RAPID3 SURVEY

Physical abilities     Please make a selection for all questions.

Are you able to:

2 Get in and out of bed?

Physical abilities Please make a selection for all questions.

Are you able to:

Pain evaluation

No pain

Pain as bad as it could be

Personal evaluation

Very well

Very poorly

Score

                Score Description


1 to 3:

Near Remission

(NR)


4 to 6:

Low

Severity

(LS)


7 to 12:

Moderate

Severity

(MS)


13 to 30:

High

Severity

(HS)

The Appointment Checklist can help you identify your personal treatment goals for a more meaningful conversation with your rheumatologist.

Please Author following fields as per Analytics Tech Specs for the Form this fragment is embedded in

Form Name

Form Category

Form Sub-Category

Form Content-Type

Form MVA-Name

Form MVA-Type

Form MVA-Tier

Form MVA-Category

Form PII Field Names for Masking