Form Coding Instructions

Please respond to each question or statement

Source: PROMIS

61577-3 In general, would you say your health is [PROMIS]

Observation ID in Form

Global01

Fully-Specified Name

Component
In general, would you say your health is
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.83 (MAJ)
Change Reason
Release 2.71: METHOD_TYP: Removed Method because this concept is not specific to PROMIS; EXTERNAL_COPYRIGHT_LINK: Removed copyright because this concept is not specific to PROMIS; ANSWER_LIST_TYPE: Updated from Normative to Example for increased usability; AnswerListId: Updated for increased usability; CLASS: Updated as the concept is not unique to PROMIS;

Normative Answer List LL4280-5

AnswerCodeScoreAnswer ID
Excellent5LA9206-9
Very Good4LA13913-1
Good3LA8967-7
Fair2LA8968-5
Poor1LA8969-3

Member of these Panels

LOINCLong Common Name
99745-2Patient reported outcomes with LASIK - post-operative panel [Patient reported outcomes with LASIK]
99192-7Patient-reported outcomes with LASIK - pre-operative panel [Patient reported outcomes with LASIK]
75418-4PCORI patient-reported outcomes common measures - core and recommended [PROMIS]
94257-3PROMIS pediatric - global health 7 - version 1.0
106970-7PROMIS Scale v1.2 - Global Physical Health 4a
61576-5PROMIS short form - global - version 1.1
85524-7PROMIS short form - global - version 1.2
71934-4Veterans Rand health survey - 12 item (VR-12)
71933-6Veterans Rand health survey - 36 item (VR-36)

61578-1 In general, would you say your quality of life is:

Observation ID in Form

Global02

Fully-Specified Name

Component
In general, would you say your quality of life is
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Long Common Name

In general, would you say your quality of life is [PROMIS]

Basic Attributes

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

Normative Answer List LL4280-5

AnswerCodeScoreAnswer ID
Excellent5LA9206-9
Very Good4LA13913-1
Good3LA8967-7
Fair2LA8968-5
Poor1LA8969-3

Member of these Panels

LOINCLong Common Name
75418-4PCORI patient-reported outcomes common measures - core and recommended [PROMIS]
94257-3PROMIS pediatric - global health 7 - version 1.0
61576-5PROMIS short form - global - version 1.1
85524-7PROMIS short form - global - version 1.2

61579-9 In general, how would you rate your physical health?

Observation ID in Form

Global03

Fully-Specified Name

Component
In general, how would you rate your physical health
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Long Common Name

In general, how would you rate your physical health [PROMIS]

Basic Attributes

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

Normative Answer List LL4280-5

AnswerCodeScoreAnswer ID
Excellent5LA9206-9
Very Good4LA13913-1
Good3LA8967-7
Fair2LA8968-5
Poor1LA8969-3

Member of these Panels

LOINCLong Common Name
75418-4PCORI patient-reported outcomes common measures - core and recommended [PROMIS]
94257-3PROMIS pediatric - global health 7 - version 1.0
61576-5PROMIS short form - global - version 1.1
85524-7PROMIS short form - global - version 1.2

61580-7 In general, how would you rate your mental health, including your mood and your ability to think?

Observation ID in Form

Global04

Fully-Specified Name

Component
In general, how would you rate your mental health, including your mood and your ability to think
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Long Common Name

In general, how would you rate your mental health, including your mood and your ability to think [PROMIS]

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.68 (NAM)
Change Reason
Release 2.68: COMPONENT: Added , after "In general" to accurately represent the form.

Normative Answer List LL4280-5

AnswerCodeScoreAnswer ID
Excellent5LA9206-9
Very Good4LA13913-1
Good3LA8967-7
Fair2LA8968-5
Poor1LA8969-3

Member of these Panels

LOINCLong Common Name
75418-4PCORI patient-reported outcomes common measures - core and recommended [PROMIS]
94257-3PROMIS pediatric - global health 7 - version 1.0
61576-5PROMIS short form - global - version 1.1
85524-7PROMIS short form - global - version 1.2

61581-5 In general, how would you rate your satisfaction with your social activities and relationships?

