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Total # of Questions: 73

Veterans Rand health survey - 36 item (VR-36) [71933-6]

Date Done

Time Done

Where Done

Comment

Name

Value

Units

In general, would you say your health is [61577-3]

Does your health now limit you in vigorous activities, such as running, lifting heavy objects, participating in strenuous sports [71932-8]

Does your health now limit you in moderate activities, such as moving a table, pushing a vacuum cleaner, bowling or playing golf [71931-0]

Does your health now limit you in lifting or carrying groceries [71930-2]

Does your health now limit you in climbing several flights of stairs [71929-4]

Does your health now limit you in climbing one flight of stairs [71928-6]

Does your health now limit you in bending, kneeling, stooping [71927-8]

Does your health now limit you in walking more than a mile [71926-0]

Does your health now limit you in walking several blocks [71925-2]

Does your health now limit you in walking one block [71924-5]

Does your health now limit you in bathing or dressing yourself [71923-7]

As a result of your physical health, have you cut down the amount of time you spent on work or other activities in the past 4W [71922-9]

As a result of your physical health, have you accomplished less than you would like in the past 4W [71921-1]

As a result of your physical health, were you limited in the kind of work in the past 4W [71920-3]

As a result of your physical health, have you had difficulty performing the work or other activities - for example, it took extra effort in the past 4W [71919-5]

As a result of any emotional problems, have you cut down the amount of time you spent on work or other activities in the past 4W [71918-7]

As a result of any emotional problems, have you accomplished less than you would like in the past 4W [71917-9]

As a result of any emotional problems, you didn't do work or other activities as carefully as usual in the past 4W [71916-1]

During the past 4W, to what extent has your physical health or emotional problems interfered with your normal social activities with family, friends, neighbors or groups [71915-3]

How much bodily pain have you had during the past 4W [71914-6]

During the past 4W, how much did pain interfere with your normal work - including both work outside the home and house work [71913-8]

Did you feel full of pep during the past 4W [71912-0]

Have you been a very nervous person during the past 4W [71911-2]

Have you felt so down in the dumps that nothing could cheer you up during the past 4W [71910-4]

Have you felt calm and peaceful during the past 4W [71909-6]

Did you have a lot of energy during the past 4W [71908-8]

Have you felt downhearted and blue during the past 4W [71907-0]

Did you feel worn out during the past 4W [71906-2]

Have you been a happy person during the past 4W [71905-4]

Did you feel tired during the past 4W [71904-7]

During the past 4W, how much of the time has your physical health or emotional problems interfered with your social activities - like visiting with friends, relatives, etc. [71903-9]

I seem to get sick a lot easier than other people [71902-1]

I am as healthy as anyone I know [71901-3]

I expect my health to get worse [71900-5]

My health is excellent [71899-9]

Compared to one Y ago, how would you rate your physical health in general now [71898-1]

Compared to one Y ago, how would you rate your emotional problems, such as feeling anxious,depressed or irritable, now [71897-3]

VR 36 MH, raw score, oblique method [71973-2]

VR 36 RE, raw score, oblique method [71974-0]

VR 36 SF, raw score, oblique method [71975-7]

VR 36 VT, raw score, oblique method [71976-5]

VR 36 GH, raw score, oblique method [71977-3]

VR 36 BP, raw score, oblique method [71978-1]

VR 36 RP, raw score, oblique method [71979-9]

VR 36 PF, raw score, oblique method [71980-7]

VR 36 MH, T score, oblique method [71981-5]

VR 36 RE, T score, oblique method [71982-3]

VR 36 SF, T score, oblique method [71983-1]

VR 36 VT, T score, oblique method [71984-9]

VR 36 GH, T score, oblique method [71985-6]

VR 36 BP, T score, oblique method [71986-4]

VR 36 RP, T score, oblique method [71987-2]

VR 36 PF, T score, oblique method [71988-0]

VR 36 PCS, T score, oblique method [71989-8]

VR 36 MCS, T score, oblique method [71990-6]

VR 36 MH, raw score, orthogonal method [71991-4]

VR 36 RE, raw score, orthogonal method [71992-2]

VR 36 SF, raw score, orthogonal method [71993-0]

VR 36 VT, raw score, orthogonal method [71994-8]

VR 36 GH, raw score, orthogonal method [71995-5]

VR 36 BP, raw score, orthogonal method [71996-3]

VR 36 RP, raw score, orthogonal method [71997-1]

VR 36 PF, raw score, orthogonal method [71998-9]

VR 36 MH, T score, orthogonal method [71999-7]

VR 36 RE, T score, orthogonal method [72000-3]

VR 36 SF, T score, orthogonal method [72001-1]

VR 36 VT, T score, orthogonal method [72002-9]

VR 36 GH, T score, orthogonal method [72003-7]

VR 36 BP, T score, orthogonal method [72004-5]

VR 36 RP, T score, orthogonal method [72005-2]

VR 36 PF, T score, orthogonal method [72006-0]

VR 36 PCS, T score, orthogonal method [72007-8]

VR 36 MCS, T score, orthogonal method [72008-6]

PLEASE WAIT