Pain and daily activities questionnaire
[DOC File]PATIENT INFORMATION QUESTIONNAIRE
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It is the policy of Rex Pain Management Center and Carolina Pain Consultants to file claims to your insurance plan and / or Workman’s Compensation carrier. If you are not covered by an insurance plan or Workman’s Compensation you are expected to pay in full.
CHILDHOOD HEALTH ASSESSMENT QUESTIONNAIRE
In this section we are interested in learning how your child's pain affects his/her ability to function in daily life. Please feel free to add any comments on the back of this page. In the following questions, please tick the one response which best describes your child's usual activities OVER THE PAST WEEK.
[DOCX File]Physical Functioning and Activities of Daily Living
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Physical Functioning and Activities of Daily Living [Study Name/ID pre-filled]Site Name: ... Questionnaire for Candidates for Inactive Control Participants. ... Do you have pain/injury that would prohibit exercise on a stationary cycle? yes / no _____ Select the activity code that best describes your level of daily …
[DOC File]Work Productivity and Activity Impairment Questionnaire:
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Work Productivity and Activity Impairment Questionnaire: Pain Associated with Fibromyalgia. V2.0 (WPAI: Pain Associated with Fibromyalgia) ... how much did your pain associated with Fibromyalgia affect your ability to do your regular daily activities, other than work at a job? By regular activities, we mean the usual activities you do, such as ...
[DOC File]Oswestry Pain Questionnaire - Good Medicine
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Title: Oswestry Pain Questionnaire Subject: Low Back Pain Disability Author: James Hawkins Last modified by: james hawkins Created Date: 10/9/2001 6:44:00 PM
THE SF-36 QUESTIONNAIRE: A TOOL TO ASSESS HEALTH …
Regarding the construct validity of the SF-36 questionnaire, Ware (2001:1-2) points out that a factor analysis of data from the medical outcomes study (MOS) on the general population of the United States of America, which used the SF-36 questionnaire, confirmed that physical and mental health factors, as measured by the eight dimensions of the ...
[DOC File]Appendix. Survey Questionnaire Administered to Take-a ...
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( 10 = Extremely uncomfortable Lower back pain or discomfort [Use scale above] Upper back, neck and shoulder pain [Use scale above] Office Behavior What proportion of the time do you conduct your work within the Health Promotion Department HPD using the following methods Informal face to face conversations _____% Moving breaks _____%
[DOC File]OUTCOME MEASURES TOOL KIT - VA
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The ODQ is a 10-item questionnaire assessing pain and pain-related limitations in daily activities (Fairbank, Couper, Davies, & O'Brien, 1980). Testee’s choose 1 of 6 response options for each item, and scores are summed across items.
[DOC File]Work Productivity and Activity Impairment Questionnaire ...
https://info.5y1.org/pain-and-daily-activities-questionnaire_1_40d7ba.html
The following questions ask about the effect of your pain associated with fibromyalgia on your ability to work and perform normal daily activities. Please fill in the blanks or circle a number, as indicated.
[DOC File]PAIN QUESTIONNAIRE
https://info.5y1.org/pain-and-daily-activities-questionnaire_1_452ab6.html
PAIN QUESTIONNAIRE. When did your pain begin?_____ Is your pain related to an injury? Yes No. Please describe how it began:_____ ... Have you resumed your normal daily activities? Yes No. Are you disabled from your usual employment? Yes No Type of work_____ If so, what is the date you were last able to work?_____ ...
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