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DVBCWPF7.m

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  1. DVBCWPF7 ;ALB/RLC - INITIAL EVAL PTSD WORKSHEET TEXT ; 05/18/2006 11:00am
  1. ;;2.7;AMIE;**183**;Apr 10, 1995;Build 8
  1. ;
  1. TXT ;
  1. ;;
  1. ;;N. Effects of PTSD on Occupational and Social Functioning
  1. ;;
  1. ;;Evaluation of PTSD is based on its effects on occupational and social
  1. ;;functioning. Select the appropriate assessment of the veteran from the
  1. ;;choices below:
  1. ;;
  1. ;; - Total occupational and social impairment due to PTSD signs and
  1. ;; symptoms.
  1. ;;
  1. ;; Provide examples and pertinent symptoms, including those
  1. ;; already reported.
  1. ;;
  1. ;; OR
  1. ;;
  1. ;; - PTSD signs and symptoms result in deficiencies in most of the
  1. ;; following areas:
  1. ;; work, school, family relations, judgment, thinking, and mood.
  1. ;;
  1. ;; Provide examples and pertinent symptoms, including those already
  1. ;; reported for each affected area.
  1. ;;
  1. ;; OR
  1. ;;
  1. ;; - There is reduced reliability and productivity due to PTSD signs and
  1. ;; symptoms.
  1. ;;
  1. ;; Provide examples and pertinent symptoms, including those already
  1. ;; reported.
  1. ;;TOF
  1. ;; OR
  1. ;;
  1. ;; - There is occasional decrease in work efficiency or there are
  1. ;; intermittent periods of inability to perform occupational tasks due
  1. ;; to signs and symptoms, but generally satisfactory functioning
  1. ;; (routine behavior, self-care, and conversation normal).
  1. ;;
  1. ;; Provide examples and pertinent symptoms, including those already
  1. ;; reported.
  1. ;;
  1. ;; OR
  1. ;;
  1. ;; - There are PTSD signs and symptoms that are transient or mild and
  1. ;; decrease work efficiency and ability to perform occupational tasks
  1. ;; only during periods of significant stress.
  1. ;;
  1. ;; Provide examples and pertinent symptoms, including those already
  1. ;; reported.
  1. ;;
  1. ;; OR
  1. ;;
  1. ;; - PTSD symptoms require continuous medication.
  1. ;;
  1. ;; OR
  1. ;;
  1. ;; - Select all that apply:
  1. ;; - PTSD symptoms are not severe enough to require continuous medication.`
  1. ;; - PTSD symptoms are not severe enough to interfere with occupational
  1. ;; and social functioning.
  1. ;;
  1. ;;
  1. ;; Include your name; your credentials (i.e., board certified psychiatrist,
  1. ;; a licensed psychologist, a psychiatry resident or a psychology intern);
  1. ;; and circumstances under which you performed the examination, if applicable
  1. ;; (i.e., under the close supervision of an attending psychiatrist or
  1. ;; psychologist); include name of supervising psychiatrist or psychologist.
  1. ;;
  1. ;;
  1. ;;Signature of Examiner: Date:
  1. ;;
  1. ;;Signature of Supervising
  1. ;;psychiatrist or psychologist: Date:
  1. ;;END