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Form Coding Instructions

The following questions refer to your heart failure and how it may affect your life. Please read and complete the following questions. There are no right or wrong answers. Please mark the answer that best applies to you

Source: John Spertus, MD, MPH

86473-6 Please indicate how much you are limited by heart failure (shortness of breath or fatigue) in your ability to do the following activities over the past 2 weeks. Dressing yourself

Observation Required in Panel

Required

Form Context

Heart failure affects different people in different ways. Some feel shortness of breath while others feel fatigue

Source: John Spertus, MD, MPH

Fully-Specified Name

Component
Dressing yourself was limited by heart failure over the past 2W
Property
Find
Time
2W
System
^Patient
Scale
Ord
Method
KCCQ

Long Common Name

Dressing yourself was limited by heart failure over the past 2 weeks [KCCQ]

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.61
Last Updated
Version 2.63 (MIN)
Order vs. Observation
Observation

Normative Answer List LL4532-9

AnswerCodeScoreAnswer ID
Extremely limited1LA27701-4
Quite a bit limited2LA27702-2
Moderately limited3LA6460-5
Slightly limited4LA9605-2
Not at all limited5LA27707-1
Limited for other reasons or did not do the activity6LA27708-9

Member of these Panels

LOINCLong Common Name
71941-9Kansas City Cardiomyopathy Questionnaire [KCCQ]

86483-5 Please indicate how much you are limited by heart failure (shortness of breath or fatigue) in your ability to do the following activities over the past 2 weeks. Showering or bathing

Observation Required in Panel

Required

Form Context

Heart failure affects different people in different ways. Some feel shortness of breath while others feel fatigue

Source: John Spertus, MD, MPH

Fully-Specified Name

Component
Showering or bathing was limited by heart failure over the past 2W
Property
Find
Time
2W
System
^Patient
Scale
Ord
Method
KCCQ

Long Common Name

Showering or bathing was limited by heart failure over the past 2 weeks [KCCQ]

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.61
Last Updated
Version 2.63 (MIN)
Order vs. Observation
Observation

Normative Answer List LL4532-9

AnswerCodeScoreAnswer ID
Extremely limited1LA27701-4
Quite a bit limited2LA27702-2
Moderately limited3LA6460-5
Slightly limited4LA9605-2
Not at all limited5LA27707-1
Limited for other reasons or did not do the activity6LA27708-9

Member of these Panels

LOINCLong Common Name
86923-0Kansas City Cardiomyopathy Questionnaire - 12 item [KCCQ-12]
71941-9Kansas City Cardiomyopathy Questionnaire [KCCQ]

86474-4 Please indicate how much you are limited by heart failure (shortness of breath or fatigue) in your ability to do the following activities over the past 2 weeks. Walking 1 block on level ground

Observation Required in Panel

Required

Form Context

Heart failure affects different people in different ways. Some feel shortness of breath while others feel fatigue

Source: John Spertus, MD, MPH

Fully-Specified Name

Component
Walking 1 block on level ground was limited by heart failure over the past 2W
Property
Find
Time
2W
System
^Patient
Scale
Ord
Method
KCCQ

Long Common Name

Walking 1 block on level ground was limited by heart failure over the past 2 weeks [KCCQ]

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.61
Last Updated
Version 2.63 (MIN)
Order vs. Observation
Observation

Normative Answer List LL4532-9

AnswerCodeScoreAnswer ID
Extremely limited1LA27701-4
Quite a bit limited2LA27702-2
Moderately limited3LA6460-5
Slightly limited4LA9605-2
Not at all limited5LA27707-1
Limited for other reasons or did not do the activity6LA27708-9

Member of these Panels

LOINCLong Common Name
86923-0Kansas City Cardiomyopathy Questionnaire - 12 item [KCCQ-12]
71941-9Kansas City Cardiomyopathy Questionnaire [KCCQ]

86475-1 Please indicate how much you are limited by heart failure (shortness of breath or fatigue) in your ability to do the following activities over the past 2 weeks. Doing yardwork, housework or carrying groceries

