| 107107-5 | Mini nutritional assessment - short form 3 months Reported.MNA-SF |
| 107108-3 | Has food intake declined due to loss of appetite, digestive problems, chewing or swallowing difficulties 3 months (qualitative) |
| 107109-1 | Weight loss 3 months (qualitative) |
| 107111-7 | Has suffered psychological stress or acute disease 3 months (qualitative) |
| 64439-3 | Over the past 3 months, I have coughed (qualitative) |
| 64440-1 | Over the past 3 months, I have brought up phlegm - sputum (qualitative) |
| 64441-9 | Over the past 3 months, I have had shortness of breath (qualitative) |
| 64442-7 | Over the past 3 months, I have had attacks of wheezing (qualitative) |
| 64443-5 | During the past 3 months, how many severe or very unpleasant attacks of chest trouble have you had |
| 64445-0 | Over the past 3 months, in an average week, how many good days, with little chest trouble, have you had |
| 64779-2 | For the past 3 months or longer, have you had dry eyes, foreign body sensation with itching and burning, sandy feeling, not related to allergy |
| 65380-8 | On how many days in the last 3 months did you have a headache, if headache lasted more than 1 day, count each day |
| 65381-6 | Because of your headaches on how many days in the last 3 months did you miss work or school |
| 65382-4 | Because of your headaches on how many days in the last 3 months was your productivity at work or school reduced (half or more) |
| 65383-2 | Because of your headaches on how many days in the last 3 months did you not do household work |
| 65384-0 | Because of your headaches on how many days in the last 3 months was your productivity in house-hold work reduced (half or more) |
| 65385-7 | Because of your headaches on how many days in the last 3 months did you miss family, social, or leisure activities |
| 65525-8 | How many times per week on average over the past 3 months have you eaten an unusually large amount of food and experienced a loss of control |
| 65926-8 | How many times per week on average over the past 3 months have you made yourself vomit to prevent weight gain or counteract the effects of eating |
| 65927-6 | How many times per week on average over the past 3 months have you used laxatives or diuretics to prevent weight gain or counteract the effects of eating |
| 65928-4 | How many times per week on average over the past 3 months have you fasted - skipped at least 2 meals in a row - to prevent weight gain or counteract the effects of eating |
| 65929-2 | How many times per week on average over the past 3 months have you engaged in excessive exercise specifically to counteract the effects of overeating episodes |
| 65930-0 | Over the past 3 months, how many menstrual periods have you missed |
| 65931-8 | Have you been taking birth control pills during the past 3 months (qualitative) |
| 66229-6 | Have you had any surgery on your hands or wrists in the past 3 months (qualitative) |
| 66281-7 | Compared to your physical activity over the past 3 months, was last week's physical activity more, less, or about the same (qualitative) |
| 66388-0 | Has the child take cortisone, prednisone, other steroids, or anticancer drugs or had x-ray treatments in the past 3 months (qualitative) |
| 69692-2 | Has this been as often, on average, as twice a week for the last 3 months (qualitative) |
| 69693-0 | Made yourself vomit often in last 3 months in order to avoid gaining weight (qualitative) |
| 69694-8 | Took more than twice the recommended dose of laxatives often in last 3 months in order to avoid gaining weight (qualitative) |
| 69695-5 | Fasted - not eaten anything at all for at least 24 hours - often in last 3 months in order to avoid gaining weight (qualitative) |
| 69696-3 | Exercised for more than an hour specifically to avoid gaining weight after binge eating often in last 3 months in order to avoid gaining weight (qualitative) |
| 86647-5 | Sexual activity in the last 3 months - Reported (qualitative) |
| 91380-6 | Number of falls in the past 3 months - Reported |
| 93255-8 | Actual suicide attempt 3 months (qualitative) |
| 93256-6 | Actual suicide attempts # 3 months |
| 93258-2 | Has subject engaged in non-suicidal self-injurious behavior 3 months (qualitative) |
| 93261-6 | Interrupted suicide attempt 3 months (qualitative) |
| 93262-4 | Interrupted suicide attempts # 3 months |
| 93265-7 | Aborted or self-interrupted suicide attempt 3 months (qualitative) |
| 93266-5 | Aborted or self-interrupted suicide attempts # 3 months |
| 93269-9 | Preparatory acts or suicidal behavior 3 months (qualitative) |
| 93270-7 | Preparatory acts or suicidal behaviors # 3 months (qualitative) |
| 93486-9 | Has subject engaged in self-injurious behavior, intent unknown 3 months (qualitative) |
| 95389-3 | Have you used an illegal drug or a prescription medication for nonmedical reasons in the past 3 months Caregiver (qualitative) |
| 95390-1 | Four or more drinks in one day in the past 3 months Caregiver (qualitative) |
| 95391-9 | Has a partner threatened, shoved, hit or kicked you or hurt you physically in any way in the past 3 months Caregiver (qualitative) |
| 95392-7 | Have you and a partner fought a lot in the past 3 months Caregiver (qualitative) |
| 95430-5 | During the past 3 months, how often have you used cannabis (qualitative) |
| 95431-3 | During the past 3 months, how often have you used cocaine (qualitative) |
| 95432-1 | During the past 3 months, how often have you used prescription stimulants (qualitative) |
| 95433-9 | During the past 3 months, how often have you used methamphetamine (qualitative) |
| 95434-7 | During the past 3 months, how often have you used inhalants (qualitative) |
| 95435-4 | During the past 3 months, how often have you used sedatives or sleeping pills (qualitative) |
