answer.\", \r\n \"columns\": 1, \r\n \"choices\
":[\r\n {\"id\": \"c3947\", \"text\": \"1. Not at all\", \"quickKey\": 1}, \r\n {\"id\": \"c3948\", \"text\": \"2. A little bit\", \"quickKey\": 2}, \r\n {\"id\": \"c3949\", \"text\": \"3. Somewhat\", \"quickKey\": 3}, \r\n
{\"id\": \"c3950\", \"text\": \"4. Quite a bit\", \"quickKey\": 4}, \r\n {\"id\": \"c3951\", \"text\": \"5. Very much\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8305\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\":
false, \r\n \"text\": \"16. Fatigue: IN THE PAST 7 DAYS - How fatigued were you on average?\", \r\n \"intro\": \"For each question or statement below, please mark one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {
\"id\": \"c3947\", \"text\": \"1. Not at all\", \"quickKey\": 1}, \r\n {\"id\": \"c3948\", \"text\": \"2. A little bit\", \"quickKey\": 2}, \r\n {\"id\": \"c3949\", \"text\": \"3. Somewhat\", \"quickKey\": 3}, \r\n {\"id\": \"c3
950\", \"text\": \"4. Quite a bit\", \"quickKey\": 4}, \r\n {\"id\": \"c3951\", \"text\": \"5. Very much\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8306\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n
\"text\": \"17. Sleep Disturbance: IN THE PAST 7 DAYS my sleep quality was,\", \r\n \"intro\": \"For each question or statement below, please mark one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c3952\"
, \"text\": \"1. Very poor\", \"quickKey\": 1}, \r\n {\"id\": \"c3953\", \"text\": \"2. Poor\", \"quickKey\": 2}, \r\n {\"id\": \"c3954\", \"text\": \"3. Fair\", \"quickKey\": 3}, \r\n {\"id\": \"c3955\", \"text\": \"4. Good\",
\"quickKey\": 4}, \r\n {\"id\": \"c3956\", \"text\": \"5. Very good\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8307\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"18. Sleep Disturbance:
IN THE PAST 7 DAYS my sleep was refreshing,\", \r\n \"intro\": \"For each question or statement below, please mark one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c4060\", \"text\": \"1. Not at all\", \"q
uired":true,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":6},{"choice":[{"choiceId":3942,"choiceText":"Never","ien":108585,"legacyValue":1,"sequence":1},{"choiceId":3943,"choiceText":"Rarely","ien":108586,"legacyValue":2,"seque
uickKey\": 1}, \r\n {\"id\": \"c4061\", \"text\": \"2. A little bit\", \"quickKey\": 2}, \r\n {\"id\": \"c4062\", \"text\": \"3. Somewhat\", \"quickKey\": 3}, \r\n {\"id\": \"c4063\", \"text\": \"4. Quite a bit\", \"quickKey\":
4}, \r\n {\"id\": \"c4064\", \"text\": \"5. Very much\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8308\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"19. Sleep Disturbance: IN THE PAST 7
DAYS I had a problem with sleep,\", \r\n \"intro\": \"For each question or statement below, please mark one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c3947\", \"text\": \"1. Not at all\", \"quickKey\":
1}, \r\n {\"id\": \"c3948\", \"text\": \"2. A little bit\", \"quickKey\": 2}, \r\n {\"id\": \"c3949\", \"text\": \"3. Somewhat\", \"quickKey\": 3}, \r\n {\"id\": \"c3950\", \"text\": \"4. Quite a bit\", \"quickKey\": 4}, \r\n
{\"id\": \"c3951\", \"text\": \"5. Very much\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8309\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"20. Sleep Disturbance: IN THE PAST 7 DAYS I had
difficulty falling asleep,\", \r\n \"intro\": \"For each question or statement below, please mark one answer.\", \r\n \"columns\": 1,
\r\n \"choices\":[\r\n {\"id\": \"c3947\", \"text\": \"1. Not at all\", \"quickKey\": 1}, \r\n {\"id\": \"c3948\", \"text\": \"2. A little bit\", \"quickKey\": 2}, \r\n {\"id\": \"c3949\", \"text\": \"3. Somewhat\", \"quickKe
y\": 3}, \r\n {\"id\": \"c3950\", \"text\": \"4. Quite a bit\", \"quickKey\": 4}, \r\n {\"id\": \"c3951\", \"text\": \"5. Very much\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8310\", \"type\": \"ChoiceQuestion\", \"required\":
true, \"inline\": false, \r\n \"text\": \"21. Satisfaction with Social Role: IN THE PAST 7 DAYS I am satisfied with how\r\n much work I can do (include work at home).\", \r\n \"intro\": \"For each question or statement below, please
mark one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c3947\", \"text\": \"1. Not at all\", \"quickKey\": 1}, \r\n {\"id\": \"c3948\", \"text\": \"2. A little bit\", \"quickKey\": 2}, \r\n {\"id\": \"c
nce":2},{"choiceId":3944,"choiceText":"Sometimes","ien":108587,"legacyValue":3,"sequence":3},{"choiceId":3945,"choiceText":"Often","ien":108588,"legacyValue":4,"sequence":4},{"choiceId":3946,"choiceText":"Always","ien":108589,"legacyValue":
3949\", \"text\": \"3. Somewhat\", \"quickKey\": 3}, \r\n {\"id\": \"c3950\", \"text\": \"4. Quite a bit\", \"quickKey\": 4}, \r\n {\"id\": \"c3951\", \"text\": \"5. Very much\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8311\",
\"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"22. Satisfaction with Social Role: IN THE PAST 7 DAYS I am satisfied with my\r\n ability to work (include work at home).\", \r\n \"intro\": \"For e
ach question or statement below, please mark one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c3947\", \"text\": \"1. Not at all\", \"quickKey\": 1}, \r\n {\"id\": \"c3948\", \"text\": \"2. A little bit\",
\"quickKey\": 2}, \r\n {\"id\": \"c3949\", \"text\": \"3. Somewhat\", \"quickKey\": 3}, \r\n {\"id\": \"c3950\", \"text\": \"4. Quite a bit\", \"quickKey\": 4}, \r\n {\"id\": \"c3951\", \"text\": \"5. Very much\", \"quickKey\":
5}\r\n ]}, \r\n {\"id\": \"q8312\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"23. Satisfaction with Social Role: IN THE PAST 7 DAYS I am satisfied with my\r\n ability to do regular persona
l and household responsibilities.\", \r\n \"intro\": \"For each question or statement below, please mark one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c3947\", \"text\": \"1. Not at all\", \"quickKey\":
1}, \r\n {\"id\": \"c3948\", \"text\": \"2. A little bit\", \"quickKey\": 2}, \r\n {\"id\": \"c3949\", \"text\": \"3. Somewhat\", \"quickKey\": 3}, \r\n {\"id\": \"c3950\", \"text\": \"4. Quite a bit\", \"quickKey\": 4}, \r\n
{\"id\": \"c3951\", \"text\": \"5. Very much\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8313\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"24. Satisfaction with Social Role: IN THE PAST
7 DAYS I am satisfied with my\r\n ability to perform my daily routines.\", \r\n \"intro\": \"For each question or statement below, please mark one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c3947\", \"tex
t\": \"1. Not at all\", \"quickKey\": 1}, \r\n {\"id\": \"c3948\", \"text\": \"2. A little bit\", \"quickKey\": 2}, \r\n {\"id\": \"c3949\", \"text\": \"3. Somewhat\", \"quickKey\": 3}, \r\n {\"id\": \"c3950\", \"text\": \"4. Qu
5,"sequence":5}],"choiceDisplay":1443,"choiceIdentifier":null,"choiceIdentifierIen":0,"choiceTypeId":108568,"designator":7,"hint":null,"id":8297,"instrument":250,"introDisplay":1470,"introId":2386,"introText":"For each question or statement
ite a bit\", \"quickKey\": 4}, \r\n {\"id\": \"c3951\", \"text\": \"5. Very much\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8314\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"25. Pain
Interference: IN THE PAST 7 DAYS - How much did pain interfere in your\r\n day to day activities?\", \r\n \"intro\": \"For each question or statement below, please mark one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n
{\"id\": \"c3947\", \"text\": \"1. Not at all\", \"quickKey\": 1}, \r\n {\"id\": \"c3948\", \"text\": \"2. A little bit\", \"quickKey\": 2},
\r\n {\"id\": \"c3949\", \"text\": \"3. Somewhat\", \"quickKey\": 3}, \r\n {\"id\": \"c3950\", \"text\": \"4. Quite a bit\", \"quickKey\": 4}, \r\n {\"id\": \"c3951\", \"text\": \"5. Very much\", \"quickKey\": 5}\r\n ]}, \r\n
{\"id\": \"q8315\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"26. Pain Interference: IN THE PAST 7 DAYS - How much did pain interfere with your\r\n work around the house?\", \r\n \"intro\"
: \"For each question or statement below, please mark one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c3947\", \"text\": \"1. Not at all\", \"quickKey\": 1}, \r\n {\"id\": \"c3948\", \"text\": \"2. A litt
le bit\", \"quickKey\": 2}, \r\n {\"id\": \"c3949\", \"text\": \"3. Somewhat\", \"quickKey\": 3}, \r\n {\"id\": \"c3950\", \"text\": \"4. Quite a bit\", \"quickKey\": 4}, \r\n {\"id\": \"c3951\", \"text\": \"5. Very much\", \"qu
ickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8316\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"27. Pain Interference: IN THE PAST 7 DAYS - How much did pain interfere with your\r\n ability to part
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\r\n| Date Given: <.Date_Given.>\r\n| Clinician: <.Staff_Ordered_By.>\r\n| Location: <.Location.>| \r\n| Veteran: <.Patient_Name_Last_First.>\r\n| SSN: <.Patient_SSN.>\r\n| DOB: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)\r\
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n| Gender: <.Patient_Gender.>\r\n| |<*Answer_7771*>\r\n| | \r\n|Questions and Answers| \r\n|Physical Function:\r\n| 1. Are you able to do chores such as vacuuming or yard work?\r\n| <*Answer_8583*>\r\n| 2. Are you able to go up and dow
n stairs at a normal pace?\r\n| <*Answer_8584*>\r\n| 3. Are you able to go for a walk of at least 15 minutes?\r\n| <*Answer_8585*>\r\n| 4. Are you able to run errands and shop?\r\n| <*Answer_8586*>|\r\n|Anxiety: In the past 7 days.