Observation Required in Panel

Required

Form Context

Heart failure affects different people in different ways. Some feel shortness of breath while others feel fatigue

Source: John Spertus, MD, MPH

Fully-Specified Name

Component
Doing yardwork, housework or carrying groceries was limited by heart failure over the past 2W
Property
Find
Time
2W
System
^Patient
Scale
Ord
Method
KCCQ

Long Common Name

Doing yardwork, housework or carrying groceries was limited by heart failure over the past 2 weeks [KCCQ]

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.61
Last Updated
Version 2.63 (MIN)
Order vs. Observation
Observation

Normative Answer List LL4532-9

AnswerCodeScoreAnswer ID
Extremely limited1LA27701-4
Quite a bit limited2LA27702-2
Moderately limited3LA6460-5
Slightly limited4LA9605-2
Not at all limited5LA27707-1
Limited for other reasons or did not do the activity6LA27708-9

Member of these Panels

LOINCLong Common Name
71941-9Kansas City Cardiomyopathy Questionnaire [KCCQ]

86476-9 Please indicate how much you are limited by heart failure (shortness of breath or fatigue) in your ability to do the following activities over the past 2 weeks. Climbing a flight of stairs without stopping

Observation Required in Panel

Required

Form Context

Heart failure affects different people in different ways. Some feel shortness of breath while others feel fatigue

Source: John Spertus, MD, MPH

Fully-Specified Name

Component
Climbing a flight of stairs without stopping was limited by heart failure over the past 2W
Property
Find
Time
2W
System
^Patient
Scale
Ord
Method
KCCQ

Long Common Name

Climbing a flight of stairs without stopping was limited by heart failure over the past 2 weeks [KCCQ]

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.61
Last Updated
Version 2.63 (MIN)
Order vs. Observation
Observation

Normative Answer List LL4532-9

AnswerCodeScoreAnswer ID
Extremely limited1LA27701-4
Quite a bit limited2LA27702-2
Moderately limited3LA6460-5
Slightly limited4LA9605-2
Not at all limited5LA27707-1
Limited for other reasons or did not do the activity6LA27708-9

Member of these Panels

LOINCLong Common Name
71941-9Kansas City Cardiomyopathy Questionnaire [KCCQ]

86477-7 Please indicate how much you are limited by heart failure (shortness of breath or fatigue) in your ability to do the following activities over the past 2 weeks. Hurrying or jogging (as if to catch a bus)

Observation Required in Panel

Required

Form Context

Heart failure affects different people in different ways. Some feel shortness of breath while others feel fatigue

Source: John Spertus, MD, MPH

Fully-Specified Name

Component
Hurrying or jogging (as if to catch a bus) was limited by heart failure over the past 2W
Property
Find
Time
2W
System
^Patient
Scale
Ord
Method
KCCQ

Long Common Name

Hurrying or jogging (as if to catch a bus) was limited by heart failure over the past 2 weeks [KCCQ]

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.61
Last Updated
Version 2.63 (MIN)
Order vs. Observation
Observation

Normative Answer List LL4532-9

AnswerCodeScoreAnswer ID
Extremely limited1LA27701-4
Quite a bit limited2LA27702-2
Moderately limited3LA6460-5
Slightly limited4LA9605-2
Not at all limited5LA27707-1
Limited for other reasons or did not do the activity6LA27708-9

Member of these Panels

LOINCLong Common Name
86923-0Kansas City Cardiomyopathy Questionnaire - 12 item [KCCQ-12]
71941-9Kansas City Cardiomyopathy Questionnaire [KCCQ]

86478-5 Compared with 2 weeks ago, have your symptoms of heart failure (shortness of breath, fatigue or ankle swelling) changed? My symptoms of heart failure have become

Observation Required in Panel

Required

Fully-Specified Name

Component
Change in symptoms of heart failure compared with 2W ago
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
KCCQ

Long Common Name

Change in symptoms of heart failure compared with 2 weeks ago [KCCQ]

