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Total # of Questions: 8

PROMIS short form - physical function 6b - version 1.2 [76804-4]

Date Done

Time Done

Where Done

Comment

Name

Value

Units

Are you able to do chores such as vacuuming or yard work? [61597-1]

Are you able to go up and down stairs at a normal pace? [61607-8]

Are you able to go for a walk of at least 15 minutes? [61609-4]

Are you able to run errands and shop? [61635-9]

Does your health now limit you in doing two hours of physical labor? [61688-8]

Does your health now limit you in doing moderate work around the house like vacuuming, sweeping floors or carrying in groceries? [61639-1]

PROMIS short form - physical function 6b - version 1.2 raw score [77797-9]

PROMIS physical function - version 1.0 T-score [77866-2]

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