Domains

Nutrition, sleep, movement, stress, relationships, purpose, environment, finances/access, and self-care.

Score each domain, identify top gaps, strengths, readiness, and first action.

WHO-5 Administered

WHO-5 Below Threshold

Determinants Spokes

Item 1

Label: Sleep and Rest
Spoke ID: sleep-rest

Item 2

Label: Nutrition
Spoke ID: nutrition

Item 3

Label: Movement
Spoke ID: movement

Item 4

Label: Stress Load
Spoke ID: stress-load

Item 5

Label: Relationships
Spoke ID: relationships

Item 6

Label: Environment
Spoke ID: environment

Item 7

Label: Purpose
Spoke ID: purpose

Item 8

Label: Community
Spoke ID: community

Item 9

Label: Resilience
Spoke ID: resilience

Item 10

Label: Access and Resources
Spoke ID: access-resources

Status

active

Variant

adult

Who5 Items

Item 1

Label: Cheerful and in Good Spirits
Item ID: who5-1

Item 2

Label: Calm and Relaxed
Item ID: who5-2

Item 3

Label: Active and Vigorous
Item ID: who5-3

Item 4

Label: Fresh and Rested
Item ID: who5-4

Item 5

Label: Daily Life Filled with Interest
Item ID: who5-5

Who5 Instrument Version

who5-v1

Promis10 Instrument Version

promis10-adult-v1

Balance Interpretation

Top 3 strengths:

Top 3 gaps:

First action:

Readiness (0-10):

Use the determinants block as the structured domain capture; these fields summarize the wheel for the plan.

Plan and Follow-Up

Focus	Documentation
Goal / readiness	Record patient goal, importance, confidence, readiness, barriers, and supports. Goal: Readiness / confidence: Barriers / supports:
Action plan	Choose the smallest realistic next step, resources needed, and how success will be measured. Next action: Resources / accountability: Success measure:
Review	Set review date, expected obstacles, adjustment plan, and escalation or referral needs. Review date: Adjustment plan: Referral / escalation:

Focus

Documentation

Goal / readiness

Record patient goal, importance, confidence, readiness, barriers, and supports.

Goal:

Readiness / confidence:

Barriers / supports:

Action plan

Choose the smallest realistic next step, resources needed, and how success will be measured.

Next action:

Resources / accountability:

Success measure:

Review

Set review date, expected obstacles, adjustment plan, and escalation or referral needs.

Review date:

Adjustment plan:

Referral / escalation:

Domains

Determinants Assessment

Details

Item 1

Item 2

Item 3

Item 4

Item 5

Item 6

Item 7

Item 8

Item 9

Item 10

Item 1

Item 2

Item 3

Item 4

Item 5

Balance Interpretation

Plan and Follow-Up

General - Wheel of Balance

Preview