112913-9 What is your main occupation?

Observation ID in Form

1

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
What is your main occupation
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Long Common Name

What is your main occupation

Basic Attributes

Class
SURVEY.BAECKE
Type
Surveys
First Released
Version 2.83
Last Updated
Version 2.83 (ADD)
Order vs. Observation
Observation

Example Answer List LL7553-2

AnswerCodeScoreAnswer ID
Low level1LA37138-7
Middle level3LA37139-5
High level5LA29490-2

Member of these Panels

LOINCLong Common Name
112914-7Baecke Questionnaire of Habitual Physical Activity [BAECKE]

112925-3 At work I sit

Observation ID in Form

2

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
At work I sit
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Basic Attributes

Class
SURVEY.BAECKE
Type
Surveys
First Released
Version 2.83
Last Updated
Version 2.83 (ADD)
Order vs. Observation
Observation

Example Answer List LL7555-7

AnswerCodeScoreAnswer ID
Never1LA6270-8
Seldom2LA32689-4
Sometimes3LA10082-8
Often4LA10044-8
Always5LA9933-8

Member of these Panels

LOINCLong Common Name
112914-7Baecke Questionnaire of Habitual Physical Activity [BAECKE]

112928-7 At work I stand

Observation ID in Form

3

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
At work I stand
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Basic Attributes

Class
SURVEY.BAECKE
Type
Surveys
First Released
Version 2.83
Last Updated
Version 2.83 (ADD)
Order vs. Observation
Observation

Example Answer List LL7555-7

AnswerCodeScoreAnswer ID
Never1LA6270-8
Seldom2LA32689-4
Sometimes3LA10082-8
Often4LA10044-8
Always5LA9933-8

Member of these Panels

LOINCLong Common Name
112914-7Baecke Questionnaire of Habitual Physical Activity [BAECKE]

112927-9 At work I walk

Observation ID in Form

4

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
At work I walk
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Basic Attributes

Class
SURVEY.BAECKE
Type
Surveys
First Released
Version 2.83
Last Updated
Version 2.83 (ADD)
Order vs. Observation
Observation

Example Answer List LL7555-7

AnswerCodeScoreAnswer ID
Never1LA6270-8
Seldom2LA32689-4
Sometimes3LA10082-8
Often4LA10044-8
Always5LA9933-8

Member of these Panels

LOINCLong Common Name
112914-7Baecke Questionnaire of Habitual Physical Activity [BAECKE]

112926-1 At work I lift heavy loads

Observation ID in Form

5

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
At work I lift heavy loads
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Basic Attributes

Class
SURVEY.BAECKE
Type
Surveys
First Released
Version 2.83
Last Updated
Version 2.83 (ADD)
Order vs. Observation
Observation

Example Answer List LL7574-8

AnswerCodeScoreAnswer ID
Never1LA6270-8
Seldom2LA32689-4
Sometimes3LA10082-8
Often4LA10044-8
Very often5LA14985-8

Member of these Panels

LOINCLong Common Name
112914-7Baecke Questionnaire of Habitual Physical Activity [BAECKE]

112929-5 After working I am tired

Observation ID in Form

6

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
After working I am tired
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Basic Attributes

Class
SURVEY.BAECKE
Type
Surveys
First Released
Version 2.83
Last Updated
Version 2.83 (ADD)
Order vs. Observation
Observation

Example Answer List LL7557-3

AnswerCodeScoreAnswer ID
Very often5LA14985-8
Often4LA10044-8
Sometimes3LA10082-8
Seldom2LA32689-4
Never1LA6270-8

Member of these Panels

LOINCLong Common Name
112914-7Baecke Questionnaire of Habitual Physical Activity [BAECKE]

112930-3 At work I sweat

Observation ID in Form

7

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
At work I sweat
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Basic Attributes

Class
SURVEY.BAECKE
Type
Surveys
First Released
Version 2.83
Last Updated
Version 2.83 (ADD)
Order vs. Observation
Observation

