• COMPASS 31

  • Date
     - -
    2 digit month, 2 digit day, 4 digit year

  • Number of weeks on treatment

  • 1. In the past year, have you ever felt faint, dizzy, "goofy", or had difficultythinking soon after standing up from a sitting or lying position?
  • 2. When standing up, how frequently do you get these feelings or symptoms?
  • 3. How would you rate the severity of these feelings or symptoms?
  • 4. In the past year, have these feelings or symptoms that you have experienced:
  • 5. In the past year, have you ever noticed color changes in your skin, such as red, white, or purple?
  • 6. What parts of your body are affected by these color changes? (Check all that apply)
  • 7. Are these changes in your skin color:
  • 8. In the past 5 years, what changes, if any, have occurred in your general body sweating?
  • 9. Do your eyes feel excessively dry?
  • 10. Does you mouth feel excessively dry?
  • 11. For the symptom of dry eyes or dry mouth that you have had for the longest period of time, is this symptom:
  • 12. In the past year, have you noticed any changes in how quickly you get full when eating a meal?
  • 13. In the past year, have you felt excessively full or persistently full (bloatedfeeling) after a meal?
  • 14. In the past year, have you vomited after a meal?
  • 15. In the past year, have you had a cramping or colick y abdominal pain?
  • 16. In the past year, have you had any bouts of diarrhea?
  • 17. How frequently does this occur?

  • Time per month:

  • 18. How severe are these bouts of diarrhea?
  • 19. Are your bouts of diarrhea getting:
  • 20. In the past year, have you been constipated?
  • 21. How frequently are you c onstipated?

  • Time per month:

  • 22. How severe are these episodes of constipation?
  • 23. Is your constipation getting:
  • 24. In the past year, have you ever lost control of your bladder function?

  • Time per month:

  • 25. In the past year, have you had diffic1Jlty passing urine?

  • Time per month:

  • 26. In the past year, have you had trouble completely emptying your bladder?

  • Time per month:

  • 27. In the past year, without sunglasses or tinted glasses, has bright lightbothered your eyes?
  • 28. How severe is this sensitivity to bright light?
  • 29. In the past year, have you had trouble focusing your eyes?
  • 30. How severe is this focusing problem?
  • 31. Is the most troublesome symptom with your eyes (i.e. sensitivity to bright light or trouble focusing) getting:

  • Sletten DM, Suarez GA, Low PA, Mandrekar J, Singer W. COMPASS 31: a refined and abbreviated Composite
    Autonomic Symptom Score. Mayo Clin Proc. 2012 Dec;87(12):1196-201. doi: 10.1016/j.mayocp.2012.10.013.
    PMID: 23218087; PMCID: PMC3541923.

  • Should be Empty: