| 45392-8 | Patient First name | |
| 45393-6 | Middle initial | |
| 45394-4 | Patient Last name | |
| 66295-7 | Received AG PhenX | |
| 66296-5 | Last 4 digits of AG serial number PhenX | |
| 66297-3 | Why didnt receive AG PhenX | |
| 44100-6 | Medical problem | |
| 66299-9 | Other physical or medical problem PhenX | |
| 66300-5 | AG is connected to USB cable PhenX | |
| 66301-3 | AG set up for free-living PhenX | |
| 66302-1 | Participant ID | |
| 66303-9 | AG disconnected from USB cable PhenX | |
| 66304-7 | AG wear instructions PhenX | |
| 66305-4 | AG placed close to IC PhenX | |
| 66306-2 | QA distribution 7D activity diary PhenX | |
| 66307-0 | AG return procedure explained PhenX | |
| 66308-8 | QA distribution questions PhenX | |
| 66309-6 | AG distribution form PhenX | |
| 66310-4 | QA actigraph review form PhenX | |
| 66311-2 | Date AG returned PhenX | |
| 66312-0 | Returned AG PhenX | |
| 66313-8 | # D AG worn PhenX | |
| 66314-6 | # D AG worn valid PhenX | |
| 66315-3 | Activity collected/recorded on AG PhenX | |
| 66316-1 | Reason no record on AG PhenX | |
| 66317-9 | Othr reason no record on AG PhenX | |
| 66318-7 | Diary completed PhenX | |
| 66319-5 | AG properly connected to USB cable PhenX | |
| 66320-3 | QA return download button PhenX | |
| 66321-1 | Data saved properly PhenX | |
| 66322-9 | QA return review diary PhenX | |
| 66323-7 | QA return enter activity computer PhenX | |
| 66324-5 | # D AG was worn on PhenX | |
| 66325-2 | # valid D AG was worn PhenX | |
| 66326-0 | Diary completed on form PhenX | |
| 66310-4 | QA actigraph review form PhenX | |
| 46501-3 | Date assessment information completed:Date:RptPeriod:^Patient:Qn:CMS Assessment | |
| 66276-7 | Day name PhenX | |
| 61136-8 | Start time:TmStp:Pt:Study:Qn: | |
| 66327-8 | Took monitor off Clock time PhenX | |
| 66328-6 | Diary time off activity PhenX | |
| 66329-4 | Monitor put back on Clock time PhenX | |
| 66332-8 | Diary end time Clock time PhenX | |
| 61137-6 | End time:TmStp:Pt:Study:Qn: | |