Form Coding Instructions

Please respond to each item by marking one box per row

Source: PROMIS

75262-6 In the past 7 days - How intense was your pain at its worst?

Fully-Specified Name

Component
How intense was your pain at its worse in the past 7D
Property
Find
Time
7D
System
^Patient
Scale
Ord
Method
PROMIS

Long Common Name

How intense was your pain at its worse in the past 7 days [PROMIS]

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.48
Last Updated
Version 2.65 (MIN)
Order vs. Observation
Observation

Normative Answer List LL2949-7

AnswerCodeScoreAnswer ID
Had no pain1LA13879-4
Mild2LA6752-5
Moderate Copyright http://snomed.info/sct ID:6736007 Moderate (severity modifier) (qualifier value)3LA6751-7
Severe4LA6750-9
Very severe5LA13958-6

Member of these Panels

LOINCLong Common Name
75259-2PROMIS short form - pain intensity 3a - version 1.0

75261-8 In the past 7 days - How intense was your average pain?

Fully-Specified Name

Component
How intense was your average pain in the past 7D
Property
Find
Time
7D
System
^Patient
Scale
Ord
Method
PROMIS

Long Common Name

How intense was your average pain in the past 7 days [PROMIS]

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.48
Last Updated
Version 2.65 (MIN)
Order vs. Observation
Observation

Normative Answer List LL2949-7

AnswerCodeScoreAnswer ID
Had no pain1LA13879-4
Mild2LA6752-5
Moderate Copyright http://snomed.info/sct ID:6736007 Moderate (severity modifier) (qualifier value)3LA6751-7
Severe4LA6750-9
Very severe5LA13958-6

Member of these Panels

LOINCLong Common Name
75259-2PROMIS short form - pain intensity 3a - version 1.0

75260-0 What is your level of pain right now?

Fully-Specified Name

Component
What is your level of pain right now
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Long Common Name

What is your level of pain right now [PROMIS]

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.48
Last Updated
Version 2.65 (MIN)
Order vs. Observation
Observation

Normative Answer List LL2951-3

AnswerCodeScoreAnswer ID
No pain1LA131-5
Mild2LA6752-5
Moderate Copyright http://snomed.info/sct ID:6736007 Moderate (severity modifier) (qualifier value)3LA6751-7
Severe4LA6750-9
Very severe5LA13958-6

Member of these Panels

LOINCLong Common Name
75259-2PROMIS short form - pain intensity 3a - version 1.0

77825-8 PROMIS short form - pain intensity 3a - version 1.0 raw score

Fully-Specified Name

Component
PROMIS short form - pain intensity 3a - version 1.0 raw score
Property
Score
Time
Pt
System
^Patient
Scale
Qn
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.52
Last Updated
Version 2.52 (ADD)
Order vs. Observation
Observation

Member of these Panels

LOINCLong Common Name
75259-2PROMIS short form - pain intensity 3a - version 1.0

Example Units

UnitSource
{score}Example UCUM Units