Version 2.77

61689-6 Are you able to run 100 yards?

Fully-Specified Name

Component
Are you able to run 100 yards
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to run 100 yards?
Source
PFC13

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
61587-2 PROMIS item bank - physical function - version 1.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

79011-3 Are you able to go up and down stairs?

Fully-Specified Name

Component
Are you able to go up and down stairs
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.54
Last Updated
Version 2.65
Order vs. Observation
Observation

Survey Question

Text
Are you able to go up and down stairs?
Source
pf21

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

78998-2 Are you able to go OUTSIDE the home, for example to shop or visit a doctor's office?

Fully-Specified Name

Component
Are you able to go OUTSIDE the home, for example to shop or visit a doctor's office
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.54
Last Updated
Version 2.65
Order vs. Observation
Observation

Survey Question

Text
Are you able to go OUTSIDE the home, for example to shop or visit a doctor's office?
Source
pf1

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

79009-7 Are you able to fasten and unfasten a seatbelt?

Fully-Specified Name

Component
Are you able to fasten and unfasten a seatbelt
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.54
Last Updated
Version 2.65
Order vs. Observation
Observation

Survey Question

Text
Are you able to fasten and unfasten a seatbelt?
Source
pf2

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

61685-4 Are you able to walk a block on flat ground?

Fully-Specified Name

Component
Are you able to walk a block on flat ground
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to walk a block on flat ground?
Source
PFC6

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
61587-2 PROMIS item bank - physical function - version 1.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

79019-6 Are you able to stand on a moving escalator?

Fully-Specified Name

Component
Are you able to stand on a moving escalator
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.54
Last Updated
Version 2.65
Order vs. Observation
Observation

Survey Question

Text
Are you able to stand on a moving escalator?
Source
pf3

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

79030-3 Are you able to take a shower?

Fully-Specified Name

Component
Are you able to take a shower
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.54
Last Updated
Version 2.65
Order vs. Observation
Observation

Survey Question

Text
Are you able to take a shower?
Source
pf4

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

79005-5 Are you able to hike a couple of miles on uneven surfaces, including hills?

Fully-Specified Name

Component
Are you able to hike a couple of miles on uneven surfaces, including hills
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.54
Last Updated
Version 2.65
Order vs. Observation
Observation

Survey Question

Text
Are you able to hike a couple of miles on uneven surfaces, including hills?
Source
pf16

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

61647-4 Are you able to make a bed, including spreading and tucking in bed sheets?

Fully-Specified Name

Component
Are you able to make a bed, including spreading and tucking in bed sheets
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to make a bed, including spreading and tucking in bed sheets?
Source
PFB12

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
89689-4 PROMIS cancer item bank - physical function - version 1.1
61587-2 PROMIS item bank - physical function - version 1.0
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

61594-8 Are you able to move a chair from one room to another?

Fully-Specified Name

Component
Are you able to move a chair from one room to another
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to move a chair from one room to another?
Source
Mobility-FA8

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
89689-4 PROMIS cancer item bank - physical function - version 1.1
61587-2 PROMIS item bank - physical function - version 1.0
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

79037-8 Are you able to move about in a dark room or hallway without falling?

Fully-Specified Name

Component
Are you able to move about in a dark room or hallway without falling
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.54
Last Updated
Version 2.65
Order vs. Observation
Observation

Survey Question

Text
Are you able to move about in a dark room or hallway without falling?
Source
pf46

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

79033-7 Are you able to move about the house?

Fully-Specified Name

Component
Are you able to move about the house
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.54
Last Updated
Version 2.65
Order vs. Observation
Observation

Survey Question

Text
Are you able to move about the house?
Source
pf42

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

79036-0 Are you able to move around on a slippery surface outdoors?

Fully-Specified Name

Component
Are you able to move around on a slippery surface outdoors
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.54
Last Updated
Version 2.65
Order vs. Observation
Observation

Survey Question

Text
Are you able to move around on a slippery surface outdoors?
Source
pf45

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

79048-5 Are you able to move from the street to the sidewalk without a curb cut?

Fully-Specified Name

Component
Are you able to move from the street to the sidewalk without a curb cut
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.54
Last Updated
Version 2.65
Order vs. Observation
Observation

Survey Question

Text
Are you able to move from the street to the sidewalk without a curb cut?
Source
pf56

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

79035-2 Are you able to move wet clothes from the washer to the dryer?

