| 75699-9 | During the past 2Ws, what was the hardest physical activity you could do for at least 2 minutes:Score:2W:^Patient:Ord:COOP.WONCA | |
| 75700-5 | During the past 2Ws, how much have you been bothered by emotional problems such as feeling anxious, depressed, irritable or downhearted and blue:Score:2W:^Patient:Ord:COOP.WONCA | |
| 75701-3 | During the past 2Ws, how much difficulty have you had doing your usual activities or tasks, both inside and outside the house because of your physical and emotional health:Score:2W:^Patient:Ord:COOP.WONCA | |
| 75702-1 | During the past 2Ws, has your physical and emotional health limited your social activities with family, friends, neighbors or groups:Score:2W:^Patient:Ord:COOP.WONCA | |
| 75703-9 | During the past 2Ws, how much bodily pain have you generally had:Score:2W:^Patient:Ord:COOP.WONCA | |
| 75704-7 | How would you rate your overall health now compared to 2Ws ago:Score:Pt:^Patient:Ord:COOP.WONCA | |
| 75705-4 | During the past 2Ws, how would you rate your health in general:Score:2W:^Patient:Ord:COOP.WONCA | |
| 75706-2 | During the past 2Ws, was someone available to help you if you needed and wanted help:Score:2W:^Patient:Ord:COOP.WONCA | |
| 75707-0 | How have things been going for you during the past 2Ws:Score:2W:^Patient:Ord:COOP.WONCA | |
| 75698-1 | Total score:Score:Pt:^Patient:Qn:COOP.WONCA | |
| 75742-7 | Dartmouth COOP Functional Assessment Charts - 2 weeks:-:Pt:^Patient:-: | |