..\r\n| 5. I felt fearful.\r\n| <*Answer_8587*>\r\n| 6. I found it hard to focus on anything other than my anxiety.\r\n| <*Answer_8588*>\r\n| 7. My worries overwhelmed me.\r\n| <*Answer_8589*>\r\n| 8. I felt uneasy.\r\n| <*Answe
r_8590*>|\r\n|Depression: In the past 7 days...\r\n| 9. I felt worthless.\r\n| <*Answer_8591*>\r\n|10. I felt helpless.\r\n| <*Answer_8592*>\r\n|11. I felt depressed.\r\n| <*Answer_8593*>\r\n|12. I felt hopeless.\r\n| <*Answer_8
594*>|\r\n|Fatigue: During the past 7 days...\r\n|13. I feel fatigued.\r\n| <*Answer_8595*>\r\n|14. I have trouble STARTING things because I am tired. \r\n| <*Answer_8596*>\r\n|15. How run down did you feel on average?\r\n| <*Answe
r_8597*>\r\n|16. How fatigued were you on average?\r\n| <*Answer_8598*>|\r\n|Sleep Disturbance: In the past 7 days...\r\n|17. My sleep quality was\r\n| <*Answer_8599*>\r\n|18. My sleep was refreshing.\r\n| <*Answer_8600*>\r\n|19. I
had a problem with my sleep.\r\n| <*Answer_8601*>\r\n|20. I had difficulty falling asleep.\r\n| <*Answer_8602*>|\r\n|Ability to Participate in Social Roles and Activities:\r\n|21. I have trouble doing all of my regular leisure activi
ties with others.\r\n| <*Answer_8603*>\r\n|22. I have trouble doing all of the family activities that I want to do.\r\n| <*Answer_8604*>\r\n|23. I have trouble doing all of my usual work (include work at home).\r\n| <*Answer_8605*>
\r\n|24. I have trouble doing all of the activities with friends that I want to do.\r\n| <*Answer_8606*>|\r\n|Pain Interference: In the past 7 days...\r\n|25. How much did pain interfere with your day to day activities?\r\n| <*Answer_
8607*>\r\n|26. How much did pain interfere with work around the home?\r\n| <*Answer_8608*>\r\n|27. How much did pain interfere with your ability to participate in social\r\n| activities?\r\n| <*Answer_8609*>\r\n|28. How much did pa
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oiceIdentifier":null,"choiceIdentifierIen":0,"choiceTypeId":108568,"designator":12,"hint":null,"id":8302,"instrument":250,"introDisplay":1470,"introId":2386,"introText":"For each question or statement below, please mark one answer.","max":n
\r\n {\"id\": \"c5167\", \"text\": \"5. Unable to do\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8587\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"5. Anxiety: IN THE PAST 7 DAYS I felt
fearful.\", \r\n \"intro\": \"Please respond to each question or statement by selecting one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5168\", \"text\": \"1. Never\", \"quickKey\": 1}, \r\n {\"id\":
\"c5169\", \"text\": \"2. Rarely\", \"quickKey\": 2}, \r\n {\"id\": \"c5170\", \"text\": \"3. Sometimes\", \"quickKey\": 3}, \r\n {\"id\": \"c5171\", \"text\": \"4. Often\", \"quickKey\": 4}, \r\n {\"id\": \"c5172\", \"text\":
\"5. Always\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8588\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"6. Anxiety: IN THE PAST 7 DAYS I found it hard to focus on anything other than my\
r\n anxiety.\", \r\n \"intro\": \"Please respond to each question or statement by selecting one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5168\", \"text\": \"1. Never\", \"quickKey\": 1}, \r\n {\"id
\": \"c5169\", \"text\": \"2. Rarely\", \"quickKey\": 2}, \r\n {\"id\": \"c5170\", \"text\": \"3. Sometimes\", \"quickKey\": 3}, \r\n {\"id\": \"c5171\", \"text\": \"4. Often\", \"quickKey\": 4}, \r\n {\"id\": \"c5172\", \"text\
": \"5. Always\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8589\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"7. Anxiety: IN THE PAST 7 DAYS my worries overwhelmed me.\", \r\n \"intro\":
\"Please respond to each question or statement by selecting one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5168\", \"text\": \"1. Never\", \"quickKey\": 1}, \r\n {\"id\": \"c5169\", \"text\": \"2. Rare
ly\", \"quickKey\": 2}, \r\n {\"id\": \"c5170\", \"text\": \"3. Sometimes\", \"quickKey\": 3}, \r\n {\"id\": \"c5171\", \"text\": \"4. Often\", \"quickKey\": 4}, \r\n {\"id\": \"c5172\", \"text\": \"5. Always\", \"quickKey\": 5}
\r\n ]}, \r\n {\"id\": \"q8590\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"8. Anxiety: IN THE PAST 7 DAYS I felt uneasy.\", \r\n \"intro\": \"Please respond to each question or statemen
ull,"min":null,"questionDisplay":1470,"questionId":8301,"questionText":"Depression: IN THE PAST 7 DAYS I felt hopeless.","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":12},{"choice":[{"choiceId":3947,"choiceText"
t by selecting one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5168\", \"text\": \"1. Never\", \"quickKey\": 1}, \r\n {\"id\": \"c5169\", \"text\": \"2. Rarely\", \"quickKey\": 2}, \r\n {\"id\": \"c5
170\", \"text\": \"3. Sometimes\", \"quickKey\": 3}, \r\n {\"id\": \"c5171\", \"text\": \"4. Often\", \"quickKey\": 4}, \r\n {\"id\": \"c5172\", \"text\": \"5. Always\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8591\", \"type\"
: \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"9. Depression: IN THE PAST 7 DAYS I felt worthless.\", \r\n \"intro\": \"Please respond to each question or statement by selecting one answer.\", \r\n \"
columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5168\", \"text\": \"1. Never\", \"quickKey\": 1}, \r\n {\"id\": \"c5169\", \"text\": \"2. Rarely\", \"quickKey\": 2}, \r\n {\"id\": \"c5170\", \"text\": \"3. Sometimes\", \"qui
ckKey\": 3}, \r\n {\"id\": \"c5171\", \"text\": \"4. Often\", \"quickKey\": 4}, \r\n {\"id\": \"c5172\", \"text\": \"5. Always\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8592\", \"type\": \"ChoiceQuestion\", \"required\": true
, \"inline\": false, \r\n \"text\": \"10. Depression: IN THE PAST 7 DAYS I felt helpless.\", \r\n \"intro\": \"Please respond to each question or statement by selecting one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n
{\"id\": \"c5168\", \"text\": \"1. Never\", \"quickKey\": 1}, \r\n {\"id\": \"c5169\", \"text\": \"2. Rarely\", \"quickKey\": 2},
\r\n {\"id\": \"c5170\", \"text\": \"3. Sometimes\", \"quickKey\": 3}, \r\n {\"id\": \"c5171\", \"text\": \"4. Often\", \"quickKey\": 4}, \r\n {\"id\": \"c5172\", \"text\": \"5. Always\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\
": \"q8593\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"11. Depression: IN THE PAST 7 DAYS I felt depressed.\", \r\n \"intro\": \"Please respond to each question or statement by selecting on
e answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5168\", \"text\": \"1. Never\", \"quickKey\": 1}, \r\n {\"id\": \"c5169\", \"text\": \"2. Rarely\", \"quickKey\": 2}, \r\n {\"id\": \"c5170\", \"text\":
:"Not at all","ien":108580,"legacyValue":1,"sequence":1},{"choiceId":3948,"choiceText":"A little bit","ien":108590,"legacyValue":2,"sequence":2},{"choiceId":3949,"choiceText":"Somewhat","ien":108591,"legacyValue":3,"sequence":3},{"choiceId"
\"3. Sometimes\", \"quickKey\": 3}, \r\n {\"id\": \"c5171\", \"text\": \"4. Often\", \"quickKey\": 4}, \r\n {\"id\": \"c5172\", \"text\": \"5. Always\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8594\", \"type\": \"ChoiceQuestio
n\", \"required\": true, \"inline\": false, \r\n \"text\": \"12. Depression: IN THE PAST 7 DAYS I felt hopeless.\", \r\n \"intro\": \"Please respond to each question or statement by selecting one answer.\", \r\n \"columns\": 1, \r\
