Version 2.78

71806-4 I feel sad, down in the dumps or unhappy

Observation ID in Form

M3-1

Fully-Specified Name

Component
I feel sad, down in the dumps or unhappy since I took my last screen
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
M3

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.40
Last Updated
Version 2.67
Order vs. Observation
Observation

Survey Question

Text
I feel sad, down in the dumps or unhappy

Normative Answer List LL2115-5

Answer Code Score Answer ID
Not at all 0 LA6568-5
Rarely 0 LA10066-1
Sometimes 1 LA10082-8
Often 2 LA10044-8
Most of the time 2 LA14734-0

Member of these Panels

LOINC Long Common Name
71891-6 M3 Checklist - follow-up [M3]

71826-2 I can't concentrate or focus

Observation ID in Form

M3-2

Fully-Specified Name

Component
I can't concentrate or focus since I took my last screen
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
M3

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.40
Last Updated
Version 2.67
Order vs. Observation
Observation

Survey Question

Text
I can't concentrate or focus

Normative Answer List LL2115-5

Answer Code Score Answer ID
Not at all 0 LA6568-5
Rarely 0 LA10066-1
Sometimes 1 LA10082-8
Often 2 LA10044-8
Most of the time 2 LA14734-0

Member of these Panels

LOINC Long Common Name
71891-6 M3 Checklist - follow-up [M3]

71807-2 Nothing seems to give me much pleasure

Observation ID in Form

M3-3

Fully-Specified Name

Component
Nothing seems to give me much pleasure since I took my last screen
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
M3

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.40
Last Updated
Version 2.67
Order vs. Observation
Observation

Survey Question

Text
Nothing seems to give me much pleasure

Normative Answer List LL2115-5

Answer Code Score Answer ID
Not at all 0 LA6568-5
Rarely 0 LA10066-1
Sometimes 1 LA10082-8
Often 2 LA10044-8
Most of the time 2 LA14734-0

Member of these Panels

LOINC Long Common Name
71891-6 M3 Checklist - follow-up [M3]

71808-0 I feel tired; have no energy

Observation ID in Form

M3-4

Fully-Specified Name

Component
I feel tired - have no energy since I took my last screen
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
M3

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.40
Last Updated
Version 2.67
Order vs. Observation
Observation

Survey Question

Text
I feel tired; have no energy

Normative Answer List LL2115-5

Answer Code Score Answer ID
Not at all 0 LA6568-5
Rarely 0 LA10066-1
Sometimes 1 LA10082-8
Often 2 LA10044-8
Most of the time 2 LA14734-0

Member of these Panels

LOINC Long Common Name
71891-6 M3 Checklist - follow-up [M3]

71809-8 I have had thoughts of suicide

Observation ID in Form

M3-5

Fully-Specified Name

Component
I have had thoughts of suicide since I took my last screen
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
M3

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.40
Last Updated
Version 2.67
Order vs. Observation
Observation

Survey Question

Text
I have had thoughts of suicide

Normative Answer List LL2115-5

Answer Code Score Answer ID
Not at all 0 LA6568-5
Rarely 0 LA10066-1
Sometimes 1 LA10082-8
Often 2 LA10044-8
Most of the time 2 LA14734-0

Member of these Panels

LOINC Long Common Name
71891-6 M3 Checklist - follow-up [M3]

72205-8 Changes in sleeping patterns - follow up [M3]

Fully-Specified Name

Component
Changes in sleeping patterns - follow up
Property
-
Time
Pt
System
^Patient
Scale
-
Method
M3

Basic Attributes

Class
PANEL.SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.42
Last Updated
Version 2.50
Panel Type
Panel

Member of these Panels

LOINC Long Common Name
71891-6 M3 Checklist - follow-up [M3]

71810-6 I have difficulty sleeping

Observation ID in Form

M3-6a

Fully-Specified Name

Component
I have difficulty sleeping since I took my last screen
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
M3

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.40
Last Updated
Version 2.67
Order vs. Observation
Observation

Survey Question

Text
I have difficulty sleeping

Normative Answer List LL2115-5

Answer Code Score Answer ID
Not at all 0 LA6568-5
Rarely 0 LA10066-1
Sometimes 1 LA10082-8
Often 2 LA10044-8
Most of the time 2 LA14734-0

