| 75809-4 | During the past 4Ws, what was the hardest physical activity you could do for at least 2 minutes:Score:4W:^Patient:Ord:COOP | |
| 75808-6 | During the past 4Ws, how much have you been bothered by emotional problems such as feeling anxious, depressed, irritable or downhearted and blue:Score:4W:^Patient:Ord:COOP | |
| 75807-8 | During the past 4Ws, 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:4W:^Patient:Ord:COOP | |
| 75806-0 | During the past 4Ws, has your physical and emotional health limited your social activities with family, friends, neighbors or groups:Score:4W:^Patient:Ord:COOP | |
| 75805-2 | During the past 4Ws, how much bodily pain have you generally had:Score:4W:^Patient:Ord:COOP | |
| 75804-5 | How would you rate your overall health now compared to 4Ws ago:Score:Pt:^Patient:Ord:COOP | |
| 75803-7 | During the past 4Ws, how would you rate your health in general:Score:4W:^Patient:Ord:COOP | |
| 75802-9 | During the past 4Ws, was someone available to help you if you needed and wanted help:Score:4W:^Patient:Ord:COOP | |
| 75801-1 | How have things been going for you during the past 4Ws:Score:4W:^Patient:Ord:COOP | |
| 75810-2 | Total score:Score:Pt:^Patient:Qn:COOP | |
| 75743-5 | Dartmouth COOP Functional Assessment Charts - 4 weeks:-:Pt:^Patient:-: | |