{"aaData": [["1", "
\n \nComplete Examination Procedure before making ratings.\n \nMOVEMENT RATINGS: Rate highest severity observed. Rate movements that\noccur upon activation one LESS than those observed spontaneously.\n
\n
\n"], ["10", "
\nThis questionnaire consists of 21 groups of statements.  Please read each\ngroup of statements carefully, and then pick out the one statement in\neach group that best describes the way you have been feeling during the\nPAST TWO WEEKS, INCLUDING TODAY. Select the number beside the statement\nyou have picked.  If several statements in the group seem to apply equally\nwell, select the highest number for that group.\n
\n
\n"], ["100", "
\nWhich of the patterns below best describes your team's typical frequency of contact with this veteran, his or her family, and others on his or her behalf in the past six months?\n
\n
\n"], ["1000", "
\nIntroduction for track bar\n
\n
\n"], ["1001", "
\nIntroduction for track bar\n
\n
\n"], ["1002", "
\nIntroduction for track bar\n
\n
\n"], ["1003", "
\nIntroduction for track bar\n
\n
\n"], ["1004", "
\nIntroduction for track bar\n
\n
\n"], ["1005", "
\nIntroduction for track bar\n
\n
\n"], ["1006", "
\nIntroduction for track bar\n
\n
\n"], ["1007", "
\nIntroduction for 9.\n
\n
\n"], ["1008", "
\nIntroduction for 9.\n
\n
\n"], ["1009", "
\nIntroduction for 9.\n
\n
\n"], ["101", "
\nThe followeing items depict different ways you might think or feel about this veteran. Please review each statement, inserting the veteran's name in place of ____ in the text. Think about your \nexperiences with this veteran over the past six months. Check the rating that best describes, all in all, how often you feel or think that way about ____ and your work together.\n
\n
\n"], ["1010", "
\nIntroduction for 9.\n
\n
\n"], ["1011", "
\nIntroduction for 9.\n
\n
\n"], ["1012", "
\nIntroduction for 9.\n
\n
\n"], ["1013", "
\nIntroduction for 9.\n
\n
\n"], ["1014", "
\nIntroduction for 9.\n
\n
\n"], ["1015", "
\nIntroduction for 9.\n
\n
\n"], ["1016", "
\nIntroduction for 9.\n
\n
\n"], ["1017", "
\nIntroduction for 9.\n
\n
\n"], ["1018", "
\nIntroduction for 9.\n
\n
\n"], ["1019", "
\nIntroduction for 21: \n
\n
\n"], ["102", "
\nWhich of the patterns below best describes your team's typical frequency of contact with this veteran, his or her family, and others on his or her behalf in the past six months?\n
\n
\n"], ["1020", "
\nIntroduction for 10: \n
\n
\n"], ["1021", "
\nSelect all that apply. (At least one item must be selected.)\n
\n
\n"], ["1022", "
\nIntroduction for radio group 2: \n
\n
\n"], ["1023", "
\nIntroduction for 12: \n
\n
\n"], ["1024", "
\nIntroduction for 2 radio grpup: \n
\n
\n"], ["1025", "
\nIntroduction for 10: \n
\n
\n"], ["1026", "
\nIntroduction for group radio 2: \n
\n
\n"], ["1027", "
\nIntroduction for 10: \n
\n
\n"], ["1028", "
\nIntroduction for 10: \n
\n
\n"], ["1029", "
\nIntroduction for 10: \n
\n
\n"], ["103", "
\nThe followeing items depict different ways you might think or feel about this veteran. Please review each statement, inserting the veteran's name in place of ____ in the text. Think about your \nexperiences with this veteran over the past six months. Check the rating that best describes, all in all, how often you feel or think that way about ____ and your work together.\n
\n
\n"], ["1030", "
\nIntroduction for 10: \n
\n
\n"], ["1031", "
\nIntroduction for 10: \n
\n
\n"], ["1032", "
\nIntroduction for 10: \n
\n
\n"], ["1033", "
\nIntroduction for 10: \n
\n
\n"], ["1034", "
\nIntroduction for 10: \n
\n
\n"], ["1035", "
\nIntroduction for 10: \n
\n
\n"], ["1036", "
\nWWIntroduction: \n
\n
\n"], ["1037", "
\nWWIntroduction: \n
\n
\n"], ["1038", "
\nIntroduction for edit 9. \n
\n
\n"], ["1039", "
\nIntroduction for edit 9. \n
\n
\n"], ["104", "
\nWhich of the patterns below best describes your team's typical frequency of contact with this veteran, his or her family, and others on his or her behalf in the past six months?\n
\n
\n"], ["1040", "
\nFor each area of functioning listed below, check description that applies.\n(The word "assistance" means supervision, direction of personal assistance.)\n
\n
\n"], ["1041", "
\n4. In the past 30 days, how many days did you use any of the following drugs:  \n
\n
\n"], ["1042", "
\nBelow is a list of statements that describe how people sometimes feel about themselves and their lives. Please read each one carefully and indicate the response that best describes the extent to   \nwhich you agree or disagree with the statement. \n
\n
\n"], ["1043", "
\nBelow is a list of statements that describe how people sometimes feel about themselves and their lives. Please read each one carefully and indicate the response that best describes the extent to   \nwhich you agree or disagree with the statement.  \n
\n
\n"], ["1044", "
\nThis inventory consists of numbered statements. Read each statement and decide whether it is true as applied to you or false as applied to you. If a statement is true or mostly true as applied to  \nyou, choose "True." If a statement is false or not usually true as applied to you, choose "False." If a statement does not apply to you or if it is something that you don't know about, go ahead to  \nthe next statement. But try to give a response to every statement. Remember to give your own opinion of yourself. Remember, try to respond to every statement. \n
\n
\n"], ["1045", "
\nThis inventory consists of numbered statements. Read each statement and decide whether it is true as applied to you or false as applied to you. If a statement is true or mostly true as applied to  \nyou, choose "True." If a statement is false or not usually true as applied to you, choose "False." If a statement does not apply to you or if it is something that you don't know about, go ahead to  \nthe next statement. But try to give a response to every statement. Remember to give your own opinion of yourself. Remember, try to respond to every statement. \n
\n
\n"], ["1046", "
\nBelow you will find a list of statements. Please rate how true each statement is for you. \n
\n
\n"], ["1047", "
\nChoose the scoring point for the statement that most closely corresponds to the patient's current level of ability for each of the following 10 items. Record actual, not potential, functioning.   \nInformation can be obtained from the patient's self-report, from a separate party who is familiar with the patient's abilities (such as a relative), or from observation.  \n
\n
\n"], ["1048", "
\nThis inventory consists of numbered statements. Read each statement and decide whether it is true as applied to you or false as applied to you. If a statement is true or mostly true as applied to  \nyou, choose "True." If a statement is false or not usually true as applied to you, choose "False." If a statement does not apply to you or if it is something that you don't know about, go ahead to  \nthe next statement. But try to give a response to every statement. Remember to give your own opinion of yourself. Remember, try to respond to every statement.  \n
\n
\n"], ["1049", "
\nThis inventory consists of numbered statements. Read each statement and decide whether it is true as applied to you or false as applied to you. If a statement is true or mostly true as applied to   \nyou, choose "True." If a statement is false or not usually true as applied to you, choose "False." If a statement does not apply to you or if it is something that you don't know about, go ahead to   \nthe next statement. But try to give a response to every statement. Remember to give your own opinion of yourself. Remember, try to respond to every statement.  \n
\n
\n"], ["105", "
\nThe followeing items depict different ways you might think or feel about this veteran. Please review each statement, inserting the veteran's name in place of ____ in the text. Think about your \nexperiences with this veteran over the past six months. Check the rating that best describes, all in all, how often you feel or think that way about ____ and your work together.\n
\n
\n"], ["1050", "
\nInstructions|This is a standard set of questions about several areas of your life such as your health, alcohol and drug use, etc. The questions generally ask about the past 30 days. Please consider   \neach question and answer as accurately as possible.|  \n
\n
\n"], ["1051", "
\n7. In the past 30 days, how many days did you use any of the following drugs:  \n
\n
\n"], ["1052", "
\nInstructions|This is a standard set of questions about several areas of your life such as your health, alcohol and drug use, etc. The questions generally ask about the past 7 days. Please consider   \neach question and answer as accurately as possible. \n
\n
\n"], ["1053", "
\n7. In the past 7 days, how many days did you use any of the following drugs: \n
\n
\n"], ["1054", "
\nInstructions|This is a standard set of questions about several areas of your life such as your health, alcohol and drug use, etc. The questions generally ask about the past 7 days. Please consider   \neach question and answer as accurately as possible.  \n
\n
\n"], ["1055", "
\n7. In the past 7 days, how many days did you use any of the following drugs:  \n
\n
\n"], ["1056", "
\nInstructions|This is a standard set of questions about several areas of your life such as your health, alcohol and drug use, etc. The questions generally ask about the past 7 days. Please consider   \neach question and answer as accurately as possible.  \n
\n
\n"], ["1057", "
\n7. In the past 7 days, how many days did you use any of the following drugs:  \n
\n
\n"], ["1058", "
\nInstructions|This is a standard set of questions about alcohol and drug use in the past 30 days. Please answer the requested items as accurately as possible and indicate the method of assessment in   \nitem B above.|  \n
\n
\n"], ["1059", "
\n4. In the past 30 days, how many days did you use any of the following drugs:  \n
\n
\n"], ["106", "
\nWhich of the following, in your clinical judgement, are reasons why this veteran terminated involvement with your program, or never became significantly involved in the first place? ("Termination" \ndoes NOT necessarily preclude efforts to contact veteran.)\n
\n
\n"], ["1060", "
\nInstructions|This is a standard set of questions about alcohol and drug use in the past 30 days. Please answer the requested items as accurately as possible and indicate the method of assessment in   \nitem B above.|  \n
\n
\n"], ["1061", "
\n4. In the past 30 days, how many days did you use any of the following drugs:  \n
\n
\n"], ["1062", "
\nInstructions|This is a standard set of questions about several areas of your life such as your health, alcohol and drug use, etc. The questions generally ask about the past 7 days. Please consider   \neach question and answer as accurately as possible.  \n
\n
\n"], ["1063", "
\n7. In the past 7 days, how many days did you use any of the following drugs:  \n
\n
\n"], ["1064", "
\nInstructions|This is a standard set of questions about alcohol and drug use in the past 30 days. Please answer the requested items as accurately as possible and indicate the method of assessment in   \nitem B above.|  \n
\n
\n"], ["1065", "
\n4. In the past 30 days, how many days did you use any of the following drugs:  \n
\n
\n"], ["1066", "
\nThe administration of the Montreal Cognitive Assessment requires the use of a pencil-and-paper answer sheet. Please be familiar with the instructions and scoring of this instrument prior to\nadministration. The subject's scores are recorded here so that the administration can be saved in VistA.\n
\n
\n"], ["1067", "
\n3. Draw a clock. Put in all the numbers and set the time to 10 past 11. \n
\n
\n"], ["1068", "
\n4. Naming pictured animal. \n
\n
\n"], ["1069", "
\nRead list of words to be recalled.||5. Attention \n
\n
\n"], ["107", "
\nWhich of the patterns below best describes your team's typical frequency of contact with this veteran, his or her family, and others on his or her behalf in the past six months?\n
\n
\n"], ["1070", "
\n6. Language \n
\n
\n"], ["1071", "
\n8. Abstraction \n
\n
\n"], ["1072", "
\n9. Delayed Recall \n
\n
\n"], ["1073", "
\n10. Orientation \n
\n
\n"], ["1074", "
\nThe administration of the Montreal Cognitive Assessment requires the use of a pencil-and-paper answer sheet. Please be familiar with the instructions and scoring of this instrument prior to\nadministration. The subject's scores are recorded here so that the administration can be saved in VistA.\n
\n
\n"], ["1075", "
\n3. Draw a clock. Put in all the numbers and set the time to 5 past 4.  \n
\n
\n"], ["1076", "
\n4. Naming pictured animal.  \n
\n
\n"], ["1077", "
\nRead list of words to be recalled.||5. Attention  \n
\n
\n"], ["1078", "
\n6. Language  \n
\n
\n"], ["1079", "
\n8. Abstraction  \n
\n
\n"], ["108", "
\nThis survey asks about how you are feeling and doing in different areas of life. Please check the item that best describes yourself during the PAST WEEK. Please answer every question. If you are   unsure about how to answer, please give the best answer you can.        During the PAST WEEK, how much difficulty did you have. . .  \n
\n
\n"], ["1080", "
\n9. Delayed Recall  \n
\n
\n"], ["1081", "
\n10. Orientation  \n
\n
\n"], ["1082", "
\nThe administration of the Montreal Cognitive Assessment requires the use of a pencil-and-paper answer sheet. Please be familiar with the instructions and scoring of this instrument prior to\nadministration. The subject's scores are recorded here so that the administration can be saved in VistA.\n
\n
\n"], ["1083", "
\n3. Draw a clock. Put in all the numbers and set the time to 10 past 9.  \n
\n
\n"], ["1084", "
\n4. Naming pictured animals.  \n
\n
\n"], ["1085", "
\nRead list of words to be recalled.||5. Attention  \n
\n
\n"], ["1086", "
\n6. Language  \n
\n
\n"], ["1087", "
\n8. Abstraction  \n
\n
\n"], ["1088", "
\n9. Delayed Recall  \n
\n
\n"], ["1089", "
\n10. Orientation  \n
\n
\n"], ["109", "
\nPlease answer the following questions True or False. Press '1' if the answer is True or Mostly True. Press '2' if the answer is False or Mostly False.\n
\n
\n"], ["1090", "
\nInstructions|This is a standard set of questions about alcohol and drug use in the past 30 days. Please answer the requested items as accurately as possible and indicate the method of assessment in   \nitem B above.|  \n
\n
\n"], ["1091", "
\n4. In the past 30 days, how many days did you use any of the following drugs:  \n
\n
\n"], ["1092", "
\nInstructions|This is a standard set of questions about alcohol and drug use in the past 30 days. Please answer the requested items as accurately as possible and indicate the method of assessment in \nitem B above.|  \n
\n
\n"], ["1093", "
\n4. In the past 30 days, how many days did you use any of the following drugs:  \n
\n
\n"], ["1094", "
\nInstructions|This is a standard set of questions about several areas of your life such as your health, alcohol and drug use, etc. The questions generally ask about the past 30 days. Please consider   \neach question and answer as accurately as possible.|  \n
\n
\n"], ["1095", "
\n7. In the past 30 days, how many days did you use any of the following drugs:  \n
\n
\n"], ["1096", "
\nInstructions|This is a standard set of questions about several areas of your life such as your health, alcohol and drug use, etc. The questions generally ask about the past 30 days. Please consider \neach question and answer as accurately as possible.|  \n
\n
\n"], ["1097", "
\n7. In the past 30 days, how many days did you use any of the following drugs:  \n
\n
\n"], ["1098", "
\nThis survey asks about how you are feeling and doing in different areas of life. Please check the item that best describes yourself during the PAST WEEK. Please answer every question. If you are   \nunsure about how to answer, please give the best answer you can. During the PAST WEEK, how much difficulty did you have. . .   \n
\n
\n"], ["1099", "
\nDuring the PAST WEEK, how much of the time did you. . .  \n
\n
\n"], ["11", "
\nThis questionnaire consists of 20 statements.  Please read each statement\ncarefully.  If the statement describes your attitude for the PAST WEEK\nINCLUDING TODAY, select '1' indicating True. If the statement does not\ndescribe your attitude select '2' indicating False.  Please read each\nstatement carefully.\n
\n
\n"], ["110", "
\nPlease read each group of statements carefully.  Select the one statement\nin each group that BEST describes how you have been feeling for the PAST\nWEEK, INCLUDING TODAY. Be sure to read all of the statements in each\ngroup before making a choice.\n
\n
\n"], ["1100", "
\nDuring the PAST WEEK, how often did you. . .  \n
\n
\n"], ["1101", "
\nDuring the PAST WEEK, how often. . .  \n
\n
\n"], ["1102", "
\nIntroduction: The questions in this scale ask you about your feelings and thoughts during the last month. In each |case, you will be asked to indicate by circling how often you felt or thought a  \ncertain way.||0 = Never 1 = Almost Never 2 = Sometimes 3 = Fairly Often 4 = Very Often  \n
\n
\n"], ["1103", "
\nIntroduction: The questions in this scale ask you about your feelings and thoughts during the last month. In each |case, you will be asked to indicate by circling how often you felt or thought a  \ncertain way.||0 = Never 1 = Almost Never 2 = Sometimes 3 = Fairly Often 4 = Very Often  \n
\n
\n"], ["1104", "
\nIntroduction: Assess the following factors. \n
\n
\n"], ["1105", "
\nIntroduction: Assess the following factors. \n
\n
\n"], ["1106", "
\nIntroduction: Assess the following factors.  \n
\n
\n"], ["1107", "
\nIntroduction: Assess the following factors.  \n
\n
\n"], ["1108", "
\nIntroduction: Assess the following factors. \n
\n
\n"], ["1109", "
\nIntroduction: Assess the following factors. \n
\n
\n"], ["111", "
\nComplete all of the following statements by answering 1 for Yes, 2 for No -- based on how you have felt during the past few days.\n
\n
\n"], ["1110", "
\nIntroduction: The questions in this scale ask you about your feelings and thoughts during the last month. In each |case, you will be asked to indicate by circling how often you felt or thought a   \ncertain way.||0 = Never 1 = Almost Never 2 = Sometimes 3 = Fairly Often 4 = Very Often  \n
\n
\n"], ["1111", "
\nIntroduction: Assess the following factors.  \n
\n
\n"], ["1112", "
\nIntroduction: Assess the following factors.  \n
\n
\n"], ["1113", "
\nIntroduction: The questions in this scale ask you about your feelings and thoughts during the last month.  \n
\n
\n"], ["1114", "
\nIntroduction: The questions in this scale ask you about your feelings and thoughts during the last month.  \n
\n
\n"], ["1115", "
\nSeveral statements reflecting people's beliefs and attitudes about sleep are listed below. Please indicate to what extent you personally agree or disagree with each statement. There is no right or  \nwrong answer. For each statement, select the number that corresponds to your own personal belief. Please respond to all items even though some may not apply directly to your own situation. \n
\n
\n"], ["1116", "
\nIntroduction: Assess the following factors.  \n
\n
\n"], ["1117", "
\nThe following questions ask how you feel about your quality of life, health, or other areas of your life. I will read out each question to you, along with the response options. Please choose the  \nanswer that appears most appropriate. If you are unsure about which response to give to a question, the first response you think of is often the best one. Please keep in mind your standards, hopes,  \npleasures and concerns. We ask that you think about your life in the last four weeks. \n
\n
\n"], ["1118", "
\nThe following questions ask about how much you have experienced certain things in the last four weeks. \n
\n
\n"], ["1119", "
\nThe following questions ask about how completely you experience or were able to do certain things in the last four weeks. \n
\n
\n"], ["112", "
\nPlease read each item carefully and answer each question as it pertains to you.\n
\n
\n"], ["1120", "
\nThe following question refers to how often you have felt or experienced certain things in the last four weeks. \n
\n
\n"], ["1121", "
\nIntroduction: Assess the following factors.  \n
\n
\n"], ["1122", "
\nIntroduction: Assess the following factors.  \n
\n
\n"], ["1123", "
\nPlease rate the CURRENT (i.e. LAST 2 WEEKS) SEVERITY of your insomnia problem(s). \n
\n
\n"], ["1124", "
\nPlease rate the CURRENT (i.e. LAST 2 WEEKS) SEVERITY of your insomnia problem(s). \n
\n
\n"], ["1125", "
\nPlease rate the CURRENT (i.e. LAST 2 WEEKS) SEVERITY of your insomnia problem(s).  \n
\n
\n"], ["1126", "
\nPlease rate the CURRENT (i.e. LAST 2 WEEKS) SEVERITY of your insomnia problem(s).  \n
\n
\n"], ["1127", "
\nPlease rate the CURRENT (i.e. LAST 2 WEEKS) SEVERITY of your insomnia problem(s).  \n
\n
\n"], ["1128", "
\nPlease rate the CURRENT (i.e. LAST 2 WEEKS) SEVERITY of your insomnia problem(s).  \n
\n
\n"], ["1129", "
\nPlease rate the CURRENT (i.e. LAST 2 WEEKS) SEVERITY of your insomnia problem(s).  \n
\n
\n"], ["113", "
\nRead each of the questions carefully and indicate how often you felt that way during the past week.\n
\n
\n"], ["1130", "
\nIntroduction: Assess the following factors.  \n
\n
\n"], ["1131", "
\nInstructions: Below are some ways that you might think, feel, and act when faced with problems in everyday living. We are not talking about the ordinary hassles and pressures that you handle  \nsuccessfully every day. In the questionnaire, a problem is something important in your life that brothers you a lot, but you don't immediately know how to make it better or stop it from brothering  \nyou so much. The problem could be something about yourself (such as your thoughts, feelings, behavior, health, or appearance), your relationships with other people (such as your family, friends,  \nteachers, or boss), or your environment and the things you own (such as your house, car, property, or money). Please read each statement carefully and choose one of the answers. See yourself as you  \nusually think, feel and act when you are faced important problems in life these days. \n
\n
\n"], ["1132", "
\nIn the past week: \n
\n
\n"], ["1133", "
\nIn the past week: \n
\n
\n"], ["1134", "
\nIn the past week: \n
\n
\n"], ["1135", "
\nMorningness/Eveningness||For each item, please check one response that best describes you.| \n
\n
\n"], ["1136", "
\nMorningness/Eveningness||For each item, please check one response that best describes you.| \n
\n
\n"], ["1137", "
\nMorningness/Eveningness||For each item, please check one response that best describes you.| \n
\n
\n"], ["1138", "
\nMorningness/Eveningness||For each item, please check one response that best describes you.| \n
\n
\n"], ["1139", "
\nMorningness/Eveningness||For each item, please check one response that best describes you.|  \n
\n
\n"], ["114", "
\nHave you ever had any experience that was so frightening, horrible or upsetting that, IN THE PAST MONTH, you:\n
\n
\n"], ["1140", "
\nMorningness/Eveningness||For each item, please check one response that best describes you.|  \n
\n
\n"], ["1141", "
\nMorningness/Eveningness||For each item, please check one response that best describes you.|  \n
\n
\n"], ["1142", "
\nMorningness/Eveningness||For each item, please check one response that best describes you.|  \n
\n
\n"], ["1143", "
\nThese questions are about how you have been FEELING during the past 4 weeks. For each question, please give the one answer that comes closest to the way you have been feeling. \n
\n
\n"], ["1144", "
\nHow much of the time during the past 4 weeks your epilepsy or antiepileptic drugs have caused trouble with: \n
\n
\n"], ["1145", "
\nDuring the past 4 weeks: \n
\n
\n"], ["1146", "
\nThese questions are about how you have been FEELING during the past 4 weeks. For each question, please give the one answer that comes closest to the way you have been feeling. \n
\n
\n"], ["1147", "
\nHow much of the time during the past 4 weeks your epilepsy or antiepileptic drugs have caused trouble with: \n
\n
\n"], ["1148", "
\nDuring the past 4 weeks: \n
\n
\n"], ["1149", "
\nThese questions are about how you have been FEELING during the past 4 weeks. For each question, please give the one answer that comes closest to the way you have been feeling. \n
\n
\n"], ["115", "
\nIntroduction: \n
\n
\n"], ["1150", "
\nHow much of the time during the past 4 weeks your epilepsy or antiepileptic drugs have caused trouble with: \n
\n
\n"], ["1151", "
\nDuring the past 4 weeks: \n
\n
\n"], ["1152", "
\nThese questions are about how you have been FEELING during the past 4 weeks. For each question, please give the one answer that comes closest to the way you have been feeling.  \n
\n
\n"], ["1153", "
\nHow much of the time during the past 4 weeks your epilepsy or antiepileptic drugs have caused trouble with:  \n
\n
\n"], ["1154", "
\nDuring the past 4 weeks: \n
\n
\n"], ["1155", "
\nThese questions are about how you have been FEELING during the past 4 weeks. \n
\n
\n"], ["1156", "
\nHow much of the time during the past 4 weeks your epilepsy or antiepileptic drugs have caused trouble with:  \n
\n
\n"], ["1157", "
\nDuring the past 4 weeks: \n
\n
\n"], ["1158", "
\nIn your life, have you ever had any experience that was so frightening, horrible, or upsetting that, in the past month, you: \n
\n
\n"], ["1159", "
\nPlease read each item carefully and give the answer that best corresponds to your agreement or disagreement.  Type 1 if the statement is definitely false or if you strongly disagree. Type 2 if the  \nstatement is mostly false or if you disagree. Type 3 if the statement is about equally true or false, if you cannot decide, or if you are neutral on the statement. Type 4 if the statement is mostly  \ntrue or if you agree. Type 5 if the statement is definitely true or if you strongly agree.  \n
\n
\n"], ["116", "
\nThe followeing items depict different ways you might think or feel about this veteran. Please review each statement, inserting the veteran's name in place of ____ in the text. Think about your \nexperiences with this veteran over the past six months. Check the rating that best describes, all in all, how often you feel or think that way about ____ and your work together.\n
\n
\n"], ["1160", "
\nPlease read each item carefully and give the answer that best corresponds to your agreement or disagreement. Type 1 if the statement is definitely false or if you strongly disagree. Type 2 if the   \nstatement is mostly false or if you disagree. Type 3 if the statement is about equally true or false, if you cannot decide, or if you are neutral on the statement. Type 4 if the statement is mostly   \ntrue or if you agree. Type 5 if the statement is definitely true or if you strongly agree.  \n
\n
\n"], ["1161", "
\nPlease read each item carefully and give the answer that best corresponds to your agreement or disagreement. Type 1 if the statement is definitely false or if you strongly disagree. Type 2 if the   \nstatement is mostly false or if you disagree. Type 3 if the statement is about equally true or false, if you cannot decide, or if you are neutral on the statement. Type 4 if the statement is mostly   \ntrue or if you agree. Type 5 if the statement is definitely true or if you strongly agree.  \n
\n
\n"], ["1162", "
\nPlease read each item carefully and give the answer that best corresponds to your agreement or disagreement. Type 1 if the statement is definitely false or if you strongly disagree. Type 2 if the   \nstatement is mostly false or if you disagree. Type 3 if the statement is about equally true or false, if you cannot decide, or if you are neutral on the statement. Type 4 if the statement is mostly   \ntrue or if you agree. Type 5 if the statement is definitely true or if you strongly agree.  \n
\n
\n"], ["1163", "
\nPlease read each item carefully and give the answer that best corresponds to your agreement or disagreement. Type 1 if the statement is definitely false or if you strongly disagree. Type 2 if the   \nstatement is mostly false or if you disagree. Type 3 if the statement is about equally true or false, if you cannot decide, or if you are neutral on the statement. Type 4 if the statement is mostly   \ntrue or if you agree. Type 5 if the statement is definitely true or if you strongly agree.  \n
\n
\n"], ["1164", "
\nPlease read each item carefully and give the answer that best corresponds to your agreement or disagreement. Type 1 if the statement is definitely false or if you strongly disagree. Type 2 if the   \nstatement is mostly false or if you disagree. Type 3 if the statement is about equally true or false, if you cannot decide, or if you are neutral on the statement. Type 4 if the statement is mostly   \ntrue or if you agree. Type 5 if the statement is definitely true or if you strongly agree.  \n
\n
\n"], ["1165", "
\nPlease read each statement carefully and decide whether it is true as applied to you or false as applied to you.  If a statement is true or mostly true, as applied to you, answer '1'. If a statement  \nis false or not usually true, as applied to you, answer '2'.  Remember to give your own opinion of yourself. \n
\n
\n"], ["1166", "
\nPlease read each statement carefully and decide whether it is true as applied to you or false as applied to you.  If a statement is true or mostly true, as applied to you, answer '1'. If a statement  \nis false or not usually true, as applied to you, answer '2'.  Remember to give your own opinion of yourself. \n
\n
\n"], ["1167", "
\nPlease read each statement carefully and decide whether it is true as applied to you or false as applied to you.  If a statement is true or mostly true, as applied to you, answer '1'. If a statement  \nis false or not usually true, as applied to you, answer '2'.  Remember to give your own opinion of yourself. \n
\n
\n"], ["1168", "
\nPlease read each statement carefully and decide whether it is true as applied to you or false as applied to you.  If a statement is true or mostly true, as applied to you, answer '1'. If a statement  \nis false or not usually true, as applied to you, answer '2'.  Remember to give your own opinion of yourself. \n
\n
\n"], ["1169", "
\nPlease read each statement carefully and decide whether it is true as applied to you or false as applied to you. If a statement is true or mostly true, as applied to you, answer '1'. If a statement   \nis false or not usually true, as applied to you, answer '2'. Remember to give your own opinion of yourself.  \n
\n
\n"], ["117", "
\nNote: MHICM veterans typically receive intensive services for at least a year or until they meet all criteria below.\n
\n
\n"], ["1170", "
\nPlease read each statement carefully and decide whether it is true as applied to you or false as applied to you. If a statement is true or mostly true, as applied to you, answer '1'. If a statement   \nis false or not usually true, as applied to you, answer '2'. Remember to give your own opinion of yourself.  \n
\n
\n"], ["1171", "
\nPlease read each statement carefully and decide whether it is true as applied to you or false as applied to you. If a statement is true or mostly true, as applied to you, answer '1'. If a statement   \nis false or not usually true, as applied to you, answer '2'. Remember to give your own opinion of yourself.  \n
\n
\n"], ["1172", "
\nPlease read each statement carefully and decide whether it is true as applied to you or false as applied to you. If a statement is true or mostly true, as applied to you, answer '1'. If a statement   \nis false or not usually true, as applied to you, answer '2'. Remember to give your own opinion of yourself.  \n
\n
\n"], ["1173", "
\nPlease read each statement carefully and decide whether it is true as applied to you or false as applied to you. If a statement is true or mostly true, as applied to you, answer '1'. If a statement   \nis false or not usually true, as applied to you, answer '2'. Remember to give your own opinion of yourself.  \n
\n
\n"], ["1174", "
\nPlease read each statement carefully and decide whether it is true as applied to you or false as applied to you. If a statement is true or mostly true, as applied to you, answer '1'. If a statement   \nis false or not usually true, as applied to you, answer '2'. Remember to give your own opinion of yourself.  \n
\n
\n"], ["1175", "
\nPlease read each statement carefully and decide whether it is true as applied to you or false as applied to you. If a statement is true or mostly true, as applied to you, answer '1'. If a statement   \nis false or not usually true, as applied to you, answer '2'. Remember to give your own opinion of yourself.  \n
\n
\n"], ["1176", "
\nPlease read each statement carefully and decide whether it is true as applied to you or false as applied to you. If a statement is true or mostly true, as applied to you, answer '1'. If a statement   \nis false or not usually true, as applied to you, answer '2'. Remember to give your own opinion of yourself.  \n
\n
\n"], ["1177", "
\nRead each statement and decide if it is an accurate statement about you.  Type a 1 if the statement is FALSE, NOT AT ALL TRUE. Type a 2 if the statement is SLIGHTLY TRUE. Type a 3 if the statement is  \nMAINLY TRUE. Type a 4 if the statement is VERY TRUE.  Give your own opinion of yourself. Be sure to answer every statement. \n
\n
\n"], ["1178", "
\nRead each statement and decide if it is an accurate statement about you.  Type a 1 if the statement is FALSE, NOT AT ALL TRUE. Type a 2 if the statement is SLIGHTLY TRUE. Type a 3 if the statement is  \nMAINLY TRUE. Type a 4 if the statement is VERY TRUE.  Give your own opinion of yourself. Be sure to answer every statement. \n
\n
\n"], ["1179", "
\nRead each statement and decide if it is an accurate statement about you.  Type a 1 if the statement is FALSE, NOT AT ALL TRUE. Type a 2 if the statement is SLIGHTLY TRUE. Type a 3 if the statement is  \nMAINLY TRUE. Type a 4 if the statement is VERY TRUE.  Give your own opinion of yourself. Be sure to answer every statement. \n
\n
\n"], ["118", "
\nWhich criteria for less intensive services did this veteran meet?\n
\n
\n"], ["1180", "
\nRead each statement and decide if it is an accurate statement about you.  Type a 1 if the statement is FALSE, NOT AT ALL TRUE. Type a 2 if the statement is SLIGHTLY TRUE. Type a 3 if the statement is  \nMAINLY TRUE. Type a 4 if the statement is VERY TRUE.  Give your own opinion of yourself. Be sure to answer every statement. \n
\n
\n"], ["1181", "
\nRead each statement and decide if it is an accurate statement about you.  Type a 1 if the statement is FALSE, NOT AT ALL TRUE. Type a 2 if the statement is SLIGHTLY TRUE. Type a 3 if the statement is  \nMAINLY TRUE. Type a 4 if the statement is VERY TRUE.  Give your own opinion of yourself. Be sure to answer every statement. \n
\n
\n"], ["1182", "
\nRead each statement and decide if it is an accurate statement about you.  Type a 1 if the statement is FALSE, NOT AT ALL TRUE. Type a 2 if the statement is SLIGHTLY TRUE. Type a 3 if the statement is  \nMAINLY TRUE. Type a 4 if the statement is VERY TRUE.  Give your own opinion of yourself. Be sure to answer every statement. \n
\n
\n"], ["1183", "
\nRead each statement and decide if it is an accurate statement about you. Type a 1 if the statement is FALSE, NOT AT ALL TRUE. Type a 2 if the statement is SLIGHTLY TRUE. Type a 3 if the statement is   \nMAINLY TRUE. Type a 4 if the statement is VERY TRUE. Give your own opinion of yourself. Be sure to answer every statement.  \n
\n
\n"], ["1184", "
\nRead each statement and decide if it is an accurate statement about you. Type a 1 if the statement is FALSE, NOT AT ALL TRUE. Type a 2 if the statement is SLIGHTLY TRUE. Type a 3 if the statement is   \nMAINLY TRUE. Type a 4 if the statement is VERY TRUE. Give your own opinion of yourself. Be sure to answer every statement.  \n
\n
\n"], ["1185", "
\nMoving Forward: A Problem Solving Approach to Achieving Life's Goals \n
\n
\n"], ["1186", "
\nThe following are six statements about how you generally react to stressful events. Please indicate the extent to which you agree with each of these statements by using the following scale \n
\n
\n"], ["1187", "
\nPlease rate each response on the scale below relating to your most recent session with your counselor.| \n
\n
\n"], ["1188", "
\nIn your session, how much did your counselor: \n
\n
\n"], ["1189", "
\nIn the past week:  \n
\n
\n"], ["119", "
\nIn view of this veteran's stability, what treatment change was made?\n
\n
\n"], ["1190", "
\nBased on the previous week: \n
\n
\n"], ["1191", "
\nBased on the previous week: \n
\n
\n"], ["1192", "
\nFor each of the following items, select the answer that best describes how you feel about your relationship.  Base your responses on your first impressions and immediate feelings about the item. \n
\n
\n"], ["1193", "
\nFor each of the following items, select the answer that best describes how you feel about your relationship. Base your responses on your first impressions and immediate feelings about the item.  \n
\n
\n"], ["1194", "
\nPlease read each statement carefully, and decide how well it describes you own family. You should answer according to how you see your family.| \n
\n
\n"], ["1195", "
\nPlease read each statement carefully, and decide how well it describes you own family. You should answer according to how you see your family.| \n
\n
\n"], ["1196", "
\nPlease read each statement carefully, and decide how well it describes you own family. You should answer according to how you see your family.|  \n
\n
\n"], ["1197", "
\nPlease read each statement carefully, and decide how well it describes you own family. You should answer according to how you see your family.|  \n
\n
\n"], ["1198", "
\nPlease read each statement carefully, and decide how well it describes you own family. You should answer according to how you see your family.|  \n
\n
\n"], ["1199", "
\n|Please take a few minutes to fill out this survey. We are interested in the way things are for you, so there are no right or wrong answers. If you are unsure about a question, just answer it as well  \nas you can. Check the box for the answer that best fits you. \n
\n
\n"], ["12", "
\nIndicate the degree to which each of the following items\ndescribes the patient's present condition.\n
\n
\n"], ["120", "
\nWere intensive services restored as a result of:\n
\n
\n"], ["1200", "
\n|Please take a few minutes to fill out this survey. We are interested in the way things are for you, so there are no right or wrong answers. If you are unsure about a question, just answer it as well  \nas you can. Check the box for the answer that best fits you. \n
\n
\n"], ["1201", "
\n|Please take a few minutes to fill out this survey. We are interested in the way things are for you, so there are no right or wrong answers. If you are unsure about a question, just answer it as well  \n as you can. Check the box for the answer that best fits you.  \n
\n
\n"], ["1202", "
\n|Please take a few minutes to fill out this survey. We are interested in the way things are for you, so there are no right or wrong answers. If you are unsure about a question, just answer it as well  \n as you can. Check the box for the answer that best fits you.  \n
\n
\n"], ["1203", "
\n|Please take a few minutes to fill out this survey. We are interested in the way things are for you, so there are no right or wrong answers. If you are unsure about a question, just answer it as well  \n as you can. Check the box for the answer that best fits you.  \n
\n
\n"], ["1204", "
\nMoving Forward: A Problem Solving Approach to Achieving Life's Goals| \n
\n
\n"], ["1205", "
\nThe following are six statements about how you generally react to stressful events. Please indicate the extent to which you agree with each of these statements by using the following scale  \n
\n
\n"], ["1206", "
\nFor each of the following items, select the answer that best describes how you feel about your relationship. Base your responses on your first impressions and immediate feelings about the item.  \n
\n
\n"], ["1207", "
\nFor each of the following items, select the answer that best describes how you feel about your relationship. Base your responses on your first impressions and immediate feelings about the item.  \n
\n
\n"], ["1208", "
\nFor each of the following items, select the answer that best describes how you feel about your relationship. Base your responses on your first impressions and immediate feelings about the item.  \n
\n
\n"], ["1209", "
\nFor each of the following items, select the answer that best describes how you feel about your relationship. Base your responses on your first impressions and immediate feelings about the item.  \n
\n
\n"], ["121", "
\nWere intensive services restored as a result of:\n
\n
\n"], ["1210", "
\nFor each of the following items, select the answer that best describes how you feel about your relationship. Base your responses on your first impressions and immediate feelings about the item.  \n
\n
\n"], ["1211", "
\nFor each of the following items, select the answer that best describes how you feel about your relationship. Base your responses on your first impressions and immediate feelings about the item.  \n
\n
\n"], ["1212", "
\nFor each of the following items, select the answer that best describes how you feel about your relationship. Base your responses on your first impressions and immediate feelings about the item.  \n
\n
\n"], ["1213", "
\nFor each of the following items, select the answer that best describes how you feel about your relationship. Base your responses on your first impressions and immediate feelings about the item.  \n
\n
\n"], ["1214", "
\nFor each of the following items, select the answer that best describes how you feel about your relationship. Base your responses on your first impressions and immediate feelings about the item.  \n
\n
\n"], ["1215", "
\nThe administration of the Montreal Cognitive Assessment requires the use of a pencil-and-paper answer sheet. Please be familiar with the instructions and scoring of this instrument prior to \nadministration. The subject's scores are recorded here so that the administration can be saved in VistA.|| \n
\n
\n"], ["1216", "
\n3. Draw a clock. Put in all the numbers and set the time to 10 past 11.  \n
\n
\n"], ["1217", "
\n4. Naming pictured animal.  \n
\n
\n"], ["1218", "
\nRead list of words to be recalled.||5. Attention  \n
\n
\n"], ["1219", "
\n6. Language  \n
\n
\n"], ["122", "
\nWhat services does this veteran currently receive on a regular basis?\n
\n
\n"], ["1220", "
\n8. Abstraction  \n
\n
\n"], ["1221", "
\n9. Delayed Recall  \n
\n
\n"], ["1222", "
\n10. Orientation  \n
\n
\n"], ["1223", "
\nThe administration of the Montreal Cognitive Assessment requires the use of a pencil-and-paper answer sheet. Please be familiar with the instructions and scoring of this instrument prior to \nadministration. The subject's scores are recorded here so that the administration can be saved in VistA.|  |   \n
\n
\n"], ["1224", "
\n3. Draw a clock. Put in all the numbers and set the time to 5 past 4.  \n
\n
\n"], ["1225", "
\n4. Naming pictured animal.  \n
\n
\n"], ["1226", "
\nRead list of words to be recalled.||5. Attention  \n
\n
\n"], ["1227", "
\n6. Language  \n
\n
\n"], ["1228", "
\n8. Abstraction  \n
\n
\n"], ["1229", "
\n9. Delayed Recall  \n
\n
\n"], ["123", "
\nWere intensive services restored as a result of:\n
\n
\n"], ["1230", "
\n10. Orientation  \n
\n
\n"], ["1231", "
\nThe administration of the Montreal Cognitive Assessment requires the use of a pencil-and-paper answer sheet. Please be familiar with the instructions and scoring of this instrument prior to \nadministration. The subject's scores are recorded here so that the administration can be saved in VistA.|  |   \n
\n
\n"], ["1232", "
\n3. Draw a clock. Put in all the numbers and set the time to 10 past 9.  \n
\n
\n"], ["1233", "
\n4. Naming pictured animals.  \n
\n
\n"], ["1234", "
\nRead list of words to be recalled.||5. Attention  \n
\n
\n"], ["1235", "
\n6. Language  \n
\n
\n"], ["1236", "
\n8. Abstraction  \n
\n
\n"], ["1237", "
\n9. Delayed Recall  \n
\n
\n"], ["1238", "
\n10. Orientation  \n
\n
\n"], ["1239", "
\nThe administration of the Montreal Cognitive Assessment requires the use of a pencil-and-paper answer sheet. Please be familiar with the instructions and scoring of this instrument prior to  \nadministration. The subject's scores are recorded here so that the administration can be saved in VistA.| |  \n
\n
\n"], ["124", "
\nWhat services does this veteran currently receive on a regular basis?\n
\n
\n"], ["1240", "
\n3. Draw a clock. Put in all the numbers and set the time to 10 past 11.  \n
\n
\n"], ["1241", "
\n4. Naming pictured animal.  \n
\n
\n"], ["1242", "
\nRead list of words to be recalled.||5. Attention  \n
\n
\n"], ["1243", "
\n6. Language  \n
\n
\n"], ["1244", "
\n8. Abstraction  \n
\n
\n"], ["1245", "
\n9. Delayed Recall  \n
\n
\n"], ["1246", "
\n10. Orientation  \n
\n
\n"], ["1247", "
\nPlease read each statement carefully, and decide how well it describes you own family. You should answer according to how you see your family.|  \n
\n
\n"], ["1248", "
\nPlease read each statement carefully, and decide how well it describes you own family. You should answer according to how you see your family.|  \n
\n
\n"], ["1249", "
\nPlease read each statement carefully, and decide how well it describes you own family. You should answer according to how you see your family.|  \n
\n
\n"], ["125", "
\nWere intensive services restored as a result of:\n
\n
\n"], ["1250", "
\nPlease read each statement carefully, and decide how well it describes you own family. You should answer according to how you see your family.|  \n
\n
\n"], ["1251", "
\nIntroduction:  \n
\n
\n"], ["1252", "
\nIntroduction:  \n
\n
\n"], ["1253", "
\nPART A ||Instructions: Please circle YES or NO for the following questions, based on your experience in the past MONTH: \n
\n
\n"], ["1254", "
\nPART A Instructions:||Please circle YES or NO for the following questions, based on your experience in the past MONTH: \n
\n
\n"], ["1255", "
\nHave you been bothered by unpleasant thoughts or images that repeatedly enter your mind, such as: \n
\n
\n"], ["1256", "
\nHave you been bothered by unpleasant thoughts or images that repeatedly enter your mind, such as:  \n
\n
\n"], ["1257", "
\nHave you worried a lot about terrible things happening, such as:  \n
\n
\n"], ["1258", "
\nHave you been bothered by unpleasant thoughts or images that repeatedly enter your mind, such as:  \n
\n
\n"], ["1259", "
\nHave you worried a lot about terrible things happening, such as:  \n
\n
\n"], ["126", "
\nWhat services does this veteran currently receive on a regular basis?\n
\n
\n"], ["1260", "
\nHave you worried about acting on an unwanted and senseless urge or impulse, such as: \n
\n
\n"], ["1261", "
\nHave you felt driven to perform certain acts over and over again, such as: \n
\n
\n"], ["1262", "
\nHave you been bothered by unpleasant thoughts or images that repeatedly enter your mind, such as:  \n
\n
\n"], ["1263", "
\nHave you worried a lot about terrible things happening, such as:  \n
\n
\n"], ["1264", "
\nHave you worried about acting on an unwanted and senseless urge or impulse, such as:  \n
\n
\n"], ["1265", "
\nHave you felt driven to perform certain acts over and over again, such as:  \n
\n
\n"], ["1266", "
\nPART B Instructions: The following questions refer to the repeated thoughts, images, urges or behaviors|identified in Part A. Consider your experience during the past 30 days when selecting an  \nanswer.||In the past month...| \n
\n
\n"], ["1267", "
\nHave you been bothered by unpleasant thoughts or images that repeatedly enter your mind, such as:  \n
\n
\n"], ["1268", "
\nHave you worried a lot about terrible things happening, such as:  \n
\n
\n"], ["1269", "
\nHave you worried about acting on an unwanted and senseless urge or impulse, such as:  \n
\n
\n"], ["127", "
\nThis form should be completed by the primary case manager or team for each MHICM veteran, within one week of the 6 && 12 month and then annual anniversaries of MHICM program entry based on the IDF \ndate. Use the time period "since" IDF or last CPR time frame if less than six months.\n
\n
\n"], ["1270", "
\nHave you felt driven to perform certain acts over and over again, such as:  \n
\n
\n"], ["1271", "
\nPART B Instructions: The following questions refer to the repeated thoughts, images, urges or behaviors|identified in Part A. Consider your experience during the past 30 days when selecting an  \nanswer.||In the past month...| \n
\n
\n"], ["1272", "
\nHave you been bothered by unpleasant thoughts or images that repeatedly enter your mind, such as:  \n
\n
\n"], ["1273", "
\nHave you worried a lot about terrible things happening, such as:  \n
\n
\n"], ["1274", "
\nHave you worried about acting on an unwanted and senseless urge or impulse, such as:  \n
\n
\n"], ["1275", "
\nHave you felt driven to perform certain acts over and over again, such as:  \n
\n
\n"], ["1276", "
\nPART B Instructions: The following questions refer to the repeated thoughts, images, urges or behaviors|identified in Part A. Consider your experience during the past 30 days when selecting an   \nanswer.||In the past month...|  \n
\n
\n"], ["1277", "
\nHave you been bothered by unpleasant thoughts or images that repeatedly enter your mind, such as:  \n
\n
\n"], ["1278", "
\nHave you worried a lot about terrible things happening, such as:  \n
\n
\n"], ["1279", "
\nHave you worried about acting on an unwanted and senseless urge or impulse, such as:  \n
\n
\n"], ["128", "
\nWhich of the following, in your clinical judgement, are reasons why this veteran terminated involvement with your program, or never became significantly involved in the first place? ("Termination" \ndoes NOT necessarily preclude efforts to contact veteran.)\n
\n
\n"], ["1280", "
\nHave you felt driven to perform certain acts over and over again, such as:  \n
