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Form Context

For the following statements, please select the response that best describes your current situation in the past 7 days

Source: PROMIS

98521-8 I worry about becoming short of breath

Observation ID in Form

DYSER001

Fully-Specified Name

Component
I worry about becoming short of breath in past 7D
Property
Find
Time
7D
System
^Patient
Scale
Ord
Method

Long Common Name

I worry about becoming short of breath in past 7 days

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.72
Last Updated
Version 2.72 (ADD)
Order vs. Observation
Observation

Normative Answer List LL5215-0

AnswerCodeScoreAnswer ID
Not at all0LA6568-5
A little bit1LA13863-8
Somewhat2LA13909-9
Quite a bit3LA13902-4
Very much4LA13914-9

Member of these Panels

LOINCLong Common Name
98536-6PROMIS item bank - dyspnea emotional response - version 1.0

98522-6 I become afraid when I have trouble catching my breath

Observation ID in Form

DYSER002

Fully-Specified Name

Component
I become afraid when I have trouble catching my breath in past 7D
Property
Find
Time
7D
System
^Patient
Scale
Ord
Method

Long Common Name

I become afraid when I have trouble catching my breath in past 7 days

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.72
Last Updated
Version 2.72 (ADD)
Order vs. Observation
Observation

Normative Answer List LL5215-0

AnswerCodeScoreAnswer ID
Not at all0LA6568-5
A little bit1LA13863-8
Somewhat2LA13909-9
Quite a bit3LA13902-4
Very much4LA13914-9

Member of these Panels

LOINCLong Common Name
98536-6PROMIS item bank - dyspnea emotional response - version 1.0

98523-4 Exercise seems unsafe for me

Observation ID in Form

DYSER003

Fully-Specified Name

Component
Exercise seems unsafe for me in past 7D
Property
Find
Time
7D
System
^Patient
Scale
Ord
Method

Long Common Name

Exercise seems unsafe for me in past 7 days

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.72
Last Updated
Version 2.72 (ADD)
Order vs. Observation
Observation

Normative Answer List LL5215-0

AnswerCodeScoreAnswer ID
Not at all0LA6568-5
A little bit1LA13863-8
Somewhat2LA13909-9
Quite a bit3LA13902-4
Very much4LA13914-9

Member of these Panels

LOINCLong Common Name
98536-6PROMIS item bank - dyspnea emotional response - version 1.0

98524-2 I am embarrassed by using my inhaled medication in public

Observation ID in Form

DYSER004

Fully-Specified Name

Component
I am embarrassed by using my inhaled medication in public in past 7D
Property
Find
Time
7D
System
^Patient
Scale
Ord
Method

Long Common Name

I am embarrassed by using my inhaled medication in public in past 7 days

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.72
Last Updated
Version 2.72 (ADD)
Order vs. Observation
Observation

Normative Answer List LL5215-0

AnswerCodeScoreAnswer ID
Not at all0LA6568-5
A little bit1LA13863-8
Somewhat2LA13909-9
Quite a bit3LA13902-4
Very much4LA13914-9

Member of these Panels

LOINCLong Common Name
98536-6PROMIS item bank - dyspnea emotional response - version 1.0

98525-9 I am embarrassed by using my oxygen in public

Observation ID in Form

DYSER005

Fully-Specified Name

Component
I am embarrassed by using my oxygen in public in past 7D
Property
Find
Time
7D
System
^Patient
Scale
Ord
Method

Long Common Name

I am embarrassed by using my oxygen in public in past 7 days

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.72
Last Updated
Version 2.72 (ADD)
Order vs. Observation
Observation

Normative Answer List LL5215-0

AnswerCodeScoreAnswer ID
Not at all0LA6568-5
A little bit1LA13863-8
Somewhat2LA13909-9
Quite a bit3LA13902-4
Very much4LA13914-9

Member of these Panels

LOINCLong Common Name
98536-6PROMIS item bank - dyspnea emotional response - version 1.0

98526-7 I am embarrassed by my shortness of breath

Observation ID in Form

DYSER006

Fully-Specified Name

Component
I am embarrassed by my shortness of breath in past 7D
Property
Find
Time
7D
System
^Patient
Scale
Ord
Method

Long Common Name

I am embarrassed by my shortness of breath in past 7 days

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.72
Last Updated
Version 2.72 (ADD)
Order vs. Observation
Observation

Normative Answer List LL5215-0

AnswerCodeScoreAnswer ID
Not at all0LA6568-5
A little bit1LA13863-8
Somewhat2LA13909-9
Quite a bit3LA13902-4
Very much4LA13914-9

Member of these Panels

LOINCLong Common Name
98536-6PROMIS item bank - dyspnea emotional response - version 1.0

98535-8 I get upset when I can’t do something because of my shortness of breath

Observation ID in Form

DYSER007

Fully-Specified Name

Component
I get upset when I can't do something because of my shortness of breath in past 7D
Property
Find
Time
7D
System
^Patient
Scale
Ord
Method

Long Common Name

I get upset when I can't do something because of my shortness of breath in past 7 days

Basic Attributes

Class
SURVEY.PROMIS
Type
Surveys
First Released
Version 2.72
Last Updated
Version 2.72 (ADD)
Order vs. Observation
Observation

Normative Answer List LL5215-0

AnswerCodeScoreAnswer ID
Not at all0LA6568-5
A little bit1LA13863-8
Somewhat2LA13909-9
Quite a bit3LA13902-4
Very much4LA13914-9

Member of these Panels

LOINCLong Common Name
98536-6PROMIS item bank - dyspnea emotional response - version 1.0

98537-4 PROMIS dyspnea emotional response - version 1.0 T-score

Fully-Specified Name

Component
PROMIS dyspnea emotional response - 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 2.72
Last Updated
Version 2.72 (ADD)
Order vs. Observation
Observation

Member of these Panels

LOINCLong Common Name
98536-6PROMIS item bank - dyspnea emotional response - version 1.0

Example Units

UnitSource
{Tscore}Example UCUM Units