n \"choices\":[\r\n {\"id\": \"c5168\", \"text\": \"1. Never\", \"quickKey\": 1}, \r\n {\"id\": \"c5169\", \"text\": \"2. Rarely\", \"quickKey\": 2}, \r\n {\"id\": \"c5170\", \"text\": \"3. Sometimes\", \"quickKey\": 3}, \r\n
{\"id\": \"c5171\", \"text\": \"4. Often\", \"quickKey\": 4}, \r\n {\"id\": \"c5172\", \"text\": \"5. Always\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8595\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": fal
se, \r\n \"text\": \"13. Fatigue: DURING THE PAST 7 DAYS I feel fatigued.\", \r\n \"intro\": \"Please respond to each question or statement by selecting one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c
5173\", \"text\": \"1. Not at all\", \"quickKey\": 1}, \r\n {\"id\": \"c5174\", \"text\": \"2. A little bit\", \"quickKey\": 2}, \r\n {\"id\": \"c5175\", \"text\": \"3. Somewhat\", \"quickKey\": 3}, \r\n {\"id\": \"c5176\", \"te
xt\": \"4. Quite a bit\", \"quickKey\": 4}, \r\n {\"id\": \"c5177\", \"text\": \"5. Very much\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8596\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\"
: \"14. Fatigue: DURING THE PAST 7 DAYS I have trouble starting things because I am\r\n tired.\", \r\n \"intro\": \"Please respond to each question or statement by selecting one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\
n {\"id\": \"c5173\", \"text\": \"1. Not at all\", \"quickKey\": 1}, \r\n {\"id\": \"c5174\", \"text\": \"2. A little bit\", \"quickKey\": 2}, \r\n {\"id\": \"c5175\", \"text\": \"3. Somewhat\", \"quickKey\": 3}, \r\n {\"id\
": \"c5176\", \"text\": \"4. Quite a bit\", \"quickKey\": 4}, \r\n {\"id\": \"c5177\", \"text\": \"5. Very much\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8597\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false
:3950,"choiceText":"Quite a bit","ien":108592,"legacyValue":4,"sequence":4},{"choiceId":3951,"choiceText":"Very much","ien":108593,"legacyValue":5,"sequence":5}],"choiceDisplay":1443,"choiceIdentifier":null,"choiceIdentifierIen":0,"choiceTy
, \r\n \"text\": \"15. Fatigue: DURING THE PAST 7 DAYS how run-down did you feel on average?\", \r\n \"intro\": \"Please respond to each question or statement by selecting one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r
\n {\"id\": \"c5173\", \"text\": \"1. Not at all\", \"quickKey\": 1}, \r\n {\"id\": \"c5174\", \"text\": \"2. A little bit\", \"quickKey\": 2}, \r\n {\"id\": \"c5175\", \"text\": \"3. Somewhat\", \"quickKey\": 3}, \r\n {\"id
\": \"c5176\", \"text\": \"4. Quite a bit\", \"quickKey\": 4}, \r\n {\"id\": \"c5177\", \"text\": \"5. Very much\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8598\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": fals
e, \r\n \"text\": \"16. Fatigue: DURING THE PAST 7 DAYS how fatigued were you on average?\",
\r\n \"intro\": \"Please respond to each question or statement by selecting one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5173\", \"text\": \"1. Not at all\", \"quickKey\": 1}, \r\n {\"id\": \"c5174
\", \"text\": \"2. A little bit\", \"quickKey\": 2}, \r\n {\"id\": \"c5175\", \"text\": \"3. Somewhat\", \"quickKey\": 3}, \r\n {\"id\": \"c5176\", \"text\": \"4. Quite a bit\", \"quickKey\": 4}, \r\n {\"id\": \"c5177\", \"text\
": \"5. Very much\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8599\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"17. Sleep Disturbance: IN THE PAST 7 DAYS my sleep quality was\", \r\n \"
intro\": \"Please respond to each question or statement by selecting one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5178\", \"text\": \"1. Very Poor\", \"quickKey\": 1}, \r\n {\"id\": \"c5179\", \"text\
": \"2. Poor\", \"quickKey\": 2}, \r\n {\"id\": \"c5180\", \"text\": \"3. Fair\", \"quickKey\": 3}, \r\n {\"id\": \"c5181\", \"text\": \"4. Good\", \"quickKey\": 4}, \r\n {\"id\": \"c5182\", \"text\": \"5. Very good\", \"quickKe
y\": 5}\r\n ]}, \r\n {\"id\": \"q8600\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"18. Sleep Disturbance: IN THE PAST 7 DAYS my sleep was refreshing.\", \r\n \"intro\": \"Please respond
Id":1,"responseTypeText":"MCHOICE","sequence":1},{"choice":[{"choiceId":3937,"choiceText":"Without any difficulty","ien":108578,"legacyValue":5,"sequence":1},{"choiceId":3938,"choiceText":"With a little difficulty","ien":108581,"legacyValue
peId":108569,"designator":13,"hint":null,"id":8303,"instrument":250,"introDisplay":1470,"introId":2386,"introText":"For each question or statement below, please mark one answer.","max":null,"min":null,"questionDisplay":1470,"questionId":830
to each question or statement by selecting one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5183\", \"text\": \"1. Not at all\", \"quickKey\": 1}, \r\n {\"id\": \"c5184\", \"text\": \"2. A little bit\", \
"quickKey\": 2}, \r\n {\"id\": \"c5185\", \"text\": \"3. Somewhat\", \"quickKey\": 3}, \r\n {\"id\": \"c5186\", \"text\": \"4. Quite a bit\", \"quickKey\": 4}, \r\n {\"id\": \"c5187\", \"text\": \"5. Very much\", \"quickKey\": 5
}\r\n ]}, \r\n {\"id\": \"q8601\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"19. Sleep Disturbance: IN THE PAST 7 DAYS I had a problem with my sleep.\", \r\n \"intro\": \"Please respond
to each question or statement by selecting one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5173\", \"text\": \"1. Not at all\", \"quickKey\": 1}, \r\n {\"id\": \"c5174\", \"text\": \"2. A little bit\", \
"quickKey\": 2}, \r\n {\"id\": \"c5175\", \"text\": \"3. Somewhat\", \"quickKey\": 3}, \r\n {\"id\": \"c5176\", \"text\": \"4. Quite a bit\", \"quickKey\": 4}, \r\n {\"id\": \"c5177\", \"text\": \"5. Very much\", \"quickKey\": 5
}\r\n ]}, \r\n {\"id\": \"q8602\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"20. Sleep Disturbance: IN THE PAST 7 DAYS I had difficulty falling asleep.\", \r\n \"intro\": \"Please respon
d to each question or statement by selecting one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5173\", \"text\": \"1. Not at all\", \"quickKey\": 1}, \r\n {\"id\": \"c5174\", \"text\": \"2. A little bit\",
\"quickKey\": 2}, \r\n {\"id\": \"c5175\", \"text\": \"3. Somewhat\", \"quickKey\": 3}, \r\n {\"id\": \"c5176\", \"text\": \"4. Quite a bit\", \"quickKey\": 4}, \r\n {\"id\": \"c5177\", \"text\": \"5. Very much\", \"quickKey\":
5}\r\n ]}, \r\n {\"id\": \"q8603\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"21. Ability to Participate in Social Roles and Activities: I have trouble doing\r\n all of my regular leisure
activities with others.\", \r\n \"intro\": \"Please respond to each question or statement by selecting one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5188\", \"text\": \"1. Never\", \"quickKey\": 1}, \r\
2,"questionText":"Fatigue: DURING THE PAST 7 DAYS I feel fatigued.","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":13},{"choice":[{
n {\"id\": \"c5189\", \"text\": \"2. Rarely\", \"quickKey\": 2}, \r\n {\"id\": \"c5190\", \"text\": \"3. Sometimes\", \"quickKey\": 3},
\r\n {\"id\": \"c5191\", \"text\": \"4. Usually\", \"quickKey\": 4}, \r\n {\"id\": \"c5192\", \"text\": \"5. Always\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8604\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\