\n
\n"], ["1281", "
\nPART B Instructions: The following questions refer to the repeated thoughts, images, urges or behaviors|identified in Part A. Consider your experience during the past 30 days when selecting an   \nanswer.||In the past month...|  \n
\n
\n"], ["1282", "
\nHave you been bothered by unpleasant thoughts or images that repeatedly enter your mind, such as:  \n
\n
\n"], ["1283", "
\nHave you worried a lot about terrible things happening, such as:  \n
\n
\n"], ["1284", "
\nHave you worried about acting on an unwanted and senseless urge or impulse, such as:  \n
\n
\n"], ["1285", "
\nHave you felt driven to perform certain acts over and over again, such as:  \n
\n
\n"], ["1286", "
\nPART B Instructions: The following questions refer to the repeated thoughts, images, urges or behaviors|identified in Part A. Consider your experience during the past 30 days when selecting an   \nanswer.||In the past month...|  \n
\n
\n"], ["1287", "
\nHave you been bothered by unpleasant thoughts or images that repeatedly enter your mind, such as:  \n
\n
\n"], ["1288", "
\nHave you worried a lot about terrible things happening, such as:  \n
\n
\n"], ["1289", "
\nHave you worried about acting on an unwanted and senseless urge or impulse, such as:  \n
\n
\n"], ["129", "
\nWhich services below did your program provide for this veteran in the past six months (since date of IDF or last CPR)?   \n
\n
\n"], ["1290", "
\nHave you felt driven to perform certain acts over and over again, such as:  \n
\n
\n"], ["1291", "
\nPART B Instructions: The following questions refer to the repeated thoughts, images, urges or behaviors|identified in Part A. Consider your experience during the past 30 days when selecting an   \nanswer.||In the past month...|  \n
\n
\n"], ["1292", "
\nInstructions: Below is a list of problems and complaints that people sometimes have in response to stressful life experiences. Please read each one carefully, then circle one of the numbers to the  \nright to indicate how much you have been bothered by that problem in the past month \n
\n
\n"], ["1293", "
\nInstructions: Below is a list of problems and complaints that people sometimes have in response to stressful life experiences. Please read each one carefully, then circle one of the numbers to the  \nright to indicate how much you have been bothered by that problem in the past month \n
\n
\n"], ["1294", "
\nMorningness/Eveningness||For each item, please check one response that best describes you.|  \n
\n
\n"], ["1295", "
\nPlease answer these questions about your thoughts and feelings in the PAST MONTH. \n
\n
\n"], ["1296", "
\nPlease answer these questions about your thoughts and feelings in the PAST MONTH. \n
\n
\n"], ["1297", "
\nPlease answer these questions about your thoughts and feelings in the PAST MONTH.  \n
\n
\n"], ["1298", "
\nPlease answer these questions about your thoughts and feelings in the PAST MONTH.  \n
\n
\n"], ["1299", "
\nPlease answer these questions about your thoughts and feelings in the PAST MONTH.  \n
\n
\n"], ["13", "
\nIntroduction for rad grp 2 \n
\n
\n"], ["130", "
\nWhich of the patterns below best describes your team's typical frequency of contact with this veteran, his or her family, and others on his or her behalf in the past six months?  \n
\n
\n"], ["1300", "
\nPlease answer these questions about your thoughts and feelings in the PAST MONTH.  \n
\n
\n"], ["1301", "
\nPlease answer these questions about your thoughts and feelings in the PAST MONTH.  \n
\n
\n"], ["1302", "
\nPlease answer these questions about your thoughts and feelings in the PAST MONTH.  \n
\n
\n"], ["1303", "
\nPlease answer these questions about your thoughts and feelings in the PAST MONTH.  \n
\n
\n"], ["1304", "
\nPlease answer these questions about your thoughts and feelings in the PAST MONTH.  \n
\n
\n"], ["1305", "
\nPlease answer these questions about your thoughts and feelings in the PAST MONTH.  \n
\n
\n"], ["1306", "
\nINSTRUCTIONS: Please read the following statements carefully. Each one describes a way that you might (or might not) feel about your drinking. For each statement, chose one number from 1 to 5, to  \nindicate how much you agree or disagree with it right now. \n
\n
\n"], ["1307", "
\nINSTRUCTIONS: Please read the following statements carefully. Each one describes a way that you might (or might not) feel about your drinking. For each statement, chose one number from 1 to 5, to   \nindicate how much you agree or disagree with it right now.  \n
\n
\n"], ["1308", "
\nINSTRUCTIONS: Please read the following statements carefully. Each one describes a way that you might (or might not) feel about your drinking. For each statement, chose one number from 1 to 5, to   \nindicate how much you agree or disagree with it right now.  \n
\n
\n"], ["1309", "
\nINSTRUCTIONS: Please read the following statements carefully. Each one describes a way that you might (or might not) feel about your drinking. For each statement, chose one number from 1 to 5, to   \nindicate how much you agree or disagree with it right now.  \n
\n
\n"], ["131", "
\nThe fallowing items depict different ways you might think or feel about this veteran. Please review each statement, inserting the veteran's name in place of ____ in the text. Think about your \nexperiences with this veteran over the past six months. Check the rating that best describes, all in all, how often you feel or think that way about ____ and your work together.\n
\n
\n"], ["1310", "
\nIntroduction: The questions in this scale ask you about your feelings and thoughts during the last month.  \n
\n
\n"], ["1311", "
\nPlease rate the CURRENT (i.e. LAST 2 WEEKS) SEVERITY of your insomnia problem(s).  \n
\n
\n"], ["1312", "
\nInstructions: For each substance, mark in the appropriate column. For example, if you have used cocaine monthly in the past year, put a mark in the Monthly column in the illegal drug row. \n
\n
\n"], ["1313", "
\nInstructions: For each substance, mark in the appropriate column. For example, if you have used cocaine monthly in the past year, put a mark in the Monthly column in the illegal drug row. \n
\n
\n"], ["1314", "
\nQuestion 1 of 8, NIDA-Modified ASSIST||In your Lifetime, which of the following substances have you ever used?  (Note:  For prescription medications, please report nonmedical use only.)| \n
\n
\n"], ["1315", "
\nInstructions: For each substance, mark in the appropriate column. For example, if you have used cocaine monthly in the past year, put a mark in the Monthly column in the illegal drug row.  \n
\n
\n"], ["1316", "
\nQuestion 1 of 8, NIDA-Modified ASSIST||In your Lifetime, which of the following substances have you ever used? (Note: For prescription medications, please report nonmedical use only.) \n
\n
\n"], ["1317", "
\nInstructions: For each substance, mark in the appropriate column. For example, if you have used cocaine monthly in the past year, put a mark in the Monthly column in the illegal drug row.  \n
\n
\n"], ["1318", "
\nQuestion 1 of 8, NIDA-Modified ASSIST||In your Lifetime, which of the following substances have you ever used? (Note: For prescription medications, please report nonmedical use only.) \n
\n
\n"], ["1319", "
\nInstructions: For each substance, mark in the appropriate column. For example, if you have used cocaine monthly in the past year, put a mark in the Monthly column in the illegal drug row.  \n
\n
\n"], ["132", "
\nNote: MHICM veterans typically receive intensive services for at least a year or until they meet all criteria below.  \n
\n
\n"], ["1320", "
\nQuestion 1 of 8, NIDA-Modified ASSIST||In your Lifetime, which of the following substances have you ever used? (Note: For prescription medications, please report nonmedical use only.)  \n
\n
\n"], ["1321", "
\nQuestion 2 of 8, NIDA-Modified ASSIST||2.  In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)? \n
\n
\n"], ["1322", "
\nInstructions: For each substance, mark in the appropriate column. For example, if you have used cocaine monthly in the past year, put a mark in the Monthly column in the illegal drug row.  \n
\n
\n"], ["1323", "
\nQuestion 1 of 8, NIDA-Modified ASSIST||In your Lifetime, which of the following substances have you ever used? (Note: For prescription medications, please report nonmedical use only.)  \n
\n
\n"], ["1324", "
\nQuestion 2 of 8, NIDA-Modified ASSIST||2.  In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)? \n
\n
\n"], ["1325", "
\nInstructions: For each substance, mark in the appropriate column. For example, if you have used cocaine monthly in the past year, put a mark in the Monthly column in the illegal drug row.  \n
\n
\n"], ["1326", "
\n1. In your Lifetime, which of the following substances have you ever used? (Note: For prescription medications, please report nonmedical use only.)  \n
\n
\n"], ["1327", "
\nQuestion 2 of 8, NIDA-Modified ASSIST||2.  In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)? \n
\n
\n"], ["1328", "
\nInstructions: For each substance, mark in the appropriate column. For example, if you have used cocaine monthly in the past year, put a mark in the Monthly column in the illegal drug row.  \n
\n
\n"], ["1329", "
\n1. In your Lifetime, which of the following substances have you ever used? (Note: For prescription medications, please report nonmedical use only.)  \n
\n
\n"], ["133", "
\nWhich criteria for less intensive services did this veteran meet?  \n
\n
\n"], ["1330", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)? \n
\n
\n"], ["1331", "
\nInstructions: For each substance, mark in the appropriate column. For example, if you have used cocaine monthly in the past year, put a mark in the Monthly column in the illegal drug row.  \n
\n
\n"], ["1332", "
\n1. In your Lifetime, which of the following substances have you ever used? (Note: For prescription medications, please report nonmedical use only.)  \n
\n
\n"], ["1333", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)? \n
\n
\n"], ["1334", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)? \n
\n
\n"], ["1335", "
\nInstructions: For each substance, mark in the appropriate column. For example, if you have used cocaine monthly in the past year, put a mark in the Monthly column in the illegal drug row.  \n
\n
\n"], ["1336", "
\n1. In your Lifetime, which of the following substances have you ever used? (Note: For prescription medications, please report nonmedical use only.)  \n
\n
\n"], ["1337", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)? \n
\n
\n"], ["1338", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)? \n
\n
\n"], ["1339", "
\n4. During the past 3 months, how often has your use of (first drug, second drug, etc) led to health, social, legal or financial problems? \n
\n
\n"], ["134", "
\nIn view of this veteran's stability, what treatment change was made?  \n
\n
\n"], ["1340", "
\nInstructions: For each substance, mark in the appropriate column. For example, if you have used cocaine monthly in the past year, put a mark in the Monthly column in the illegal drug row.  \n
\n
\n"], ["1341", "
\n1. In your Lifetime, which of the following substances have you ever used? (Note: For prescription medications, please report nonmedical use only.)  \n
\n
\n"], ["1342", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)? \n
\n
\n"], ["1343", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)? \n
\n
\n"], ["1344", "
\n4. During the past 3 months, how often has your use of (first drug, second drug, etc) led to health, social, legal or financial problems? \n
\n
\n"], ["1345", "
\n5. During the past 3 months, how often have you failed to do what was normally expected of you because of your use of (first drug, second drug, etc)? \n
\n
\n"], ["1346", "
\n6. Has a friend or relative or anyone else ever expressed concern about your use of (first drug, second drug, etc)? \n
\n
\n"], ["1347", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)? \n
\n
\n"], ["1348", "
\nInstructions: For each substance, mark in the appropriate column. For example, if you have used cocaine monthly in the past year, put a mark in the Monthly column in the illegal drug row.  \n
\n
\n"], ["1349", "
\n1. In your Lifetime, which of the following substances have you ever used? (Note: For prescription medications, please report nonmedical use only.)  \n
\n
\n"], ["135", "
\nWere intensive services restored as a result of:  \n
\n
\n"], ["1350", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)?  \n
\n
\n"], ["1351", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)?  \n
\n
\n"], ["1352", "
\n4. During the past 3 months, how often has your use of (first drug, second drug, etc) led to health, social, legal or financial problems?  \n
\n
\n"], ["1353", "
\n5. During the past 3 months, how often have you failed to do what was normally expected of you because of your use of (first drug, second drug, etc)?  \n
\n
\n"], ["1354", "
\n6. Has a friend or relative or anyone else ever expressed concern about your use of (first drug, second drug, etc)?  \n
\n
\n"], ["1355", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["1356", "
\nInstructions: For each substance, mark in the appropriate column. For example, if you have used cocaine monthly in the past year, put a mark in the Monthly column in the illegal drug row.  \n
\n
\n"], ["1357", "
\n1. In your Lifetime, which of the following substances have you ever used? (Note: For prescription medications, please report nonmedical use only.)  \n
\n
\n"], ["1358", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)?  \n
\n
\n"], ["1359", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)?  \n
\n
\n"], ["136", "
\nWhat services does this veteran currently receive on a regular basis?  \n
\n
\n"], ["1360", "
\n4. During the past 3 months, how often has your use of (first drug, second drug, etc) led to health, social, legal or financial problems?  \n
\n
\n"], ["1361", "
\n5. During the past 3 months, how often have you failed to do what was normally expected of you because of your use of (first drug, second drug, etc)?  \n
\n
\n"], ["1362", "
\n6. Has a friend or relative or anyone else ever expressed concern about your use of (first drug, second drug, etc)?  \n
\n
\n"], ["1363", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["1364", "
\nInstructions: For each substance, mark in the appropriate column. For example, if you have used cocaine monthly in the past year, put a mark in the Monthly column in the illegal drug row.  \n
\n
\n"], ["1365", "
\n1. In your Lifetime, which of the following substances have you ever used? |       (Note: For prescription medications, please report nonmedical use only.)  \n
\n
\n"], ["1366", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)?  \n
\n
\n"], ["1367", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)?  \n
\n
\n"], ["1368", "
\n4. During the past 3 months, how often has your use of (first drug, second drug, etc) led to health, social, legal or financial problems?  \n
\n
\n"], ["1369", "
\n5. During the past 3 months, how often have you failed to do what was normally expected of you because of your use of (first drug, second drug, etc)?  \n
\n
\n"], ["137", "
\nIntroduction 1:\n
\n
\n"], ["1370", "
\n6. Has a friend or relative or anyone else ever expressed concern about your use of (first drug, second drug, etc)?  \n
\n
\n"], ["1371", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["1372", "
\nIn the following table you will find a set of difficulties and problems which possibly describe you. Please work through the questionnaire and decide how much you suffered from each problem in the  \ncourse of the last week. In case you have no feelings at all at the present moment, please answer according to how you think you might have felt. Please answer honestly. All questions refer to the  \nlast week. If you felt different ways at different times in the week, give a rating for how things were for you on average. ||Please be sure to answer each question. \n
\n
\n"], ["1373", "
\nIn the following table you will find a set of difficulties and problems which possibly describe you. Please work through the questionnaire and decide how much you suffered from each problem in the  \ncourse of the last week. In case you have no feelings at all at the present moment, please answer according to how you think you might have felt. Please answer honestly. All questions refer to the  \nlast week. If you felt different ways at different times in the week, give a rating for how things were for you on average. ||Please be sure to answer each question. \n
\n
\n"], ["1374", "
\n|Please take a few minutes to fill out this survey. We are interested in the way things are for you, so there are no right or wrong answers. If you are unsure about a question, just answer it as well  \n as you can. Check the box for the answer that best fits you.  \n
\n
\n"], ["1375", "
\nIn the past week:  \n
\n
\n"], ["1376", "
\nCheck all that apply. Current symptoms are those present in the last 30 days. \n
\n
\n"], ["1377", "
\nCheck all that apply. Current symptoms are those present in the last 30 days. \n
\n
\n"], ["1378", "
\nCheck all that apply. Current symptoms are those present in the last 30 days.  \n
\n
\n"], ["1379", "
\nObsessions: \n
\n
\n"], ["138", "
\nIntroduction 2: \n
\n
\n"], ["1380", "
\nCheck all that apply. Current symptoms are those present in the last 30 days.  \n
\n
\n"], ["1381", "
\nCheck all that apply. Current symptoms are those present in the last 30 days.  \n
\n
\n"], ["1382", "
\n|Please take a few minutes to fill out this survey. We are interested in the way things are for you, so there are no right or wrong answers. If you are unsure about a question, just answer it as well  \n as you can. Check the box for the answer that best fits you.  \n
\n
\n"], ["1383", "
\nPlease read each statement carefully, and decide how well it describes you own family. You should answer according to how you see your family.|  \n
\n
\n"], ["1384", "
\nINSTRUCTIONS: Here are a number of events that people sometimes experience. Read each one carefully, and circle the number that indicates whether this has EVER happened to you (0 = No, 1 = Yes). If  \nan item does not apply to you, circle zero (0). \n
\n
\n"], ["1385", "
\nINSTRUCTIONS: Here are a number of events that people sometimes experience. Read each one carefully, and circle the number that indicates whether this has EVER happened to you (0 an item does not  \napply to you, circle zero (0).  \n
\n
\n"], ["1386", "
\nINSTRUCTIONS: Here are a number of events that people sometimes experience. Read each one carefully, and circle the number that indicates whether this has EVER happened to you (0 an item does not  \napply to you, circle zero (0).  \n
\n
\n"], ["1387", "
\nINSTRUCTIONS: Here are a number of events that people sometimes experience. Read each one carefully, and circle the number that indicates whether this has EVER happened to you (0 an item does not   \napply to you, circle zero (0).  \n
\n
\n"], ["1388", "
\nINSTRUCTIONS: Here are a number of events that people sometimes experience. Read each one carefully, and circle the number that indicates whether this has EVER happened to you (0 an item does not   \napply to you, circle zero (0).  \n
\n
\n"], ["1389", "
\nINSTRUCTIONS: Here are a number of events that people sometimes experience. Read each one carefully, and circle the number that indicates whether this has EVER happened to you (0 = No, 1 = Yes). If  \nan item does not  apply to you, circle zero (0).  \n
\n
\n"], ["139", "
\nThis survey asks about how you are feeling and doing in different areas of life. Please check the item that best describes yourself during the PAST WEEK. Please answer every question. If you are   \nunsure about how to answer, please give the best answer you can.        During the PAST WEEK, how much difficulty did you have. . . \n
\n
\n"], ["1390", "
\nInstructions: For each substance, mark in the appropriate column. For example, if you have used cocaine monthly in the past year, put a mark in the Monthly column in the illegal drug row.  \n
\n
\n"], ["1391", "
\n1. In your Lifetime, which of the following substances have you ever used? |    (Note: For prescription medications, please report nonmedical use only.)  \n
\n
\n"], ["1392", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)?  \n
\n
\n"], ["1393", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)?  \n
\n
\n"], ["1394", "
\n4. During the past 3 months, how often has your use of (first drug, second drug, etc) led to health, social, legal or financial problems?  \n
\n
\n"], ["1395", "
\n5. During the past 3 months, how often have you failed to do what was normally expected of you because of your use of (first drug, second drug, etc)?  \n
\n
\n"], ["1396", "
\n6. Has a friend or relative or anyone else ever expressed concern about your use of (first drug, second drug, etc)?  \n
\n
\n"], ["1397", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["1398", "
\nInstructions: For each substance, mark in the appropriate column. For example, if you have used cocaine monthly in the past year, put a mark in the Monthly column in the illegal drug row.  \n
\n
\n"], ["1399", "
\nInstructions: For each substance, mark in the appropriate column. For example, if you have used cocaine monthly in the past year, put a mark in the Monthly column in the illegal drug row.  \n
\n
\n"], ["14", "
\nA list of problems people sometimes have will be presented. Read each one\ncarefully and select the answer that best describes HOW MUCH THAT PROBLEM\nHAS DISTRESSED OR BOTHERED YOU DURING THE PAST 7 DAYS INCLUDING TODAY. Do\nnot skip any items.\n
\n
\n"], ["140", "
\nDuring the PAST WEEK, how much of the time did you. . . \n
\n
\n"], ["1400", "
\n1. In your Lifetime, which of the following substances have you ever used? |  (Note: For prescription medications, please report nonmedical use only.)  \n
\n
\n"], ["1401", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)?  \n
\n
\n"], ["1402", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)?  \n
\n
\n"], ["1403", "
\n4. During the past 3 months, how often has your use of (first drug, second drug, etc) led to health, social, legal or financial problems?  \n
\n
\n"], ["1404", "
\n5. During the past 3 months, how often have you failed to do what was normally expected of you because of your use of (first drug, second drug, etc)?  \n
\n
\n"], ["1405", "
\n6. Has a friend or relative or anyone else ever expressed concern about your use of (first drug, second drug, etc)?  \n
\n
\n"], ["1406", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["1407", "
\nInstructions: For each substance, mark in the appropriate column. For example, if you have used cocaine monthly in the past year, put a mark in the Monthly column in the illegal drug row.  \n
\n
\n"], ["1408", "
\n1. In your Lifetime, which of the following substances have you ever used? | (Note: For prescription medications, please report nonmedical use only.)  \n
\n
\n"], ["1409", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)?  \n
\n
\n"], ["141", "
\nDuring the PAST WEEK, how often did you. . .\n
\n
\n"], ["1410", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)?  \n
\n
\n"], ["1411", "
\n4. During the past 3 months, how often has your use of (first drug, second drug, etc) led to health, social, legal or financial problems?  \n
\n
\n"], ["1412", "
\n5. During the past 3 months, how often have you failed to do what was normally expected of you because of your use of (first drug, second drug, etc)?  \n
\n
\n"], ["1413", "
\n6. Has a friend or relative or anyone else ever expressed concern about your use of (first drug, second drug, etc)?  \n
\n
\n"], ["1414", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["1415", "
\nInstructions: For each substance, mark in the appropriate column. For example, if you have used cocaine monthly in the past year, put a mark in the Monthly column in the illegal drug row.  \n
\n
\n"], ["1416", "
\n1. In your Lifetime, which of the following substances have you ever used? | (Note: For prescription medications, please report nonmedical use only.)  \n
\n
\n"], ["1417", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)?  \n
\n
\n"], ["1418", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)?  \n
\n
\n"], ["1419", "
\n4. During the past 3 months, how often has your use of (first drug, second drug, etc) led to health, social, legal or financial problems?  \n
\n
\n"], ["142", "
\nDuring the PAST WEEK, how often. . .\n
\n
\n"], ["1420", "
\n5. During the past 3 months, how often have you failed to do what was normally expected of you because of your use of (first drug, second drug, etc)?  \n
\n
\n"], ["1421", "
\n6. Has a friend or relative or anyone else ever expressed concern about your use of (first drug, second drug, etc)?  \n
\n
\n"], ["1422", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["1423", "
\nInstructions: For each substance, mark in the appropriate column. For example, if you have used cocaine monthly in the past year, put a mark in the Monthly column in the illegal drug row.  \n
\n
\n"], ["1424", "
\n1. In your Lifetime, which of the following substances have you ever used? | (Note: For prescription medications, please report nonmedical use only.)  \n
\n
\n"], ["1425", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)?  \n
\n
\n"], ["1426", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)?  \n
\n
\n"], ["1427", "
\n4. During the past 3 months, how often has your use of (first drug, second drug, etc) led to health, social, legal or financial problems?  \n
\n
\n"], ["1428", "
\n5. During the past 3 months, how often have you failed to do what was normally expected of you because of your use of (first drug, second drug, etc)?  \n
\n
\n"], ["1429", "
\n6. Has a friend or relative or anyone else ever expressed concern about your use of (first drug, second drug, etc)?  \n
\n
\n"], ["143", "
\nThis survey asks about how you are feeling and doing in different areas of life. Please check the item that best describes yourself during the PAST WEEK. Please answer every question. If you are  \nunsure about how to answer, please give the best answer you can. During the PAST WEEK, how much difficulty did you have. . . \n
\n
\n"], ["1430", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["1431", "
\nThese questions are about how you have been FEELING during the past 4 weeks.  \n
\n
\n"], ["1432", "
\nThe following questions ask about problems you may have with certain activities.||How much of the time during the past 4 weeks your epilepsy or antiepileptic drugs have caused trouble with:  \n
\n
\n"], ["1433", "
\nDuring the past 4 weeks:  \n
\n
\n"], ["1434", "
\nThese questions are about how you have been FEELING during the past 4 weeks.  \n
\n
\n"], ["1435", "
\nThe following questions ask about problems you may have with certain activities.||How much of the time during the past 4 weeks your epilepsy or antiepileptic drugs have caused trouble with:  \n
\n
\n"], ["1436", "
\nDuring the past 4 weeks:  \n
\n
\n"], ["1437", "
\nPart B.|Reviewing all the questions you have answered in Part A, consider the overall impact of these problems on your quality of life in the past 4 weeks. \n
\n
\n"], ["1438", "
\nPart C.|Considering ALL the questions you have answered, please indicate the areas related to your epilepsy that are most IMPORTANT to you NOW. \n
\n
\n"], ["1439", "
\nThese questions are about how you have been FEELING during the past 4 weeks.  \n
\n
\n"], ["144", "
\nThis survey asks about how you are feeling and doing in different areas of life. Please check the item that best describes yourself during the PAST WEEK. Please answer every question. If you are  \nunsure about how to answer, please give the best answer you can. During the PAST WEEK, how much difficulty did you have. . . \n
\n
\n"], ["1440", "
\nThe following questions ask about problems you may have with certain activities.||How much of the time during the past 4 weeks your epilepsy or antiepileptic drugs have caused trouble with:  \n
\n
\n"], ["1441", "
\nDuring the past 4 weeks:  \n
\n
\n"], ["1442", "
\nPart B.|Reviewing all the questions you have answered in Part A, consider the overall impact of these problems on your quality of life in the past 4 weeks. \n
\n
\n"], ["1443", "
\nPart C.|Considering ALL the questions you have answered, please indicate the areas related to your epilepsy that are most IMPORTANT to you NOW. \n
\n
\n"], ["1444", "
\n12.  Number the following topics from 1 -7 with 1 corresponding to the most important topic and 7 to the least important one.  Please use each number once. \n
\n
\n"], ["1445", "
\nThese questions are about how you have been FEELING during the past 4 weeks.  \n
\n
\n"], ["1446", "
\nThe following questions ask about problems you may have with certain activities.||How much of the time during the past 4 weeks your epilepsy or antiepileptic drugs have caused trouble with:  \n
\n
\n"], ["1447", "
\nDuring the past 4 weeks:  \n
\n
\n"], ["1448", "
\nPart B.|Reviewing all the questions you have answered in Part A, consider the overall impact of these problems on your quality of life in the past 4 weeks.  \n
\n
\n"], ["1449", "
\n12. Number the following topics from 1 -7 with 1 corresponding to the most important topic and 7 to the least important one. ||Please use each number once.  \n
\n
\n"], ["145", "
\nPlease rate the following symptoms with regard to how much they have disturbed you SINCE YOUR INJURY.\n
\n
\n"], ["1450", "
\nInstructions:|This survey asks about your health and daily activities.  Answer every question by circling the appropriate number (1, 2, 3...).||If you are unsure about how to answer a question,  \nplease give the best answer you can. \n
\n
\n"], ["1451", "
\nThese questions are about how you FEEL and how things have been for you during the past 4 weeks. For each question, please indicate the one answer that comes closest to the way you have been  \nfeeling.||How much of the ime during the past 4 weeks... \n
\n
\n"], ["1452", "
\nInstructions:|This survey asks about your health and daily activities.  Answer every question by circling the appropriate number (1, 2, 3...).||If you are unsure about how to answer a question,  \nplease give the best answer you can. \n
\n
\n"], ["1453", "
\nThese questions are about how you FEEL and how things have been for you during the past 4 weeks. For each question, please indicate the one answer that comes closest to the way you have been  \nfeeling.||How much of the ime during the past 4 weeks... \n
\n
\n"], ["1454", "
\nInstructions:|This survey asks about your health and daily activities. Answer every question by circling the appropriate number (1, 2, 3...).||If you are unsure about how to answer a question,   \nplease give the best answer you can.  \n
\n
\n"], ["1455", "
\nThese questions are about how you FEEL and how things have been for you during the past 4 weeks. For each question, please indicate the one answer that comes closest to the way you have been   \nfeeling.||How much of the ime during the past 4 weeks...  \n
\n
\n"], ["1456", "
\nThe following question is about MEMORY. \n
\n
\n"], ["1457", "
\nCircle one number for how often in the past 4 weeks you have had trouble remembering or how often this memory problem has interfered with your normal work or living \n
\n
\n"], ["1458", "
\nThe following questions are about CONCENTRATION problems you may have.  Circle one number for how often in the past 4 weeks you had trouble concentrating or how often these problems interfered with  \nyou normal work or living. \n
\n
\n"], ["1459", "
\nInstructions:|This survey asks about your health and daily activities. Answer every question by circling the appropriate number (1, 2, 3...).||If you are unsure about how to answer a question,   \nplease give the best answer you can.  \n
\n
\n"], ["146", "
\nPlease rate the following symptoms with regard to how much they have disturbed you SINCE YOUR INJURY.\n
\n
\n"], ["1460", "
\nThese questions are about how you FEEL and how things have been for you during the past 4 weeks. For each question, please indicate the one answer that comes closest to the way you have been   \nfeeling.||How much of the ime during the past 4 weeks...  \n
\n
\n"], ["1461", "
\nThe following question is about MEMORY. \n
\n
\n"], ["1462", "
\nCircle one number for how often in the past 4 weeks you have had trouble remembering or how often this memory problem has interfered with your normal work or living \n
\n
\n"], ["1463", "
\nThe following questions are about CONCENTRATION problems you may have.  Circle one number for how often in the past 4 weeks you had trouble concentrating or how often these problems interfered with  \nyou normal work or living. \n
\n
\n"], ["1464", "
\nThe following questions are about problems you may have with certain ACTIVITIES. Circle one number for how much during the past 4 weeks you epilepsy or antiepileptic medication has caused trouble  \nwith... \n
\n
\n"], ["1465", "
\nThe following questions relate to the way you FEEL about your seizures.  Circle one number on each line. \n
\n
\n"], ["1466", "
\nFor each of these PROBLEMS, circle one number for how much they bother you on a scale of 1 to 5 where 1 = Not at all bothersome, and 5 = Extremely bothersome. \n
\n
\n"], ["1467", "
\nHow good or bad do you think your health is?  On the scale below, the best imaginble state of health is10 and the worst is 0.  Please indicate how you feel about your health by selecting one number  \non the scale.  Please consider epilepsy as part of your health when you answer this question. \n
\n
\n"], ["1468", "
\nInstructions:|This survey asks about your health and daily activities. Answer every question by circling the appropriate number (1, 2, 3...).||If you are unsure about how to answer a question,   \nplease give the best answer you can.  \n
\n
\n"], ["1469", "
\nThese questions are about how you FEEL and how things have been for you during the past 4 weeks. For each question, please indicate the one answer that comes closest to the way you have been   \nfeeling.||How much of the ime during the past 4 weeks...  \n
\n
\n"], ["147", "
\n0 = None- Rarely if ever present; not a problem at all.  1 = Mild- Occasionally present, but it does not disrupt activities; I can usually continue what I'm doing; doesn't really concern me.  2 = \nModerate- Often present, occasionally disrupts my activities; I can usually continue what I'm doing with some effort; I feel somewhat concerned.  3 = Severe- Frequently present and disrupts \nactivities; I can only do things that are fairly simple or take little effort; I feel like I need help.  4 = Very Severe- Almost always present and I have been unable to perform at work, school or \nhome due to this problem; I probably cannot function without help.\n
\n
\n"], ["1470", "
\nThe following question is about MEMORY.  \n
\n
\n"], ["1471", "
\nCircle one number for how often in the past 4 weeks you have had trouble remembering or how often this memory problem has interfered with your normal work or living  \n
\n
\n"], ["1472", "
\nThe following questions are about CONCENTRATION problems you may have. Circle one number for how often in the past 4 weeks you had trouble concentrating or how often these problems interfered with   \nyou normal work or living.  \n
\n
\n"], ["1473", "
\nThe following questions are about problems you may have with certain ACTIVITIES. Circle one number for how much during the past 4 weeks you epilepsy or antiepileptic medication has caused trouble   \nwith...  \n
\n
\n"], ["1474", "
\nThe following questions relate to the way you FEEL about your seizures. Circle one number on each line.  \n
\n
\n"], ["1475", "
\nFor each of these PROBLEMS, circle one number for how much they bother you on a scale of 1 to 5 where 1  \n
\n
\n"], ["1476", "
\nHow good or bad do you think your health is? On the scale below, the best imaginble state of health is10 and the worst is 0. Please indicate how you feel about your health by selecting one number  on  \nthe scale. Please consider epilepsy as part of your health when you answer this question.  \n
\n
\n"], ["1477", "
\nInstructions:|This survey asks about your health and daily activities. Answer every question by selecting the appropriate number (1, 2, 3...).||If you are unsure about how to answer a question,   \nplease give the best answer you can.  \n
\n
\n"], ["1478", "
\nThese questions are about how you FEEL and how things have been for you during the past 4 weeks. For each question, please indicate the one answer that comes closest to the way you have been   \nfeeling.||How much of the ime during the past 4 weeks...  \n
\n
\n"], ["1479", "
\nThe following question is about MEMORY.  \n
\n
\n"], ["148", "
\nPlease rate the following symptoms with regard to how much they have disturbed you SINCE YOUR INJURY.0 = None- Rarely if ever present; not a problem at all1 = Mild- Occasionally present, but \nit does not disrupt activities; I can usually continue what I'm doing; doesn't really concern me.2 = Moderate- Often present, occasionally disrupts my activities; I can usually continue what I'm \ndoing with some effort; I feel somewhat concerned.3 = Severe- Frequently present and disrupts activities; I can only do things that are fairly simple or take little effort; I feel like I need \nhelp.4 = Very Severe- Almost always present and I have been unable to perform at work, school or home due to this problem; I probably cannot function without help.\n
\n
\n"], ["1480", "
\nCircle one number for how often in the past 4 weeks you have had trouble remembering or how often this memory problem has interfered with your normal work or living  \n
\n
\n"], ["1481", "
\nThe following questions are about CONCENTRATION problems you may have. Select one number for how often in the past 4 weeks you had trouble concentrating or how often these problems interfered with   \nyou normal work or living.  \n
\n
\n"], ["1482", "
\nThe following questions are about problems you may have with certain ACTIVITIES. Select one number for how much during the past 4 weeks you epilepsy or antiepileptic medication has caused trouble  \nwith...  \n
\n
\n"], ["1483", "
\nThe following questions relate to the way you FEEL about your seizures. Select one number on each line.  \n
\n
\n"], ["1484", "
\nFor each of these PROBLEMS, select one number for how much they bother you on a scale of 1 to 5 where 1  \n
\n
\n"], ["1485", "
\nHow good or bad do you think your health is? On the scale below, the best imaginble state of health is 10 and the worst is 0. Please indicate how you feel about your health by selecting one number on  \n the scale. Please consider epilepsy as part of your health when you answer this question.  \n
\n
\n"], ["1486", "
\nInstructions:|This survey asks about your health and daily activities. Answer every question by selecting the appropriate number (1, 2, 3...).||If you are unsure about how to answer a question,   \nplease give the best answer you can.  \n
\n
\n"], ["1487", "
\nThese questions are about how you FEEL and how things have been for you during the past 4 weeks. For each question, please indicate the one answer that comes closest to the way you have been   \nfeeling.||How much of the ime during the past 4 weeks...  \n
\n
\n"], ["1488", "
\nThe following question is about MEMORY.  \n
\n
\n"], ["1489", "
\nCircle one number for how often in the past 4 weeks you have had trouble remembering or how often this memory problem has interfered with your normal work or living  \n
\n
\n"], ["149", "
\nPlease rate the following symptoms with regard to how much they have disturbed you SINCE YOUR INJURY.0 = None- Rarely if ever present; not a problem at all1 = Mild- Occasionally present, but \nit does not disrupt activities; I can usually continue what I'm doing; doesn't really concern me.2 = Moderate- Often present, occasionally disrupts my activities; I can usually continue what I'm \ndoing with some effort; I feel somewhat concerned.3 = Severe- Frequently present and disrupts activities; I can only do things that are fairly simple or take little effort; I feel like I need \nhelp.4 = Very Severe- Almost always present and I have been unable to perform at work, school or home due to this problem; I probably cannot function without help.\n
\n
\n"], ["1490", "
\nThe following questions are about CONCENTRATION problems you may have. Select one number for how often in the past 4 weeks you had trouble concentrating or how often these problems interfered with   \nyou normal work or living.  \n
\n
\n"], ["1491", "
\nThe following questions are about problems you may have with certain ACTIVITIES. Select one number for how much during the past 4 weeks you epilepsy or antiepileptic medication has caused trouble  \nwith...  \n
\n
\n"], ["1492", "
\nThe following questions relate to the way you FEEL about your seizures. Select one number on each line.  \n
\n
\n"], ["1493", "
\nFor each of these PROBLEMS, select one number for how much they bother you on a scale of 1 to 5 where 1  \n
\n
\n"], ["1494", "
\nHow good or bad do you think your health is? On the scale below, the best imaginble state of health is 10 and the worst is 0. Please indicate how you feel about your health by selecting one number on  \n the scale. Please consider epilepsy as part of your health when you answer this question.  \n
\n
\n"], ["1495", "
\nInstructions:|This survey asks about your health and daily activities. Answer every question by selecting the appropriate number (1, 2, 3...).||If you are unsure about how to answer a question,   \nplease give the best answer you can.  \n
\n
\n"], ["1496", "
\nThese questions are about how you FEEL and how things have been for you during the past 4 weeks. For each question, please indicate the one answer that comes closest to the way you have been   \nfeeling.||How much of the ime during the past 4 weeks...  \n
\n
\n"], ["1497", "
\nThe following question is about MEMORY.  \n
\n
\n"], ["1498", "
\nSelect one number for how often in the past 4 weeks you have had trouble remembering or how often this memory problem has interfered with your normal work or living  \n
\n
\n"], ["1499", "
\nThe following questions are about CONCENTRATION problems you may have. Select one number for how often in the past 4 weeks you had trouble concentrating or how often these problems interfered with   \nyou normal work or living.  \n
\n
\n"], ["15", "
\nIntroduction for edit 9. \n
\n
\n"], ["150", "
\nPlease rate the following symptoms with regard to how much they have disturbed you SINCE YOUR INJURY.0 = None- Rarely if ever present; not a problem at all1 = Mild- Occasionally present, but \nit does not disrupt activities; I can usually continue what I'm doing; doesn't really concern me.2 = Moderate- Often present, occasionally disrupts my activities; I can usually continue what I'm \ndoing with some effort; I feel somewhat concerned.3 = Severe- Frequently present and disrupts activities; I can only do things that are fairly simple or take little effort; I feel like I need \nhelp.4 = Very Severe- Almost always present and I have been unable to perform at work, school or home due to this problem; I probably cannot function without help.\n
\n
\n"], ["1500", "
\nThe following questions are about problems you may have with certain ACTIVITIES. Select one number for how much during the past 4 weeks you epilepsy or antiepileptic medication has caused trouble  \nwith...  \n
\n
\n"], ["1501", "
\nThe following questions relate to the way you FEEL about your seizures. Select one number on each line.  \n
\n
\n"], ["1502", "
\nFor each of these PROBLEMS, select one number for how much they bother you on a scale of 1 to 5 where 1 = bothersome, and 5 = Extremely bothersome. \n
\n
\n"], ["1503", "
\nHow good or bad do you think your health is? On the scale below, the best imaginble state of health is 10 and the worst is 0. Please indicate how you feel about your health by selecting one number on  \n the scale. Please consider epilepsy as part of your health when you answer this question.  \n
\n
\n"], ["1504", "
\nDuring the past TWO (2) WEEKS, how much have you been bothered by the following problems. \n
\n
\n"], ["1505", "
\nDuring the past TWO (2) WEEKS, how much have you been bothered by the following problems.  \n
\n
\n"], ["1506", "
\nMoving Forward: A Problem Solving Approach to Achieving Life's Goals|  \n
\n
\n"], ["1507", "
\nThe following are six statements about how you generally react to stressful events. Please indicate the extent to which you agree with each of these statements by using the following scale  \n
\n
\n"], ["1508", "
\nIn the following table you will find a set of difficulties and problems which possibly describe you. Please work through the questionnaire and decide how much you suffered from each problem in the   \ncourse of the last week. In case you have no feelings at all at the present moment, please answer according to how you think you might have felt. Please answer honestly. All questions refer to the   \nlast week. If you felt different ways at different times in the week, give a rating for how things were for you on average. ||Please be sure to answer each question.  \n
\n
\n"], ["1509", "
\nIn your session, how much did your counselor:  \n
\n
\n"], ["151", "
\nPlease rate the following symptoms with regard to how much they have disturbed you SINCE YOUR INJURY.0 = None- Rarely if ever present; not a problem at all1 = Mild- Occasionally present, but  \nit does not disrupt activities; I can usually continue what I'm doing; doesn't really concern me.2 = Moderate- Often present, occasionally disrupts my activities; I can usually continue what I'm  \ndoing with some effort; I feel somewhat concerned.3 = Severe- Frequently present and disrupts activities; I can only do things that are fairly simple or take little effort; I feel like I need  \nhelp.4 = Very Severe- Almost always present and I have been unable to perform at work, school or home due to this problem; I probably cannot function without help. \n
\n
\n"], ["1510", "
\nFor each of the following items, select the answer that best describes how you feel about your relationship. Base your responses on your first impressions and immediate feelings about the item.  \n
\n
\n"], ["1511", "
\nSeveral statements reflecting people's beliefs and attitudes about sleep are listed below. Please indicate to what extent you personally agree or disagree with each statement. There is no right or   \nwrong answer. For each statement, select the number that corresponds to your own personal belief. Please respond to all items even though some may not apply directly to your own situation.  \n
\n
\n"], ["1512", "
\nPlease rate the CURRENT (i.e. LAST 2 WEEKS) SEVERITY of your insomnia problem(s).  \n
\n
\n"], ["1513", "
\nIntroduction: The questions in this scale ask you about your feelings and thoughts during the last month.  \n
\n
\n"], ["1514", "
\nIn the past week:  \n
\n
\n"], ["1515", "
\nIn the past week:  \n
\n
\n"], ["1516", "
\nPlease answer these questions about your thoughts and feelings in the PAST MONTH.  \n
\n
\n"], ["1517", "
\nINSTRUCTIONS: Please read the following statements carefully. Each one describes a way that you might (or might not) feel about your drinking. For each statement, chose one number from 1 to 5, to   \nindicate how much you agree or disagree with it right now.  \n
\n
\n"], ["1518", "
\nINSTRUCTIONS: Please read the following statements carefully. Each one describes a way that you might (or might not) feel about your drinking. For each statement, chose one number from 1 to 5, to   \nindicate how much you agree or disagree with it right now.  \n
\n
\n"], ["1519", "
\nDirections: For each item, please check one response that best describes you. \n
\n
\n"], ["152", "
\nPlease rate the following symptoms with regard to how much they have disturbed you SINCE YOUR INJURY.    0 = None- Rarely if ever present; not a problem at all    1 = Mild- Occasionally present, but  \nit does not disrupt activities; I can usually continue what I'm doing; doesn't really concern me.    2 = Moderate- Often present, occasionally disrupts my activities; I can usually continue what I'm  \ndoing with some effort; I feel somewhat concerned.    3 = Severe- Frequently present and disrupts activities; I can only do things that are fairly simple or take little effort; I feel like I need  \nhelp.    4 = Very Severe- Almost always present and I have been unable to perform at work, school or home due to this problem; I probably cannot function without help.   \n
\n
\n"], ["1520", "
\nDirections: For each item, please check one response that best describes you. \n
\n
\n"], ["1521", "
\nDirections: For each item, please check one response that best describes you.  \n
\n
\n"], ["1522", "
\nDirections: For each item, please check one response that best describes you.  \n
\n
\n"], ["1523", "
\nDirections: For each item, please check one response that best describes you.  \n
\n
\n"], ["1524", "
\nFor this questionnaire, we use the term "substance problem" or "problem with substances" to refer to any problems that you have experienced as a result of your use of drugs or alcohol.  \n
\n
\n"], ["1525", "
\nFor this questionnaire, we use the term "substance problem" or "problem with substances" to refer to any problems that you have experienced as a result of your use of drugs or alcohol.  \n
\n
\n"], ["1526", "
\nSection 1||Below is a list of statements describing thoughts or feelings that you may have from time to time or may be familiar to you. Most of these statements describe thoughts and feelings that  \nare generally painful or negative in some way. Try to be as honest as you can in responding.||As you see it now, please rate how often you have the thoughts or experiences listed below. Use the scale  \nbelow to make your choice. Please circle only one number and not in between numbers. | \n
\n
\n"], ["1527", "
