70673-9
Functional Assessment of Chronic Illness Therapy (FACIT) - Non cancer Specific Measures Panel
Active
Reference Information
| Type | Source | Reference |
|---|---|---|
| Citation | David Cella, PhDCopyright Copyright © 2010 David Cella, PhD. | FACIT Copyright FACIT Copyright |
Panel Hierarchy
Details for each LOINC in Panel LHC-Forms
| LOINC | Name | R/O/C | Cardinality | Example UCUM Units |
|---|---|---|---|---|
| 70673-9 | Functional Assessment of Chronic Illness Therapy (FACIT) - Non cancer Specific Measures Panel | |||
| Indent70982-4 | Functional Assessment of Chronic Illness Therapy - Dyspnea Questionnaire - 10 items (FACIT-Dyspnea - 10) | |||
| Indent Indent70971-7 | How short of breath did you get dressing yourself without help? | |||
| Indent Indent70981-6 | Please indicate why you did not do this in the past 7 days | |||
| Indent Indent70972-5 | How short of breath did you get walking 50 steps-paces on flat ground at a normal speed without stopping? | |||
| Indent Indent70981-6 | Please indicate why you did not do this in the past 7 days | |||
| Indent Indent70973-3 | How short of breath did you get walking up 20 stairs, 2 flights, without stopping? | |||
| Indent Indent70981-6 | Please indicate why you did not do this in the past 7 days | |||
| Indent Indent70974-1 | How short of breath did you get preparing meals? | |||
| Indent Indent70981-6 | Please indicate why you did not do this in the past 7 days | |||
| Indent Indent70975-8 | How short of breath did you get washing dishes? | |||
| Indent Indent70981-6 | Please indicate why you did not do this in the past 7 days | |||
| Indent Indent70976-6 | How short of breath did you get sweeping or mopping? | |||
| Indent Indent70981-6 | Please indicate why you did not do this in the past 7 days | |||
| Indent Indent70977-4 | How short of breath did you get making a bed? | |||
| Indent Indent70981-6 | Please indicate why you did not do this in the past 7 days | |||
| Indent Indent70978-2 | How short of breath did you get lifting something weighing 10-20 lbs, about 4.5-9kg , like a large bag of groceries? | |||
| Indent Indent70981-6 | Please indicate why you did not do this in the past 7 days | |||
| Indent Indent70979-0 | How short of breath did you get carrying something weighing 10-20 lbs, about 4.5-9kg, like a large bag of groceries, from one room to another? | |||
| Indent Indent70981-6 | Please indicate why you did not do this in the past 7 days | |||
| Indent Indent70980-8 | How short of breath did you get walking faster than your usual speed for half a mile, almost 1 km, without stopping? | |||
| Indent Indent70981-6 | Please indicate why you did not do this in the past 7 days | |||
| Indent70983-2 | Functional Assessment of Chronic Illness Therapy - Dyspnea Questionnaire - 33 items (FACIT-Dyspnea - 33) | |||
| Indent Indent70971-7 | How short of breath did you get dressing yourself without help? | |||
| Indent Indent70981-6 | Please indicate why you did not do this in the past 7 days | |||
| Indent Indent70972-5 | How short of breath did you get walking 50 steps-paces on flat ground at a normal speed without stopping? | |||
| Indent Indent70981-6 | Please indicate why you did not do this in the past 7 days | |||
| Indent Indent70973-3 | How short of breath did you get walking up 20 stairs, 2 flights, without stopping? | |||
| Indent Indent70981-6 | Please indicate why you did not do this in the past 7 days | |||
| Indent Indent70974-1 | How short of breath did you get preparing meals? | |||
| Indent Indent70981-6 | Please indicate why you did not do this in the past 7 days | |||
| Indent Indent70975-8 | How short of breath did you get washing dishes? | |||
| Indent Indent70981-6 | Please indicate why you did not do this in the past 7 days | |||
| Indent Indent70976-6 | How short of breath did you get sweeping or mopping? | |||
| Indent Indent70981-6 | Please indicate why you did not do this in the past 7 days | |||
| Indent Indent70977-4 | How short of breath did you get making a bed? | |||
| Indent Indent70981-6 | Please indicate why you did not do this in the past 7 days | |||
| Indent Indent70978-2 | How short of breath did you get lifting something weighing 10-20 lbs, about 4.5-9kg , like a large bag of groceries? | |||
| Indent Indent70981-6 | Please indicate why you did not do this in the past 7 days | |||
| Indent Indent70979-0 | How short of breath did you get carrying something weighing 10-20 lbs, about 4.5-9kg, like a large bag of groceries, from one room to another? | |||
| Indent Indent70981-6 | Please indicate why you did not do this in the past 7 days | |||
