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IMH Chronic Disease Links
 
  Chronic Illness Follow-up
All Systems (General follow-up)
Blood Tests
Satisfaction Survey (Exit survey)
Satisfaction Survey (Prior visit)
Symptoms Follow-up Comprehensive
Cardiovascular
Aberdeen Varicose Veins Scale
Angina
Anticoagulant (Coumadin) Management
Atherosclerosis (Heart / blood vessels)
Barsky Palpitations Screening Instrument
Congestive Heart Failure
Dyslipidemia
Heart Disease
Hvidovre Heart Failure Scale
Hypertension Follow-up
Varicose Veins
Eye
Glaucoma
Gastrointestinal
Aberdeen Dyspepsia Questionnaire
Bowel Problems Impact Scale
Constipation Scoring System
Defecatory Dysfunction Scale
Fecal Incontinence Bother Scale
Gastroesophageal Reflux (GERD)
Hemorrhoids Bother Scale
Genitourinary
Gynecology
Osteoporosis
Painful Periods Disability Assessment Scale
Pelvic Pain Disability Assessment Scale
Benign Prostatic Hypertrophy (AUA scale)
Chronic Renal Failure
Dysparunia Scale
Herniation Problems Impact Scale
Incontinence Impact Questionnaire - Long Form
Incontinence Impact Questionnaire - Short Form
Kidney Disease
Kidney Stones
Overactive Bladder - Validated 8-Question Screener
Pelvic Pain Disability Scale
Urethral Discharge
Infections
HIV or AIDS
Lyme Disease
Metabolic / Endocrine
Diabetes
Gout
Problem Areas in Diabetes (PAID)
Musculoskeletal
Back Pain
Back Pain Follow-up (General)
Lower Back Pain
Middle Back Pain
Neck Disability Index
Oswestry Low Back Pain Disability Questionnaire
Upper Back Pain
Joint Pain Syndromes
Joint Pain Follow-up
Osteoarthritis
Rheumatoid Arthritis
Gout
Osteoporosis
Repetitive Stress Syndromes
Carpal Tunnel Syndrome
Neurological Symptoms
Dementias
Activities of Daily Living (Complete)
Fatigue
Brief Fatigue Inventory (BFI)
Fatigue or Lethargy
Iowa Fatigue Scale (IFS)
Headache
Cluster Headache
Migraine Disability Assessment Scale (MIDAS)
Migraine Headache
Migraine Headache Rapid Assessment Tool
Migraine Treatment Optimization Questionnaire (MTOQ) - 5
Tension Headache
Other Neurological Symptoms
Adult ADHD Self-Report Scale (ASRS)
Brief Fatigue Inventory (BFI)
Chronic Fatigue
Dizziness Handicap Inventory (DHI)
Hospital Anxiety Depression Scale (HADS)
Mood Disorder Questionnaire for Bipolar Disorder (MDQ)
Patient Health Questionnaire (PHQ-9)
Pain
Headache
Cluster Headache
Migraine Disability Assessment Scale (MIDAS)
Migraine Headache
Migraine Headache Rapid Assessment Tool
Migraine Treatment Optimization Questionnaire (MTOQ) - 5
Tension Headache
Back Pain
Lower Back Pain
Middle Back Pain
Neck Disability Index
Oswestry Low Back Pain Disability Questionnaire
Upper Back Pain
American Pain Society Guidelines for the Treatment of Pain
Mankowski Pain Scale
Migraine Disability Assessment Scale (MIDAS)
Narcotics Addiction
Pain Disability Assessment Scale
Painful Periods Disability Assessment Scale
Patient Comfort Assessment Guide for Pain Management
Pelvic Pain Disability Assessment Scale
Psychiatric
Anxiety/ Depression
Carroll Depression
Center for Epidemiologic Studies Depression Scale (CES-D)
Geriatric Depression Scale (GDS)
Hamilton Anxiety Rating Scale
Hospital Anxiety Depression Scale (HADS)
Montgomery / Asberg Depression Rating Scale (MADRS)
Patient Health Questionnaire (PHQ-9)
Single Question Depression Screen
Two Question Depression Screen
Zung Anxiety
Zung Depression
Adult ADHD Self-Report Scale (ASRS)
Brief Fatigue Inventory (BFI)
Burden (of caregiving) Interview (BI)
Hospital Anxiety Depression Scale (HADS)
Iowa Fatigue Scale (IFS)
Mood Disorder Questionnaire for Bipolar Disorder (MDQ)
Narcotics Addiction
Patient Health Questionnaire (PHQ-9)
Respiratory
Asthma - Follow up Visit (Suburban Pediatrics)
Asthma / Chronic Follow-up
Asthma Control Test (ACT)
COPD (Emphysema) Symptoms
Medical Research Council Dyspnea Scale (MRC)
Sleep Apnea / Hyponea Syndrome (SAHS)
Other Interviews
Pre-procedure Interviews
Beta Blocker Pre-Op Assessment Tool
Biopsy, Liver
Biopsy, Prostate
Biopsy, Skin
Endoscopy Work up
Excision Lesion
Pre-anesthestic Medical Exam
Pre-operative Exam
Wells Score for Deep Venous Thrombosis
Satisfaction Studies
General Practice Assessment Questionnaire
Satisfaction Survey (Exit survey)
Satisfaction Survey (Prior visit)
Anticoagulant (Coumadin) Management
Appointment Request
Blood Tests
Burden (of caregiving) Interview (BI)
Demographics Check
Locus of Control for Medical Issues
Medicolegal Issues
Prompt for Medication Refill
Referral to Another Provider
Spirituality History
Past, Family, Social History
Allergy History
Animals
Foods / Tobacco
General - Long
General - Short
Habitat / Environment
Home Allergies
Inhaled Chemicals or Cosmetics
Latex
Medications
Plants
Medication History
Current Medications
Medication History
Over the Counter Medications
Prescription Medications
Prompt for Medication Refill
Family History
Pediatric Past Medical History (under 9)
Personal / Family History
Social History
Surgical History
Travel Medicine
Periodic, Prevention, Wellness Screening
Functional Status Inventories
Activities of Daily Living (Complete)
Asthma Control Test (ACT)
Asthma Control Test (ACT) - Under 12
Barthel Index
Burden (of caregiving) Interview (BI)
Disability
Dizziness Handicap Inventory (DHI)
Functional Status Health
Incontinence Impact Questionnaire (IIQ) - Long Form
Instrumental Activities of Daily Living
Iowa Fatigue Scale (IFS)
Patient Health Questionnaire (PHQ-9)
Propensity to Seek Health Care
Psychiatric Impairment Scale
Toomey Functional Impairment Scale
Nutrition
Nutrition (General)
Nutrition Initiative Checklist Modified
Rate Your Plate