F2548-C22019
C22019
Dizziness Handicap Inventory (DHI) - Emotional score
Quantifies the emotional impact on disability domain score for the subject, as part of the Dizziness Handicap Inventory
Supplemental-Highly Recommended
Dizziness Handicap Inventory (DHI)
False
Sport-Related Concussion
Subacute
F2548-C22020
C22020
Dizziness Handicap Inventory (DHI) - Problem frustation scale
Scale to rate the frequency the subject thinks they feel frustrated because of their problem, as a part of the Dizziness Handicap Inventory
Supplemental-Highly Recommended
Dizziness Handicap Inventory (DHI)
False
Sport-Related Concussion
Subacute
F2548-C22021
C22021
Dizziness Handicap Inventory (DHI) - Problem ability limit scale
Scale to rate the frequency the subject feels handicapped because of their problem, as a part of the Dizziness Handicap Inventory
Supplemental-Highly Recommended
Dizziness Handicap Inventory (DHI)
False
Sport-Related Concussion
Subacute
F2548-C22022
C22022
Dizziness Handicap Inventory (DHI) - Functional score
Quantifies the functional impact on disability domain score for the subject, as part of the Dizziness Handicap Inventory
Supplemental-Highly Recommended
Dizziness Handicap Inventory (DHI)
False
Sport-Related Concussion
Subacute
F2548-C22023
C22023
Dizziness Handicap Inventory (DHI) - Problem look up increase scale
Scale to rate the frequency the subject thinks looking up increases their problem, as a part of the Dizziness Handicap Inventory
Supplemental-Highly Recommended
Dizziness Handicap Inventory (DHI)
False
Sport-Related Concussion
Subacute
F2548-C22024
C22024
Dizziness Handicap Inventory (DHI) - Physical score
Quantifies the physical impact on disability domain score for the subject, as part of the Dizziness Handicap Inventory
Supplemental-Highly Recommended
Dizziness Handicap Inventory (DHI)
False
Sport-Related Concussion
Subacute
F2548-C22053
C22053
Dizziness Handicap Inventory (DHI) - Problem responsibility interfere scale
Scale to rate the frequency the subject thinks their problem interferes with their job or household responsibilities, as a part of the Dizziness Handicap Inventory
Supplemental-Highly Recommended
Dizziness Handicap Inventory (DHI)
False
Sport-Related Concussion
Subacute
F2548-C22054
C22054
Dizziness Handicap Inventory (DHI) - Problem head quick movement increase scale
Scale to rate the frequency the subject thinks quick movements of their head increase their problem, as a part of the Dizziness Handicap Inventory
Supplemental-Highly Recommended
Dizziness Handicap Inventory (DHI)
False
Sport-Related Concussion
Subacute
F2548-C22055
C22055
Dizziness Handicap Inventory (DHI) - Problem social activity restrict participation scale
Scale to rate the frequency the subject thinks they significantly restrict their participation in social activities because of their problem, as a part of the Dizziness Handicap Inventory
Supplemental-Highly Recommended
Dizziness Handicap Inventory (DHI)
False
Sport-Related Concussion
Subacute
F2548-C22056
C22056
Dizziness Handicap Inventory (DHI) - Problem travel restrict scale
Scale to rate the frequency the subject thinks they restrict travel for business or recreation because of their problem, as a part of the Dizziness Handicap Inventory
Supplemental-Highly Recommended
Dizziness Handicap Inventory (DHI)
False
Sport-Related Concussion
Subacute
F2548-C22057
C22057
Dizziness Handicap Inventory (DHI) - Problem relationship stress scale
Scale to rate the frequency the subject thinks their problem has placed stress on their relationships with members of their family or friends, as a part of the Dizziness Handicap Inventory
Supplemental-Highly Recommended
Dizziness Handicap Inventory (DHI)
False
Sport-Related Concussion
Subacute
F2548-C22059
C22059
Dizziness Handicap Inventory (DHI) - Total score
Quantifies the total emotional, functional, and physical impacts on disability score for the subject, as part of the Dizziness Handicap Inventory
Supplemental-Highly Recommended
Dizziness Handicap Inventory (DHI)
False
Sport-Related Concussion
Subacute
F2548-C22060
C22060
