{
    "section": "kct-cognitive-functional",
    "templateSet": "Promis 29",
    "templates": [
        {
            "text": "Physical Function",
            "template": "Promis-29Physical Function {children}",
            "children": [
                {
                    "text": "Do chores such as vacuuming\/yard work?",
                    "template": "Are you able to do chores such as vacuuming or yard work?",
                    "children": [
                        {
                            "text": "Without any difficulty (5)",
                            "template": "Without any difficulty (5)"
                        },
                        {
                            "text": "With a little difficulty (4)",
                            "template": "With a little difficulty (4)"
                        },
                        {
                            "text": "With some difficulty (3)",
                            "template": "With some difficulty (3)"
                        },
                        {
                            "text": "With much difficulty (2)",
                            "template": "With much difficulty (2)"
                        },
                        {
                            "text": "Unable to do (1)",
                            "template": "Unable to do (1)"
                        }
                    ]
                },
                {
                    "text": "Able to go up & down stairs at normal pace?",
                    "template": "Are you able to go up and down stairs at a normal pace?",
                    "children": [
                        {
                            "text": "Without any difficulty (5)",
                            "template": "Without any difficulty (5)"
                        },
                        {
                            "text": "With a little difficulty (4)",
                            "template": "With a little difficulty (4)"
                        },
                        {
                            "text": "With some difficulty (3)",
                            "template": "With some difficulty (3)"
                        },
                        {
                            "text": "With much difficulty (2)",
                            "template": "With much difficulty (2)"
                        },
                        {
                            "text": "Unable to do (1)",
                            "template": "Unable to do (1)"
                        }
                    ]
                },
                {
                    "text": "Able to go for a walk of at least 15 mins?",
                    "template": "Are you able to go for a walk of at least 15 minutes?",
                    "children": [
                        {
                            "text": "Without any difficulty (5)",
                            "template": "Without any difficulty (5)"
                        },
                        {
                            "text": "With a little difficulty (4)",
                            "template": "With a little difficulty (4)"
                        },
                        {
                            "text": "With some difficulty (3)",
                            "template": "With some difficulty (3)"
                        },
                        {
                            "text": "With much difficulty (2)",
                            "template": "With much difficulty (2)"
                        },
                        {
                            "text": "Unable to do (1)",
                            "template": "Unable to do (1)"
                        }
                    ]
                },
                {
                    "text": "Are you able to run errands and shop?",
                    "template": "Are you able to run errands and shop?",
                    "children": [
                        {
                            "text": "Without any difficulty (5)",
                            "template": "Without any difficulty (5)"
                        },
                        {
                            "text": "With a little difficulty (4)",
                            "template": "With a little difficulty (4)"
                        },
                        {
                            "text": "With some difficulty (3)",
                            "template": "With some difficulty (3)"
                        },
                        {
                            "text": "With much difficulty (2)",
                            "template": "With much difficulty (2)"
                        },
                        {
                            "text": "Unable to do (1)",
                            "template": "Unable to do (1)"
                        }
                    ]
                }
            ]
        },
        {
            "text": "Anxiety (In the past 7 days)",
            "template": "AnxietyIn the past 7 days\u2026{children}",
            "children": [
                {
                    "text": "I felt fearful",
                    "template": "I felt fearful",
                    "children": [
                        {
                            "text": "never (1)",
                            "template": "never (1)"
                        },
                        {
                            "text": "rarely (2)",
                            "template": "rarely (2)"
                        },
                        {
                            "text": "sometimes (3)",
                            "template": "sometimes (3)"
                        },
                        {
                            "text": "often (4)",
                            "template": "often (4)"
                        },
                        {
                            "text": "always (5)",
                            "template": "always (5)"
                        }
                    ]
                },
                {
                    "text": "Hard to focus on anything than my anxiety",
                    "template": "I found it hard to focus on anything other than my anxiety",
                    "children": [
                        {
                            "text": "never (1)",
                            "template": "never (1)"
                        },
                        {
                            "text": "rarely (2)",
                            "template": "rarely (2)"
                        },