": false, \r\n \"text\": \"22. Ability to Participate in Social Roles and Activities: I have trouble doing\r\n all of the family activities that I want to do.\", \r\n \"intro\": \"Please respond to each question or statement by select
ing one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5188\", \"text\": \"1. Never\", \"quickKey\": 1}, \r\n {\"id\": \"c5189\", \"text\": \"2. Rarely\", \"quickKey\": 2}, \r\n {\"id\": \"c5190\", \"te
xt\": \"3. Sometimes\", \"quickKey\": 3}, \r\n {\"id\": \"c5191\", \"text\": \"4. Usually\", \"quickKey\": 4}, \r\n {\"id\": \"c5192\", \"text\": \"5. Always\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8605\", \"type\": \"Choic
eQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"23. Ability to Participate in Social Roles and Activities: I have trouble doing\r\n all of my usual work (include work at home).\", \r\n \"intro\": \"Please respond
to each question or statement by selecting one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5188\", \"text\": \"1. Never\", \"quickKey\": 1}, \r\n {\"id\": \"c5189\", \"text\": \"2. Rarely\", \"quickKey\"
: 2}, \r\n {\"id\": \"c5190\", \"text\": \"3. Sometimes\", \"quickKey\": 3}, \r\n {\"id\": \"c5191\", \"text\": \"4. Usually\", \"quickKey\": 4}, \r\n {\"id\": \"c5192\", \"text\": \"5. Always\", \"quickKey\": 5}\r\n ]}, \r\n
{\"id\": \"q8606\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"24. Ability to Participate in Social Roles and Activities: I have trouble doing\r\n all of the activities with friends that I wan
t to do.\", \r\n \"intro\": \"Please respond to each question or statement by selecting one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5188\", \"text\": \"1. Never\", \"quickKey\": 1}, \r\n {\"id\":
"choiceId":3947,"choiceText":"Not at all","ien":108580,"legacyValue":1,"sequence":1},{"choiceId":3948,"choiceText":"A little bit","ien":108590,"legacyValue":2,"sequence":2},{"choiceId":3949,"choiceText":"Somewhat","ien":108591,"legacyValue"
\"c5189\", \"text\": \"2. Rarely\", \"quickKey\": 2}, \r\n {\"id\": \"c5190\", \"text\": \"3. Sometimes\", \"quickKey\": 3}, \r\n {\"id\": \"c5191\", \"text\": \"4. Usually\", \"quickKey\": 4}, \r\n {\"id\": \"c5192\", \"text\":
\"5. Always\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8607\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"25. Pain Interference: IN THE PAST 7 DAYS how much did pain interfere with your\r
\n day to day activities?\", \r\n \"intro\": \"Please respond to each question or statement by selecting one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5173\", \"text\": \"1. Not at all\", \"quickKey\":
1}, \r\n {\"id\": \"c5174\", \"text\": \"2. A little bit\", \"quickKey\": 2}, \r\n {\"id\": \"c5175\", \"text\": \"3. Somewhat\", \"quickKey\": 3}, \r\n {\"id\": \"c5176\", \"text\": \"4. Quite a bit\", \"quickKey\": 4}, \r\n
{\"id\": \"c5177\", \"text\": \"5. Very much\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8608\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"26. Pain Interference: IN THE PAST 7 DAYS how m
uch did pain interfere with work\r\n around the home?\", \r\n \"intro\": \"Please respond to each question or statement by selecting one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5173\", \"text\": \"1.
Not at all\", \"quickKey\": 1}, \r\n {\"id\": \"c5174\", \"text\": \"2. A little bit\", \"quickKey\": 2}, \r\n {\"id\": \"c5175\", \"text\": \"3. Somewhat\", \"quickKey\": 3}, \r\n {\"id\": \"c5176\", \"text\": \"4. Quite a bit\
", \"quickKey\": 4}, \r\n {\"id\": \"c5177\", \"text\": \"5. Very much\", \"quickKey\": 5}\r\n ]},
\r\n {\"id\": \"q8609\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"27. Pain Interference: IN THE PAST 7 DAYS how much did pain interfere with your\r\n ability to participate in social activit
ies?\", \r\n \"intro\": \"Please respond to each question or statement by selecting one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5173\", \"text\": \"1. Not at all\", \"quickKey\": 1}, \r\n {\"id\":
:3,"sequence":3},{"choiceId":3950,"choiceText":"Quite a bit","ien":108592,"legacyValue":4,"sequence":4},{"choiceId":3951,"choiceText":"Very much","ien":108593,"legacyValue":5,"sequence":5}],"choiceDisplay":1443,"choiceIdentifier":null,"choi
\"c5174\", \"text\": \"2. A little bit\", \"quickKey\": 2}, \r\n {\"id\": \"c5175\", \"text\": \"3. Somewhat\", \"quickKey\": 3}, \r\n {\"id\": \"c5176\", \"text\": \"4. Quite a bit\", \"quickKey\": 4}, \r\n {\"id\": \"c5177\",
\"text\": \"5. Very much\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8610\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"28. Pain Interference: IN THE PAST 7 DAYS how much did pain interfer
e with your\r\n household chores?\", \r\n \"intro\": \"Please respond to each question or statement by selecting one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5173\", \"text\": \"1. Not at all\", \"quic
kKey\": 1}, \r\n {\"id\": \"c5174\", \"text\": \"2. A little bit\", \"quickKey\": 2}, \r\n {\"id\": \"c5175\", \"text\": \"3. Somewhat\", \"quickKey\": 3}, \r\n {\"id\": \"c5176\", \"text\": \"4. Quite a bit\", \"quickKey\": 4},
\r\n {\"id\": \"c5177\", \"text\": \"5. Very much\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8613\", \"type\": \"SliderQuestion\", \"required\": true, \r\n \"text\": \"29. Pain Intensity: IN THE PAST 7 DAYS how would you rate
your pain on average?\", \r\n \"intro\": \"Please respond to each question or statement by selecting one answer.\", \r\n \"min\": 0, \"max\": 10, \r\n \"legend\":[\"No pain\", \"Worst pain imaginable\"]}]\r\n}","instrument":267,"la
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"introText":"Please respond to each question or statement by selecting one answer.","max":0,"min":0,"questionDisplay":97350,"questionId":8609,"questionText":"Pain Interference: IN THE PAST 7 DAYS how much did pain interfere with your abilit
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1470,"introId":2386,"introText":"For each question or statement below, please mark one answer.","max":null,"min":null,"questionDisplay":1470,"questionId":8306,"questionText":"Sleep Disturbance: IN THE PAST 7 DAYS my sleep quality was,","req
hoiceId":5177,"choiceText":"Very much","ien":100140,"legacyValue":5,"sequence":5}],"choiceDisplay":82590,"choiceIdentifier":1,"choiceIdentifierIen":42274,"choiceTypeId":15029,"designator":"29.","hint":null,"id":8611,"instrument":266,"introD
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have been able to concentrate.","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":290},{"choice":[{"choiceId":5173,"choiceText":"Not at all","ien":100136,"legacyValue":1,"sequence":1},{"choiceId":5174,"choiceText":"
A little bit","ien":100137,"legacyValue":2,"sequence":2},{"choiceId":5175,"choiceText":"Somewhat","ien":100138,"legacyValue":3,"sequence":3},{"choiceId":5176,
"choiceText":"Quite a bit","ien":100139,"legacyValue":4,"sequence":4},{"choiceId":5177,"choiceText":"Very much","ien":100140,"legacyValue":5,"sequence":5}],"choiceDisplay":82590,"choiceIdentifier":1,"choiceIdentifierIen":42274,"choiceTypeId
":15029,"designator":"30.","hint":null,"id":8612,"instrument":266,"introDisplay":82614,"introId":2455,"introText":"Please respond to each question or statement by selecting one answer.","max":0,"min":0,"questionDisplay":97350,"questionId":8