\nFor this questionnaire, we use the term "substance problem" or "problem with substances" to refer to any problems that you have experienced as a result of your use of drugs or alcohol.  \n
\n
\n"], ["1528", "
\nSection 1||Below is a list of statements describing thoughts or feelings that you may have from time to time or may be familiar to you. Most of these statements describe thoughts and feelings that  \nare generally painful or negative in some way. Try to be as honest as you can in responding.||As you see it now, please rate how often you have the thoughts or experiences listed below. Use the scale  \nbelow to make your choice. Please circle only one number and not in between numbers. | \n
\n
\n"], ["1529", "
\nSection 2||Please read each statement below and circle the number that indicates how many people you think would react to you as described. Please use the scale below, and please do not omit any item. \n
\n
\n"], ["153", "
\nPlease rate the following symptoms with regard to how much they have disturbed you SINCE YOUR INJURY.    0. None - Rarely if ever present; not a problem at all.     1. Mild - Occasionally present,  \nbut it does not disrupt activities; I can usually continue what I'm doing; doesn't really concern me.    2. Moderate - Often present, occasionally disrupts my activities; I can usually continue what  \nI'm doing with some effort; I feel somewhat concerned.    3. Severe - Frequently present and disrupts activities; I can only do things that are fairly simple or take little effort; I feel like I need  \nhelp.    4. Very Severe - Almost always present and I have been unable to perform at work, school or home due to this problem; I probably cannot function without help.   \n
\n
\n"], ["1530", "
\nFor this questionnaire, we use the term "substance problem" or "problem with substances" to refer to any problems that you have experienced as a result of your use of drugs or alcohol.  \n
\n
\n"], ["1531", "
\nSection 1||Below is a list of statements describing thoughts or feelings that you may have from time to time or may be familiar to you. Most of these statements describe thoughts and feelings that  \nare generally painful or negative in some way. Try to be as honest as you can in responding.||As you see it now, please rate how often you have the thoughts or experiences listed below. Use the scale  \nbelow to make your choice. Please circle only one number and not in between numbers. | \n
\n
\n"], ["1532", "
\nSection 2||Please read each statement below and circle the number that indicates how many people you think would react to you as described. Please use the scale below, and please do not omit any item. \n
\n
\n"], ["1533", "
\nSection 3|Below you will find a list of statements. As you see it now, please rate how true each statement is for you by writing a number next to it. Use the scale below to make your choice.| \n
\n
\n"], ["1534", "
\nFor this questionnaire, we use the term "substance problem" or "problem with substances" to refer to any problems that you have experienced as a result of your use of drugs or alcohol.  \n
\n
\n"], ["1535", "
\nSection 1||Below is a list of statements describing thoughts or feelings that you may have from time to time or may be familiar to you. Most of these statements describe thoughts and feelings that  \nare generally painful or negative in some way. Try to be as honest as you can in responding.||As you see it now, please rate how often you have the thoughts or experiences listed below. Use the scale  \nbelow to make your choice. Please circle only one number and not in between numbers. | \n
\n
\n"], ["1536", "
\nSection 2||Please read each statement below and circle the number that indicates how many people you think would react to you as described. Please use the scale below, and please do not omit any item. \n
\n
\n"], ["1537", "
\nSection 3|Below you will find a list of statements. As you see it now, please rate how true each statement is for you by writing a number next to it. Use the scale below to make your choice.| \n
\n
\n"], ["1538", "
\nSection 1||Below is a list of statements describing thoughts or feelings that you may have from time to time or may be familiar to you. Most of these statements describe thoughts and feelings that   \nare generally painful or negative in some way. Try to be as honest as you can in responding.||As you see it now, please rate how often you have the thoughts or experiences listed below. Use the scale  \n below to make your choice. Please circle only one number and not in between numbers. |  \n
\n
\n"], ["1539", "
\nSection 2||Please read each statement below and circle the number that indicates how many people you think would react to you as described. Please use the scale below, and please do not omit any  \nitem.  \n
\n
\n"], ["154", "
\nYou were referred because the primary level screening indicated that you may have had a head injury; that is you reported having had an alteration of consciousness after some traumatic event.  We are  \ntrying to determine the nature and severity of any of those type of injuries or related injuries, to determine how best we can assist you. \n
\n
\n"], ["1540", "
\nSection 3|Below you will find a list of statements. As you see it now, please rate how true each statement is for you by writing a number next to it. Use the scale below to make your choice.|  \n
\n
\n"], ["1541", "
\nSection 1||Below is a list of statements describing thoughts or feelings that you may have from time to time or may be familiar to you. Most of these statements describe thoughts and feelings that   \nare generally painful or negative in some way. Try to be as honest as you can in responding.||As you see it now, please rate how often you have the thoughts or experiences listed below. Use the scale  \n below to make your choice. Please circle only one number and not in between numbers. |  \n
\n
\n"], ["1542", "
\nSection 2||Please read each statement below and circle the number that indicates how many people you think would react to you as described. Please use the scale below, and please do not omit any   \nitem.  \n
\n
\n"], ["1543", "
\nSection 3|Below you will find a list of statements. As you see it now, please rate how true each statement is for you by writing a number next to it. Use the scale below to make your choice.|  \n
\n
\n"], ["1544", "
\nSection 1||Below is a list of statements describing thoughts or feelings that you may have from time to time or may be familiar to you. Most of these statements describe thoughts and feelings that   \nare generally painful or negative in some way. Try to be as honest as you can in responding.||As you see it now, please rate how often you have the thoughts or experiences listed below. Use the scale  \n below to make your choice. Please circle only one number and not in between numbers. |  \n
\n
\n"], ["1545", "
\nSection 2||Please read each statement below and circle the number that indicates how many people you think would react to you as described. Please use the scale below, and please do not omit any   \nitem.  \n
\n
\n"], ["1546", "
\nSection 3|Below you will find a list of statements. As you see it now, please rate how true each statement is for you by writing a number next to it. Use the scale below to make your choice.|  \n
\n
\n"], ["1547", "
\nDirections: For each item, please check one response that best describes you.  \n
\n
\n"], ["1548", "
\nPlease answer these questions about your thoughts and feelings in the PAST MONTH.  \n
\n
\n"], ["1549", "
\nMoving Forward: A Problem Solving Approach to Achieving Life's Goals \n
\n
\n"], ["155", "
\n4. Date(s) of most serious OEF/OIF deployment related injuries: \n
\n
\n"], ["1550", "
\nThe following are six statements about how you generally react to stressful events. Please indicate the extent to which you agree with each of these statements by using the following scale  \n
\n
\n"], ["1551", "
\n|Please take a few minutes to fill out this survey. We are interested in the way things are for you, so there are no right or wrong answers. If you are unsure about a question, just answer it as well  \n as you can. Check the box for the answer that best fits you.  \n
\n
\n"], ["1552", "
\nCheck all that apply. Current symptoms are those present in the last 30 days.  \n
\n
\n"], ["1553", "
\nBelow is a list of statements describing thoughts or feelings that you may have from time to time or may be familiar to you. Most of these statements describe thoughts and feelings that  are  \ngenerally painful or negative in some way. Try to be as honest as you can in responding.  As you see it now, please rate how often you have the thoughts or experiences listed below. Use the scale   \nbelow to make your choice. Please circle only one number and not in between numbers.  \n
\n
\n"], ["1554", "
\nPlease read each statement below and circle the number that indicates how many people you think would react to you as described. Please use the scale below, and please do not omit any  item.  \n
\n
\n"], ["1555", "
\nBelow you will find a list of statements. As you see it now, please rate how true each statement is for you by writing a number next to it. Use the scale below to make your choice.  \n
\n
\n"], ["1556", "
\nHave you been bothered by unpleasant thoughts or images that repeatedly enter your mind, such as:  \n
\n
\n"], ["1557", "
\nHave you worried a lot about terrible things happening, such as:  \n
\n
\n"], ["1558", "
\nHave you worried about acting on an unwanted and senseless urge or impulse, such as:  \n
\n
\n"], ["1559", "
\nHave you felt driven to perform certain acts over and over again, such as:  \n
\n
\n"], ["156", "
\n5. Injury etiology (Indicate all that apply) \n
\n
\n"], ["1560", "
\nPART B Instructions: The following questions refer to the repeated thoughts, images, urges or behaviors identified in Part A. Consider your experience during the past 30 days when selecting an  \nanswer. ||In the past month...  \n
\n
\n"], ["1561", "
\nPlease take a few minutes to fill out this survey. We are interested in the way things are for you, so there are no right or wrong answers. If you are unsure about a question, just answer it as well   \nas you can. Check the box for the answer that best fits you.  \n
\n
\n"], ["1562", "
\nPlease take a few minutes to fill out this survey. We are interested in the way things are for you, so there are no right or wrong answers. If you are unsure about a question, just answer it as well   \nas you can. Check the box for the answer that best fits you.  \n
\n
\n"], ["1563", "
\nPlease take a few minutes to fill out this survey. We are interested in the way things are for you, so there are no right or wrong answers. If you are unsure about a question, just answer it as well   \nas you can. Check the box for the answer that best fits you.  \n
\n
\n"], ["1564", "
\nInstructions:  This survey asks about your health and daily activities. Answer every question by selecting the appropriate number (1, 2, 3...).  If you are unsure about how to answer a question,   \nplease give the best answer you can.  \n
\n
\n"], ["1565", "
\nThese questions are about how you FEEL and how things have been for you during the past 4 weeks. For each question, please indicate the one answer that comes closest to the way you have been   \nfeeling.  How much of the ime during the past 4 weeks...  \n
\n
\n"], ["1566", "
\nThe following question is about MEMORY.  \n
\n
\n"], ["1567", "
\nSelect one number for how often in the past 4 weeks you have had trouble remembering or how often this memory problem has interfered with your normal work or living  \n
\n
\n"], ["1568", "
\nThe following questions are about CONCENTRATION problems you may have. Select one number for how often in the past 4 weeks you had trouble concentrating or how often these problems interfered with   \nyou normal work or living.  \n
\n
\n"], ["1569", "
\nThe following questions are about problems you may have with certain ACTIVITIES. Select one number for how much during the past 4 weeks you epilepsy or antiepileptic medication has caused trouble  \nwith...  \n
\n
\n"], ["157", "
\nYou were referred because the primary level screening indicated that you may have had a head injury; that is you reported having had an alteration of consciousness after some traumatic event.  We are  \ntrying to determine the nature and severity of any of those type of injuries or related injuries, to determine how best we can assist you. \n
\n
\n"], ["1570", "
\nThe following questions relate to the way you FEEL about your seizures. Select one number on each line.  \n
\n
\n"], ["1571", "
\nFor each of these PROBLEMS, select one number for how much they bother you on a scale of 1 to 5 where 1  \n
\n
\n"], ["1572", "
\nHow good or bad do you think your health is? On the scale below, the best imaginble state of health is 10 and the worst is 0. Please indicate how you feel about your health by selecting one number on  \n the scale. Please consider epilepsy as part of your health when you answer this question.  \n
\n
\n"], ["1573", "
\nPlease take a few minutes to fill out this survey. We are interested in the way things are for you, so there are no right or wrong answers. If you are unsure about a question, just answer it as well   \nas you can. Check the box for the answer that best fits you.  \n
\n
\n"], ["1574", "
\nPlease take a few minutes to fill out this survey. We are interested in the way things are for you, so there are no right or wrong answers. If you are unsure about a question, just answer it as well   \nas you can. Check the box for the answer that best fits you.  \n
\n
\n"], ["1575", "
\nInstructions: This survey asks about your health and daily activities. Answer every question by selecting the appropriate number (1, 2, 3...). If you are unsure about how to answer a question,   \nplease give the best answer you can.  \n
\n
\n"], ["1576", "
\nThese questions are about how you FEEL and how things have been for you during the past 4 weeks. For each question, please indicate the one answer that comes closest to the way you have been   \nfeeling. How much of the time during the past 4 weeks...  \n
\n
\n"], ["1577", "
\nThe following question is about MEMORY.  \n
\n
\n"], ["1578", "
\nSelect one number for how often in the past 4 weeks you have had trouble remembering or how often this memory problem has interfered with your normal work or living  \n
\n
\n"], ["1579", "
\nThe following questions are about CONCENTRATION problems you may have. Select one number for how often in the past 4 weeks you had trouble concentrating or how often these problems interfered with  \nyour normal work or living.  \n
\n
\n"], ["158", "
\n4. Date(s) of most serious OEF/OIF deployment related injuries: \n
\n
\n"], ["1580", "
\nThe following questions are about problems you may have with certain ACTIVITIES. Select one number for how much during the past 4 weeks you epilepsy or antiepileptic medication has caused trouble  \nwith...  \n
\n
\n"], ["1581", "
\nThe following questions relate to the way you FEEL about your seizures. Select one number on each line.  \n
\n
\n"], ["1582", "
\nFor each of these PROBLEMS, select one number for how much they bother you on a scale of 1 to 5 where 1  \n
\n
\n"], ["1583", "
\nHow good or bad do you think your health is? On the scale below, the best imaginble state of health is 10 and the worst is 0. Please indicate how you feel about your health by selecting one number on  \n the scale. Please consider epilepsy as part of your health when you answer this question.  \n
\n
\n"], ["1584", "
\nHave you been bothered by unpleasant thoughts or images that repeatedly enter your mind, such as:  \n
\n
\n"], ["1585", "
\nHave you worried a lot about terrible things happening, such as:  \n
\n
\n"], ["1586", "
\nHave you worried about acting on an unwanted and senseless urge or impulse, such as:  \n
\n
\n"], ["1587", "
\nHave you felt driven to perform certain acts over and over again, such as:  \n
\n
\n"], ["1588", "
\nPART B Instructions: The following questions refer to the repeated thoughts, images, urges or behaviors identified in Part A. Consider your experience during the past 30 days when selecting an  \nanswer.    In the past month...  \n
\n
\n"], ["1589", "
\n11 Q:  How much time do you spend performing compulsive behaviors?" [When rituals involving activities of daily living are chiefly present, ask:] "How much longer than most people does it take to  \ncomplete routine activities because of your rituals?" [When compulsions occur as brief, intermittent behaviors, it may be difficult to assess time spent performing them in terms of total hours. In  \nsuch cases, estimate time by determining how frequently they are performed. Consider both the number of times compulsions are performed and how much of the day is affected. When estimating frequency,  \ncount separate occurrences of compulsive behaviors, not number of repetitions. In most cases compulsions are observable behaviors (e.g., hand washing or refusing to shake hands), but some compulsions  \nare covert (e.g., silent checking or praying); these mental rituals should be rated as you would overt compulsions. "Active avoidance" (e.g., rule governed behaviors that ensure a minimum "safe"  \ndistance from contaminated areas or wearing a glove on one hand to keep it clean) like compulsions, can manifest as discrete behavioral acts, measurable in hours or by frequency, so should be rated  \non this item. "Passive avoidance", on the other hand, may be difficult to quantify temporally; however, its relationship to compulsions and resultant impact on distress and functioning can be  \nmeasured on items 9 and 10 respectively. \n
\n
\n"], ["159", "
\n5. Injury etiology (Indicate all that apply) \n
\n
\n"], ["1590", "
\n10 Q: How much do your compulsive behaviors interfere with your social, school, or work (or role) functioning?" [If currently not working (or attending school), determine how much performance would  \nbe affected if patient were employed (or in school).] "Have you been avoiding doing anything, going any place, or being out of concern you will trigger the compulsions?" [Evaluate impact of avoidance  \non functioning. An example of avoidance relevant to assessment of compulsions is letting soiled clothes pile up instead of launching into an exhausting and prolonged laundry routine that will defy  \ninterruption.] \n
\n
\n"], ["1591", "
\n11 Q: How much time do you spend performing compulsive behaviors?" [When rituals involving activities of daily living are chiefly present, ask:] "How much longer than most people does it take to   \ncomplete routine activities because of your rituals?" [When compulsions occur as brief, intermittent behaviors, it may be difficult to assess time spent performing them in terms of total hours. In   \nsuch cases, estimate time by determining how frequently they are performed. Consider both the number of times compulsions are performed and how much of the day is affected. When estimating frequency,  \n count separate occurrences of compulsive behaviors, not number of repetitions. In most cases compulsions are observable behaviors (e.g., hand washing or refusing to shake hands), but some  \ncompulsions  are covert (e.g., silent checking or praying); these mental rituals should be rated as you would overt compulsions. "Active avoidance" (e.g., rule governed behaviors that ensure a  \nminimum "safe"  distance from contaminated areas or wearing a glove on one hand to keep it clean) like compulsions, can manifest as discrete behavioral acts, measurable in hours or by frequency, so  \nshould be rated  on this item. "Passive avoidance", on the other hand, may be difficult to quantify temporally; however, its relationship to compulsions and resultant impact on distress and  \nfunctioning can be  measured on items 9 and 10 respectively. \n
\n
\n"], ["1592", "
\n10 Q: How much do your compulsive behaviors interfere with your social, school, or work (or role) functioning?" [If currently not working (or attending school), determine how much performance would   \nbe affected if patient were employed (or in school).] "Have you been avoiding doing anything, going any place, or being out of concern you will trigger the compulsions?" [Evaluate impact of avoidance  \n on functioning. An example of avoidance relevant to assessment of compulsions is letting soiled clothes pile up instead of launching into an exhausting and prolonged laundry routine that will defy   \ninterruption.] \n
\n
\n"], ["1593", "
\n11 Q: How much time do you spend performing compulsive behaviors?" [When rituals involving activities of daily living are chiefly present, ask:] "How much longer than most people does it take to   \ncomplete routine activities because of your rituals?" [When compulsions occur as brief, intermittent behaviors, it may be difficult to assess time spent performing them in terms of total hours. In   \nsuch cases, estimate time by determining how frequently they are performed. Consider both the number of times compulsions are performed and how much of the day is affected. When estimating frequency,  \n count separate occurrences of compulsive behaviors, not number of repetitions. In most cases compulsions are observable behaviors (e.g., hand washing or refusing to shake hands), but some   \ncompulsions are covert (e.g., silent checking or praying); these mental rituals should be rated as you would overt compulsions. "Active avoidance" (e.g., rule governed behaviors that ensure a   \nminimum "safe" distance from contaminated areas or wearing a glove on one hand to keep it clean) like compulsions, can manifest as discrete behavioral acts, measurable in hours or by frequency, so   \nshould be rated on this item. "Passive avoidance", on the other hand, may be difficult to quantify temporally; however, its relationship to compulsions and resultant impact on distress and   \nfunctioning can be measured on items 9 and 10 respectively. \n
\n
\n"], ["1594", "
\nThese questions are about how you have been FEELING during the past 4 weeks.  \n
\n
\n"], ["1595", "
\nThe following questions ask about problems you may have with certain activities.||How much of the time during the past 4 weeks your epilepsy or antiepileptic drugs have caused trouble with:  \n
\n
\n"], ["1596", "
\nDuring the past 4 weeks:  \n
\n
\n"], ["1597", "
\nPart B.|Reviewing all the questions you have answered in Part A, consider the overall impact of these problems on your quality of life in the past 4 weeks.  \n
\n
\n"], ["1598", "
\nPart C:|Considering ALL the questions you have answered, please indicate the areas related to your epilepsy that are most IMPORTANT to you NOW. \n
\n
\n"], ["1599", "
\n12. Number the following topics from 1 -7 with 1 corresponding to the most important topic and 7 to the least important one. ||Please use each number once.  \n
\n
\n"], ["16", "
\nPlease read each item carefully and select the answer that best\ndescribes you.\n
\n
\n"], ["160", "
\nYou were referred because the primary level screening indicated that you may have had a head injury; that is you reported having had an alteration of consciousness after some traumatic event.  We are  \ntrying to determine the nature and severity of any of those type of injuries or related injuries, to determine how best we can assist you. \n
\n
\n"], ["1600", "
\nPlease answer these questions about your thoughts and feelings in the PAST MONTH.  \n
\n
\n"], ["1601", "
\nPlease answer these questions about your thoughts and feelings in the PAST MONTH.  \n
\n
\n"], ["1602", "
\nPlease answer these questions about your thoughts and feelings in the PAST MONTH.  \n
\n
\n"], ["1603", "
\nPlease answer these questions about your thoughts and feelings in the PAST MONTH.| \n
\n
\n"], ["1604", "
\nIn your most recent session, how much did your counselor:  \n
\n
\n"], ["1605", "
\nThis booklet contains a number of statements about families. Please read each statement carefully, and decide how well it describes you own family. You should answer according to how you see your  \nfamily. Try not to spend too much time thinking about each statement, but respond as quickly and as honestly as you can. If you have trouble with one, answer with your first reaction.||For each  \nstatement there are four (4) possible responses:||Strongly Agree (SA)  -- Check SA if you feel that the statement describes your family very accurately.||Agree (A) -- Check A if you feel that the  \nstatement describes your family for the most part.||Disagree (D) -- Check D if you feel that the statement does not describe your family for the most part.||Strongly Disagree (SD) -- Check SD if you  \nfeel that the statement does not describe your family at all. \n
\n
\n"], ["1606", "
\nMoving Forward: A Problem Solving Approach to Achieving Life's Goals  \n
\n
\n"], ["1607", "
\nThe following are six statements about how you generally react to stressful events. Please indicate the extent to which you agree with each of these statements. \n
\n
\n"], ["1608", "
\nMoving Forward: A Problem Solving Approach to Achieving Life's Goals  \n
\n
\n"], ["1609", "
\nThe following are six statements about how you generally react to stressful events. Please indicate the extent to which you agree with each of these statements.| \n
\n
\n"], ["161", "
\n4. Date(s) of most serious OEF/OIF deployment related injuries: \n
\n
\n"], ["1610", "
\nIn the past year, how often have you used the following? Following are a few questions that will help us give you better medical care.  The questions relate to our experience with alcohol,  \ncigarettes, and other drugs.  Some of the substances listed are prescribed by a doctor (like pain medications).  You are only asked to record those you have taken for reasons or in doses other than  \nprescribed.  You will also be asked about illicit or illegal drug use - but only to better diagnose and treat you. For each substance, mark in the appropriate column. For example, if you have used  \ncocaine monthly in the past year, put a mark in the Monthly column in the illegal drug row. | \n
\n
\n"], ["1611", "
\n1. In your Lifetime, which of the following substances have you ever used? | (Note: For prescription medications, please report nonmedical use only.)  \n
\n
\n"], ["1612", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)?  \n
\n
\n"], ["1613", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)?  \n
\n
\n"], ["1614", "
\n4. During the past 3 months, how often has your use of (first drug, second drug, etc) led to health, social, legal or financial problems?  \n
\n
\n"], ["1615", "
\n5. During the past 3 months, how often have you failed to do what was normally expected of you because of your use of (first drug, second drug, etc)?  \n
\n
\n"], ["1616", "
\n6. Has a friend or relative or anyone else ever expressed concern about your use of (first drug, second drug, etc)?  \n
\n
\n"], ["1617", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["1618", "
\n1. Has there ever been a period of time when you were not your usual self and \n
\n
\n"], ["1619", "
\nFollowing are a few questions that will help us give you better medical care.  The questions relate to our experience with alcohol, cigarettes, and other drugs.  Some of the substances listed are  \nprescribed by a doctor (like pain medications).  You are only asked to record those you have taken for reasons or in doses other than prescribed.  You will also be asked about illicit or illegal drug  \nuse - but only to better diagnose and treat you. For each substance, mark in the appropriate column. For example, if you have used cocaine monthly in the past year, put a mark in the Monthly column  \nin the illegal drug row.||In the past year, how often have you used the following?  \n
\n
\n"], ["162", "
\n5. Cause of Head Injury (Indicate all that apply). \n
\n
\n"], ["1620", "
\n1. In your Lifetime, which of the following substances have you ever used? | (Note: For prescription medications, please report nonmedical use only.)  \n
\n
\n"], ["1621", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)?  \n
\n
\n"], ["1622", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)?  \n
\n
\n"], ["1623", "
\n4. During the past 3 months, how often has your use of (first drug, second drug, etc) led to health, social, legal or financial problems?  \n
\n
\n"], ["1624", "
\n5. During the past 3 months, how often have you failed to do what was normally expected of you because of your use of (first drug, second drug, etc)?  \n
\n
\n"], ["1625", "
\n6. Has a friend or relative or anyone else ever expressed concern about your use of (first drug, second drug, etc)?  \n
\n
\n"], ["1626", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["1627", "
\nPlease take a few minutes to fill out this survey. We are interested in the way things are for you, so there are no right or wrong answers. If you are unsure about a question, just answer it as well   \nas you can. Check the box for the answer that best fits you. | \n
\n
\n"], ["1628", "
\nInstructions: Below is a list of problems and complaints that people sometimes have in response to stressful life experiences. Please read each one carefully, then select one of the numbers to the   \nright to indicate how much you have been bothered by that problem in the past month  \n
\n
\n"], ["1629", "
\nInstructions: Below is a list of problems and complaints that people sometimes have in response to stressful life experiences. Please read each one carefully, then select one of the numbers to the   \nright to indicate how much you have been bothered by that problem in the past month  \n
\n
\n"], ["163", "
\nYou were referred because the primary level screening indicated that you may have had a head injury; that is you reported having had an alteration of consciousness after some traumatic event.  We are  \ntrying to determine the nature and severity of any of those type of injuries or related injuries, to determine how best we can assist you. \n
\n
\n"], ["1630", "
\n1 Q: "How much of your time is occupied by obsessive thoughts?" [When obsessions occur as brief,intermittent intrusions, it may be difficult to assess time occupied by them in terms of total hours.  \nIn such cases, posing item #2 first may help identify most appropriate response to item #1. Be sure to exclude ruminations and reoccupations that, unlike obsessions, are ego-syntonic and rational  \nalbeit excessive.)] \n
\n
\n"], ["1631", "
\n2 Q: "On average, what is the longest continuous period (or block) of time in which you are free of obsessive thoughts?" [Only consider time while awake. You can also ask:] "How frequently do the  \nobsessive thoughts occur?" \n
\n
\n"], ["1632", "
\n3 Q: "How much control do you have over your obsessive thoughts? How successful are you in stopping or ignoring them? Can you dismiss them?" \n
\n
\n"], ["1633", "
\n4 Q: "How much distress do your obsessive thoughts cause you?" [In most cases, distress is equated with anxiety; however, patients may report that their obsessions are "disturbing" or "upsetting" but  \ndeny "anxiety." Only rate distress that seems generated by obsessions, not generalized anxiety or anxiety associated with other conditions.] \n
\n
\n"], ["1634", "
\nIntroduction:  \n
\n
\n"], ["1635", "
\nIntroduction:  \n
\n
\n"], ["1636", "
\n10 Q: How much do your compulsive behaviors interfere with your social, school, or work (or role) functioning?" [If currently not working (or attending school), determine how much performance would   \nbe affected if patient were employed (or in school).] "Have you been avoiding doing anything, going any place, or being out of concern you will trigger the compulsions?" [Evaluate impact of avoidance  \n on functioning. An example of avoidance relevant to assessment of compulsions is letting soiled clothes pile up instead of launching into an exhausting and prolonged laundry routine that will defy   \ninterruption.]  \n
\n
\n"], ["1637", "
\n11 Q: How much time do you spend performing compulsive behaviors?" [When rituals involving activities of daily living are chiefly present, ask:] "How much longer than most people does it take to   \ncomplete routine activities because of your rituals?" [When compulsions occur as brief, intermittent behaviors, it may be difficult to assess time spent performing them in terms of total hours. In   \nsuch cases, estimate time by determining how frequently they are performed. Consider both the number of times compulsions are performed and how much of the day is affected. When estimating frequency,  \n count separate occurrences of compulsive behaviors, not number of repetitions. In most cases compulsions are observable behaviors (e.g., hand washing or refusing to shake hands), but some   \ncompulsions are covert (e.g., silent checking or praying); these mental rituals should be rated as you would overt compulsions. "Active avoidance" (e.g., rule governed behaviors that ensure a   \nminimum "safe" distance from contaminated areas or wearing a glove on one hand to keep it clean) like compulsions, can manifest as discrete behavioral acts, measurable in hours or by frequency, so   \nshould be rated on this item. "Passive avoidance", on the other hand, may be difficult to quantify temporally; however, its relationship to compulsions and resultant impact on distress and   \nfunctioning can be measured on items 9 and 10 respectively.  \n
\n
\n"], ["1638", "
\n1 Q: "How much of your time is occupied by obsessive thoughts?" [When obsessions occur as brief,intermittent intrusions, it may be difficult to assess time occupied by them in terms of total hours.  \nIn such cases, posing item #2 first may help identify most appropriate response to item #1. Be sure to exclude ruminations and reoccupations that, unlike obsessions, are ego-syntonic and rational  \nalbeit excessive.)] \n
\n
\n"], ["1639", "
\n2 Q: "On average, what is the longest continuous period (or block) of time in which you are free of obsessive thoughts?" [Only consider time while awake. You can also ask:] "How frequently do the  \nobsessive thoughts occur?" \n
\n
\n"], ["164", "
\n4. Date(s) of most serious OEF/OIF deployment related injuries: \n
\n
\n"], ["1640", "
\n3 Q: "How much control do you have over your obsessive thoughts? How successful are you in stopping or ignoring them? Can you dismiss them?" \n
\n
\n"], ["1641", "
\n4 Q: "How much distress do your obsessive thoughts cause you?" [In most cases, distress is equated with anxiety; however, patients may report that their obsessions are "disturbing" or "upsetting" but  \ndeny "anxiety." Only rate distress that seems generated by obsessions, not generalized anxiety or anxiety associated with other conditions.] \n
\n
\n"], ["1642", "
\n5 Q: "How much do your obsessive thoughts interfere with your social, school, or work (role) functioning?" [If currently not working (or attending school), determine how much performance  would be  \naffected if patient were employed (or in school).] "Have you been avoiding doing anything, going any place, or being with anyone because of your obsessions?" [Evaluate impact of avoidance on  \nfunctioning.] \n
\n
\n"], ["1643", "
\n6 Q: "How much time do you spend performing compulsive behaviors?" [When rituals involving activities of daily living are chiefly present, ask:] "How much longer than most people does it take to  \ncomplete routine activities because of your rituals?" [When compulsions occur as brief, intermittent behaviors, it may be difficult to assess time spent performing them in terms of total hours. In  \nsuch cases, estimate time by determining how frequently they are performed. Consider both the number of times compulsions are performed and how much of the day is affected. When estimating frequency,  \ncount separate occurrences of compulsive behaviors, not number of repetitions. In most cases compulsions are observable behaviors (e.g., hand washing or refusing to shake hands), but some compulsions  \nare covert (e.g., silent checking or praying); these mental rituals should be rated as you would overt compulsions. "Active avoidance" (e.g., rule governed behaviors that ensure a minimum "safe"  \ndistance from contaminated areas or wearing a glove on one hand to keep it clean) like compulsions, can manifest as discrete behavioral acts, measurable in hours or by frequency, so should be rated  \non this item. "Passive avoidance", on the other hand, may be difficult to quantify temporally; however, its relationship to compulsions and resultant impact on distress and functioning can be  \nmeasured on items 9 and 10 respectively. \n
\n
\n"], ["1644", "
\n7 Q: "How much of an effort do you make to resist the compulsions?" [Only rate effort made to resist, not success or failure in actually controlling the compulsions. How much the patient resists the  \ncompulsions may or may not correlate with his ability to control them. Note that this item does not directly measure the severity of the compulsions; rather it rates a manifestation of health, i.e.,  \nthe effort the patient makes to counteract the compulsions. Thus, the more the patient tries to resist, the less impaired is this aspect of his functioning. If the compulsions are minimal, the  \npatient may not feel the need to resist them. In such cases, a rating of "0" should be given.] \n
\n
\n"], ["1645", "
\n8 Q: "How strong is the drive to perform the compulsions?" [Pause] "How much control do you have over the behaviors?" [In contrast to the preceding item on resistance, this item directly measures  \nsuccess or failure in controlling compulsions.] \n
\n
\n"], ["1646", "
\n9 Q: "How would you feel if prevented from performing your compulsion(s)?" [Pause] "How distressed would you become?" [Rate degree of distress patient would experience if performance of the ritual  \nwere prevented or suddenly interrupted without reassurance. Like compulsions, avoidance maneuvers can reduce distress; conversely, forced confrontation with avoided objects can engender distress. Ask  \nsimilar questions about avoidance:] "How would you feel if you werent allowed to avoid?" [In most, but not all cases, performing compulsions reduces anxiety. In other cases, the compulsions  \nthemselves can be a source of distress when laborious or demanding; they can even be painful as in the case of washing with scalding hot water. In these cases, distress or discomfort produced by the  \ncompulsions can be taken into account when ratig this item. Apart from these latter instances, this item can be viewed as an indirect measure of how dependent the individual is on compulsions or  \navoidance to keep distress in check.] \n
\n
\n"], ["1647", "
\n10 Q: How much do your compulsive behaviors interfere with your social, school, or work (or role) functioning?" [If currently not working (or attending school), determine how much performance would   \nbe affected if patient were employed (or in school).] "Have you been avoiding doing anything, going any place, or being out of concern you will trigger the compulsions?" [Evaluate impact of avoidance  \n on functioning. An example of avoidance relevant to assessment of compulsions is letting soiled clothes pile up instead of launching into an exhausting and prolonged laundry routine that will defy   \ninterruption.]  \n
\n
\n"], ["1648", "
\n11 Q: How much time do you spend performing compulsive behaviors?" [When rituals involving activities of daily living are chiefly present, ask:] "How much longer than most people does it take to   \ncomplete routine activities because of your rituals?" [When compulsions occur as brief, intermittent behaviors, it may be difficult to assess time spent performing them in terms of total hours. In   \nsuch cases, estimate time by determining how frequently they are performed. Consider both the number of times compulsions are performed and how much of the day is affected. When estimating frequency,  \n count separate occurrences of compulsive behaviors, not number of repetitions. In most cases compulsions are observable behaviors (e.g., hand washing or refusing to shake hands), but some   \ncompulsions are covert (e.g., silent checking or praying); these mental rituals should be rated as you would overt compulsions. "Active avoidance" (e.g., rule governed behaviors that ensure a   \nminimum "safe" distance from contaminated areas or wearing a glove on one hand to keep it clean) like compulsions, can manifest as discrete behavioral acts, measurable in hours or by frequency, so   \nshould be rated on this item. "Passive avoidance", on the other hand, may be difficult to quantify temporally; however, its relationship to compulsions and resultant impact on distress and   \nfunctioning can be measured on items 9 and 10 respectively.  \n
\n
\n"], ["1649", "
\n1 Q: "How much of your time is occupied by obsessive thoughts?" [When obsessions occur as brief,intermittent intrusions, it may be difficult to assess time occupied by them in terms of total hours.   \nIn such cases, posing item #2 first may help identify most appropriate response to item #1. Be sure to exclude ruminations and reoccupations that, unlike obsessions, are ego-syntonic and rational   \nalbeit excessive.)]  \n
\n
\n"], ["165", "
\n5. Cause of Head Injury (Indicate all that apply). \n
\n
\n"], ["1650", "
\n2 Q: "On average, what is the longest continuous period (or block) of time in which you are free of obsessive thoughts?" [Only consider time while awake. You can also ask:] "How frequently do the   \nobsessive thoughts occur?"  \n
\n
\n"], ["1651", "
\n3 Q: "How much control do you have over your obsessive thoughts? How successful are you in stopping or ignoring them? Can you dismiss them?"  \n
\n
\n"], ["1652", "
\n4 Q: "How much distress do your obsessive thoughts cause you?" [In most cases, distress is equated with anxiety; however, patients may report that their obsessions are "disturbing" or "upsetting" but  \n deny "anxiety." Only rate distress that seems generated by obsessions, not generalized anxiety or anxiety associated with other conditions.]  \n
\n
\n"], ["1653", "
\n5 Q: "How much do your obsessive thoughts interfere with your social, school, or work (role) functioning?" [If currently not working (or attending school), determine how much performance would be   \naffected if patient were employed (or in school).] "Have you been avoiding doing anything, going any place, or being with anyone because of your obsessions?" [Evaluate impact of avoidance on   \nfunctioning.]  \n
\n
\n"], ["1654", "
\n6 Q: "How much time do you spend performing compulsive behaviors?" [When rituals involving activities of daily living are chiefly present, ask:] "How much longer than most people does it take to   \ncomplete routine activities because of your rituals?" [When compulsions occur as brief, intermittent behaviors, it may be difficult to assess time spent performing them in terms of total hours. In   \nsuch cases, estimate time by determining how frequently they are performed. Consider both the number of times compulsions are performed and how much of the day is affected. When estimating frequency,  \n count separate occurrences of compulsive behaviors, not number of repetitions. In most cases compulsions are observable behaviors (e.g., hand washing or refusing to shake hands), but some  \ncompulsions  are covert (e.g., silent checking or praying); these mental rituals should be rated as you would overt compulsions. "Active avoidance" (e.g., rule governed behaviors that ensure a  \nminimum "safe"  distance from contaminated areas or wearing a glove on one hand to keep it clean) like compulsions, can manifest as discrete behavioral acts, measurable in hours or by frequency, so  \nshould be rated  on this item. "Passive avoidance", on the other hand, may be difficult to quantify temporally; however, its relationship to compulsions and resultant impact on distress and  \nfunctioning can be  measured on items 9 and 10 respectively.  \n
\n
\n"], ["1655", "
\n7 Q: "How much of an effort do you make to resist the compulsions?" [Only rate effort made to resist, not success or failure in actually controlling the compulsions. How much the patient resists the   \ncompulsions may or may not correlate with his ability to control them. Note that this item does not directly measure the severity of the compulsions; rather it rates a manifestation of health, i.e.,   \nthe effort the patient makes to counteract the compulsions. Thus, the more the patient tries to resist, the less impaired is this aspect of his functioning. If the compulsions are minimal, the   \npatient may not feel the need to resist them. In such cases, a rating of "0" should be given.]  \n
\n
\n"], ["1656", "
\n8 Q: "How strong is the drive to perform the compulsions?" [Pause] "How much control do you have over the behaviors?" [In contrast to the preceding item on resistance, this item directly measures   \nsuccess or failure in controlling compulsions.]  \n
\n
\n"], ["1657", "
\n9 Q: "How would you feel if prevented from performing your compulsion(s)?" [Pause] "How distressed would you become?" [Rate degree of distress patient would experience if performance of the ritual   \nwere prevented or suddenly interrupted without reassurance. Like compulsions, avoidance maneuvers can reduce distress; conversely, forced confrontation with avoided objects can engender distress. Ask  \n similar questions about avoidance:] "How would you feel if you werent allowed to avoid?" [In most, but not all cases, performing compulsions reduces anxiety. In other cases, the compulsions   \nthemselves can be a source of distress when laborious or demanding; they can even be painful as in the case of washing with scalding hot water. In these cases, distress or discomfort produced by the   \ncompulsions can be taken into account when ratig this item. Apart from these latter instances, this item can be viewed as an indirect measure of how dependent the individual is on compulsions or   \navoidance to keep distress in check.]  \n
\n
\n"], ["1658", "
\n10 Q: "How much do your compulsive behaviors interfere with your social, school, or work (or role) functioning?" [If currently not working (or attending school), determine how much performance would   \nbe affected if patient were employed (or in school).] "Have you been avoiding doing anything, going any place, or being out of concern you will trigger the compulsions?" [Evaluate impact of avoidance  \n on functioning. An example of avoidance relevant to assessment of compulsions is letting soiled clothes pile up instead of launching into an exhausting and prolonged laundry routine that will defy   \ninterruption.]  \n
\n
\n"], ["1659", "
\n11 Q: "Do you think your concerns or behaviors are reasonable?" [Pause] "What do you think would happen if you did not perform the compulsion(s)? Are you convinced something would really happen?"  \n[Rate patient's insight into the senselessness or excessiveness of his obsession(s) based on beliefs expressed at the time of the interview.] \n
\n
\n"], ["166", "
\nYou were referred because the primary level screening indicated that you may have had a head injury; that is you reported having had an alteration of consciousness after some traumatic event.  We are  \ntrying to determine the nature and severity of any of those type of injuries or related injuries, to determine how best we can assist you. \n
\n
\n"], ["1660", "
\nPART A Instructions:  Please circle YES or NO for the following questions, based on your experience in the past MONTH: \n
\n
\n"], ["1661", "
\nHave you been bothered by unpleasant thoughts or images that repeatedly enter your mind, such as:  \n
\n
\n"], ["1662", "
\nHave you worried a lot about terrible things happening, such as:  \n
\n
\n"], ["1663", "
\nHave you worried about acting on an unwanted and senseless urge or impulse, such as:  \n
\n
\n"], ["1664", "
\nHave you felt driven to perform certain acts over and over again, such as:  \n
\n
\n"], ["1665", "
\nPART B Instructions: The following questions refer to the repeated thoughts, images, urges or behaviors identified in Part A. Consider your experience during the past 30 days when selecting an   \nanswer.  In the past month...  \n
\n
\n"], ["1666", "
\nPART A Instructions: Please circle YES or NO for the following questions, based on your experience in the past MONTH: \n
\n
\n"], ["1667", "
\nHave you been bothered by unpleasant thoughts or images that repeatedly enter your mind, such as:  \n
\n
\n"], ["1668", "
\nHave you worried a lot about terrible things happening, such as:  \n
\n
\n"], ["1669", "
\nHave you worried about acting on an unwanted and senseless urge or impulse, such as:  \n
\n
\n"], ["167", "
\n4. Date(s) of most serious OEF/OIF deployment related injuries: \n
\n
\n"], ["1670", "
\nHave you felt driven to perform certain acts over and over again, such as:  \n
\n
\n"], ["1671", "
\nPART B Instructions: The following questions refer to the repeated thoughts, images, urges or behaviors identified in Part A. Consider your experience during the past 30 days when selecting an   \nanswer. In the past month...  \n
\n
\n"], ["1672", "
\nPART A Instructions: Please circle YES or NO for the following questions, based on your experience in the past MONTH: \n
\n
\n"], ["1673", "
\nHave you been bothered by unpleasant thoughts or images that repeatedly enter your mind, such as:  \n
\n
\n"], ["1674", "
\nHave you worried a lot about terrible things happening, such as:  \n
\n
\n"], ["1675", "
\nHave you worried about acting on an unwanted and senseless urge or impulse, such as:  \n
\n
\n"], ["1676", "
\nHave you felt driven to perform certain acts over and over again, such as:  \n
\n
\n"], ["1677", "
\nPART B Instructions: The following questions refer to the repeated thoughts, images, urges or behaviors identified in Part A. Consider your experience during the past 30 days when selecting an   \nanswer. In the past month...  \n