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.61
Last Updated
Version 2.61 (MIN)
Order vs. Observation
Observation

Normative Answer List LL4533-7

AnswerCodeScoreAnswer ID
Much worse1LA18865-8
Slightly worse2LA27710-5
Not changed3LA27711-3
Slightly better4LA27712-1
Much better5LA18864-1
I've had no symptoms over the last 2 weeks6LA27717-0

Member of these Panels

LOINCLong Common Name
71941-9Kansas City Cardiomyopathy Questionnaire [KCCQ]

86479-3 Over the past 2 weeks, how many times did you have swelling in your feet, ankles or legs when you woke up in the morning?

Observation Required in Panel

Required

Fully-Specified Name

Component
Swelling in your feet, ankles or legs when you woke up over the past 2W
Property
Find
Time
2W
System
^Patient
Scale
Ord
Method
KCCQ

Long Common Name

Swelling in your feet, ankles or legs when you woke up over the past 2 weeks [KCCQ]

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.61
Last Updated
Version 2.61 (MIN)
Order vs. Observation
Observation

Normative Answer List LL4534-5

AnswerCodeScoreAnswer ID
Every morning1LA27719-6
3 or more times a week, but not every day2LA27720-4
1-2 times a week3LA14506-2
Less than once a week4LA27722-0
Never over the past 2 weeks5LA27723-8

Member of these Panels

LOINCLong Common Name
86923-0Kansas City Cardiomyopathy Questionnaire - 12 item [KCCQ-12]
71941-9Kansas City Cardiomyopathy Questionnaire [KCCQ]

86480-1 Over the past 2 weeks, how much has swelling in your feet, ankles or legs bothered you? It has been

Observation Required in Panel

Required

Fully-Specified Name

Component
Bothered by swelling in your feet, ankles or legs over the past 2W
Property
Find
Time
2W
System
^Patient
Scale
Ord
Method
KCCQ

Long Common Name

Bothered by swelling in your feet, ankles or legs over the past 2 weeks [KCCQ]

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.61
Last Updated
Version 2.61 (MIN)
Order vs. Observation
Observation

Normative Answer List LL4535-2

AnswerCodeScoreAnswer ID
Extremely bothersome1LA27766-7
Quite a bit bothersome2LA27724-6
Moderately bothersome3LA27725-3
Slightly bothersome4LA27726-1
Not at all bothersome5LA24969-0
I've had no swelling6LA27718-8

Member of these Panels

LOINCLong Common Name
71941-9Kansas City Cardiomyopathy Questionnaire [KCCQ]

86481-9 Over the past 2 weeks, on average, how many times has fatigue limited your ability to do what you want?

Observation Required in Panel

Required

Fully-Specified Name

Component
Fatigue limited your ability to do what you wanted over the past 2W
Property
Find
Time
2W
System
^Patient
Scale
Ord
Method
KCCQ

Long Common Name

Fatigue limited your ability to do what you wanted over the past 2 weeks [KCCQ]

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.61
Last Updated
Version 2.61 (MIN)
Order vs. Observation
Observation

Normative Answer List LL4536-0

AnswerCodeScoreAnswer ID
All of the time1LA6154-4
Several times per day2LA27729-5
At least once a day3LA27730-3
3 or more times per week but not every day4LA27770-9
1-2 times per week5LA13834-9
Less than once a week6LA27722-0
Never over the past 2 weeks7LA27723-8

Member of these Panels

LOINCLong Common Name
86923-0Kansas City Cardiomyopathy Questionnaire - 12 item [KCCQ-12]
71941-9Kansas City Cardiomyopathy Questionnaire [KCCQ]

86482-7 Over the past 2 weeks, how much has your fatigue bothered you? It has been

Observation Required in Panel

Required

Fully-Specified Name

Component
Bothered by fatigue over the past 2W
Property
Find
Time
2W
System
^Patient
Scale
Ord
Method
KCCQ