Member of these Panels

LOINC Long Common Name
71891-6 M3 Checklist - follow-up [M3]

71811-4 I have been sleeping too much

Observation ID in Form

M3-6b

Fully-Specified Name

Component
I have been sleeping too much since I took my last screen
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
M3

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.40
Last Updated
Version 2.67
Order vs. Observation
Observation

Survey Question

Text
I have been sleeping too much

Normative Answer List LL2115-5

Answer Code Score Answer ID
Not at all 0 LA6568-5
Rarely 0 LA10066-1
Sometimes 1 LA10082-8
Often 2 LA10044-8
Most of the time 2 LA14734-0

Member of these Panels

LOINC Long Common Name
71891-6 M3 Checklist - follow-up [M3]

72204-1 Changes in appetite - follow up [M3]

Fully-Specified Name

Component
Changes in appetite - follow up
Property
-
Time
Pt
System
^Patient
Scale
-
Method
M3

Basic Attributes

Class
PANEL.SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.42
Last Updated
Version 2.50
Panel Type
Panel

Member of these Panels

LOINC Long Common Name
71891-6 M3 Checklist - follow-up [M3]

71812-2 I have lost some appetite

Observation ID in Form

M3-7a

Fully-Specified Name

Component
I have lost some appetite since I took my last screen
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
M3

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.40
Last Updated
Version 2.67
Order vs. Observation
Observation

Survey Question

Text
I have lost some appetite

Normative Answer List LL2115-5

Answer Code Score Answer ID
Not at all 0 LA6568-5
Rarely 0 LA10066-1
Sometimes 1 LA10082-8
Often 2 LA10044-8
Most of the time 2 LA14734-0

Member of these Panels

LOINC Long Common Name
71891-6 M3 Checklist - follow-up [M3]

71813-0 I have been eating more

Observation ID in Form

M3-7b

Fully-Specified Name

Component
I have been eating more since I took my last screen
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
M3

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.40
Last Updated
Version 2.67
Order vs. Observation
Observation

Survey Question

Text
I have been eating more

Normative Answer List LL2115-5

Answer Code Score Answer ID
Not at all 0 LA6568-5
Rarely 0 LA10066-1
Sometimes 1 LA10082-8
Often 2 LA10044-8
Most of the time 2 LA14734-0

Member of these Panels

LOINC Long Common Name
71891-6 M3 Checklist - follow-up [M3]

71814-8 I feel tense, anxious or can't sit still

Observation ID in Form

M3-8

Fully-Specified Name

Component
I feel tense, anxious or can't sit still since I took my last screen
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
M3

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.40
Last Updated
Version 2.67
Order vs. Observation
Observation

Survey Question

Text
I feel tense, anxious or can't sit still

Normative Answer List LL2115-5

Answer Code Score Answer ID
Not at all 0 LA6568-5
Rarely 0 LA10066-1
Sometimes 1 LA10082-8
Often 2 LA10044-8
Most of the time 2 LA14734-0

Member of these Panels

LOINC Long Common Name
71891-6 M3 Checklist - follow-up [M3]

71815-5 I feel worried or fearful

Observation ID in Form

M3-9

Fully-Specified Name

Component
I feel worried or fearful since I took my last screen
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
M3

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.40
Last Updated
Version 2.67
Order vs. Observation
Observation

Survey Question

Text
I feel worried or fearful

Normative Answer List LL2115-5

Answer Code Score Answer ID
Not at all 0 LA6568-5
Rarely 0 LA10066-1
Sometimes 1 LA10082-8
Often 2 LA10044-8
Most of the time 2 LA14734-0

Member of these Panels

LOINC Long Common Name
71891-6 M3 Checklist - follow-up [M3]

71816-3 I have attacks of anxiety or panic

Observation ID in Form

M3-10

Fully-Specified Name

Component
I have attacks of anxiety or panic since I took my last screen
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
M3

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.40
Last Updated
Version 2.67
Order vs. Observation
Observation

Survey Question

Text
I have attacks of anxiety or panic

Normative Answer List LL2115-5

Answer Code Score Answer ID
Not at all 0 LA6568-5
Rarely 0 LA10066-1
Sometimes 1 LA10082-8
Often 2 LA10044-8
Most of the time 2 LA14734-0

Member of these Panels

LOINC Long Common Name
71891-6 M3 Checklist - follow-up [M3]

