CDEs
Forms
In the past 7 days, how often did you have very severe pain?
In the past 7 days, how often did you have pain so bad that you had to stop what you were doing?
In the past 7 days, how often did you have pain so bad that it was hard to finish what you were doing?
Have you ever had open sores on your legs or feet (leg ulcers)?
Has a doctor or nurse ever told you that you have lung damage?
Has a doctor or nurse ever told you that you have kidney damage?
Has a doctor or nurse ever told you that you have eye damage called retinopathy?
Has a doctor or nurse ever told you that you have damage to your hip or shoulder due to sickle cell disease?
Has a doctor or nurse ever told you that you have had a stroke?
Has your spleen either been removed or seriously damaged due to sickle cell disease?
Do you get regular blood transfusions for your sickle cell disease?
Do you take pain medicine every day for your sickle cell disease?
In the past 12 months, how many sickle cell pain attacks (crises) days did you have?
When was your last pain attack (crisis)?
Using any number from 0 to 10, where 0 is no pain and 10 is the worst pain imaginable, how severe was your pain during your last pain attack (crisis)?
How much did your last pain attack (crisis) interfere with your life?
About how long did your most recent pain attack (crisis) last?
In the past 7 days, how often did you stay up most of the night because you could not fall asleep?
In the past 7 days, how often was it very easy for you to fall asleep?
In the past 7 days, how often did you have a lot of trouble falling asleep?
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