©2011-2018 Open Source Electronic Health Record Alliance
This work is licensed under a Creative Commons Attribution 3.0 Unported License
This work is licensed under a Creative Commons Attribution 3.0 Unported License
DVBCWPF3 ;ALB/RLC - INITIAL EVAL PTSD WORKSHEET TEXT ; 05/18/2006 11:00am
;;2.7;AMIE;**87**;Apr 10, 1995;Build 6
;Per VHA Directive 10-92-142, this routine should not be modified
;
TXT ;
;;
;;N. Effects of PTSD on Occupational and Social Functioning
;;
;;Evaluation of PTSD is based on its effects on occupational and social
;;functioning. Select the appropriate assessment of the veteran from the
;;choices below:
;;
;; - Total occupational and social impairment due to PTSD signs and
;; symptoms.
;;
;; Provide examples and pertinent symptoms, including those
;; already reported.
;;
;; OR
;;
;; - PTSD signs and symptoms result in deficiencies in most of the
;; following areas:
;; work, school, family relations, judgement, thinking, and mood.
;;
;; Provide examples and pertinent symptoms, including those already
;; reported for each affected area.
;;
;; OR
;;
;; - There is reduced reliability and productivity due to PTSD signs and
;; symptoms.
;;
;; Provide examples and pertinent symptoms, including those already
;; reported.
;;TOF
;; OR
;;
;; - There is occasional decrease in work efficiency or there are
;; intermittent periods of inability to perform occupational tasks due
;; to signs and symptoms, but generally satisfactory functioning
;; (routine behavior, self-care, and conversation normal).
;;
;; Provide examples and pertinent symptoms, including those already
;; reported.
;;
;; OR
;;
;; - There are PTSD signs and symptoms that are transient or mild and
;; decrease work efficiency and ability to perform occupational tasks
;; only during periods of significant stress.
;;
;; Provide examples and pertinent symptoms, including those already
;; reported.
;;
;; OR
;;
;; - PTSD symptoms require continuous medication.
;;
;; OR
;;
;; - Select all that apply:
;; - PTSD symptoms are not severe enough to require continuous medication.`
;; - PTSD symptoms are not severe enough to interfere with occupational
;; and social functioning.
;;
;;
;; Include your name; your credentials (i.e., board certified psychiatrist,
;; a licensed psychologist, a psychiatry resident or a psychology intern);
;; and circumstances under which you performed the examination, if applicable
;; (i.e., under the close supervision of an attending psychiatrist or
;; psychologist); include name of supervising psychiatrist or psychologist.
;;
;;
;;Signature of Examiner: Date:
;;
;;Signature of Supervising
;;psychiatrist or psychologist: Date:
;;END