71817-1 I worry about dying or losing control

Observation ID in Form

M3-11

Fully-Specified Name

Component
I worry about dying or losing control since I took my last screen
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
M3

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.40
Last Updated
Version 2.67
Order vs. Observation
Observation

Survey Question

Text
I worry about dying or losing control

Normative Answer List LL2115-5

Answer Code Score Answer ID
Not at all 0 LA6568-5
Rarely 0 LA10066-1
Sometimes 1 LA10082-8
Often 2 LA10044-8
Most of the time 2 LA14734-0

Member of these Panels

LOINC Long Common Name
71891-6 M3 Checklist - follow-up [M3]

71818-9 I am nervous or shaky in social situations

Observation ID in Form

M3-12

Fully-Specified Name

Component
I am nervous or shaky in social situations since I took my last screen
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
M3

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.40
Last Updated
Version 2.67
Order vs. Observation
Observation

Survey Question

Text
I am nervous or shaky in social situations

Normative Answer List LL2115-5

Answer Code Score Answer ID
Not at all 0 LA6568-5
Rarely 0 LA10066-1
Sometimes 1 LA10082-8
Often 2 LA10044-8
Most of the time 2 LA14734-0

Member of these Panels

LOINC Long Common Name
71891-6 M3 Checklist - follow-up [M3]

71819-7 I have nightmares or flashbacks

Observation ID in Form

M3-13

Fully-Specified Name

Component
I have nightmares or flashbacks since I took my last screen
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
M3

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.40
Last Updated
Version 2.67
Order vs. Observation
Observation

Survey Question

Text
I have nightmares or flashbacks

Normative Answer List LL2115-5

Answer Code Score Answer ID
Not at all 0 LA6568-5
Rarely 0 LA10066-1
Sometimes 1 LA10082-8
Often 2 LA10044-8
Most of the time 2 LA14734-0

Member of these Panels

LOINC Long Common Name
71891-6 M3 Checklist - follow-up [M3]

71820-5 I am jumpy or feel startled easily

Observation ID in Form

M3-14

Fully-Specified Name

Component
I am jumpy or feel startled easily since I took my last screen
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
M3

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.40
Last Updated
Version 2.67
Order vs. Observation
Observation

Survey Question

Text
I am jumpy or feel startled easily

Normative Answer List LL2115-5

Answer Code Score Answer ID
Not at all 0 LA6568-5
Rarely 0 LA10066-1
Sometimes 1 LA10082-8
Often 2 LA10044-8
Most of the time 2 LA14734-0

Member of these Panels

LOINC Long Common Name
71891-6 M3 Checklist - follow-up [M3]

71821-3 I avoid places that strongly remind me of a bad experience

Observation ID in Form

M3-15

Fully-Specified Name

Component
I avoid places that strongly remind me of a bad experience since I took my last screen
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
M3

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.40
Last Updated
Version 2.67
Order vs. Observation
Observation

Survey Question

Text
I avoid places that strongly remind me of a bad experience

Normative Answer List LL2115-5

Answer Code Score Answer ID
Not at all 0 LA6568-5
Rarely 0 LA10066-1
Sometimes 1 LA10082-8
Often 2 LA10044-8
Most of the time 2 LA14734-0

Member of these Panels

LOINC Long Common Name
71891-6 M3 Checklist - follow-up [M3]

71822-1 I feel dull, numb, or detached

Observation ID in Form

M3-16

Fully-Specified Name

Component
I feel dull, numb, or detached since I took my last screen
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
M3

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.40
Last Updated
Version 2.67
Order vs. Observation
Observation

Survey Question

Text
I feel dull, numb, or detached

Normative Answer List LL2115-5

Answer Code Score Answer ID
Not at all 0 LA6568-5
Rarely 0 LA10066-1
Sometimes 1 LA10082-8
Often 2 LA10044-8
Most of the time 2 LA14734-0

Member of these Panels

LOINC Long Common Name
71891-6 M3 Checklist - follow-up [M3]

71823-9 I can't get certain things out of my mind

Observation ID in Form

M3-17

Fully-Specified Name

Component
I can't get certain things out of my mind since I took my last screen
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
M3

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.40
Last Updated
Version 2.67
Order vs. Observation
Observation

