Patient Survey - Strados ePro

Patient ID

Patient Name

First Last

Oxygen Level from Pulse Oximeter:

As you answer the following questions, please select the option that best describes your experience.

1 of 14. Did your chest feel congested today?*

2 of 14. How often did you cough today?*

3 of 14. How much mucus (phlegm) did you bring up when coughing today?*

4 of 14. How difficult was it to bring up mucus (phlegm) today?*

5 of 14. Did you have chest discomfort today?*

6 of 14. Did your chest feel tight today?*

7 of 14. Were you breathless today?*

8 of 14. Describe how breathless you were today:*

9 of 14. Were you short of breath today when performing your usual personal care activities like washing or dressing?*

10 of 14. Were you short of breath today when performing your usual indoor activities like cleaning or household work?*

11 of 14. Were you short of breath today when performing your usual activities outside the home such as yard work or errands?*

12 of 14. Were you tired or weak today?*

13 of 14. Last night, was your sleep disturbed?*

14 of 14. How scared or worried were you about your lung problems today?*

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Patient_Score

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SHORE Patient Survey