Symptoms

Patient reported symptoms are factors that can decisively affect patient well-being and patient recovery. The symptoms are reported by the patient during the Patient Well-Being Assessment or updated regularly through well-being status.

Pain or Discomfort

General

Muscles cramps or spasms (painful)
Tenderness to touch
Swelling
Bruising or discoloration
Stiffness or decreased movement
Body aches
Itching or burning

Head area

Sore throat
Headache
Enlarged or swollen glands
Ear ache
Mouth, teeth or gums

Stomach Area

stomach ache
Menstrual cramps
Bloating or fullness
Pressure or fullness
Gas

Chest Area

Chest Pain
Feeling heart pound or race
Heart palpitations
Indigestion
Heart burn
Shortness of breath
Lung congestion

Other

Joints
Back
Arms or legs
Muscles other
Other

Sleep & Fatigue

Night sweats
Trouble sleeping
Sleepy all the time
Unusual Fatigue

Visual Symptoms

Skin ulcer
Skin rash
Lump or bulge
Bleeding or wound
Drainage or pus
Vaginal discharge
Visible deformity

Cold and Flu-like

Fever
Head ache
Aches and pains
Fatigue and weakness
Extreme exhaustion
Stuffy nose
Sneezing
High temperature or fever (warm to touch)
Cough - productive
Cough - dry
Congested lungs

Abnormal Activities

Numbness or tingling
Dizziness
Cough
Fainting spells
Nausea or vomiting
Nasal Congestion
Abnormal bowel movements (Change in bowel habits, Diarrhea, constipation, loose bowels)
Abnormal urination (frequent urge to urinate, cloudy urine with strong order, pain during urination, frequent bladder infections)
Weight - unusual weigh gain or loss
Hair loss - unexpected

Mental Health

General/Other

Functional Limitations

Hearing

Difficulty Hearing in some environments
Absence of useful hearing

Walking

Some difficulty without devices
Some difficulty with devices
Requires wheel chair or devices

Sleeping

Trouble falling asleep
Trouble staying asleep

Understanding (by care giver)

Misses part of message
Limited understanding
Unable to understand

Communication (by care giver)

Some Difficulty expressing needs and ideas
Frequent difficulty expressing needs and ideas
Very difficult to understand

Vision

Large objects and print only
Object identification questionable

Standing

Need device assistance
Unable with device assistance

Grip

Limited
Absent

Breathing

Severe shortness of breath at rest
Mild shortness of breath at rest
Shortness of breath with minimal exertion
Shortness of breath with moderate exertion
SOB when climbing stairs
Uses ventilator

Mobility Endurance

Walk or wheel chair 50 feet
Can't do it
Only with rest

Sitting Endurance

Tolerate sitting for 15 minutes
Can't do it
Only with support

Primary Mobility Mode

Cane/crutch
Walker
Orthotics/prosthetics
Wheelchair/scooter full time
Wheelchair/scooter part time
No movement from bed

Activities of Daily Living - Limitation

Bathing and showering
Shower/bathe requires transfer
Wash face, hands, chest, arms
Dressing (Upper body, Lower body, put on/take off socks and shoes)
Self-feeding (not including chewing or swallowing)
Movement from one place to another to perform activities
Personal hygiene and grooming
Toilet hygiene
Toilet transfer - safely on an off

Mobility

Lying to sitting on side of bed
Sit to stand
Chair/Bed to wheelchair
Sit to lying flat on bed
Roll left and right
Bend and pick up objects

Transportation Mobility

Unable to car transfer
Wheel chair lift only

Instrumental Activities of Daily Living (IADLS)- Limitation

Telephone (Answer phone, place calls
Take medications as prescribed (oral, inhalants/mists, injectable)
Make light meal
Wipe down surface
Light shopping
Laundry
Use public transportation
Mange money and pay bills
Use computer
Use a smart phone

Instrumental Activities of Daily Living (IADLS)- Other

Care of others (Family members)
Care of pets
Child rearing
Maintain social relationships
Community Mobility
Maintain Financial Management
Maintain Health Management
Maintain Home Management
Meal preparation and cleanup
Maintain Religious Observances
Maintain safety procedures and emergency responses
Shopping