Survey Question

Text
I can't get certain things out of my mind

Normative Answer List LL2115-5

Answer Code Score Answer ID
Not at all 0 LA6568-5
Rarely 0 LA10066-1
Sometimes 1 LA10082-8
Often 2 LA10044-8
Most of the time 2 LA14734-0

Member of these Panels

LOINC Long Common Name
71891-6 M3 Checklist - follow-up [M3]

71824-7 I feel I must repeat certain acts or rituals

Observation ID in Form

M3-18

Fully-Specified Name

Component
I feel I must repeat certain acts or rituals since I took my last screen
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
M3

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.40
Last Updated
Version 2.67
Order vs. Observation
Observation

Survey Question

Text
I feel I must repeat certain acts or rituals

Normative Answer List LL2115-5

Answer Code Score Answer ID
Not at all 0 LA6568-5
Rarely 0 LA10066-1
Sometimes 1 LA10082-8
Often 2 LA10044-8
Most of the time 2 LA14734-0

Member of these Panels

LOINC Long Common Name
71891-6 M3 Checklist - follow-up [M3]

71825-4 I feel the need to check and recheck things

Observation ID in Form

M3-19

Fully-Specified Name

Component
I feel the need to check and recheck things since I took my last screen
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
M3

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.40
Last Updated
Version 2.67
Order vs. Observation
Observation

Survey Question

Text
I feel the need to check and recheck things

Normative Answer List LL2115-5

Answer Code Score Answer ID
Not at all 0 LA6568-5
Rarely 0 LA10066-1
Sometimes 1 LA10082-8
Often 2 LA10044-8
Most of the time 2 LA14734-0

Member of these Panels

LOINC Long Common Name
71891-6 M3 Checklist - follow-up [M3]

71561-5 Had more energy than usual

Observation ID in Form

M3-20

Fully-Specified Name

Component
At any time in your life, have you had more energy than usual
Property
Find
Time
Lifetime
System
^Patient
Scale
Ord
Method
M3

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.40
Last Updated
Version 2.67
Order vs. Observation
Observation

Survey Question

Text
Had more energy than usual
Source
M3-20

Normative Answer List LL2115-5

Answer Code Score Answer ID
Not at all 0 LA6568-5
Rarely 0 LA10066-1
Sometimes 1 LA10082-8
Often 2 LA10044-8
Most of the time 2 LA14734-0

Member of these Panels

LOINC Long Common Name
71891-6 M3 Checklist - follow-up [M3]
71569-8 M3 Checklist [M3]

71562-3 Felt unusually irritable or angry

Observation ID in Form

M3-21

Fully-Specified Name

Component
At any time in your life, have you felt unusually irritable or angry
Property
Find
Time
Lifetime
System
^Patient
Scale
Ord
Method
M3

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.40
Last Updated
Version 2.67
Order vs. Observation
Observation

Survey Question

Text
Felt unusually irritable or angry
Source
M3-21

Normative Answer List LL2115-5

Answer Code Score Answer ID
Not at all 0 LA6568-5
Rarely 0 LA10066-1
Sometimes 1 LA10082-8
Often 2 LA10044-8
Most of the time 2 LA14734-0

Member of these Panels

LOINC Long Common Name
71891-6 M3 Checklist - follow-up [M3]
71569-8 M3 Checklist [M3]

71563-1 Felt unusually excited, revved up or high

Observation ID in Form

M3-22

Fully-Specified Name

Component
At any time in your life have you felt unusually excited, revved up or high
Property
Find
Time
Lifetime
System
^Patient
Scale
Ord
Method
M3

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.40
Last Updated
Version 2.67
Order vs. Observation
Observation

Survey Question

Text
Felt unusually excited, revved up or high
Source
M3-22

Normative Answer List LL2115-5

Answer Code Score Answer ID
Not at all 0 LA6568-5
Rarely 0 LA10066-1
Sometimes 1 LA10082-8
Often 2 LA10044-8
Most of the time 2 LA14734-0

Member of these Panels

LOINC Long Common Name
71891-6 M3 Checklist - follow-up [M3]
71569-8 M3 Checklist [M3]

71564-9 Needed less sleep than usual

Observation ID in Form

M3-23

Fully-Specified Name

Component
At any time in your life have you needed less sleep than usual
Property
Find
Time
Lifetime
System
^Patient
Scale
Ord
Method
M3

