CPRN CDM
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FormNew FormTherapyParent ElementData SourceRangeAttributeTypeChoicesNotes / RelationshipsCollected Multiple Times? (Yes/No)Scope
(Patient-Level, Encounter-Level, Individual Observation Level)
Transform
(Min, Max, Median, Average, First, Most Recent, etc.
)
*Applies when Scope is not at the Individual Observation Leve
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Time in Continuum of Care?
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Patient DemographicsDemographicsPatient nameLast NameFree TextFree TextNoPatient-LevelIntake
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Patient DemographicsFirst NameFree TextFree TextNoPatient-LevelIntake
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Patient DemographicsDemographicsPatient Date of BirthDateDatetimeDatetimeNoPatient-LevelIntake
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Patient ConsentPatient ConsentDemographicsGUIDGUIDFree TextFree TextNoPatient-Level
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Patient ConsentPatient ConsentDemographicsEmail AddressEmail AddressFree TextFree TextTypical Email FormatYesPatient-LevelMost RecentConsent
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Patient ConsentPatient ConsentDemographicsConsent Information RecordedConsent InformationMultichoiceConsent to share | Consent to be contacted for future research | Consent for patient-reported outcomes | Consent for patient-reported registryNoPatient-LevelConsent
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Patient DemographicsBirth HistoryDemographicsBirth WeightBirth WeightrealrealRange 0 - 12, unit = kgNoPatient-LevelInitial Visit
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Patient DemographicsBirth HistoryDemographicsBirth Height/LengthBirth Height/LengthrealrealRange 0-275, unit = cmNoPatient-LevelInitial Visit
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Patient DemographicsBirth HistoryDemographicsGestational ageGestational AgeintegerintegerRange 0-60, unit = weeksNoPatient-LevelInitial Visit
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Patient DemographicsDemographicsPatient GenderPatient GenderSingle ChoiceFemale | Male | Unknown | Not Specified | Not ReportedNoPatient-LevelIntake
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Patient DemographicsDemographicsPatient ethnicityPatient EthnicitySingle ChoiceHispanic or Latino | Not Hispanic or Latino | Unknown | Not Reported NoPatient-LevelIntake
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Patient DemographicsDemographicsPatient RacePatient RaceMultichoiceAmerican Indian or Alaska Native | Asian | Black or African American | Native Hawaiian or Other Pacific Islander | White | Unknown | Not ReportedNoPatient-LevelIntake
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Patient DemographicsBirth HistoryDemographicsBirth history/problems during pregnancyMaternal Substance UseMultichoiceSubstance Use | Prescription Drug Use | Tobacco Use | OtherNoPatient-LevelInitial Visit
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Birth HistoryBirth ComplicationsMultichoicePreterm Labor | Placental Abruption | Oligohydramnios | Fetal Anomalies | IUGRInitial Visit
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Patient DemographicsBirth HistoryDemographicsMaternal HistoryMultiple GestationYes/NoYes | NoNoPatient-LevelInitial Visit
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Patient DemographicsBirth HistoryRoute of DeliverySingle ChoiceC-section | Vaginal birthNoPatient-LevelInitial Visit
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Patient DemographicsBirth HistoryAnesthesiaYes/NoYes | NoNoPatient-LevelInitial Visit
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Patient DemographicsMedical HistoryDemographicsChild HistoryAdmitted to Neonatal ICUYes/NoYes | NoNoPatient-LevelInitial Visit
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Patient DemographicsBirth HistoryDemographicsApgar TestApgar TestMultichoice1 Minute | 5 Minute | 10 Minute | Not PerformedNoPatient-LevelInitial Visit
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Birth HistoryApgar ScoreSingle ChoiceintegerRange 0-10 ; Can have multiple test valuesYes
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Patient DemographicsVitalSignsDemographicsPatient WeightPatient Weightrealrealrange 0-700, unit = kgYesIndividual Observation LevelEvery Visit
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Patient DemographicsVitalSignsDemographicsPatient LengthPatient Lengthrealrealrange 0-275, unit = cmYesIndividual Observation LevelEvery Visit