Fully-Specified Name

Component
Are you able to move wet clothes from the washer to the dryer
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.54
Last Updated
Version 2.65
Order vs. Observation
Observation

Survey Question

Text
Are you able to move wet clothes from the washer to the dryer?
Source
pf44

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

61611-0 Are you able to open a can with a hand can opener?

Fully-Specified Name

Component
Are you able to open a can with a hand can opener
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to open a can with a hand can opener?
Source
Mobility-FA28

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
61587-2 PROMIS item bank - physical function - version 1.0
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0
91611-4 PROMIS item bank - upper extremity - version 2.0

61665-6 Are you able to open a new milk carton?

Fully-Specified Name

Component
Are you able to open a new milk carton
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to open a new milk carton?
Source
PFB30

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
61587-2 PROMIS item bank - physical function - version 1.0
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0
91611-4 PROMIS item bank - upper extremity - version 2.0

79061-8 Are you able to open a tight or new jar?

Fully-Specified Name

Component
Are you able to open a tight or new jar
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.54
Last Updated
Version 2.65
Order vs. Observation
Observation

Survey Question

Text
Are you able to open a tight or new jar?
Source
pfc42

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

61618-5 Are you able to open and close a zipper?

Fully-Specified Name

Component
Are you able to open and close a zipper
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to open and close a zipper?
Source
Mobility-FA35

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
67892-0 Neuro-Qol item bank - upper extremity - version 1.0
67906-8 Neuro-Qol short form - upper extremity - version 1.0
61587-2 PROMIS item bank - physical function - version 1.0
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0
91611-4 PROMIS item bank - upper extremity - version 2.0

79007-1 Are you able to open and squeeze a new tube of toothpaste?

Fully-Specified Name

Component
Are you able to open and squeeze a new tube of toothpaste
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.54
Last Updated
Version 2.65
Order vs. Observation
Observation

Survey Question

Text
Are you able to open and squeeze a new tube of toothpaste?
Source
pf18

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

61666-4 Are you able to open car doors?

Fully-Specified Name

Component
Are you able to open car doors
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to open car doors?
Source
PFB31

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
61587-2 PROMIS item bank - physical function - version 1.0
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0
91611-4 PROMIS item bank - upper extremity - version 2.0

61608-6 Are you able to open previously opened jars?

Fully-Specified Name

Component
Are you able to open previously opened jars
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to open previously opened jars?
Source
Mobility-FA22

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
67892-0 Neuro-Qol item bank - upper extremity - version 1.0
61587-2 PROMIS item bank - physical function - version 1.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

61630-0 Are you able to peel fruit?

Fully-Specified Name

Component
Are you able to peel fruit
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to peel fruit?
Source
Mobility-FA48

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
61587-2 PROMIS item bank - physical function - version 1.0
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0
91611-4 PROMIS item bank - upper extremity - version 2.0

61656-5 Are you able to pick up coins from a table top?

Fully-Specified Name

Component
Are you able to pick up coins from a table top
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to pick up coins from a table top?
Source
PFB21

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
67892-0 Neuro-Qol item bank - upper extremity - version 1.0
67906-8 Neuro-Qol short form - upper extremity - version 1.0
61587-2 PROMIS item bank - physical function - version 1.0
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0
91611-4 PROMIS item bank - upper extremity - version 2.0

61658-1 Are you able to pour liquid from a bottle into a glass?

Fully-Specified Name

Component
Are you able to pour liquid from a bottle into a glass
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to pour liquid from a bottle into a glass?
Source
PFB23

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
61587-2 PROMIS item bank - physical function - version 1.0
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0
91611-4 PROMIS item bank - upper extremity - version 2.0

79020-4 Are you able to pour liquid from a container into a cup?

Fully-Specified Name

Component
Are you able to pour liquid from a container into a cup
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.54
Last Updated
Version 2.65
Order vs. Observation
Observation

Survey Question

Text
Are you able to pour liquid from a container into a cup?
Source
pf30

Normative Answer List LL1020-8

Answer Code Score Answer ID
Never 1 LA6270-8
Once a week or less 2 LA13898-4
Once every few days 3 LA13899-2
Once a day 4 LA13897-6
Every few hours 5 LA13875-2

Member of these Panels

LOINC Long Common Name
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

79022-0 Are you able to prepare simple meals for yourself or for others?

