- 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 Mar 13, 2025@20:58:15 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