PaRIS Showcards

Attach2_PaRIS_Showcards.pdf

Patient-Reported Indicator Survey (PaRIS) (CMS-10792)

PaRIS Showcards

OMB: 0938-1434

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PaRIS Showcards

• Excellent
• Very Good
• Good
• Fair
• Poor

PR1

PR2
• Not at all
• A little bit
• Somewhat
• Quite a bit
• Very much

PR3
• Never
• Rarely
• Sometimes
• Often
• Always

PR4
• All of the time
• Most of the time
• More than half of the time
• Less than half of the time
• Some of the time
• At no time

PR5
• Once or more a day
• 4-6 times a week
• 1-3 times a week
• Less than once a week
• Never

PR6
• Every day almost
• 5-6 days a week
• 3-4 times a week
• 1-2 days a week
• 2-3 days in a month
• Less than once a month
• Not n the past we months, as I no longer drink

alcohol
• Never, or only a few sips or tries, in my whole life

PR7
• Strongly disagree
• Disagree
• Neither agree nor disagree
• Agree
• Strongly agree

PR8
• Not at all
• To some extent
• More often than not
• Always
• Not sure

PR9
• Very confident
• Confident
• Somewhat confident
• Not confident at all

PR10
• 1 year or less
• More than 1 year but not more than 3 years
• More than 3 years but no more than 5 years
• More than 5 years but no more than 10 years
• 10 years or more
• Not sure

PR11
• Not in the past 12 months
• Once
• 2-4 times
• 5 times or more
• Not sure

PR12
• A primary care doctor, family doctor, or general

practitioner
• A specialist doctor
• A primary care nurse
• A hospital nurse
• Other doctor
• Other nurse
• Other healthcare professional
• Not sure

PR13
• Always
• Often
• Sometimes
• Rarely
• Never

PR14
• On the same day
• On the next day
• A few days and up to a week later
• More than a week and up to one month later
• More than one month later
• Can’t remember

PR15
• Yes, definitely
• Yes, to some extent
• No, not really
• No, definitely not
• Not sure


File Typeapplication/pdf
File TitlePaRIS Showcards
SubjectPaRIS Showcards, Attachment 2
AuthorNORC
File Modified2022-01-12
File Created2022-01-12

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