CDC Chronic Fatigue Scale
MedaFile - modifications

       ID:         DATE:           TIME (24hr): 


Instructions: Please describe, during the PAST MONTH, how often you have the following symptoms.
If you have them, please ALSO specify the intensity of each symptom and if it has been present for 6 months or more.

FREQUENCY INTENSITY PRESENT FOR 6 MONTHS OR MORE
Fill in one answer for each category of each item. Never A little of the time Some of the time Most of the time All of the time Mild Moderate Severe No Yes
0 1 2 3 4 0 1 2 0 1
 1.   Prolonged fatigue or a feeling of illness, lasting longer than a day, after mild exercise.
 2.   Unrefreshing sleep.
 3.   Substantial problems remembering.
 4.   Substantial problems concentrating.
 5.   Muscle discomfort or pains/aches.
 6.   Pain in joints such as elbows, knees and fingers, without redness or swelling.
 7.   Sore throat.
 8.   Tender glands in neck, jaw, or armpits.
 9.   New types of headaches.
 10.   Diarrhea.
 11.   Feeling feverish.
 12.   Chills.
 13.   Sleeping problems.
 14.   Nausea.
 15.   Stomach or abdominal pain.
 16.   Sinus or nasal problems.
 17.   Shortness of breath.
 18.   Sensitivity to light.
 19.   Depression.

TEXT FOR YOUR RECORDS

Need reference - CDC Chronic Fatigue Scale

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Last update: 11/14/2021