Home
  • CDEs
  • Forms
  • In the past 7 days I got impatient with other people
  • In the past 7 days I was bothered by little things
  • In the past 7 days It was hard for my child to play sports or exercise because of asthma.
  • In the past 7 days, My child felt overwhelmed.
  • In the past 4 weeks, I have to work really hard to pay attention or I make mistakes
  • In the past 7 days I have had to work harder than usual to keep track of what I was doing
  • In the past 7 days, How many days were you strong enough to pour a drink from a full pitcher or carton?
  • <u>Over the past 7 days</u>, how short of breath did you get with each of these activities? Walking up 20 stairs (2 flights) without stopping
  • In the past 7 days It was hard for me to have fun
  • In general, how would you rate your mental health, including your mood and your ability to think?
  • In the past 7 days, I felt unable to manage things in my life.
  • In the past 7 days It was hard for my child to run when he/she had pain.
  • In the past 7 days My child felt lonely.
  • I feel better after smoking a cigarette.
  • Smoking stimulates me.
  • In the past 7 days, when I was in pain I asked for someone to help me.
  • CURRENT level of confidence I can list my medications, including the doses and schedule.
  • Are you able to open and close a zipper?
  • In the past 7 days, How many days was your child strong enough to carry heavy things with his/her hands?
  • In the past 7 days, How many days was your child strong enough to open a jar by himself/herself?
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16
  • 17
  • 18
  • 19
  • 20
  • 21
  • 22
  • 23
  • 24
  • 25
  • 26
  • 27
  • 28
  • 29
  • 30
  • 31

Copyright , Privacy , Accessibility

U.S. National Library of Medicine
8600 Rockville Pike, Bethesda, MD 20894
USA.gov logo National Library of Medicine logo
National Institutes of Health
Health & Human Services
Freedom of Information Act
NLM Customer Support