| Indent Indent70980-8 | How short of breath did you get walking faster than your usual speed for half a mile, almost 1 km, without stopping? | |||
| Indent Indent70981-6 | Please indicate why you did not do this in the past 7 days | |||
| Indent Indent70984-0 | How short of breath did you get taking a bath? | |||
| Indent Indent70981-6 | Please indicate why you did not do this in the past 7 days | |||
| Indent Indent70985-7 | How short of breath did you get taking a shower? | |||
| Indent Indent70981-6 | Please indicate why you did not do this in the past 7 days | |||
| Indent Indent70986-5 | How short of breath did you get putting on socks or stockings? | |||
| Indent Indent70981-6 | Please indicate why you did not do this in the past 7 days | |||
| Indent Indent70987-3 | How short of breath did you get standing for at least 5 minutes? | |||
| Indent Indent70981-6 | Please indicate why you did not do this in the past 7 days | |||
| Indent Indent70988-1 | How short of breath did you get walking 10 steps/paces on flat ground at a normal speed without stopping? | |||
| Indent Indent70981-6 | Please indicate why you did not do this in the past 7 days | |||
| Indent Indent70989-9 | How short of breath did you get walking 1/2 mile, almost 1 km, on flat ground at a normal speed, without stopping? | |||
| Indent Indent70981-6 | Please indicate why you did not do this in the past 7 days | |||
| Indent Indent70990-7 | How short of breath did you get walking up 5 stairs without stopping? | |||
| Indent Indent70981-6 | Please indicate why you did not do this in the past 7 days | |||
| Indent Indent70991-5 | How short of breath did you get walking up 10 stairs, 1 flight, without stopping? | |||
| Indent Indent70981-6 | Please indicate why you did not do this in the past 7 days | |||
| Indent Indent70992-3 | How short of breath did you get walking up 30 stairs, 3 flights, without stopping? | |||
| Indent Indent70981-6 | Please indicate why you did not do this in the past 7 days | |||
| Indent Indent71006-1 | How short of breath did you get scrubbing the floor or counter? | |||
| Indent Indent70981-6 | Please indicate why you did not do this in the past 7 days | |||
| Indent Indent70993-1 | How short of breath did you get lifting something weighing less than 5 lbs, about 2 kg, like a houseplant? | |||
| Indent Indent70981-6 | Please indicate why you did not do this in the past 7 days | |||
| Indent Indent70994-9 | How short of breath did you get lifting something weighing 5-10 lbs, about 2-4.5 kg, like a basket of clothes? | |||
| Indent Indent70981-6 | Please indicate why you did not do this in the past 7 days | |||
| Indent Indent70995-6 | How short of breath did you get lifting something weighing more than 20 lbs, about 9 kg, like a medium-sized suitcase? | |||
| Indent Indent70981-6 | Please indicate why you did not do this in the past 7 days | |||
| Indent Indent70996-4 | How short of breath did you get carrying something weighing less than 5 lbs, about 2 kg, like a houseplant, from one room to another? | |||
| Indent Indent70981-6 | Please indicate why you did not do this in the past 7 days | |||
| Indent Indent70997-2 | How short of breath did you get carrying something weighing 5-10 lbs, about 2-4.5 kg, like a basket of clothes, from one room to another | |||
| Indent Indent70981-6 | Please indicate why you did not do this in the past 7 days | |||
| Indent Indent70998-0 | How short of breath did you get getting in or out of a car? | |||
| Indent Indent70981-6 | Please indicate why you did not do this in the past 7 days | |||
| Indent Indent70999-8 | How short of breath did you get dining out? | |||
| Indent Indent70981-6 | Please indicate why you did not do this in the past 7 days | |||
| Indent Indent71000-4 | How short of breath did you get low-intensity leisure activity - gardening, etc? | |||
| Indent Indent70981-6 | Please indicate why you did not do this in the past 7 days | |||
| Indent Indent71001-2 | How short of breath did you get moderate-intensity leisure activity - bicycling on level terrain, etc? | |||
| Indent Indent70981-6 | Please indicate why you did not do this in the past 7 days | |||
| Indent Indent71002-0 | How short of breath did you get walking, faster than your usual speed, for 50 steps without stopping? | |||
| Indent Indent70981-6 | Please indicate why you did not do this in the past 7 days | |||
| Indent Indent71003-8 | How short of breath did you get walking, faster than your usual speed, for at least 1 mile, a little more than 1.5 km, without stopping? | |||
| Indent Indent70981-6 | Please indicate why you did not do this in the past 7 days | |||
