US · guidance
HOPE All Items v1.01, Item J2053
SFV Symptom Impact
J2053. SFV Symptom Impact
Since the last Symptom Impact assessment was completed, how has the patient been affected by each of the following
symptoms? Base this on your observations and/or clinical assessment (including input from patient and/or caregiver). Symptoms
may impact multiple patient activities including, but not limited to, sleep, concentration, day to day activities, or ability to interact
with others.
Coding:
0. Not at all – symptom does not affect the patient, including symptoms well-controlled with current treatment
1. Slight
2. Moderate
3. Severe
9. Not applicable (the patient is not experiencing the symptom)
Enter Code
↓
A. Pain
B. Shortness of breath
C. Anxiety
D. Nausea
E. Vomiting
F. Diarrhea
G. Constipation
H. Agitation
History
HOPE All Items v1.01, effective October 1, 2025 (OMB control number 0938-1153).
Provenance
- Source
- cms.gov
- Retrieved
- 2026-09-17
- Edition
- hope-v1.02
- Content hash
fd05748d9c1830b41e71affc2a02dec00c000d8505c1b9758d75bfd59bcef7bb
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