                        {
                            "text": "sometimes (3)",
                            "template": "sometimes (3)"
                        },
                        {
                            "text": "often (4)",
                            "template": "often (4)"
                        },
                        {
                            "text": "always (5)",
                            "template": "always (5)"
                        }
                    ]
                },
                {
                    "text": "My worries overwhelmed me",
                    "template": "My worries overwhelmed me",
                    "children": [
                        {
                            "text": "never (1)",
                            "template": "never (1)"
                        },
                        {
                            "text": "rarely (2)",
                            "template": "rarely (2)"
                        },
                        {
                            "text": "sometimes (3)",
                            "template": "sometimes (3)"
                        },
                        {
                            "text": "often (4)",
                            "template": "often (4)"
                        },
                        {
                            "text": "always (5)",
                            "template": "always (5)"
                        }
                    ]
                },
                {
                    "text": "I felt uneasy",
                    "template": "I felt uneasy",
                    "children": [
                        {
                            "text": "never (1)",
                            "template": "never (1)"
                        },
                        {
                            "text": "rarely (2)",
                            "template": "rarely (2)"
                        },
                        {
                            "text": "sometimes (3)",
                            "template": "sometimes (3)"
                        },
                        {
                            "text": "often (4)",
                            "template": "often (4)"
                        },
                        {
                            "text": "always (5)",
                            "template": "always (5)"
                        }
                    ]
                }
            ]
        },
        {
            "text": "Depression (In the past 7 days)",
            "template": "Depression In the past 7 days\u2026{children}",
            "children": [
                {
                    "text": "I felt worthless",
                    "template": "I felt worthless",
                    "children": [
                        {
                            "text": "never (1)",
                            "template": "never (1)"
                        },
                        {
                            "text": "rarely (2)",
                            "template": "rarely (2)"
                        },
                        {
                            "text": "sometimes (3)",
                            "template": "sometimes (3)"
                        },
                        {
                            "text": "often (4)",
                            "template": "often (4)"
                        },
                        {
                            "text": "always (5)",
                            "template": "always (5)"
                        }
                    ]
                },
                {
                    "text": "I felt helpless",
                    "template": "I felt helpless",
                    "children": [
                        {
                            "text": "never (1)",
                            "template": "never (1)"
                        },
                        {
                            "text": "rarely (2)",
                            "template": "rarely (2)"
                        },
                        {
                            "text": "sometimes (3)",
                            "template": "sometimes (3)"
                        },
                        {
                            "text": "often (4)",
                            "template": "often (4)"
                        },
                        {
                            "text": "always (5)",
                            "template": "always (5)"
                        }
                    ]
                },
                {
                    "text": "I felt depressed",
                    "template": "I felt depressed",
                    "children": [
                        {
                            "text": "never (1)",
                            "template": "never (1)"
                        },
                        {
                            "text": "rarely (2)",
                            "template": "rarely (2)"
                        },
                        {
                            "text": "sometimes (3)",
                            "template": "sometimes (3)"
                        },
                        {
                            "text": "often (4)",
                            "template": "often (4)"
                        },
                        {
                            "text": "always (5)",
                            "template": "always (5)"
                        }
                    ]
                },
                {
                    "text": "I felt hopeless",
                    "template": "I felt hopeless",
                    "children": [
                        {
                            "text": "never (1)",
                            "template": "never (1)"
                        },
                        {
                            "text": "rarely (2)",
                            "template": "rarely (2)"
                        },
                        {
                            "text": "sometimes (3)",
                            "template": "sometimes (3)"
                        },
                        {
                            "text": "often (4)",
                            "template": "often (4)"
                        },
                        {
                            "text": "always (5)",
                            "template": "always (5)"
                        }
                    ]
                }
            ]
        },
        {
