- DVBCWPF7 ;ALB/RLC - INITIAL EVAL PTSD WORKSHEET TEXT ; 05/18/2006 11:00am
- ;;2.7;AMIE;**183**;Apr 10, 1995;Build 8
- ;
- 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, judgment, 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
- --- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HDVBCWPF7 2952 printed Feb 18, 2025@23:19:54 Page 2
- DVBCWPF7 ;ALB/RLC - INITIAL EVAL PTSD WORKSHEET TEXT ; 05/18/2006 11:00am
- +1 ;;2.7;AMIE;**183**;Apr 10, 1995;Build 8
- +2 ;
- TXT ;
- +1 ;;
- +2 ;;N. Effects of PTSD on Occupational and Social Functioning
- +3 ;;
- +4 ;;Evaluation of PTSD is based on its effects on occupational and social
- +5 ;;functioning. Select the appropriate assessment of the veteran from the
- +6 ;;choices below:
- +7 ;;
- +8 ;; - Total occupational and social impairment due to PTSD signs and
- +9 ;; symptoms.
- +10 ;;
- +11 ;; Provide examples and pertinent symptoms, including those
- +12 ;; already reported.
- +13 ;;
- +14 ;; OR
- +15 ;;
- +16 ;; - PTSD signs and symptoms result in deficiencies in most of the
- +17 ;; following areas:
- +18 ;; work, school, family relations, judgment, thinking, and mood.
- +19 ;;
- +20 ;; Provide examples and pertinent symptoms, including those already
- +21 ;; reported for each affected area.
- +22 ;;
- +23 ;; OR
- +24 ;;
- +25 ;; - There is reduced reliability and productivity due to PTSD signs and
- +26 ;; symptoms.
- +27 ;;
- +28 ;; Provide examples and pertinent symptoms, including those already
- +29 ;; reported.
- +30 ;;TOF
- +31 ;; OR
- +32 ;;
- +33 ;; - There is occasional decrease in work efficiency or there are
- +34 ;; intermittent periods of inability to perform occupational tasks due
- +35 ;; to signs and symptoms, but generally satisfactory functioning
- +36 ;; (routine behavior, self-care, and conversation normal).
- +37 ;;
- +38 ;; Provide examples and pertinent symptoms, including those already
- +39 ;; reported.
- +40 ;;
- +41 ;; OR
- +42 ;;
- +43 ;; - There are PTSD signs and symptoms that are transient or mild and
- +44 ;; decrease work efficiency and ability to perform occupational tasks
- +45 ;; only during periods of significant stress.
- +46 ;;
- +47 ;; Provide examples and pertinent symptoms, including those already
- +48 ;; reported.
- +49 ;;
- +50 ;; OR
- +51 ;;
- +52 ;; - PTSD symptoms require continuous medication.
- +53 ;;
- +54 ;; OR
- +55 ;;
- +56 ;; - Select all that apply:
- +57 ;; - PTSD symptoms are not severe enough to require continuous medication.`
- +58 ;; - PTSD symptoms are not severe enough to interfere with occupational
- +59 ;; and social functioning.
- +60 ;;
- +61 ;;
- +62 ;; Include your name; your credentials (i.e., board certified psychiatrist,
- +63 ;; a licensed psychologist, a psychiatry resident or a psychology intern);
- +64 ;; and circumstances under which you performed the examination, if applicable
- +65 ;; (i.e., under the close supervision of an attending psychiatrist or
- +66 ;; psychologist); include name of supervising psychiatrist or psychologist.
- +67 ;;
- +68 ;;
- +69 ;;Signature of Examiner: Date:
- +70 ;;
- +71 ;;Signature of Supervising
- +72 ;;psychiatrist or psychologist: Date:
- +73 ;;END