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Patient DemographicsVitalSignsDemographicsPatient BMIPatient BMIrealrealCalculated FieldYesIndividual Observation LevelEvery Visit
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Patient DemographicsVitalSignsDemographicsWaist CircumferenceWaist CircumferencerealrealRange 0-?YesIndividual Observation LevelEvery Visit
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Patient Reported Medical HistoryPatient Reported Outcome Originally From PT/OTPhysical Therapy within the Last Four MonthsPatient Reported Medical HistoryPhysical Therapy within the Last Four MonthsMultichoiceSchool-Based | Outpatient Center or Clinic-Based | Home| Inpatient | No Physical Therapy in Last MonthYesEncounter-LevelAnnual Clinic, Pre-Op Clinic, Post Op Clinic
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Patient Reported Medical HistorySettingMultichoiceGroup | Individual*Present this Attribute if Physical Therapy in Last Four Months in ('School-Based','Outpatient Center or Clinic-Based')YesEncounter-LevelAnnual Clinic, Pre-Op Clinic, Post Op Clinic
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Patient Reported Medical HistoryFrequencySingle ChoiceSet 1) 1/wk | 2/month | 1/month | less than 1/month | Don't know
Set 2) 4-5/wk | 2-3/wk | 1/wk | 2/month | 1/month | Less than 1/month | Yearly | Don't know
*Present this attribute if Physical Therapy within the Last Four Months in ('School-Based','Outpatient Center or Clinic-Based','Home'), and present for each setting selected
*If Physical Therapy within the Last Four Months in ('School-Based') then present choices from Set 1
*If Physical Therapy within the Last Four Months in ('Outpatient Center or Clinic-Based','Home') then present choices from Set 2
YesEncounter-LevelAnnual Clinic, Pre-Op Clinic, Post Op Clinic
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Patient Reported Medical HistoryMinutes per SessionSingle ChoiceSet 1) 0-30 | 30-60 | 60-90 | Don't know
Set 2) 0-30 | 30-60 | 60-90 | 90-120 | 120-160 | 160-180| Don't Know
*Present this attribute if Physical Therapy within the Last Four Months in ('School-Based','Outpatient Center or Clinic-Based','Home'), and present for each setting selected
*If Physical Therapy within the Last Four Months in ('School-Based','Home') then present choices from Set 1
*If Physical Therapy within the Last Four Months in ('Outpatient Center or Clinic-Based') then present choices from Set 2
YesEncounter-LevelAnnual Clinic, Pre-Op Clinic, Post Op Clinic
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Patient Reported Medical HistoryMinutes per DaySingle Choice0-30 | 30-60 | 60-90 | 90-120 | Don't know*Present this attribute if Physical Therapy within the Last Four Months in ('Inpatient')YesEncounter-LevelAnnual Clinic, Pre-Op Clinic, Post Op Clinic
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Patient Reported Medical HistoryPatient Reported Outcome Originally From PT/OTOccupational Therapy within the Last Four MonthsPatient Reported Medical HistoryOccupational Therapy within the Last Four MonthsMultichoiceSchool-Based | Outpatient Center or Clinic-Based | Home| Inpatient | No Occupational Therapy in Last Four MonthsYesEncounter-LevelAnnual Clinic, Pre-Op Clinic, Post Op Clinic
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Patient Reported Medical HistorySettingMultichoiceGroup | Individual*Present this Attribute if Occupational Therapy in Last Four Months in ('School-Based','Outpatient Center or Clinic-Based')YesEncounter-LevelAnnual Clinic, Pre-Op Clinic, Post Op Clinic
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Patient Reported Medical HistoryFrequencySingle ChoiceSet 1) 1/wk | 2/month | 1/month | Less than 1/month | Don't know
Set 2) 4-5/wk | 2-3/wk | 1/wk | 2/month | 1/month | Less than 1/month | Yearly | Don't know
*Present this attribute if Occupational Therapy within the Last Four Months in ('School-Based','Outpatient Center or Clinic-Based','Home'), and present for each setting selected
*If Occupational Therapy within the Last Four Months in ('School-Based') then present choices from Set 1
*If Occupational Therapy within the Last Four Months in ('Outpatient Center or Clinic-Based','Home') then present choices from Set 2
YesEncounter-LevelAnnual Clinic, Pre-Op Clinic, Post Op Clinic
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Patient Reported Medical HistoryMinutes per SessionSingle ChoiceSet 1) 0-30 | 30-60 | 60-90 | Don't know
