Form Context

The following is a list of activities that people often do during the week. Although for some people with several medical problems it is difficult to determine what it is that limits them, please go over the activities listed below and indicate how much limitation you have had due to chest pain, chest tightness or angina over the past 4 weeks

Source: John Spertus, MD, MPH

Form Coding Instructions

Place an X in one box on each line

Source: John Spertus, MD, MPH

88480-9 Walking indoors on level ground

Fully-Specified Name

Component
Walking indoors on level ground limited by chest pain, chest tightness or angina over the past 4W
Property
Find
Time
4W
System
^Patient
Scale
Ord
Method
SAQ

Long Common Name

Walking indoors on level ground limited by chest pain, chest tightness or angina over the past 4 weeks [SAQ]

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.64
Last Updated
Version 2.65 (MIN)
Order vs. Observation
Observation

Normative Answer List LL4859-6

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

Member of these Panels

LOINCLong Common Name
88479-1Seattle Angina Questionnaire - 7 items [SAQ]

88478-3 Gardening, vacuuming or carrying groceries

Fully-Specified Name

Component
Gardening, vacuuming, or carrying groceries limited by chest pain, chest tightness or angina over the past 4W
Property
Find
Time
4W
System
^Patient
Scale
Ord
Method
SAQ

Long Common Name

Gardening, vacuuming, or carrying groceries limited by chest pain, chest tightness or angina over the past 4 weeks [SAQ]

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.64
Last Updated
Version 2.65 (MIN)
Order vs. Observation
Observation

Normative Answer List LL4859-6

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

Member of these Panels

LOINCLong Common Name
88479-1Seattle Angina Questionnaire - 7 items [SAQ]

88477-5 Lifting or moving heavy objects (e.g. furniture, children)

Fully-Specified Name

Component
Lifting or moving heavy objects limited by chest pain, chest tightness or angina over the past 4W
Property
Find
Time
4W
System
^Patient
Scale
Ord
Method
SAQ

Long Common Name

Lifting or moving heavy objects limited by chest pain, chest tightness or angina over the past 4 weeks [SAQ]

Basic Attributes

Class
SURVEY.GNHLTH
Type
Surveys
First Released
Version 2.64
Last Updated
Version 2.65 (MIN)
Order vs. Observation
Observation

Normative Answer List LL4859-6

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

Member of these Panels

LOINCLong Common Name
88479-1Seattle Angina Questionnaire - 7 items [SAQ]