Dizziness Handicap Inventory (DHI) - Problem increase turning over in bed scale
Scale to rate the frequency the subject thinks turning over in bed increases their problem, as a part of the Dizziness Handicap Inventory
Supplemental-Highly Recommended
Dizziness Handicap Inventory (DHI)
False
Sport-Related Concussion
Subacute
F2548-C22061
C22061
Dizziness Handicap Inventory (DHI) - Problem increase walk sidewalk scale
Scale to rate the frequency the subject thinks walking down a sidewalk increases their problem, as a part of the Dizziness Handicap Inventory
Supplemental-Highly Recommended
Dizziness Handicap Inventory (DHI)
False
Sport-Related Concussion
Subacute
F2548-C22092
C22092
Dizziness Handicap Inventory (DHI) - Problem increase walk aisle supermarket scale
Scale to rate the frequency the subject thinks walking down the aisle of a supermarket increases their problems, as a part of the Dizziness Handicap Inventory
Supplemental-Highly Recommended
Dizziness Handicap Inventory (DHI)
False
Sport-Related Concussion
Subacute
F2548-C22093
C22093
Dizziness Handicap Inventory (DHI) - Home leave alone fear scale
Scale to rate the frequency the subject thinks they are afraid to leave home without having someone accompany them because of their problem, as a part of the Dizziness Handicap Inventory
Supplemental-Highly Recommended
Dizziness Handicap Inventory (DHI)
False
Sport-Related Concussion
Subacute
F2548-C22094
C22094
Dizziness Handicap Inventory (DHI) - Problem embarrassment scale
Scale to rate the frequency the subject thinks they are embarrassed in front of others because of their problem, as a part of the Dizziness Handicap Inventory
Supplemental-Highly Recommended
Dizziness Handicap Inventory (DHI)
False
Sport-Related Concussion
Subacute
F2549-C15910
C15910
Assessment date and time
The date of participant's injury
Supplemental-Highly Recommended
Vestibular/Ocular Motor Screening (VOMS) for Concussion
False
Sport-Related Concussion
Subacute
F2549-C17733
C17733
Person completing form name
Name of person completing the form
Supplemental-Highly Recommended
Vestibular/Ocular Motor Screening (VOMS) for Concussion
False
Sport-Related Concussion
Subacute
F2549-C54626
C54626
Vestibular/Ocular Motor Screening (VOMS) for Concussion - Baseline symptom type
The type related to baseline symptoms, as part of the Vestibular/Ocular Motor Screening (VOMS) for Concussion
Supplemental-Highly Recommended
Vestibular/Ocular Motor Screening (VOMS) for Concussion
False
Sport-Related Concussion
Subacute
F2549-C54637
C54637
Vestibular/Ocular Motor Screening (VOMS) for Concussion - Headache intensity scale
The scale related to headache intensity, as it related to the Vestibular/Ocular Motor Screening (VOMS) for Concussion
Supplemental-Highly Recommended
Vestibular/Ocular Motor Screening (VOMS) for Concussion
False
Sport-Related Concussion
Subacute
F2549-C54638
C54638
Vestibular/Ocular Motor Screening (VOMS) for Concussion - Dizziness intensity scale
The dizziness scale test item, as part of the Vestibular/Ocular Motor Screening Test
Supplemental-Highly Recommended
Vestibular/Ocular Motor Screening (VOMS) for Concussion
False
Sport-Related Concussion
Subacute
F2549-C54639
C54639
Vestibular/Ocular Motor Screening (VOMS) for Concussion - Nausea intensity scale
The nausea intensity scale test item, as part of the Vestibular/Ocular Motor Screening Test
Supplemental-Highly Recommended
Vestibular/Ocular Motor Screening (VOMS) for Concussion
False
Sport-Related Concussion
Subacute
F2549-C54640
C54640
Vestibular/Ocular Motor Screening (VOMS) for Concussion - Fogginess intensity scale
The fogginess intensity scale test item, as part of the Vestibular/Ocular Motor Screening Test
Supplemental-Highly Recommended
Vestibular/Ocular Motor Screening (VOMS) for Concussion
False
Sport-Related Concussion
Subacute
F2549-C54641
C54641
Vestibular/Ocular Motor Screening (VOMS) for Concussion - Total score
The total score test item, as part of the Vestibular/Ocular Motor Screening Test
Supplemental-Highly Recommended
Vestibular/Ocular Motor Screening (VOMS) for Concussion
False
Sport-Related Concussion
Subacute