Long Common Name

Bothered by fatigue over the past 2 weeks [KCCQ]

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.61
Last Updated
Version 2.61 (MIN)
Order vs. Observation
Observation

Normative Answer List LL4537-8

AnswerCodeScoreAnswer ID
Extremely bothersome1LA27766-7
Quite a bit bothersome2LA27724-6
Moderately bothersome3LA27725-3
Slightly bothersome4LA27726-1
Not at all bothersome5LA24969-0
I've had no fatigue6LA27733-7

Member of these Panels

LOINCLong Common Name
71941-9Kansas City Cardiomyopathy Questionnaire [KCCQ]

86472-8 Over the past 2 weeks, on average, how many times has shortness of breath limited your ability to do what you wanted?

Observation Required in Panel

Required

Fully-Specified Name

Component
Shortness of breath limited your ability to do what you wanted over the past 2W
Property
Find
Time
2W
System
^Patient
Scale
Ord
Method
KCCQ

Long Common Name

Shortness of breath limited your ability to do what you wanted over the past 2 weeks [KCCQ]

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.61
Last Updated
Version 2.61 (MIN)
Order vs. Observation
Observation

Normative Answer List LL4536-0

AnswerCodeScoreAnswer ID
All of the time1LA6154-4
Several times per day2LA27729-5
At least once a day3LA27730-3
3 or more times per week but not every day4LA27770-9
1-2 times per week5LA13834-9
Less than once a week6LA27722-0
Never over the past 2 weeks7LA27723-8

Member of these Panels

LOINCLong Common Name
86923-0Kansas City Cardiomyopathy Questionnaire - 12 item [KCCQ-12]
71941-9Kansas City Cardiomyopathy Questionnaire [KCCQ]

86484-3 Over the past 2 weeks, how much has your shortness of breath bothered you? It has been...

Observation Required in Panel

Required

Fully-Specified Name

Component
Bothered by shortness of breath over the past 2W
Property
Find
Time
2W
System
^Patient
Scale
Ord
Method
KCCQ

Long Common Name

Bothered by shortness of breath over the past 2 weeks [KCCQ]

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.61
Last Updated
Version 2.63 (MIN)
Change Reason
Corrected display of the Component
Order vs. Observation
Observation

Normative Answer List LL4538-6

AnswerCodeScoreAnswer ID
Extremely bothersome1LA27766-7
Quite a bit bothersome2LA27724-6
Moderately bothersome3LA27725-3
Slightly bothersome4LA27726-1
Not at all bothersome5LA24969-0
I've had no shortness of breath6LA27734-5

Member of these Panels

LOINCLong Common Name
71941-9Kansas City Cardiomyopathy Questionnaire [KCCQ]

86485-0 Over the past 2 weeks, on average, how many times have you been forced to sleep sitting up in a chair or with at least 3 pillows to prop you up because of shortness of breath?

Observation Required in Panel

Required

Fully-Specified Name

Component
Sleep sitting up in a chair or with at least 3 pillows to prop you up because of shortness of breath over the past 2W
Property
Find
Time
2W
System
^Patient
Scale
Ord
Method
KCCQ

Long Common Name

Sleep sitting up in a chair or with at least 3 pillows to prop you up because of shortness of breath over the past 2 weeks [KCCQ]

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.61
Last Updated
Version 2.61 (MIN)
Order vs. Observation
Observation

Normative Answer List LL4539-4

AnswerCodeScoreAnswer ID
Every night1LA14806-6
3 or more times a week, but not every day2LA27720-4
1-2 times a week3LA14506-2
Less than once a week4LA27722-0
Never over the past 2 weeks5LA27723-8

Member of these Panels

LOINCLong Common Name
86923-0Kansas City Cardiomyopathy Questionnaire - 12 item [KCCQ-12]
71941-9Kansas City Cardiomyopathy Questionnaire [KCCQ]

86486-8 How sure are you that you know what to do, or whom to call, if your heart failure gets worse?