612,"questionText":"Cognitive Function - Abilities: IN THE PAST 7 DAYS I have been able to remember to do things, like take medicine or buy something I needed.","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":300}
,{"choice":[{"choiceId":5193,"choiceText":"0 - No pain","ien":100156,"legacyValue":0,"sequence":1},{"choiceId":5194,"choiceText":1,"ien":100157,"legacyValue":1,"sequence":2},{"choiceId":5195,"choiceText":2,"ien":100158,"legacyValue":2,"sequ
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scoringTag":"DLLSTR","staffOnly":"N","submitNational":true,"targetPopulation":null,"version":2.1,"wasOperational":true},"report":{"id":189,"instrument":266,
"template":"|Patient Reported Outcome Measurement Information System (PROMIS) 29+2 Profile\r\n|PROMIS29+2 Profile v2.1 (PROPr)\r\n| \r\n| Date Given: <.Date_Given.>\r\n| Clinician: <.Staff_Ordered_By.>\r\n| Location: <.Location.>|
\r\n| Veteran: <.Patient_Name_Last_First.>\r\n| SSN: <.Patient_SSN.>\r\n| DOB: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)\r\n| Gender: <.Patient_Gender.>\r\n| |<*Answer_7771*>\r\n| | \r\n|Questions and Answers| \r\n|Physical Func
tion:\r\n| 1. Are you able to do chores such as vacuuming or yard work?\r\n| <*Answer_8583*>\r\n| 2. Are you able to go up and down stairs at a normal pace?\r\n| <*Answer_8584*>\r\n| 3. Are you able to go for a walk of at least 15 min
utes?\r\n| <*Answer_8585*>\r\n| 4. Are you able to run errands and shop?\r\n| <*Answer_8586*>|\r\n|Anxiety: In the past 7 days...\r\n| 5. I felt fearful.\r\n| <*Answer_8587*>\r\n| 6. I found it hard to focus on anything other than
my anxiety.\r\n| <*Answer_8588*>\r\n| 7. My worries overwhelmed me.\r\n| <*Answer_8589*>\r\n| 8. I felt uneasy.\r\n| <*Answer_8590*>|\r\n|Depression: In the past 7 days...\r\n| 9. I felt worthless.\r\n| <*Answer_8591*>\r\n|10. I
felt helpless.\r\n| <*Answer_8592*>\r\n|11. I felt depressed.\r\n| <*Answer_8593*>\r\n|12. I felt hopeless.\r\n| <*Answer_8594*>|\r\n|Fatigue: During the past 7 days...\r\n|13. I feel fatigued.\r\n| <*Answer_8595*>\r\n|14. I ha
ve trouble STARTING things because I am tired. \r\n| <*Answer_8596*>\r\n|15. How run down did you feel on average?\r\n| <*Answer_8597*>\r\n|16. How fatigued were you on average?\r\n| <*Answer_8598*>|\r\n|Sleep Disturbance: In the p
ast 7 days...\r\n|17. My sleep quality was\r\n| <*Answer_8599*>\r\n|18. My sleep was refreshing.\r\n| <*Answer_8600*>\r\n|19. I had a problem with my sleep.\r\n| <*Answer_8601*>\r\n|20. I had difficulty falling asleep.\r\n| <*An
swer_8602*>|\r\n|Ability to Participate in Social Roles and Activities:\r\n|21. I have trouble doing all of my regular leisure activities with others.\r\n| <*Answer_8603*>\r\n|22. I have trouble doing all of the family activities that I
"legacyValue":2,"sequence":4},{"choiceId":4064,"choiceText":"Very much","ien":108700,"legacyValue":1,"sequence":5}],"choiceDisplay":1443,"choiceIdentifier":null,"choiceIdentifierIen":0,"choiceTypeId":108590,"designator":18,"hint":null,"id":
want to do.\r\n| <*Answer_8604*>\r\n|23. I have trouble doing all of my usual work (include work at home).\r\n| <*Answer_8605*>\r\n|24. I have trouble doing all of the activities with friends that I want to do.\r\n| <*Answer_8606*>
|\r\n|Pain Interference: In the past 7 days...\r\n|25. How much did pain interfere with your day to day activities?\r\n| <*Answer_8607*>\r\n|26. How much did pain interfere with work around the home?\r\n| <*Answer_8608*>\r\n|27. How m
uch did pain interfere with your ability to participate in social\r\n| activities?\r\n| <*Answer_8609*>\r\n|28. How much did pain interfere with your household chores?\r\n| <*Answer_8610*>|\r\n|Cognitive Function -- Abilities: In t
he past 7 days...\r\n|29. I have been able to concentrate.\r\n| <*Answer_8611*>\r\n|30. I have been able to remember to do things, like take medicine or buy\r\n| something I needed.\r\n| <*Answer_8612*>|\r\n|Pain Intensity: In the
past 7 days...\r\n|31. How would you rate your pain on average?\r\n| <*Answer_8613*>\r\n| \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 conjunction with \r\n|other diagnostic activities.\r\n| \r\n| 2008-2016 PROMIS Health Organization and PROMIS Cooperative Group"},"scaleGroup":[{"grid1":0,"grid2":0,"gri
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sequence":2,"xLabel":null},{"groupId":320,"id":1385,"name":"Depression","sequence":3,"xLabel":null},{"groupId":320,"id":1386,"name":"Fatigue","sequence":4,
"xLabel":null},{"groupId":320,"id":1387,"name":"Sleep Disturbance","sequence":5,"xLabel":null},{"groupId":320,"id":1388,"name":"Social Roles and Activities","sequence":6,"xLabel":null},{"groupId":320,"id":1389,"name":"Pain Interference","se
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"Unable to do","ien":108584,"legacyValue":1,"sequence":5}],"choiceDisplay":1443,"choiceIdentifier":null,"choiceIdentifierIen":0,"choiceTypeId":108567,"designator":2,"hint":null,"id":8292,"instrument":250,"introDisplay":1470,"introId":2386,"
8308,"instrument":250,"introDisplay":1470,"introId":2386,"introText":"For each question or statement below, please mark one answer.","max":null,"min":null,"questionDisplay":1470,"questionId":8307,"questionText":"Sleep Disturbance: IN THE PA
Health Organization (PHO)\", \r\n \"restartDays\": 2, \r\n \"content\":[\r\n {\"id\": \"i2455\", \"type\": \"IntroText\", \r\n \"text\": \"Please respond to each question or statement by selecting one answer.\"\r\n }, \r\n {\"id\
": \"q8583\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"1. Physical Function: Are you able to do chores such as vacuuming or yard work?\", \r\n \"intro\": \"Please respond to each question o
r statement by selecting one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5163\", \"text\": \"1. Without any difficulty\", \"quickKey\": 1}, \r\n {\"id\": \"c5164\", \"text\": \"2. With a little difficult
y\", \"quickKey\": 2}, \r\n {\"id\": \"c5165\", \"text\": \"3. With some difficulty\", \"quickKey\": 3}, \r\n {\"id\": \"c5166\", \"text\": \"4. With much difficulty\", \"quickKey\": 4}, \r\n {\"id\": \"c5167\", \"text\": \"5. U
nable to do\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8584\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"2. Physical Function: Are you able to go up and down stairs at a normal pace?\", \
r\n \"intro\": \"Please respond to each question or statement by selecting one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5163\", \"text\": \"1. Without any difficulty\", \"quickKey\": 1}, \r\n {\"id
\": \"c5164\", \"text\": \"2. With a little difficulty\", \"quickKey\": 2}, \r\n {\"id\": \"c5165\", \"text\": \"3. With some difficulty\", \"quickKey\": 3}, \r\n {\"id\": \"c5166\", \"text\": \"4. With much difficulty\", \"quickKey
\": 4}, \r\n {\"id\": \"c5167\", \"text\": \"5. Unable to do\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8585\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"3. Physical Function: Are you
able to go for a walk of at least 15 minutes?\", \r\n \"intro\": \"Please respond to each question or statement by selecting one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5163\", \"text\": \"1. Without