\n
\n"], ["1678", "
\nPART A Instructions: Please select either YES or NO for the following questions, based on your experience in the past MONTH: \n
\n
\n"], ["1679", "
\nHave you been bothered by unpleasant thoughts or images that repeatedly enter your mind, such as:  \n
\n
\n"], ["168", "
\n5. Cause of Head Injury (Indicate all that apply). \n
\n
\n"], ["1680", "
\nHave you worried a lot about terrible things happening, such as:  \n
\n
\n"], ["1681", "
\nHave you worried about acting on an unwanted and senseless urge or impulse, such as:  \n
\n
\n"], ["1682", "
\nHave you felt driven to perform certain acts over and over again, such as:  \n
\n
\n"], ["1683", "
\nPART B Instructions: The following questions refer to the repeated thoughts, images, urges or behaviors identified in Part A. Consider your experience during the past 30 days when selecting an   \nanswer. In the past month...  \n
\n
\n"], ["1684", "
\nPART A Instructions:  Please select YES or NO for the following questions, based on your experience in the past MONTH: \n
\n
\n"], ["1685", "
\nHave you been bothered by unpleasant thoughts or images that repeatedly enter your mind, such as:  \n
\n
\n"], ["1686", "
\nHave you worried a lot about terrible things happening, such as:  \n
\n
\n"], ["1687", "
\nHave you worried about acting on an unwanted and senseless urge or impulse, such as:  \n
\n
\n"], ["1688", "
\nHave you felt driven to perform certain acts over and over again, such as:  \n
\n
\n"], ["1689", "
\nPART B Instructions: The following questions refer to the repeated thoughts, images, urges or behaviors identified in Part A. Consider your experience during the past 30 days when selecting an   \nanswer. In the past month...  \n
\n
\n"], ["169", "
\nPlease rate the following symptoms with regard to how much they have disturbed you SINCE YOUR INJURY. Use the following scale:  None 0 - Rarely if ever present; not a problem at all  Mild 1 -  \nOccasionally present, but it does not disrupt activities;  I can usually continue what I'm doing; doesn't really concern me.  Moderate 2 - Often present, occasionally disrupts my activities;  I can  \nusually continue what I'm doing with some effort;  I somewhat concerned.  Severe 3 - Frequently present and disrupts activities;  I can only do things that are fairly simple or take little effort; I  \nfeel like I need help.  Very Severe 4 - Almost always present and I have been unable to perform at work, school, or home due to this problem; I probably cannot function without help \n
\n
\n"], ["1690", "
\nPART A Instructions: \n
\n
\n"], ["1691", "
\nHave you been bothered by unpleasant thoughts or images that repeatedly enter your mind, such as:  \n
\n
\n"], ["1692", "
\nHave you worried a lot about terrible things happening, such as:  \n
\n
\n"], ["1693", "
\nHave you worried about acting on an unwanted and senseless urge or impulse, such as:  \n
\n
\n"], ["1694", "
\nHave you felt driven to perform certain acts over and over again, such as:  \n
\n
\n"], ["1695", "
\nPART B Instructions: The following questions refer to the repeated thoughts, images, urges or behaviors identified in Part A. Consider your experience during the past 30 days when selecting an   \nanswer. In the past month...  \n
\n
\n"], ["1696", "
\nFor each of the following items, select the answer that best describes how you feel about your relationship. Base your responses on your first impressions and immediate feelings about the item.  \n
\n
\n"], ["1697", "
\nFor each of the following items, select the answer that best describes how you feel about your relationship. Base your responses on your first impressions and immediate feelings about the item.  \n
\n
\n"], ["1698", "
\nFor each of the following items, select the answer that best describes how you feel about your relationship. Base your responses on your first impressions and immediate feelings about the item.  \n
\n
\n"], ["1699", "
\nFor each of the following items, select the answer that best describes how you feel about your relationship. Base your responses on your first impressions and immediate feelings about the item.  \n
\n
\n"], ["17", "
\n12 Introduction: \n
\n
\n"], ["170", "
\n5. Cause of Head Injury: \n
\n
\n"], ["1700", "
\nHave you been bothered by unpleasant thoughts or images that repeatedly enter your mind, such as:  \n
\n
\n"], ["1701", "
\nHave you worried a lot about terrible things happening, such as:  \n
\n
\n"], ["1702", "
\nHave you worried about acting on an unwanted and senseless urge or impulse, such as:  \n
\n
\n"], ["1703", "
\nHave you felt driven to perform certain acts over and over again, such as:  \n
\n
\n"], ["1704", "
\nPART B Instructions: The following questions refer to the repeated thoughts, images, urges or behaviors identified in Part A. Consider your experience during the past 30 days when selecting an   \nanswer. In the past month...  \n
\n
\n"], ["1705", "
\nIntroduction:  \n
\n
\n"], ["1706", "
\nHave you been bothered by unpleasant thoughts or images that repeatedly enter your mind, such as:  \n
\n
\n"], ["1707", "
\nHave you worried a lot about terrible things happening, such as:  \n
\n
\n"], ["1708", "
\nHave you worried about acting on an unwanted and senseless urge or impulse, such as:  \n
\n
\n"], ["1709", "
\nHave you felt driven to perform certain acts over and over again, such as:  \n
\n
\n"], ["171", "
\n15. Please rate the following symptoms with regard to how much they have disturbed you SINCE YOUR INJURY. Use the following scale:  None 0 - Rarely if ever present; not a problem at all  Mild 1 -    \nOccasionally present, but it does not disrupt activities;  I can usually continue what I'm doing; doesn't really concern me.  Moderate 2 - Often present, occasionally disrupts my activities;  I can    \nusually continue what I'm doing with some effort;  I somewhat concerned.  Severe 3 - Frequently present and disrupts activities;  I can only do things that are fairly simple or take little effort; I   \n feel like I need help.  Very Severe 4 - Almost always present and I have been unable to perform at work, school, or home due to this problem; I probably cannot function without help  \n
\n
\n"], ["1710", "
\nPART B Instructions: The following questions refer to the repeated thoughts, images, urges or behaviors identified in Part A. Consider your experience during the past 30 days when selecting an   \nanswer. In the past month...  \n
\n
\n"], ["1711", "
\nIntroduction:  \n
\n
\n"], ["1712", "
\nGeneral Instructions:  The questions below are designed to help health professionals evaluate anxiety symptoms.  Keep in mind, a high score on this questionnaire does| not necessarily mean you have an anxiety disorder- only an evaluation by a\n health professional can make this determination.  Answer these questions as accurately as you can.| |\n \nPart A Instructions:  Please respond Yes or No for the following questions, based on your experience in the past MONTH:| |\n \nHave you been bothered by unpleasant thoughts or images that repeatedly enter your mind, such as:\n
\n
\n"], ["1713", "
\nHave you worried a lot about terrible things happening, such as:  \n
\n
\n"], ["1714", "
\nHave you worried about acting on an unwanted and senseless urge or impulse, such as:  \n
\n
\n"], ["1715", "
\nHave you felt driven to perform certain acts over and over again, such as:  \n
\n
\n"], ["1716", "
\n|\nIf you answered YES to one or more of these questions, please continue with Part B.| |\n \n| |PART B Instructions: The following questions refer to the repeated thoughts, images, urges or behaviors identified in Part A. Consider your experience during the past 30|\n days when selecting an answer. Select the most appropriate number from 0 to 4. | |\n \nIn the past month...  \n
\n
\n"], ["1717", "
\nFor each of the following items, select the answer that best describes how you feel about your relationship. Base your responses on your first impressions and immediate feelings about the item.  \n
\n
\n"], ["1718", "
\nFor each of the following items, select the answer that best describes how you feel about your relationship. Base your responses on your first impressions and immediate feelings about the item.  \n
\n
\n"], ["1719", "
\nFor each of the following items, select the answer that best describes how you feel about your relationship. Base your responses on your first impressions and immediate feelings about the item.  \n
\n
\n"], ["172", "
\nFollow up Care within the VA \n
\n
\n"], ["1720", "
\nFor each of the following items, select the answer that best describes how you feel about your relationship. Base your responses on your first impressions and immediate feelings about the item.  \n
\n
\n"], ["1721", "
\nBelow is a list of statements describing thoughts or feelings that you may have from time to time or may be familiar to you. Most of these statements describe thoughts and feelings that are generally  \npainful or negative in some way. Try to be as honest as you can in responding. As you see it now, please rate how often you have the thoughts or experiences listed below. Use the scale below to make  \nyour choice. Please choose only one number and not in between numbers.  \n
\n
\n"], ["1722", "
\nPlease read each statement below and choose the number that indicates how many people you think would react to you as described. Please use the scale below, and please do not omit any item.  \n
\n
\n"], ["1723", "
\nBelow you will find a list of statements. As you see it now, please rate how true each statement is for you. Use the scale below to make your choice.  \n
\n
\n"], ["1724", "
\n In the following questions you will find a set of difficulties and \nproblems which possibly describe you. Please work through the \nquestionnaire and decide how much you suffered from each problem in the\ncourse of the last week. In case you have no feelings at all at the \npresent moment, please answer according to how you think you\nmight have felt. Please answer honestly. All questions refer to the last \nweek. If you felt different ways at different times in the week, give a \nrating for how things were for you on average. Please be sure to answer\neach question.\n
\n
\n"], ["1725", "
\nPlease indicate how often the following statements apply to you by selecting the appropriate number from the scale below each item.\n
\n
\n"], ["1726", "
\nInstructions: This survey asks about your health and daily activities. Answer every question by selecting the appropriate number (1, 2, 3...). If you are unsure about how to answer a question,   \nplease give the best answer you can.  \n
\n
\n"], ["1727", "
\nThese questions are about how you FEEL and how things have been for you during the past 4 weeks. For each question, please indicate the one answer that comes closest to the way you have been   \nfeeling. How much of the time during the past 4 weeks...  \n
\n
\n"], ["1728", "
\nThe following question is about MEMORY.  \n
\n
\n"], ["1729", "
\nSelect one number for how often in the past 4 weeks you have had trouble remembering or how often this memory problem has interfered with your normal work or living  \n
\n
\n"], ["173", "
\n5. Cause of Head Injury: \n
\n
\n"], ["1730", "
\nThe following questions are about CONCENTRATION problems you may have. Select one number for how often in the past 4 weeks you had trouble concentrating or how often these problems interfered with   \nyour normal work or living.  \n
\n
\n"], ["1731", "
\nThe following questions are about problems you may have with certain ACTIVITIES. Select one number for how much during the past 4 weeks your epilepsy or antiepileptic medication has caused trouble  \nwith... \n
\n
\n"], ["1732", "
\nThe following questions relate to the way you FEEL about your seizures. Select one number on each line.  \n
\n
\n"], ["1733", "
\nFor each of these PROBLEMS, select one number for how much they bother you on a scale of 1 to 5 where 1  = Not at all bothersome, and 5 = Extremely bothersome. \n
\n
\n"], ["1734", "
\nHow good or bad do you think your health is? On the scale below, the best imaginble state of health is 10 and the worst is 0. Please indicate how you feel about your health by selecting one number on  \n the scale. Please consider epilepsy as part of your health when you answer this question.  \n
\n
\n"], ["1735", "
\nInstructions: This survey asks about your health and daily activities. Answer every question by selecting the appropriate number (1, 2, 3...). If you are unsure about how to answer a question,   \nplease give the best answer you can.  \n
\n
\n"], ["1736", "
\nThese questions are about how you FEEL and how things have been for you during the past 4 weeks. For each question, please indicate the one answer that comes closest to the way you have been   \nfeeling. How much of the time during the past 4 weeks...  \n
\n
\n"], ["1737", "
\nThe following question is about MEMORY.  \n
\n
\n"], ["1738", "
\nSelect one number for how often in the past 4 weeks you have had trouble remembering or how often this memory problem has interfered with your normal work or living  \n
\n
\n"], ["1739", "
\nThe following questions are about CONCENTRATION problems you may have. Select one number for how often in the past 4 weeks you had trouble concentrating or how often these problems interfered with   \nyour normal work or living.  \n
\n
\n"], ["174", "
\n15. Please rate the following symptoms with regard to how much they have disturbed you SINCE YOUR INJURY. Use the following scale:  None 0 - Rarely if ever present; not a problem at all  Mild 1 -    \nOccasionally present, but it does not disrupt activities;  I can usually continue what I'm doing; doesn't really concern me.  Moderate 2 - Often present, occasionally disrupts my activities;  I can    \nusually continue what I'm doing with some effort;  I somewhat concerned.  Severe 3 - Frequently present and disrupts activities;  I can only do things that are fairly simple or take little effort; I   \n feel like I need help.  Very Severe 4 - Almost always present and I have been unable to perform at work, school, or home due to this problem; I probably cannot function without help  \n
\n
\n"], ["1740", "
\nThe following questions are about problems you may have with certain ACTIVITIES. Select one number for how much during the past 4 weeks your epilepsy or antiepileptic medication has caused trouble   \nwith...  \n
\n
\n"], ["1741", "
\nThe following questions relate to the way you FEEL about your seizures. Select one number on each line.  \n
\n
\n"], ["1743", "
\nHow good or bad do you think your health is? On the scale below, the best imaginble state of health is 10 and the worst is 0. Please indicate how you feel about your health by selecting one number on  \n the scale. Please consider epilepsy as part of your health when you answer this question.  \n
\n
\n"], ["1744", "
\nInstructions: This survey asks about your health and daily activities. Answer every question by selecting the appropriate number (1, 2, 3...). If you are unsure about how to answer a question,   \nplease give the best answer you can.  \n
\n
\n"], ["1745", "
\nThese questions are about how you FEEL and how things have been for you during the past 4 weeks. For each question, please indicate the one answer that comes closest to the way you have been   \nfeeling. How much of the time during the past 4 weeks...  \n
\n
\n"], ["1746", "
\nThe following question is about MEMORY.  \n
\n
\n"], ["1747", "
\nSelect one number for how often in the past 4 weeks you have had trouble remembering or how often this memory problem has interfered with your normal work or living  \n
\n
\n"], ["1748", "
\nThe following questions are about CONCENTRATION problems you may have. Select one number for how often in the past 4 weeks you had trouble concentrating or how often these problems interfered with   \nyour normal work or living.  \n
\n
\n"], ["1749", "
\nThe following questions are about problems you may have with certain ACTIVITIES. Select one number for how much during the past 4 weeks your epilepsy or antiepileptic medication has caused trouble   \nwith...  \n
\n
\n"], ["175", "
\nFollow up Care within the VA \n
\n
\n"], ["1750", "
\nThe following questions relate to the way you FEEL about your seizures. Select one number on each line.  \n
\n
\n"], ["1751", "
\nFor each of these PROBLEMS, select one number for how much they bother you on a scale of 1 to 5 where 1 = Not at all bothersome, and 5 = Extremely bothersome. \n
\n
\n"], ["1752", "
\nHow good or bad do you think your health is? On the scale below, the best imaginble state of health is 10 and the worst is 0. Please indicate how you feel about your health by selecting one number on  \n the scale. Please consider epilepsy as part of your health when you answer this question.  \n
\n
\n"], ["1753", "
\nInstructions: This survey asks about your health and daily activities. Answer every question by selecting the appropriate number (1, 2, 3...). If you are unsure about how to answer a question,   \nplease give the best answer you can.  \n
\n
\n"], ["1754", "
\nThese questions are about how you FEEL and how things have been for you during the past 4 weeks. For each question, please indicate the one answer that comes closest to the way you have been   \nfeeling. How much of the time during the past 4 weeks...  \n
\n
\n"], ["1755", "
\nThe following question is about MEMORY.  \n
\n
\n"], ["1756", "
\nSelect one number for how often in the past 4 weeks you have had trouble remembering or how often this memory problem has interfered with your normal work or living  \n
\n
\n"], ["1757", "
\nThe following questions are about CONCENTRATION problems you may have. Select one number for how often in the past 4 weeks you had trouble concentrating or how often these problems interfered with   \nyour normal work or living.  \n
\n
\n"], ["1758", "
\nThe following questions are about problems you may have with certain ACTIVITIES. Select one number for how much during the past 4 weeks your epilepsy or antiepileptic medication has caused trouble   \nwith...  \n
\n
\n"], ["1759", "
\nThe following questions relate to the way you FEEL about your seizures. Select one number on each line.  \n
\n
\n"], ["176", "
\n5. Cause of Head Injury: \n
\n
\n"], ["1760", "
\nFor each of these PROBLEMS, select one number for how much they bother you on a scale of 1 to 5 where 1 equals Not at all bothersome, and 5 equals Extremely bothersome.| \n
\n
\n"], ["1761", "
\nHow good or bad do you think your health is? On the scale below, the best imaginble state of health is 10 and the worst is 0. Please indicate how you feel about your health by selecting one number on  \n the scale. Please consider epilepsy as part of your health when you answer this question.  \n
\n
\n"], ["1762", "
\nInstructions: This survey asks about your health and daily activities. Answer every question by selecting the appropriate number (1, 2, 3...). If you are unsure about how to answer a question,   \nplease give the best answer you can.  \n
\n
\n"], ["1763", "
\nThese questions are about how you FEEL and how things have been for you during the past 4 weeks. For each question, please indicate the one answer that comes closest to the way you have been   \nfeeling. How much of the time during the past 4 weeks...  \n
\n
\n"], ["1764", "
\nThe following question is about MEMORY.  \n
\n
\n"], ["1765", "
\nSelect one number for how often in the past 4 weeks you have had trouble remembering or how often this memory problem has interfered with your normal work or living  \n
\n
\n"], ["1766", "
\nThe following questions are about CONCENTRATION problems you may have. Select one number for how often in the past 4 weeks you had trouble concentrating or how often these problems interfered with   \nyour normal work or living.  \n
\n
\n"], ["1767", "
\nThe following questions are about problems you may have with certain ACTIVITIES. Select one number for how much during the past 4 weeks your epilepsy or antiepileptic medication has caused trouble   \nwith...  \n
\n
\n"], ["1768", "
\nThe following questions relate to the way you FEEL about your seizures. Select one number on each line.  \n
\n
\n"], ["1769", "
\nFor each of these PROBLEMS, select one number for how much they bother you on a scale of 1 to 5 where 1 equals Not at all bothersome, and 5 equals Extremely bothersome. \n
\n
\n"], ["177", "
\n15. Please rate the following symptoms with regard to how much they have disturbed you SINCE YOUR INJURY. Use the following scale:  None 0 - Rarely if ever present; not a problem at all  Mild 1 -    \nOccasionally present, but it does not disrupt activities;  I can usually continue what I'm doing; doesn't really concern me.  Moderate 2 - Often present, occasionally disrupts my activities;  I can    \nusually continue what I'm doing with some effort;  I somewhat concerned.  Severe 3 - Frequently present and disrupts activities;  I can only do things that are fairly simple or take little effort; I   \n feel like I need help.  Very Severe 4 - Almost always present and I have been unable to perform at work, school, or home due to this problem; I probably cannot function without help  \n
\n
\n"], ["1770", "
\nHow good or bad do you think your health is? On the scale below, the best imaginble state of health is 10 and the worst is 0. Please indicate how you feel about your health by selecting one number on  \n the scale. Please consider epilepsy as part of your health when you answer this question.  \n
\n
\n"], ["1771", "
\nINSTRUCTIONS: Please read the following statements carefully. Each one describes a way that you might (or might not) feel about your drug use. For each statement, chose one number from 1 to 5, to   \nindicate how much you agree or disagree with it right now.  \n
\n
\n"], ["1772", "
\nInstructions: Below is a list of problems that people sometimes have in response to a very stressful experience. \nPlease read each problem carefully and then select one of the numbers below to indicate how much you have been\nbothered by that problem in the past month.\n
\n
\n"], ["1773", "
\nPlease answer these questions about your thoughts and feelings in the PAST MONTH.|  \n
\n
\n"], ["1774", "
\nThis assessment asks how you feel about your quality of life, health, or other areas  of your life. Please answer all the questions. If you are unsure about which response  to give to a question,  \nplease choose the one that appears most appropriate. This  can often be your first response.||Please keep in mind your standards, hopes, pleasures and concerns. We ask that  you think about your life  \nin the last two weeks. \n
\n
\n"], ["1775", "
\nThe following questions ask about how much you have experienced certain things in the last four weeks.  \n
\n
\n"], ["1776", "
\nThe following questions ask about how completely you experience or were able to do certain things in the last four weeks.  \n
\n
\n"], ["1777", "
\nThe following question refers to how often you have felt or experienced certain things in the last four weeks.  \n
\n
\n"], ["1778", "
\nThis assessment asks how you feel about your quality of life, health, or other areas of your life. Please answer all the questions. If you are unsure about which response to give to a question,   \nplease choose the one that appears most appropriate. This can often be your first response.||Please keep in mind your standards, hopes, pleasures and concerns. We ask that you think about your life   \nin the last two weeks.  \n
\n
\n"], ["1779", "
\nThe following questions ask about how much you have experienced certain things in the last two weeks.  \n
\n
\n"], ["178", "
\nFollow up Care within the VA \n
\n
\n"], ["1780", "
\nThe following questions ask about how completely you experience or were able to do certain things in the last two weeks.  \n
\n
\n"], ["1781", "
\nThe following questions ask you to say how good or satisfied you have felt about various aspects of your life over the last two weeks. \n
\n
\n"], ["1782", "
\nThe following question refers to how often you have felt or experienced certain things in the last two weeks.  \n
\n
\n"], ["1783", "
\nINSTRUCTIONS: Here are a number of events that people sometimes experience. Read each one carefullyand indicate whether this has EVER happened to you (0=No, 1=Yes).  If an item does not apply to you,  \nindicate No (0).||Has this EVER happened to you? \n
\n
\n"], ["1784", "
\nINSTRUCTIONS: Here are a number of events that people sometimes experience. Read each one carefullyand indicate whether this has EVER happened to you (0 indicate No (0) ).||Has this EVER happened to  \nyou?  \n
\n
\n"], ["1785", "
\nFollowing are a few questions that will help us give you better medical care. The questions relate to our experience with alcohol, cigarettes, and other drugs. Some of the substances listed are   \nprescribed by a doctor (like pain medications). You are only asked to record those you have taken for reasons or in doses other than prescribed. You will also be asked about illicit or illegal drug   \nuse - but only to better diagnose and treat you. For each substance, mark in the appropriate column. For example, if you have used cocaine monthly in the past year, put a mark in the Monthly column   \nin the illegal drug row.||In the past year, how often have you used the following?  \n
\n
\n"], ["1786", "
\n1. In your Lifetime, which of the following substances have you ever used? | (Note: For prescription medications, please report nonmedical use only.)  \n
\n
\n"], ["1787", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)?  \n
\n
\n"], ["1788", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)?  \n
\n
\n"], ["1789", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)?  \n
\n
\n"], ["179", "
\n5. Cause of Head Injury: \n
\n
\n"], ["1790", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)?  \n
\n
\n"], ["1791", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)?  \n
\n
\n"], ["1792", "
\n4. During the past 3 months, how often has your use of (first drug, second drug, etc) led to health, social, legal or financial problems?  \n
\n
\n"], ["1793", "
\n5. During the past 3 months, how often have you failed to do what was normally expected of you because of your use of (first drug, second drug, etc)?  \n
\n
\n"], ["1794", "
\n6. Has a friend or relative or anyone else ever expressed concern about your use of (first drug, second drug, etc)?  \n
\n
\n"], ["1795", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["1796", "
\nIntroduction:  \n
\n
\n"], ["1797", "
\nIntroduction:  \n
\n
\n"], ["1798", "
\nIntroduction:  \n
\n
\n"], ["1799", "
\nIntroduction:  \n
\n
\n"], ["18", "
\nThis survey asks for your views about your feelings and your health.\nThis information will be kept confidential and will help your\ndoctors keep track of how you feel.\n \nIf you are unsure about how to answer a question,\nplease give the best answer you can.\n
\n
\n"], ["180", "
\n15. Please rate the following symptoms with regard to how much they have disturbed you SINCE YOUR INJURY. Use the following scale:  None 0 - Rarely if ever present; not a problem at all  Mild 1 -    \nOccasionally present, but it does not disrupt activities;  I can usually continue what I'm doing; doesn't really concern me.  Moderate 2 - Often present, occasionally disrupts my activities;  I can    \nusually continue what I'm doing with some effort;  I somewhat concerned.  Severe 3 - Frequently present and disrupts activities;  I can only do things that are fairly simple or take little effort; I   \n feel like I need help.  Very Severe 4 - Almost always present and I have been unable to perform at work, school, or home due to this problem; I probably cannot function without help  \n
\n
\n"], ["1800", "
\nIntroduction:  \n
\n
\n"], ["1801", "
\nFollowing are a few questions that will help us give you better medical care. The questions relate to our experience with alcohol, cigarettes, and other drugs. Some of the substances listed are   \nprescribed by a doctor (like pain medications). You are only asked to record those you have taken for reasons or in doses other than prescribed. You will also be asked about illicit or illegal drug   \nuse - but only to better diagnose and treat you. For each substance, mark in the appropriate column. For example, if you have used cocaine monthly in the past year, put a mark in the Monthly column   \nin the illegal drug row.||In the past year, how often have you used the following?  \n
\n
\n"], ["1802", "
\n1. In your Lifetime, which of the following substances have you ever used? | (Note: For prescription medications, please report nonmedical use only.)  \n
\n
\n"], ["1804", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)?  \n
\n
\n"], ["1805", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)?  \n
\n
\n"], ["1806", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)?  \n
\n
\n"], ["1807", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)?  \n
\n
\n"], ["1808", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)?  \n
\n
\n"], ["1809", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)?  \n
\n
\n"], ["181", "
\nFollow up Care within the VA \n
\n
\n"], ["1810", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)?  \n
\n
\n"], ["1811", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)?  \n
\n
\n"], ["1812", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)?  \n
\n
\n"], ["1814", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)?  \n
\n
\n"], ["1815", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)?  \n
\n
\n"], ["1816", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)?  \n
\n
\n"], ["1817", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)?  \n
\n
\n"], ["1818", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)?  \n
\n
\n"], ["1819", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)?  \n
\n
\n"], ["182", "
\n5. Cause of Head Injury: \n
\n
\n"], ["1820", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)?  \n
\n
\n"], ["1821", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)?  \n
\n
\n"], ["1822", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)?  \n
\n
\n"], ["1826", "
\nFollowing are a few questions that will help us give you better medical care. The questions relate to our experience with alcohol, cigarettes, and other drugs. Some of the substances listed are   \nprescribed by a doctor (like pain medications). You are only asked to record those you have taken for reasons or in doses other than prescribed. You will also be asked about illicit or illegal drug   \nuse - but only to better diagnose and treat you. For each substance, mark in the appropriate column. For example, if you have used cocaine monthly in the past year, put a mark in the Monthly column   \nin the illegal drug row.||In the past year, how often have you used the following?  \n
\n
\n"], ["1827", "
\n1. In your Lifetime, which of the following substances have you ever used? | (Note: For prescription medications, please report nonmedical use only.)  \n
\n
\n"], ["1828", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)?  \n
\n
\n"], ["1829", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)?  \n
\n
\n"], ["183", "
\n15. Please rate the following symptoms with regard to how much they have disturbed you SINCE YOUR INJURY. Use the following scale:  None 0 - Rarely if ever present; not a problem at all  Mild 1 -    \nOccasionally present, but it does not disrupt activities;  I can usually continue what I'm doing; doesn't really concern me.  Moderate 2 - Often present, occasionally disrupts my activities;  I can    \nusually continue what I'm doing with some effort;  I somewhat concerned.  Severe 3 - Frequently present and disrupts activities;  I can only do things that are fairly simple or take little effort; I   \n feel like I need help.  Very Severe 4 - Almost always present and I have been unable to perform at work, school, or home due to this problem; I probably cannot function without help  \n
\n
\n"], ["1830", "
\n4. During the past 3 months, how often has your use of (first drug, second drug, etc) led to health, social, legal or financial problems?  \n
\n
\n"], ["1831", "
\n5. During the past 3 months, how often have you failed to do what was normally expected of you because of your use of (first drug, second drug, etc)?  \n
\n
\n"], ["1832", "
\n6. Has a friend or relative or anyone else ever expressed concern about your use of (first drug, second drug, etc)?  \n
\n
\n"], ["1833", "
\nFollowing are a few questions that will help us give you better medical care. The questions relate to our experience with alcohol, cigarettes, and other drugs. Some of the substances listed are   \nprescribed by a doctor (like pain medications). You are only asked to record those you have taken for reasons or in doses other than prescribed. You will also be asked about illicit or illegal drug   \nuse - but only to better diagnose and treat you. For each substance, mark in the appropriate column. For example, if you have used cocaine monthly in the past year, put a mark in the Monthly column   \nin the illegal drug row.||In the past year, how often have you used the following?  \n
\n
\n"], ["1834", "
\n1. In your Lifetime, which of the following substances have you ever used? | (Note: For prescription medications, please report nonmedical use only.)  \n
\n
\n"], ["1835", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)?  \n
\n
\n"], ["1836", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)?  \n
\n
\n"], ["1837", "
\n4. During the past 3 months, how often has your use of (first drug, second drug, etc) led to health, social, legal or financial problems?  \n
\n
\n"], ["1838", "
\n5. During the past 3 months, how often have you failed to do what was normally expected of you because of your use of (first drug, second drug, etc)?  \n
\n
\n"], ["1839", "
\n6. Has a friend or relative or anyone else ever expressed concern about your use of (first drug, second drug, etc)?  \n
\n
\n"], ["184", "
\nFollow up Care within the VA \n
\n
\n"], ["1840", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["1841", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["1842", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["1843", "
\nFollowing are a few questions that will help us give you better medical care. The questions relate to our experience with alcohol, cigarettes, and other drugs. Some of the substances listed are   \nprescribed by a doctor (like pain medications). You are only asked to record those you have taken for reasons or in doses other than prescribed. You will also be asked about illicit or illegal drug   \nuse - but only to better diagnose and treat you. For each substance, mark in the appropriate column. For example, if you have used cocaine monthly in the past year, put a mark in the Monthly column   \nin the illegal drug row.||In the past year, how often have you used the following?  \n
\n
\n"], ["1844", "
\n1. In your Lifetime, which of the following substances have you ever used? | (Note: For prescription medications, please report nonmedical use only.)  \n
\n
\n"], ["1845", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)?  \n
\n
\n"], ["1846", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)?  \n
\n
\n"], ["1847", "
\n4. During the past 3 months, how often has your use of (first drug, second drug, etc) led to health, social, legal or financial problems?  \n
\n
\n"], ["1848", "
\n5. During the past 3 months, how often have you failed to do what was normally expected of you because of your use of (first drug, second drug, etc)?  \n
\n
\n"], ["1849", "
\n6. Has a friend or relative or anyone else ever expressed concern about your use of (first drug, second drug, etc)?  \n
\n
\n"], ["185", "
\nYou were referred because the primary level screening indicated that you may have had a head injury; that is you reported having had an alteration of consciousness after some traumatic event.  We are  \ntrying to determine the nature and severity of any of those type of injuries or related injuries, to determine how best we can assist you. \n
\n
\n"], ["1850", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["1851", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["1852", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["1853", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["1854", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["1855", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["1856", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["1857", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["1858", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["1859", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["186", "
\n4. Date(s) of most serious OEF/OIF deployment related injuries: \n
\n
\n"], ["1860", "
\nFollowing are a few questions that will help us give you better medical care. The questions relate to our experience with alcohol, cigarettes, and other drugs. Some of the substances listed are   \nprescribed by a doctor (like pain medications). You are only asked to record those you have taken for reasons or in doses other than prescribed. You will also be asked about illicit or illegal drug   \nuse - but only to better diagnose and treat you. For each substance, mark in the appropriate column. For example, if you have used cocaine monthly in the past year, put a mark in the Monthly column   \nin the illegal drug row.||In the past year, how often have you used the following?  \n
\n
\n"], ["1861", "
\n1. In your Lifetime, which of the following substances have you ever used? | (Note: For prescription medications, please report nonmedical use only.)  \n
\n
\n"], ["1862", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)? \n
\n
\n"], ["1863", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)? \n
\n
\n"], ["1864", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)? \n
\n
\n"], ["1865", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)? \n
\n
\n"], ["1866", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)? \n
\n
\n"], ["1867", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)? \n
\n
\n"], ["1868", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)? \n
\n
\n"], ["1869", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)? \n
\n
\n"], ["187", "
\n5. Cause of Head Injury: \n
\n
\n"], ["1870", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)?  \n
\n
\n"], ["1871", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)?  \n
\n
\n"], ["1872", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)?  \n
\n
\n"], ["1873", "
\n4. During the past 3 months, how often has your use of (first drug, second drug, etc) led to health, social, legal or financial problems?  \n
\n
\n"], ["1874", "
\n5. During the past 3 months, how often have you failed to do what was normally expected of you because of your use of (first drug, second drug, etc)?  \n
\n
\n"], ["1875", "
\n6. Has a friend or relative or anyone else ever expressed concern about your use of (first drug, second drug, etc)?  \n
\n
\n"], ["1876", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["1877", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["1878", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["1879", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["188", "
\n15. Please rate the following symptoms with regard to how much they have disturbed you SINCE YOUR INJURY. Use the following scale:  None 0 - Rarely if ever present; not a problem at all  Mild 1 -    \nOccasionally present, but it does not disrupt activities;  I can usually continue what I'm doing; doesn't really concern me.  Moderate 2 - Often present, occasionally disrupts my activities;  I can    \nusually continue what I'm doing with some effort;  I somewhat concerned.  Severe 3 - Frequently present and disrupts activities;  I can only do things that are fairly simple or take little effort; I   \n feel like I need help.  Very Severe 4 - Almost always present and I have been unable to perform at work, school, or home due to this problem; I probably cannot function without help \n
\n
\n"], ["1880", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["1881", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["1882", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["1883", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["1884", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["1885", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["1886", "
\nFollowing are a few questions that will help us give you better medical care. The questions relate to our experience with alcohol, cigarettes, and other drugs. Some of the substances listed are   \nprescribed by a doctor (like pain medications). You are only asked to record those you have taken for reasons or in doses other than prescribed. You will also be asked about illicit or illegal drug   \nuse - but only to better diagnose and treat you. For each substance, mark in the appropriate column. For example, if you have used cocaine monthly in the past year, put a mark in the Monthly column   \nin the illegal drug row.||In the past year, how often have you used the following?  \n
\n
\n"], ["1887", "
\n1. In your Lifetime, which of the following substances have you ever used? | (Note: For prescription medications, please report nonmedical use only.)  \n
\n
\n"], ["1888", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)? \n
\n
\n"], ["1889", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)? \n
\n
\n"], ["189", "
\nFollow up Care within the VA \n
\n
\n"], ["1890", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)? \n
\n
\n"], ["1891", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)? \n
\n
\n"], ["1892", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)? \n
\n
\n"], ["1893", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)? \n
\n
\n"], ["1894", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)? \n
\n
\n"], ["1895", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)? \n
\n
\n"], ["1896", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)?  \n
\n
\n"], ["1897", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)?  \n
\n
\n"], ["1898", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)? \n
\n
\n"], ["1899", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)? \n
\n
\n"], ["19", "
\nThis survey asks for your views about your feelings and your health.\nThis information will be kept confidential and will help your\ndoctors keep track of how you feel.\n \nIf you are unsure about how to answer a question,\nplease give the best answer you can.\n
\n
\n"], ["190", "
\n5. Cause of Injury:  \n
\n
\n"], ["1900", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)? \n
\n
\n"], ["1901", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)? \n
\n
\n"], ["1902", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)? \n
\n
\n"], ["1903", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)? \n
\n
\n"], ["1904", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)? \n
\n
\n"], ["1905", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)? \n
\n
\n"], ["1906", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)? \n
\n
\n"], ["1907", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)? \n
\n
\n"], ["1908", "
\n5. During the past 3 months, how often have you failed to do what was normally expected of you because of your use of (first drug, second drug, etc)?  \n
\n
\n"], ["1909", "
\n6. Has a friend or relative or anyone else ever expressed concern about your use of (first drug, second drug, etc)?  \n
\n
\n"], ["191", "
\nFollow up care within the VA  \n
\n
\n"], ["1910", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["1911", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["1912", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["1913", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["1914", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["1915", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["1916", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["1917", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["1918", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["1919", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["192", "
\nYou were referred because the primary level screening indicated that you may have had a head injury; that is you reported having had an alteration of consciousness after some traumatic event.  We are  \ntrying to determine the nature and severity of any of those type of injuries or related injuries, to determine how best we can assist you.  \n
\n
\n"], ["1920", "
\nFollowing are a few questions that will help us give you better medical care. The questions relate to our experience with alcohol, cigarettes, and other drugs. Some of the substances listed are   \nprescribed by a doctor (like pain medications). You are only asked to record those you have taken for reasons or in doses other than prescribed. You will also be asked about illicit or illegal drug   \nuse - but only to better diagnose and treat you. For each substance, mark in the appropriate column. For example, if you have used cocaine monthly in the past year, put a mark in the Monthly column   \nin the illegal drug row.||In the past year, how often have you used the following?  \n
\n
\n"], ["1921", "
\n1. In your Lifetime, which of the following substances have you ever used? | (Note: For prescription medications, please report nonmedical use only.)  \n
\n
\n"], ["1922", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)? \n
\n
\n"], ["1923", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)? \n
\n
\n"], ["1924", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)? \n
\n
\n"], ["1925", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)? \n
\n
\n"], ["1926", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)? \n
\n
\n"], ["1927", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)? \n
\n
\n"], ["1928", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)? \n
\n
\n"], ["1929", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)? \n
\n
\n"], ["193", "
\nYou were referred because the primary level screening indicated that you may have had a head injury; that is you reported having had an alteration of consciousness after some traumatic event.  We  \naretrying to determine the nature and severity of any of those type of injuries or related injuries, to determine how best we can assist you.   \n
\n
\n"], ["1930", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)?  \n
\n
\n"], ["1931", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)?  \n
\n
\n"], ["1932", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)? \n
\n
\n"], ["1933", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)? \n
\n
\n"], ["1934", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)? \n
\n
\n"], ["1935", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)? \n
\n
\n"], ["1936", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)? \n
\n
\n"], ["1937", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)? \n
\n
\n"], ["1938", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)? \n
\n
\n"], ["1939", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)? \n
\n
\n"], ["194", "
\nFor this question, "fitness" is a combination of your weight and physical strength and endurance. \n
\n
\n"], ["1940", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)? \n
\n
\n"], ["1941", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)? \n
\n
\n"], ["1942", "
\n4. During the past 3 months, how often has your use of (first drug, second drug, etc) led to health, social, legal or financial problems? \n
\n
\n"], ["1943", "
\n4. During the past 3 months, how often has your use of (first drug, second drug, etc) led to health, social, legal or financial problems? \n
\n
\n"], ["1944", "
\n4. During the past 3 months, how often has your use of (first drug, second drug, etc) led to health, social, legal or financial problems? \n
\n
\n"], ["1945", "
\n4. During the past 3 months, how often has your use of (first drug, second drug, etc) led to health, social, legal or financial problems? \n
\n
\n"], ["1946", "
\n4. During the past 3 months, how often has your use of (first drug, second drug, etc) led to health, social, legal or financial problems? \n
\n
\n"], ["1947", "
\n4. During the past 3 months, how often has your use of (first drug, second drug, etc) led to health, social, legal or financial problems? \n
\n
\n"], ["1948", "
\n4. During the past 3 months, how often has your use of (first drug, second drug, etc) led to health, social, legal or financial problems? \n
\n
\n"], ["1949", "
\n4. During the past 3 months, how often has your use of (first drug, second drug, etc) led to health, social, legal or financial problems? \n
\n
\n"], ["195", "
\n4. Dates of most serious OEF/OIF deployment related injury or injuries:  \n
\n
\n"], ["1950", "
\n4. During the past 3 months, how often has your use of (first drug, second drug, etc) led to health, social, legal or financial problems? \n
\n
\n"], ["1951", "
\n4. During the past 3 months, how often has your use of (first drug, second drug, etc) led to health, social, legal or financial problems? \n
\n
\n"], ["1952", "
\n6. Has a friend or relative or anyone else ever expressed concern about your use of (first drug, second drug, etc)?  \n
\n
\n"], ["1953", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["1954", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["1955", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["1956", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["1957", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["1958", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["1959", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["196", "