Example Answer List LL7557-3

AnswerCodeScoreAnswer ID
Very often5LA14985-8
Often4LA10044-8
Sometimes3LA10082-8
Seldom2LA32689-4
Never1LA6270-8

Member of these Panels

LOINCLong Common Name
112914-7Baecke Questionnaire of Habitual Physical Activity [BAECKE]

112932-9 In comparison with others of my own age I think my work is physically

Observation ID in Form

8

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
In comparison with others of my own age I think my work is physically
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Basic Attributes

Class
SURVEY.BAECKE
Type
Surveys
First Released
Version 2.83
Last Updated
Version 2.83 (ADD)
Order vs. Observation
Observation

Example Answer List LL7561-5

AnswerCodeScoreAnswer ID
Much heavier5LA37141-1
Heavier4LA37142-9
As heavy3LA37143-7
Lighter2LA37144-5
Much lighter1LA37145-2

Member of these Panels

LOINCLong Common Name
112914-7Baecke Questionnaire of Habitual Physical Activity [BAECKE]

112933-7 Do you play sport?

Observation ID in Form

9

Type of Entry

Question expects user entry - requires response [Q]

Skip Logic

If "no" go to 10

Fully-Specified Name

Component
Do you play sport
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Long Common Name

Do you play sport

Basic Attributes

Class
SURVEY.BAECKE
Type
Surveys
First Released
Version 2.83
Last Updated
Version 2.83 (ADD)
Order vs. Observation
Observation

Example Answer List LL361-7

AnswerCodeScoreAnswer ID
Yes Copyright http://snomed.info/sct ID:373066001 Yes (qualifier value)LA33-6
No Copyright http://snomed.info/sct ID:373067005 No (qualifier value)LA32-8

Member of these Panels

LOINCLong Common Name
112914-7Baecke Questionnaire of Habitual Physical Activity [BAECKE]

112934-5 If yes: which sport do you play most frequently?

Observation ID in Form

9.1

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
If yes: which sport do you play most frequently
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Long Common Name

If yes: which sport do you play most frequently

Basic Attributes

Class
SURVEY.BAECKE
Type
Surveys
First Released
Version 2.83
Last Updated
Version 2.83 (ADD)
Order vs. Observation
Observation

Example Answer List LL7563-1

AnswerCodeScoreAnswer ID
Low level intensity (Score: 0.76)LA37146-0
Middle level intensity (Score: 1.26)LA37147-8
High level intensity (Score: 1.76)LA37148-6

Member of these Panels

LOINCLong Common Name
112914-7Baecke Questionnaire of Habitual Physical Activity [BAECKE]

112936-0 If yes: how many hours a week?

Observation ID in Form

9.2

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
If yes: how many hours a week
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Long Common Name

If yes: how many hours a week

Basic Attributes

Class
SURVEY.BAECKE
Type
Surveys
First Released
Version 2.83
Last Updated
Version 2.83 (ADD)
Order vs. Observation
Observation

Example Answer List LL7565-6

AnswerCodeScoreAnswer ID
<1 hour a week (Score: 0.5)LA37149-4
1-2 hours a week (Score: 1.5)LA37150-2
2-3 hours a week (Score: 2.5)LA37151-0
3-4 hours a week (Score: 3.5)LA37152-8
>4 hours a week (Score: 4.5)LA37153-6

Member of these Panels

LOINCLong Common Name
112914-7Baecke Questionnaire of Habitual Physical Activity [BAECKE]

112938-6 If yes: how many months a year?

Observation ID in Form

9.3

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
If yes: how many months a year
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Long Common Name

If yes: how many months a year

Basic Attributes

Class
SURVEY.BAECKE
Type
Surveys
First Released
Version 2.83
Last Updated
Version 2.83 (ADD)
Order vs. Observation
Observation

Example Answer List LL7567-2

AnswerCodeScoreAnswer ID
<1 month a year (Score: 0.04)LA37154-4
1-3 months a year (Score: 0.17)LA37155-1
4-6 months a year (Score: 0.42)LA37156-9
7-9 months a year (Score: 0.67)LA37157-7
>9 months a year (Score: 0.92)LA37158-5

Member of these Panels

LOINCLong Common Name
112914-7Baecke Questionnaire of Habitual Physical Activity [BAECKE]

112935-2 If you play a second sport: which sport is it?