any difficulty\", \"quickKey\": 1}, \r\n {\"id\": \"c5164\", \"text\": \"2. With a little difficulty\", \"quickKey\": 2}, \r\n {\"id\": \"c5165\", \"text\": \"3. With some difficulty\", \"quickKey\": 3}, \r\n {\"id\": \"c5166\"
ST 7 DAYS my sleep was refreshing,","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":18},{"choice":[{"choiceId":3947,"choiceText":"Not at all","ien":108580,"legacyValue":1,"sequence":1},{"choiceId":3948,"choiceText
, \"text\": \"4. With much difficulty\", \"quickKey\": 4}, \r\n {\"id\": \"c5167\", \"text\": \"5. Unable to do\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8586\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false
, \r\n \"text\": \"4. Physical Function: Are you able to run errands and shop?\", \r\n \"intro\": \"Please respond to each question or statement by selecting one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\"
: \"c5163\", \"text\": \"1. Without any difficulty\", \"quickKey\": 1}, \r\n {\"id\": \"c5164\", \"text\": \"2. With a little difficulty\", \"quickKey\": 2}, \r\n {\"id\": \"c5165\", \"text\": \"3. With some difficulty\", \"quickKey
\": 3}, \r\n {\"id\": \"c5166\", \"text\": \"4. With much difficulty\", \"quickKey\": 4}, \r\n {\"id\": \"c5167\", \"text\": \"5. Unable to do\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8587\", \"type\": \"ChoiceQuestion\", \"
required\": true, \"inline\": false, \r\n \"text\": \"5. Anxiety: IN THE PAST 7 DAYS I felt fearful.\",
\r\n \"intro\": \"Please respond to each question or statement by selecting one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5168\", \"text\": \"1. Never\", \"quickKey\": 1}, \r\n {\"id\": \"c5169\", \
"text\": \"2. Rarely\", \"quickKey\": 2}, \r\n {\"id\": \"c5170\", \"text\": \"3. Sometimes\", \"quickKey\": 3}, \r\n {\"id\": \"c5171\", \"text\": \"4. Often\", \"quickKey\": 4}, \r\n {\"id\": \"c5172\", \"text\": \"5. Always\"
, \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8588\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"6. Anxiety: IN THE PAST 7 DAYS I found it hard to focus on anything other than my\r\n anxiety.\
", \r\n \"intro\": \"Please respond to each question or statement by selecting one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5168\", \"text\": \"1. Never\", \"quickKey\": 1}, \r\n {\"id\": \"c5169\"
, \"text\": \"2. Rarely\", \"quickKey\": 2}, \r\n {\"id\": \"c5170\", \"text\": \"3. Sometimes\", \"quickKey\": 3}, \r\n {\"id\": \"c5171\", \"text\": \"4. Often\", \"quickKey\": 4}, \r\n {\"id\": \"c5172\", \"text\": \"5. Alway
":"A little bit","ien":108590,"legacyValue":2,"sequence":2},{"choiceId":3949,"choiceText":"Somewhat","ien":108591,"legacyValue":3,"sequence":3},{"choiceId":3950,"choiceText":"Quite a bit","ien":108592,"legacyValue":4,"sequence":4},{"choiceI
s\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8589\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"7. Anxiety: IN THE PAST 7 DAYS my worries overwhelmed me.\", \r\n \"intro\": \"Please res
pond to each question or statement by selecting one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5168\", \"text\": \"1. Never\", \"quickKey\": 1}, \r\n {\"id\": \"c5169\", \"text\": \"2. Rarely\", \"quick
Key\": 2}, \r\n {\"id\": \"c5170\", \"text\": \"3. Sometimes\", \"quickKey\": 3}, \r\n {\"id\": \"c5171\", \"text\": \"4. Often\", \"quickKey\": 4}, \r\n {\"id\": \"c5172\", \"text\": \"5. Always\", \"quickKey\": 5}\r\n ]}, \r
\n {\"id\": \"q8590\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"8. Anxiety: IN THE PAST 7 DAYS I felt uneasy.\", \r\n \"intro\": \"Please respond to each question or statement by selectin
g one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5168\", \"text\": \"1. Never\", \"quickKey\": 1}, \r\n {\"id\": \"c5169\", \"text\": \"2. Rarely\", \"quickKey\": 2}, \r\n {\"id\": \"c5170\", \"text
\": \"3. Sometimes\", \"quickKey\": 3}, \r\n {\"id\": \"c5171\", \"text\": \"4. Often\", \"quickKey\": 4}, \r\n {\"id\": \"c5172\", \"text\": \"5. Always\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8591\", \"type\": \"ChoiceQue
stion\", \"required\": true, \"inline\": false, \r\n \"text\": \"9. Depression: IN THE PAST 7 DAYS I felt worthless.\", \r\n \"intro\": \"Please respond to each question or statement by selecting one answer.\", \r\n \"columns\": 1,
\r\n \"choices\":[\r\n {\"id\": \"c5168\", \"text\": \"1. Never\", \"quickKey\": 1}, \r\n {\"id\": \"c5169\", \"text\": \"2. Rarely\", \"quickKey\": 2}, \r\n {\"id\": \"c5170\", \"text\": \"3. Sometimes\", \"quickKey\": 3},
\r\n {\"id\": \"c5171\", \"text\": \"4. Often\", \"quickKey\": 4}, \r\n {\"id\": \"c5172\", \"text\": \"5. Always\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8592\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\":
false, \r\n \"text\": \"10. Depression: IN THE PAST 7 DAYS I felt helpless.\", \r\n \"intro\": \"Please respond to each question or statement by selecting one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\":
d":3951,"choiceText":"Very much","ien":108593,"legacyValue":5,"sequence":5}],"choiceDisplay":1443,"choiceIdentifier":null,"choiceIdentifierIen":0,"choiceTypeId":108569,"designator":19,"hint":null,"id":8309,"instrument":250,"introDisplay":14
\"c5168\", \"text\": \"1. Never\", \"quickKey\": 1}, \r\n {\"id\": \"c5169\", \"text\": \"2. Rarely\", \"quickKey\": 2}, \r\n {\"id\": \"c5170\", \"text\": \"3. Sometimes\", \"quickKey\": 3}, \r\n {\"id\": \"c5171\", \"text\": \
"4. Often\", \"quickKey\": 4}, \r\n {\"id\": \"c5172\", \"text\": \"5. Always\", \"quickKey\": 5}\r\n ]},
\r\n {\"id\": \"q8593\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"11. Depression: IN THE PAST 7 DAYS I felt depressed.\", \r\n \"intro\": \"Please respond to each question or statement by
selecting one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5168\", \"text\": \"1. Never\", \"quickKey\": 1}, \r\n {\"id\": \"c5169\", \"text\": \"2. Rarely\", \"quickKey\": 2}, \r\n {\"id\": \"c5170\
", \"text\": \"3. Sometimes\", \"quickKey\": 3}, \r\n {\"id\": \"c5171\", \"text\": \"4. Often\", \"quickKey\": 4}, \r\n {\"id\": \"c5172\", \"text\": \"5. Always\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8594\", \"type\": \"
ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"12. Depression: IN THE PAST 7 DAYS I felt hopeless.\", \r\n \"intro\": \"Please respond to each question or statement by selecting one answer.\", \r\n \"colu
mns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5168\", \"text\": \"1. Never\", \"quickKey\": 1}, \r\n {\"id\": \"c5169\", \"text\": \"2. Rarely\", \"quickKey\": 2}, \r\n {\"id\": \"c5170\", \"text\": \"3. Sometimes\", \"quickKe
y\": 3}, \r\n {\"id\": \"c5171\", \"text\": \"4. Often\", \"quickKey\": 4}, \r\n {\"id\": \"c5172\", \"text\": \"5. Always\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8595\", \"type\": \"ChoiceQuestion\", \"required\": true, \"
inline\": false, \r\n \"text\": \"13. Fatigue: DURING THE PAST 7 DAYS I feel fatigued.\", \r\n \"intro\": \"Please respond to each question or statement by selecting one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n
{\"id\": \"c5173\", \"text\": \"1. Not at all\", \"quickKey\": 1}, \r\n {\"id\": \"c5174\", \"text\": \"2. A little bit\", \"quickKey\": 2}, \r\n {\"id\": \"c5175\", \"text\": \"3. Somewhat\", \"quickKey\": 3}, \r\n {\"id\": \"
