DVBCWPG3 ;ALB/RLC - REVIEW EXAM PTSD WORKSHEET TEXT ; 05/18/2006 12:00pm
;;2.7;AMIE;**87**;Apr 10, 1995;Build 6
;Per VHA Directive 10-92-142, this routine should not be modified
;
TXT ;
;;
;;M. 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.
;;TOF
;; OR
;;
;; - There is reduced reliability and productivity due to PTSD signs and
;; symptoms.
;;
;; Provide examples and pertinent symptoms, including those already reported.
;;
;; 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,
;; licensed psychologist, psychiatry resident or psychology intern,
;; LCSW, or NP); circumstances under which you performed the examination,
;; if applicable (i.e., under the close supervision of an attending
;; psychiatrist or psychologist); name of supervising psychiatrist or
;; psychologist, if applicable.
;;
;;
;;Signature: Date:
;;
;;
;;Signature of Supervising
;;psychiatrist or psychologist: Date:
;;END
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HDVBCWPG3 2905 printed Sep 23, 2025@19:29:36 Page 2
DVBCWPG3 ;ALB/RLC - REVIEW EXAM PTSD WORKSHEET TEXT ; 05/18/2006 12:00pm
+1 ;;2.7;AMIE;**87**;Apr 10, 1995;Build 6
+2 ;Per VHA Directive 10-92-142, this routine should not be modified
+3 ;
TXT ;
+1 ;;
+2 ;;M. 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 symptoms.
+9 ;;
+10 ;; Provide examples and pertinent symptoms, including those already reported.
+11 ;;
+12 ;; OR
+13 ;;
+14 ;; - PTSD signs and symptoms result in deficiencies in most of the following
+15 ;; areas:
+16 ;; work, school, family relations, judgment, thinking, and mood.
+17 ;;
+18 ;; Provide examples and pertinent symptoms, including those already
+19 ;; reported for each affected area.
+20 ;;TOF
+21 ;; OR
+22 ;;
+23 ;; - There is reduced reliability and productivity due to PTSD signs and
+24 ;; symptoms.
+25 ;;
+26 ;; Provide examples and pertinent symptoms, including those already reported.
+27 ;;
+28 ;; OR
+29 ;;
+30 ;; - There is occasional decrease in work efficiency or there are intermittent
+31 ;; periods of inability to perform occupational tasks due to signs and
+32 ;; symptoms, but generally satisfactory functioning (routine behavior,
+33 ;; self-care, and conversation normal).
+34 ;;
+35 ;; Provide examples and pertinent symptoms, including those already reported.
+36 ;;
+37 ;; OR
+38 ;;
+39 ;; - There are PTSD signs and symptoms that are transient or mild and
+40 ;; decrease work efficiency and ability to perform occupational tasks
+41 ;; only during periods of significant stress.
+42 ;;
+43 ;; Provide examples and pertinent symptoms, including those already reported.
+44 ;;
+45 ;; OR
+46 ;;
+47 ;; - PTSD symptoms require continuous medication.
+48 ;;
+49 ;; OR
+50 ;;
+51 ;; - Select all that apply.
+52 ;; - PTSD symptoms are not severe enough to require continuous medication.
+53 ;; - PTSD symptoms are not severe enough to interfere with occupational
+54 ;; and social functioning.
+55 ;;
+56 ;;
+57 ;; Include your name; your credentials, (i.e., board certified psychiatrist,
+58 ;; licensed psychologist, psychiatry resident or psychology intern,
+59 ;; LCSW, or NP); circumstances under which you performed the examination,
+60 ;; if applicable (i.e., under the close supervision of an attending
+61 ;; psychiatrist or psychologist); name of supervising psychiatrist or
+62 ;; psychologist, if applicable.
+63 ;;
+64 ;;
+65 ;;Signature: Date:
+66 ;;
+67 ;;
+68 ;;Signature of Supervising
+69 ;;psychiatrist or psychologist: Date:
+70 ;;END
