Symptom Assessment

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Symptoms can be reported by the patient with the Symptom Assessment, which is a component of the Well-Being Assessment. There is a capability being developed tat will enable symptoms to be updated regularly via the well-being status. Symptoms are typically addressed by assigning Care Goals and interventions and activities in the Care Plan.

SYMPTOMS ASSESSMENT

This is based on the Physical Symptoms (PHQ-15)

During the past 4 weeks, how much have you been bothered by any of the problems?

S1. Stomach pain?
□ Bothered a lot
□ Bothered a little
□ Not bothered at all

S2. During the past 4 weeks, how much have you been bothered by back pain?
□ Bothered a lot
□ Bothered a little
□ Not bothered at all

S3. During the past 4 weeks, how much have you been bothered by pain in your arms, legs, or jopints (knees, hips, etc.)?
□ Bothered a lot
□ Bothered a little
□ Not bothered at all

S1. During the past 4 weeks, how much have you been bothered by stomach pain?
□ Bothered a lot
□ Bothered a little
□ Not bothered at all

S2. During the past 4 weeks, how much have you been bothered by back pain?
□ Bothered a lot
□ Bothered a little
□ Not bothered at all

S3. During the past 4 weeks, how much have you been bothered by pain in your arms, legs, or jopints (knees, hips, etc.)?
□ Bothered a lot
□ Bothered a little
□ Not bothered at all

S1. During the past 4 weeks, how much have you been bothered by stomach pain?
□ Bothered a lot
□ Bothered a little
□ Not bothered at all

S2. During the past 4 weeks, how much have you been bothered by back pain?
□ Bothered a lot
□ Bothered a little
□ Not bothered at all

S3. During the past 4 weeks, how much have you been bothered by pain in your arms, legs, or jopints (knees, hips, etc.)?
□ Bothered a lot
□ Bothered a little
□ Not bothered at all

S1. During the past 4 weeks, how much have you been bothered by stomach pain?
□ Bothered a lot
□ Bothered a little
□ Not bothered at all

S2. During the past 4 weeks, how much have you been bothered by back pain?
□ Bothered a lot
□ Bothered a little
□ Not bothered at all

S3. During the past 4 weeks, how much have you been bothered by pain in your arms, legs, or jopints (knees, hips, etc.)?
□ Bothered a lot
□ Bothered a little
□ Not bothered at all

S1. During the past 4 weeks, how much have you been bothered by stomach pain?
□ Bothered a lot
□ Bothered a little
□ Not bothered at all

S2. During the past 4 weeks, how much have you been bothered by back pain?
□ Bothered a lot
□ Bothered a little
□ Not bothered at all

S3. During the past 4 weeks, how much have you been bothered by pain in your arms, legs, or jopints (knees, hips, etc.)?
□ Bothered a lot
□ Bothered a little
□ Not bothered at all

S1. During the past 4 weeks, how much have you been bothered by stomach pain?
□ Bothered a lot
□ Bothered a little
□ Not bothered at all

S2. During the past 4 weeks, how much have you been bothered by back pain?
□ Bothered a lot
□ Bothered a little
□ Not bothered at all

S3. During the past 4 weeks, how much have you been bothered by pain in your arms, legs, or jopints (knees, hips, etc.)?
□ Bothered a lot
□ Bothered a little
□ Not bothered at all

S1. During the past 4 weeks, how much have you been bothered by stomach pain?
□ Bothered a lot
□ Bothered a little
□ Not bothered at all

S2. During the past 4 weeks, how much have you been bothered by back pain?
□ Bothered a lot
□ Bothered a little
□ Not bothered at all

S3. During the past 4 weeks, how much have you been bothered by pain in your arms, legs, or jopints (knees, hips, etc.)?
□ Bothered a lot
□ Bothered a little
□ Not bothered at all

S1. During the past 4 weeks, how much have you been bothered by stomach pain?
□ Bothered a lot
□ Bothered a little
□ Not bothered at all

S2. During the past 4 weeks, how much have you been bothered by back pain?
□ Bothered a lot
□ Bothered a little
□ Not bothered at all

S3. During the past 4 weeks, how much have you been bothered by pain in your arms, legs, or jopints (knees, hips, etc.)?
□ Bothered a lot
□ Bothered a little
□ Not bothered at all

S1. During the past 4 weeks, how much have you been bothered by stomach pain?
□ Bothered a lot
□ Bothered a little
□ Not bothered at all

S2. During the past 4 weeks, how much have you been bothered by back pain?
□ Bothered a lot
□ Bothered a little
□ Not bothered at all

S3. During the past 4 weeks, how much have you been bothered by pain in your arms, legs, or jopints (knees, hips, etc.)?
□ Bothered a lot
□ Bothered a little
□ Not bothered at all

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