\n16. Please rate the following symptoms with regard to how much they have disturbed you SINCE YOUR INJURY. Use the following scale:  None 0 - Rarely if ever present; not a problem at all  Mild 1 -      \nOccasionally present, but it does not disrupt activities;  I can usually continue what I'm doing; doesn't really concern me.  Moderate 2 - Often present, occasionally disrupts my activities;  I can    \n  usually continue what I'm doing with some effort;  I somewhat concerned.  Severe 3 - Frequently present and disrupts activities;  I can only do things that are fairly simple or take little effort;  \nI     feel like I need help.  Very Severe 4 - Almost always present and I have been unable to perform at work, school, or home due to this problem; I probably cannot function without help  \n
\n
\n"], ["1960", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["1961", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["1962", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["1963", "
\nFollowing are a few questions that will help us give you better medical care. The questions relate to our experience with alcohol, cigarettes, and other drugs. Some of the substances listed are   \nprescribed by a doctor (like pain medications). You are only asked to record those you have taken for reasons or in doses other than prescribed. You will also be asked about illicit or illegal drug   \nuse - but only to better diagnose and treat you. For each substance, mark in the appropriate column. For example, if you have used cocaine monthly in the past year, put a mark in the Monthly column   \nin the illegal drug row.||In the past year, how often have you used the following?  \n
\n
\n"], ["1964", "
\n1. In your Lifetime, which of the following substances have you ever used? | (Note: For prescription medications, please report nonmedical use only.)  \n
\n
\n"], ["1965", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)? \n
\n
\n"], ["1966", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)? \n
\n
\n"], ["1967", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)? \n
\n
\n"], ["1968", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)? \n
\n
\n"], ["1969", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)? \n
\n
\n"], ["197", "
\nYou were referred because the primary level screening indicated that you may have had a head injury; that is you reported having had an alteration of consciousness after some traumatic event.  We    \naretrying to determine the nature and severity of any of those type of injuries or related injuries, to determine how best we can assist you.    \n
\n
\n"], ["1970", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)? \n
\n
\n"], ["1971", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)? \n
\n
\n"], ["1972", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)? \n
\n
\n"], ["1973", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)?  \n
\n
\n"], ["1974", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)?  \n
\n
\n"], ["1975", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)? \n
\n
\n"], ["1976", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)? \n
\n
\n"], ["1977", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)? \n
\n
\n"], ["1978", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)? \n
\n
\n"], ["1979", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)? \n
\n
\n"], ["198", "
\n4. Dates of most serious OEF/OIF deployment related injury or injuries:   \n
\n
\n"], ["1980", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)? \n
\n
\n"], ["1981", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)? \n
\n
\n"], ["1982", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)? \n
\n
\n"], ["1983", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)? \n
\n
\n"], ["1984", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)? \n
\n
\n"], ["1985", "
\n4. During the past 3 months, how often has your use of (first drug, second drug, etc) led to health, social, legal or financial problems? \n
\n
\n"], ["1986", "
\n4. During the past 3 months, how often has your use of (first drug, second drug, etc) led to health, social, legal or financial problems? \n
\n
\n"], ["1987", "
\n4. During the past 3 months, how often has your use of (first drug, second drug, etc) led to health, social, legal or financial problems? \n
\n
\n"], ["1988", "
\n4. During the past 3 months, how often has your use of (first drug, second drug, etc) led to health, social, legal or financial problems? \n
\n
\n"], ["1989", "
\n4. During the past 3 months, how often has your use of (first drug, second drug, etc) led to health, social, legal or financial problems? \n
\n
\n"], ["199", "
\n5. Cause of Injury:   \n
\n
\n"], ["1990", "
\n4. During the past 3 months, how often has your use of (first drug, second drug, etc) led to health, social, legal or financial problems? \n
\n
\n"], ["1991", "
\n4. During the past 3 months, how often has your use of (first drug, second drug, etc) led to health, social, legal or financial problems? \n
\n
\n"], ["1992", "
\n4. During the past 3 months, how often has your use of (first drug, second drug, etc) led to health, social, legal or financial problems? \n
\n
\n"], ["1993", "
\n4. During the past 3 months, how often has your use of (first drug, second drug, etc) led to health, social, legal or financial problems? \n
\n
\n"], ["1994", "
\n4. During the past 3 months, how often has your use of (first drug, second drug, etc) led to health, social, legal or financial problems? \n
\n
\n"], ["1995", "
\n5. During the past 3 months, how often have you failed to do what was normally expected of you because of your use of (first drug, second drug, etc)? \n
\n
\n"], ["1996", "
\n5. During the past 3 months, how often have you failed to do what was normally expected of you because of your use of (first drug, second drug, etc)? \n
\n
\n"], ["1997", "
\n5. During the past 3 months, how often have you failed to do what was normally expected of you because of your use of (first drug, second drug, etc)? \n
\n
\n"], ["1998", "
\n5. During the past 3 months, how often have you failed to do what was normally expected of you because of your use of (first drug, second drug, etc)? \n
\n
\n"], ["1999", "
\n5. During the past 3 months, how often have you failed to do what was normally expected of you because of your use of (first drug, second drug, etc)? \n
\n
\n"], ["2", "
\nThis test consists of a series of questions involving the analysis\nof relationships of various sorts. Choose the correct answer.\nThere is no time limit.\n
\n
\n"], ["20", "
\nDepression Outcomes Module:  Clinician Baseline Assessment (Form 8.2)\n \nPlease answer all questions carefully!\n
\n
\n"], ["200", "
\n16. Please rate the following symptoms with regard to how much they have disturbed you SINCE YOUR INJURY. Use the following scale:  None 0 - Rarely if ever present; not a problem at all  Mild 1 -      \n  Occasionally present, but it does not disrupt activities;  I can usually continue what I'm doing; doesn't really concern me.  Moderate 2 - Often present, occasionally disrupts my activities;  I can  \n      usually continue what I'm doing with some effort;  I somewhat concerned.  Severe 3 - Frequently present and disrupts activities;  I can only do things that are fairly simple or take little  \neffort;   I     feel like I need help.  Very Severe 4 - Almost always present and I have been unable to perform at work, school, or home due to this problem; I probably cannot function without help   \n
\n
\n"], ["2000", "
\n5. During the past 3 months, how often have you failed to do what was normally expected of you because of your use of (first drug, second drug, etc)? \n
\n
\n"], ["2001", "
\n5. During the past 3 months, how often have you failed to do what was normally expected of you because of your use of (first drug, second drug, etc)? \n
\n
\n"], ["2002", "
\n5. During the past 3 months, how often have you failed to do what was normally expected of you because of your use of (first drug, second drug, etc)? \n
\n
\n"], ["2003", "
\n5. During the past 3 months, how often have you failed to do what was normally expected of you because of your use of (first drug, second drug, etc)? \n
\n
\n"], ["2004", "
\n5. During the past 3 months, how often have you failed to do what was normally expected of you because of your use of (first drug, second drug, etc)? \n
\n
\n"], ["2005", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["2006", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["2007", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["2008", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["2009", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["201", "
\nFollow up care within the VA   \n
\n
\n"], ["2010", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["2011", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["2012", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["2013", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["2014", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["2015", "
\nFollowing are a few questions that will help us give you better medical care. The questions relate to our experience with alcohol, cigarettes, and other drugs. Some of the substances listed are   \nprescribed by a doctor (like pain medications). You are only asked to record those you have taken for reasons or in doses other than prescribed. You will also be asked about illicit or illegal drug   \nuse - but only to better diagnose and treat you. For each substance, mark in the appropriate column. For example, if you have used cocaine monthly in the past year, put a mark in the Monthly column   \nin the illegal drug row.||In the past year, how often have you used the following?  \n
\n
\n"], ["2016", "
\n1. In your Lifetime, which of the following substances have you ever used? | (Note: For prescription medications, please report nonmedical use only.)  \n
\n
\n"], ["2018", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)? \n
\n
\n"], ["2019", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)? \n
\n
\n"], ["202", "
\nYou were referred because the primary level screening indicated that you may have had a head injury; that is you reported having had an alteration of consciousness after some traumatic event.  We are  \ntrying to determine the nature and severity of any of those type of injuries or related injuries, to determine how best we can assist you.     \n
\n
\n"], ["2020", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)? \n
\n
\n"], ["2021", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)? \n
\n
\n"], ["2022", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)? \n
\n
\n"], ["2023", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)? \n
\n
\n"], ["2024", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)? \n
\n
\n"], ["2025", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)?  \n
\n
\n"], ["2026", "
\n2. In the past three months, how often have you used the substances you mentioned (first drug, second drug, etc)?  \n
\n
\n"], ["2027", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)? \n
\n
\n"], ["2028", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)? \n
\n
\n"], ["2029", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)? \n
\n
\n"], ["203", "
\n16. Please rate the following symptoms with regard to how much they have disturbed you SINCE YOUR INJURY. Use the following scale:  None 0 - Rarely if ever present; not a problem at all  Mild 1 -  \nOccasionally present, but it does not disrupt activities;  I can usually continue what I'm doing; doesn't really concern me.  Moderate 2 - Often present, occasionally disrupts my activities;  I can  \nusually continue what I'm doing with some effort;  I somewhat concerned.  Severe 3 - Frequently present and disrupts activities;  I can only do things that are fairly simple or take little effort;  I  \nfeel like I need help.  Very Severe 4 - Almost always present and I have been unable to perform at work, school, or home due to this problem; I probably cannot function without help    \n
\n
\n"], ["2030", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)? \n
\n
\n"], ["2031", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)? \n
\n
\n"], ["2032", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)? \n
\n
\n"], ["2033", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)? \n
\n
\n"], ["2034", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)? \n
\n
\n"], ["2035", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)? \n
\n
\n"], ["2036", "
\n3. In the past 3 months, how often have you had a strong desire or urge to use (first drug, second drug, etc)? \n
\n
\n"], ["2037", "
\n4. During the past 3 months, how often has your use of (first drug, second drug, etc) led to health, social, legal or financial problems? \n
\n
\n"], ["2038", "
\n4. During the past 3 months, how often has your use of (first drug, second drug, etc) led to health, social, legal or financial problems? \n
\n
\n"], ["2039", "
\n4. During the past 3 months, how often has your use of (first drug, second drug, etc) led to health, social, legal or financial problems? \n
\n
\n"], ["204", "
\nThe following items depict different ways you might think or feel about this veteran. Please review each statement, inserting the veteran's name in place of ____ in the text. Think about your   \nexperiences with this veteran over the past six months. Check the rating that best describes, all in all, how often you feel or think that way about ____ and your work together.  \n
\n
\n"], ["2040", "
\n4. During the past 3 months, how often has your use of (first drug, second drug, etc) led to health, social, legal or financial problems? \n
\n
\n"], ["2041", "
\n4. During the past 3 months, how often has your use of (first drug, second drug, etc) led to health, social, legal or financial problems? \n
\n
\n"], ["2042", "
\n4. During the past 3 months, how often has your use of (first drug, second drug, etc) led to health, social, legal or financial problems? \n
\n
\n"], ["2043", "
\n4. During the past 3 months, how often has your use of (first drug, second drug, etc) led to health, social, legal or financial problems? \n
\n
\n"], ["2044", "
\n4. During the past 3 months, how often has your use of (first drug, second drug, etc) led to health, social, legal or financial problems? \n
\n
\n"], ["2045", "
\n4. During the past 3 months, how often has your use of (first drug, second drug, etc) led to health, social, legal or financial problems? \n
\n
\n"], ["2046", "
\n4. During the past 3 months, how often has your use of (first drug, second drug, etc) led to health, social, legal or financial problems? \n
\n
\n"], ["2047", "
\n5. During the past 3 months, how often have you failed to do what was normally expected of you because of your use of (first drug, second drug, etc)? \n
\n
\n"], ["2048", "
\n5. During the past 3 months, how often have you failed to do what was normally expected of you because of your use of (first drug, second drug, etc)? \n
\n
\n"], ["2049", "
\n5. During the past 3 months, how often have you failed to do what was normally expected of you because of your use of (first drug, second drug, etc)? \n
\n
\n"], ["205", "
\nRepeat this phrase after me: John Brown, 42 Market Street, Chicago. \n
\n
\n"], ["2050", "
\n5. During the past 3 months, how often have you failed to do what was normally expected of you because of your use of (first drug, second drug, etc)? \n
\n
\n"], ["2051", "
\n5. During the past 3 months, how often have you failed to do what was normally expected of you because of your use of (first drug, second drug, etc)? \n
\n
\n"], ["2052", "
\n5. During the past 3 months, how often have you failed to do what was normally expected of you because of your use of (first drug, second drug, etc)? \n
\n
\n"], ["2053", "
\n5. During the past 3 months, how often have you failed to do what was normally expected of you because of your use of (first drug, second drug, etc)? \n
\n
\n"], ["2054", "
\n5. During the past 3 months, how often have you failed to do what was normally expected of you because of your use of (first drug, second drug, etc)? \n
\n
\n"], ["2055", "
\n5. During the past 3 months, how often have you failed to do what was normally expected of you because of your use of (first drug, second drug, etc)? \n
\n
\n"], ["2056", "
\n5. During the past 3 months, how often have you failed to do what was normally expected of you because of your use of (first drug, second drug, etc)? \n
\n
\n"], ["2057", "
\n6. Has a friend or relative or anyone else ever expressed concern about your use of (first drug, second drug, etc)? \n
\n
\n"], ["2058", "
\n6. Has a friend or relative or anyone else ever expressed concern about your use of (first drug, second drug, etc)? \n
\n
\n"], ["2059", "
\n6. Has a friend or relative or anyone else ever expressed concern about your use of (first drug, second drug, etc)? \n
\n
\n"], ["206", "
\nPlease complete the form below; you are strongly encouraged to answer all questions indicated by a '*'. Once you have completed the form click the 'Create Note' button to create the note.  \n
\n
\n"], ["2060", "
\n6. Has a friend or relative or anyone else ever expressed concern about your use of (first drug, second drug, etc)? \n
\n
\n"], ["2061", "
\n6. Has a friend or relative or anyone else ever expressed concern about your use of (first drug, second drug, etc)? \n
\n
\n"], ["2062", "
\n6. Has a friend or relative or anyone else ever expressed concern about your use of (first drug, second drug, etc)? \n
\n
\n"], ["2063", "
\n6. Has a friend or relative or anyone else ever expressed concern about your use of (first drug, second drug, etc)? \n
\n
\n"], ["2064", "
\n6. Has a friend or relative or anyone else ever expressed concern about your use of (first drug, second drug, etc)? \n
\n
\n"], ["2065", "
\n6. Has a friend or relative or anyone else ever expressed concern about your use of (first drug, second drug, etc)? \n
\n
\n"], ["2066", "
\n6. Has a friend or relative or anyone else ever expressed concern about your use of (first drug, second drug, etc)? \n
\n
\n"], ["2067", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["2068", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["2069", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["207", "
\nIn your life, any experiences so frightening, horrible or upsetting, that in past month you:  1. Have had nightmares about it or thought about it when you did not want to?  2. Tried hard not to think  \nabout it or went out of your way to avoid situations that reminded you of it?  3. Were constantly on guard, watchful or easily startled?  4. Felt numb or detached from others, activities or your  \nsurroundings? \n
\n
\n"], ["2070", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["2071", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["2072", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["2073", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["2074", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["2075", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["2076", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["2077", "
\nIntroduction: Assess the following factors.  \n
\n
\n"], ["2078", "
\nIntroduction: Assess the following factors.  \n
\n
\n"], ["2079", "
\nIntroduction: Assess the following factors.  \n
\n
\n"], ["208", "
\nIn your life, any experiences so frightening, horrible or upsetting, that in past month you:  1. Have had nightmares about it or thought about it when you did not want to?  2. Tried hard not to think  \nabout it or went out of your way to avoid situations that reminded you of it?  3. Were constantly on guard, watchful or easily startled?  4. Felt numb or detached from others, activities or your  \nsurroundings? \n
\n
\n"], ["2080", "
\nIntroduction: Assess the following factors.  \n
\n
\n"], ["2081", "
\nIntroduction: Assess the following factors.  \n
\n
\n"], ["2082", "
\nIntroduction: Assess the following factors.  \n
\n
\n"], ["2083", "
\nIntroduction: Assess the following factors.  \n
\n
\n"], ["2084", "
\nIntroduction: Assess the following factors.  \n
\n
\n"], ["2085", "
\nIf you experienced a simple or complex partial seizure within the previous four hours, or a generalized tonic-clonic seizure within the previous 24 hours, please delay completing this  \nquestionnaire.||INSTRUCTIONS:  This questionnaire asks about your health and daily activities. Answer each question by selecting the appropriate number (1, 2, 3, ...).  If you are unsure about how to  \nanswer a question, please give the best answer you can. Please feel free to ask someone to help you if you have difficulty reading or completing the form.||These questions are about how you have been  \nFEELING during the past 4 weeks.  \n
\n
\n"], ["2086", "
\nThe following questions ask about problems you may have with certain activities.||How much of the time during the past 4 weeks your epilepsy or antiepileptic drugs have caused trouble with:  \n
\n
\n"], ["2087", "
\nDuring the past 4 weeks:  \n
\n
\n"], ["2088", "
\nPart B.  Reviewing all the questions you have answered in Part A, consider the overall impact of these problems on your quality of life in the past 4 weeks.  \n
\n
\n"], ["2089", "
\nConsidering ALL the questions you have answered, please indicate the areas related to your epilepsy that are most IMPORTANT to you NOW. \n
\n
\n"], ["209", "
\nIn your life, any experiences so frightening, horrible or upsetting, that in past month you:  1. Have had nightmares about it or thought about it when you did not want to?  2. Tried hard not to think  \nabout it or went out of your way to avoid situations that reminded you of it?  3. Were constantly on guard, watchful or easily startled?  4. Felt numb or detached from others, activities or your  \nsurroundings?  \n
\n
\n"], ["2090", "
\n12. Number the following topics from 1 -7 with 1 corresponding to the most important topic and 7 to the least important one.  Please use each number once.  \n
\n
\n"], ["2091", "
\nIf you experienced a simple or complex partial seizure within the previous four hours, or a generalized tonic-clonic seizure within the previous 24 hours, please delay completing this  \nquestionnaire.||INSTRUCTIONS:  This questionnaire asks about your health and daily activities. Answer each question by selecting the appropriate number (1, 2, 3, ...).  If you are unsure about how to  \nanswer a question, please give the best answer you can. Please feel free to ask someone to help you if you have difficulty reading or completing the form.||These questions are about how you have been  \nFEELING during the past 4 weeks.  \n
\n
\n"], ["2092", "
\nThe following questions ask about problems you may have with certain activities.||How much of the time during the past 4 weeks your epilepsy or antiepileptic drugs have caused trouble with:  \n
\n
\n"], ["2093", "
\nDuring the past 4 weeks:  \n
\n
\n"], ["2094", "
\nPart B.  Reviewing all the questions you have answered in Part A, consider the overall impact of these problems on your quality of life in the past 4 weeks.  \n
\n
\n"], ["2095", "
\nConsidering ALL the questions you have answered, please indicate the areas related to your epilepsy that are most IMPORTANT to you NOW. \n
\n
\n"], ["2096", "
\n12. Number the following topics from 1 -7 with 1 corresponding to the most important topic and 7 to the least important one.  Please use each number once.  \n
\n
\n"], ["2097", "
\nIf you experienced a simple or complex partial seizure within the previous four hours, or a generalized tonic-clonic seizure within the previous 24 hours, please delay completing this   \nquestionnaire.||INSTRUCTIONS: This questionnaire asks about your health and daily activities. Answer each question by selecting the appropriate number (1, 2, 3, ...). If you are unsure about how to   \nanswer a question, please give the best answer you can. Please feel free to ask someone to help you if you have difficulty reading or completing the form.||These questions are about how you have been  \n FEELING during the past 4 weeks.  \n
\n
\n"], ["2098", "
\nThe following questions ask about problems you may have with certain activities.||How much of the time during the past 4 weeks your epilepsy or antiepileptic drugs have caused trouble with:  \n
\n
\n"], ["2099", "
\nDuring the past 4 weeks:  \n
\n
\n"], ["21", "
\nWhen evaluating the following symptoms, please do not include symptoms due\nto physical conditions, medication, or drug/alcohol use.\n
\n
\n"], ["210", "
\nOnce you have completed this form click the 'Create Note' button to create the note.   \n
\n
\n"], ["2100", "
\nPart B. Reviewing all the questions you have answered in Part A, consider the overall impact of these problems on your quality of life in the past 4 weeks.  \n
\n
\n"], ["2101", "
\n12. Number the following topics from 1 -7 with 1 corresponding to the most important topic and 7 to the least important one. Please use each number once.  \n
\n
\n"], ["2102", "
\nPlease answer these questions about your thoughts and feelings in the PAST MONTH.|  \n
\n
\n"], ["2103", "
\nPlease answer these questions about your thoughts and feelings in the PAST MONTH.||Relationships:|  \n
\n
\n"], ["2104", "
\nIf you experienced a simple or complex partial seizure within the previous four hours, or a generalized tonic-clonic seizure within the previous 24 hours, please delay completing this   \nquestionnaire.||INSTRUCTIONS: This questionnaire asks about your health and daily activities. Answer each question by selecting the appropriate number (1, 2, 3, ...). If you are unsure about how to   \nanswer a question, please give the best answer you can. Please feel free to ask someone to help you if you have difficulty reading or completing the form.||These questions are about how you have been  \n FEELING during the past 4 weeks.  \n
\n
\n"], ["2105", "
\nThe following questions ask about problems you may have with certain activities.||How much of the time during the past 4 weeks your epilepsy or antiepileptic drugs have caused trouble with:  \n
\n
\n"], ["2106", "
\nDuring the past 4 weeks:  \n
\n
\n"], ["2107", "
\nPart B. Reviewing all the questions you have answered in Part A, consider the overall impact of these problems on your quality of life in the past 4 weeks.  \n
\n
\n"], ["2108", "
\nConsidering ALL the questions you have answered, please indicate the areas related to your epilepsy that are most IMPORTANT to you NOW.  \n
\n
\n"], ["2109", "
\n12. Number the following topics from 1 -7 with 1 corresponding to the most important topic and 7 to the least important one. Please use each number once.  \n
\n
\n"], ["211", "
\nDepression care managers contact patients six to eight times or more over the course of 24 weeks of depression care management, mostly by telephone.  The PHQ-9 (and AUDIT C for any patient previously  \nscreen-positive for alcohol abuse), should be completed during any call that follows a month or more after the most recent PHQ-9 (or AUDIT C).  These measures should be administered strictly  \naccording to protocol, to maintain reliability.  Other than the administration of standardized instruments, the follow-up assessment should be responsive to the individual patient's needs and  \nproblems.  The follow-up assessment is a conversation between the depression care manager and patient.  It is semi-structured, in the sense that specific content areas are covered in a certain order,  \nand some questions require selection from a set of specific response options.  You want to get the necessary information for clinical decision-making, but in the context of a supportive relationship  \nwith the patient, not as a standardized interview where you ask questions exactly as prescribed in a script.  The depression care manager asks questions much in the way a patient's clinical problems  \nare reviewed during a clinic visit.  Providing patient education and encouraging patient activation/self-help are critical parts of each follow-up encounter.Before calling the patient, check CPRS for  \ncompliance with PC and MH appointments and medication refills as relevant, and review the last assessment and current medical record notes.  Identify any particular care plan targets for the patient  \n(e.g., poor adherence, social isolation, difficulty sleeping, poor understanding of depression). \n
\n
\n"], ["2110", "
\nSeveral statements reflecting people's beliefs and attitudes about sleep are listed below. Please indicate to what extent you personally agree or disagree with each statement. There is no right or   \nwrong answer. For each statement, select the number that corresponds to your own personal experience. Consider the whole scale, rather than only the extremes of the continuum. \n
\n
\n"], ["2111", "
\nSeveral statements reflecting people's beliefs and attitudes about sleep \ndisagree                                                                        agree\nare listed below. Please indicate to what extent you personally agree or \ndisagree with each statement. There is no right or wrong answer. For each \nstatement, SELECT A NUMBER THAT BEST REFLECTS YOUR PERSONAL EXPERIENCE.\nConsider the whole scale, rather than only the extremes of the continuum.| |\n \nUse the following to describe your feelings:|\n0 - 1 - 2 - 3 -4 - 5 - 6 - 7 - 8 - 9 - 10|\nStrongly                                                                        Strongly|\n
\n
\n"], ["2112", "
\nIf you experienced a simple or complex partial seizure within the previous four hours, or a generalized tonic-clonic seizure within the previous 24 hours, please delay completing this   \nquestionnaire.||INSTRUCTIONS: This questionnaire asks about your health and daily activities. Answer each question by selecting the appropriate number (1, 2, 3, ...). If you are unsure about how to   \nanswer a question, please give the best answer you can. Please feel free to ask someone to help you if you have difficulty reading or completing the form.||These questions are about how you have been  \n FEELING during the past 4 weeks.  \n
\n
\n"], ["2113", "
\nThe following questions ask about problems you may have with certain activities.||How much of the time during the past 4 weeks your epilepsy or antiepileptic drugs have caused trouble with:  \n
\n
\n"], ["2114", "
\nDuring the past 4 weeks:  \n
\n
\n"], ["2115", "
\nPart B. Reviewing all the questions you have answered in Part A, consider the overall impact of these problems on your quality of life in the past 4 weeks.  \n
\n
\n"], ["2116", "
\nConsidering ALL the questions you have answered, please indicate the areas  related to your epilepsy that are most IMPORTANT to you NOW.||12. Number the following topics from 1 -7 with 1  \ncorresponding to the most important topic and 7 to the least important one. Please use each number once.  \n
\n
\n"], ["2117", "
\nIf you experienced a simple or complex partial seizure within the previous four hours, or a generalized tonic-clonic seizure within the previous 24 hours, please delay completing this   \nquestionnaire.||INSTRUCTIONS: This questionnaire asks about your health and daily activities. Answer each question by selecting the appropriate number (1, 2, 3, ...). If you are unsure about how to   \nanswer a question, please give the best answer you can. Please feel free to ask someone to help you if you have difficulty reading or completing the form.||These questions are about how you have been  \n FEELING during the past 4 weeks.  \n
\n
\n"], ["2118", "
\nThe following questions ask about problems you may have with certain activities.||How much of the time during the past 4 weeks your epilepsy or antiepileptic drugs have caused trouble with:  \n
\n
\n"], ["2119", "
\nDuring the past 4 weeks:  \n
\n
\n"], ["212", "
\nAt each follow-up, monitoring depression severity for evidence of progress toward recovery vs. ineffective treatment requiring adjustment or referral is essential.  It is also a point where education  \nabout depression can be reinforced.  Be sure to do the PHQ-9 in a manner consistent with previous administrations of the instrument. \n
\n
\n"], ["2120", "
\nPart B. Reviewing all the questions you have answered in Part A, consider the overall impact of these problems on your quality of life in the past 4 weeks.  \n
\n
\n"], ["2121", "
\nConsidering ALL the questions you have answered, please indicate the areas related to your epilepsy that are most IMPORTANT to you NOW.||12. Number the following topics from 1 - 7 with 1   \ncorresponding to the most important topic and 7 to the least important one. Please use each number once.  \n
\n
\n"], ["2122", "
\nFollowing are a few questions that will help us give you better medical care. The questions relate to our experience with alcohol, cigarettes, and other drugs. Some of the substances listed are   \nprescribed by a doctor (like pain medications). You are only asked to record those you have taken for reasons or in doses other than prescribed. You will also be asked about illicit or illegal drug   \nuse - but only to better diagnose and treat you. For each substance, mark in the appropriate column. For example, if you have used cocaine monthly in the past year, put a mark in the Monthly column   \nin the illegal drug row.||In the past year, how often have you used the following?  \n
\n
\n"], ["2123", "
\n1. In your Lifetime, which of the following substances have you ever used? | (Note: For prescription medications, please report nonmedical use only.)  \n
\n
\n"], ["2125", "
\n4. During the past 3 months, how often has your use of (first drug, second drug, etc) led to health, social, legal or financial problems?  \n
\n
\n"], ["2126", "
\n5. During the past 3 months, how often have you failed to do what was normally expected of you because of your use of (first drug, second drug, etc)?  \n
\n
\n"], ["2127", "
\n6. Has a friend or relative or anyone else ever expressed concern about your use of (first drug, second drug, etc)?  \n
\n
\n"], ["2128", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["2129", "
\nFollowing are a few questions that will help us give you better medical care. The questions relate to our experience with alcohol, cigarettes, and other drugs. Some of the substances listed are   \nprescribed by a doctor (like pain medications). You are only asked to record those you have taken for reasons or in doses other than prescribed. You will also be asked about illicit or illegal drug   \nuse - but only to better diagnose and treat you. For each substance, mark in the appropriate column. For example, if you have used cocaine monthly in the past year, put a mark in the Monthly column   \nin the illegal drug row.||In the past year, how often have you used the following?  \n
\n
\n"], ["213", "
\nThis section is important for triage of patients who indicate possible suicide ideation.  Ask suicide questions if patient expressed current thoughts of suicide on PHQ-9 or if suicidal ideation is  \nnoted at other points in this or a previous assessment. \n
\n
\n"], ["2130", "
\n1. In your Lifetime, which of the following substances have you ever used? | (Note: For prescription medications, please report nonmedical use only.)  \n
\n
\n"], ["2131", "
\n4. During the past 3 months, how often has your use of (first drug, second drug, etc) led to health, social, legal or financial problems?  \n
\n
\n"], ["2132", "
\n5. During the past 3 months, how often have you failed to do what was normally expected of you because of your use of (first drug, second drug, etc)?  \n
\n
\n"], ["2133", "
\n6. Has a friend or relative or anyone else ever expressed concern about your use of (first drug, second drug, etc)?  \n
\n
\n"], ["2134", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["2135", "
\nFollowing are a few questions that will help us give you better medical care. The questions relate to our experience with alcohol, cigarettes, and other drugs. Some of the substances listed are   \nprescribed by a doctor (like pain medications). You are only asked to record those you have taken for reasons or in doses other than prescribed. You will also be asked about illicit or illegal drug   \nuse - but only to better diagnose and treat you. For each substance, mark in the appropriate column. For example, if you have used cocaine monthly in the past year, put a mark in the Monthly column   \nin the illegal drug row.||In the past year, how often have you used the following?  \n
\n
\n"], ["2136", "
\n1. In your Lifetime, which of the following substances have you ever used? | (Note: For prescription medications, please report nonmedical use only.)  \n
\n
\n"], ["2138", "
\n5. During the past 3 months, how often have you failed to do what was normally expected of you because of your use of (first drug, second drug, etc)?  \n
\n
\n"], ["2139", "
\n6. Has a friend or relative or anyone else ever expressed concern about your use of (first drug, second drug, etc)?  \n
\n
\n"], ["214", "
\nSince symptoms do not resolve immediately after anti-depressant medication is started, patients may need encouragement to stick with the medication, or if taking it properly for a reasonable trial  \nperiod, may need a dosage or drug adjustment, or consideration of referral for psychotherapy or consultation.  Side effects require the same attention.  Patients may not realize side effects are  \ntemporary, or may suffer too long with a problem that can be alleviated or resolved by changing meds. \n
\n
\n"], ["2140", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["2141", "
\nFollowing are a few questions that will help us give you better medical care. The questions relate to our experience with alcohol, cigarettes, and other drugs. Some of the substances listed are   \nprescribed by a doctor (like pain medications). You are only asked to record those you have taken for reasons or in doses other than prescribed. You will also be asked about illicit or illegal drug   \nuse - but only to better diagnose and treat you. For each substance, mark in the appropriate column. For example, if you have used cocaine monthly in the past year, put a mark in the Monthly column   \nin the illegal drug row.||In the past year, how often have you used the following?  \n
\n
\n"], ["2142", "
\n1. In your Lifetime, which of the following substances have you ever used? | (Note: For prescription medications, please report nonmedical use only.)  \n
\n
\n"], ["2144", "
\n6. Has a friend or relative or anyone else ever expressed concern about your use of (first drug, second drug, etc)?  \n
\n
\n"], ["2145", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["2146", "
\nFollowing are a few questions that will help us give you better medical care. The questions relate to our experience with alcohol, cigarettes, and other drugs. Some of the substances listed are   \nprescribed by a doctor (like pain medications). You are only asked to record those you have taken for reasons or in doses other than prescribed. You will also be asked about illicit or illegal drug   \nuse - but only to better diagnose and treat you. For each substance, mark in the appropriate column. For example, if you have used cocaine monthly in the past year, put a mark in the Monthly column   \nin the illegal drug row.||In the past year, how often have you used the following?  \n
\n
\n"], ["2147", "
\n1. In your Lifetime, which of the following substances have you ever used? | (Note: For prescription medications, please report nonmedical use only.)  \n
\n
\n"], ["2149", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["215", "
\nThis section was covered at the initial assessment but should be repeated as needed.  Any exacerbations of co-morbid problems can interfere with depression treatment and response, and may require  \nreferral to other programs.  If drugs and alcohol were not already assessed in the risk assessment above, use the initial assessment, any previous follow-up assessments, and the medical record to  \ndecide whether alcohol, substance abuse or other mental health co-morbidities need re-assessment.  Any patient who was "screen positive" for substance abuse on the initial assessment should be  \nreassessed with the AUDIT C and counseled about substance use.  \n
\n
\n"], ["2150", "
\nFollowing are a few questions that will help us give you better medical care. The questions relate to our experience with alcohol, cigarettes, and other drugs. Some of the substances listed are   \nprescribed by a doctor (like pain medications). You are only asked to record those you have taken for reasons or in doses other than prescribed. You will also be asked about illicit or illegal drug   \nuse - but only to better diagnose and treat you. For each substance, mark in the appropriate column. For example, if you have used cocaine monthly in the past year, put a mark in the Monthly column   \nin the illegal drug row.||In the past year, how often have you used the following?  \n
\n
\n"], ["2151", "
\n1. In your Lifetime, which of the following substances have you ever used? | (Note: For prescription medications, please report nonmedical use only.)  \n
\n
\n"], ["2152", "
\n7. Have you ever tried and failed to control, cut down or stop using (first drug, second drug, etc)?  \n
\n
\n"], ["2153", "
\nFollowing are a few questions that will help us give you better medical care. The questions relate to our experience with alcohol, cigarettes, and other drugs. Some of the substances listed are   \nprescribed by a doctor (like pain medications). You are only asked to record those you have taken for reasons or in doses other than prescribed. You will also be asked about illicit or illegal drug   \nuse - but only to better diagnose and treat you. For each substance, mark in the appropriate column. For example, if you have used cocaine monthly in the past year, put a mark in the Monthly column   \nin the illegal drug row.||In the past year, how often have you used the following?  \n
\n
\n"], ["2154", "
\n1. In your Lifetime, which of the following substances have you ever used? | (Note: For prescription medications, please report nonmedical use only.)  \n
\n
\n"], ["2155", "
\nFollowing are a few questions that will help us give you better medical care. The questions relate to our experience with alcohol, cigarettes, and other drugs. Some of the substances listed are   \nprescribed by a doctor (like pain medications). You are only asked to record those you have taken for reasons or in doses other than prescribed. You will also be asked about illicit or illegal drug   \nuse - but only to better diagnose and treat you. For each substance, mark in the appropriate column. For example, if you have used cocaine monthly in the past year, put a mark in the Monthly column   \nin the illegal drug row.||In the past year, how often have you used the following?  \n
\n
\n"], ["2156", "
\n1. In your Lifetime, which of the following substances have you ever used? | (Note: For prescription medications, please report nonmedical use only.)  \n
\n
\n"], ["2157", "
\nFollowing are a few questions that will help us give you better medical care. The questions relate to our experience with alcohol, cigarettes, and other drugs. Some of the substances listed are   \nprescribed by a doctor (like pain medications). You are only asked to record those you have taken for reasons or in doses other than prescribed. You will also be asked about illicit or illegal drug   \nuse - but only to better diagnose and treat you. For each substance, mark in the appropriate column. For example, if you have used cocaine monthly in the past year, put a mark in the Monthly column   \nin the illegal drug row.||In the past year, how often have you used the following?  \n
\n
\n"], ["2158", "
\n1. In your Lifetime, which of the following substances have you ever used? | (Note: For prescription medications, please report nonmedical use only.)  \n
\n
\n"], ["2159", "
\nFollowing are a few questions that will help us give you better medical care. The questions relate to our experience with alcohol, cigarettes, and other drugs. Some of the substances listed are   \nprescribed by a doctor (like pain medications). You are only asked to record those you have taken for reasons or in doses other than prescribed. You will also be asked about illicit or illegal drug   \nuse - but only to better diagnose and treat you. For each substance, mark in the appropriate column. For example, if you have used cocaine monthly in the past year, put a mark in the Monthly column   \nin the illegal drug row.||In the past year, how often have you used the following?  \n
\n
\n"], ["216", "
\nIf the patient is doing well at participating in self-help activities, different or additional options can be discussed to increase the activity level if desired.  If previous goals were too  \nambitious, goals can be reduced and simplified.  This section also guides review of education and information offered and changes in the patient's barriers to learning, and summarizes compliance with  \nany PC and MH appointments. \n
\n
\n"], ["2160", "
\n1. In your Lifetime, which of the following substances have you ever used? | (Note: For prescription medications, please report nonmedical use only.)  \n
\n
\n"], ["2161", "
\nFollowing are a few questions that will help us give you better medical care. The questions relate to our experience with alcohol, cigarettes, and other drugs. Some of the substances listed are   \nprescribed by a doctor (like pain medications). You are only asked to record those you have taken for reasons or in doses other than prescribed. You will also be asked about illicit or illegal drug   \nuse - but only to better diagnose and treat you. For each substance, mark in the appropriate column. For example, if you have used cocaine monthly in the past year, put a mark in the Monthly column   \nin the illegal drug row.||In the past year, how often have you used the following?  \n
\n
\n"], ["2162", "
\n1. In your Lifetime, which of the following substances have you ever used? | (Note: For prescription medications, please report nonmedical use only.)  \n
\n
\n"], ["2163", "
\nFollowing are a few questions that will help us give you better medical care. The questions relate to our experience with alcohol, cigarettes, and other drugs. Some of the substances listed are   \nprescribed by a doctor (like pain medications). You are only asked to record those you have taken for reasons or in doses other than prescribed. You will also be asked about illicit or illegal drug   \nuse - but only to better diagnose and treat you. For each substance, mark in the appropriate column. For example, if you have used cocaine monthly in the past year, put a mark in the Monthly column   \nin the illegal drug row.||In the past year, how often have you used the following?  \n
\n
\n"], ["2164", "
\n1. In your Lifetime, which of the following substances have you ever used? | (Note: For prescription medications, please report nonmedical use only.)  \n
\n
\n"], ["2165", "
\nFollowing are a few questions that will help us give you better medical care. The questions relate to our experience with alcohol, cigarettes, and other drugs. Some of the substances listed are   \nprescribed by a doctor (like pain medications). You are only asked to record those you have taken for reasons or in doses other than prescribed. You will also be asked about illicit or illegal drug   \nuse - but only to better diagnose and treat you. For each substance, mark in the appropriate column. For example, if you have used cocaine monthly in the past year, put a mark in the Monthly column   \nin the illegal drug row.||In the past year, how often have you used the following?  \n
\n
\n"], ["2166", "
\n1. In your Lifetime, which of the following substances have you ever used? | (Note: For prescription medications, please report nonmedical use only.)  \n
\n
\n"], ["2167", "
\nFollowing are a few questions that will help us give you better medical care. The questions relate to our experience with alcohol, cigarettes, and other drugs. Some of the substances listed are   \nprescribed by a doctor (like pain medications). You are only asked to record those you have taken for reasons or in doses other than prescribed. You will also be asked about illicit or illegal drug   \nuse - but only to better diagnose and treat you. For each substance, mark in the appropriate column. For example, if you have used cocaine monthly in the past year, put a mark in the Monthly column   \nin the illegal drug row.||In the past year, how often have you used the following?  \n
\n
\n"], ["2168", "
\n1. In your Lifetime, which of the following substances have you ever used? | (Note: For prescription medications, please report nonmedical use only.)  \n
\n
\n"], ["2169", "
\nFollowing are a few questions that will help us give you better medical care. The questions relate to our experience with alcohol, cigarettes, and other drugs. Some of the substances listed are   \nprescribed by a doctor (like pain medications). You are only asked to record those you have taken for reasons or in doses other than prescribed. You will also be asked about illicit or illegal drug   \nuse - but only to better diagnose and treat you. For each substance, mark in the appropriate column. For example, if you have used cocaine monthly in the past year, put a mark in the Monthly column   \nin the illegal drug row.||In the past year, how often have you used the following?  \n
\n
\n"], ["217", "
\nSince symptoms do not resolve immediately after anti-depressant medication is started, patients may need encouragement to stick with the medication, or if taking it properly for a reasonable trial  \nperiod, may need a dosage or drug adjustment, or consideration of referral for psychotherapy or consultation.  Side effects require the same attention.  Patients may not realize side effects are  \ntemporary, or may suffer too long with a problem that can be alleviated or resolved by changing meds. \n
\n
\n"], ["2170", "