Observation ID in Form

9.4

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
If you play a second sport: which sport do you play most frequently
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Long Common Name

If you play a second sport: which sport is it

Basic Attributes

Class
SURVEY.BAECKE
Type
Surveys
First Released
Version 2.83
Last Updated
Version 2.83 (ADD)
Order vs. Observation
Observation

Example Answer List LL7563-1

AnswerCodeScoreAnswer ID
Low level intensity (Score: 0.76)LA37146-0
Middle level intensity (Score: 1.26)LA37147-8
High level intensity (Score: 1.76)LA37148-6

Member of these Panels

LOINCLong Common Name
112914-7Baecke Questionnaire of Habitual Physical Activity [BAECKE]

112937-8 If you play a second sport: how many hours a week?

Observation ID in Form

9.5

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
If you play a second sport: how many hours a week
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Long Common Name

If you play a second sport: how many hours a week

Basic Attributes

Class
SURVEY.BAECKE
Type
Surveys
First Released
Version 2.83
Last Updated
Version 2.83 (ADD)
Order vs. Observation
Observation

Example Answer List LL7565-6

AnswerCodeScoreAnswer ID
<1 hour a week (Score: 0.5)LA37149-4
1-2 hours a week (Score: 1.5)LA37150-2
2-3 hours a week (Score: 2.5)LA37151-0
3-4 hours a week (Score: 3.5)LA37152-8
>4 hours a week (Score: 4.5)LA37153-6

Member of these Panels

LOINCLong Common Name
112914-7Baecke Questionnaire of Habitual Physical Activity [BAECKE]

112939-4 If you play a second sport: how many months a year?

Observation ID in Form

9.6

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
If you play a second sport: how many months a year
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Long Common Name

If you play a second sport: how many months a year

Basic Attributes

Class
SURVEY.BAECKE
Type
Surveys
First Released
Version 2.83
Last Updated
Version 2.83 (ADD)
Order vs. Observation
Observation

Example Answer List LL7567-2

AnswerCodeScoreAnswer ID
<1 month a year (Score: 0.04)LA37154-4
1-3 months a year (Score: 0.17)LA37155-1
4-6 months a year (Score: 0.42)LA37156-9
7-9 months a year (Score: 0.67)LA37157-7
>9 months a year (Score: 0.92)LA37158-5

Member of these Panels

LOINCLong Common Name
112914-7Baecke Questionnaire of Habitual Physical Activity [BAECKE]

112940-2 In comparison with others of my own age I think my physical activity during leisure time is

Observation ID in Form

10

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
In comparison with others of my own age I think my physical activity during leisure time is
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Basic Attributes

Class
SURVEY.BAECKE
Type
Surveys
First Released
Version 2.83
Last Updated
Version 2.83 (ADD)
Order vs. Observation
Observation

Example Answer List LL7569-8

AnswerCodeScoreAnswer ID
Much more5LA37159-3
More4LA16824-7
The same3LA37160-1
Less2LA16823-9
Much less1LA37161-9

Member of these Panels

LOINCLong Common Name
112914-7Baecke Questionnaire of Habitual Physical Activity [BAECKE]

112931-1 During leisure time I sweat

Observation ID in Form

11

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
During leisure time I sweat
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Basic Attributes

Class
SURVEY.BAECKE
Type
Surveys
First Released
Version 2.83
Last Updated
Version 2.83 (ADD)
Order vs. Observation
Observation

Example Answer List LL7557-3

AnswerCodeScoreAnswer ID
Very often5LA14985-8
Often4LA10044-8
Sometimes3LA10082-8
Seldom2LA32689-4
Never1LA6270-8

Member of these Panels

LOINCLong Common Name
112914-7Baecke Questionnaire of Habitual Physical Activity [BAECKE]