Fully-Specified Name

Component
Are you able to prepare simple meals for yourself or for others
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.54
Last Updated
Version 2.65
Order vs. Observation
Observation

Survey Question

Text
Are you able to prepare simple meals for yourself or for others?
Source
pf32

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

61651-6 Are you able to press with your index finger (for example ringing a doorbell)?

Fully-Specified Name

Component
Are you able to press with your index finger (for example ringing a doorbell)
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to press with your index finger (for example ringing a doorbell)?
Source
PFB16

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
61587-2 PROMIS item bank - physical function - version 1.0
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0
91611-4 PROMIS item bank - upper extremity - version 2.0

79015-4 Are you able to pull a sweater or t-shirt over your head?

Fully-Specified Name

Component
Are you able to pull a sweater or t-shirt over your head
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.54
Last Updated
Version 2.65
Order vs. Observation
Observation

Survey Question

Text
Are you able to pull a sweater or t-shirt over your head?
Source
pf26

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

79006-3 Are you able to walk more than a mile?

Fully-Specified Name

Component
Are you able to walk more than a mile
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.54
Last Updated
Version 2.65
Order vs. Observation
Observation

Survey Question

Text
Are you able to walk more than a mile?
Source
pf17

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

79041-0 Are you able to wash and dry your feet?

Fully-Specified Name

Component
Are you able to wash and dry your feet
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.54
Last Updated
Version 2.65
Order vs. Observation
Observation

Survey Question

Text
Are you able to wash and dry your feet?
Source
pf5

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

79045-1 Are you able to stand upright briefly without support?

Fully-Specified Name

Component
Are you able to stand upright briefly without support
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.54
Last Updated
Version 2.65
Order vs. Observation
Observation

Survey Question

Text
Are you able to stand upright briefly without support?
Source
pf53

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

61609-4 Are you able to go for a walk of at least 15 minutes?

Fully-Specified Name

Component
Are you able to go for a walk of at least 15 minutes
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to go for a walk of at least 15 minutes?
Source
Mobility-FA23

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
67893-8 Neuro-Qol item bank - lower extremity - version 1.0
67907-6 Neuro-Qol short form - lower extremity - version 1.0
62337-1 PROMIS item bank - 29 profile
62336-3 PROMIS item bank - 43 profile
62338-9 PROMIS item bank - 57 profile
91613-0 PROMIS item bank - mobility - version 2.0
61587-2 PROMIS item bank - physical function - version 1.0
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0
76700-4 PROMIS short form - physical function 4a - version 1.0
76804-4 PROMIS short form - physical function 6b - version 1.2
76805-1 PROMIS short form - physical function 8b - version 1.2

79052-7 Are you able to cut your toenails

Fully-Specified Name

Component
Are you able to cut your toenails
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.54
Last Updated
Version 2.65
Order vs. Observation
Observation

Survey Question

Text
Are you able to cut your toenails
Source
pf6

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

61596-3 Are you able to stand for one hour?

Fully-Specified Name

Component
Are you able to stand for one hour
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to stand for one hour?
Source
Mobility-FA10

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
91613-0 PROMIS item bank - mobility - version 2.0
61587-2 PROMIS item bank - physical function - version 1.0
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

61625-0 Are you able to carry a laundry basket up a flight of stairs?

Fully-Specified Name

Component
Are you able to carry a laundry basket up a flight of stairs
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to carry a laundry basket up a flight of stairs?
Source
Mobility-FA42

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
89689-4 PROMIS cancer item bank - physical function - version 1.1
61587-2 PROMIS item bank - physical function - version 1.0
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

79059-2 Are you able to exercise regularly?

Fully-Specified Name

Component
Are you able to exercise regularly
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.54
Last Updated
Version 2.65
Order vs. Observation
Observation

Survey Question

Text
Are you able to exercise regularly?
Source
pf7

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

Member of these Groups Get Info

LOINC Group Group Name
LG41761-4 Exercise/Activity

61620-1 Are you able to stand for short periods of time?

Fully-Specified Name

Component
Are you able to stand for short periods of time
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to stand for short periods of time?
Source
Mobility-FA37

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
61587-2 PROMIS item bank - physical function - version 1.0
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

61624-3 Are you able to squat and get up?

Fully-Specified Name

Component
Are you able to squat and get up
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to squat and get up?
Source
Mobility-FA41

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
89689-4 PROMIS cancer item bank - physical function - version 1.1
61587-2 PROMIS item bank - physical function - version 1.0
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

61644-1 Are you able to jump up and down?

