CDEs
Forms
Fagerstrom Test First Hours Smoking Score
PROMIS Adult Short Form 6b Pain Interference v1.0 PAININ8 Past 7 Days How Much Did Pain Interfere with Ability to Concentrate Score 5 Point Scale
PROMIS Adult Short Form 8a Pain Interference v1.0 PAININ12 5 Past 7 Days How Much Did Pain Interfere with Things Usually Done for Fun Score 5 Point Scale
PROMIS Adult Short Form 8a Pain Interference v1.0 PAININ22 2 Past 7 Days How Much Did Pain Interfere with Work Around the Home Score 5 Point Scale
Smoking Current Use Indicator
PROMIS Adult Short Form 8a Pain Interference v1.0 PAININ3 7 Past 7 Days How Much Did Pain Interfere with Enjoyment of Life Score 5 Point Scale
PROMIS Adult Short Form 8a Pain Interference v1.0 PAININ36 6 Past 7 Days How Much Did Pain Interfere with Enjoyment of Social Activities Score 5 Point Scale
Patient Alcohol Consumption Related Injury Indicator
Person Hispanic or Latino Ethnicity Coded Indicator
PROMIS Adult Short Form 8a Pain Interference v1.0 PAININ13 8 Past 7 Days How Much Did Pain Interfere with Family Life Score 5 Point Scale
PROMIS Adult Short Form 8a Pain Interference v1.0 PAININ9 1 Past 7 Days How Much Did Pain Interfere with Day to Day Activity Score 5 Point Scale
Patient Alcohol Consumption Behavior Concern Recommendation Indicator
PROMIS Adult Short Form 8a Pain Interference v1.0 PAININ34 4 Past 7 Days How Much Did Pain Interfere with Household Chores Score 5 Point Scale
Current Employment Status
Patient Health Questionnaire (PHQ-9) Last Two Weeks How Often Difficulty Concentrating Reading Newspaper or Watching Television Score 4 Point Scale
Substance Abuse Illicit Substance Intravenous Route of Administration Personal Medical History Frequency
PROMIS Parent Proxy Short Form 8 Pain Interference v1.0 Pf2pain7 Past 7 Days Child Felt Angry When in Pain Score 5 Point Scale
PROMIS Adult Short Form 8a Pain Interference v1.0 PAININ31 3 Past 7 Days How Much Did Pain Interfere with Ability to Participate in Social Activities Score 5 Point Scale
Patient Health Questionnaire (PHQ-9) Last Two Weeks How Often Moving or Speaking So Slowly that Other People Could Have Noticed or Opposite So Fidgety or Restless that You Have Been Moving Around More Score 4 Point Scale
Person Current Quality of Life Assessment Score
1
2
3
4
5
6