112941-0 During leisure time I play sport

Observation ID in Form

12

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
During leisure time I play sport
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Basic Attributes

Class
SURVEY.BAECKE
Type
Surveys
First Released
Version 2.83
Last Updated
Version 2.83 (ADD)
Order vs. Observation
Observation

Example Answer List LL7574-8

AnswerCodeScoreAnswer ID
Never1LA6270-8
Seldom2LA32689-4
Sometimes3LA10082-8
Often4LA10044-8
Very often5LA14985-8

Member of these Panels

LOINCLong Common Name
112914-7Baecke Questionnaire of Habitual Physical Activity [BAECKE]

112942-8 During leisure time I watch television

Observation ID in Form

13

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
During leisure time I watch television
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Basic Attributes

Class
SURVEY.BAECKE
Type
Surveys
First Released
Version 2.83
Last Updated
Version 2.83 (ADD)
Order vs. Observation
Observation

Example Answer List LL7574-8

AnswerCodeScoreAnswer ID
Never1LA6270-8
Seldom2LA32689-4
Sometimes3LA10082-8
Often4LA10044-8
Very often5LA14985-8

Member of these Panels

LOINCLong Common Name
112914-7Baecke Questionnaire of Habitual Physical Activity [BAECKE]

112943-6 During leisure time I walk

Observation ID in Form

14

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
During leisure time I walk
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Basic Attributes

Class
SURVEY.BAECKE
Type
Surveys
First Released
Version 2.83
Last Updated
Version 2.83 (ADD)
Order vs. Observation
Observation

Example Answer List LL7574-8

AnswerCodeScoreAnswer ID
Never1LA6270-8
Seldom2LA32689-4
Sometimes3LA10082-8
Often4LA10044-8
Very often5LA14985-8

Member of these Panels

LOINCLong Common Name
112914-7Baecke Questionnaire of Habitual Physical Activity [BAECKE]

112944-4 During leisure time I cycle

Observation ID in Form

15

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
During leisure time I cycle
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Basic Attributes

Class
SURVEY.BAECKE
Type
Surveys
First Released
Version 2.83
Last Updated
Version 2.83 (ADD)
Order vs. Observation
Observation

Example Answer List LL7574-8

AnswerCodeScoreAnswer ID
Never1LA6270-8
Seldom2LA32689-4
Sometimes3LA10082-8
Often4LA10044-8
Very often5LA14985-8

Member of these Panels

LOINCLong Common Name
112914-7Baecke Questionnaire of Habitual Physical Activity [BAECKE]

112945-1 How many minutes do you walk and or cycle per day to and from work, school and shopping?

Observation ID in Form

16

Type of Entry

Question expects user entry - requires response [Q]

Fully-Specified Name

Component
How many minutes do you walk and or cycle per day to and from work, school and shopping
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method

Long Common Name

How many minutes do you walk and or cycle per day to and from work, school and shopping

Basic Attributes

Class
SURVEY.BAECKE
Type
Surveys
First Released
Version 2.83
Last Updated
Version 2.83 (ADD)
Order vs. Observation
Observation

Example Answer List LL7575-5

AnswerCodeScoreAnswer ID
<5 minutes per day1LA37162-7
5-15 minutes per day2LA37163-5
15-30 minutes per day3LA37164-3
30-45 minutes per day4LA37165-0
>45 minutes per day5LA37166-8

Member of these Panels

LOINCLong Common Name
112914-7Baecke Questionnaire of Habitual Physical Activity [BAECKE]

112946-9 Simple sport-score [BAECKE]

Term Description

For the first and second sport, multiply the answers for intensity, time and proportion, respectively, and add the results, i.e.

simple sport-score = ((value for intensity of most frequent sport) * (value for weekly time of most frequent
sport) * (value for yearly proportion of most frequent sport)) + ((value for intensity of second sport) * (value for
weekly time of second sport) * (value for yearly proportion of second sport))
A score of zero is given to people who do not play sport

Type of Entry

Question - computer calculates response [C]