| 95436-2 | During the past 3 months, how often have you used hallucinogens (qualitative) |
| 95437-0 | During the past 3 months, how often have you used street opioids (qualitative) |
| 95438-8 | During the past 3 months, how often have you used prescription opioids (qualitative) |
| 95439-6 | During the past 3 months, how often have you used other substances (qualitative) |
| 95440-4 | During the past 3 months, how often have you had a strong desire or urge to use cannabis (qualitative) |
| 95441-2 | During the past 3 months, how often have you had a strong desire or urge to use cocaine (qualitative) |
| 95442-0 | During the past 3 months, how often have you had a strong desire or urge to use prescription stimulants (qualitative) |
| 95443-8 | During the past 3 months, how often have you had a strong desire or urge to use methamphetamine (qualitative) |
| 95444-6 | During the past 3 months, how often have you had a strong desire or urge to use inhalants (qualitative) |
| 95445-3 | During the past 3 months, how often have you had a strong desire or urge to use sedatives or sleeping pills (qualitative) |
| 95446-1 | During the past 3 months, how often have you had a strong desire or urge to use hallucinogens (qualitative) |
| 95447-9 | During the past 3 months, how often have you had a strong desire or urge to use street opioids (qualitative) |
| 95448-7 | During the past 3 months, how often have you had a strong desire or urge to use prescription opioids (qualitative) |
| 95449-5 | During the past 3 months, how often have you had a strong desire or urge to use other substances (qualitative) |
| 95450-3 | During the past 3 months, how often has your use of cannabis led to health, social, legal or financial problems (qualitative) |
| 95451-1 | During the past 3 months, how often has your use of cocaine led to health, social, legal or financial problems (qualitative) |
| 95452-9 | During the past 3 months, how often has your use of prescription stimulants led to health, social, legal or financial problems (qualitative) |
| 95453-7 | During the past 3 months, how often has your use of methamphetamine led to health, social, legal or financial problems (qualitative) |
| 95454-5 | During the past 3 months, how often has your use of inhalants led to health, social, legal or financial problems (qualitative) |
| 95455-2 | During the past 3 months, how often has your use of sedatives or sleeping pills led to health, social, legal or financial problems (qualitative) |
| 95456-0 | During the past 3 months, how often has your use of hallucinogens led to health, social, legal or financial problems (qualitative) |
| 95457-8 | During the past 3 months, how often has your use of street opioids led to health, social, legal or financial problems (qualitative) |
| 95458-6 | During the past 3 months, how often has your use of prescription opioids led to health, social, legal or financial problems (qualitative) |
| 95459-4 | During the past 3 months, how often has your use of other substances led to health, social, legal or financial problems (qualitative) |
| 95460-2 | During the past 3 months, how often have you failed to do what was normally expected of you because of your use of cannabis (qualitative) |
| 95461-0 | During the past 3 months, how often have you failed to do what was normally expected of you because of your use of cocaine (qualitative) |
| 95462-8 | During the past 3 months, how often have you failed to do what was normally expected of you because of your use of prescribed Amphetamine type stimulants (qualitative) |
| 95463-6 | During the past 3 months, how often have you failed to do what was normally expected of you because of your use of methamphetamine (qualitative) |
| 95464-4 | During the past 3 months, how often have you failed to do what was normally expected of you because of your use of inhalants (qualitative) |
| 95465-1 | During the past 3 months, how often have you failed to do what was normally expected of you because of your use of sedatives or sleeping pills (qualitative) |
| 95466-9 | During the past 3 months, how often have you failed to do what was normally expected of you because of your use of hallucinogens (qualitative) |
| 95467-7 | During the past 3 months, how often have you failed to do what was normally expected of you because of your use of street opioids (qualitative) |
| 95468-5 | During the past 3 months, how often have you failed to do what was normally expected of you because of your use of prescription opioids (qualitative) |
| 95469-3 | During the past 3 months, how often have you failed to do what was normally expected of you because of your use of other substances (qualitative) |
| 95495-8 | Other substances used during the past 3 months |
| 95496-6 | Other substances that you have had a strong desire or urge to use in the past 3 months |
| 95497-4 | Other substances that have led to health, social, legal or financial problems in the past 3 months |
| 95498-2 | Other substances that have caused you to fail to do what was normally expected of you in the past 3 months |
| 95500-5 | Substances you have had a strong desire or urge to use during the past 3 months |
| 95501-3 | Substances that have led to health, social, legal or financial problems during the past 3 months |
| 95502-1 | Substances that have caused you to fail to do what was normally expected of you during the past 3 months |
| 96845-3 | Tobacco, Alcohol, Prescription medications, and other Substance use assessment |
| 96846-1 | Smoked at least one cigarette containing tobacco in past 3 months (qualitative) |
| 96847-9 | Smoked more than 10 cigarettes per day in past 3 months (qualitative) |
| 96848-7 | Smoked cigarette within 30M after waking in past 3 months (qualitative) |
| 96849-5 | At least one drink in past 3 months (qualitative) |