Observation Required in Panel

Required

Form Context

Heart failure symptoms can worsen for a number of reasons

Source: John Spertus, MD, MPH

Fully-Specified Name

Component
You know what to do, or whom to call, if your heart failure gets worse
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
KCCQ

Long Common Name

You know what to do, or whom to call, if your heart failure gets worse [KCCQ]

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.61
Last Updated
Version 2.63 (MIN)
Order vs. Observation
Observation

Normative Answer List LL4540-2

AnswerCodeScoreAnswer ID
Not at all sure1LA27735-2
Not very sure2LA27736-0
Somewhat sure3LA27737-8
Mostly sure4LA27738-6
Completely sure5LA27739-4

Member of these Panels

LOINCLong Common Name
71941-9Kansas City Cardiomyopathy Questionnaire [KCCQ]

86487-6 How well do you understand what things you are able to do to keep your heart failure symptoms from getting worse? (for example, weighing yourself, eating a low salt diet, etc.)

Observation Required in Panel

Required

Fully-Specified Name

Component
Understand what things you are able to do to keep your heart failure symptoms from getting worse
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
KCCQ

Long Common Name

Understand what things you are able to do to keep your heart failure symptoms from getting worse [KCCQ]

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.61
Last Updated
Version 2.61 (MIN)
Order vs. Observation
Observation

Normative Answer List LL4541-0

AnswerCodeScoreAnswer ID
Do not understand at all1LA27740-2
Do not understand very well2LA27741-0
Somewhat understand3LA27742-8
Mostly understand4LA27743-6
Completely understand5LA27744-4

Member of these Panels

LOINCLong Common Name
71941-9Kansas City Cardiomyopathy Questionnaire [KCCQ]

86488-4 Over the past 2 weeks, how much has your heart failure limited your enjoyment of life?

Observation Required in Panel

Required

Fully-Specified Name

Component
Enjoyment of life limited by heart failure over the past 2W
Property
Find
Time
2W
System
^Patient
Scale
Ord
Method
KCCQ

Long Common Name

Enjoyment of life limited by heart failure over the past 2 weeks [KCCQ]

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.61
Last Updated
Version 2.61 (MIN)
Order vs. Observation
Observation

Normative Answer List LL4542-8

AnswerCodeScoreAnswer ID
It has extremely limited my enjoyment of life1LA27745-1
It has limited my enjoyment of life quite a bit2LA27746-9
It has moderately limited my enjoyment of life3LA27747-7
It has slightly limited my enjoyment of life4LA27748-5
It has not limited my enjoyment of life at all5LA27749-3

Member of these Panels

LOINCLong Common Name
86923-0Kansas City Cardiomyopathy Questionnaire - 12 item [KCCQ-12]
71941-9Kansas City Cardiomyopathy Questionnaire [KCCQ]

86489-2 If you had to spend the rest of your life with your heart failure the way it is right now, how would you feel about this?

Observation Required in Panel

Required

Fully-Specified Name

Component
How would you feel if you had to spend the rest of your life with your heart failure the way it is right now
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
KCCQ

Long Common Name

How would you feel if you had to spend the rest of your life with your heart failure the way it is right now [KCCQ]

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.61
Last Updated
Version 2.61 (MIN)
Order vs. Observation
Observation

Normative Answer List LL4543-6

AnswerCodeScoreAnswer ID
Not at all satisfied1LA27750-1
Mostly dissatisfied2LA24976-5
Somewhat satisfied3LA27752-7
Mostly satisfied4LA24974-0
Completely satisfied5LA27754-3

Member of these Panels

LOINCLong Common Name
86923-0Kansas City Cardiomyopathy Questionnaire - 12 item [KCCQ-12]
71941-9Kansas City Cardiomyopathy Questionnaire [KCCQ]

86490-0 Over the past 2 weeks, how often have you felt discouraged or down in the dumps because of your heart failure?