Observation ID in Form

Global05

Fully-Specified Name

Component
In general, how would you rate your satisfaction with you social activities and relationships
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Long Common Name

In general, how would you rate your satisfaction with you social activities and relationships [PROMIS]

Basic Attributes

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

Normative Answer List LL4280-5

AnswerCodeScoreAnswer ID
Excellent5LA9206-9
Very Good4LA13913-1
Good3LA8967-7
Fair2LA8968-5
Poor1LA8969-3

Member of these Panels

LOINCLong Common Name
61576-5PROMIS short form - global - version 1.1
85524-7PROMIS short form - global - version 1.2

61585-6 In general, please rate how well you carry out your usual social activities and roles. (This includes activities at home, at work and in your community, and responsibilities as a parent, child, spouse, employee, friend, etc.)

Observation ID in Form

Global09r

Fully-Specified Name

Component
In general, please rate how well you carry out your usual social activities and roles
Property
Find
Time
Pt
System
^Patient
Scale
Ord
Method
PROMIS

Long Common Name

In general, please rate how well you carry out your usual social activities and roles [PROMIS]

Basic Attributes

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

Normative Answer List LL4280-5

AnswerCodeScoreAnswer ID
Excellent5LA9206-9
Very Good4LA13913-1
Good3LA8967-7
Fair2LA8968-5
Poor1LA8969-3

Member of these Panels

LOINCLong Common Name
61576-5PROMIS short form - global - version 1.1
85524-7PROMIS short form - global - version 1.2

61582-3 To what extent are you able to carry out your everyday physical activities such as walking, climbing stairs, carrying groceries, or moving a chair [PROMIS]

Observation ID in Form

Global06

Fully-Specified Name

Component
To what extent are you able to carry out your everyday physical activities such as walking, climbing stairs, carrying groceries, or moving a 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 2.83 (MIN)

Normative Answer List LL1013-3

AnswerCodeScoreAnswer ID
Completely5LA13937-0
Mostly4LA13938-8
Moderately3LA13939-6
A little2LA13940-4
Not at all1LA6568-5

Member of these Panels

LOINCLong Common Name
75418-4PCORI patient-reported outcomes common measures - core and recommended [PROMIS]
91722-9PROMIS item bank - physical function - version 2.0
106970-7PROMIS Scale v1.2 - Global Physical Health 4a
61576-5PROMIS short form - global - version 1.1
85524-7PROMIS short form - global - version 1.2

61586-4 In the past 7 days - How often have you been bothered by emotional problems such as feeling anxious, depressed or irritable?

Observation ID in Form

Global10r

Fully-Specified Name

Component
How often have you been bothered by emotional problems such as feeling anxious, depressed or irritable in past 7D
Property
Find
Time
7D
System
^Patient
Scale
Ord
Method
PROMIS

Long Common Name

How often have you been bothered by emotional problems such as feeling anxious, depressed or irritable in past 7 days [PROMIS]

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.73 (MIN)
Common Test Rank Get Info
2045

Normative Answer List LL3122-0

AnswerCodeScoreAnswer ID
Never5LA6270-8
Rarely4LA10066-1
Sometimes3LA10082-8
Often2LA10044-8
Always1LA9933-8

Member of these Panels

LOINCLong Common Name
61576-5PROMIS short form - global - version 1.1
85524-7PROMIS short form - global - version 1.2

61584-9 In the past 7 days - How would you rate your fatigue on average?

Observation ID in Form

Global08r

Fully-Specified Name

Component
How would you rate your fatigue on average in past 7D
Property
Find
Time
7D
System
^Patient
Scale
Ord
Method
PROMIS

Long Common Name

How would you rate your fatigue on average in past 7 days [PROMIS]

Basic Attributes

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

Normative Answer List LL4478-5

AnswerCodeScoreAnswer ID
None Copyright http://snomed.info/sct ID:260413007 None (qualifier value)5LA137-2
Mild4LA6752-5
Moderate Copyright http://snomed.info/sct ID:6736007 Moderate (severity modifier) (qualifier value)3LA6751-7
Severe2LA6750-9
Very severe1LA13958-6

Member of these Panels

LOINCLong Common Name
106970-7PROMIS Scale v1.2 - Global Physical Health 4a
61576-5PROMIS short form - global - version 1.1
85524-7PROMIS short form - global - version 1.2

61583-1 How would you rate your pain on average in past 7 days [PROMIS]

