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Total # of Questions: 15

PROMIS short form - global - version 1.2 [85524-7]

Date Done

Time Done

Where Done

Comment

Name

Value

Units

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

In general, would you say your quality of life is: [61578-1]

In general, how would you rate your physical health? [61579-9]

In general, how would you rate your mental health, including your mood and your ability to think? [61580-7]

In general, how would you rate your satisfaction with your social activities and relationships? [61581-5]

In general, please rate how well you carry out your usual social activities and roles. (This includes activities at home, at work and in your community, and responsibilities as a parent, child, spouse, employee, friend, etc.) [61585-6]

To what extent are you able to carry out your everyday physical activities such as walking, climbing stairs, carrying groceries, or moving a chair? [61582-3]

In the past 7 days - How often have you been bothered by emotional problems such as feeling anxious, depressed or irritable? [61586-4]

In the past 7 days - How would you rate your fatigue on average? [61584-9]

In the past 7 days - How would you rate your pain on average? [61583-1]

PROMIS-10 Global Health, GMH, T score [71969-0]

PROMIS-10 Global Health, GMH raw score [71970-8]

PROMIS-10 Global Health, GPH, T score [71971-6]

PROMIS-10 Global Health, GPH, raw score [71972-4]

PROMIS short form - global - version 1.2 raw score [85523-9]

Su	Mo	Tu	We	Th	Fr	Sa
		1	2	3	4	5
6	7	8	9	10	11	12
13	14	15	16	17	18	19
20	21	22	23	24	25	26
27	28	29	30

PLEASE WAIT