Observation Required in Panel

Required

Fully-Specified Name

Component
Felt discouraged or down in the dumps because of heart failure over the past 2W
Property
Find
Time
2W
System
^Patient
Scale
Ord
Method
KCCQ

Long Common Name

Felt discouraged or down in the dumps because of heart failure over the past 2 weeks [KCCQ]

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.61
Last Updated
Version 2.61 (MIN)
Order vs. Observation
Observation

Normative Answer List LL4544-4

AnswerCodeScoreAnswer ID
I felt that way all of the time1LA27755-0
I felt that way most of the time2LA27756-8
I occasionally felt that way3LA27757-6
I rarely felt that way4LA27758-4
I never felt that way5LA27759-2

Member of these Panels

LOINCLong Common Name
71941-9Kansas City Cardiomyopathy Questionnaire [KCCQ]

86491-8 Please indicate how your heart failure may have limited your participation in the following activities over the past 2 weeks. Hobbies, recreational activities

Observation Required in Panel

Required

Form Context

How much does your heart failure affect your lifestyle?

Source: John Spertus, MD, MPH

Fully-Specified Name

Component
Participation in hobbies, recreational activities limited by heart failure over the past 2W
Property
Find
Time
2W
System
^Patient
Scale
Ord
Method
KCCQ

Long Common Name

Participation in hobbies, recreational activities limited by heart failure over the past 2 weeks [KCCQ]

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.61
Last Updated
Version 2.63 (MIN)
Order vs. Observation
Observation

Normative Answer List LL4545-1

AnswerCodeScoreAnswer ID
Severely limited1LA27761-8
Limited quite a bit2LA27760-0
Moderately limited3LA6460-5
Slightly limited4LA9605-2
Did not limit at all5LA27764-2
Does not apply or did not do for other reasons6LA27765-9

Member of these Panels

LOINCLong Common Name
86923-0Kansas City Cardiomyopathy Questionnaire - 12 item [KCCQ-12]
71941-9Kansas City Cardiomyopathy Questionnaire [KCCQ]

86492-6 Please indicate how your heart failure may have limited your participation in the following activities over the past 2 weeks. Working or doing household chores

Observation Required in Panel

Required

Form Context

How much does your heart failure affect your lifestyle?

Source: John Spertus, MD, MPH

Fully-Specified Name

Component
Participation in working or doing household chores limited by heart failure over the past 2W
Property
Find
Time
2W
System
^Patient
Scale
Ord
Method
KCCQ

Long Common Name

Participation in working or doing household chores limited by heart failure over the past 2 weeks [KCCQ]

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.61
Last Updated
Version 2.63 (MIN)
Order vs. Observation
Observation

Normative Answer List LL4545-1

AnswerCodeScoreAnswer ID
Severely limited1LA27761-8
Limited quite a bit2LA27760-0
Moderately limited3LA6460-5
Slightly limited4LA9605-2
Did not limit at all5LA27764-2
Does not apply or did not do for other reasons6LA27765-9

Member of these Panels

LOINCLong Common Name
86923-0Kansas City Cardiomyopathy Questionnaire - 12 item [KCCQ-12]
71941-9Kansas City Cardiomyopathy Questionnaire [KCCQ]

86493-4 Please indicate how your heart failure may have limited your participation in the following activities over the past 2 weeks. Visiting family or friends out of your home

Observation Required in Panel

Required

Form Context

How much does your heart failure affect your lifestyle?

Source: John Spertus, MD, MPH

Fully-Specified Name

Component
Participation in visiting family or friends out of your home limited by heart failure over the past 2W
Property
Find
Time
2W
System
^Patient
Scale
Ord
Method
KCCQ

Long Common Name

Participation in visiting family or friends out of your home limited by heart failure over the past 2 weeks [KCCQ]

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.61
Last Updated
Version 2.63 (MIN)
Order vs. Observation
Observation

Normative Answer List LL4545-1

AnswerCodeScoreAnswer ID
Severely limited1LA27761-8
Limited quite a bit2LA27760-0
Moderately limited3LA6460-5
Slightly limited4LA9605-2
Did not limit at all5LA27764-2
Does not apply or did not do for other reasons6LA27765-9

Member of these Panels

LOINCLong Common Name
86923-0Kansas City Cardiomyopathy Questionnaire - 12 item [KCCQ-12]
71941-9Kansas City Cardiomyopathy Questionnaire [KCCQ]

86494-2 Please indicate how your heart failure may have limited your participation in the following activities over the past 2 weeks. Intimate relationships with loved ones

Observation Required in Panel

Required

Form Context

How much does your heart failure affect your lifestyle?