Fully-Specified Name

Component
Are you able to jump up and down
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to jump up and down?
Source
PFB9

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
91613-0 PROMIS item bank - mobility - version 2.0
61587-2 PROMIS item bank - physical function - version 1.0
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

79060-0 Are you able to receive a call on a cell phone?

Fully-Specified Name

Component
Are you able to receive a call on a cell phone
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.54
Last Updated
Version 2.65
Order vs. Observation
Observation

Survey Question

Text
Are you able to receive a call on a cell phone?
Source
pf9

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

Member of these Groups Get Info

LOINC Group Group Name
LG51306-5 SDOH

61693-8 Are you able to climb up 5 flights of stairs?

Fully-Specified Name

Component
Are you able to climb up 5 flights of stairs
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to climb up 5 flights of stairs?
Source
PFC32

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
61587-2 PROMIS item bank - physical function - version 1.0
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

61645-8 Are you able to climb up five steps?

Fully-Specified Name

Component
Are you able to climb up five steps
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to climb up five steps?
Source
PFB10

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
89689-4 PROMIS cancer item bank - physical function - version 1.1
91613-0 PROMIS item bank - mobility - version 2.0
61587-2 PROMIS item bank - physical function - version 1.0
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

78999-0 Are you able to dial a number on a phone with large buttons?

Fully-Specified Name

Component
Are you able to dial a number on a phone with large buttons
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.54
Last Updated
Version 2.65
Order vs. Observation
Observation

Survey Question

Text
Are you able to dial a number on a phone with large buttons?
Source
pf10

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

79000-6 Are you able to clean up after a meal?

Fully-Specified Name

Component
Are you able to clean up after a meal
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.54
Last Updated
Version 2.65
Order vs. Observation
Observation

Survey Question

Text
Are you able to clean up after a meal?
Source
pf11

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

61667-2 Are you able to stand unsupported for 10 minutes?

Fully-Specified Name

Component
Are you able to stand unsupported for 10 minutes
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to stand unsupported for 10 minutes?
Source
PFB32

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
89689-4 PROMIS cancer item bank - physical function - version 1.1
91613-0 PROMIS item bank - mobility - version 2.0
61587-2 PROMIS item bank - physical function - version 1.0
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

61699-5 Are you able to walk at a normal speed?

Fully-Specified Name

Component
Are you able to walk at a normal speed
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to walk at a normal speed?
Source
PFC38

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
91613-0 PROMIS item bank - mobility - version 2.0
61587-2 PROMIS item bank - physical function - version 1.0
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

61691-2 Are you able to walk up and down two steps?

Fully-Specified Name

Component
Are you able to walk up and down two steps
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to walk up and down two steps?
Source
PFC29

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
61587-2 PROMIS item bank - physical function - version 1.0
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

79002-2 Are you able to dial a number on the keypad of a cell phone?

Fully-Specified Name

Component
Are you able to dial a number on the keypad of a cell phone
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.54
Last Updated
Version 2.65
Order vs. Observation
Observation

Survey Question

Text
Are you able to dial a number on the keypad of a cell phone?
Source
pf13

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

61701-9 Are you able to kneel on the floor?

Fully-Specified Name

Component
Are you able to kneel on the floor
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to kneel on the floor?
Source
PFC40

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
61587-2 PROMIS item bank - physical function - version 1.0
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

79003-0 Are you able to roll onto your stomach while lying in bed?

Fully-Specified Name

Component
Are you able to roll onto your stomach while lying in bed
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.54
Last Updated
Version 2.65
Order vs. Observation
Observation

Survey Question

Text
Are you able to roll onto your stomach while lying in bed?
Source
pf14

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

79004-8 Are you able to pull up covers while lying in bed?

Fully-Specified Name

Component
Are you able to pull up covers while lying in bed
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.54
Last Updated
Version 2.65
Order vs. Observation
Observation

Survey Question

Text
Are you able to pull up covers while lying in bed?
Source
pf15

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

61654-0 Are you able to squeeze a new tube of toothpaste?

Fully-Specified Name

Component
Are you able to squeeze a new tube of toothpaste
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to squeeze a new tube of toothpaste?
Source
PFB19

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
61587-2 PROMIS item bank - physical function - version 1.0
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0
91611-4 PROMIS item bank - upper extremity - version 2.0
76702-0 PROMIS short form - physical function 20a - version 1.0

79010-5 Are you able to do chores such as vacuuming carpet or mopping floors?