Set 2) 0-30 | 30-60 | 60-90 | 90-120 | 120-160 | 160-180| Don't Know
*Present this attribute if Occupational Therapy within the Last Four Months in ('School-Based','Outpatient Center or Clinic-Based','Home'), and present for each setting selected
*If Occupational Therapy within the Last Four Months in ('School-Based','Home') then present choices from Set 1
*If Occupational Therapy within the Last Four Months in ('Outpatient Center or Clinic-Based') then present choices from Set 2
YesEncounter-LevelAnnual Clinic, Pre-Op Clinic, Post Op Clinic
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Patient Reported Medical HistoryMinutes per DaySingle Choice0-30 | 30-60 | 60-90 | 90-120 | Don't know*Present this attribute if Occupational Therapy within the Last Four Months in ('Inpatient')YesEncounter-LevelAnnual Clinic, Pre-Op Clinic, Post Op Clinic
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Patient Reported Medical HistoryPatient Reported Outcome Originally From PT/OTSpeech Therapy within the Last Four MonthsPatient Reported Medical HistorySpeech Therapy within the Last Four MonthsMultichoiceSchool-Based | Outpatient Center or Clinic-Based | Home| Inpatient | No Speech Therapy in Last Four MonthsYesEncounter-LevelAnnual Clinic, Pre-Op Clinic, Post Op Clinic
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Patient Reported Medical HistorySettingMultichoiceGroup | Individual*Present this Attribute if Speech Therapy in Last Four Months in ('School-Based','Outpatient Center or Clinic-Based')YesEncounter-LevelAnnual Clinic, Pre-Op Clinic, Post Op Clinic
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Patient Reported Medical HistoryFrequencySingle ChoiceSet 1) 1/wk | 2/month | 1/month | Less than 1/month | Don't know
Set 2) 4-5/wk | 2-3/wk | 1/wk | 2/month | 1/month | Less than 1/month | Yearly | Don't know
*Present this attribute if Speech Therapy within the Last Four Months in ('School-Based','Outpatient Center or Clinic-Based','Home'), and present for each setting selected
*If Speech Therapy within the Last Four Months in ('School-Based') then present choices from Set 1
*If Speech Therapy within the Last Four Months in ('Outpatient Center or Clinic-Based','Home') then present choices from Set 2
YesEncounter-LevelAnnual Clinic, Pre-Op Clinic, Post Op Clinic
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Patient Reported Medical HistoryMinutes per SessionSingle ChoiceSet 1) 0-30 | 30-60 | 60-90 | Don't know
Set 2) 0-30 | 30-60 | 60-90 | 90-120 | 120-160 | 160-180| Don't Know
*Present this attribute if Speech Therapy within the Last Four Months in ('School-Based','Outpatient Center or Clinic-Based','Home'), and present for each setting selected
*If Speech Therapy within the Last Four Months in ('School-Based','Home') then present choices from Set 1
*If Speech Therapy within the Last Four Months in ('Outpatient Center or Clinic-Based') then present choices from Set 2
YesEncounter-LevelAnnual Clinic, Pre-Op Clinic, Post Op Clinic
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Patient Reported Medical HistoryMinutes per DaySingle Choice0-30 | 30-60 | 60-90 | 90-120 | Don't know*Present this attribute if Speech Therapy within the Last Four Months in ('Inpatient'), and present for each setting selectedYesEncounter-LevelAnnual Clinic, Pre-Op Clinic, Post Op Clinic
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Patient Reported Medical HistoryPatient Reported Outcome Originally From PT/OTVision services within the Last Four MonthsPatient Reported OutcomeVision services in Last Four MonthsYes/NoYes | NoYesEncounter-LevelAnnual Clinic, Pre-Op Clinic, Post Op Clinic
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Patient Reported Medical HistoryFrequencySingle Choice4-5/wk | 2-3/wk | 1/wk | 2 month | 1 month | Less than 1/month | Yearly | Don't know*If Vision services in Last Four Months in ('Yes') then present this attributeYesEncounter-LevelAnnual Clinic, Pre-Op Clinic, Post Op Clinic
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Patient Reported Medical HistoryDelivered byMultichoiceDevelopmental Optometrist | Occupational Therapist | Other | Don't Know*If Vision services in Last Four Months in ('Yes') then present this attributeYesEncounter-LevelAnnual Clinic, Pre-Op Clinic, Post Op Clinic
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Patient Reported Medical HistoryPatient Reported Outcome Originally From PT/OTSerial CastingsPatient Reported Medical HistoryChild Participated in Serial Castings in Last 4 MonthsYes/NoYes | NoYesEncounter-LevelAnnual Clinic, Pre-Op Clinic, Post Op Clinic