| Indent Indent71004-6 | How short of breath did you get singing or humming? | |||
| Indent Indent70981-6 | Please indicate why you did not do this in the past 7 days | |||
| Indent Indent71005-3 | How short of breath did you get talking while walking? | |||
| Indent Indent70981-6 | Please indicate why you did not do this in the past 7 days | |||
| Indent71007-9 | Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal) | |||
| Indent Indent70498-1 | Physical well-being [FACIT] | |||
| Indent Indent Indent70405-6 | I have a lack of energy | |||
| Indent Indent Indent70406-4 | I have nausea | |||
| Indent Indent Indent70407-2 | Because of my physical condition, I have trouble meeting the needs of my family | |||
| Indent Indent Indent70408-0 | I have pain | |||
| Indent Indent Indent70409-8 | I am bothered by side effects of treatment | |||
| Indent Indent Indent70410-6 | I feel ill | |||
| Indent Indent Indent70411-4 | I am forced to spend time in bed | |||
| Indent Indent70499-9 | Social - family well-being [FACIT] | |||
| Indent Indent Indent70412-2 | I feel close to my friends | |||
| Indent Indent Indent70413-0 | I get emotional support from my family | |||
| Indent Indent Indent70414-8 | I get support from my friends | |||
| Indent Indent Indent70415-5 | My family has accepted my illness | |||
| Indent Indent Indent70416-3 | I am satisfied with family communication about my illness | |||
| Indent Indent Indent70417-1 | I felt close to my partner, or the person who is my main support | |||
| Indent Indent Indent70914-7 | Regardless of your current level of sexual activity, please answer the following question. If you prefer not to answer it, please mark this box and go to the next section. | |||
| Indent Indent Indent70418-9 | I am satisfied with my sex life | |||
| Indent Indent70500-4 | Emotional well being [FACIT] | |||
| Indent Indent Indent70392-6 | I feel sad | |||
| Indent Indent Indent70393-4 | I am satisfied with how I am coping with my illness | |||
| Indent Indent Indent70394-2 | I am losing hope in the fight against my illness | |||
| Indent Indent Indent70395-9 | I am nervous | |||
| Indent Indent Indent70396-7 | I worry about dying | |||
| Indent Indent Indent70397-5 | I worry that my condition will get worse | |||
| Indent Indent70501-2 | Functional well-being [FACIT] | |||
| Indent Indent Indent70398-3 | I am able to work (include work at home) | |||
| Indent Indent Indent70399-1 | My work (include work at home) is fulfilling | |||
| Indent Indent Indent70400-7 | I am able to enjoy life | |||
| Indent Indent Indent70401-5 | I have accepted my illness | |||
| Indent Indent Indent70402-3 | I am sleeping well | |||
| Indent Indent Indent70403-1 | I am enjoying the things I usually do for fun | |||
| Indent Indent Indent70404-9 | I am content with the quality of my life right now | |||
| Indent Indent71008-7 | Additional concerns - FACIT-Pal [FACIT] | |||
| Indent Indent Indent71009-5 | I maintain contact with my friends | |||
| Indent Indent Indent71010-3 | I have family members who will take on my responsibilities | |||
| Indent Indent Indent71011-1 | I feel that my family appreciates me | |||
| Indent Indent Indent71012-9 | I feel like a burden to my family | |||
| Indent Indent Indent70305-8 | I have been short of breath | |||
| Indent Indent Indent71013-7 | I am constipated | |||
| Indent Indent Indent70346-2 | I am losing weight | |||
| Indent Indent Indent70479-1 | I have been vomiting | |||
| Indent Indent Indent71014-5 | I have swelling in parts of my body | |||
| Indent Indent Indent71015-2 | My mouth and throat are dry | |||
| Indent Indent Indent70341-3 | I feel independent | |||
| Indent Indent Indent71016-0 | I feel useful | |||
| Indent Indent Indent71017-8 | I make each day count | |||
| Indent Indent Indent71018-6 | I have peace of mind | |||
| Indent Indent Indent71019-4 | I feel hopeful | |||
| Indent Indent Indent71020-2 | I am able to make decisions | |||
| Indent Indent Indent70441-1 | My thinking is clear | |||
| Indent Indent Indent71021-0 | I have been able to reconcile (make peace) with other people | |||
| Indent Indent Indent71022-8 | I am able to openly discuss my concerns with the people closest to me | |||
| Indent71439-4 | Functional Assessment of Chronic Illness Therapy Spiritual Well-being Questionnaire - version 4 (FACIT-Sp) | |||
| Indent Indent70498-1 | Physical well-being [FACIT] | |||
| Indent Indent Indent70405-6 | I have a lack of energy | |||
| Indent Indent Indent70406-4 | I have nausea | |||
| Indent Indent Indent70407-2 | Because of my physical condition, I have trouble meeting the needs of my family | |||