\n1. In your Lifetime, which of the following substances have you ever used? | (Note: For prescription medications, please report nonmedical use only.)  \n
\n
\n"], ["2171", "
\nFollowing are a few questions that will help us give you better medical care. The questions relate to our experience with alcohol, cigarettes, and other drugs. Some of the substances listed are   \nprescribed by a doctor (like pain medications). You are only asked to record those you have taken for reasons or in doses other than prescribed. You will also be asked about illicit or illegal drug   \nuse - but only to better diagnose and treat you. For each substance, mark in the appropriate column. For example, if you have used cocaine monthly in the past year, put a mark in the Monthly column   \nin the illegal drug row.||In the past year, how often have you used the following?  \n
\n
\n"], ["2172", "
\n1. In your Lifetime, which of the following substances have you ever used? | (Note: For prescription medications, please report nonmedical use only.)  \n
\n
\n"], ["2173", "
\nFollowing are a few questions that will help us give you better medical care. The questions relate to our experience with alcohol, cigarettes, and other drugs. Some of the substances listed are   \nprescribed by a doctor (like pain medications). You are only asked to record those you have taken for reasons or in doses other than prescribed. You will also be asked about illicit or illegal drug   \nuse - but only to better diagnose and treat you. For each substance, mark in the appropriate column. For example, if you have used cocaine monthly in the past year, put a mark in the Monthly column   \nin the illegal drug row.||In the past year, how often have you used the following?  \n
\n
\n"], ["2174", "
\n1. In your Lifetime, which of the following substances have you ever used? | (Note: For prescription medications, please report nonmedical use only.)  \n
\n
\n"], ["2175", "
\nFollowing are a few questions that will help us give you better medical care. The questions relate to your experience with alcohol, cigarettes, and other drugs. Some of the substances listed are   \nprescribed by a doctor (like pain medications). You are only asked to record those you have taken for reasons or in doses other than prescribed. You will also be asked about illicit or illegal drug   \nuse - but only to better diagnose and treat you. For each substance, select the appropriate frequency of use.  For example, if you have used cocaine monthly in the past year, select Monthly for  \nIllegal drugs.||In the past year, how often have you used the following?  \n
\n
\n"], ["2176", "
\n1. In your Lifetime, which of the following substances have you ever used? | (Note: For prescription medications, please report nonmedical use only.)  \n
\n
\n"], ["2177", "
\nFollowing are a few questions that will help us give you better medical care. The questions relate to your experience with alcohol, cigarettes, and other drugs. Some of the substances listed are   \nprescribed by a doctor (like pain medications). You are only asked to record those you have taken for reasons or in doses other than prescribed. You will also be asked about illicit or illegal drug   \nuse - but only to better diagnose and treat you. For each substance, select the appropriate frequency of use. For example, if you have used cocaine monthly in the past year, select Monthly for\nillegal drugs.||In the past year, how often have you used the following?  \n
\n
\n"], ["2178", "
\n1. In your Lifetime, which of the following substances have you ever used? | (Note: For prescription medications, please report nonmedical use only.)  \n
\n
\n"], ["2179", "
\nThis checklist is intended to be clinician-administered.  For the purposes of the initial administration of the Symptom Checklist, 'recent' symptoms are defined as having been present in the last 30  \ndays, including the day of the interview.  By definition, 'past' symptoms are those that appeared more than 30 days prior to the initial assessment.  \n
\n
\n"], ["218", "
\nThis section was covered at the initial assessment but should be repeated as needed.  Any exacerbations of co-morbid problems can interfere with depression treatment and response, and may require  \nreferral to other programs.  If drugs and alcohol were not already assessed in the risk assessment above, use the initial assessment, any previous follow-up assessments, and the medical record to  \ndecide whether alcohol, substance abuse or other mental health co-morbidities need re-assessment.  Any patient who was "screen positive" for substance abuse on the initial assessment should be  \nreassessed with the AUDIT C and counseled about substance use.  \n
\n
\n"], ["2180", "
\nCheck all that apply. Current symptoms are those present in the last 30 days.  \n
\n
\n"], ["2181", "
\nThis checklist is intended to be clinician-administered.  For the purposes of the initial administration of the Symptom Checklist, 'recent' symptoms are defined as having been present in the last 30  \ndays, including the day of the interview.  By definition, 'past' symptoms are those that appeared more than 30 days prior to the initial assessment.  \n
\n
\n"], ["2182", "
\nCheck all that apply. Current symptoms are those present in the last 30 days.  \n
\n
\n"], ["2183", "
\nThis checklist is intended to be clinician-administered.  For the purposes of the initial administration of the Symptom Checklist, 'recent' symptoms are defined as having been present in the last 30  \ndays, including the day of the interview.  By definition, 'past' symptoms are those that appeared more than 30 days prior to the initial assessment.  \n
\n
\n"], ["2184", "
\nCheck all that apply. Current symptoms are those present in the last 30 days.  \n
\n
\n"], ["2185", "
\nThis checklist is intended to be clinician-administered.  For the purposes of the initial administration of the Symptom Checklist, "recent" symptoms are defined as having been present in the last 30  \ndays, including the day of the interview.  By definition, "past" symptoms are those that appeared more than 30 days prior to the initial assessment. \n
\n
\n"], ["2186", "
\nCheck all that apply. Current symptoms are those present in the last 30 days.  \n
\n
\n"], ["2187", "
\nThis checklist is intended to be clinician-administered.  For the purposes of the initial administration of the Symptom Checklist, "recent" symptoms are defined as having been present in the last 30  \ndays, including the day of the interview.  By definition, "past" symptoms are those that appeared more than 30 days prior to the initial assessment.||Obsession: \n
\n
\n"], ["2188", "
\nCheck all that apply. Current symptoms are those present in the last 30 days.  \n
\n
\n"], ["2189", "
\nThis checklist is intended to be clinician-administered.  For the purposes of the initial administration of the Symptom Checklist, "recent" symptoms are defined as having been present in the last 30  \ndays, including the day of the interview.  By definition, "past" symptoms are those that appeared more than 30 days prior to the initial assessment.||Obsession:  \n
\n
\n"], ["219", "
\nIf the patient is doing well at participating in self-help activities, different or additional options can be discussed to increase the activity level if desired.  If previous goals were too  \nambitious, goals can be reduced and simplified.  This section also guides review of education and information offered and changes in the patient's barriers to learning, and summarizes compliance with  \nany PC and MH appointments. \n
\n
\n"], ["2190", "
\nThis checklist is intended to be clinician-administered.  For the purposes of the initial administration of the Symptom Checklist, "recent" symptoms are defined as having been present in the last 30  \ndays, including the day of the interview.  By definition, "past" symptoms are those that appeared more than 30 days prior to the initial assessment.||Obsession:  \n
\n
\n"], ["2191", "
\nThis checklist is intended to be clinician-administered.  For the purposes of the initial administration of the Symptom Checklist, "recent" symptoms are defined as having been present in the last 30  \ndays, including the day of the interview.  By definition, "past" symptoms are those that appeared more than 30 days prior to the initial assessment.||Obsession:  \n
\n
\n"], ["2192", "
\n1 Q: "How much of your time is occupied by obsessive thoughts?" [When obsessions occur as brief,intermittent intrusions, it may be difficult to assess time occupied by them in terms of total hours.   \nIn such cases, posing item #2 first may help identify most appropriate response to item #1. Be sure to exclude ruminations and reoccupations that, unlike obsessions, are ego-syntonic and rational   \nalbeit excessive.)]  \n
\n
\n"], ["2193", "
\n2 Q: "On average, what is the longest continuous period (or block) of time in which you are free of obsessive thoughts?" [Only consider time while awake. You can also ask:] "How frequently do the   \nobsessive thoughts occur?"  \n
\n
\n"], ["2194", "
\n3 Q: "How much control do you have over your obsessive thoughts? How successful are you in stopping or ignoring them? Can you dismiss them?"  \n
\n
\n"], ["2195", "
\n4 Q: "How much distress do your obsessive thoughts cause you?" [In most cases, distress is equated with anxiety; however, patients may report that their obsessions are "disturbing" or "upsetting" but  \n deny "anxiety." Only rate distress that seems generated by obsessions, not generalized anxiety or anxiety associated with other conditions.]  \n
\n
\n"], ["2196", "
\n5 Q: "How much do your obsessive thoughts interfere with your social, school, or work (role) functioning?" [If currently not working (or attending school), determine how much performance would be   \naffected if patient were employed (or in school).] "Have you been avoiding doing anything, going any place, or being with anyone because of your obsessions?" [Evaluate impact of avoidance on   \nfunctioning.]  \n
\n
\n"], ["2197", "
\n6 Q: "How much time do you spend performing compulsive behaviors?" [When rituals involving activities of daily living are chiefly present, ask:] "How much longer than most people does it take to   \ncomplete routine activities because of your rituals?" [When compulsions occur as brief, intermittent behaviors, it may be difficult to assess time spent performing them in terms of total hours. In   \nsuch cases, estimate time by determining how frequently they are performed. Consider both the number of times compulsions are performed and how much of the day is affected. When estimating frequency,  \n count separate occurrences of compulsive behaviors, not number of repetitions. In most cases compulsions are observable behaviors (e.g., hand washing or refusing to shake hands), but some   \ncompulsions are covert (e.g., silent checking or praying); these mental rituals should be rated as you would overt compulsions. "Active avoidance" (e.g., rule governed behaviors that ensure a   \nminimum "safe" distance from contaminated areas or wearing a glove on one hand to keep it clean) like compulsions, can manifest as discrete behavioral acts, measurable in hours or by frequency, so   \nshould be rated on this item. "Passive avoidance", on the other hand, may be difficult to quantify temporally; however, its relationship to compulsions and resultant impact on distress and   \nfunctioning can be measured on items 9 and 10 respectively.  \n
\n
\n"], ["2198", "
\n7 Q: "How much of an effort do you make to resist the compulsions?" [Only rate effort made to resist, not success or failure in actually controlling the compulsions. How much the patient resists the   \ncompulsions may or may not correlate with his ability to control them. Note that this item does not directly measure the severity of the compulsions; rather it rates a manifestation of health, i.e.,   \nthe effort the patient makes to counteract the compulsions. Thus, the more the patient tries to resist, the less impaired is this aspect of his functioning. If the compulsions are minimal, the   \npatient may not feel the need to resist them. In such cases, a rating of "0" should be given.]  \n
\n
\n"], ["2199", "
\n8 Q: "How strong is the drive to perform the compulsions?" [Pause] "How much control do you have over the behaviors?" [In contrast to the preceding item on resistance, this item directly measures   \nsuccess or failure in controlling compulsions.]  \n
\n
\n"], ["22", "
\nPlease give your clinical opinion about other possible causes for the\ndepressed mood.\n
\n
\n"], ["220", "
\nSince symptoms do not resolve immediately after anti-depressant medication is started, patients may need encouragement to stick with the medication, or if taking it properly for a reasonable trial  \nperiod, may need a dosage or drug adjustment, or consideration of referral for psychotherapy or consultation.  Side effects require the same attention.  Patients may not realize side effects are  \ntemporary, or may suffer too long with a problem that can be alleviated or resolved by changing meds. \n
\n
\n"], ["2200", "
\n9 Q: "How would you feel if prevented from performing your compulsion(s)?" [Pause] "How distressed would you become?" [Rate degree of distress patient would experience if performance of the ritual   \nwere prevented or suddenly interrupted without reassurance. Like compulsions, avoidance maneuvers can reduce distress; conversely, forced confrontation with avoided objects can engender distress. Ask  \n similar questions about avoidance:] "How would you feel if you werent allowed to avoid?" [In most, but not all cases, performing compulsions reduces anxiety. In other cases, the compulsions   \nthemselves can be a source of distress when laborious or demanding; they can even be painful as in the case of washing with scalding hot water. In these cases, distress or discomfort produced by the   \ncompulsions can be taken into account when ratig this item. Apart from these latter instances, this item can be viewed as an indirect measure of how dependent the individual is on compulsions or   \navoidance to keep distress in check.]  \n
\n
\n"], ["2201", "
\n10 Q: "How much do your compulsive behaviors interfere with your social, school, or work (or role) functioning?" [If currently not working (or attending school), determine how much performance would   \nbe affected if patient were employed (or in school).] "Have you been avoiding doing anything, going any place, or being out of concern you will trigger the compulsions?" [Evaluate impact of avoidance  \n on functioning. An example of avoidance relevant to assessment of compulsions is letting soiled clothes pile up instead of launching into an exhausting and prolonged laundry routine that will defy   \ninterruption.]  \n
\n
\n"], ["2202", "
\n11 Q: "Do you think your concerns or behaviors are reasonable?" [Pause] "What do you think would happen if you did not perform the compulsion(s)? Are you convinced something would really happen?"   \n[Rate patient's insight into the senselessness or excessiveness of his obsession(s) based on beliefs expressed at the time of the interview.]  \n
\n
\n"], ["2203", "
\n1 Q: "How much of your time is occupied by obsessive thoughts?" [When obsessions occur as brief,intermittent intrusions, it may be difficult to assess time occupied by them in terms of total hours.   \nIn such cases, posing item #2 first may help identify most appropriate response to item #1. Be sure to exclude ruminations and reoccupations that, unlike obsessions, are ego-syntonic and rational   \nalbeit excessive.)]  \n
\n
\n"], ["2204", "
\n2 Q: "On average, what is the longest continuous period (or block) of time in which you are free of obsessive thoughts?" [Only consider time while awake. You can also ask:] "How frequently do the   \nobsessive thoughts occur?"  \n
\n
\n"], ["2205", "
\n3 Q: "How much control do you have over your obsessive thoughts? How successful are you in stopping or ignoring them? Can you dismiss them?"  \n
\n
\n"], ["2206", "
\n4 Q: "How much distress do your obsessive thoughts cause you?" [In most cases, distress is equated with anxiety; however, patients may report that their obsessions are "disturbing" or "upsetting" but  \n deny "anxiety." Only rate distress that seems generated by obsessions, not generalized anxiety or anxiety associated with other conditions.]  \n
\n
\n"], ["2207", "
\n5 Q: "How much do your obsessive thoughts interfere with your social, school, or work (role) functioning?" [If currently not working (or attending school), determine how much performance would be   \naffected if patient were employed (or in school).] "Have you been avoiding doing anything, going any place, or being with anyone because of your obsessions?" [Evaluate impact of avoidance on   \nfunctioning.]  \n
\n
\n"], ["2208", "
\n6 Q: "How much time do you spend performing compulsive behaviors?" [When rituals involving activities of daily living are chiefly present, ask:] "How much longer than most people does it take to   \ncomplete routine activities because of your rituals?" [When compulsions occur as brief, intermittent behaviors, it may be difficult to assess time spent performing them in terms of total hours. In   \nsuch cases, estimate time by determining how frequently they are performed. Consider both the number of times compulsions are performed and how much of the day is affected. When estimating frequency,  \n count separate occurrences of compulsive behaviors, not number of repetitions. In most cases compulsions are observable behaviors (e.g., hand washing or refusing to shake hands), but some   \ncompulsions are covert (e.g., silent checking or praying); these mental rituals should be rated as you would overt compulsions. "Active avoidance" (e.g., rule governed behaviors that ensure a   \nminimum "safe" distance from contaminated areas or wearing a glove on one hand to keep it clean) like compulsions, can manifest as discrete behavioral acts, measurable in hours or by frequency, so   \nshould be rated on this item. "Passive avoidance", on the other hand, may be difficult to quantify temporally; however, its relationship to compulsions and resultant impact on distress and   \nfunctioning can be measured on items 9 and 10 respectively.  \n
\n
\n"], ["2209", "
\n7 Q: "How much of an effort do you make to resist the compulsions?" [Only rate effort made to resist, not success or failure in actually controlling the compulsions. How much the patient resists the   \ncompulsions may or may not correlate with his ability to control them. Note that this item does not directly measure the severity of the compulsions; rather it rates a manifestation of health, i.e.,   \nthe effort the patient makes to counteract the compulsions. Thus, the more the patient tries to resist, the less impaired is this aspect of his functioning. If the compulsions are minimal, the   \npatient may not feel the need to resist them. In such cases, a rating of "0" should be given.]  \n
\n
\n"], ["221", "
\nThis section was covered at the initial assessment but should be repeated as needed.  Any exacerbations of co-morbid problems can interfere with depression treatment and response, and may require  \nreferral to other programs.  If drugs and alcohol were not already assessed in the risk assessment above, use the initial assessment, any previous follow-up assessments, and the medical record to  \ndecide whether alcohol, substance abuse or other mental health co-morbidities need re-assessment.  Any patient who was "screen positive" for substance abuse on the initial assessment should be  \nreassessed with the AUDIT C and counseled about substance use.  \n
\n
\n"], ["2210", "
\n8 Q: "How strong is the drive to perform the compulsions?" [Pause] "How much control do you have over the behaviors?" [In contrast to the preceding item on resistance, this item directly measures   \nsuccess or failure in controlling compulsions.]  \n
\n
\n"], ["2211", "
\n9 Q: "How would you feel if prevented from performing your compulsion(s)?" [Pause] "How distressed would you become?" [Rate degree of distress patient would experience if performance of the ritual   \nwere prevented or suddenly interrupted without reassurance. Like compulsions, avoidance maneuvers can reduce distress; conversely, forced confrontation with avoided objects can engender distress. Ask  \n similar questions about avoidance:] "How would you feel if you werent allowed to avoid?" [In most, but not all cases, performing compulsions reduces anxiety. In other cases, the compulsions   \nthemselves can be a source of distress when laborious or demanding; they can even be painful as in the case of washing with scalding hot water. In these cases, distress or discomfort produced by the   \ncompulsions can be taken into account when ratig this item. Apart from these latter instances, this item can be viewed as an indirect measure of how dependent the individual is on compulsions or   \navoidance to keep distress in check.]  \n
\n
\n"], ["2212", "
\n10 Q: "How much do your compulsive behaviors interfere with your social, school, or work (or role) functioning?" [If currently not working (or attending school), determine how much performance would   \nbe affected if patient were employed (or in school).] "Have you been avoiding doing anything, going any place, or being out of concern you will trigger the compulsions?" [Evaluate impact of avoidance  \n on functioning. An example of avoidance relevant to assessment of compulsions is letting soiled clothes pile up instead of launching into an exhausting and prolonged laundry routine that will defy   \ninterruption.]  \n
\n
\n"], ["2213", "
\n11 Q: "Do you think your concerns or behaviors are reasonable?" [Pause] "What do you think would happen if you did not perform the compulsion(s)? Are you convinced something would really happen?"   \n[Rate patient's insight into the senselessness or excessiveness of his obsession(s) based on beliefs expressed at the time of the interview.]  \n
\n
\n"], ["2214", "
\n1 Q: "How much of your time is occupied by obsessive thoughts?" [When obsessions occur as brief,intermittent intrusions, it may be difficult to assess time occupied by them in terms of total hours.   \nIn such cases, posing item #2 first may help identify most appropriate response to item #1. Be sure to exclude ruminations and reoccupations that, unlike obsessions, are ego-syntonic and rational   \nalbeit excessive.)]  \n
\n
\n"], ["2215", "
\n2 Q: "On average, what is the longest continuous period (or block) of time in which you are free of obsessive thoughts?" [Only consider time while awake. You can also ask:] "How frequently do the   \nobsessive thoughts occur?"  \n
\n
\n"], ["2216", "
\n3 Q: "How much control do you have over your obsessive thoughts? How successful are you in stopping or ignoring them? Can you dismiss them?"  \n
\n
\n"], ["2217", "
\n4 Q: "How much distress do your obsessive thoughts cause you?" [In most cases, distress is equated with anxiety; however, patients may report that their obsessions are "disturbing" or "upsetting" but  \n deny "anxiety." Only rate distress that seems generated by obsessions, not generalized anxiety or anxiety associated with other conditions.]  \n
\n
\n"], ["2218", "
\n5 Q: "How much do your obsessive thoughts interfere with your social, school, or work (role) functioning?" [If currently not working (or attending school), determine how much performance would be   \naffected if patient were employed (or in school).] "Have you been avoiding doing anything, going any place, or being with anyone because of your obsessions?" [Evaluate impact of avoidance on   \nfunctioning.]  \n
\n
\n"], ["2219", "
\n6 Q: "How much time do you spend performing compulsive behaviors?" [When rituals involving activities of daily living are chiefly present, ask:] "How much longer than most people does it take to   \ncomplete routine activities because of your rituals?" [When compulsions occur as brief, intermittent behaviors, it may be difficult to assess time spent performing them in terms of total hours. In   \nsuch cases, estimate time by determining how frequently they are performed. Consider both the number of times compulsions are performed and how much of the day is affected. When estimating frequency,  \n count separate occurrences of compulsive behaviors, not number of repetitions. In most cases compulsions are observable behaviors (e.g., hand washing or refusing to shake hands), but some   \ncompulsions are covert (e.g., silent checking or praying); these mental rituals should be rated as you would overt compulsions. "Active avoidance" (e.g., rule governed behaviors that ensure a   \nminimum "safe" distance from contaminated areas or wearing a glove on one hand to keep it clean) like compulsions, can manifest as discrete behavioral acts, measurable in hours or by frequency, so   \nshould be rated on this item. "Passive avoidance", on the other hand, may be difficult to quantify temporally; however, its relationship to compulsions and resultant impact on distress and   \nfunctioning can be measured on items 9 and 10 respectively.  \n
\n
\n"], ["222", "
\nIf the patient is doing well at participating in self-help activities, different or additional options can be discussed to increase the activity level if desired.  If previous goals were too  \nambitious, goals can be reduced and simplified.  This section also guides review of education and information offered and changes in the patient's barriers to learning, and summarizes compliance with  \nany PC and MH appointments. \n
\n
\n"], ["2220", "
\n7 Q: "How much of an effort do you make to resist the compulsions?" [Only rate effort made to resist, not success or failure in actually controlling the compulsions. How much the patient resists the   \ncompulsions may or may not correlate with his ability to control them. Note that this item does not directly measure the severity of the compulsions; rather it rates a manifestation of health, i.e.,   \nthe effort the patient makes to counteract the compulsions. Thus, the more the patient tries to resist, the less impaired is this aspect of his functioning. If the compulsions are minimal, the   \npatient may not feel the need to resist them. In such cases, a rating of "0" should be given.]  \n
\n
\n"], ["2221", "
\n8 Q: "How strong is the drive to perform the compulsions?" [Pause] "How much control do you have over the behaviors?" [In contrast to the preceding item on resistance, this item directly measures   \nsuccess or failure in controlling compulsions.]  \n
\n
\n"], ["2222", "
\n9 Q: "How would you feel if prevented from performing your compulsion(s)?" [Pause] "How distressed would you become?" [Rate degree of distress patient would experience if performance of the ritual   \nwere prevented or suddenly interrupted without reassurance. Like compulsions, avoidance maneuvers can reduce distress; conversely, forced confrontation with avoided objects can engender distress. Ask  \n similar questions about avoidance:] "How would you feel if you werent allowed to avoid?" [In most, but not all cases, performing compulsions reduces anxiety. In other cases, the compulsions   \nthemselves can be a source of distress when laborious or demanding; they can even be painful as in the case of washing with scalding hot water. In these cases, distress or discomfort produced by the   \ncompulsions can be taken into account when ratig this item. Apart from these latter instances, this item can be viewed as an indirect measure of how dependent the individual is on compulsions or   \navoidance to keep distress in check.]  \n
\n
\n"], ["2223", "
\n10 Q: "How much do your compulsive behaviors interfere with your social, school, or work (or role) functioning?" [If currently not working (or attending school), determine how much performance would   \nbe affected if patient were employed (or in school).] "Have you been avoiding doing anything, going any place, or being out of concern you will trigger the compulsions?" [Evaluate impact of avoidance  \n on functioning. An example of avoidance relevant to assessment of compulsions is letting soiled clothes pile up instead of launching into an exhausting and prolonged laundry routine that will defy   \ninterruption.]  \n
\n
\n"], ["2224", "
\n11 Q: "Do you think your concerns or behaviors are reasonable?" [Pause] "What do you think would happen if you did not perform the compulsion(s)? Are you convinced something would really happen?"   \n[Rate patient's insight into the senselessness or excessiveness of his obsession(s) based on beliefs expressed at the time of the interview.]  \n
\n
\n"], ["2225", "
\n1 Q: "How much of your time is occupied by obsessive thoughts?" [When obsessions occur as brief,intermittent intrusions, it may be difficult to assess time occupied by them in terms of total hours.   \nIn such cases, posing item #2 first may help identify most appropriate response to item #1. Be sure to exclude ruminations and reoccupations that, unlike obsessions, are ego-syntonic and rational   \nalbeit excessive.)]  \n
\n
\n"], ["2226", "
\n2 Q: "On average, what is the longest continuous period (or block) of time in which you are free of obsessive thoughts?" [Only consider time while awake. You can also ask:] "How frequently do the   \nobsessive thoughts occur?"  \n
\n
\n"], ["2227", "
\n3 Q: "How much control do you have over your obsessive thoughts? How successful are you in stopping or ignoring them? Can you dismiss them?"  \n
\n
\n"], ["2228", "
\n4 Q: "How much distress do your obsessive thoughts cause you?" [In most cases, distress is equated with anxiety; however, patients may report that their obsessions are "disturbing" or "upsetting" but  \n deny "anxiety." Only rate distress that seems generated by obsessions, not generalized anxiety or anxiety associated with other conditions.]  \n
\n
\n"], ["2229", "
\n5 Q: "How much do your obsessive thoughts interfere with your social, school, or work (role) functioning?" [If currently not working (or attending school), determine how much performance would be   \naffected if patient were employed (or in school).] "Have you been avoiding doing anything, going any place, or being with anyone because of your obsessions?" [Evaluate impact of avoidance on   \nfunctioning.]  \n
\n
\n"], ["223", "
\nFamily interventions have been found to reduce relapse and improve adherence in the treatment of other psychiatric disorders (e.g., schizophrenia, bipolar depression).  Conversely, some studies have  \nfound that without intervention, families tend to discourage treatment adherence and attempt to maintain the patient within the informal network.  Previous research on care management programs shows  \nthat limited social support is a strong predictor of continued depression.  If you believe that involving family members in the patient's care will be beneficial, be sure to follow medical center and  \nHIPAA regulations regarding the disclosure of private information.  As a general rule, be sure to document contact with family members in the medical record and show that it was done with the  \npatient's knowledge and permission -- or conversely, document that the patient has asked that his information be kept strictly private. \n
\n
\n"], ["2230", "
\n6 Q: "How much time do you spend performing compulsive behaviors?" [When rituals involving activities of daily living are chiefly present, ask:] "How much longer than most people does it take to   \ncomplete routine activities because of your rituals?" [When compulsions occur as brief, intermittent behaviors, it may be difficult to assess time spent performing them in terms of total hours. In   \nsuch cases, estimate time by determining how frequently they are performed. Consider both the number of times compulsions are performed and how much of the day is affected. When estimating frequency,  \n count separate occurrences of compulsive behaviors, not number of repetitions. In most cases compulsions are observable behaviors (e.g., hand washing or refusing to shake hands), but some   \ncompulsions are covert (e.g., silent checking or praying); these mental rituals should be rated as you would overt compulsions. "Active avoidance" (e.g., rule governed behaviors that ensure a   \nminimum "safe" distance from contaminated areas or wearing a glove on one hand to keep it clean) like compulsions, can manifest as discrete behavioral acts, measurable in hours or by frequency, so   \nshould be rated on this item. "Passive avoidance", on the other hand, may be difficult to quantify temporally; however, its relationship to compulsions and resultant impact on distress and   \nfunctioning can be measured on items 9 and 10 respectively.  \n
\n
\n"], ["2231", "
\n7 Q: "How much of an effort do you make to resist the compulsions?" [Only rate effort made to resist, not success or failure in actually controlling the compulsions. How much the patient resists the   \ncompulsions may or may not correlate with his ability to control them. Note that this item does not directly measure the severity of the compulsions; rather it rates a manifestation of health, i.e.,   \nthe effort the patient makes to counteract the compulsions. Thus, the more the patient tries to resist, the less impaired is this aspect of his functioning. If the compulsions are minimal, the   \npatient may not feel the need to resist them. In such cases, a rating of "0" should be given.]  \n
\n
\n"], ["2232", "
\n8 Q: "How strong is the drive to perform the compulsions?" [Pause] "How much control do you have over the behaviors?" [In contrast to the preceding item on resistance, this item directly measures   \nsuccess or failure in controlling compulsions.]  \n
\n
\n"], ["2233", "
\n9 Q: "How would you feel if prevented from performing your compulsion(s)?" [Pause] "How distressed would you become?" [Rate degree of distress patient would experience if performance of the ritual   \nwere prevented or suddenly interrupted without reassurance. Like compulsions, avoidance maneuvers can reduce distress; conversely, forced confrontation with avoided objects can engender distress. Ask  \n similar questions about avoidance:] "How would you feel if you werent allowed to avoid?" [In most, but not all cases, performing compulsions reduces anxiety. In other cases, the compulsions   \nthemselves can be a source of distress when laborious or demanding; they can even be painful as in the case of washing with scalding hot water. In these cases, distress or discomfort produced by the   \ncompulsions can be taken into account when ratig this item. Apart from these latter instances, this item can be viewed as an indirect measure of how dependent the individual is on compulsions or   \navoidance to keep distress in check.]  \n
\n
\n"], ["2234", "
\n10 Q: "How much do your compulsive behaviors interfere with your social, school, or work (or role) functioning?" [If currently not working (or attending school), determine how much performance would   \nbe affected if patient were employed (or in school).] "Have you been avoiding doing anything, going any place, or being out of concern you will trigger the compulsions?" [Evaluate impact of avoidance  \n on functioning. An example of avoidance relevant to assessment of compulsions is letting soiled clothes pile up instead of launching into an exhausting and prolonged laundry routine that will defy   \ninterruption.]  \n
\n
\n"], ["2235", "
\n11 Q: "Do you think your concerns or behaviors are reasonable?" [Pause] "What do you think would happen if you did not perform the compulsion(s)? Are you convinced something would really happen?"   \n[Rate patient's insight into the senselessness or excessiveness of his obsession(s) based on beliefs expressed at the time of the interview.]  \n
\n
\n"], ["2236", "
\n1 Q: "How much of your time is occupied by obsessive thoughts?" [When obsessions occur as brief,intermittent intrusions, it may be difficult to assess time occupied by them in terms of total hours.   \nIn such cases, posing item #2 first may help identify most appropriate response to item #1. Be sure to exclude ruminations and reoccupations that, unlike obsessions, are ego-syntonic and rational   \nalbeit excessive.)]  \n
\n
\n"], ["2237", "
\n2 Q: "On average, what is the longest continuous period (or block) of time in which you are free of obsessive thoughts?" [Only consider time while awake. You can also ask:] "How frequently do the   \nobsessive thoughts occur?"  \n
\n
\n"], ["2238", "
\n3 Q: "How much control do you have over your obsessive thoughts? How successful are you in stopping or ignoring them? Can you dismiss them?"  \n
\n
\n"], ["2239", "
\n4 Q: "How much distress do your obsessive thoughts cause you?" [In most cases, distress is equated with anxiety; however, patients may report that their obsessions are "disturbing" or "upsetting" but  \n deny "anxiety." Only rate distress that seems generated by obsessions, not generalized anxiety or anxiety associated with other conditions.]  \n
\n
\n"], ["224", "
\nSince symptoms do not resolve immediately after anti-depressant medication is started, patients may need encouragement to stick with the medication, or if taking it properly for a reasonable trial  \nperiod, may need a dosage or drug adjustment, or consideration of referral for psychotherapy or consultation.  Side effects require the same attention.  Patients may not realize side effects are  \ntemporary, or may suffer too long with a problem that can be alleviated or resolved by changing meds. \n
\n
\n"], ["2240", "
\n5 Q: "How much do your obsessive thoughts interfere with your social, school, or work (role) functioning?" [If currently not working (or attending school), determine how much performance would be   \naffected if patient were employed (or in school).] "Have you been avoiding doing anything, going any place, or being with anyone because of your obsessions?" [Evaluate impact of avoidance on   \nfunctioning.]  \n
\n
\n"], ["2241", "
\n6 Q: "How much time do you spend performing compulsive behaviors?" [When rituals involving activities of daily living are chiefly present, ask:] "How much longer than most people does it take to   \ncomplete routine activities because of your rituals?" [When compulsions occur as brief, intermittent behaviors, it may be difficult to assess time spent performing them in terms of total hours. In   \nsuch cases, estimate time by determining how frequently they are performed. Consider both the number of times compulsions are performed and how much of the day is affected. When estimating frequency,  \n count separate occurrences of compulsive behaviors, not number of repetitions. In most cases compulsions are observable behaviors (e.g., hand washing or refusing to shake hands), but some   \ncompulsions are covert (e.g., silent checking or praying); these mental rituals should be rated as you would overt compulsions. "Active avoidance" (e.g., rule governed behaviors that ensure a   \nminimum "safe" distance from contaminated areas or wearing a glove on one hand to keep it clean) like compulsions, can manifest as discrete behavioral acts, measurable in hours or by frequency, so   \nshould be rated on this item. "Passive avoidance", on the other hand, may be difficult to quantify temporally; however, its relationship to compulsions and resultant impact on distress and   \nfunctioning can be measured on items 9 and 10 respectively.  \n
\n
\n"], ["2242", "
\n7 Q: "How much of an effort do you make to resist the compulsions?" [Only rate effort made to resist, not success or failure in actually controlling the compulsions. How much the patient resists the   \ncompulsions may or may not correlate with his ability to control them. Note that this item does not directly measure the severity of the compulsions; rather it rates a manifestation of health, i.e.,   \nthe effort the patient makes to counteract the compulsions. Thus, the more the patient tries to resist, the less impaired is this aspect of his functioning. If the compulsions are minimal, the   \npatient may not feel the need to resist them. In such cases, a rating of "0" should be given.]  \n
\n
\n"], ["2243", "
\n8 Q: "How strong is the drive to perform the compulsions?" [Pause] "How much control do you have over the behaviors?" [In contrast to the preceding item on resistance, this item directly measures   \nsuccess or failure in controlling compulsions.]  \n
\n
\n"], ["2244", "
\n9 Q: "How would you feel if prevented from performing your compulsion(s)?" [Pause] "How distressed would you become?" [Rate degree of distress patient would experience if performance of the ritual   \nwere prevented or suddenly interrupted without reassurance. Like compulsions, avoidance maneuvers can reduce distress; conversely, forced confrontation with avoided objects can engender distress. Ask  \n similar questions about avoidance:] "How would you feel if you werent allowed to avoid?" [In most, but not all cases, performing compulsions reduces anxiety. In other cases, the compulsions   \nthemselves can be a source of distress when laborious or demanding; they can even be painful as in the case of washing with scalding hot water. In these cases, distress or discomfort produced by the   \ncompulsions can be taken into account when ratig this item. Apart from these latter instances, this item can be viewed as an indirect measure of how dependent the individual is on compulsions or   \navoidance to keep distress in check.]  \n
\n
\n"], ["2245", "
\n10 Q: "How much do your compulsive behaviors interfere with your social, school, or work (or role) functioning?" [If currently not working (or attending school), determine how much performance would   \nbe affected if patient were employed (or in school).] "Have you been avoiding doing anything, going any place, or being out of concern you will trigger the compulsions?" [Evaluate impact of avoidance  \n on functioning. An example of avoidance relevant to assessment of compulsions is letting soiled clothes pile up instead of launching into an exhausting and prolonged laundry routine that will defy   \ninterruption.]  \n
\n
\n"], ["2246", "
\n11 Q: "Do you think your concerns or behaviors are reasonable?" [Pause] "What do you think would happen if you did not perform the compulsion(s)? Are you convinced something would really happen?"   \n[Rate patient's insight into the senselessness or excessiveness of his obsession(s) based on beliefs expressed at the time of the interview.]  \n
\n
\n"], ["2247", "
\nBefore proceeding with the questions, define "obsessions", "compulsions" and avoidance" for the patient as follows:||"OBSESSIONS are unwelcome and distressing ideas, thoughts, images or impulses that  \nyou hadn't done anything harmful (mental compulsion)."||"AVOIDANCE of feared situations is often used in addition to or in place of compulsions in order to prevent contact with triggers to OCD. An  \nexample would be to drive no closer than a one mile of a hospital in a person concerned with contracting a serious disease."||"Do you have any questions about what these words mean?" [If not,  \nproceed.]||This checklist is intended to be clinician-administered. For the purposes of the initial administration of the Symptom Checklist, "recent" symptoms are defined as having been present in  \nthe last 30  days, including the day of the interview. By definition, "past" symptoms are those that appeared more than 30 days prior to the initial assessment.||Obsession:  \nrepeatedly enter your mind. They may seem to occur against your will. They may be repugnant to you, you may recognize them as senseless, and they may not fit your personality or value system." "An  \nexample of an obsession is: the recurrent thought you might be responsible for making a loved one ill because you weren't careful enough about washing your hands."||"COMPULSIONS, on the other hand,  \nare behaviors or mental acts that you feel driven to|perform although you may recognize them as senseless or excessive. At times, you may try to resist doing them but this may prove difficult. You  \nmay experience anxiety that does not diminish until the behavior or mental act is completed. Sometimes compulsions are also referred to as rituals." [The term "rituals" will be used interchangeably  \nwith compulsions, although the former usually connotes particularly rule-governed, rigid, or complex behavior]|||"An example of a compulsion is: the need to repeatedly check appliances, water  \nfaucets, and the lock on the front door before you can leave the house. While most compulsions are observable behaviors, some are unobservable mental acts, such as silent checking or having to recite  \nnonsense phrases to yourself each time you have a bad thought. These mental compulsions are different from obsessions, which are unwelcome and senseless ideas that enter your mind against your will.  \nSo, you might have a persistent irrational thought that you had done something to endanger someone's life (obsession), which you then try to neutralize by saying over and over again in your mind that  \n
\n
\n"], ["2248", "
\nBefore proceeding with the questions, define "obsessions", "compulsions" and avoidance" for the patient as follows:||"OBSESSIONS are unwelcome and distressing ideas, thoughts, images or impulses that  \nyou hadn't done anything harmful (mental compulsion)."||"AVOIDANCE of feared situations is often used in addition to or in place of compulsions in order to prevent contact with triggers to OCD. An  \nexample would be to drive no closer than a one mile of a hospital in a person concerned with contracting a serious disease."||"Do you have any questions about what these words mean?" [If not,  \nproceed.]||This checklist is intended to be clinician-administered. For the purposes of the initial administration of the Symptom Checklist, "recent" symptoms are defined as having been present in  \nthe last 30  days, including the day of the interview. By definition, "past" symptoms are those that appeared more than 30 days prior to the initial assessment.||Obsession:  \nrepeatedly enter your mind. They may seem to occur against your will. They may be repugnant to you, you may recognize them as senseless, and they may not fit your personality or value system." "An  \nexample of an obsession is: the recurrent thought you might be responsible for making a loved one ill because you weren't careful enough about washing your hands."||"COMPULSIONS, on the other hand,  \nare behaviors or mental acts that you feel driven to|perform although you may recognize them as senseless or excessive. At times, you may try to resist doing them but this may prove difficult. You  \nmay experience anxiety that does not diminish until the behavior or mental act is completed. Sometimes compulsions are also referred to as rituals." [The term "rituals" will be used interchangeably  \nwith compulsions, although the former usually connotes particularly rule-governed, rigid, or complex behavior]|||"An example of a compulsion is: the need to repeatedly check appliances, water  \nfaucets, and the lock on the front door before you can leave the house. While most compulsions are observable behaviors, some are unobservable mental acts, such as silent checking or having to recite  \nnonsense phrases to yourself each time you have a bad thought. These mental compulsions are different from obsessions, which are unwelcome and senseless ideas that enter your mind against your will.  \nSo, you might have a persistent irrational thought that you had done something to endanger someone's life (obsession), which you then try to neutralize by saying over and over again in your mind that  \n
\n
\n"], ["2249", "
\nBefore proceeding with the questions, define "obsessions", "compulsions" and avoidance" for the patient as follows:||"OBSESSIONS are unwelcome and distressing ideas, thoughts, images or impulses that  \nyou hadn't done anything harmful (mental compulsion)."||"AVOIDANCE of feared situations is often used in addition to or in place of compulsions in order to prevent contact with triggers to OCD. An  \nexample would be to drive no closer than a one mile of a hospital in a person concerned with contracting a serious disease."||"Do you have any questions about what these words mean?" [If not,  \nproceed.]||This checklist is intended to be clinician-administered. For the purposes of the initial administration of the Symptom Checklist, "recent" symptoms are defined as having been present in  \nthe last 30  days, including the day of the interview. By definition, "past" symptoms are those that appeared more than 30 days prior to the initial assessment.||Obsession:  \nrepeatedly enter your mind. They may seem to occur against your will. They may be repugnant to you, you may recognize them as senseless, and they may not fit your personality or value system." "An  \nexample of an obsession is: the recurrent thought you might be responsible for making a loved one ill because you weren't careful enough about washing your hands."||"COMPULSIONS, on the other hand,  \nare behaviors or mental acts that you feel driven to|perform although you may recognize them as senseless or excessive. At times, you may try to resist doing them but this may prove difficult. You  \nmay experience anxiety that does not diminish until the behavior or mental act is completed. Sometimes compulsions are also referred to as rituals." [The term "rituals" will be used interchangeably  \nwith compulsions, although the former usually connotes particularly rule-governed, rigid, or complex behavior]|||"An example of a compulsion is: the need to repeatedly check appliances, water  \nfaucets, and the lock on the front door before you can leave the house. While most compulsions are observable behaviors, some are unobservable mental acts, such as silent checking or having to recite  \nnonsense phrases to yourself each time you have a bad thought. These mental compulsions are different from obsessions, which are unwelcome and senseless ideas that enter your mind against your will.  \nSo, you might have a persistent irrational thought that you had done something to endanger someone's life (obsession), which you then try to neutralize by saying over and over again in your mind that  \n