            "text": "Fatigue (During the past 7 days)",
            "template": "FatiguedDuring the past 7 days\u2026{children}",
            "children": [
                {
                    "text": "I feel fatigued",
                    "template": "I feel fatigued",
                    "children": [
                        {
                            "text": "not at all (1)",
                            "template": "not at all (1)"
                        },
                        {
                            "text": "a little bit (2)",
                            "template": "a little bit (2)"
                        },
                        {
                            "text": "somewhat (3)",
                            "template": "somewhat (3)"
                        },
                        {
                            "text": "quite a bit (4)",
                            "template": "quite a bit (4)"
                        },
                        {
                            "text": "very much (5)",
                            "template": "very much (5)"
                        }
                    ]
                },
                {
                    "text": "Trouble starting things because I am tired",
                    "template": "I have trouble starting things because I am tired",
                    "children": [
                        {
                            "text": "not at all (1)",
                            "template": "not at all (1)"
                        },
                        {
                            "text": "a little bit (2)",
                            "template": "a little bit (2)"
                        },
                        {
                            "text": "somewhat (3)",
                            "template": "somewhat (3)"
                        },
                        {
                            "text": "quite a bit (4)",
                            "template": "quite a bit (4)"
                        },
                        {
                            "text": "very much (5)",
                            "template": "very much (5)"
                        }
                    ]
                }
            ]
        },
        {
            "text": "Fatigue (In the past 7 days)",
            "template": "In the past 7 days \u2026{children}",
            "children": [
                {
                    "text": "How run-down did you feel on average?",
                    "template": "How run-down did you feel on average?",
                    "children": [
                        {
                            "text": "Not at all (1)",
                            "template": "Not at all (1)"
                        },
                        {
                            "text": "A little bit (2)",
                            "template": "A little bit (2)"
                        },
                        {
                            "text": "Somewhat (3)",
                            "template": "Somewhat (3)"
                        },
                        {
                            "text": "Quite a bit (4)",
                            "template": "Quite a bit (4)"
                        },
                        {
                            "text": "Very much (5)",
                            "template": "Very much (5)"
                        }
                    ]
                },
                {
                    "text": "How fatigued were you on average?",
                    "template": "How fatigued were you on average?",
                    "children": [
                        {
                            "text": "Not at all (1)",
                            "template": "Not at all (1)"
                        },
                        {
                            "text": "A little bit (2)",
                            "template": "A little bit (2)"
                        },
                        {
                            "text": "Somewhat (3)",
                            "template": "Somewhat (3)"
                        },
                        {
                            "text": "Quite a bit (4)",
                            "template": "Quite a bit (4)"
                        },
                        {
                            "text": "Very much (5)",
                            "template": "Very much (5)"
                        }
                    ]
                }
            ]
        },
        {
            "text": "Sleep Disturbance (In the past 7 days)",
            "template": "Sleep DisturbanceIn the past 7 days\u2026{children}",
            "children": [
                {
                    "text": "My sleep quality was",
                    "template": "My sleep quality was",
                    "children": [
                        {
                            "text": "very poor (5)",
                            "template": "very poor (5)"
                        },
                        {
                            "text": "poor (4)",
                            "template": "poor (4)"
                        },
                        {
                            "text": "fair (3)",
                            "template": "fair (3)"
                        },
                        {
                            "text": "good (2)",
                            "template": "good (2)"
                        },
                        {
                            "text": "very good (1)",
                            "template": "very good (1)"
                        }
                    ]
                },
                {
                    "text": "My sleep was refreshing",
                    "template": "My sleep was refreshing",
                    "children": [
                        {
                            "text": "not at all (5)",
                            "template": "not at all (5)"
                        },
                        {
                            "text": "a little bit (4)",
                            "template": "a little bit (4)"
                        },
                        {
                            "text": "somewhat (3)",
                            "template": "somewhat (3)"
                        },
                        {
                            "text": "quite a bit (2)",
                            "template": "quite a bit (2)"
                        },
                        {
                            "text": "very much (1)",