Source: John Spertus, MD, MPH

Fully-Specified Name

Component
Participation in intimate relationships with loved ones limited by heart failure over the past 2W
Property
Find
Time
2W
System
^Patient
Scale
Ord
Method
KCCQ

Long Common Name

Participation in intimate relationships with loved ones limited by heart failure over the past 2 weeks [KCCQ]

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.61
Last Updated
Version 2.63 (MIN)
Order vs. Observation
Observation

Normative Answer List LL4545-1

AnswerCodeScoreAnswer ID
Severely limited1LA27761-8
Limited quite a bit2LA27760-0
Moderately limited3LA6460-5
Slightly limited4LA9605-2
Did not limit at all5LA27764-2
Does not apply or did not do for other reasons6LA27765-9

Member of these Panels

LOINCLong Common Name
71941-9Kansas City Cardiomyopathy Questionnaire [KCCQ]

72195-1 KCCQ physical limitation score

Term Description

KCCQ physical limitation score is calculated from the average of responses to 6 items (1a through 1f).

Fully-Specified Name

Component
Physical limitation score
Property
Score
Time
Pt
System
^Patient
Scale
Qn
Method
KCCQ

Long Common Name

Physical limitation score [KCCQ]

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.42
Last Updated
Version 2.67 (MIN)
Order vs. Observation
Observation

Member of these Panels

LOINCLong Common Name
71941-9Kansas City Cardiomyopathy Questionnaire [KCCQ]

Example Units

UnitSource
{score}Example UCUM Units

72196-9 KCCQ social limitation score

Term Description

KCCQ social limitation score is calculated from the average of responses to 4 items (15a through 15d).

Fully-Specified Name

Component
Social limitation score
Property
Score
Time
Pt
System
^Patient
Scale
Qn
Method
KCCQ

Long Common Name

Social limitation score [KCCQ]

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.42
Last Updated
Version 2.67 (MIN)
Order vs. Observation
Observation

Member of these Panels

LOINCLong Common Name
71941-9Kansas City Cardiomyopathy Questionnaire [KCCQ]

Example Units

UnitSource
{score}Example UCUM Units

72189-4 KCCQ quality of life score

Term Description

KCCQ quality of life score is calculated from the average of responses to 3 items (12 through 14).

Fully-Specified Name

Component
Quality of life score
Property
Score
Time
Pt
System
^Patient
Scale
Qn
Method
KCCQ

Long Common Name

Quality of life score [KCCQ]

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.42
Last Updated
Version 2.67 (MIN)
Order vs. Observation
Observation

Member of these Panels

LOINCLong Common Name
71941-9Kansas City Cardiomyopathy Questionnaire [KCCQ]

Example Units

UnitSource
{score}Example UCUM Units

72190-2 KCCQ self-efficacy score

Term Description

KCCQ self-efficacy score is calculated from the average of responses to 2 items (10 and 11).

Fully-Specified Name

Component
Self-efficacy score
Property
Score
Time
Pt
System
^Patient
Scale
Qn
Method
KCCQ

Long Common Name

Self-efficacy score [KCCQ]

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.42
Last Updated
Version 2.67 (MIN)
Order vs. Observation
Observation

Member of these Panels

LOINCLong Common Name
71941-9Kansas City Cardiomyopathy Questionnaire [KCCQ]

Example Units

UnitSource
{score}Example UCUM Units

72192-8 KCCQ symptom burden score

Term Description

KCCQ symptom burden score is calculated from the average of responses to 3 items (4, 6, and 8).