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Serial Castings: ArmsMultichoiceLeft | Right*Present this attribute if Child Participated in Serial Castings in Last 4 Months in ('Yes')
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Serial Castings: LegsMultichoiceLeft | Right
*Present this attribute if Child Participated in Serial Castings in Last 4 Months in ('Yes')
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Patient Reported Medical HistorySerial Castings: Combined with BotoxSingle ChoiceYes | No*Present this attribute for each combination of arms/legs selected for serial castingsYesEncounter-LevelAnnual Clinic, Pre-Op Clinic, Post Op Clinic
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Patient Reported Medical HistoryPatient Reported Outcome Originally From PT/OTIntensive Therapy ProgramPatient Reported Medical HistoryChild Participated in Intensive Therapy Program (2 or more times per week over several weeks)Yes/NoYes | NoYesEncounter-LevelAnnual Clinic, Pre-Op Clinic, Post Op Clinic
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Patient Reported Medical HistoryIntensive Therapy TypeMultichoiceConstraint Induced / Forced Use | Treadmill Training | Strengthening | Other*Present this Attribute if Child Participated in Intensive Therapy Program (2 or more times per week over several weeks) in ('Yes')YesEncounter-LevelAnnual Clinic, Pre-Op Clinic, Post Op Clinic
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Patient Reported Medical HistoryIntensive Therapy - OtherFree TextFree Text*Present this Attribute if Intensive Therapy Type in ('Other')YesEncounter-LevelAnnual Clinic, Pre-Op Clinic, Post Op Clinic
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Patient Reported Medical HistoryPatient Reported Outcome Originally From PT/OTOrthopedic or Neurosurgery Since Last VisitPatient Reported Medical HistoryOrthopedic or Neurosurgery Since Last VisitYes/NoYes | NoYesEncounter-LevelAnnual Clinic
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Patient Reported Medical HistoryPhysical or Occupational Therapist Evaluated Child Before Surgery and Made Recommendations for Seating and Equipment that Would be Needed Post-SurgeryYes/NoYes | No*Present this Attribute if Orthopedic or Neurosurgery Since Last Visit in ('Yes')YesEncounter-LevelAnnual Clinic
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Patient Reported Medical HistoryChild Received an Increase in Physical and/or Occupational Therapy Services Since SurgeryYes/NoYes | No*Present this Attribute if Orthopedic or Neurosurgery Since Last Visit in ('Yes')YesEncounter-LevelAnnual Clinic
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Patient Reported Medical HistoryIncrease in Physical/Occupational TherapyMultichoicePhysical | Occupational*Present this Attribute if Child Received an Increase in Physical and/or Occupational Therapy Services Since Surgery in ('Yes')YesEncounter-LevelAnnual Clinic
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Patient Reported Medical HistoryLocationSingle ChoiceInpatient | Home | Outpatient Clinic | School*Present this Attribute when Increase in Physical/Occupational Therapy in ('Physical','Occupational')YesEncounter-LevelAnnual Clinic
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Patient Reported Medical HistoryChild Participated in Inpatient Rehabilitation Program After SurgerySingle ChoiceYes | No*Present this Attribute if Orthopedic or Neurosurgery Since Last Visit in ('Yes')YesEncounter-LevelPost Op Clinic
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Patient Reported Medical HistoryDays Child Was an Inpatient Following an Orthopedic or Neuro ProcedureSingle Choice7 Days or Less | 8-14 Days | 15-21 Days | Greater than 21 Days*Present this Attribute if Child Participated in Rehabilitation Program After Surgery in ('Yes')YesEncounter-LevelPost Op Clinic
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Patient Reported Medical HistoryPatient Reported Outcome Originally From PT/OTHow difficult is it for your child to perform upper body dressing?Patient Reported Medical HistoryDifficultyInteger0, Not Possible (Almost Impossible) |
1, Very Difficult |
2, Difficult |
3, Slightly Difficult |
4, Easy |
5, Very easy |
6, No Problem At All |
*Present only if GMFCS Level I-III & GOAL Complete *Using CP Child element "Putting On/Taking Off Upper Body Clothing"
*Range 0-6 (0=Not Possible (Almost Impossible), 1=Very Difficult, 2=Difficult, 3=Slightly Difficult, 4=Easy, 5=Very Easy, 6=No Problem At All
YesEncounter-LevelAnnual Clinic, Pre-Op Clinic, Post Op Clinic
