The questionnaires below are for use by physicians. If you are trying to enroll in the NDB, please see the NDB enrollment page. If you are already enrolled and are having trouble locating your questionnaire please see this page or  contact the NDB.

 

A guide to questionnaires available from the NDB

The NDB offers questionnaires without charge, for your clinical practice or for research. You can choose which questionnaire you need. These forms can be utilized as the basis of a mailed or faxback report to you or we can set up a secure site for you to be able to download data or pdfs to your electronic medical record system.

The NDB offers several general types of questionnaires. Modification of the questionnaires to include or exclude items is possible. When used in the clinic, these questionnaires are not meant to be sufficient in and of themselves. Usually clinicians collect physical examination, laboratory and treatment data separately, although it is possible to collect them with NDB forms, too.

Most questionnaires are also available in Spanish and International English.

Questionnaires are available for download in Adobe Acrobat PDF format for use by rheumatologists. Click here for the free Adobe Acrobat Reader

Click to see complete table of questionnaire details.

The HAQ II functional assessment questionnaire.

Arthritis and Rheumatology Clinics of Kansas clinical questionnaire, ARCK.

The CLINHAQ is a one-page questionnaire designed to collect basic visit information as well as contact information. With this form, the goal is to enroll patients into the NDB so they will receive NDB Comprehensive questionnaires

The CLINHAQ II is based on the HAQ and HAQ-II functional assessments. It also contains additional scales. In exchange for the increased length, these questionnaires handle more dimensions of health and provide more clinical information.

The NDB Comprehensive Survey Questionnaire (CSQ) is a 28 page comprehensive assessment administered by mail, Web entry or email PDF format at 6 month intervals to NDB study participants. The CSQ documents all treatments, SF-36, direct and indirect medical cost, adverse events, symptoms, utilities and all other key rheumatic disease outcomes. The CSQ includes single item scales for sleep, anxiety and depression. It also includes review of systems and a self-report joint count.

BSQ: Brief survey questionnaire is a shorter version of the CSQ questionnaire for patients with rheumatic diseases. It is designed for patients who are unable to complete the CSQ.

ACR FM 2010 diagnostic criteria questionnaire modified for direct patient administration. For details, see Wolfe F, Clauw D, Fitzcharles MA, Goldenberg D, Häuser W, Katz RS, et al. Fibromyalgia Criteria and Severity Scales for Clinical and Epidemiological Studies: A Modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia. J Rheumatol. 2011;38:113-22.

 

Need help with the questionnaire options available? Contact the NDB for more information.

 

 

Data entry methods for NDB questionnaires

PAPER QUESTIONNAIRE: The easiest option for use in the clinic. After completion of forms by patients, they can be scored by the physician or physician's staff and/or mailed to the NDB in postage paid envelopes, or faxed to the NDB for automatic scoring. The data is then reported back to the physician within minutes in a longitudinal flow sheet format that incorporates all of the patient's previous data. Click here to see faxback report.

Questionnaires can also be scored by rheumatologists themselves for immediate use in the clinic. If forwarded to the NDB, data will be entered into a longitudinal data bank for use by the rheumatologist.

DIRECT INTERNET ENTRY: All questionnaires are available through the web for easy data entry.

OFF-LINE ELECTRONIC ENTRY: All questionnaires are available as programmed PDF forms.

Please note: All of these forms are HIPAA compliant and have been approved by IRBs.