Fully-Specified Name

Component
Are you able to do chores such as vacuuming carpet or mopping floors
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.54
Last Updated
Version 2.65
Order vs. Observation
Observation

Survey Question

Text
Are you able to do chores such as vacuuming carpet or mopping floors?
Source
pf20

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

79012-1 Are you able to lift small objects (such as a can of soup) above your shoulder?

Fully-Specified Name

Component
Are you able to lift small objects (such as a can of soup) above your shoulder
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.54
Last Updated
Version 2.65
Order vs. Observation
Observation

Survey Question

Text
Are you able to lift small objects (such as a can of soup) above your shoulder?
Source
pf22

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

75909-2 Are you able to reach and get down an object (such as a can of soup) from above your head?

Fully-Specified Name

Component
Are you able to reach and get down an object (such as a can of soup) from above your head
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.50
Last Updated
Version 2.65
Order vs. Observation
Observation

Survey Question

Text
Are you able to reach and get down an object (such as a can of soup) from above your head?
Source
PF_23

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

79013-9 Are you able to carry a bag of groceries for a short distance?

Fully-Specified Name

Component
Are you able to carry a bag of groceries for a short distance
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.54
Last Updated
Version 2.65
Order vs. Observation
Observation

Survey Question

Text
Are you able to carry a bag of groceries for a short distance?
Source
pf24

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

79014-7 Are you able to put on socks

Observation ID in Form

pf25

Fully-Specified Name

Component
Able to put on socks
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.54
Last Updated
Version 2.73
Change Reason
Release 2.73: COMPONENT: Updated to match current LOINC modeling practices;
Order vs. Observation
Observation

Survey Question

Text
Are you able to put on socks?
Source
pf25

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

79015-4 Are you able to pull a sweater or t-shirt over your head?

Fully-Specified Name

Component
Are you able to pull a sweater or t-shirt over your head
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.54
Last Updated
Version 2.65
Order vs. Observation
Observation

Survey Question

Text
Are you able to pull a sweater or t-shirt over your head?
Source
pf26

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

79017-0 Are you able to do an exercise of your choice for 20 minutes several times a week?

Fully-Specified Name

Component
Are you able to do an exercise of your choice for 20 minutes several times a week
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.54
Last Updated
Version 2.65
Order vs. Observation
Observation

Survey Question

Text
Are you able to do an exercise of your choice for 20 minutes several times a week?
Source
pf28

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

Member of these Groups Get Info

LOINC Group Group Name
LG41761-4 Exercise/Activity

79026-1 Are you able to take a letter out of an envelope?

Fully-Specified Name

Component
Are you able to take a letter out of an envelope
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.54
Last Updated
Version 2.65
Order vs. Observation
Observation

Survey Question

Text
Are you able to take a letter out of an envelope?
Source
pf36

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

79029-5 Are you able to turn a key to unlock a door?

Fully-Specified Name

Component
Are you able to turn a key to unlock a door
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.54
Last Updated
Version 2.65
Order vs. Observation
Observation

Survey Question

Text
Are you able to turn a key to unlock a door?
Source
pf39

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

79031-1 Are you able to turn sink faucets on and off?

Fully-Specified Name

Component
Are you able to turn sink faucets on and off
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.54
Last Updated
Version 2.65
Order vs. Observation
Observation

Survey Question

Text
Are you able to turn sink faucets on and off?
Source
pf40

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

79032-9 Are you able to type a few sentences on a computer keyboard?

Fully-Specified Name

Component
Are you able to type a few sentences on a computer keyboard
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.54
Last Updated
Version 2.65
Order vs. Observation
Observation

Survey Question

Text
Are you able to type a few sentences on a computer keyboard?
Source
pf41

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

79039-4 Are you able to carry a shopping bag?

Fully-Specified Name

Component
Are you able to carry a shopping bag
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.54
Last Updated
Version 2.65
Order vs. Observation
Observation

Survey Question

Text
Are you able to carry a shopping bag?
Source
pf48

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

61709-2 Are you able to turn from side to side in bed?

Fully-Specified Name

Component
Are you able to turn from side to side in bed
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to turn from side to side in bed?
Source
PFC52

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
61587-2 PROMIS item bank - physical function - version 1.0
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

61648-2 Are you able to carry a shopping bag or briefcase?

