106708-1
SFV Symptom Impact
Active
106703-2 Pain
Observation ID in Form
J2053A
Fully-Specified Name
- Component
- SFV Symptom Impact - Pain
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Long Common Name
SFV Symptom Impact - Pain during assessment period [CMS Assessment]
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.80
- Last Updated
- Version 2.80 (ADD)
- Order vs. Observation
- Observation
Normative Answer List LL6962-6
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Not at all - symptom does not affect the patient, including symptoms well-controlled with current treatment | 0 | LA34627-2 | |
| Slight | 1 | LA11910-9 | |
| Moderate | 2 | LA6751-7 | |
| Severe | 3 | LA6750-9 | |
| Not applicable (the patient is not experiencing the symptom) | 9 | LA34628-0 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 106623-2 | Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.0 during assessment period [CMS Assessment] |
| 106933-5 | Hospice Outcomes and Patient Evaluation (HOPE) Update Visit v1.0 [CMS Assessment] |
106702-4 Shortness of breath
Observation ID in Form
J2053B
Fully-Specified Name
- Component
- SFV Symptom Impact - Shortness of breath
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Long Common Name
SFV Symptom Impact - Shortness of breath during assessment period [CMS Assessment]
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.80
- Last Updated
- Version 2.80 (ADD)
- Order vs. Observation
- Observation
Normative Answer List LL6962-6
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Not at all - symptom does not affect the patient, including symptoms well-controlled with current treatment | 0 | LA34627-2 | |
| Slight | 1 | LA11910-9 | |
| Moderate | 2 | LA6751-7 | |
| Severe | 3 | LA6750-9 | |
| Not applicable (the patient is not experiencing the symptom) | 9 | LA34628-0 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 106623-2 | Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.0 during assessment period [CMS Assessment] |
| 106933-5 | Hospice Outcomes and Patient Evaluation (HOPE) Update Visit v1.0 [CMS Assessment] |
106701-6 Anxiety
Observation ID in Form
J2053C
Fully-Specified Name
- Component
- SFV Symptom Impact - Anxiety
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Long Common Name
SFV Symptom Impact - Anxiety during assessment period [CMS Assessment]
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.80
- Last Updated
- Version 2.80 (ADD)
- Order vs. Observation
- Observation
Normative Answer List LL6962-6
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Not at all - symptom does not affect the patient, including symptoms well-controlled with current treatment | 0 | LA34627-2 | |
| Slight | 1 | LA11910-9 | |
| Moderate | 2 | LA6751-7 | |
| Severe | 3 | LA6750-9 | |
| Not applicable (the patient is not experiencing the symptom) | 9 | LA34628-0 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 106623-2 | Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.0 during assessment period [CMS Assessment] |
| 106933-5 | Hospice Outcomes and Patient Evaluation (HOPE) Update Visit v1.0 [CMS Assessment] |
106700-8 Nausea
Observation ID in Form
J2053D
Fully-Specified Name
- Component
- SFV Symptom Impact - Nausea
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Long Common Name
SFV Symptom Impact - Nausea during assessment period [CMS Assessment]
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.80
- Last Updated
- Version 2.80 (ADD)
- Order vs. Observation
- Observation
Normative Answer List LL6962-6
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Not at all - symptom does not affect the patient, including symptoms well-controlled with current treatment | 0 | LA34627-2 | |
| Slight | 1 | LA11910-9 | |
| Moderate | 2 | LA6751-7 | |
| Severe | 3 | LA6750-9 | |
| Not applicable (the patient is not experiencing the symptom) | 9 | LA34628-0 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 106623-2 | Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.0 during assessment period [CMS Assessment] |
| 106933-5 | Hospice Outcomes and Patient Evaluation (HOPE) Update Visit v1.0 [CMS Assessment] |
106699-2 Vomiting
Observation ID in Form
