PROMIS: Pediatric Anxiety: Short Form 8a
Today's Date
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Year
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Month
Day
Date
Patient Name
First Name
Last Name
Date of Birth
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Month
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Day
Year
In the past 7 days......
*
Never
Almost Never
Sometimes
Often
Almost Always
I felt like something awful might happen
I felt nervous
I felt scared
I felt worried
I worried when I was at home
I got scared really easy
I worried about what could happen to me
I worried when I went to bed at night
Last update 27th of July, 2016
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