Fully-Specified Name

Component
Symptom burden score
Property
Score
Time
Pt
System
^Patient
Scale
Qn
Method
KCCQ

Long Common Name

Symptom burden score [KCCQ]

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.42
Last Updated
Version 2.67 (MIN)
Order vs. Observation
Observation

Member of these Panels

LOINCLong Common Name
71941-9Kansas City Cardiomyopathy Questionnaire [KCCQ]

Example Units

UnitSource
{score}Example UCUM Units

72193-6 KCCQ symptom frequency score

Term Description

KCCQ symptom frequency score is calculated from the average of responses to 4 items (3, 5, 7, and 9).

Fully-Specified Name

Component
Symptom frequency score
Property
Score
Time
Pt
System
^Patient
Scale
Qn
Method
KCCQ

Long Common Name

Symptom frequency score [KCCQ]

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.42
Last Updated
Version 2.67 (MIN)
Order vs. Observation
Observation

Member of these Panels

LOINCLong Common Name
71941-9Kansas City Cardiomyopathy Questionnaire [KCCQ]

Example Units

UnitSource
{score}Example UCUM Units

72194-4 KCCQ symptom stability score

Term Description

KCCQ symptom stability score is calculated from the response to 1 item (2).

Fully-Specified Name

Component
Symptom stability score
Property
Score
Time
Pt
System
^Patient
Scale
Qn
Method
KCCQ

Long Common Name

Symptom stability score [KCCQ]

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.42
Last Updated
Version 2.67 (MIN)
Order vs. Observation
Observation

Member of these Panels

LOINCLong Common Name
71941-9Kansas City Cardiomyopathy Questionnaire [KCCQ]

Example Units

UnitSource
{score}Example UCUM Units

72191-0 KCCQ total symptom score

Term Description

KCCQ total symptom score is the mean of the following available summary scores: KCCQ symptom frequency score, KCCQ symptom burden score.

Fully-Specified Name

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

Long Common Name

Total symptom score [KCCQ]

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.42
Last Updated
Version 2.67 (MIN)
Order vs. Observation
Observation

Member of these Panels

LOINCLong Common Name
71941-9Kansas City Cardiomyopathy Questionnaire [KCCQ]

Example Units

UnitSource
{score}Example UCUM Units

72188-6 KCCQ clinical summary score

Term Description

KCCQ clinical summary score is the mean of the following available summary scores: KCCQ physical limitation score, KCCQ total symptom score.

Fully-Specified Name

Component
Clinical summary score
Property
Score
Time
Pt
System
^Patient
Scale
Qn
Method
KCCQ

Long Common Name

Clinical summary score [KCCQ]

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.42
Last Updated
Version 2.67 (MIN)
Order vs. Observation
Observation

Member of these Panels

LOINCLong Common Name
71941-9Kansas City Cardiomyopathy Questionnaire [KCCQ]

Example Units

UnitSource
{score}Example UCUM Units

71940-1 KCCQ overall summary score

Term Description

KCCQ overall summary score is the sum of responses from all 23 items.

Reference Information

TypeSourceReference
CitationJohn Spertus, MD, MPHCopyright Copyright © 1996-2005 John Spertus, MD, MPH.Green CP, Porter CB, Bresnahan DR, Spertus JA. Development and evaluation of the Kansas City Cardiomyopathy Questionnaire: a new health status measure for heart failure. J Am Coll Cardiol. 2000 Apr;35(5):1245-55. [PMID: 10758967]

Fully-Specified Name

Component
Overall summary score
Property
Score
Time
Pt
System
^Patient
Scale
Qn
Method
KCCQ

Long Common Name

Overall summary score [KCCQ]

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.40
Last Updated
Version 2.67 (MIN)
Order vs. Observation
Observation

Member of these Panels

LOINCLong Common Name
71941-9Kansas City Cardiomyopathy Questionnaire [KCCQ]

Example Units

UnitSource
{score}Example UCUM Units