| Indent Indent Indent70408-0 | I have pain | |||
| Indent Indent Indent70409-8 | I am bothered by side effects of treatment | |||
| Indent Indent Indent70410-6 | I feel ill | |||
| Indent Indent Indent70411-4 | I am forced to spend time in bed | |||
| Indent Indent70499-9 | Social - family well-being [FACIT] | |||
| Indent Indent Indent70412-2 | I feel close to my friends | |||
| Indent Indent Indent70413-0 | I get emotional support from my family | |||
| Indent Indent Indent70414-8 | I get support from my friends | |||
| Indent Indent Indent70415-5 | My family has accepted my illness | |||
| Indent Indent Indent70416-3 | I am satisfied with family communication about my illness | |||
| Indent Indent Indent70417-1 | I felt close to my partner, or the person who is my main support | |||
| Indent Indent Indent70914-7 | Regardless of your current level of sexual activity, please answer the following question. If you prefer not to answer it, please mark this box and go to the next section. | |||
| Indent Indent Indent70418-9 | I am satisfied with my sex life | |||
| Indent Indent70500-4 | Emotional well being [FACIT] | |||
| Indent Indent Indent70392-6 | I feel sad | |||
| Indent Indent Indent70393-4 | I am satisfied with how I am coping with my illness | |||
| Indent Indent Indent70394-2 | I am losing hope in the fight against my illness | |||
| Indent Indent Indent70395-9 | I am nervous | |||
| Indent Indent Indent70396-7 | I worry about dying | |||
| Indent Indent Indent70397-5 | I worry that my condition will get worse | |||
| Indent Indent70501-2 | Functional well-being [FACIT] | |||
| Indent Indent Indent70398-3 | I am able to work (include work at home) | |||
| Indent Indent Indent70399-1 | My work (include work at home) is fulfilling | |||
| Indent Indent Indent70400-7 | I am able to enjoy life | |||
| Indent Indent Indent70401-5 | I have accepted my illness | |||
| Indent Indent Indent70402-3 | I am sleeping well | |||
| Indent Indent Indent70403-1 | I am enjoying the things I usually do for fun | |||
| Indent Indent Indent70404-9 | I am content with the quality of my life right now | |||
| Indent Indent71131-7 | Additional concerns - FACIT-Sp [FACIT] | |||
| Indent Indent Indent71024-4 | I feel peaceful | |||
| Indent Indent Indent71025-1 | I have a reason for living | |||
| Indent Indent Indent71026-9 | My life has been productive | |||
| Indent Indent Indent71027-7 | I have trouble feeling peace of mind | |||
| Indent Indent Indent71028-5 | I feel a sense of purpose in my life | |||
| Indent Indent Indent71029-3 | I am able to reach down deep into myself for comfort | |||
| Indent Indent Indent71030-1 | I feel a sense of harmony within myself | |||
| Indent Indent Indent71031-9 | My life lacks meaning and purpose | |||
| Indent Indent Indent70697-8 | I find comfort in my faith or spiritual beliefs | |||
| Indent Indent Indent71032-7 | I find strength in my faith or spiritual beliefs | |||
| Indent Indent Indent71033-5 | My illness has strengthened my faith or spiritual beliefs | |||
| Indent Indent Indent71034-3 | I know that whatever happens with my illness things will be okay | |||
| Indent71023-6 | Functional Assessment of Chronic Illness Therapy - Spiritual well-being Questionnaire - 12 items - version 4 (FACIT-Sp-12) | |||
| Indent Indent71024-4 | I feel peaceful | |||
| Indent Indent71025-1 | I have a reason for living | |||
| Indent Indent71026-9 | My life has been productive | |||
| Indent Indent71027-7 | I have trouble feeling peace of mind | |||
| Indent Indent71028-5 | I feel a sense of purpose in my life | |||
| Indent Indent71029-3 | I am able to reach down deep into myself for comfort | |||
| Indent Indent71030-1 | I feel a sense of harmony within myself | |||
| Indent Indent71031-9 | My life lacks meaning and purpose | |||
| Indent Indent70697-8 | I find comfort in my faith or spiritual beliefs | |||
| Indent Indent71032-7 | I find strength in my faith or spiritual beliefs | |||
| Indent Indent71033-5 | My illness has strengthened my faith or spiritual beliefs | |||
| Indent Indent71034-3 | I know that whatever happens with my illness things will be okay | |||
| Indent71035-0 | Functional Assessment of Chronic Illness Therapy - Spiritual well-being, expanded version questionnaire - version 4 (FACIT-Sp-Ex) | |||
| Indent Indent71024-4 | I feel peaceful | |||
| Indent Indent71025-1 | I have a reason for living | |||
| Indent Indent71026-9 | My life has been productive | |||
| Indent Indent71027-7 | I have trouble feeling peace of mind | |||
| Indent Indent71028-5 | I feel a sense of purpose in my life | |||