Observation ID in Form

Global07r

Fully-Specified Name

Component
How would you rate your pain on average in past 7D
Property
Find
Time
7D
System
^Patient
Scale
Ord
Method
PROMIS

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.34
Last Updated
Version 2.83 (MIN)

Normative Answer List LL4258-1

AnswerCodeScoreAnswer ID
0:"No pain"0LA26951-6
11LA6112-2
2 or more2LA6113-0
33LA6114-8
44LA6115-5
55LA10137-0
66LA10138-8
77LA10139-6
88LA10140-4
99LA10141-2
10: "Worst pain imaginable"10LA26952-4

Member of these Panels

LOINCLong Common Name
62337-1PROMIS item bank - 29 profile
62336-3PROMIS item bank - 43 profile
62338-9PROMIS item bank - 57 profile
106970-7PROMIS Scale v1.2 - Global Physical Health 4a
61576-5PROMIS short form - global - version 1.1
85524-7PROMIS short form - global - version 1.2

71969-0 PROMIS-10 Global Health, GMH, T score

Term Description

GMH = Global Mental Health. This score is calculated from question responses via coefficients. Valid range: 21.2 to 67.6.

Fully-Specified Name

Component
PROMIS-10 Global Mental Health score
Property
Tscore
Time
Pt
System
^Patient
Scale
Qn
Method
PROMIS

Long Common Name

PROMIS-10 Global Mental Health (GMH) score T-score

Basic Attributes

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

Member of these Panels

LOINCLong Common Name
76464-7American Physical Therapy Association registry panel
61576-5PROMIS short form - global - version 1.1
85524-7PROMIS short form - global - version 1.2

Example Units

UnitSource
{score}Example UCUM Units

71970-8 PROMIS-10 Global Health, GMH raw score

Term Description

GMH = Global Mental Health. This score is obtained from answers to some questions. Valid range: integer 4 to 20.

Fully-Specified Name

Component
PROMIS-10 Global Mental Health score
Property
Score
Time
Pt
System
^Patient
Scale
Qn
Method
PROMIS

Long Common Name

PROMIS-10 Global Mental Health (GMH) score

Basic Attributes

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

Member of these Panels

LOINCLong Common Name
61576-5PROMIS short form - global - version 1.1
85524-7PROMIS short form - global - version 1.2

Example Units

UnitSource
{score}Example UCUM Units

71971-6 PROMIS-10 Global Physical Health (GPH) score T-score

Term Description

GPH = Global Physical Health. This score is calculated from question responses via coefficients. Valid range: 16.2 to 67.7.

Fully-Specified Name

Component
PROMIS-10 Global Physical Health score
Property
Tscore
Time
Pt
System
^Patient
Scale
Qn
Method
PROMIS

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.40
Last Updated
Version 2.83 (MIN)
Order vs. Observation
Observation

Member of these Panels

LOINCLong Common Name
76464-7American Physical Therapy Association registry panel
106970-7PROMIS Scale v1.2 - Global Physical Health 4a
61576-5PROMIS short form - global - version 1.1
85524-7PROMIS short form - global - version 1.2

Example Units

UnitSource
{score}Example UCUM Units

71972-4 PROMIS-10 Global Health, GPH, raw score

Term Description

GPH = Global Physical Health. This score is obtained from answers to some questions. Valid range: integer 4 to 20.

Fully-Specified Name

Component
PROMIS-10 Global Physical Health score
Property
Score
Time
Pt
System
^Patient
Scale
Qn
Method
PROMIS

Long Common Name

PROMIS-10 Global Physical Health (GPH) score

Basic Attributes

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

Member of these Panels

LOINCLong Common Name
106970-7PROMIS Scale v1.2 - Global Physical Health 4a
61576-5PROMIS short form - global - version 1.1
85524-7PROMIS short form - global - version 1.2

Example Units

UnitSource
{score}Example UCUM Units

85523-9 PROMIS short form - global - version 1.2 raw score

Fully-Specified Name

Component
PROMIS short form - global - version 1.2 raw score
Property
Score
Time
Pt
System
^Patient
Scale
Qn
Method
PROMIS

Basic Attributes

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

Member of these Panels

LOINCLong Common Name
85524-7PROMIS short form - global - version 1.2

Example Units

UnitSource
{score}Example UCUM Units