                            "template": "very much (1)"
                        }
                    ]
                },
                {
                    "text": "I had a problem with my sleep",
                    "template": "I had a problem with my sleep",
                    "children": [
                        {
                            "text": "not at all (1)",
                            "template": "not at all (1)"
                        },
                        {
                            "text": "a little bit (2)",
                            "template": "a little bit (2)"
                        },
                        {
                            "text": "somewhat (3)",
                            "template": "somewhat (3)"
                        },
                        {
                            "text": "quite a bit (4)",
                            "template": "quite a bit (4)"
                        },
                        {
                            "text": "very much (5)",
                            "template": "very much (5)"
                        }
                    ]
                },
                {
                    "text": "I had difficulty falling asleep",
                    "template": "I had difficulty falling asleep",
                    "children": [
                        {
                            "text": "not at all (1)",
                            "template": "not at all (1)"
                        },
                        {
                            "text": "a little bit (2)",
                            "template": "a little bit (2)"
                        },
                        {
                            "text": "somewhat (3)",
                            "template": "somewhat (3)"
                        },
                        {
                            "text": "quite a bit (4)",
                            "template": "quite a bit (4)"
                        },
                        {
                            "text": "very much (5)",
                            "template": "very much (5)"
                        }
                    ]
                }
            ]
        },
        {
            "text": "Satisfaction with Social Role (In the past 7 days)",
            "template": "Satisfaction with Social RoleIn the past 7 days...{children}",
            "children": [
                {
                    "text": "I am satisfied with how much work I can do",
                    "template": "I am satisfied with how much work I can do (including work at home)",
                    "children": [
                        {
                            "text": "not at all (1)",
                            "template": "not at all (1)"
                        },
                        {
                            "text": "a little bit (2)",
                            "template": "a little bit (2)"
                        },
                        {
                            "text": "somewhat (3)",
                            "template": "somewhat (3)"
                        },
                        {
                            "text": "quite a bit (4)",
                            "template": "quite a bit (4)"
                        },
                        {
                            "text": "very much (5)",
                            "template": "very much (5)"
                        }
                    ]
                },
                {
                    "text": "I am satisfied with my ability to work",
                    "template": "I am satisfied with my ability to work (include work at home)",
                    "children": [
                        {
                            "text": "not at all (1)",
                            "template": "not at all (1)"
                        },
                        {
                            "text": "a little bit (2)",
                            "template": "a little bit (2)"
                        },
                        {
                            "text": "somewhat (3)",
                            "template": "somewhat (3)"
                        },
                        {
                            "text": "quite a bit (4)",
                            "template": "quite a bit (4)"
                        },
                        {
                            "text": "very much (5)",
                            "template": "very much (5)"
                        }
                    ]
                },
                {
                    "text": "Satisfied ability person\/household responsibility",
                    "template": "I am satisfied with my ability to do regular personal and household\n                                responsibilities\n                            ",
                    "children": [
                        {
                            "text": "not at all (1)",
                            "template": "not at all (1)"
                        },
                        {
                            "text": "a little bit (2)",
                            "template": "a little bit (2)"
                        },
                        {
                            "text": "somewhat (3)",
                            "template": "somewhat (3)"
                        },
                        {
                            "text": "quite a bit (4)",
                            "template": "quite a bit (4)"
                        },
                        {
                            "text": "very much (5)",
                            "template": "very much (5)"
                        }
                    ]
                },
                {
                    "text": "Satisfied w\/ ability to perform daily routines",
                    "template": "I am satisfied with my ability to perform my daily routines",
                    "children": [
                        {
                            "text": "not at all (1)",
                            "template": "not at all (1)"
                        },
                        {
                            "text": "a little bit (2)",
                            "template": "a little bit (2)"
                        },
                        {
                            "text": "somewhat (3)",
                            "template": "somewhat (3)"
                        },
                        {
                            "text": "quite a bit (4)",
                            "template": "quite a bit (4)"