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.40
Last Updated
Version 2.67
Order vs. Observation
Observation

Survey Question

Text
Needed less sleep than usual
Source
M3-23

Normative Answer List LL2115-5

Answer Code Score Answer ID
Not at all 0 LA6568-5
Rarely 0 LA10066-1
Sometimes 1 LA10082-8
Often 2 LA10044-8
Most of the time 2 LA14734-0

Member of these Panels

LOINC Long Common Name
71891-6 M3 Checklist - follow-up [M3]
71569-8 M3 Checklist [M3]

71565-6 Interferes with work or school

Observation ID in Form

M3-24

Fully-Specified Name

Component
These symptoms interfere with work or school
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
M3

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.40
Last Updated
Version 2.67
Order vs. Observation
Observation

Survey Question

Text
Interferes with work or school
Source
M3-24

Normative Answer List LL2115-5

Answer Code Score Answer ID
Not at all 0 LA6568-5
Rarely 0 LA10066-1
Sometimes 1 LA10082-8
Often 2 LA10044-8
Most of the time 2 LA14734-0

Member of these Panels

LOINC Long Common Name
71891-6 M3 Checklist - follow-up [M3]
71569-8 M3 Checklist [M3]

71566-4 Affects my relationships with friends or family

Observation ID in Form

M3-25

Fully-Specified Name

Component
These symptoms affect my relationships with friends or family
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
M3

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.40
Last Updated
Version 2.67
Order vs. Observation
Observation

Survey Question

Text
Affects my relationships with friends or family
Source
M3-25

Normative Answer List LL2115-5

Answer Code Score Answer ID
Not at all 0 LA6568-5
Rarely 0 LA10066-1
Sometimes 1 LA10082-8
Often 2 LA10044-8
Most of the time 2 LA14734-0

Member of these Panels

LOINC Long Common Name
71891-6 M3 Checklist - follow-up [M3]
71569-8 M3 Checklist [M3]

71567-2 Has led to my using alcohol to get by

Observation ID in Form

M3-26

Fully-Specified Name

Component
These symptoms have led to my using alcohol to get by
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
M3

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.40
Last Updated
Version 2.67
Order vs. Observation
Observation

Survey Question

Text
Has led to my using alcohol to get by
Source
M3-26

Normative Answer List LL2115-5

Answer Code Score Answer ID
Not at all 0 LA6568-5
Rarely 0 LA10066-1
Sometimes 1 LA10082-8
Often 2 LA10044-8
Most of the time 2 LA14734-0

Member of these Panels

LOINC Long Common Name
71891-6 M3 Checklist - follow-up [M3]
71569-8 M3 Checklist [M3]

71568-0 Has led to my using drugs

Observation ID in Form

M3-27

Fully-Specified Name

Component
These symptoms have led to my using drugs
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
M3

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.40
Last Updated
Version 2.67
Order vs. Observation
Observation

Survey Question

Text
Has led to my using drugs
Source
M3-27

Normative Answer List LL2115-5

Answer Code Score Answer ID
Not at all 0 LA6568-5
Rarely 0 LA10066-1
Sometimes 1 LA10082-8
Often 2 LA10044-8
Most of the time 2 LA14734-0

Member of these Panels

LOINC Long Common Name
71891-6 M3 Checklist - follow-up [M3]
71569-8 M3 Checklist [M3]

71755-3 Anxiety score [M3]

Term Description

M3 Anxiety Score is based on patient responses to questions 8-19. Interpretation: 0-2 Unlikely; 3-5 Low; 6-11 Medium; 12-24 High. The reference range for the anxiety score is 0-2. Any score greater than 2 is out of range
Source: Regenstrief LOINC

Fully-Specified Name

Component
Anxiety score
Property
Score
Time
Pt
System
^Patient
Scale
Qn
Method
M3

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.40
Last Updated
Version 2.67
Order vs. Observation
Observation

Member of these Panels

LOINC Long Common Name
71891-6 M3 Checklist - follow-up [M3]
71569-8 M3 Checklist [M3]

Example Units

Unit Source
{score} Example UCUM Units

71756-1 Score out of range [M3]

Form Coding Instructions

Select Yes if Depression score is >4, Anxiety score is >2, PTSD score is >1, Bipolar score is >1

Source: My Mood Monitor Checklist

Fully-Specified Name

Component
Score out of range
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
M3

