CDEs
Forms
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
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