| Indent Indent71029-3 | I am able to reach down deep into myself for comfort | |||
| Indent Indent71030-1 | I feel a sense of harmony within myself | |||
| Indent Indent71031-9 | My life lacks meaning and purpose | |||
| Indent Indent70697-8 | I find comfort in my faith or spiritual beliefs | |||
| Indent Indent71032-7 | I find strength in my faith or spiritual beliefs | |||
| Indent Indent71033-5 | My illness has strengthened my faith or spiritual beliefs | |||
| Indent Indent71034-3 | I know that whatever happens with my illness things will be okay | |||
| Indent Indent71036-8 | I feel connected to a higher power (or God) | |||
| Indent Indent71037-6 | I feel connected to other people | |||
| Indent Indent71038-4 | I feel loved | |||
| Indent Indent71039-2 | I feel love for others | |||
| Indent Indent71040-0 | I am able to forgive others for any harm they have ever caused me | |||
| Indent Indent71041-8 | I feel forgiven for any harm I may have ever caused | |||
| Indent Indent71042-6 | Throughout the course of my day, I feel a sense of thankfulness for my life | |||
| Indent Indent71043-4 | Throughout the course of my day, I feel a sense of thankfulness for what others bring to my life | |||
| Indent Indent71019-4 | I feel hopeful | |||
| Indent Indent71044-2 | I feel a sense of appreciation for the beauty of nature | |||
| Indent Indent71045-9 | I feel compassion for others in the difficulties they are facing | |||
| Indent71046-7 | Functional Assessment of Chronic Illness Therapy - Spiritual well-being - non-illness questionnaire - version 4 (FACIT-Sp - non-illness) | |||
| Indent Indent70498-1 | Physical well-being [FACIT] | |||
| Indent Indent Indent70405-6 | I have a lack of energy | |||
| Indent Indent Indent70406-4 | I have nausea | |||
| Indent Indent Indent70407-2 | Because of my physical condition, I have trouble meeting the needs of my family | |||
| Indent Indent Indent70408-0 | I have pain | |||
| Indent Indent Indent70409-8 | I am bothered by side effects of treatment | |||
| Indent Indent Indent70410-6 | I feel ill | |||
| Indent Indent Indent70411-4 | I am forced to spend time in bed | |||
| Indent Indent70499-9 | Social - family well-being [FACIT] | |||
| Indent Indent Indent70412-2 | I feel close to my friends | |||
| Indent Indent Indent70413-0 | I get emotional support from my family | |||
| Indent Indent Indent70414-8 | I get support from my friends | |||
| Indent Indent Indent70415-5 | My family has accepted my illness | |||
| Indent Indent Indent70416-3 | I am satisfied with family communication about my illness | |||
| Indent Indent Indent70417-1 | I felt close to my partner, or the person who is my main support | |||
| Indent Indent Indent70914-7 | Regardless of your current level of sexual activity, please answer the following question. If you prefer not to answer it, please mark this box and go to the next section. | |||
| Indent Indent Indent70418-9 | I am satisfied with my sex life | |||
| Indent Indent70500-4 | Emotional well being [FACIT] | |||
| Indent Indent Indent70392-6 | I feel sad | |||
| Indent Indent Indent70393-4 | I am satisfied with how I am coping with my illness | |||
| Indent Indent Indent70394-2 | I am losing hope in the fight against my illness | |||
| Indent Indent Indent70395-9 | I am nervous | |||
| Indent Indent Indent70396-7 | I worry about dying | |||
| Indent Indent Indent70397-5 | I worry that my condition will get worse | |||
| Indent Indent70501-2 | Functional well-being [FACIT] | |||
| Indent Indent Indent70398-3 | I am able to work (include work at home) | |||
| Indent Indent Indent70399-1 | My work (include work at home) is fulfilling | |||
| Indent Indent Indent70400-7 | I am able to enjoy life | |||
| Indent Indent Indent70401-5 | I have accepted my illness | |||
| Indent Indent Indent70402-3 | I am sleeping well | |||
| Indent Indent Indent70403-1 | I am enjoying the things I usually do for fun | |||
| Indent Indent Indent70404-9 | I am content with the quality of my life right now | |||
| Indent Indent71132-5 | Additional concerns - FACIT-Sp-NI [FACIT] | |||
| Indent Indent Indent71024-4 | I feel peaceful | |||
| Indent Indent Indent71025-1 | I have a reason for living | |||
| Indent Indent Indent71026-9 | My life has been productive | |||
| Indent Indent Indent71027-7 | I have trouble feeling peace of mind | |||
| Indent Indent Indent71028-5 | I feel a sense of purpose in my life | |||
| Indent Indent Indent71029-3 | I am able to reach down deep into myself for comfort | |||
| Indent Indent Indent71030-1 | I feel a sense of harmony within myself | |||
| Indent Indent Indent71031-9 | My life lacks meaning and purpose | |||
