PDF-The DASI Patient Questionnaire(to be completed by the patient)DUKE ACT

1 Take care of yourself that is eat dress bathe or use the toiletYesNo 2 Walk indoors such as around your houseYesNo 3 Walk a block or two on level groundYesNo 4 Climb a flight of stair. Care Patients. UCLA Fielding School of Public Health. Hector P. Rodriguez. Beth Glenn. Roshan Bastani. Dylan Roby. Ritesh Mistry. National Cancer Institute. Russ Glasgow. Suzanne . Heurtin. -Roberts. of the IBD-Control Questionnaire. :. . Results from a l. arge-scale . e. lectronic . p. atient . e. xperience . s. urvey . (IBD2020. ). Keith . Bodger. 1. , . Tamsin. . Gledhill. 1. , . Richard . Driscoll. August 29, 2017. About the Speakers. Paul Shorrosh. NAHAM Board Member and Industry Standards Committee Chair. Founder and CEO, AccuReg. Jase DuRard. Chief Revenue Officer, AccuReg. Agenda . What do CFOs need and want?. . REsults. for Uterine Fibroids. Evan R. Myers, MD, MPH. Department of Obstetrics & Gynecology and Duke Clinical Research Institute, Duke University, Durham, NC. evan.myers@duke.edu. ORGANIZATION. 1. Take care of yourself, that is, eat, dress, bathe or use the toilet?2.75Yes/No 2. Walk indoors, such as around your house?1.75Yes/No 3. Walk a block or two on level ground?2.75 Yes/No 4. Climb a fl The Duke Activity Status Index is a self - administered questionnaire that measures a patient's functional capacity. It can be used to get a rough estimate of a patient's peak oxygen uptake. Yes No When you call, you will be greeted by DASI and asked for caller validation. Dental ofces need to provide the dentist’s valid tax identication number (TIN). This validation is required b PATIENT SLEEP/WAKE QUESTIONNAIRE Today’s Date: _________________ _________ Date of Birth: _______________ Sex: M F Ht: __________ Wt: ____________ Occupation: ________ none Does your 18-25 BILLING ADDRESS EMAIL ADDRESSEMERGENCY CONTACTNAMEPHONE NUMBERRELATIONINSURANCE CARRIERBILLING ADDRESS IF DIFFERENT FROM ABOVESUBSCRIBERS NAME AND DOB HOW DID YOU HEAR ABOUT USFIRST AND LAST NA Patient Name: _________________________________________ Date: ___________________ Not at all Several days More than half the days Nearly every day 1. Over the last 2 weeks , how often have yo MRN: Patient Label) The following questions ask about your feelings There are no right or wrong answers. Please be sure None of 9. Made you feel anxious about the 10. Made you feel anxious about tr . Ron D. Hays, Ph.D.. October 21, 2014 (12:00 – 1:00). 44. th. Presentation of the UCLA Center for Maximizing . Outcomes and Research on Effectiveness (C-MORE). Live Webinar at: . https://uclahs.webex.com/. Activity/Function . Outcome Measures. Dr Ann Taylor. Prof Ernest Choy. http://www.paincommunitycentre.org/. http://. twitter.com/paincommunity. Background. People living with long term conditions can experience physical activity limitations or suffer from increase symptoms during activity. NOTIFICATION OF MASSIVE PROTOCOL. BLOOD TRANSFUSION SERVICE NOTIFICATION. Receive phone call from medical team member: Lab requires Patient name and Medical Record Number . BTS staff perform Patient History Search for completed testing .