PROMIS RESULT

Date: [Date]
Patient: [Name or ID, age]
Reason: [Baseline, follow-up, re-evaluation, or discharge]

MEASURE
Measure and version: [PROMIS-29 Profile v2.1, a short form such as Anxiety 8a, a CAT, or Global Health]
Administration: [Paper, patient portal, or clinic tablet; self-completed or read aloud; language]
Scoring: [Scored by the platform, the HealthMeasures Scoring Service, or the scoring manual table]

T-SCORES
Higher is worse: [Each symptom domain with its T-score and severity label]
Higher is better: [Each function domain with its T-score and severity label]
Pain intensity: [0 to 10, or not part of this measure]

CHANGE OVER TIME
Baseline: [Date and T-score for each domain]
Change: [Points up or down for each domain since baseline]
Meaningful change: [Domains that moved 5 points or more, and which way]

CLINICAL READING
Context: [Diagnosis, treatment so far, and what the history and exam show]
Interpretation: [What the scores mean for this patient, and where they agree or disagree with the exam]

PLAN
Next step: [Continue, change treatment, refer, or discharge]
Goal: [Target T-score for each tracked domain]
Repeat: [Measure, and the date or interval]

Clinician: [Name, credentials]