| 69520-5 | Lying flat - confidence:Find:Pt:^Patient:Ord:OPTIMAL | required |
| 69521-3 | Rolling over - confidence:Find:Pt:^Patient:Ord:OPTIMAL | required |
| 69522-1 | Moving - lying to sitting - confidence:Find:Pt:^Patient:Ord:OPTIMAL | required |
| 69523-9 | Sitting - confidence:Find:Pt:^Patient:Ord:OPTIMAL | required |
| 69524-7 | Squatting - confidence:Find:Pt:^Patient:Ord:OPTIMAL | required |
| 69525-4 | Bending - stooping - confidence:Find:Pt:^Patient:Ord:OPTIMAL | required |
| 69526-2 | Balancing - confidence:Find:Pt:^Patient:Ord:OPTIMAL | required |
| 69527-0 | Kneeling - confidence:Find:Pt:^Patient:Ord:OPTIMAL | required |
| 69528-8 | Walking - short distance - confidence:Find:Pt:^Patient:Ord:OPTIMAL | required |
| 69529-6 | Walking - long distance - confidence:Find:Pt:^Patient:Ord:OPTIMAL | required |
| 69530-4 | Walking - outdoors - confidence:Find:Pt:^Patient:Ord:OPTIMAL | required |
| 69531-2 | Climbing stairs - confidence:Find:Pt:^Patient:Ord:OPTIMAL | required |
| 69532-0 | Hopping - confidence:Find:Pt:^Patient:Ord:OPTIMAL | required |
| 69533-8 | Jumping - confidence:Find:Pt:^Patient:Ord:OPTIMAL | required |
| 69534-6 | Running - confidence:Find:Pt:^Patient:Ord:OPTIMAL | required |
| 69535-3 | Pushing - confidence:Find:Pt:^Patient:Ord:OPTIMAL | required |
| 69536-1 | Pulling - confidence:Find:Pt:^Patient:Ord:OPTIMAL | required |
| 69537-9 | Reaching - confidence:Find:Pt:^Patient:Ord:OPTIMAL | required |
| 69538-7 | Grasping - confidence:Find:Pt:^Patient:Ord:OPTIMAL | required |
| 69539-5 | Lifting - confidence:Find:Pt:^Patient:Ord:OPTIMAL | required |
| 69540-3 | Carrying - confidence:Find:Pt:^Patient:Ord:OPTIMAL | required |
| 69541-1 | Overall level of confidence with these activities today:Find:Pt:^Patient:Nom:OPTIMAL | required |
| 69654-2 | Total confidence score - follow-up:Score:Pt:^Patient:Qn:OPTIMAL | optional |