70,"introId":2386,"introText":"For each question or statement below, please mark one answer.","max":null,"min":null,"questionDisplay":1470,"questionId":8308,"questionText":"Sleep Disturbance: IN THE PAST 7 DAYS I had a problem with sleep,",
c5176\", \"text\": \"4. Quite a bit\", \"quickKey\": 4}, \r\n {\"id\": \"c5177\", \"text\": \"5. Very much\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8596\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\
n \"text\": \"14. Fatigue: DURING THE PAST 7 DAYS I have trouble starting things because I am\r\n tired.\", \r\n \"intro\": \"Please respond to each question or statement by selecting one answer.\", \r\n \"columns\": 1, \r\n \"c
hoices\":[\r\n {\"id\": \"c5173\", \"text\": \"1. Not at all\", \"quickKey\": 1}, \r\n {\"id\": \"c5174\", \"text\": \"2. A little bit\", \"quickKey\": 2}, \r\n {\"id\": \"c5175\", \"text\": \"3. Somewhat\", \"quickKey\": 3}, \r
\n {\"id\": \"c5176\", \"text\": \"4. Quite a bit\", \"quickKey\": 4}, \r\n {\"id\": \"c5177\", \"text\": \"5. Very much\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8597\", \"type\": \"ChoiceQuestion\", \"required\": true, \"in
line\": false, \r\n \"text\": \"15. Fatigue: DURING THE PAST 7 DAYS how run-down did you feel on average?\", \r\n \"intro\": \"Please respond to each question or statement by selecting one answer.\", \r\n \"columns\": 1, \r\n \"
choices\":[\r\n {\"id\": \"c5173\", \"text\": \"1. Not at all\", \"quickKey\": 1}, \r\n {\"id\": \"c5174\", \"text\": \"2. A little bit\", \"quickKey\": 2}, \r\n {\"id\": \"c5175\", \"text\": \"3. Somewhat\", \"quickKey\": 3}, \
r\n {\"id\": \"c5176\", \"text\": \"4. Quite a bit\", \"quickKey\": 4}, \r\n {\"id\": \"c5177\", \"text\": \"5. Very much\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8598\", \"type\": \"ChoiceQuestion\", \"required\": true, \"i
nline\": false, \r\n \"text\": \"16. Fatigue: DURING THE PAST 7 DAYS how fatigued were you on average?\", \r\n \"intro\": \"Please respond to each question or statement by selecting one answer.\", \r\n \"columns\": 1, \r\n \"cho
ices\":[\r\n {\"id\": \"c5173\", \"text\": \"1. Not at all\", \"quickKey\": 1},
\r\n {\"id\": \"c5174\", \"text\": \"2. A little bit\", \"quickKey\": 2}, \r\n {\"id\": \"c5175\", \"text\": \"3. Somewhat\", \"quickKey\": 3}, \r\n {\"id\": \"c5176\", \"text\": \"4. Quite a bit\", \"quickKey\": 4}, \r\n {\
"required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":19},{"choice":[{"choiceId":3947,"choiceText":"Not at all","ien":108580,"legacyValue":1,"sequence":1},{"choiceId":3948,"choiceText":"A little bit","ien":108590,"legac
"id\": \"c5177\", \"text\": \"5. Very much\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8599\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"17. Sleep Disturbance: IN THE PAST 7 DAYS my sleep
quality was\", \r\n \"intro\": \"Please respond to each question or statement by selecting one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5178\", \"text\": \"1. Very Poor\", \"quickKey\": 1}, \r\n {\
"id\": \"c5179\", \"text\": \"2. Poor\", \"quickKey\": 2}, \r\n {\"id\": \"c5180\", \"text\": \"3. Fair\", \"quickKey\": 3}, \r\n {\"id\": \"c5181\", \"text\": \"4. Good\", \"quickKey\": 4}, \r\n {\"id\": \"c5182\", \"text\": \"
5. Very good\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8600\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"18. Sleep Disturbance: IN THE PAST 7 DAYS my sleep was refreshing.\", \r\n \"i
ntro\": \"Please respond to each question or statement by selecting one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5183\", \"text\": \"1. Not at all\", \"quickKey\": 1}, \r\n {\"id\": \"c5184\", \"text\
": \"2. A little bit\", \"quickKey\": 2}, \r\n {\"id\": \"c5185\", \"text\": \"3. Somewhat\", \"quickKey\": 3}, \r\n {\"id\": \"c5186\", \"text\": \"4. Quite a bit\", \"quickKey\": 4}, \r\n {\"id\": \"c5187\", \"text\": \"5. Ver
y much\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8601\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"19. Sleep Disturbance: IN THE PAST 7 DAYS I had a problem with my sleep.\", \r\n \"i
ntro\": \"Please respond to each question or statement by selecting one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5173\", \"text\": \"1. Not at all\", \"quickKey\": 1}, \r\n {\"id\": \"c5174\", \"text\
": \"2. A little bit\", \"quickKey\": 2}, \r\n {\"id\": \"c5175\", \"text\": \"3. Somewhat\", \"quickKey\": 3}, \r\n {\"id\": \"c5176\", \"text\": \"4. Quite a bit\", \"quickKey\": 4}, \r\n {\"id\": \"c5177\", \"text\": \"5. Ver
y much\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8602\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"20. Sleep Disturbance: IN THE PAST 7 DAYS I had difficulty falling asleep.\", \r\n \
yValue":2,"sequence":2},{"choiceId":3949,"choiceText":"Somewhat","ien":108591,"legacyValue":3,"sequence":3},{"choiceId":3950,"choiceText":"Quite a bit","ien":108592,"legacyValue":4,"sequence":4},{"choiceId":3951,"choiceText":"Very much","ie
"intro\": \"Please respond to each question or statement by selecting one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5173\", \"text\": \"1. Not at all\", \"quickKey\": 1}, \r\n {\"id\": \"c5174\", \"tex
t\": \"2. A little bit\", \"quickKey\": 2}, \r\n {\"id\": \"c5175\", \"text\": \"3. Somewhat\", \"quickKey\": 3}, \r\n {\"id\": \"c5176\", \"text\": \"4. Quite a bit\", \"quickKey\": 4}, \r\n {\"id\": \"c5177\", \"text\": \"5. V
ery much\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8603\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"21. Ability to Participate in Social Roles and Activities: I have trouble doing\r\n a
ll of my regular leisure activities with others.\", \r\n \"intro\": \"Please respond to each question or statement by selecting one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5188\", \"text\": \"1. Never
\", \"quickKey\": 1}, \r\n {\"id\": \"c5189\", \"text\": \"2. Rarely\", \"quickKey\": 2}, \r\n {\"id\": \"c5190\", \"text\": \"3. Sometimes\", \"quickKey\": 3}, \r\n {\"id\": \"c5191\", \"text\": \"4. Usually\", \"quickKey\": 4}
, \r\n {\"id\": \"c5192\", \"text\": \"5. Always\", \"quickKey\": 5}\r\n ]},
\r\n {\"id\": \"q8604\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"22. Ability to Participate in Social Roles and Activities: I have trouble doing\r\n all of the family activities that I want
to do.\", \r\n \"intro\": \"Please respond to each question or statement by selecting one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5188\", \"text\": \"1. Never\", \"quickKey\": 1}, \r\n {\"id\": \
"c5189\", \"text\": \"2. Rarely\", \"quickKey\": 2}, \r\n {\"id\": \"c5190\", \"text\": \"3. Sometimes\", \"quickKey\": 3}, \r\n {\"id\": \"c5191\", \"text\": \"4. Usually\", \"quickKey\": 4}, \r\n {\"id\": \"c5192\", \"text\":
\"5. Always\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8605\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"23. Ability to Participate in Social Roles and Activities: I have trouble doing\r\
n":108593,"legacyValue":5,"sequence":5}],"choiceDisplay":1443,"choiceIdentifier":null,"choiceIdentifierIen":0,"choiceTypeId":108569,"designator":20,"hint":null,"id":8310,"instrument":250,"introDisplay":1470,"introId":2386,"introText":"For e