J2053E
Fully-Specified Name
- Component
- SFV Symptom Impact - Vomiting
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Long Common Name
SFV Symptom Impact - Vomiting during assessment period [CMS Assessment]
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.80
- Last Updated
- Version 2.80 (ADD)
- Order vs. Observation
- Observation
Normative Answer List LL6962-6
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Not at all - symptom does not affect the patient, including symptoms well-controlled with current treatment | 0 | LA34627-2 | |
| Slight | 1 | LA11910-9 | |
| Moderate | 2 | LA6751-7 | |
| Severe | 3 | LA6750-9 | |
| Not applicable (the patient is not experiencing the symptom) | 9 | LA34628-0 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 106623-2 | Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.0 during assessment period [CMS Assessment] |
| 106933-5 | Hospice Outcomes and Patient Evaluation (HOPE) Update Visit v1.0 [CMS Assessment] |
106698-4 Diarrhea
Observation ID in Form
J2053F
Fully-Specified Name
- Component
- SFV Symptom Impact - Diarrhea
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Long Common Name
SFV Symptom Impact - Diarrhea during assessment period [CMS Assessment]
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.80
- Last Updated
- Version 2.80 (ADD)
- Order vs. Observation
- Observation
Normative Answer List LL6962-6
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Not at all - symptom does not affect the patient, including symptoms well-controlled with current treatment | 0 | LA34627-2 | |
| Slight | 1 | LA11910-9 | |
| Moderate | 2 | LA6751-7 | |
| Severe | 3 | LA6750-9 | |
| Not applicable (the patient is not experiencing the symptom) | 9 | LA34628-0 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 106623-2 | Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.0 during assessment period [CMS Assessment] |
| 106933-5 | Hospice Outcomes and Patient Evaluation (HOPE) Update Visit v1.0 [CMS Assessment] |
106697-6 Constipation
Observation ID in Form
J2053G
Fully-Specified Name
- Component
- SFV Symptom Impact - Constipation
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Long Common Name
SFV Symptom Impact - Constipation during assessment period [CMS Assessment]
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.80
- Last Updated
- Version 2.80 (ADD)
- Order vs. Observation
- Observation
Normative Answer List LL6962-6
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Not at all - symptom does not affect the patient, including symptoms well-controlled with current treatment | 0 | LA34627-2 | |
| Slight | 1 | LA11910-9 | |
| Moderate | 2 | LA6751-7 | |
| Severe | 3 | LA6750-9 | |
| Not applicable (the patient is not experiencing the symptom) | 9 | LA34628-0 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 106623-2 | Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.0 during assessment period [CMS Assessment] |
| 106933-5 | Hospice Outcomes and Patient Evaluation (HOPE) Update Visit v1.0 [CMS Assessment] |
106696-8 Agitation
Observation ID in Form
J2053H
Fully-Specified Name
- Component
- SFV Symptom Impact - Agitation
- Property
- Find
- Time
- RptPeriod
- System
- ^Patient
- Scale
- Ord
- Method
- CMS Assessment
Long Common Name
SFV Symptom Impact - Agitation during assessment period [CMS Assessment]
Basic Attributes
- Class
- SURVEY.CMS
- Type
- Surveys
- First Released
- Version 2.80
- Last Updated
- Version 2.80 (ADD)
- Order vs. Observation
- Observation
Normative Answer List LL6962-6
| Answer | Code | Score | Answer ID |
|---|---|---|---|
| Not at all - symptom does not affect the patient, including symptoms well-controlled with current treatment | 0 | LA34627-2 | |
| Slight | 1 | LA11910-9 | |
| Moderate | 2 | LA6751-7 | |
| Severe | 3 | LA6750-9 | |
| Not applicable (the patient is not experiencing the symptom) | 9 | LA34628-0 |
Member of these Panels
| LOINC | Long Common Name |
|---|---|
| 106623-2 | Hospice Outcomes and Patient Evaluation (HOPE) Admission v1.0 during assessment period [CMS Assessment] |
| 106933-5 | Hospice Outcomes and Patient Evaluation (HOPE) Update Visit v1.0 [CMS Assessment] |