\n
\n"], ["225", "
\nThis section was covered at the initial assessment but should be repeated as needed.  Any exacerbations of co-morbid problems can interfere with depression treatment and response, and may require  \nreferral to other programs.  If drugs and alcohol were not already assessed in the risk assessment above, use the initial assessment, any previous follow-up assessments, and the medical record to  \ndecide whether alcohol, substance abuse or other mental health co-morbidities need re-assessment.  Any patient who was "screen positive" for substance abuse on the initial assessment should be  \nreassessed with the AUDIT C and counseled about substance use.  \n
\n
\n"], ["2250", "
\nBefore proceeding with the questions, define "obsessions", "compulsions" and avoidance" for the patient as follows:||"OBSESSIONS are unwelcome and distressing ideas, thoughts, images or impulses that  \nthat  you hadn't done anything harmful (mental compulsion)." \n repeatedly enter your mind. They may seem to occur against your will. They may be repugnant to you, you may recognize them as senseless, and they may not fit your personality or value system." "An   \nexample of an obsession is: the recurrent thought you might be responsible for making a loved one ill because you weren't careful enough about washing your hands."||"COMPULSIONS, on the other hand,   \nare behaviors or mental acts that you feel driven to perform although you may recognize them as senseless or excessive. At times, you may try to resist doing them but this may prove difficult. You   \nmay experience anxiety that does not diminish until the behavior or mental act is completed. Sometimes compulsions are also referred to as rituals." [The term "rituals" will be used interchangeably   \nwith compulsions, although the former usually connotes particularly rule-governed, rigid, or complex behavior]||"An example of a compulsion is: the need to repeatedly check appliances, water   \nfaucets, and the lock on the front door before you can leave the house. While most compulsions are observable behaviors, some are unobservable mental acts, such as silent checking or having to recite  \n nonsense phrases to yourself each time you have a bad thought. These mental compulsions are different from obsessions, which are unwelcome and senseless ideas that enter your mind against your will.  \n So, you might have a persistent irrational thought that you had done something to endanger someone's life (obsession), which you then try to neutralize by saying over and over again in your mind  \n
\n
\n"], ["2251", "
\n"AVOIDANCE of feared situations is often used in addition to or in place of compulsions in order to prevent contact with triggers to OCD. An example would be to drive no closer than a one mile of a  \nhospital in a person concerned with contracting a serious disease."||"Do you have any questions about what these words mean?" [If not, proceed.]||This checklist is intended to be  \nclinician-administered.  For the purposes of the initial administration of the Symptom Checklist, "recent" symptoms are defined as having been present in the last 30 days, including the day of the  \ninterview.  By definition, "past" symptoms are those that appeared more than 30 days prior to the initial assessment. \n
\n
\n"], ["2252", "
\nBefore proceeding with the questions, define "obsessions", "compulsions" and "avoidance" for the patient as follows:||"OBSESSIONS are unwelcome and distressing ideas, thoughts, images or impulses  \nagain in your mind that you hadn't done anything harmful (mental compulsion)."|"AVOIDANCE of feared situations is often used in addition to or in place of compulsions in order to prevent \ncontact with triggers to OCD. An example would be to drive no closer than a one mile of a hospital in a person concerned with contracting a serious disease."|"Do you have any questions \nabout what these words mean?" [If not, proceed.]|This checklist is intended to be clinician-administered.  For the purposes of the initial administration of the Symptom Checklist,\n "recent" symptoms are defined as having been present in the last 30 days, including the day of the interview.  By definition, "past" symptoms are those that appeared more than\n30 days prior to the initial assessment.\nthat repeatedly enter your mind. They may seem to occur against your will. They may be repugnant to you, you may recognize them as senseless, and they may not fit your personality or value system."  \n"An example of an obsession is: the recurrent thought you might be responsible for making a loved one ill because you weren't careful enough about washing your hands."||"COMPULSIONS, on the other  \nhand, are behaviors or mental acts that you feel driven to perform although you may recognize them as senseless or excessive. At times, you may try to resist doing them but this may prove difficult.  \nYou may experience anxiety that does not diminish until the behavior or mental act is completed. Sometimes compulsions are also referred to as rituals."|[The term "rituals" will be used  \ninterchangeably with compulsions, although the former usually connotes particularly rule-governed, rigid, or complex behavior]||"An example of a compulsion is: the need to repeatedly check  \nappliances, water faucets, and the lock on the front door before you can leave the house. While most compulsions are observable behaviors, some are unobservable mental acts, such as silent checking  \nor having to recite nonsense phrases to yourself each time you have a bad thought. These mental compulsions are different from obsessions, which are unwelcome and senseless ideas that enter your mind  \nagainst your will. So, you might have a persistent irrational thought that you had done something to endanger someone's life (obsession), which you then try to neutralize by saying over and over  \n
\n
\n"], ["2253", "
\nBefore proceeding with the questions, define "obsessions", "compulsions" and "avoidance" for the patient as follows:||"OBSESSIONS are unwelcome and distressing ideas, thoughts, images or impulses   \ndays prior to the initial assessment. \nthat repeatedly enter your mind. They may seem to occur against your will. They may be repugnant to you, you may recognize them as senseless, and they may not fit your personality or value system."   \n"An example of an obsession is: the recurrent thought you might be responsible for making a loved one ill because you weren't careful enough about washing your hands."||"COMPULSIONS, on the other   \nhand, are behaviors or mental acts that you feel driven to perform although you may recognize them as senseless or excessive. At times, you may try to resist doing them but this may prove difficult.   \nYou may experience anxiety that does not diminish until the behavior or mental act is completed. Sometimes compulsions are also referred to as rituals." [The term "rituals" will be used   \ninterchangeably with compulsions, although the former usually connotes particularly rule-governed, rigid, or complex behavior]||"AVOIDANCE of feared situations is often used in addition to or in  \nplace of compulsions in order to prevent contact with triggers to OCD. An example would be to drive no closer than a one mile of a hospital in a person concerned with contracting a serious  \ndisease."||"Do you have any questions about what these words mean?" [If not, proceed.]||This checklist is intended to be clinician-administered.  For the purposes of the initial administration of the  \nSymptom Checklist, "recent" symptoms are defined as having been present in the last 30 days, including the day of the interview.  By definition, "past" symptoms are those that appeared more than 30  \n
\n
\n"], ["2254", "
\nBefore proceeding with the questions, define "obsessions", "compulsions" and "avoidance" for the patient as follows:||"OBSESSIONS are unwelcome and distressing ideas, thoughts, images or impulses   \ndays prior to the initial assessment.  \nthat repeatedly enter your mind. They may seem to occur against your will. They may be repugnant to you, you may recognize them as senseless, and they may not fit your personality or value system."   \n"An example of an obsession is: the recurrent thought you might be responsible for making a loved one ill because you weren't careful enough about washing your hands."||"COMPULSIONS, on the other   \nhand, are behaviors or mental acts that you feel driven to perform although you may recognize them as senseless or excessive. At times, you may try to resist doing them but this may prove difficult.   \nYou may experience anxiety that does not diminish until the behavior or mental act is completed. Sometimes compulsions are also referred to as rituals." [The term "rituals" will be used   \ninterchangeably with compulsions, although the former usually connotes particularly rule-governed, rigid, or complex behavior]||"AVOIDANCE of feared situations is often used in addition to or in   \nplace of compulsions in order to prevent contact with triggers to OCD. An example would be to drive no closer than a one mile of a hospital in a person concerned with contracting a serious   \ndisease."||"Do you have any questions about what these words mean?" [If not, proceed.]||This checklist is intended to be clinician-administered. For the purposes of the initial administration of the   \nSymptom Checklist, "recent" symptoms are defined as having been present in the last 30 days, including the day of the interview. By definition, "past" symptoms are those that appeared more than 30   \n
\n
\n"], ["2255", "
\nBefore proceeding with the questions, define "obsessions", "compulsions" and "avoidance" for the patient as follows:||"OBSESSIONS are unwelcome and distressing ideas, thoughts, images or impulses   \ndays prior to the initial assessment.||OBESSIONS: \nthat repeatedly enter your mind. They may seem to occur against your will. They may be repugnant to you, you may recognize them as senseless, and they may not fit your personality or value system."   \n"An example of an obsession is: the recurrent thought you might be responsible for making a loved one ill because you weren't careful enough about washing your hands."||"COMPULSIONS, on the other   \nhand, are behaviors or mental acts that you feel driven to perform although you may recognize them as senseless or excessive. At times, you may try to resist doing them but this may prove difficult.   \nYou may experience anxiety that does not diminish until the behavior or mental act is completed. Sometimes compulsions are also referred to as rituals." [The term "rituals" will be used   \ninterchangeably with compulsions, although the former usually connotes particularly rule-governed, rigid, or complex behavior]||"AVOIDANCE of feared situations is often used in addition to or in   \nplace of compulsions in order to prevent contact with triggers to OCD. An example would be to drive no closer than a one mile of a hospital in a person concerned with contracting a serious   \ndisease."||"Do you have any questions about what these words mean?" [If not, proceed.]||This checklist is intended to be clinician-administered. For the purposes of the initial administration of the   \nSymptom Checklist, "recent" symptoms are defined as having been present in the last 30 days, including the day of the interview. By definition, "past" symptoms are those that appeared more than 30   \n
\n
\n"], ["2256", "
\nThis rating scale is intended for use as a semi-structured interview. The interviewer should assess the items in the listed order and use the questions provided. However, the interviewer is free to  \nask additional questions for purposes of clarification. If the patient volunteers information at any time during the interview, that information will be considered. Ratings should be based primarily  \non reports and observations gained during the interview. If you judge that the information being provided is grossly inaccurate, then the reliability of the patient is in doubt and should be noted  \naccordingly at the end of the interview (last item).||Rate the characteristics of each item during the prior week up until and including the time of the interview.  Score should reflect the average  \n(mean) occurrence of each item for the entire week.||"I am now going to ask several questions about your obsessive thoughts." [Make reference to the patient's specific obsessions.]||1 Q: "How much of  \nyour time is occupied by obsessive thoughts?" [When obsessions occur as brief,intermittent intrusions, it may be difficult to assess time occupied by them in terms of total hours.  In such cases,  \nposing item #2 first may help identify most appropriate response to item #1. Be sure to exclude ruminations and reoccupations that, unlike obsessions, are ego-syntonic and rational  albeit  \nexcessive.)]  \n
\n
\n"], ["2257", "
\n2 Q: "On average, what is the longest continuous period (or block) of time in which you are free of obsessive thoughts?" [Only consider time while awake. You can also ask:] "How frequently do the   \nobsessive thoughts occur?"  \n
\n
\n"], ["2258", "
\n3 Q: "How much control do you have over your obsessive thoughts? How successful are you in stopping or ignoring them? Can you dismiss them?"  \n
\n
\n"], ["2259", "
\n4 Q: "How much distress do your obsessive thoughts cause you?" [In most cases, distress is equated with anxiety; however, patients may report that their obsessions are "disturbing" or "upsetting" but  \n deny "anxiety." Only rate distress that seems generated by obsessions, not generalized anxiety or anxiety associated with other conditions.]  \n
\n
\n"], ["226", "
\nIf the patient is doing well at participating in self-help activities, different or additional options can be discussed to increase the activity level if desired.  If previous goals were too  \nambitious, goals can be reduced and simplified.  This section also guides review of education and information offered and changes in the patient's barriers to learning, and summarizes compliance with  \nany PC and MH appointments. \n
\n
\n"], ["2260", "
\n5 Q: "How much do your obsessive thoughts interfere with your social, school, or work (role) functioning?" [If currently not working (or attending school), determine how much performance would be   \naffected if patient were employed (or in school).] "Have you been avoiding doing anything, going any place, or being with anyone because of your obsessions?" [Evaluate impact of avoidance on   \nfunctioning.]  \n
\n
\n"], ["2261", "
\n6 Q: "How much time do you spend performing compulsive behaviors?" [When rituals involving activities of daily living are chiefly present, ask:] "How much longer than most people does it take to   \ncomplete routine activities because of your rituals?" [When compulsions occur as brief, intermittent behaviors, it may be difficult to assess time spent performing them in terms of total hours. In   \nsuch cases, estimate time by determining how frequently they are performed. Consider both the number of times compulsions are performed and how much of the day is affected. When estimating frequency,  \n count separate occurrences of compulsive behaviors, not number of repetitions. In most cases compulsions are observable behaviors (e.g., hand washing or refusing to shake hands), but some   \ncompulsions are covert (e.g., silent checking or praying); these mental rituals should be rated as you would overt compulsions. "Active avoidance" (e.g., rule governed behaviors that ensure a   \nminimum "safe" distance from contaminated areas or wearing a glove on one hand to keep it clean) like compulsions, can manifest as discrete behavioral acts, measurable in hours or by frequency, so   \nshould be rated on this item. "Passive avoidance", on the other hand, may be difficult to quantify temporally; however, its relationship to compulsions and resultant impact on distress and   \nfunctioning can be measured on items 9 and 10 respectively.  \n
\n
\n"], ["2262", "
\n7 Q: "How much of an effort do you make to resist the compulsions?" [Only rate effort made to resist, not success or failure in actually controlling the compulsions. How much the patient resists the   \ncompulsions may or may not correlate with his ability to control them. Note that this item does not directly measure the severity of the compulsions; rather it rates a manifestation of health, i.e.,   \nthe effort the patient makes to counteract the compulsions. Thus, the more the patient tries to resist, the less impaired is this aspect of his functioning. If the compulsions are minimal, the   \npatient may not feel the need to resist them. In such cases, a rating of "0" should be given.]  \n
\n
\n"], ["2263", "
\n8 Q: "How strong is the drive to perform the compulsions?" [Pause] "How much control do you have over the behaviors?" [In contrast to the preceding item on resistance, this item directly measures   \nsuccess or failure in controlling compulsions.]  \n
\n
\n"], ["2264", "
\n9 Q: "How would you feel if prevented from performing your compulsion(s)?" [Pause] "How distressed would you become?" [Rate degree of distress patient would experience if performance of the ritual   \nwere prevented or suddenly interrupted without reassurance. Like compulsions, avoidance maneuvers can reduce distress; conversely, forced confrontation with avoided objects can engender distress. Ask  \n similar questions about avoidance:] "How would you feel if you werent allowed to avoid?" [In most, but not all cases, performing compulsions reduces anxiety. In other cases, the compulsions   \nthemselves can be a source of distress when laborious or demanding; they can even be painful as in the case of washing with scalding hot water. In these cases, distress or discomfort produced by the   \ncompulsions can be taken into account when ratig this item. Apart from these latter instances, this item can be viewed as an indirect measure of how dependent the individual is on compulsions or   \navoidance to keep distress in check.]  \n
\n
\n"], ["2265", "
\n10 Q: "How much do your compulsive behaviors interfere with your social, school, or work (or role) functioning?" [If currently not working (or attending school), determine how much performance would   \nbe affected if patient were employed (or in school).] "Have you been avoiding doing anything, going any place, or being out of concern you will trigger the compulsions?" [Evaluate impact of avoidance  \n on functioning. An example of avoidance relevant to assessment of compulsions is letting soiled clothes pile up instead of launching into an exhausting and prolonged laundry routine that will defy   \ninterruption.]  \n
\n
\n"], ["2266", "
\n11 Q: "Do you think your concerns or behaviors are reasonable?" [Pause] "What do you think would happen if you did not perform the compulsion(s)? Are you convinced something would really happen?"   \n[Rate patient's insight into the senselessness or excessiveness of his obsession(s) based on beliefs expressed at the time of the interview.]  \n
\n
\n"], ["2267", "
\nThis rating scale is intended for use as a semi-structured interview. The interviewer should assess the items in the listed order and use the questions provided. However, the interviewer is free to  \nask additional questions for purposes of clarification. If the patient volunteers information at any time during the interview, that information will be considered. Ratings should be based primarily  \non reports and observations gained during the interview. If you judge that the information being provided is grossly inaccurate, then the reliability of the patient is in doubt and should be noted  \naccordingly at the end of the interview (last item).||Rate the characteristics of each item during the prior week up until and including the time of the interview.  Score should reflect the average  \n(mean) occurrence of each item for the entire week.||"I am now going to ask several questions about your obsessive thoughts." [Make reference to the patient's specific obsessions.]||1 Q: "How much of  \nyour time is occupied by obsessive thoughts?" [When obsessions occur as brief,intermittent intrusions, it may be difficult to assess time occupied by them in terms of total hours.  In such cases,  \nposing item #2 first may help identify most appropriate response to item #1. Be sure to exclude ruminations and reoccupations that, unlike obsessions, are ego-syntonic and rational  albeit  \nexcessive.)]  \n
\n
\n"], ["2268", "
\n2 Q: "On average, what is the longest continuous period (or block) of time in which you are free of obsessive thoughts?" [Only consider time while awake. You can also ask:] "How frequently do the   \nobsessive thoughts occur?"  \n
\n
\n"], ["2269", "
\n3 Q: "How much control do you have over your obsessive thoughts? How successful are you in stopping or ignoring them? Can you dismiss them?"  \n
\n
\n"], ["227", "
\nFamily interventions have been found to reduce relapse and improve adherence in the treatment of other psychiatric disorders (e.g., schizophrenia, bipolar depression).  Conversely, some studies have  \nfound that without intervention, families tend to discourage treatment adherence and attempt to maintain the patient within the informal network.  Previous research on care management programs shows  \nthat limited social support is a strong predictor of continued depression.  If you believe that involving family members in the patient's care will be beneficial, be sure to follow medical center and  \nHIPAA regulations regarding the disclosure of private information.  As a general rule, be sure to document contact with family members in the medical record and show that it was done with the  \npatient's knowledge and permission -- or conversely, document that the patient has asked that his information be kept strictly private. \n
\n
\n"], ["2270", "
\n4 Q: "How much distress do your obsessive thoughts cause you?" [In most cases, distress is equated with anxiety; however, patients may report that their obsessions are "disturbing" or "upsetting" but  \n deny "anxiety." Only rate distress that seems generated by obsessions, not generalized anxiety or anxiety associated with other conditions.]  \n
\n
\n"], ["2271", "
\n5 Q: "How much do your obsessive thoughts interfere with your social, school, or work (role) functioning?" [If currently not working (or attending school), determine how much performance would be   \naffected if patient were employed (or in school).] "Have you been avoiding doing anything, going any place, or being with anyone because of your obsessions?" [Evaluate impact of avoidance on   \nfunctioning.]  \n
\n
\n"], ["2272", "
\n"The next several questions are about your compulsions."||6 Q: "How much time do you spend performing compulsive behaviors?" [When rituals involving activities of daily living are chiefly present,  \nask:] "How much longer than most people does it take to  complete routine activities because of your rituals?" [When compulsions occur as brief, intermittent behaviors, it may be difficult to assess  \ntime spent performing them in terms of total hours. In  such cases, estimate time by determining how frequently they are performed. Consider both the number of times compulsions are performed and how  \nmuch of the day is affected. When estimating frequency,  count separate occurrences of compulsive behaviors, not number of repetitions. In most cases compulsions are observable behaviors (e.g., hand  \nwashing or refusing to shake hands), but some  compulsions are covert (e.g., silent checking or praying); these mental rituals should be rated as you would overt compulsions. "Active avoidance"  \n(e.g., rule governed behaviors that ensure a  minimum "safe" distance from contaminated areas or wearing a glove on one hand to keep it clean) like compulsions, can manifest as discrete behavioral  \nacts, measurable in hours or by frequency, so  should be rated on this item. "Passive avoidance", on the other hand, may be difficult to quantify temporally; however, its relationship to compulsions  \nand resultant impact on distress and  functioning can be measured on items 9 and 10 respectively.  \n
\n
\n"], ["2273", "
\n7 Q: "How much of an effort do you make to resist the compulsions?" [Only rate effort made to resist, not success or failure in actually controlling the compulsions. How much the patient resists the   \ncompulsions may or may not correlate with his ability to control them. Note that this item does not directly measure the severity of the compulsions; rather it rates a manifestation of health, i.e.,   \nthe effort the patient makes to counteract the compulsions. Thus, the more the patient tries to resist, the less impaired is this aspect of his functioning. If the compulsions are minimal, the   \npatient may not feel the need to resist them. In such cases, a rating of "0" should be given.]  \n
\n
\n"], ["2274", "
\n8 Q: "How strong is the drive to perform the compulsions?" [Pause] "How much control do you have over the behaviors?" [In contrast to the preceding item on resistance, this item directly measures   \nsuccess or failure in controlling compulsions.]  \n
\n
\n"], ["2275", "
\n9 Q: "How would you feel if prevented from performing your compulsion(s)?" [Pause] "How distressed would you become?" [Rate degree of distress patient would experience if performance of the ritual   \nwere prevented or suddenly interrupted without reassurance. Like compulsions, avoidance maneuvers can reduce distress; conversely, forced confrontation with avoided objects can engender distress. Ask  \n similar questions about avoidance:] "How would you feel if you werent allowed to avoid?" [In most, but not all cases, performing compulsions reduces anxiety. In other cases, the compulsions   \nthemselves can be a source of distress when laborious or demanding; they can even be painful as in the case of washing with scalding hot water. In these cases, distress or discomfort produced by the   \ncompulsions can be taken into account when ratig this item. Apart from these latter instances, this item can be viewed as an indirect measure of how dependent the individual is on compulsions or   \navoidance to keep distress in check.]  \n
\n
\n"], ["2276", "
\n10 Q: "How much do your compulsive behaviors interfere with your social, school, or work (or role) functioning?" [If currently not working (or attending school), determine how much performance would   \nbe affected if patient were employed (or in school).] "Have you been avoiding doing anything, going any place, or being out of concern you will trigger the compulsions?" [Evaluate impact of avoidance  \n on functioning. An example of avoidance relevant to assessment of compulsions is letting soiled clothes pile up instead of launching into an exhausting and prolonged laundry routine that will defy   \ninterruption.]  \n
\n
\n"], ["2277", "
\nThe remaining items refer to both obsessions and compulsions. Responses to these items are not included in total Y-BOCS-II score. In most clinical trials, item 11 (Insight) should only be rated at  \nthe baseline and endpoint of the study period, not at each visit.]||11 Q: "Do you think your concerns or behaviors are reasonable?" [Pause] "What do you think would happen if you did not perform the  \ncompulsion(s)? Are you convinced something would really happen?"  [Rate patient's insight into the senselessness or excessiveness of his obsession(s) based on beliefs expressed at the time of the  \ninterview.]  \n
\n
\n"], ["2278", "
\nThis rating scale is intended for use as a semi-structured interview. The interviewer should assess the items in the listed order and use the questions provided. However, the interviewer is free to  \nask additional questions for purposes of clarification. If the patient volunteers information at any time during the interview, that information will be considered. Ratings should be based primarily  \non reports and observations gained during the interview. If you judge that the information being provided is grossly inaccurate, then the reliability of the patient is in doubt and should be noted  \naccordingly at the end of the interview (last item).||Rate the characteristics of each item during the prior week up until and including the time of the interview.  Score should reflect the average  \n(mean) occurrence of each item for the entire week.||"I am now going to ask several questions about your obsessive thoughts." [Make reference to the patient's specific obsessions.]||1 Q: "How much of  \nyour time is occupied by obsessive thoughts?" [When obsessions occur as brief,intermittent intrusions, it may be difficult to assess time occupied by them in terms of total hours.  In such cases,  \nposing item #2 first may help identify most appropriate response to item #1. Be sure to exclude ruminations and reoccupations that, unlike obsessions, are ego-syntonic and rational  albeit  \nexcessive.)]  \n
\n
\n"], ["2279", "
\n2 Q: "On average, what is the longest continuous period (or block) of time in which you are free of obsessive thoughts?" [Only consider time while awake. You can also ask:] "How frequently do the   \nobsessive thoughts occur?"  \n
\n
\n"], ["228", "
\nThere are no questions to ask the patient.  Use this section to document details of the care management plan, especially if it has changed since the last assessment. \n
\n
\n"], ["2280", "
\n3 Q: "How much control do you have over your obsessive thoughts? How successful are you in stopping or ignoring them? Can you dismiss them?"  \n
\n
\n"], ["2281", "
\n4 Q: "How much distress do your obsessive thoughts cause you?" [In most cases, distress is equated with anxiety; however, patients may report that their obsessions are "disturbing" or "upsetting" but  \n deny "anxiety." Only rate distress that seems generated by obsessions, not generalized anxiety or anxiety associated with other conditions.]  \n
\n
\n"], ["2282", "
\n5 Q: "How much do your obsessive thoughts interfere with your social, school, or work (role) functioning?" [If currently not working (or attending school), determine how much performance would be   \naffected if patient were employed (or in school).] "Have you been avoiding doing anything, going any place, or being with anyone because of your obsessions?" [Evaluate impact of avoidance on   \nfunctioning.]  \n
\n
\n"], ["2283", "
\n"The next several questions are about your compulsions."||6 Q: "How much time do you spend performing compulsive behaviors?" [When rituals involving activities of daily living are chiefly present,  \nask:] "How much longer than most people does it take to  complete routine activities because of your rituals?" [When compulsions occur as brief, intermittent behaviors, it may be difficult to assess  \ntime spent performing them in terms of total hours. In  such cases, estimate time by determining how frequently they are performed. Consider both the number of times compulsions are performed and how  \nmuch of the day is affected. When estimating frequency,  count separate occurrences of compulsive behaviors, not number of repetitions. In most cases compulsions are observable behaviors (e.g., hand  \nwashing or refusing to shake hands), but some  compulsions are covert (e.g., silent checking or praying); these mental rituals should be rated as you would overt compulsions. "Active avoidance"  \n(e.g., rule governed behaviors that ensure a  minimum "safe" distance from contaminated areas or wearing a glove on one hand to keep it clean) like compulsions, can manifest as discrete behavioral  \nacts, measurable in hours or by frequency, so  should be rated on this item. "Passive avoidance", on the other hand, may be difficult to quantify temporally; however, its relationship to compulsions  \nand resultant impact on distress and  functioning can be measured on items 9 and 10 respectively.  \n
\n
\n"], ["2284", "
\n7 Q: "How much of an effort do you make to resist the compulsions?" [Only rate effort made to resist, not success or failure in actually controlling the compulsions. How much the patient resists the   \ncompulsions may or may not correlate with his ability to control them. Note that this item does not directly measure the severity of the compulsions; rather it rates a manifestation of health, i.e.,   \nthe effort the patient makes to counteract the compulsions. Thus, the more the patient tries to resist, the less impaired is this aspect of his functioning. If the compulsions are minimal, the   \npatient may not feel the need to resist them. In such cases, a rating of "0" should be given.]  \n
\n
\n"], ["2285", "
\n8 Q: "How strong is the drive to perform the compulsions?" [Pause] "How much control do you have over the behaviors?" [In contrast to the preceding item on resistance, this item directly measures   \nsuccess or failure in controlling compulsions.]  \n
\n
\n"], ["2286", "
\n9 Q: "How would you feel if prevented from performing your compulsion(s)?" [Pause] "How distressed would you become?" [Rate degree of distress patient would experience if performance of the ritual   \nwere prevented or suddenly interrupted without reassurance. Like compulsions, avoidance maneuvers can reduce distress; conversely, forced confrontation with avoided objects can engender distress. Ask  \n similar questions about avoidance:] "How would you feel if you werent allowed to avoid?" [In most, but not all cases, performing compulsions reduces anxiety. In other cases, the compulsions   \nthemselves can be a source of distress when laborious or demanding; they can even be painful as in the case of washing with scalding hot water. In these cases, distress or discomfort produced by the   \ncompulsions can be taken into account when ratig this item. Apart from these latter instances, this item can be viewed as an indirect measure of how dependent the individual is on compulsions or   \navoidance to keep distress in check.]  \n
\n
\n"], ["2287", "
\n10 Q: "How much do your compulsive behaviors interfere with your social, school, or work (or role) functioning?" [If currently not working (or attending school), determine how much performance would   \nbe affected if patient were employed (or in school).] "Have you been avoiding doing anything, going any place, or being out of concern you will trigger the compulsions?" [Evaluate impact of avoidance  \n on functioning. An example of avoidance relevant to assessment of compulsions is letting soiled clothes pile up instead of launching into an exhausting and prolonged laundry routine that will defy   \ninterruption.]  \n
\n
\n"], ["2288", "
\nThe remaining items refer to both obsessions and compulsions. Responses to these items are not included in total Y-BOCS-II score. In most clinical trials, item 11 (Insight) should only be rated at  \nthe baseline and endpoint of the study period, not at each visit.]||11 Q: "Do you think your concerns or behaviors are reasonable?" [Pause] "What do you think would happen if you did not perform the  \ncompulsion(s)? Are you convinced something would really happen?"  [Rate patient's insight into the senselessness or excessiveness of his obsession(s) based on beliefs expressed at the time of the  \ninterview.]  \n
\n
\n"], ["2289", "
\n12 Q: Rate the overall reliability of the rating scores obtained. Factors that may affect reliability include the patient's cooperativeness and his/her natural ability to communicate. The type and  \nseverity of obsessive-compulsive symptoms present may interfere with the patient's concentration, attention, or freedom to speak spontaneously (e.g., the content of some obsessions may cause the  \npatient to choose his words very carefully). \n
\n
\n"], ["229", "
\nThere are no questions to ask the patient.  Complete these summary items for the referring clinician if the patient is continuing in your care management panel.  Especially document any concerns  \nexpressed by the patient.  Then skip to section J. \n
\n
\n"], ["2290", "
\nThis rating scale is intended for use as a semi-structured interview. The interviewer should assess the items in the listed order and use the questions provided. However, the interviewer is free to  \nask additional questions for purposes of clarification. If the patient volunteers information at any time during the interview, that information will be considered. Ratings should be based primarily  \non reports and observations gained during the interview. If you judge that the information being provided is grossly inaccurate, then the reliability of the patient is in doubt and should be noted  \naccordingly at the end of the interview (last item).||Rate the characteristics of each item during the prior week up until and including the time of the interview.  Score should reflect the average  \n(mean) occurrence of each item for the entire week.||"I am now going to ask several questions about your obsessive thoughts." [Make reference to the patient's specific obsessions.]||1 Q: "How much of  \nyour time is occupied by obsessive thoughts?" [When obsessions occur as brief,intermittent intrusions, it may be difficult to assess time occupied by them in terms of total hours.  In such cases,  \nposing item #2 first may help identify most appropriate response to item #1. Be sure to exclude ruminations and reoccupations that, unlike obsessions, are ego-syntonic and rational  albeit  \nexcessive.)]  \n
\n
\n"], ["2291", "
\n2 Q: "On average, what is the longest continuous period (or block) of time in which you are free of obsessive thoughts?" [Only consider time while awake. You can also ask:] "How frequently do the   \nobsessive thoughts occur?"  \n
\n
\n"], ["2292", "
\n3 Q: "How much control do you have over your obsessive thoughts? How successful are you in stopping or ignoring them? Can you dismiss them?"  \n
\n
\n"], ["2293", "
\n4 Q: "How much distress do your obsessive thoughts cause you?" [In most cases, distress is equated with anxiety; however, patients may report that their obsessions are "disturbing" or "upsetting" but  \n deny "anxiety." Only rate distress that seems generated by obsessions, not generalized anxiety or anxiety associated with other conditions.]  \n
\n
\n"], ["2294", "
\n5 Q: "How much do your obsessive thoughts interfere with your social, school, or work (role) functioning?" [If currently not working (or attending school), determine how much performance would be   \naffected if patient were employed (or in school).] "Have you been avoiding doing anything, going any place, or being with anyone because of your obsessions?" [Evaluate impact of avoidance on   \nfunctioning.]  \n
\n
\n"], ["2295", "
\n"The next several questions are about your compulsions."||6 Q: "How much time do you spend performing compulsive behaviors?" [When rituals involving activities of daily living are chiefly present,  \nask:] "How much longer than most people does it take to  complete routine activities because of your rituals?" [When compulsions occur as brief, intermittent behaviors, it may be difficult to assess  \ntime spent performing them in terms of total hours. In  such cases, estimate time by determining how frequently they are performed. Consider both the number of times compulsions are performed and how  \nmuch of the day is affected. When estimating frequency,  count separate occurrences of compulsive behaviors, not number of repetitions. In most cases compulsions are observable behaviors (e.g., hand  \nwashing or refusing to shake hands), but some  compulsions are covert (e.g., silent checking or praying); these mental rituals should be rated as you would overt compulsions. "Active avoidance"  \n(e.g., rule governed behaviors that ensure a  minimum "safe" distance from contaminated areas or wearing a glove on one hand to keep it clean) like compulsions, can manifest as discrete behavioral  \nacts, measurable in hours or by frequency, so  should be rated on this item. "Passive avoidance", on the other hand, may be difficult to quantify temporally; however, its relationship to compulsions  \nand resultant impact on distress and  functioning can be measured on items 9 and 10 respectively.  \n
\n
\n"], ["2296", "
\n7 Q: "How much of an effort do you make to resist the compulsions?" [Only rate effort made to resist, not success or failure in actually controlling the compulsions. How much the patient resists the   \ncompulsions may or may not correlate with his ability to control them. Note that this item does not directly measure the severity of the compulsions; rather it rates a manifestation of health, i.e.,   \nthe effort the patient makes to counteract the compulsions. Thus, the more the patient tries to resist, the less impaired is this aspect of his functioning. If the compulsions are minimal, the   \npatient may not feel the need to resist them. In such cases, a rating of "0" should be given.]  \n
\n
\n"], ["2297", "
\n8 Q: "How strong is the drive to perform the compulsions?" [Pause] "How much control do you have over the behaviors?" [In contrast to the preceding item on resistance, this item directly measures   \nsuccess or failure in controlling compulsions.]  \n
\n
\n"], ["2298", "
\n9 Q: "How would you feel if prevented from performing your compulsion(s)?" [Pause] "How distressed would you become?" [Rate degree of distress patient would experience if performance of the ritual   \nwere prevented or suddenly interrupted without reassurance. Like compulsions, avoidance maneuvers can reduce distress; conversely, forced confrontation with avoided objects can engender distress. Ask  \n similar questions about avoidance:] "How would you feel if you werent allowed to avoid?" [In most, but not all cases, performing compulsions reduces anxiety. In other cases, the compulsions   \nthemselves can be a source of distress when laborious or demanding; they can even be painful as in the case of washing with scalding hot water. In these cases, distress or discomfort produced by the   \ncompulsions can be taken into account when ratig this item. Apart from these latter instances, this item can be viewed as an indirect measure of how dependent the individual is on compulsions or   \navoidance to keep distress in check.]  \n
\n
\n"], ["2299", "
\n10 Q: "How much do your compulsive behaviors interfere with your social, school, or work (or role) functioning?" [If currently not working (or attending school), determine how much performance would   \nbe affected if patient were employed (or in school).] "Have you been avoiding doing anything, going any place, or being out of concern you will trigger the compulsions?" [Evaluate impact of avoidance  \n on functioning. An example of avoidance relevant to assessment of compulsions is letting soiled clothes pile up instead of launching into an exhausting and prolonged laundry routine that will defy   \ninterruption.]  \n
\n
\n"], ["23", "
\nRead each of the questions carefully and indicate how often you felt that\nway during the past week.\n
\n
\n"], ["230", "
\nSince symptoms do not resolve immediately after anti-depressant medication is started, patients may need encouragement to stick with the medication, or if taking it properly for a reasonable trial  \nperiod, may need a dosage or drug adjustment, or consideration of referral for psychotherapy or consultation.  Side effects require the same attention.  Patients may not realize side effects are  \ntemporary, or may suffer too long with a problem that can be alleviated or resolved by changing meds. \n
\n
\n"], ["2300", "
\nThe remaining items refer to both obsessions and compulsions. Responses to these items are not included in total Y-BOCS-II score. In most clinical trials, item 11 (Insight) should only be rated at  \nthe baseline and endpoint of the study period, not at each visit.]||11 Q: "Do you think your concerns or behaviors are reasonable?" [Pause] "What do you think would happen if you did not perform the  \ncompulsion(s)? Are you convinced something would really happen?"  [Rate patient's insight into the senselessness or excessiveness of his obsession(s) based on beliefs expressed at the time of the  \ninterview.]  \n
\n
\n"], ["2301", "
\n12 Q: Rate the overall reliability of the rating scores obtained. Factors that may affect reliability include the patient's cooperativeness and his/her natural ability to communicate. The type and  \nseverity of obsessive-compulsive symptoms present may interfere with the patient's concentration, attention, or freedom to speak spontaneously (e.g., the content of some obsessions may cause the  \npatient to choose his words very carefully). \n
\n
\n"], ["2302", "
\n[Items 13 and 14 refer to global illness severity. The rater is required to consider global function, not just the severity of obsessive-compulsive symptoms.]||13 Q: Interviewer's judgment of the  \noverall severity of the patient's illness. Rated|from 0 (no illness) to 6 (most severe patient seen). [Consider the degree of distress reported by the patient, the symptoms observed, and the  \nfunctional impairment reported. Your judgment is required both in averaging this data as well as weighing the reliability or accuracy of the data obtained and should be based on information obtained  \nduring the interview.] \n
\n
\n"], ["2303", "
\n14 Q: Rate total overall improvement present SINCE THE INITIAL RATING whether or not, in your judgment, it is due to treatment effects. \n
\n
\n"], ["2304", "
\nItems 13 and 14 are adapted from the Clinical Global Impression Scale (Guy W: ECDEU Assessment Manual for Psychopharmacology: Publication 76-338. Washington, D.C., U.S. Department of Health,  \nEducation, and Welfare (1976)). \n
\n
\n"], ["2305", "
\nINSTRUCTIONS: Here are a number of events that people sometimes experience. Read each one carefully and indicate whether this has EVER happened to you (0 equals No; 1 equals Yes).  If an item does  \nnot apply to you, indicate zero (0). ||Has this EVER happened to  you?  \n
\n
\n"], ["2306", "
\nThis rating scale is intended for use as a semi-structured interview. The interviewer should assess the items in the listed order and use the questions provided. However, the interviewer is free to   \nask additional questions for purposes of clarification. If the patient volunteers information at any time during the interview, that information will be considered. Ratings should be based primarily   \non reports and observations gained during the interview. If you judge that the information being provided is grossly inaccurate, then the reliability of the patient is in doubt and should be noted   \naccordingly at the end of the interview (last item).||Rate the characteristics of each item during the prior week up until and including the time of the interview. Score should reflect the average   \n(mean) occurrence of each item for the entire week.||"I am now going to ask several questions about your obsessive thoughts." [Make reference to the patient's specific obsessions.]||1 Q: "How much of  \n your time is occupied by obsessive thoughts?" [When obsessions occur as brief,intermittent intrusions, it may be difficult to assess time occupied by them in terms of total hours. In such cases,   \nposing item #2 first may help identify most appropriate response to item #1. Be sure to exclude ruminations and reoccupations that, unlike obsessions, are ego-syntonic and rational albeit   \nexcessive.)]  \n
\n
\n"], ["2307", "
\n2 Q: "On average, what is the longest continuous period (or block) of time in which you are free of obsessive thoughts?" [Only consider time while awake. You can also ask:] "How frequently do the   \nobsessive thoughts occur?"  \n
\n
\n"], ["2308", "
\n3 Q: "How much control do you have over your obsessive thoughts? How successful are you in stopping or ignoring them? Can you dismiss them?"  \n
\n
\n"], ["2309", "
\n4 Q: "How much distress do your obsessive thoughts cause you?" [In most cases, distress is equated with anxiety; however, patients may report that their obsessions are "disturbing" or "upsetting" but  \n deny "anxiety." Only rate distress that seems generated by obsessions, not generalized anxiety or anxiety associated with other conditions.]  \n
\n
\n"], ["231", "
\nIf possible, this follow-up would be individualized to patient based on DCM/MH supervisor consultation. If treatment is being done by someone else (MH), PCP should consider having patient do PHQ9 in  \nMHA on subsequent visits so s/he can monitor depression improvement/worsening. \n
\n
\n"], ["2310", "
\n5 Q: "How much do your obsessive thoughts interfere with your social, school, or work (role) functioning?" [If currently not working (or attending school), determine how much performance would be   \naffected if patient were employed (or in school).] "Have you been avoiding doing anything, going any place, or being with anyone because of your obsessions?" [Evaluate impact of avoidance on   \nfunctioning.]  \n
\n
\n"], ["2311", "