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.40
Last Updated
Version 2.67
Order vs. Observation
Observation

Normative Answer List LL361-7

Answer Code Score Answer 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

LOINC Long Common Name
71891-6 M3 Checklist - follow-up [M3]
71569-8 M3 Checklist [M3]

71827-0 Score interpretation [M3]

Term Description

The score interpretation is the analysis of risk for potential mood and anxiety disorders.
Source: Regenstrief LOINC

Form Coding Instructions

For Total Score (LOINC 71777-57) Select Unlikely if Question 5 is less than 1 AND Question 27 is less than 1 AND Question 24 is less than 3 AND Question 25 is less than 3 AND Question 26 is less than 3; Select Low if Unlikely AND Total score is less than 34; Select Medium if NOT Unlikely AND Total score is greater than 33 and less than 50, Select High if NOT Unlikely AND Total score greater than 50. For Anxiety (LOINC 71755-3) Select Unlikely if <3, Low if >2<6, Medium if >5<12, High if >11 For Depression (LOINC 71757-9) Select Unlikely if <5, Low if >4<8, Medium if >7<11, High if >10 For Bipolar (LOINC 71758-7) Select Unlikely if <2, Low if >1<4, Medium if >3<7, High if >6 For PTSD (LOINC 71754-6) Select Unlikely if <2, Low if >1<4, Medium if >3<7, High if >6

Source: My Mood Monitor Checklist

Fully-Specified Name

Component
Score interpretation
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
M3

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.40
Last Updated
Version 2.67
Order vs. Observation
Observation

Normative Answer List LL2149-4

Answer Code Score Answer ID
Unlikely LA15588-9
Low LA9194-7
Medium LA8982-6
High LA9193-9

Member of these Panels

LOINC Long Common Name
71891-6 M3 Checklist - follow-up [M3]
71569-8 M3 Checklist [M3]

71757-9 Depression score [M3]

Term Description

M3 Depression Score is based on patient responses to questions 1-7. Interpretation: 0-4 Unlikely; 5-7 Low; 8-10 Medium; 11-40 High. The reference range for the depression score is 0-4. Any score greater than 4 is out of range
Source: Regenstrief LOINC

Fully-Specified Name

Component
Depression score
Property
Score
Time
Pt
System
^Patient
Scale
Qn
Method
M3

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.40
Last Updated
Version 2.67
Order vs. Observation
Observation

Member of these Panels

LOINC Long Common Name
71891-6 M3 Checklist - follow-up [M3]
71569-8 M3 Checklist [M3]

Example Units

Unit Source
{score} Example UCUM Units

71756-1 Score out of range [M3]

Form Coding Instructions

Select Yes if Depression score is >4, Anxiety score is >2, PTSD score is >1, Bipolar score is >1

Source: My Mood Monitor Checklist

Fully-Specified Name

Component
Score out of range
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
M3

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.40
Last Updated
Version 2.67
Order vs. Observation
Observation

Normative Answer List LL361-7

Answer Code Score Answer 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

LOINC Long Common Name
71891-6 M3 Checklist - follow-up [M3]
71569-8 M3 Checklist [M3]

71827-0 Score interpretation [M3]

Term Description

The score interpretation is the analysis of risk for potential mood and anxiety disorders.
Source: Regenstrief LOINC

Form Coding Instructions

For Total Score (LOINC 71777-57) Select Unlikely if Question 5 is less than 1 AND Question 27 is less than 1 AND Question 24 is less than 3 AND Question 25 is less than 3 AND Question 26 is less than 3; Select Low if Unlikely AND Total score is less than 34; Select Medium if NOT Unlikely AND Total score is greater than 33 and less than 50, Select High if NOT Unlikely AND Total score greater than 50. For Anxiety (LOINC 71755-3) Select Unlikely if <3, Low if >2<6, Medium if >5<12, High if >11 For Depression (LOINC 71757-9) Select Unlikely if <5, Low if >4<8, Medium if >7<11, High if >10 For Bipolar (LOINC 71758-7) Select Unlikely if <2, Low if >1<4, Medium if >3<7, High if >6 For PTSD (LOINC 71754-6) Select Unlikely if <2, Low if >1<4, Medium if >3<7, High if >6

Source: My Mood Monitor Checklist

Fully-Specified Name

Component
Score interpretation
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
M3