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Patient Reported Medical HistoryPatient Reported Outcome Originally From PT/OTHow difficult is it for your child to perform lower body dressing?Patient Reported Medical HistoryDifficultyInteger0, Not Possible (Almost Impossible) |
1, Very Difficult |
2, Difficult |
3, Slightly Difficult |
4, Easy |
5, Very easy |
6, No Problem At All |
*Present only if GMFCS Level I-III & GOAL Complete *Using CP Child element "Putting On/Taking Off Lower Body Clothing"
*Range 0-6 (0=Not Possible (Almost Impossible), 1=Very Difficult, 2=Difficult, 3=Slightly Difficult, 4=Easy, 5=Very Easy, 6=No Problem At All
YesEncounter-LevelAnnual Clinic, Pre-Op Clinic, Post Op Clinic
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Patient Reported Medical HistoryPatient Reported Outcome Originally From PT/OTHow difficult is it for your child to perform grooming activities?Patient Reported Medical HistoryDifficultyInteger0, Not Possible (Almost Impossible) |
1, Very Difficult |
2, Difficult |
3, Slightly Difficult |
4, Easy |
5, Very easy |
6, No Problem At All |
*Present only if GMFCS Level I-III & GOAL Complete *Using CP Child element "Bathing/Washing"
*Range 0-6 (0=Not Possible (Almost Impossible), 1=Very Difficult, 2=Difficult, 3=Slightly Difficult, 4=Easy, 5=Very Easy, 6=No Problem At All
YesEncounter-LevelAnnual Clinic, Pre-Op Clinic, Post Op Clinic
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Patient Reported Medical HistoryPatient Reported Outcome Originally From PT/OTHow difficult is it for your child to perform feeding activities?Patient Reported Medical HistoryDifficultyInteger0, Not Possible (Almost Impossible) |
1, Very Difficult |
2, Difficult |
3, Slightly Difficult |
4, Easy |
5, Very easy |
6, No Problem At All |
*Present only if GMFCS Level I-III & GOAL Complete *Using CP Child element "Eating/Drinking or Being Fed"
*Range 0-6 (0=Not Possible (Almost Impossible), 1=Very Difficult, 2=Difficult, 3=Slightly Difficult, 4=Easy, 5=Very Easy, 6=No Problem At All
YesEncounter-LevelAnnual Clinic, Pre-Op Clinic, Post Op Clinic
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Patient Reported Medical HistoryPatient Reported Outcome Originally From PT/OTMobility EquipmentPatient Reported Medical HistoryType of Device(s) Child HasMultichoiceWalker (hand-held, no extra support for trunk or pelvis) | Gait-trainer/walker with extra supports for trunk or pelvis | Bilateral canes |Bilateral crutches | Unilateral canes | Unilateral crutches | Manual wheelchair | Power wheelchair | Stander | Adapted bike/toy car | Child Has No Mobile SupportsYesEncounter-LevelAnnual Clinic, Pre-Op Clinic, Post Op Clinic
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Patient Reported Medical HistoryChild UsesYes/NoYes | No*For each Type of Device(s) Child Has, present this attribute
(for example, if child has walker, does child use walker)
YesEncounter-LevelAnnual Clinic, Pre-Op Clinic, Post Op Clinic
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Patient Reported Medical HistoryLocation of useMultichoiceHome | School | Community | During therapy*For each device that child has and Child Uses in ('Yes') present this attributeYesEncounter-LevelAnnual Clinic, Pre-Op Clinic, Post Op Clinic
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Patient Reported Medical HistoryPercent of time useMultichoice100 | 75 | 50 | 25 or less*For each device that child has and Child Uses in ('Yes') present this attributeYesEncounter-LevelAnnual Clinic, Pre-Op Clinic, Post Op Clinic
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Patient Reported Medical HistoryPatient Reported Outcome Originally From PT/OTCommunication devicesPatient Reported Medical HistoryType of Device(s) Child HasMultichoiceNon-electronic communication device | Electronic communication device | No Communication DevicesYesEncounter-LevelAnnual Clinic
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Patient Reported Medical HistoryChild UsesYes/NoYes | No*For each Type of Device(s) Child Has, present this attributeYesEncounter-LevelAnnual Clinic
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Patient Reported Medical HistoryLocation of useMultichoiceHome | School | Community | During therapy*For each device that child has and Child Uses in ('Yes') present this attributeYesEncounter-LevelAnnual Clinic
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Patient Reported Medical HistoryPercent of time useMultichoice100 | 75 | 50 | 25 or less*For each device that child has and Child Uses in ('Yes') present this attributeYesEncounter-LevelAnnual Clinic