                        },
                        {
                            "text": "very much (5)",
                            "template": "very much (5)"
                        }
                    ]
                }
            ]
        },
        {
            "text": "Pain Interference (In the past 7 days)",
            "template": "Pain Interference In the past 7 days \u2026{children}",
            "children": [
                {
                    "text": "Pain interfere with your day to day activities?",
                    "template": "How much did pain interfere with your day to day activities?",
                    "children": [
                        {
                            "text": "Not at all (1)",
                            "template": "Not at all (1)"
                        },
                        {
                            "text": "A little bit (2)",
                            "template": "A little bit (2)"
                        },
                        {
                            "text": "Somewhat (3)",
                            "template": "Somewhat (3)"
                        },
                        {
                            "text": "Quite a bit (4)",
                            "template": "Quite a bit (4)"
                        },
                        {
                            "text": "Very much (5)",
                            "template": "Very much (5)"
                        }
                    ]
                },
                {
                    "text": "Pain interfere with work around the home?",
                    "template": "How much did pain interfere with work around the home?",
                    "children": [
                        {
                            "text": "Not at all (1)",
                            "template": "Not at all (1)"
                        },
                        {
                            "text": "A little bit (2)",
                            "template": "A little bit (2)"
                        },
                        {
                            "text": "Somewhat (3)",
                            "template": "Somewhat (3)"
                        },
                        {
                            "text": "Quite a bit (4)",
                            "template": "Quite a bit (4)"
                        },
                        {
                            "text": "Very much (5)",
                            "template": "Very much (5)"
                        }
                    ]
                },
                {
                    "text": "Pain interfere w\/ participation social activity?",
                    "template": "How much did pain interfere with your ability to participate in social\n                                activities?\n                            ",
                    "children": [
                        {
                            "text": "Not at all (1)",
                            "template": "Not at all (1)"
                        },
                        {
                            "text": "A little bit (2)",
                            "template": "A little bit (2)"
                        },
                        {
                            "text": "Somewhat (3)",
                            "template": "Somewhat (3)"
                        },
                        {
                            "text": "Quite a bit (4)",
                            "template": "Quite a bit (4)"
                        },
                        {
                            "text": "Very much (5)",
                            "template": "Very much (5)"
                        }
                    ]
                },
                {
                    "text": "Pain interfere with your household chores?",
                    "template": "How much did pain interfere with your household chores?",
                    "children": [
                        {
                            "text": "Not at all (1)",
                            "template": "Not at all (1)"
                        },
                        {
                            "text": "A little bit (2)",
                            "template": "A little bit (2)"
                        },
                        {
                            "text": "Somewhat (3)",
                            "template": "Somewhat (3)"
                        },
                        {
                            "text": "Quite a bit (4)",
                            "template": "Quite a bit (4)"
                        },
                        {
                            "text": "Very much (5)",
                            "template": "Very much (5)"
                        }
                    ]
                }
            ]
        },
        {
            "text": "In the past 7 days, rate your pain on average?",
            "template": "Pain IntensityIn the past 7 days\u2026How would you rate your pain on average, 0\n                        (no pain) - 10 (worst pain imaginable)? {children}\n                    ",
            "children": [
                {
                    "text": "0 (no pain)",
                    "template": "(0)"
                },
                {
                    "text": "1",
                    "template": "(1)"
                },
                {
                    "text": "2",
                    "template": "(2)"
                },
                {
                    "text": "3",
                    "template": "(3)"
                },
                {
                    "text": "4",
                    "template": "(4)"
                },
                {
                    "text": "5",
                    "template": "(5)"
                },
                {
                    "text": "6",
                    "template": "(6)"
                },
                {
                    "text": "7",
                    "template": "(7)"
                },
                {
                    "text": "8",
                    "template": "(8)"
                },
                {
                    "text": "9",
                    "template": "(9)"
                },
                {
                    "text": "10 (worst imaginable pain)",
                    "template": "(10)"
                }
            ]
        },
        {
            "text": "Total Score (#)",
            "template": "Total Score: {text}",
            "type": "number"
        }
    ]
}