• Substance Abuse Prescription Illicit Substance Over the Counter Product Cessation Ability Personal Medical History Yes No Indicator
• PROMIS Pediatric Short Form 8a Pain Interference v1.0 2049R1 Past 7 Days Hard to Walk One Block When in Pain Score 5 Point Scale
• Fagerstrom Test for Nicotine Dependence Assessment Score
• Substance Abuse Prescription Illicit Substance Past Year Self-Administered Evaluation Method Personal Medical History Count
• Patient Alcohol Consumption Past Year Amnesia Episode Frequency
• Patient Health Questionnaire (PHQ-9) Last Two Weeks How Often Little Interest or Pleasure in Doing Things Score 4 Point Scale
• Alcoholic Beverage Consumption MoreThan Six At One Occasion Frequency
• PROMIS Parent Proxy Short Form 8 Pain Interference v1.0 Pf3pain4 Past 7 Days Child Had Trouble Having Fun When in Pain Score 5 Point Scale
• Substance Abuse Illicit Substance Marijuana Personal Medical History Frequency
• PROMIS Pediatric Short Form 8a Pain Interference v1.0 1703R1 Past 7 Days Hard to Have Fun When in Pain Score 5 Point Scale
• Substance Abuse Prescription Illicit Substance Over the Counter Product Guilt Regret Personal Medical History Yes No Indicator
• Substance Abuse Illicit Substance Stimulant Personal Medical History Frequency
• Substance Abuse Illicit Substance Cocaine Personal Medical History Frequency
• Timeline Followback Method Illicit Substance Sedative and Hypnotics Negation Benzodiazepines Assessment Yes No Indicator
• Substance Abuse Substance-Related Disorder Current Therapy Personal Medical History Yes No Indicator
• PROMIS Short Form 3a Pain Intensity v1.0 PAINQU8 Past 7 Days Intensity of Average Pain Score 5 Point Scale
• Substance Abuse Illicit Substance Sedative Personal Medical History Frequency
• Poor Physical Well-being Or Mental Health Limit Usual Activity Past 30 Day Count
• Substance Abuse Substance-Related Disorder Prior Therapy Personal Medical History Yes No Indicator
• Timeline Followback Method Illicit Substance Heroin Assessment Yes No Indicator