Pediatric Quality of Life Inventory™ Family Information Form (PedsQL™ Family Information Form)

Varni James W

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Basic description

Conditions of use
The PedsQL™ Family Information Form is a specific module of the PedsQL™


Varni James W

Copyright © 1998 JW Varni, Ph.D.
The PedsQL™ Family Information Form, completed by parents, contains demographic information on the child and parents, including the child’s date of birth, gender, race/ethnicity, and parental education information and whether the child has a chronic health condition. It also asks for information on the number of days during the past 30 days that the child needed care or missed school because of health, the number of days the parent missed work because of the child's health, and the impact of the child's health on the parent's daily work routine and ability to concentrate at work. The PedsQL™ Family Information Form contains the demographic information required to calculate the Hollingshead socioeconomic status (SES) index (Hollingshead, 1975).
Therapeutic area
  • Generic
Therapeutic indication


Type of Clinical Outcome Assessment (COA)
  • ObsRO ObsRO
Original language(s)
  • English for the USA
Bibliographic reference(s) of the original questionnaire

Varni, J.W., Seid, M., & Kurtin, P.S. (2001).  PedsQL™ 4.0: Reliability and validity of the Pediatric Quality of Life Inventory™ Version 4.0 Generic Core Scales in healthy and patient populations.  Medical Care, 39, 800-812. 

Last update: February 2017
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