n all of my usual work (include work at home).\", \r\n \"intro\": \"Please respond to each question or statement by selecting one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5188\", \"text\": \"1. Never\"
, \"quickKey\": 1}, \r\n {\"id\": \"c5189\", \"text\": \"2. Rarely\", \"quickKey\": 2}, \r\n {\"id\": \"c5190\", \"text\": \"3. Sometimes\", \"quickKey\": 3}, \r\n {\"id\": \"c5191\", \"text\": \"4. Usually\", \"quickKey\": 4},
\r\n {\"id\": \"c5192\", \"text\": \"5. Always\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8606\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"24. Ability to Participate in Social Roles
and Activities: I have trouble doing\r\n all of the activities with friends that I want to do.\", \r\n \"intro\": \"Please respond to each question or statement by selecting one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\
n {\"id\": \"c5188\", \"text\": \"1. Never\", \"quickKey\": 1}, \r\n {\"id\": \"c5189\", \"text\": \"2. Rarely\", \"quickKey\": 2}, \r\n {\"id\": \"c5190\", \"text\": \"3. Sometimes\", \"quickKey\": 3}, \r\n {\"id\": \"c5191
\", \"text\": \"4. Usually\", \"quickKey\": 4}, \r\n {\"id\": \"c5192\", \"text\": \"5. Always\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8607\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\
": \"25. Pain Interference: IN THE PAST 7 DAYS how much did pain interfere with your\r\n day to day activities?\", \r\n \"intro\": \"Please respond to each question or statement by selecting one answer.\", \r\n \"columns\": 1, \r\n
\"choices\":[\r\n {\"id\": \"c5173\", \"text\": \"1. Not at all\", \"quickKey\": 1}, \r\n {\"id\": \"c5174\", \"text\": \"2. A little bit\", \"quickKey\": 2}, \r\n {\"id\": \"c5175\", \"text\": \"3. Somewhat\", \"quickKey\": 3}
, \r\n {\"id\": \"c5176\", \"text\": \"4. Quite a bit\", \"quickKey\": 4}, \r\n {\"id\": \"c5177\", \"text\": \"5. Very much\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8608\", \"type\": \"ChoiceQuestion\", \"required\": true,
\"inline\": false, \r\n \"text\": \"26. Pain Interference: IN THE PAST 7 DAYS how much did pain interfere with work\r\n around the home?\", \r\n \"intro\": \"Please respond to each question or statement by selecting one answer.\", \r\
ach question or statement below, please mark one answer.","max":null,"min":null,"questionDisplay":1470,"questionId":8309,"questionText":"Sleep Disturbance: IN THE PAST 7 DAYS I had difficulty falling asleep,","required":true,"responseTypeId
n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5173\", \"text\": \"1. Not at all\", \"quickKey\": 1}, \r\n {\"id\": \"c5174\", \"text\": \"2. A little bit\", \"quickKey\": 2}, \r\n {\"id\": \"c5175\", \"text\": \"3.
Somewhat\", \"quickKey\": 3}, \r\n {\"id\": \"c5176\", \"text\": \"4. Quite a bit\", \"quickKey\": 4}, \r\n {\"id\": \"c5177\", \"text\": \"5. Very much\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8609\", \"type\": \"ChoiceQues
tion\", \"required\": true, \"inline\": false, \r\n \"text\": \"27. Pain Interference: IN THE PAST 7 DAYS how much did pain interfere with your
\r\n ability to participate in social activities?\", \r\n \"intro\": \"Please respond to each question or statement by selecting one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5173\", \"text\": \"1. Not
at all\", \"quickKey\": 1}, \r\n {\"id\": \"c5174\", \"text\": \"2. A little bit\", \"quickKey\": 2}, \r\n {\"id\": \"c5175\", \"text\": \"3. Somewhat\", \"quickKey\": 3}, \r\n {\"id\": \"c5176\", \"text\": \"4. Quite a bit\", \
"quickKey\": 4}, \r\n {\"id\": \"c5177\", \"text\": \"5. Very much\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8610\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text\": \"28. Pain Interference:
IN THE PAST 7 DAYS how much did pain interfere with your\r\n household chores?\", \r\n \"intro\": \"Please respond to each question or statement by selecting one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \
"c5173\", \"text\": \"1. Not at all\", \"quickKey\": 1}, \r\n {\"id\": \"c5174\", \"text\": \"2. A little bit\", \"quickKey\": 2}, \r\n {\"id\": \"c5175\", \"text\": \"3. Somewhat\", \"quickKey\": 3}, \r\n {\"id\": \"c5176\", \"
text\": \"4. Quite a bit\", \"quickKey\": 4}, \r\n {\"id\": \"c5177\", \"text\": \"5. Very much\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8611\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": false, \r\n \"text
\": \"29. Cognitive Function - Abilities: IN THE PAST 7 DAYS I have been able to\r\n concentrate.\", \r\n \"intro\": \"Please respond to each question or statement by selecting one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[
":1,"responseTypeText":"MCHOICE","sequence":20},{"choice":[{"choiceId":3947,"choiceText":"Not at all","ien":108580,"legacyValue":1,"sequence":1},{"choiceId":3948,"choiceText":"A little bit","ien":108590,"legacyValue":2,"sequence":2},{"choic
\r\n {\"id\": \"c5173\", \"text\": \"1. Not at all\", \"quickKey\": 1}, \r\n {\"id\": \"c5174\", \"text\": \"2. A little bit\", \"quickKey\": 2}, \r\n {\"id\": \"c5175\", \"text\": \"3. Somewhat\", \"quickKey\": 3}, \r\n {\"
id\": \"c5176\", \"text\": \"4. Quite a bit\", \"quickKey\": 4}, \r\n {\"id\": \"c5177\", \"text\": \"5. Very much\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\": \"q8612\", \"type\": \"ChoiceQuestion\", \"required\": true, \"inline\": fa
lse, \r\n \"text\": \"30. Cognitive Function - Abilities: IN THE PAST 7 DAYS I have been able to\r\n remember to do things, like take medicine or buy something I needed.\", \r\n \"intro\": \"Please respond to each question or statemen
t by selecting one answer.\", \r\n \"columns\": 1, \r\n \"choices\":[\r\n {\"id\": \"c5173\", \"text\": \"1. Not at all\", \"quickKey\": 1}, \r\n {\"id\": \"c5174\", \"text\": \"2. A little bit\", \"quickKey\": 2}, \r\n {\
"id\": \"c5175\", \"text\": \"3. Somewhat\", \"quickKey\": 3}, \r\n {\"id\": \"c5176\", \"text\": \"4. Quite a bit\", \"quickKey\": 4}, \r\n {\"id\": \"c5177\", \"text\": \"5. Very much\", \"quickKey\": 5}\r\n ]}, \r\n {\"id\":
\"q8613\", \"type\": \"SliderQuestion\", \"required\": true, \r\n \"text\": \"31. Pain Intensity: IN THE PAST 7 DAYS how would you rate your pain on average?\", \r\n \"intro\": \"Please respond to each question or statement by selecti
ng one answer.\", \r\n \"min\": 0, \"max\": 10, \r\n \"legend\":[\"No pain\", \"Worst pain imaginable\"]}]\r\n}","instrument":266,"lastUpdate":"2021-02-22T18:10:50","specIen":133},"verify":["601.71:266","601.72:8583","601.72:8584","60
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ence":5}],"choiceDisplay":1443,"choiceIdentifier":null,"choiceIdentifierIen":0,"choiceTypeId":108569,"designator":21,"hint":null,"id":8311,"instrument":250,"introDisplay":1470,"introId":2386,"introText":"For each question or statement below
, please mark one answer.","max":null,"min":null,"questionDisplay":1470,"questionId":8310,"questionText":"Satisfaction with Social Role: IN THE PAST 7 DAYS I am satisfied with how\r\nmuch work I can do (include work at home).","required":tr
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"instrument":250,"introDisplay":1470,"introId":2386,"introText":"For each question or statement below, please mark one answer.","max":null,"min":null,"questionDisplay":1470,"questionId":8311,"questionText":"Satisfaction with Social Role: IN
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