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Patient Reported Medical HistoryPatient Reported Outcome Originally From PT/OTAids/ Other Assistive EquipmentPatient Reported Medical HistoryType of Aid(s) Child HasMultichoiceFeeding | Bathing | Toileting | Dressing | Vision Intervention | Written Communication/Materials manipulation | Hoyer lift/other lift system | No Aids UsedYesEncounter-LevelAnnual Clinic
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Patient Reported Medical HistoryChild UsesYes/NoYes | No*For Each type of Aid child has, present this attributeYesEncounter-LevelAnnual Clinic
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Patient Reported Medical HistoryLocation of useMultichoiceHome | School | Community | During therapy*For each type of AID that child has and Child Uses in (''Yes') present this attributeYesEncounter-LevelAnnual Clinic
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Patient Reported Medical HistoryPercent of time useSingle Choice100 | 75 | 50 | 25 or less*For each type of AID that child has and Child Uses in ('Yes') present this attributeYesEncounter-LevelAnnual Clinic
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Patient Reported Medical HistoryPatient Reported Outcome Originally From PT/OTThoraco-Lumbo-Sacral Orthosis (TLSO)Patient Reported Medical HistoryChild Has Thoraco-Lumbo-Sacral Orthosis (TLSO)Yes/NoYes | NoYesEncounter-LevelAnnual Clinic
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Patient Reported Medical HistoryChild UsesYes/NoYes | No*If Child Has Thoraco-Lumbo-Sacral Orthosis (TLSO) in ('Yes') then present this attributeYesEncounter-LevelAnnual Clinic
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Patient Reported Medical HistoryFrequencySingle ChoiceAll day and night | All night only | All day only | All day only | Day only when upright*If Child Uses in ('Yes) then present this attributeYesEncounter-LevelAnnual Clinic
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Patient Reported Medical HistoryTypeSingle ChoiceSoft | Hard*If Child Uses in ('Yes') then present this attributeYesEncounter-LevelAnnual Clinic
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Patient Reported Medical HistoryPatient Reported Outcome Originally From PT/OTAbduction wedgePatient Reported Medical HistoryChild Has Abduction WedgeYes/NoYes | NoYesEncounter-LevelAnnual Clinic
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Patient Reported Medical HistoryChild UsesYes/NoYes | No*If Child Has Abduction Wedge in ('Yes') then present this attributeYesEncounter-LevelAnnual Clinic
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Patient Reported Medical HistoryFrequencySingle choiceAll day and night | All night only | Only in chair*If Child Uses in ('Yes') then present this attributeYesEncounter-LevelAnnual Clinic
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Patient Reported Medical HistoryPatient Reported Outcome Originally From PT/OTOrthotic Device(s)Patient Reported Medical HistoryType of Orthotic Device(s) Child HasMultichoiceKnee | Ankle | Elbow | Wrist | Finger | Hip | Child Has No Orthotic DeviceYesEncounter-LevelAnnual Clinic
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Patient Reported Medical HistoryChild UsesYes/NoYes | No*For each Type of Orthotic Device Child has present this elementYesEncounter-LevelAnnual Clinic
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Patient Reported Medical HistoryTime of daySingle choiceDaytime | Nightime | Both*For each Type of Orthotic Device child has and child uses present this element
Note: "Hip" only has the option of "Nighttime"
YesEncounter-LevelAnnual Clinic
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Patient Reported Medical HistoryFrequencySingle choiceSet 1)Every day | 3-5 days/wk | 2-3 days/wk | 1 day/wk | Less than 1 day/wk
Set 2) At Least 6-8 Hrs Every Day | Less than 6 Hrs Every Day | 3-5 Days/wk | Less than 3 Days/wk
Set 3) All Night Every Night | A Few Hours Every Night | All Night, 3-5 Nights /wk | All Night, Less than 3 Nights /wk | A Few Hours Each Night, Less than 3 Nights /wl
Set 4) Occassionally | 1x/wk | 2-3x/wk | More than 3x/wk
*For each type of orthotic device child has and uses, present this attribute
*For Type of Orthotic Device in ('Knee') present choices from Set 1
*For Type of Orthotic Device in ('Ankle') and Time of Day in ('Daytime') present choices from Set 2
*For Type of Orthotic Device in ('Ankle') and Time of Day in ('Nighttime') present choices from Set 3
