Questions 312-313: Specify POEMS clinical features (check all that apply):

Indicate which clinical features, specific to POEMS only, are present at the time of evaluation for this reporting period. Check all that apply. If there are other clinical features not listed in this section, select “other” in question 312, in addition to any available options that apply, and specify the other clinical feature in question 313.

Questions 314-315: Thyroid stimulating hormone (TSH):

Indicate whether the thyroid stimulating hormone (TSH) level was “known” or “unknown” at the last evaluation. If “known,” report the value (in mU/L) in question 315 (mU/L is equivalent to μU/mL) and continue with question 316. If “unknown,” continue with question 317.

Question 316: Upper limit of normal for thyroid stimulating hormone (TSH) level:

Indicate the upper limit of normal (in mU/L) for thyroid stimulating hormone (TSH) level found on the laboratory report.

Questions 317-318: Testosterone level:

Indicate whether the testosterone level was “known” or “unknown” at the last evaluation. If “known,” report the value and unit of measure documented on the laboratory report in question 318 and continue with question 319. If “unknown,” continue with question 320.

Question 319: Upper limit of normal for testosterone level:

Indicate the upper limit of normal for testosterone level found on the laboratory report.

Questions 320-321: Estradiol level:

Indicate whether the estradiol level was “known” or “unknown” at the last evaluation. If “known,” report the value (in pg/mL) in question 321 and continue with question 322. If “unknown,” continue with question 323.

Question 322: Upper limit of normal for estradiol level:

Indicate the upper limit of normal (in pg/mL) for estradiol level found on the laboratory report.

Questions 323-324: Prolactin level:

Indicate whether the prolactin level was “known” or “unknown” at the last evaluation. If “known,” report the value (in ng/mL) in question 324 and continue with question 325. If “unknown,” continue with question 326.

Question 325: Upper limit of normal for prolactin level:

Indicate the upper limit of normal (in ng/mL) for prolactin level found on the laboratory report.

Questions 326-327: Cortisol level:

Indicate whether the cortisol level was “known” or “unknown” at the last evaluation. If “known,” report the value and unit of measure to the nearest tenth documented on the laboratory report in question 327 and continue with question 328. If “unknown,” continue with question 329.

Question 328: Upper limit of normal for cortisol level:

Indicate the upper limit of normal for cortisol level found on the laboratory report.

Questions 329-330: Interleukin-6:

Indicate whether the interleukin-6 value was “known” or “unknown” at the last evaluation. If “known,” report the value (in pg/mL) to the nearest tenth in question 330 and continue with question 331. If “unknown,” continue with question 332.

Question 331: Upper limit of normal for interleukin-6:

Indicate the upper limit of normal for interleukin-6 found on the laboratory report.

Questions 332-333: Was pulmonary artery hypertension present?

Pulmonary hypertension (PH) refers to elevated pulmonary arterial pressure. PH can be due to primary elevation of pressure in the pulmonary arterial system alone (pulmonary arterial hypertension), or secondary to elevations of pressure in the pulmonary venous and pulmonary capillary systems (pulmonary venous hypertension; post-capillary PH). Indicate whether pulmonary artery hypertension was present at the time of evaluation for this reporting period. If present, report the estimated systolic artery pressure documented on the laboratory report in question 333. If not present, continue with question 334.

Questions 334-335: Forced vital capacity (FVC):

Forced vital capacity is the total amount of air that can be exhaled during the forced expiratory volume test. FVC is a measurement taken during spirometry studies. Indicate whether the forced vital capacity percentage was “known” or “unknown” at the time of evaluation for this reporting period. If “known,” report the percentage documented on the pulmonary function test (PFT) in question 335. If “unknown,” continue with question 336.

Questions 336-337: Total lung capacity:

Indicate whether the total lung capacity (volume) was “known” or “unknown” at the time of evaluation for this reporting period. If “known,” report the value documented on the pulmonary function report in question 337. If “unknown,” continue with question 338.

Questions 338-339: Vascular endothelial growth factor (VEGF) serum value:

Vascular endothelial growth factor (VEGF) promotes the growth of new blood vessels and acts as a signaling protein influencing the rate at which this process is performed. Indicate whether the serum-derived vascular endothelial growth factor (VEGF) value was “known” or “unknown” at the time of evaluation for this reporting period. If “known,” report the value documented on the laboratory report in question 339 and continue with question 340. If “unknown,” continue with question 341.

Question 340: Upper limit of normal for vascular endothelial growth factor (VEGF) serum value:

Indicate the upper limit of normal for serum-derived vascular endothelial growth factor (VEGF) value used found on the laboratory report.

Questions 341-342: Vascular endothelial growth factor (VEGF) plasma value:

Vascular endothelial growth factor (VEGF) promotes the growth of new blood vessels and acts as a signaling protein influencing the rate at which this process is performed. Indicate whether the plasma-derived vascular endothelial growth factor (VEGF) value was “known” or “unknown” at the time of evaluation for this reporting period. If “known,” report the value documented on the laboratory report in question 342 and continue with question 343. If “unknown,” submit the form.

Question 343: Upper limit of normal for vascular endothelial growth factor (VEGF) plasma value:

Indicate the upper limit of normal for plasma-derived vascular endothelial growth factor (VEGF) value found on the laboratory report.

Last modified: May 08, 2020

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