| Indent Indent Indent70697-8 | I find comfort in my faith or spiritual beliefs | |||
| Indent Indent Indent71032-7 | I find strength in my faith or spiritual beliefs | |||
| Indent Indent Indent71124-2 | Difficult times have strengthened my faith or spiritual beliefs | |||
| Indent Indent Indent71125-9 | Even during difficult times, I know that things will be okay | |||
| Indent71047-5 | Functional Assessment of Chronic Illness Therapy - Satisfaction with Pharmacist Scale - version 4 (FACIT - SWiP) | |||
| Indent Indent71048-3 | My pharmacist advises me on the proper use of my medicines | |||
| Indent Indent71049-1 | My pharmacist advises me on the adverse (side) effects of my medicines | |||
| Indent Indent71050-9 | I have confidence in my pharmacist(s) | |||
| Indent Indent71051-7 | My pharmacist is available to answer my questions | |||
| Indent Indent71052-5 | My pharmacist helps with the arrangements necessary to obtain my medicines | |||
| Indent Indent71053-3 | My pharmacist is aware of my treatment-related needs | |||
| Indent Indent71054-1 | My pharmacist responds to my treatment-related needs | |||
| Indent71055-8 | Functional Assessment of Chronic Illness Therapy - Treatment satisfaction - General Questionnaire - version 1 (FACIT-TS-G) | |||
| Indent Indent71064-0 | Name of treatment [FACIT] | |||
| Indent Indent71056-6 | Compared to what you expected, how do you rate the effectiveness of the treatment so far? | |||
| Indent Indent71057-4 | Compared to what you expected, how do you rate the side effects of treatment so far? | |||
| Indent Indent71058-2 | Did your doctor(s) help you evaluate the effects of your treatment so far? | |||
| Indent Indent71059-0 | Do you feel you received the treatment that was right for you? | |||
| Indent Indent71060-8 | Are you satisfied with the effects of this treatment so far? | |||
| Indent Indent71061-6 | Would you recommend this treatment to others with your illness? | |||
| Indent Indent71062-4 | Would you choose this treatment again? | |||
| Indent Indent71063-2 | How do you rate this treatment overall [FACIT] | |||
| Indent Indent8251-1 | Do you have any comments | |||
| Indent71065-7 | Functional Assessment of Chronic Illness therapy - Treatment satisfaction - patient satisfaction questionnaire - version 1 (FACIT-TS-PS) | |||
| Indent Indent71066-5 | Please mark one box to choose the visit(s) you would like to rate | 1..3 | ||
| Indent Indent71067-3 | Explanations [FACIT] | |||
| Indent Indent Indent71068-1 | Did your doctor(s) give explanations that you could understand? | |||
| Indent Indent Indent71069-9 | Did your doctor(s) explain the possible benefits of your treatment? | |||
| Indent Indent Indent71070-7 | Did your doctor-s explain the possible side effects or risks of your treatment | |||
| Indent Indent Indent71071-5 | Did you have an opportunity to ask questions? | |||
| Indent Indent71072-3 | Interpersonal [FACIT] | |||
| Indent Indent Indent71073-1 | Did you get to say the things that were important to you? | |||
| Indent Indent Indent71074-9 | Did your doctor(s) seem to understand what was important to you? | |||
| Indent Indent Indent71075-6 | Did your doctor(s) show genuine concern for you? | |||
| Indent Indent71076-4 | Comprehensive care [FACIT] | |||
| Indent Indent Indent71077-2 | Did your doctor(s) seem to understand your needs? | |||
| Indent Indent Indent71078-0 | Did you feel that the treatment staff worked together towards the same goal? | |||
| Indent Indent Indent71079-8 | Were you able to talk to your doctor(s) when you needed to | |||
| Indent Indent Indent71080-6 | Did the treatment staff discuss how your health and treatment may affect your normal work (including housework)? | |||
| Indent Indent Indent71081-4 | Did the treatment staff discuss how your health and treatment may affect your normal daily activities? | |||
| Indent Indent Indent71082-2 | Did the treatment staff discuss how your health and treatment may affect your personal relationships? | |||
| Indent Indent Indent71083-0 | Did the treatment staff discuss how your health and treatment may affect you emotionally? | |||
| Indent Indent71084-8 | Technical quality [FACIT] | |||
| Indent Indent Indent71085-5 | Did you feel your doctors had experience treating your illness? | |||
| Indent Indent Indent71086-3 | Did you feel your doctor(s) knew about the latest medical developments for your illness? | |||
| Indent Indent Indent71087-1 | Was the treatment staff thorough in examining and treating you? | |||
| Indent Indent71088-9 | Decision-making [FACIT] | |||
| Indent Indent Indent71089-7 | Did your doctor(s) discuss other treatments, example, alternative medicine or new for treatments? | |||
| Indent Indent Indent71090-5 | Were you encouraged to participate in decisions about your health care? | |||
| Indent Indent Indent71091-3 | Did you have enough time to make decisions about your health care | |||
| Indent Indent Indent71092-1 | Did you have enough information to make decisions about your health care? | |||
| Indent Indent Indent71093-9 | Did your doctor(s) seem to respect your opinions? | |||
| Indent Indent71094-7 | Nurses [FACIT] | |||
| Indent Indent Indent71095-4 | Did your nurses give explanations that you could understand? | |||
| Indent Indent Indent71096-2 | Did your nurses show genuine concern for you? | |||
| Indent Indent Indent71097-0 | Did your nurse(s) seem to understand your needs | |||
| Indent Indent71098-8 | Trust [FACIT] | |||
| Indent Indent Indent71099-6 | Did you feel that the treatment staff answered your questions honestly? | |||
| Indent Indent Indent71100-2 | Did the treatment staff respect your privacy? | |||
| Indent Indent Indent71101-0 | Did you have confidence in your doctor(s)? | |||
| Indent Indent Indent71102-8 | Did you trust your doctor(s) suggestions for treatment? | |||
| Indent Indent71103-6 | Overall [FACIT] | |||
| Indent Indent Indent71104-4 | Would you recommend this clinic or office to others? | |||
| Indent Indent Indent71105-1 | Would you choose this clinic or office again? | |||
| Indent Indent Indent71106-9 | How do you rate the care you received? | |||
| Indent Indent Indent8251-1 | Do you have any comments | |||
| Indent71133-3 | Functional Assessment of HIV Infection Questionnaire - version 4 (FAHI) [FACIT] | |||
| Indent Indent71126-7 | Physical well-being - FAHI [FACIT] | |||
| Indent Indent Indent70405-6 | I have a lack of energy | |||
| Indent Indent Indent70406-4 | I have nausea | |||
| Indent Indent Indent70408-0 | I have pain | |||
| Indent Indent Indent70409-8 | I am bothered by side effects of treatment | |||
| Indent Indent Indent70411-4 | I am forced to spend time in bed | |||
| Indent Indent Indent70305-8 | I have been short of breath | |||
| Indent Indent Indent70312-4 | I am bothered by a change in weight | |||
| Indent Indent Indent70528-5 | I get tired easily | |||
| Indent Indent Indent70426-2 | I feel fatigued | |||
| Indent Indent Indent70425-4 | I feel weak all over | |||
| Indent Indent Indent70442-9 | I have been coughing | |||
| Indent Indent Indent70410-6 | I feel ill | |||
| Indent Indent Indent70407-2 | Because of my physical condition, I have trouble meeting the needs of my family | |||
| Indent Indent71127-5 | Emotional well-being - living with HIV [FACIT] | |||
| Indent Indent Indent70392-6 | I feel sad | |||
| Indent Indent Indent70395-9 | I am nervous | |||
| Indent Indent Indent70396-7 | I worry about dying | |||
| Indent Indent Indent70397-5 | I worry that my condition will get worse | |||
| Indent Indent Indent71134-1 | I am unhappy with my appearance | |||
| Indent Indent Indent71135-8 | It is hard to tell other people about my infection | |||
| Indent Indent Indent71136-6 | I worry about spreading my infection | |||
| Indent Indent Indent71137-4 | I am concerned about what the future holds for me | |||
| Indent Indent Indent70311-6 | I worry about the effect of stress on my illness | |||
| Indent Indent Indent71138-2 | I am embarrassed by my illness | |||
| Indent Indent71128-3 | Functional and global well-being [FACIT] | |||
| Indent Indent Indent70398-3 | I am able to work (include work at home) | |||
| Indent Indent Indent70399-1 | My work (include work at home) is fulfilling | |||
| Indent Indent Indent70400-7 | I am able to enjoy life | |||
| Indent Indent Indent70401-5 | I have accepted my illness | |||
| Indent Indent Indent70402-3 | I am sleeping well | |||
| Indent Indent Indent70403-1 | I am enjoying the things I usually do for fun | |||
| Indent Indent Indent70404-9 | I am content with the quality of my life right now | |||
| Indent Indent Indent70393-4 | I am satisfied with how I am coping with my illness | |||
| Indent Indent Indent70394-2 | I am losing hope in the fight against my illness | |||
| Indent Indent Indent70308-2 | I feel sexually attractive | |||
| Indent Indent Indent70350-4 | I have a good appetite | |||
| Indent Indent Indent70654-9 | I feel motivated to do things | |||
| Indent Indent Indent70696-0 | I am hopeful about the future | |||
| Indent Indent71129-1 | Social well-being [FACIT] | |||
| Indent Indent Indent70412-2 | I feel close to my friends | |||
| Indent Indent Indent70413-0 | I get emotional support from my family | |||
