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ā | Question | Possible answers | Scoring |
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(1) | How often did you feel pruritus within the last 3 days? | (i) All time | 3 points |
(ii) All morning/afternoon/evening/night long itch episodes | 2 points |
(iii) Occasionally, short itch episodes | 1 point |
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(2) | Did pruritus hinder your ability to do simply things, like watching TV, hearing music, etc.? | (i) Yes (ii) No | 1 point 0 points |
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(3) | Did you feel irritated or nervous because of your itching? | (i) Yes (ii) No | 1 point 0 points |
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(4) | Did your pruritus cause you depressed? | (i) Yes (ii) No | 1 point 0 points |
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(5) | Did your pruritus impede your work or learning abilities? | (i) Yes (ii) No | 1 point 0 points |
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(6) | Did you scratch your skin because of itching? | (i) Yes (ii) No | 1 point 0 points |
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(7) | Did scratching bring you relief? | (i) Yes (ii) No | 0 points 1 point |
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(8) | Were you able to refrain from scratching? | (i) Yes (ii) No | 0 points 1 point |
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(9) | Did you wake up during last night because of pruritus? | (i) No (ii) Yes, 1-2 times (iii) Yes, 3-4 times (iv) Yes, 5 and more times | 0 points 1 point 2 points 3 points |
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(10) | Could you assess the severity of your pruritus within last 3 days? | (i) Very mild (ii) Mild (iii) Moderate (iv) Severe (v) Very severe | 1 point 2 points 3 points 4 points 5 points |
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(11) | Could you indicate pruritus location? | (i) Single locations of pruritus (ii) Large body areas (iii) Generalized pruritus | 1 point 2 points 3 points |
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(12) | Are excoriations or other scratch lesions present? | (i) Yes (ii) No | 1 point 0 points |
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