SF-12 Health Survey

SF-12 Health Survey

Calculator & Report Generator

Instructions: Please answer all 12 questions by selecting one option. If unsure, give the best answer you can.
1. In general, would you say your health is:

2 Physical Functioning

Does your health now limit you in these activities?
2. Moderate activities (moving table, vacuuming, bowling, golf)
3. Climbing several flights of stairs

3 Role – Physical

Problems with work/daily activities due to physical health?
4. Accomplished less than you would like
5. Limited in kind of work or other activities

4 Role – Emotional

Problems with work/daily activities due to emotional problems?
6. Accomplished less than you would like
7. Didn't do work or activities as carefully as usual

5 Bodily Pain

8. How much did pain interfere with normal work?

6 Vitality, Mental Health & Social

How much of the time during the past week...
9. Have you felt calm and peaceful?
10. Did you have a lot of energy?
11. Have you felt downhearted and blue?
12. Health/emotional problems interfered with social activities?

✓ Component Summary Scores

Norm-based T-scores (U.S. mean = 50, SD = 10). Higher is better.

Physical Component (PCS-12)
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0255075100
Mental Component (MCS-12)
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0255075100

Clinical Interpretation

i Response Summary

DomainItemResponsePCS WtMCS Wt

? Score Guide

Norm-based: Mean = 50, SD = 10 in U.S. general population.

  • >50: Better than average
  • 40–50: Slightly below average
  • <40: >1 SD below average; possible clinical impairment

A 3–5 point change is clinically meaningful.

Ref: Ware JE Jr, et al. Med Care. 1996;34(3):220-233.

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Dr. Prince Kawser