| Indent Indent Indent70414-8 | I get support from my friends | |||
| Indent Indent Indent70415-5 | My family has accepted my illness | |||
| Indent Indent Indent70416-3 | I am satisfied with family communication about my illness | |||
| Indent Indent Indent70417-1 | I felt close to my partner, or the person who is my main support | |||
| Indent Indent Indent70714-1 | I have people to help me if I need it | |||
| Indent Indent Indent70914-7 | Regardless of your current level of sexual activity, please answer the following question. If you prefer not to answer it, please mark this box and go to the next section. | |||
| Indent Indent Indent70418-9 | I am satisfied with my sex life | |||
| Indent Indent71130-9 | Cognitive functioning [FACIT] | |||
| Indent Indent Indent70441-1 | My thinking is clear | |||
| Indent Indent Indent70530-1 | I have trouble concentrating | |||
| Indent Indent Indent70651-5 | I have trouble remembering things | |||
| Indent Indent71118-4 | Thinking and fatigue [FACIT] | |||
| Indent Indent Indent70405-6 | I have a lack of energy | |||
| Indent Indent Indent70304-1 | I feel tired | |||
| Indent Indent Indent70728-1 | I have trouble starting things because I am tired | |||
| Indent Indent Indent70729-9 | I have trouble finishing things because I am tired | |||
| Indent Indent Indent70815-6 | I need to rest during the day | |||
| Indent Indent Indent70651-5 | I have trouble remembering things | |||
| Indent Indent Indent70530-1 | I have trouble concentrating | |||
| Indent Indent Indent71139-0 | My thinking is slower than before | |||
| Indent Indent Indent71140-8 | I have trouble learning new tasks or directions | |||
| Indent Indent71141-6 | Social - family well-being - FAMS [FACIT] | |||
| Indent Indent Indent70412-2 | I feel close to my friends | |||
| Indent Indent Indent70413-0 | I get emotional support from my family | |||
| Indent Indent Indent70414-8 | I get support from my friends | |||
| Indent Indent Indent70415-5 | My family has accepted my illness | |||
| Indent Indent Indent70416-3 | I am satisfied with family communication about my illness | |||
| Indent Indent Indent71119-2 | My family has trouble understanding when my condition gets worse | |||
| Indent Indent Indent71120-0 | I feel left out of things | |||
| Indent Indent71121-8 | Additional concerns - FAMS [FACIT] | |||
| Indent Indent Indent70409-8 | I am bothered by side effects of treatment | |||
| Indent Indent Indent70411-4 | I am forced to spend time in bed | |||
| Indent Indent Indent70417-1 | I felt close to my partner, or the person who is my main support | |||
| Indent Indent Indent70418-9 | I am satisfied with my sex life | |||
| Indent Indent Indent70393-4 | I am satisfied with how I am coping with my illness | |||
| Indent Indent Indent70395-9 | I am nervous | |||
| Indent Indent Indent70397-5 | I worry that my condition will get worse | |||
| Indent Indent Indent70402-3 | I am sleeping well | |||
| Indent Indent Indent71122-6 | Heat worsens my symptoms | |||
| Indent Indent Indent70314-0 | I have trouble controlling my urine | |||
| Indent Indent Indent70315-7 | I urinate more frequently than usual | |||
| Indent Indent Indent70527-7 | I am bothered by the chills | |||
| Indent Indent Indent70344-7 | I am bothered by fevers (episodes of high body temperature) | |||
| Indent Indent Indent71123-4 | I am bothered by muscle spasms |
Fully-Specified Name
- Component
- Functional assessment of chronic illness therapy - non cancer specific measures panel
- Property
- -
- Time
- Pt
- System
- ^Patient
- Scale
- -
- Method
- FACIT
Basic Attributes
- Class
- PANEL.SURVEY.GNHLTH
- Type
- Surveys
- First Released
- Version 2.40
- Last Updated
- Version 2.50
- Panel Type
- Panel
LOINC Terminology Service (API) using HL7® FHIR® Get Info
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- CodeSystem lookup
- https:
//fhir.loinc.org/CodeSystem/$lookup?system=http: //loinc.org&code=70673-9 - Questionnaire definition
- https:
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Copyright
- Organization
- Functional Assessment of Chronic Illness Therapy
- Copyright
- Copyright © 2010 FACIT.org.
- Terms of Use
- Used with permission. All translations, adaptations, symptom indices, computer programs, and scoring algorithms, and any other related documents of the Functional Assessment of Chronic Illness Therapy (FACIT) Measurement System, including the Functional Assessment of Cancer Therapy (FACT), are owned and copyrighted by, and the intellectual property of, David Cella, Ph.D.
- URL
- http://www.facit.org/FACITOrg/AboutUs/Copyright
LOINC Copyright
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