Fully-Specified Name

Component
Are you able to carry a shopping bag or briefcase
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to carry a shopping bag or briefcase?
Source
PFB13

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
89689-4 PROMIS cancer item bank - physical function - version 1.1
61587-2 PROMIS item bank - physical function - version 1.0
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0
91611-4 PROMIS item bank - upper extremity - version 2.0
92605-5 PROMIS short form - upper extremity 7a - version 2.0

61643-3 Are you able to carry two bags filled with groceries 100 yards?

Fully-Specified Name

Component
Are you able to carry two bags filled with groceries 100 yards
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to carry two bags filled with groceries 100 yards?
Source
PFB8

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
61587-2 PROMIS item bank - physical function - version 1.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

61606-0 Are you able to cut your food using eating utensils?

Fully-Specified Name

Component
Are you able to cut your food using eating utensils
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to cut your food using eating utensils?
Source
Mobility-FA20

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
61587-2 PROMIS item bank - physical function - version 1.0
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0
91611-4 PROMIS item bank - upper extremity - version 2.0

79042-8 Are you able to wash dishes and utensils by hand?

Fully-Specified Name

Component
Are you able to wash dishes and utensils by hand
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.54
Last Updated
Version 2.65
Order vs. Observation
Observation

Survey Question

Text
Are you able to wash dishes and utensils by hand?
Source
pf50

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

61646-6 Are you able to wash dishes, pots, and utensils by hand while standing at a sink?

Fully-Specified Name

Component
Are you able to wash dishes, pots, and utensils by hand while standing at a sink
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to wash dishes, pots, and utensils by hand while standing at a sink?
Source
PFB11

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
89689-4 PROMIS cancer item bank - physical function - version 1.1
61587-2 PROMIS item bank - physical function - version 1.0
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0
91611-4 PROMIS item bank - upper extremity - version 2.0

61617-7 Are you able to wash your back?

Fully-Specified Name

Component
Are you able to wash your back
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to wash your back?
Source
Mobility-FA34

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
61587-2 PROMIS item bank - physical function - version 1.0
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0
91611-4 PROMIS item bank - upper extremity - version 2.0
76702-0 PROMIS short form - physical function 20a - version 1.0
92605-5 PROMIS short form - upper extremity 7a - version 2.0

61708-4 Are you able to wipe yourself after using the toilet?

Fully-Specified Name

Component
Are you able to wipe yourself after using the toilet
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to wipe yourself after using the toilet?
Source
PFC51

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
61587-2 PROMIS item bank - physical function - version 1.0
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

61626-8 Are you able to write with a pen or pencil?

Fully-Specified Name

Component
Are you able to write with a pen or pencil
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to write with a pen or pencil?
Source
Mobility-FA43

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
67892-0 Neuro-Qol item bank - upper extremity - version 1.0
67906-8 Neuro-Qol short form - upper extremity - version 1.0
61587-2 PROMIS item bank - physical function - version 1.0
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0
91611-4 PROMIS item bank - upper extremity - version 2.0

61633-4 Are you able to sit on the edge of a bed?

Fully-Specified Name

Component
Are you able to sit on the edge of a bed
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to sit on the edge of a bed?
Source
Mobility-FA51

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
61587-2 PROMIS item bank - physical function - version 1.0
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0
76702-0 PROMIS short form - physical function 20a - version 1.0

61634-2 Are you able to tie your shoelaces?

Fully-Specified Name

Component
Are you able to tie your shoelaces
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to tie your shoelaces?
Source
Mobility-FA52

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
61587-2 PROMIS item bank - physical function - version 1.0
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

61637-5 Are you able to wash and dry your body?

Fully-Specified Name

Component
Are you able to wash and dry your body
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to wash and dry your body?
Source
Mobility-FA55

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
67892-0 Neuro-Qol item bank - upper extremity - version 1.0
67906-8 Neuro-Qol short form - upper extremity - version 1.0
61587-2 PROMIS item bank - physical function - version 1.0
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0
62199-5 PROMIS short form - physical function 10a - version 1.0
92580-0 PROMIS short form - physical function 10a - version 2.0
76702-0 PROMIS short form - physical function 20a - version 1.0

61650-8 Are you able to change the bulb in a table lamp?

Fully-Specified Name

Component
Are you able to change the bulb in a table lamp
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to change the bulb in a table lamp?
Source
PFB15

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
61587-2 PROMIS item bank - physical function - version 1.0
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0
91611-4 PROMIS item bank - upper extremity - version 2.0

61655-7 Are you able to cut a piece of paper with scissors?