Fully-Specified Name

Component
Simple sport-score
Property
Score
Time
Pt
System
^Patient
Scale
Ord
Method
BAECKE

Basic Attributes

Class
SURVEY.BAECKE
Type
Surveys
First Released
Version 2.83
Last Updated
Version 2.83 (ADD)
Order vs. Observation
Observation

Normative Answer List LL7576-3

AnswerCodeScoreAnswer ID
01LA6111-4
0.01-<42LA37168-4
4-<83LA37169-2
8-<124LA37170-0
>125LA28556-1

Member of these Panels

LOINCLong Common Name
112914-7Baecke Questionnaire of Habitual Physical Activity [BAECKE]

Example Units

UnitSource
{score}Example UCUM Units

112947-7 Leisure-time index [BAECKE]

Term Description

First, substract the value of question I13 ("During leisure time I play sport") from 6. Second, take the resulting value and add the values from questions I14, I15 and I16. Divide the sum by 4, i.e.

leisure-time index = ((6-I13) + I14 + I15 + I16)/4

Type of Entry

Question - computer calculates response [C]

Fully-Specified Name

Component
Leisure-time index
Property
Score
Time
Pt
System
^Patient
Scale
Qn
Method
BAECKE

Basic Attributes

Class
SURVEY.BAECKE
Type
Surveys
First Released
Version 2.83
Last Updated
Version 2.83 (ADD)
Order vs. Observation
Observation

Member of these Panels

LOINCLong Common Name
112914-7Baecke Questionnaire of Habitual Physical Activity [BAECKE]

Example Units

UnitSource
{score}Example UCUM Units

112948-5 Work index [BAECKE]

Term Description

First, subtract the value of question I2 ("At work I sit") from 6. Second, take the sum of the questions I1-I8, but take the modified value for question I2. Divide the sum by 8, i.e.

work index = (I1 + (6-I2 ) + I3 + I4 + I5 + I6 + I7 + I8)/8

Type of Entry

Question - computer calculates response [C]

Fully-Specified Name

Component
Work index
Property
Score
Time
Pt
System
^Patient
Scale
Qn
Method
BAECKE

Basic Attributes

Class
SURVEY.BAECKE
Type
Surveys
First Released
Version 2.83
Last Updated
Version 2.83 (ADD)
Order vs. Observation
Observation

Member of these Panels

LOINCLong Common Name
112914-7Baecke Questionnaire of Habitual Physical Activity [BAECKE]

Example Units

UnitSource
{score}Example UCUM Units

112949-3 Sport index [BAECKE]

Term Description

First, add the values from the simple sport score (I9) and questions I10, I11, I12. Then, divide the result by 4, i.e.

sport index = (simple sport-score + I10 + I11 + I12) / 4

Type of Entry

Question - computer calculates response [C]

Fully-Specified Name

Component
Sport index
Property
Score
Time
Pt
System
^Patient
Scale
Qn
Method
BAECKE

Basic Attributes

Class
SURVEY.BAECKE
Type
Surveys
First Released
Version 2.83
Last Updated
Version 2.83 (ADD)
Order vs. Observation
Observation

Member of these Panels

LOINCLong Common Name
112914-7Baecke Questionnaire of Habitual Physical Activity [BAECKE]

Example Units

UnitSource
{score}Example UCUM Units

112950-1 Total score [BAECKE]

Term Description

The total score is the sum of the three indices leisure-time index, work index and sport index.

Type of Entry

Question - computer calculates response [C]

Fully-Specified Name

Component
Total score
Property
Score
Time
Pt
System
^Patient
Scale
Qn
Method
BAECKE

Basic Attributes

Class
SURVEY.BAECKE
Type
Surveys
First Released
Version 2.83
Last Updated
Version 2.83 (ADD)
Order vs. Observation
Observation

Member of these Panels

LOINCLong Common Name
112914-7Baecke Questionnaire of Habitual Physical Activity [BAECKE]

Example Units

UnitSource
{score}Example UCUM Units