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.40
Last Updated
Version 2.67
Order vs. Observation
Observation

Normative Answer List LL2149-4

Answer Code Score Answer ID
Unlikely LA15588-9
Low LA9194-7
Medium LA8982-6
High LA9193-9

Member of these Panels

LOINC Long Common Name
71891-6 M3 Checklist - follow-up [M3]
71569-8 M3 Checklist [M3]

71758-7 Bipolar score [M3]

Term Description

M3 Bipolar Score is based on patient responses to questions 20-23. Interpretation: 0-1 Unlikely; 2-3 Low; 4-6 Medium; 7-40 High. The reference range for the bipolar score is 0-1. Any score greater than 1 is out of range
Source: Regenstrief LOINC

Fully-Specified Name

Component
Bipolar score
Property
Score
Time
Pt
System
^Patient
Scale
Qn
Method
M3

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.40
Last Updated
Version 2.67
Order vs. Observation
Observation

Member of these Panels

LOINC Long Common Name
71891-6 M3 Checklist - follow-up [M3]
71569-8 M3 Checklist [M3]

Example Units

Unit Source
{score} Example UCUM Units

71756-1 Score out of range [M3]

Form Coding Instructions

Select Yes if Depression score is >4, Anxiety score is >2, PTSD score is >1, Bipolar score is >1

Source: My Mood Monitor Checklist

Fully-Specified Name

Component
Score out of range
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
M3

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.40
Last Updated
Version 2.67
Order vs. Observation
Observation

Normative Answer List LL361-7

Answer Code Score Answer 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

LOINC Long Common Name
71891-6 M3 Checklist - follow-up [M3]
71569-8 M3 Checklist [M3]

71827-0 Score interpretation [M3]

Term Description

The score interpretation is the analysis of risk for potential mood and anxiety disorders.
Source: Regenstrief LOINC

Form Coding Instructions

For Total Score (LOINC 71777-57) Select Unlikely if Question 5 is less than 1 AND Question 27 is less than 1 AND Question 24 is less than 3 AND Question 25 is less than 3 AND Question 26 is less than 3; Select Low if Unlikely AND Total score is less than 34; Select Medium if NOT Unlikely AND Total score is greater than 33 and less than 50, Select High if NOT Unlikely AND Total score greater than 50. For Anxiety (LOINC 71755-3) Select Unlikely if <3, Low if >2<6, Medium if >5<12, High if >11 For Depression (LOINC 71757-9) Select Unlikely if <5, Low if >4<8, Medium if >7<11, High if >10 For Bipolar (LOINC 71758-7) Select Unlikely if <2, Low if >1<4, Medium if >3<7, High if >6 For PTSD (LOINC 71754-6) Select Unlikely if <2, Low if >1<4, Medium if >3<7, High if >6

Source: My Mood Monitor Checklist

Fully-Specified Name

Component
Score interpretation
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
M3

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.40
Last Updated
Version 2.67
Order vs. Observation
Observation

Normative Answer List LL2149-4

Answer Code Score Answer ID
Unlikely LA15588-9
Low LA9194-7
Medium LA8982-6
High LA9193-9

Member of these Panels

LOINC Long Common Name
71891-6 M3 Checklist - follow-up [M3]
71569-8 M3 Checklist [M3]

71754-6 PTSD score [M3]

Term Description

M3 PTSD Score is based on patient responses to questions 13-16. The reference range for the PTSD score is 0-1. Interpretation: 0-1 Unlikely, 2-3 Low; 4-6 Medium; 7-40 High. The reference range for the PTSD score is 0-1. Any score greater than 1 is out of range
Source: Regenstrief LOINC

Fully-Specified Name

Component
PTSD score
Property
Score
Time
Pt
System
^Patient
Scale
Qn
Method
M3

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.40
Last Updated
Version 2.67
Order vs. Observation
Observation

Member of these Panels

LOINC Long Common Name
71891-6 M3 Checklist - follow-up [M3]
71569-8 M3 Checklist [M3]

Example Units

Unit Source
{score} Example UCUM Units

71756-1 Score out of range [M3]

Form Coding Instructions

Select Yes if Depression score is >4, Anxiety score is >2, PTSD score is >1, Bipolar score is >1

Source: My Mood Monitor Checklist

Fully-Specified Name

Component
Score out of range
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
M3