*For Type of Orthotic Device in ('Elbow','Wrist','Finger','Hip') present choices from Set 4
YesEncounter-LevelAnnual Clinic
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Patient Reported Medical HistoryPatient Reported Outcome Originally From PT/OTDoes child participate in activites that increase heart rate and makes them sweat?Patient Reported Medical HistoryDoes child participate in activites that increase heart rate and makes them sweat?Yes/NoYes | NoYesEncounter-LevelAnnual Clinic
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Patient Reported Medical HistoryFrequencySingle ChoiceOccasionally | 1/wk | 2-3/wk | More than 3/wk *If Does child participate in activites that increase heart rate and makes them sweat in ("Yes") then present this attributeYesEncounter-LevelAnnual Clinic
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Patient Reported Medical HistoryPatient Reported Outcome Originally From PT/OTDoes child participate in recreational strengthening activities?Patient Reported Medical HistoryDoes child participate in recreational strengthening activities?Yes/NoYes | NoYesEncounter-LevelAnnual Clinic
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Patient Reported Medical HistoryFrequencyOccasionally | 1/wk | 2-3/wk | More than 3/wk *If in Does child participate in recreational strengthening activities in ("Yes") then present this attributeYesEncounter-LevelAnnual Clinic
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Patient Reported Medical HistoryPatient Reported Outcome Originally From PT/OTIs child physically active with at least 60 minutes with increased heart rate?Patient Reported Medical HistoryIs child physically active with at least 60 minutes with increased heart rate?Yes/NoYes | NoYesEncounter-LevelAnnual Clinic
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Patient Reported Medical HistoryFrequencyOccasionally | 1/wk | 2-3/wk | More than 3/wk *If Activities in ('Yes') then present this attributeYesEncounter-LevelAnnual Clinic
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Patient Reported Medical HistoryPatient Reported Outcome Originally From PT/OTRecreational activities in which child participatesPatient Reported Medical HistoryGeneral Activities MultichoiceGroup sports | Individual sports | Recreational sports | Outdoor activities | Playground activities | Calisthenics/general exercise | Strengthening | Other | No Recreational ActivitiesYesEncounter-LevelAnnual Clinic
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Patient Reported Medical HistoryGeneral Activities - OtherFree TextFree Text*If General Activities in which child participates in ('Other') then present this attributeYesEncounter-LevelAnnual Clinic
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Patient Reported Medical HistorySpecific Activities MultichoiceDance | Martial arts | Swimming | Therapeutic horseback riding | Biking | Soccer | Baseball | Basketball | Yoga | Sled Hockey | Cheerleading | Boxing | Other*If General Activities NOT in ('No Recreational Activities') then present this attributeYesEncounter-LevelAnnual Clinic
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Patient Reported Medical HistorySpecific Activities - OtherFree TextFree Text*If Specific Activities in ('Other') then present this attributeYesEncounter-LevelAnnual Clinic
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Patient Reported Medical HistoryPatient Reported Outcome Originally From PT/OTOther Programs or Activities Due to Child's CPPatient Reported Medical HistoryOther Programs or Activities Due to Child's CPYes/NoYes | NoYesEncounter-LevelAnnual Clinic
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Patient Reported Medical HistoryList Other Programs or ActivitiesFree TextFree Text*If Other Programs or Activities Due to Child's CP in ('Yes') then present this attributeYesEncounter-LevelAnnual Clinic
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CP CHILDPatient Reported Outcome Originally From OrthopedicCP CHILDCP CHILD AssessedYes/NoYes | NoYesEncounter-LevelAnnual Clinic, Pre-Op, Post-Op
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CP CHILDPatient Reported OutcomeDate of CompletionDatetimeDatetime*Present this Attribute if CP CHILD Assessed in ('Yes')YesEncounter-LevelAnnual Clinic, Pre-Op, Post-Op
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CP CHILDPatient Reported OutcomeVersionSingle ChoiceParent | Child*Present this Attribute if CP CHILD Assessed in ('Yes')YesEncounter-LevelAnnual Clinic, Pre-Op, Post-Op
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