Fully-Specified Name

Component
Are you able to cut a piece of paper with scissors
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to cut a piece of paper with scissors?
Source
PFB20

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
61587-2 PROMIS item bank - physical function - version 1.0
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0
91611-4 PROMIS item bank - upper extremity - version 2.0

61702-7 Are you able to sit down in and stand up from a low, soft couch?

Fully-Specified Name

Component
Are you able to sit down in and stand up from a low, soft couch
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to sit down in and stand up from a low, soft couch?
Source
PFC41

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
61587-2 PROMIS item bank - physical function - version 1.0
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

78066-8 Are you able to sit on and get up from the toilet?

Fully-Specified Name

Component
Are you able to sit on and get up from the toilet
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.54
Last Updated
Version 2.65
Order vs. Observation
Observation

Survey Question

Text
Are you able to sit on and get up from the toilet?
Source
PFC45r1

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0
92580-0 PROMIS short form - physical function 10a - version 2.0

79019-6 Are you able to stand on a moving escalator?

Fully-Specified Name

Component
Are you able to stand on a moving escalator
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.54
Last Updated
Version 2.65
Order vs. Observation
Observation

Survey Question

Text
Are you able to stand on a moving escalator?
Source
pf3

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

61675-5 Are you able to stand unsupported for 30 minutes?

Fully-Specified Name

Component
Are you able to stand unsupported for 30 minutes
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to stand unsupported for 30 minutes?
Source
PFB42

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
89689-4 PROMIS cancer item bank - physical function - version 1.1
91613-0 PROMIS item bank - mobility - version 2.0
61587-2 PROMIS item bank - physical function - version 1.0
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

61601-1 Are you able to stand up from an armless straight chair?

Fully-Specified Name

Component
Are you able to stand up from an armless straight chair
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to stand up from an armless straight chair?
Source
Mobility-FA15

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
91613-0 PROMIS item bank - mobility - version 2.0
61587-2 PROMIS item bank - physical function - version 1.0
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

61673-0 Are you able to stand up on tiptoes?

Fully-Specified Name

Component
Are you able to stand up on tiptoes
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to stand up on tiptoes?
Source
PFB40

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
91613-0 PROMIS item bank - mobility - version 2.0
61587-2 PROMIS item bank - physical function - version 1.0
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

61615-1 Are you able to stand with your knees straight?

Fully-Specified Name

Component
Are you able to stand with your knees straight
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to stand with your knees straight?
Source
Mobility-FA32

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
61587-2 PROMIS item bank - physical function - version 1.0
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

61700-1 Are you able to stand without losing your balance for several minutes?

Fully-Specified Name

Component
Are you able to stand without losing your balance for several minutes
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to stand without losing your balance for several minutes?
Source
PFC39

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
61587-2 PROMIS item bank - physical function - version 1.0
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

61613-6 Are you able to step up and down curbs?

Fully-Specified Name

Component
Are you able to step up and down curbs
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to step up and down curbs?
Source
Mobility-FA30

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
67893-8 Neuro-Qol item bank - lower extremity - version 1.0
67907-6 Neuro-Qol short form - lower extremity - version 1.0
61587-2 PROMIS item bank - physical function - version 1.0
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

61649-0 Are you able to take a tub bath?

Fully-Specified Name

Component
Are you able to take a tub bath
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to take a tub bath?
Source
PFB14

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
61587-2 PROMIS item bank - physical function - version 1.0
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

61705-0 Are you able to transfer from a bed to a chair and back?

Fully-Specified Name

Component
Are you able to transfer from a bed to a chair and back
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to transfer from a bed to a chair and back?
Source
PFC46

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
61587-2 PROMIS item bank - physical function - version 1.0
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0
76702-0 PROMIS short form - physical function 20a - version 1.0

79046-9 Are you able to transfer from a bed to a chair or a wheelchair?

Fully-Specified Name

Component
Are you able to transfer from a bed to a chair or a wheelchair
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.54
Last Updated
Version 2.65
Order vs. Observation
Observation

Survey Question

Text
Are you able to transfer from a bed to a chair or a wheelchair?
Source
pf54

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

61623-5 Are you able to turn a key in a lock?

Fully-Specified Name

Component
Are you able to turn a key in a lock
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to turn a key in a lock?
Source
Mobility-FA40

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
67892-0 Neuro-Qol item bank - upper extremity - version 1.0
67906-8 Neuro-Qol short form - upper extremity - version 1.0
61587-2 PROMIS item bank - physical function - version 1.0
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0
91611-4 PROMIS item bank - upper extremity - version 2.0

79021-2 Are you able to turn pages in a book?