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.40
Last Updated
Version 2.67
Order vs. Observation
Observation

Normative Answer List LL361-7

Answer Code Score Answer 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

LOINC Long Common Name
71891-6 M3 Checklist - follow-up [M3]
71569-8 M3 Checklist [M3]

71827-0 Score interpretation [M3]

Term Description

The score interpretation is the analysis of risk for potential mood and anxiety disorders.
Source: Regenstrief LOINC

Form Coding Instructions

For Total Score (LOINC 71777-57) Select Unlikely if Question 5 is less than 1 AND Question 27 is less than 1 AND Question 24 is less than 3 AND Question 25 is less than 3 AND Question 26 is less than 3; Select Low if Unlikely AND Total score is less than 34; Select Medium if NOT Unlikely AND Total score is greater than 33 and less than 50, Select High if NOT Unlikely AND Total score greater than 50. For Anxiety (LOINC 71755-3) Select Unlikely if <3, Low if >2<6, Medium if >5<12, High if >11 For Depression (LOINC 71757-9) Select Unlikely if <5, Low if >4<8, Medium if >7<11, High if >10 For Bipolar (LOINC 71758-7) Select Unlikely if <2, Low if >1<4, Medium if >3<7, High if >6 For PTSD (LOINC 71754-6) Select Unlikely if <2, Low if >1<4, Medium if >3<7, High if >6

Source: My Mood Monitor Checklist

Fully-Specified Name

Component
Score interpretation
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
M3

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.40
Last Updated
Version 2.67
Order vs. Observation
Observation

Normative Answer List LL2149-4

Answer Code Score Answer ID
Unlikely LA15588-9
Low LA9194-7
Medium LA8982-6
High LA9193-9

Member of these Panels

LOINC Long Common Name
71891-6 M3 Checklist - follow-up [M3]
71569-8 M3 Checklist [M3]

71777-7 Total score [M3]

Term Description

M3 Score is an algorithm to allow a person to take a self test and receive a personalized score that shows: 1) an assessment of an individuals risk of suffering from any mood disorder, and 2) a patient on a clinical map showing if they have a low, medium or high risk for each of the following: Depression, Anxiety, Bipolar, PTSD.
Source: Regenstrief LOINC

Fully-Specified Name

Component
Total score
Property
Score
Time
Pt
System
^Patient
Scale
Qn
Method
M3

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.40
Last Updated
Version 2.67
Order vs. Observation
Observation

Member of these Panels

LOINC Long Common Name
71891-6 M3 Checklist - follow-up [M3]
71569-8 M3 Checklist [M3]

Example Units

Unit Source
{score} Example UCUM Units

71827-0 Score interpretation [M3]

Term Description

The score interpretation is the analysis of risk for potential mood and anxiety disorders.
Source: Regenstrief LOINC

Form Coding Instructions

For Total Score (LOINC 71777-57) Select Unlikely if Question 5 is less than 1 AND Question 27 is less than 1 AND Question 24 is less than 3 AND Question 25 is less than 3 AND Question 26 is less than 3; Select Low if Unlikely AND Total score is less than 34; Select Medium if NOT Unlikely AND Total score is greater than 33 and less than 50, Select High if NOT Unlikely AND Total score greater than 50. For Anxiety (LOINC 71755-3) Select Unlikely if <3, Low if >2<6, Medium if >5<12, High if >11 For Depression (LOINC 71757-9) Select Unlikely if <5, Low if >4<8, Medium if >7<11, High if >10 For Bipolar (LOINC 71758-7) Select Unlikely if <2, Low if >1<4, Medium if >3<7, High if >6 For PTSD (LOINC 71754-6) Select Unlikely if <2, Low if >1<4, Medium if >3<7, High if >6

Source: My Mood Monitor Checklist

Fully-Specified Name

Component
Score interpretation
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
M3

Basic Attributes

Class
SURVEY.MTLHLTH
Type
Surveys
First Released
Version 2.40
Last Updated
Version 2.67
Order vs. Observation
Observation

Normative Answer List LL2149-4

Answer Code Score Answer ID
Unlikely LA15588-9
Low LA9194-7
Medium LA8982-6
High LA9193-9

Member of these Panels

LOINC Long Common Name
71891-6 M3 Checklist - follow-up [M3]
71569-8 M3 Checklist [M3]