Fully-Specified Name

Component
Are you able to turn pages in a book
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.54
Last Updated
Version 2.65
Order vs. Observation
Observation

Survey Question

Text
Are you able to turn pages in a book?
Source
pf31

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

61671-4 Are you able to turn faucets on and off?

Fully-Specified Name

Component
Are you able to turn faucets on and off
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to turn faucets on and off?
Source
PFB37

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
61587-2 PROMIS item bank - physical function - version 1.0
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0
91611-4 PROMIS item bank - upper extremity - version 2.0

61604-5 Are you able to use a hammer to pound a nail?

Fully-Specified Name

Component
Are you able to use a hammer to pound a nail
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to use a hammer to pound a nail?
Source
Mobility-FA18

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
89689-4 PROMIS cancer item bank - physical function - version 1.1
61587-2 PROMIS item bank - physical function - version 1.0
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0
91611-4 PROMIS item bank - upper extremity - version 2.0

79049-3 Are you able to use a moving escalator safely?

Fully-Specified Name

Component
Are you able to use a moving escalator safely
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.54
Last Updated
Version 2.65
Order vs. Observation
Observation

Survey Question

Text
Are you able to use a moving escalator safely?
Source
pf57

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

79034-5 Are you able to use a regular computer mouse?

Fully-Specified Name

Component
Are you able to use a regular computer mouse
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.54
Last Updated
Version 2.65
Order vs. Observation
Observation

Survey Question

Text
Are you able to use a regular computer mouse?
Source
pf43

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0

61703-5 Are you able to use your hands, such as for turning faucets, using kitchen gadgets, or sewing?

Fully-Specified Name

Component
Are you able to use your hands, such as for turning faucets, using kitchen gadgets, or sewing
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to use your hands, such as for turning faucets, using kitchen gadgets, or sewing?
Source
PFC43

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
61587-2 PROMIS item bank - physical function - version 1.0
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0
91611-4 PROMIS item bank - upper extremity - version 2.0

61662-3 Are you able to tie a knot or a bow?

Fully-Specified Name

Component
Are you able to tie a knot or a bow
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to tie a knot or a bow?
Source
PFB27

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
61587-2 PROMIS item bank - physical function - version 1.0
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0
91611-4 PROMIS item bank - upper extremity - version 2.0

61669-8 Are you able to change a light bulb overhead?

Fully-Specified Name

Component
Are you able to change a light bulb overhead
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to change a light bulb overhead?
Source
PFB34

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
61587-2 PROMIS item bank - physical function - version 1.0
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0
91611-4 PROMIS item bank - upper extremity - version 2.0
92605-5 PROMIS short form - upper extremity 7a - version 2.0

61674-8 Are you able to trim your fingernails?

Fully-Specified Name

Component
Are you able to trim your fingernails
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to trim your fingernails?
Source
PFB41

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
67892-0 Neuro-Qol item bank - upper extremity - version 1.0
61587-2 PROMIS item bank - physical function - version 1.0
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0
91611-4 PROMIS item bank - upper extremity - version 2.0

61707-6 Are you able to water a house plant?

Fully-Specified Name

Component
Are you able to water a house plant
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.65

Survey Question

Text
Are you able to water a house plant?
Source
PFC49

Normative Answer List LL1022-4

Answer Code Score Answer ID
Without any difficulty 5 LA13921-4
With a little difficulty 4 LA13918-0
With some difficulty 3 LA13920-6
With much difficulty 2 LA13919-8
Unable to do 1 LA13912-3

Member of these Panels

LOINC Long Common Name
61587-2 PROMIS item bank - physical function - version 1.0
91722-9 PROMIS item bank - physical function - version 2.0
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0
91611-4 PROMIS item bank - upper extremity - version 2.0

77580-9 PROMIS physical function w mobility aids - version 1.0 T-score

Fully-Specified Name

Component
PROMIS physical function w mobility aids - version 1.0 T-score
Property
Tscore
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
Order vs. Observation
Observation

Member of these Panels

LOINC Long Common Name
76464-7 American Physical Therapy Association registry panel
79062-6 PROMIS item bank - physical function w mobility aids - version 1.0
79063-4 PROMIS short form - physical function w mobility aids - version 1.0

Example Units

Unit Source
{Tscore} Example UCUM Units