\n"The next several questions are about your compulsions."||6 Q: "How much time do you spend performing compulsive behaviors?" [When rituals involving activities of daily living are chiefly present,   \nask:] "How much longer than most people does it take to complete routine activities because of your rituals?" [When compulsions occur as brief, intermittent behaviors, it may be difficult to assess   \ntime spent performing them in terms of total hours. In such cases, estimate time by determining how frequently they are performed. Consider both the number of times compulsions are performed and how   \nmuch of the day is affected. When estimating frequency, count separate occurrences of compulsive behaviors, not number of repetitions. In most cases compulsions are observable behaviors (e.g., hand   \nwashing or refusing to shake hands), but some compulsions are covert (e.g., silent checking or praying); these mental rituals should be rated as you would overt compulsions. "Active avoidance"   \n(e.g., rule governed behaviors that ensure a minimum "safe" distance from contaminated areas or wearing a glove on one hand to keep it clean) like compulsions, can manifest as discrete behavioral   \nacts, measurable in hours or by frequency, so should be rated on this item. "Passive avoidance", on the other hand, may be difficult to quantify temporally; however, its relationship to compulsions   \nand resultant impact on distress and functioning can be measured on items 9 and 10 respectively.  \n
\n
\n"], ["2312", "
\n7 Q: "How much of an effort do you make to resist the compulsions?" [Only rate effort made to resist, not success or failure in actually controlling the compulsions. How much the patient resists the   \ncompulsions may or may not correlate with his ability to control them. Note that this item does not directly measure the severity of the compulsions; rather it rates a manifestation of health, i.e.,   \nthe effort the patient makes to counteract the compulsions. Thus, the more the patient tries to resist, the less impaired is this aspect of his functioning. If the compulsions are minimal, the   \npatient may not feel the need to resist them. In such cases, a rating of "0" should be given.]  \n
\n
\n"], ["2313", "
\n8 Q: "How strong is the drive to perform the compulsions?" [Pause] "How much control do you have over the behaviors?" [In contrast to the preceding item on resistance, this item directly measures   \nsuccess or failure in controlling compulsions.]  \n
\n
\n"], ["2314", "
\n9 Q: "How would you feel if prevented from performing your compulsion(s)?" [Pause] "How distressed would you become?" [Rate degree of distress patient would experience if performance of the ritual   \nwere prevented or suddenly interrupted without reassurance. Like compulsions, avoidance maneuvers can reduce distress; conversely, forced confrontation with avoided objects can engender distress. Ask  \n similar questions about avoidance:] "How would you feel if you werent allowed to avoid?" [In most, but not all cases, performing compulsions reduces anxiety. In other cases, the compulsions   \nthemselves can be a source of distress when laborious or demanding; they can even be painful as in the case of washing with scalding hot water. In these cases, distress or discomfort produced by the   \ncompulsions can be taken into account when ratig this item. Apart from these latter instances, this item can be viewed as an indirect measure of how dependent the individual is on compulsions or   \navoidance to keep distress in check.]  \n
\n
\n"], ["2315", "
\n10 Q: "How much do your compulsive behaviors interfere with your social, school, or work (or role) functioning?" [If currently not working (or attending school), determine how much performance would   \nbe affected if patient were employed (or in school).] "Have you been avoiding doing anything, going any place, or being out of concern you will trigger the compulsions?" [Evaluate impact of avoidance  \n on functioning. An example of avoidance relevant to assessment of compulsions is letting soiled clothes pile up instead of launching into an exhausting and prolonged laundry routine that will defy   \ninterruption.]  \n
\n
\n"], ["2316", "
\nThe remaining items refer to both obsessions and compulsions. Responses to these items are not included in total Y-BOCS-II score. In most clinical trials, item 11 (Insight) should only be rated at   \nthe baseline and endpoint of the study period, not at each visit.]||11 Q: "Do you think your concerns or behaviors are reasonable?" [Pause] "What do you think would happen if you did not perform the   \ncompulsion(s)? Are you convinced something would really happen?" [Rate patient's insight into the senselessness or excessiveness of his obsession(s) based on beliefs expressed at the time of the   \ninterview.]  \n
\n
\n"], ["2317", "
\n12 Q: Rate the overall reliability of the rating scores obtained. Factors that may affect reliability include the patient's cooperativeness and his/her natural ability to communicate. The type and   \nseverity of obsessive-compulsive symptoms present may interfere with the patient's concentration, attention, or freedom to speak spontaneously (e.g., the content of some obsessions may cause the   \npatient to choose his words very carefully).  \n
\n
\n"], ["2318", "
\n[Items 13 and 14 refer to global illness severity. The rater is required to consider global function, not just the severity of obsessive-compulsive symptoms.]||13 Q: Interviewer's judgment of the   \noverall severity of the patient's illness. Rated|from 0 (no illness) to 6 (most severe patient seen). [Consider the degree of distress reported by the patient, the symptoms observed, and the   \nfunctional impairment reported. Your judgment is required both in averaging this data as well as weighing the reliability or accuracy of the data obtained and should be based on information obtained   \nduring the interview.]  \n
\n
\n"], ["2319", "
\n14 Q: Rate total overall improvement present SINCE THE INITIAL RATING whether or not, in your judgment, it is due to treatment effects.  \n
\n
\n"], ["232", "
\nDepression care managers contact patients six to eight times or more over the course of 24 weeks of depression care management, mostly by telephone.  The PHQ-9 (and AUDIT C for any patient previously  \n  screen-positive for alcohol abuse), should be completed during any call that follows a month or more after the most recent PHQ-9 (or AUDIT C).  These measures should be administered strictly    \naccording to protocol, to maintain reliability.  Other than the administration of standardized instruments, the follow-up assessment should be responsive to the individual patient's needs and    \nproblems.  The follow-up assessment is a conversation between the depression care manager and patient.  It is semi-structured, in the sense that specific content areas are covered in a certain order,  \n  and some questions require selection from a set of specific response options.  You want to get the necessary information for clinical decision-making, but in the context of a supportive  \nrelationship   with the patient, not as a standardized interview where you ask questions exactly as prescribed in a script.  The depression care manager asks questions much in the way a patient's  \nclinical problems   are reviewed during a clinic visit.  Providing patient education and encouraging patient activation/self-help are critical parts of each follow-up encounter.Before calling the  \npatient, check CPRS for   compliance with PC and MH appointments and medication refills as relevant, and review the last assessment and current medical record notes.  Identify any particular care  \nplan targets for the patient   (e.g., poor adherence, social isolation, difficulty sleeping, poor understanding of depression). \n
\n
\n"], ["2320", "
\nThis rating scale is intended for use as a semi-structured interview. The interviewer should assess the items in the listed order and use the questions provided. However, the interviewer is free to   \nask additional questions for purposes of clarification. If the patient volunteers information at any time during the interview, that information will be considered. Ratings should be based primarily   \non reports and observations gained during the interview. If you judge that the information being provided is grossly inaccurate, then the reliability of the patient is in doubt and should be noted   \naccordingly at the end of the interview (last item).||Rate the characteristics of each item during the prior week up until and including the time of the interview. Score should reflect the average   \n(mean) occurrence of each item for the entire week.||"I am now going to ask several questions about your obsessive thoughts." [Make reference to the patient's specific obsessions.]||1 Q: "How much of  \n your time is occupied by obsessive thoughts?" [When obsessions occur as brief,intermittent intrusions, it may be difficult to assess time occupied by them in terms of total hours. In such cases,   \nposing item #2 first may help identify most appropriate response to item #1. Be sure to exclude ruminations and reoccupations that, unlike obsessions, are ego-syntonic and rational albeit   \nexcessive.)]  \n
\n
\n"], ["2321", "
\n2 Q: "On average, what is the longest continuous period (or block) of time in which you are free of obsessive thoughts?" [Only consider time while awake. You can also ask:] "How frequently do the   \nobsessive thoughts occur?"  \n
\n
\n"], ["2322", "
\n3 Q: "How much control do you have over your obsessive thoughts? How successful are you in stopping or ignoring them? Can you dismiss them?"  \n
\n
\n"], ["2323", "
\n4 Q: "How much distress do your obsessive thoughts cause you?" [In most cases, distress is equated with anxiety; however, patients may report that their obsessions are "disturbing" or "upsetting" but  \n deny "anxiety." Only rate distress that seems generated by obsessions, not generalized anxiety or anxiety associated with other conditions.]  \n
\n
\n"], ["2324", "
\n5 Q: "How much do your obsessive thoughts interfere with your social, school, or work (role) functioning?" [If currently not working (or attending school), determine how much performance would be   \naffected if patient were employed (or in school).] "Have you been avoiding doing anything, going any place, or being with anyone because of your obsessions?" [Evaluate impact of avoidance on   \nfunctioning.]  \n
\n
\n"], ["2325", "
\n"The next several questions are about your compulsions." [Make reference to the patient's specific symptoms.]||6 Q: "How much time do you spend performing compulsive behaviors?" [When rituals  \ninvolving activities of daily living are chiefly present,  ask:] "How much longer than most people does it take to complete routine activities because of your rituals?" [When compulsions occur as  \nbrief, intermittent behaviors, it may be difficult to assess  time spent performing them in terms of total hours. In such cases, estimate time by determining how frequently they are performed.  \nConsider both the number of times compulsions are performed and how  much of the day is affected. When estimating frequency, count separate occurrences of compulsive behaviors, not number of  \nrepetitions. In most cases compulsions are observable behaviors (e.g., hand  washing or refusing to shake hands), but some compulsions are covert (e.g., silent checking or praying); these mental  \nrituals should be rated as you would overt compulsions. "Active avoidance"  (e.g., rule governed behaviors that ensure a minimum "safe" distance from contaminated areas or wearing a glove on one hand  \nto keep it clean) like compulsions, can manifest as discrete behavioral  acts, measurable in hours or by frequency, so should be rated on this item. "Passive avoidance", on the other hand, may be  \ndifficult to quantify temporally; however, its relationship to compulsions  and resultant impact on distress and functioning can be measured on items 9 and 10 respectively.  \n
\n
\n"], ["2326", "
\n7 Q: "How much of an effort do you make to resist the compulsions?" [Only rate effort made to resist, not success or failure in actually controlling the compulsions. How much the patient resists the   \ncompulsions may or may not correlate with his ability to control them. Note that this item does not directly measure the severity of the compulsions; rather it rates a manifestation of health, i.e.,   \nthe effort the patient makes to counteract the compulsions. Thus, the more the patient tries to resist, the less impaired is this aspect of his functioning. If the compulsions are minimal, the   \npatient may not feel the need to resist them. In such cases, a rating of "0" should be given.]  \n
\n
\n"], ["2327", "
\n8 Q: "How strong is the drive to perform the compulsions?" [Pause] "How much control do you have over the behaviors?" [In contrast to the preceding item on resistance, this item directly measures   \nsuccess or failure in controlling compulsions.]  \n
\n
\n"], ["2328", "
\n9 Q: "How would you feel if prevented from performing your compulsion(s)?" [Pause] "How distressed would you become?" [Rate degree of distress patient would experience if performance of the ritual   \nwere prevented or suddenly interrupted without reassurance. Like compulsions, avoidance maneuvers can reduce distress; conversely, forced confrontation with avoided objects can engender distress. Ask  \n similar questions about avoidance:] "How would you feel if you werent allowed to avoid?" [In most, but not all cases, performing compulsions reduces anxiety. In other cases, the compulsions   \nthemselves can be a source of distress when laborious or demanding; they can even be painful as in the case of washing with scalding hot water. In these cases, distress or discomfort produced by the   \ncompulsions can be taken into account when ratig this item. Apart from these latter instances, this item can be viewed as an indirect measure of how dependent the individual is on compulsions or   \navoidance to keep distress in check.]  \n
\n
\n"], ["2329", "
\n10 Q: "How much do your compulsive behaviors interfere with your social, school, or work (or role) functioning?" [If currently not working (or attending school), determine how much performance would   \nbe affected if patient were employed (or in school).] "Have you been avoiding doing anything, going any place, or being out of concern you will trigger the compulsions?" [Evaluate impact of avoidance  \n on functioning. An example of avoidance relevant to assessment of compulsions is letting soiled clothes pile up instead of launching into an exhausting and prolonged laundry routine that will defy   \ninterruption.]  \n
\n
\n"], ["233", "
\nAt each follow-up, monitoring depression severity for evidence of progress toward recovery vs. ineffective treatment requiring adjustment or referral is essential.  It is also a point where education  \n  about depression can be reinforced.  Be sure to do the PHQ-9 in a manner consistent with previous administrations of the instrument. \n
\n
\n"], ["2330", "
\nThe remaining items refer to both obsessions and compulsions. Responses to these items are not included in total Y-BOCS-II score. In most clinical trials, item 11 (Insight) should only be rated at   \nthe baseline and endpoint of the study period, not at each visit.]||11 Q: "Do you think your concerns or behaviors are reasonable?" [Pause] "What do you think would happen if you did not perform the   \ncompulsion(s)? Are you convinced something would really happen?" [Rate patient's insight into the senselessness or excessiveness of his obsession(s) based on beliefs expressed at the time of the   \ninterview.]  \n
\n
\n"], ["2331", "
\n12 Q: Rate the overall reliability of the rating scores obtained. Factors that may affect reliability include the patient's cooperativeness and his/her natural ability to communicate. The type and   \nseverity of obsessive-compulsive symptoms present may interfere with the patient's concentration, attention, or freedom to speak spontaneously (e.g., the content of some obsessions may cause the   \npatient to choose his words very carefully).  \n
\n
\n"], ["2332", "
\n[Items 13 and 14 refer to global illness severity. The rater is required to consider global function, not just the severity of obsessive-compulsive symptoms.]||13 Q: Interviewer's judgment of the   \noverall severity of the patient's illness. Rated|from 0 (no illness) to 6 (most severe patient seen). [Consider the degree of distress reported by the patient, the symptoms observed, and the   \nfunctional impairment reported. Your judgment is required both in averaging this data as well as weighing the reliability or accuracy of the data obtained and should be based on information obtained   \nduring the interview.]  \n
\n
\n"], ["2333", "
\n14 Q: Rate total overall improvement present SINCE THE INITIAL RATING whether or not, in your judgment, it is due to treatment effects.  \n
\n
\n"], ["2334", "
\nDuring the past TWO (2) WEEKS, how much (or how often) have you been bothered by the following problems? \n
\n
\n"], ["234", "
\nThis section is important for triage of patients who indicate possible suicide ideation.  Ask suicide questions if patient expressed current thoughts of suicide on PHQ-9 or if suicidal ideation is    \nnoted at other points in this or a previous assessment. \n
\n
\n"], ["2345", "
\nPlease pick the response corresponding to how you have felt about your relationship IN THE LAST WEEK. |\n
\n
\n"], ["2346", "
\nScore activities on level of independence: ||INDEPENDENCE: NO supervision, direction or personal assistance (1 POINT) |DEPENDENCE: WITH supervision, direction, personal assistance or total care (0 POINTS)\n
\n
\n"], ["2347", "
\nNOTE: This version of the Couple Satisfaction Index is to be completed by the Veteran's Partner.\n
\n
\n"], ["2348", "
\n| Please pick the response corresponding to how you have felt about your relationship with your partner IN THE LAST MONTH.\n
\n
\n"], ["2349", "
\nPlease read each item carefully and give your best response.\n \nOver the past two weeks, how often have you been bothered by any of the \nfollowing problems?\n
\n
\n"], ["235", "
\nSince symptoms do not resolve immediately after antidepressant medication is started, patients may need encouragement to stick with the medication, or if taking it properly for a reasonable trial    \nperiod, may need a dosage or drug adjustment, or consideration of referral for psychotherapy or consultation.  Side effects require the same attention.  Patients may not realize side effects are    \ntemporary, or may suffer too long with a problem that can be alleviated or resolved by changing meds. \n
\n
\n"], ["2350", "
\nPlease read each item carefully and give your best response.\n
\n
\n"], ["2352", "
\nSometimes things happen to people that are unusually or especially \nfrightening, horrible, or traumatic. For example:|  |\n               A serious accident or fire |\n               A physical or sexual assault or abuse|\n               An earthquake or flood|\n               A war|\n               Seeing someone be killed or seriously injured|\n               Having a loved one die through homicide or suicide|\n
\n
\n"], ["2353", "
\nIn the past month, have you...\n
\n
\n"], ["2354", "
\nProvide the responses to the following questions for the time period designated.\n
\n
\n"], ["2356", "
\nThis questionnaire asks about difficulties due to health conditions. Health conditions include diseases or illnesses, other health problems that may be short or long lasting, injuries, mental or emotional\nproblems, and problems with alcohol or drugs.|  |\nThink back over the past 30 days and answer these questions, thinking  about how much difficulty you had doing the following activities. In the past 30 days, how much DIFFICULTY did you have in:\n
\n
\n"], ["2357", "
\nSometimes things happen to people that are unusually or especially frightening, horrible, or traumatic. For example:|  |\n              A serious accident or fire|\n              A physical or sexual assault or abuse|\n              An earthquake or flood|\n              A war|\n              Seeing someone be killed or seriously injured|\n              Having a loved one die through homicide or suicide\n
\n
\n"], ["2358", "
\nIn the past month, have you...\n
\n
\n"], ["236", "
\nThis section was covered at the initial assessment but should be repeated as needed.  Any exacerbations of co-morbid problems can interfere with depression treatment and response, and may require    \nreferral to other programs.  If drugs and alcohol were not already assessed in the risk assessment above, use the initial assessment, any previous follow-up assessments, and the medical record to    \ndecide whether alcohol, substance abuse or other mental health co-morbidities need re-assessment.  Any patient who was "screen positive" for substance abuse on the initial assessment should be    \nreassessed with the AUDIT C and counseled about substance use. \n
\n
\n"], ["2360", "
\nIn the past week:\n
\n
\n"], ["2361", "
\nIn the past 3 days:\n
\n
\n"], ["2363", "
\nThis is a clinician rating, based on the PSS3 scoring, not designed for self-report.| |\nA "yes" on any of the items below means the treating physician should consider consulting a mental health professional.\n
\n
\n"], ["2364", "
\nIndicate the degree to which each of the following items\ndescribes the patient's present condition.\n| | \nIn the past week:\n
\n
\n"], ["2365", "
\nIn the last 3 days:\n
\n
\n"], ["2366", "
\nIn the last week:\n
\n
\n"], ["2367", "
\nInstructions: Below is a list of problems that people sometimes have in response to a very stressful experience.\nPlease read each problem and then select one of the options to indicate how much you have been bothered by\nthat problem in the past week. The options include not at all, a little bit, moderately, quite a bit, and extremely.\n||In the past week, how much were you bothered by:\n
\n
\n"], ["2368", "
\nPlease read each item carefully and give your best response.\n
\n
\n"], ["2369", "
\nBelow are some statements about feelings and thoughts. Please select the \nnumber that best describes your experience of each statement over the \nlast 2 weeks.\n
\n
\n"], ["237", "
\nIf the patient is doing well at participating in self-help activities, different or additional options can be discussed to increase the activity level if desired.  If previous goals were too    \nambitious, goals can be reduced and simplified.  This section also guides review of education and information offered and changes in the patient's barriers to learning, and summarizes compliance with  \n  any PC and MH appointments. \n
\n
\n"], ["2370", "
\nThe goal of this questionnaire is to find out how you view your own current recovery process. The mental health recovery process is complex and is different for each individual. There are no right or wrong answers.| | \nPlease read each statement carefully, with regard to your own current recovery process. For each question, indicate the statement that best represents the way you feel:| |\n \n1. Strongly Disagree 2. Disagree 3. Not sure 4. Agree 5. Strongly Agree\n
\n
\n"], ["2371", "
\nThe instrument may be self-administered or can be read aloud. It is preferable to administer the AD8 to an informant, \nif available. If an informant is not available, the AD8 questionnaire may be administered to the patient. Rater should \nonly rate changes in the patient due to cognitive problems.| |\n \nRemember, "Yes, a change" indicates that there has been a change in the\nlast several years caused by cognitive (thinking and memory) problems.\n
\n
\n"], ["2372", "
\nAs you are pregnant or have recently had a baby, we would like to know \n|     No, not at all  | |\n \nPlease complete the other questions in the same way. Please complete the \nother questions in the same way.\nhow you are feeling. Please check the answer that comes closest to how \nyou have felt IN THE PAST 7 DAYS, not just how you feel today. Here is an \nexample, already completed.|\n \n| I have felt happy:  |\n|     Yes, all the time\n|  X  Yes, most of the time (This would mean: "I have felt happy most of the time" during the past week.)\n|     No, not very often\n
\n
\n"], ["2373", "
\nPlease select the number with the answer that best describes your \nexperience.\n
\n
\n"], ["2374", "
\nPlease read each item carefully and give your best response.\n
\n
\n"], ["2375", "
\nThis survey asks about how you are feeling and doing in different areas \nof life. Please check the item that best describes yourself during the \nPAST WEEK. Please answer every question. If you are unsure about how to \nanswer, please give the best answer you can.\n \n \n||During the PAST WEEK, how often did you ...\n
\n
\n"], ["2377", "
\nIn the following 9 questions, you will be asked to describe your pain and how it affects your life.  Under each question is a scale to record your answer.  Read each question carefully and then select a number on the scale under that question to\nindicate how that specific question applies to you. It is recommended that you use the number keys on the keyboard to select the response for each question.\n
\n
\n"], ["2378", "
\nPlease select the number aligned with each statement that best describes \nyour experience.\n
\n
\n"], ["2379", "
\nProvide the responses to the following questions for the time period designated.\n
\n
\n"], ["238", "
\nFamily interventions have been found to reduce relapse and improve adherence in the treatment of other psychiatric disorders (e.g., schizophrenia, bipolar depression).  Conversely, some studies have   \n found that without intervention, families tend to discourage treatment adherence and attempt to maintain the patient within the informal network.  Previous research on care management programs shows  \n  that limited social support is a strong predictor of continued depression.  If you believe that involving family members in the patient's care will be beneficial, be sure to follow medical center  \nand   HIPAA regulations regarding the disclosure of private information.  As a general rule, be sure to document contact with family members in the medical record and show that it was done with the    \npatient's knowledge and permission -- or conversely, document that the patient has asked that his information be kept strictly private. \n
\n
\n"], ["2381", "
\nThis inventory contains a list of statements that can be used to describe \ndecide, choose "False."||There is no time limit for completing the inventory, but it is best to work as quickly as is comfortable for you. \na person's feelings and attitudes. Read each statement carefully and \nanswer it as truthfully as you can as the results of this inventory are \ndesigned to help you. Do not be concerned if a few of the statements seem \nunusual; they are included to describe the feelings and attitudes of \npeople with many types of problems.||If you agree with a statement or decide that it describes you, choose \n"True." If you disagree with a statement or decide that it does not \ndescribe you, choose "False." Try to answer every statement, even if you \nare not sure of your choice. If you have tried your best and still cannot \n
\n
\n"], ["2382", "
\nINSTRUCTIONS: Read each question carefully and respond as instructed.\n| |\nTaking everything into consideration, during the past week how satisfied \nhave you been with:\n
\n
\n"], ["2383", "
\nThis survey will help your caregiver better understand how you feel. There are no right or wrong answers. This survey usually takes about 10 minutes to complete.||\nThis part contains questions concerning your level of pain during the past month.| |\nUse the following to describe your level of pain:| |\n0 - 1 - 2 - 3 - 4 - 5 - 6 - 7 - 8 - 9 - 10|\nNo Pain                                           Worst Pain You|      \n                                                                          Could Imagine\n
\n
\n"], ["2384", "
\nThis part contains a list of symptoms that people sometimes have. For each symptom, decide how much of a problem it has been for you in the past month.\n
\n
\n"], ["2385", "
\nThis part consists of a number of statements. Read each statement and decide how it applies to you.\n
\n
\n"], ["2386", "
\nFor each question or statement below, please mark one answer.\n
\n
\n"], ["2387", "
\nTaking everything into consideration, during the past week how satisfied \nhave you been with:\n
\n
\n"], ["2388", "
\n \nTaking everything into consideration, during the last week how satisfied have you been with:\n
\n
\n"], ["2389", "
\nFor each of the following statements, please select \nthe number that best describes the way you have felt over the \npast 24 hours. While there may have been some change during that time, \ntry to give a single summary rating for each item.| |\nUse the following to describe your feelings:| |\n0    -    10    -    20    -    30    -    40    -    50    -    60    -    70    -    80    - \n  90    -    100|\nNot at all/Rarely                                                           Very Much So/Much of the time\n
\n
\n"], ["239", "
\nThere are no questions to ask the patient.  Use this section to document details of the care management plan, especially if it has changed since the last assessment. \n
\n
\n"], ["2390", "
\nUse the following to describe your feelings:| |\n0    -    10    -    20    -    30    -    40    -    50    -    60    -    70    -    80    -    90    -    100|\nDepressed/Down                                Normal                                               Manic/High\n
\n
\n"], ["2391", "
\nPlease take a few minutes to fill out this survey. We are interested in the way things are for you, so there is no right or wrong answer. If you are not sure about a question, just answer it as best as you can. Just select the number of the\nanswer that fits you best.\n
\n
\n"], ["2392", "
\nThis questionnaire will help you and your healthcare professional measure the impact COPD (Chronic Obstructive Pulmonary Disease) is having on your well-being and daily life. Your answers, and test score, can be used by you and your healthcare\nprofessional to help improve the management of your COPD and get the greatest benefit from treatment.||\nFor each item below, select the number that best describes you currently.\n
\n
\n"], ["2393", "
\nRatings should be based on symptoms and signs occurring during the week before interview. If symptoms result from physical disability or illness, select the corresponding response below (response #4). Ratings are based on two semi-structured\ninterviews: an interview of an informant and an interview of the patient. If there are discrepancies in ratings from the informant and the patient interviews, the rater should re-interview both the informant and the patient with the goal to\nresolve the discrepancies.The final ratings of the CSDD items represent the rater's clinical impression rather than the responses of the informant or the patient. The semi-structured interviews can be found at the Geriatric Mental Health Site on\nthe VHA Pulse or by contacting the Mental Health Program Office.\n
\n
\n"], ["2394", "
\nRating should be based on symptoms and signs occurring during two weeks prior to the interview. If symptom is due to physical disability or illness choose response option 5.\n
\n
\n"], ["24", "
\nThis is a survey used to learn about the many feelings people have toward\nworking.  Please read the statements and select the number that explains\nthe way you feel about the statement.\n
\n
\n"], ["240", "
\nThere are no questions to ask the patient.  Complete these summary items for the referring clinician if the patient is continuing in your care management panel.  Especially document any concerns    \nexpressed by the patient.  Then skip to section J. \n
\n
\n"], ["2404", "
\nInstructions: Below are some statements about feelings and thoughts.\n|Please select the response that best describes your experience of each over the last 2 weeks.\n
\n
\n"], ["2405", "
\n \nThe goal of this questionnaire is to find out how you view your own current recovery process. The mental health recovery process is complex and is different for each individual. There are no right or wrong answers. Please read each statement \ncarefully, with regard to your own current recovery process, and indicate how much you agree or disagree with each item by selecting the appropriate response.\n
\n
\n"], ["2406", "
\nThis is a screening measure to help you determine whether you might have an eating disorder that needs professional attention. This screening measure is not designed to make a diagnosis of an eating disorder or take\n the place of a professional consultation.||Please complete the questions below as accurately, honestly and completely as possible.  There are no right or wrong answers.\n||Part A: Complete the following questions:||Height:\n
\n
\n"], ["2407", "
\nPart B: Select a response for each of the following statements:\n
\n
\n"], ["2408", "
\nPart C: Behavioral Questions: ||In the past 6 months have you:\n
\n
\n"], ["2409", "
\nWeight:\n
\n
\n"], ["241", "
\nIf possible, this follow-up would be individualized to patient based on DCM/MH supervisor consultation. If treatment is being done by someone else (MH), PCP should consider having patient do PHQ9 in   \n MHA on subsequent visits so s/he can monitor depression improvement/worsening. \n
\n
\n"], ["2410", "
\nWhile you were growing up, during the first 18 years of life:\n
\n
\n"], ["2411", "
\nPlease select the response for each item that best describes you.\n
\n
\n"], ["2414", "
\nI have been unhappy because of my drinking or drug use.\n
\n
\n"], ["2415", "
\nBecause of my drinking or drug use I have not eaten.\n
\n
\n"], ["2416", "
\nI have failed to do what was expected of me because of my drinking or \ndrug use.\n
\n
\n"], ["2417", "
\nI have felt guilty or ashamed because of my drinking or drug use.\n
\n
\n"], ["2418", "
\nI have taken foolish risks when I have been drinking or using drugs.\n
\n
\n"], ["2419", "
\nWhen drinking or using drugs, I have done impulsive things that I \nregretted later.\n
\n
\n"], ["242", "
\nDepression care managers contact patients six to eight times or more over the course of 24 weeks of depression care management, mostly by telephone.  The PHQ-9 (and AUDIT C for any patient previously  \n  screen-positive for alcohol abuse), should be completed during any call that follows a month or more after the most recent PHQ-9 (or AUDIT C).  These measures should be administered strictly    \naccording to protocol, to maintain reliability.  Other than the administration of standardized instruments, the follow-up assessment should be responsive to the individual patient's needs and    \nproblems.  The follow-up assessment is a conversation between the depression care manager and patient.  It is semi-structured, in the sense that specific content areas are covered in a certain order,  \n  and some questions require selection from a set of specific response options.  You want to get the necessary information for clinical decision-making, but in the context of a supportive  \nrelationship   with the patient, not as a standardized interview where you ask questions exactly as prescribed in a script.  The depression care manager asks questions much in the way a patient's  \nclinical problems   are reviewed during a clinic visit.  Providing patient education and encouraging patient activation/self-help are critical parts of each follow-up encounter.Before calling the  \npatient, check CPRS for   compliance with PC and MH appointments and medication refills as relevant, and review the last assessment and current medical record notes.  Identify any particular care  \nplan targets for the patient   (e.g., poor adherence, social isolation, difficulty sleeping, poor understanding of depression). \n
\n
\n"], ["2420", "
\nI have been harmed by my drinking or drug use.\n
\n
\n"], ["2421", "
\nI have had money problems because of my drinking or drug use.\n
\n
\n"], ["2423", "
\nMy physical appearance has been harmed by my drinking or drug use.\n
\n
\n"], ["2424", "
\nMy family has been hurt by my drinking or drug use.\n
\n
\n"], ["2425", "
\nA friendship or close relationship has been damaged by my drinking or \ndrug use.\n
\n
\n"], ["2426", "
\nMy drinking or drug use has gotten in the way of my growth as a person.\n
\n
\n"], ["2427", "
\nMy drinking or drug use has damaged my social life, popularity, and \nreputation.\n
\n
\n"], ["2428", "
\nI have spent too much or lost a lot of money because of my drinking or \ndrug use.\n
\n
\n"], ["2429", "
\nI have had an accident while using or under the influence of alcohol or \ndrugs.\n
\n
\n"], ["243", "
\nAt each follow-up, monitoring depression severity for evidence of progress toward recovery vs. ineffective treatment requiring adjustment or referral is essential.  It is also a point where education  \n  about depression can be reinforced.  Be sure to do the PHQ-9 in a manner consistent with previous administrations of the instrument. \n
\n
\n"], ["2431", "
\nHere are a number of events that people sometimes experience in relation \nto their use of alcohol and other drugs. Read each one carefully and then \na) indicate if each one has happened to you EVER (No or Yes) in your \nlifetime, and b) rate how often each has happened IN THE PAST 30 DAYS by \nmarking the appropriate column (Never, Once or a few times, Once or twice\na week, Daily or almost daily).\n
\n
\n"], ["2432", "
\n Here are a number of events that people sometimes experience in relation to their use of alcohol and other drugs.\nRead each one carefully and then indicate how often each one has happened to you IN THE PAST 30 DAYS by selecting\nthe appropriate response (Never, Once or a few times, Once or twice a week, Daily or almost daily).\nIf any item does not apply to you select Never.\n
\n
\n"], ["2433", "
\nThis is an observational screening tool. Please use your best judgment as \nto what the patient is demonstrating. Each item contains 3 descriptors to \nchoose from.|\n
\n
\n"], ["2434", "
\n   \n
\n
\n"], ["2435", "
\nBEHAVIOR Descriptions|0  Behavior requires no intervention. |1  Needs and receives occasional staff intervention in the form of cues because the person is anxious,|      irritable, lethargic or demanding. Person responds \nto cues. |2  Needs and receives regular staff intervention in the form of redirection because the person has|      episodes of disorientation, hallucinates, wanders, is withdrawn or exhibits similar behaviors.|      Person \nmay be resistive but responds to redirection. |3  Needs and receives behavior management and staff intervention because person exhibits|      disruptive behavior such as verbally abusing others, wandering in \nto private areas, removing or|      destroying property, or acts in a sexually aggressive manner. Person may be resistant to redirection. |4  Needs and receives behavior management and staff intervention because person \nis physically|      abusive to self and others. Person may physically resist redirection.\n
\n
\n"], ["2436", "
\n   \n
\n
\n"], ["244", "
\nThis section is important for triage of patients who indicate possible suicide ideation.  Ask suicide questions if patient expressed current thoughts of suicide on PHQ-9 or if suicidal ideation is    \nnoted at other points in this or a previous assessment. \n
\n
\n"], ["2440", "
\nRate where you feel you are on the scales below from 1-5, with 1 being not so good and 5 being great.|\n
\n
\n"], ["2441", "
\n||Where You Are and Where You Would Like to Be|\n|For each area below, consider "Where you are" and "Where you want to be". Select a number between 1 (low) and 5 (high)\n|that best represents where you are and where you want to be. You do not need to be a 5 in any of the areas now,\n|nor even wish to be a 5 in the future.\n|| --- Areas of Self Care ---|\n|MOVING THE BODY: Our physical, mental, and emotional health are impacted by the amount and kind of movement we do.\n
\n
\n"], ["2442", "
\n|RECHARGE: Our bodies and minds need rest in order to optimize our health. Recharging also involves activities \n|that replenish your mental and physical energy.\n
\n
\n"], ["2443", "
\n|FOOD AND DRINK: What we eat and drink can have a huge effect on how we experience life, both physically and mentally.\n
\n
\n"], ["2444", "
\n|PERSONAL DEVELOPMENT: Our health is impacted by how we spend our time. We feel best when we can do things that \n|really matter to us or bring us joy.\n
\n
\n"], ["2445", "
\n|FAMILY, FRIENDS, AND CO-WORKERS: Our relationships, including those with pets, have as significant an effect \n|on our physical and emotional health as any other factor associated with well-being.\n
\n
\n"], ["2446", "
\n|SPIRIT AND SOUL: Connecting with something greater than ourselves may provide a sense of meaning and purpose, \n|peace, or comfort. Spiritual connection can take many forms.\n
\n
\n"], ["2447", "
\n|SURROUNDINGS: Surroundings include where we live, work, learn, play, and worship--both indoors and out. \n|Safe, stable, and comfortable surroundings have a positive effect on our health.\n
\n
\n"], ["2448", "
\n|POWER OF THE MIND: Our thoughts are powerful and can affect our physical, mental, and emotional health. Changing \n|our mindset can aid in healing and coping.\n
\n
\n"], ["2449", "
\n|PROFESSIONAL CARE: Partnering with your healthcare team to address your health concerns, understand care \n|options, and define actions you may take to promote your health and goals.\n
\n
\n"], ["245", "
\nSince symptoms do not resolve immediately after antidepressant medication is started, patients may need encouragement to stick with the medication, or if taking it properly for a reasonable trial    \nperiod, may need a dosage or drug adjustment, or consideration of referral for psychotherapy or consultation.  Side effects require the same attention.  Patients may not realize side effects are    \ntemporary, or may suffer too long with a problem that can be alleviated or resolved by changing meds. \n
\n
\n"], ["2450", "
\n|REFLECTIONS|\n
\n
\n"], ["2451", "
\n|What matters most to you in your life right now?\n
\n
\n"], ["2452", "
\n|  \n
\n
\n"], ["2454", "
\nNEURODIAGNOSIS and ICD-10 Code(s)|  |Diseases of the nervous system excluding sense organs|     G00-99, excluding G30.9 and G47|Cerebrovascular\n Disease|     I60-I69|Fracture of the skull|     S02.0XXA|Spinal Cord Injury without evidence of spinal bone injury|     S14.101A-S14.104A|Injury\n to nerve roots and spinal plexus|     S14.2XXA|Neoplasms of the brain and\n spine|     C41.2, C41.4, C71.0-71.9, C79.31, C74.49, C79.32,|     D16.6, D16.8, D33.2-D33.9, D42.0, D42.1, D42.9, D49.6\n
\n
\n"], ["2455", "
\nPlease respond to each question or statement by selecting one answer.\n
\n
\n"], ["2456", "
\nPlease indicate how strongly you agree or disagree with each of the following statements.\n
\n
\n"], ["2457", "
\nPlease rate each item according to how you react or think when confronted with a problem by selecting a number on a scale from 1 to 5:\n
\n
\n"], ["2458", "
\nSelect a rating on the scale of 0 (Not at All) to 6 (Very Much) for each item.\n  Select 7 if the item is not applicable.||Overall, in the PAST 30 DAYS:\n
\n
\n"], ["2459", "
\nCAT\n
\n
\n"], ["246", "
\nThis section was covered at the initial assessment but should be repeated as needed.  Any exacerbations of co-morbid problems can interfere with depression treatment and response, and may require    \nreferral to other programs.  If drugs and alcohol were not already assessed in the risk assessment above, use the initial assessment, any previous follow-up assessments, and the medical record to    \ndecide whether alcohol, substance abuse or other mental health co-morbidities need re-assessment.  Any patient who was "screen positive" for substance abuse on the initial assessment should be    \nreassessed with the AUDIT C and counseled about substance use. \n
\n
\n"], ["2460", "
\nAfter reading some statements about employment, please rank the following by selecting a number on a scale of 0 to 10, \n|where 0 indicates strong disagreement to the statement, 10 indicates strong agreement, and 5 indicates neutral.\n
\n
\n"], ["2461", "
\nAfter reading some statements about employment, please rank the following by selecting a number on a scale of 1 to 5 \n|according to how each item affects your securing a job. 1=Not a barrier and 5=Strong barrier.\n
\n
\n"], ["2462", "
\nFor these questions, please consider the most important things that you do, or wish to do, in your daily life. \nThis might include having a job, spending time with family and friends, participating in leisure-time activities, \nor managing your health or finances.\n||Over the past three months, what percentage of the time have you been:\n
\n
\n"], ["2463", "
\nSelect the option that best describes how you have felt and conducted yourself over the past 6 months.|\n
\n
\n"], ["2464", "
\nThinking over the past 4 weeks, select the option that best describes the amount of time you felt that way.\n
\n
\n"], ["2465", "
\nInstructions: The following questions are concerned with the past four weeks (28 days) only.\n|Please read each question carefully. Please answer all the questions. Thank you.\n|\n|Questions 1 to 12: Please select the appropriate option. Remember that the questions\nonly refer to the past four weeks (28 days) only.\n|\n|ON HOW MANY OF THE PAST 28 DAYS ...\n
\n
\n"], ["2466", "
\n|Questions 13-18: Please enter the appropriate number in the box below each question. Remember that\nthe questions only refer to the past four weeks (28 days).\n|\n|OVER THE PAST FOUR WEEKS (28 DAYS) ...\n
\n
\n"], ["2467", "
\n|Questions 19 to 21: Please select the appropriate option. Please note that for these questions the\nterm "binge eating" means eating what others would regard as an unusually large amount of food\nfor the circumstances, accompanied by a sense of having lost control over eating.\n
\n
\n"], ["2468", "
\n|Questions 22 to 28: Please select the appropriate option.  Remember that the questions only refer to the past four weeks (28 days).\n|\n|OVER THE PAST 28 DAYS ...\n
\n
\n"], ["2469", ""], ["247", "
\nIf the patient is doing well at participating in self-help activities, different or additional options can be discussed to increase the activity level if desired.  If previous goals were too    \nambitious, goals can be reduced and simplified.  This section also guides review of education and information offered and changes in the patient's barriers to learning, and summarizes compliance with  \n  any PC and MH appointments. \n
\n
\n"], ["2470", "
\nINSTRUCTIONS\n| ... or your feelings about your eating, shape or weight ...\n|Please select the option that best describes how your eating habits, \n|exercising or feelings about your eating, shape or weight have affected\n|your life over the past four weeks (28 days).  Thank you.\n|\n|\n|Over the past 28 days, to what extent have your\n| ... eating habits\n| ... exercising\n
\n
\n"], ["2472", "
\nFor each of the following items select one response to indicate the difficulty level.\n||\nThese questions relate to reading and near vision activities. Remember if you use\na low vision device, adaptive device, or an adaptive technique to assist with the\nactivity then please respond as though you were using the device or technique.\n
\n
\n"], ["2473", "
\nThe FAST scale is a functional scale designed to evaluate patients at the moderate-severe stages of dementia.\n In the early stages the patient may be able to participate in the FAST administration but usually the information\n should be collected from a caregiver or, in the case of nursing home care, the nursing home staff. The FAST Stage\n is the highest consecutive level of disability.  For clinical purposes, in addition to staging the level of\n disability, additional, non-ordinal (nonconsecutive) deficits should be noted, since these additional deficits\n are of clear clinical relevance.\n
\n
\n"], ["2474", "
\nWe would like to ask you some questions about your health in general.\n|Please respond to each question or statement by selecting one box in each.\n
\n
\n"], ["2476", "
\n|This questionnaire is about how you have been recently. It is being used to see if you are \nsuffering from side effects from your antipsychotic medication.\n|Please select the choice which best indicates the degree to which you have experienced the \nfollowing side effects. Also when you have had a side effect, please select from 1-10 to show how distressing that was for you.\n||OVER THE PAST WEEK:\n
\n
\n"], ["2477", "
\n|Select yes or no for the LAST THREE MONTHS|\n
\n
\n"], ["248", "
\nFamily interventions have been found to reduce relapse and improve adherence in the treatment of other psychiatric disorders (e.g., schizophrenia, bipolar depression).  Conversely, some studies have   \n found that without intervention, families tend to discourage treatment adherence and attempt to maintain the patient within the informal network.  Previous research on care management programs shows  \n  that limited social support is a strong predictor of continued depression.  If you believe that involving family members in the patient's care will be beneficial, be sure to follow medical center  \nand   HIPAA regulations regarding the disclosure of private information.  As a general rule, be sure to document contact with family members in the medical record and show that it was done with the    \npatient's knowledge and permission -- or conversely, document that the patient has asked that his information be kept strictly private. \n
\n
\n"], ["2482", "
\nVIGILANCE|\n|Below is a list of behaviors that people sometimes use to make themselves feel more comfortable.\n|For each behavior please pick the response that most accurately describes how often or frequently you engage in that behavior.\n
\n
\n"], ["2483", "
\nBelow is a list of behaviors that people sometimes use to make themselves feel more comfortable.  |For each behavior please pick the response that most accurately describes how often or frequently you engage in that behavior. \n
\n
\n"], ["2485", "
\nThis questionnaire asks about experiences you may have had after a very stressful experience in which you: (A) did something (or failed to do something) that went against your moral code or values; or (B) you saw someone (or people) do something or fail to do something that went against your moral code or values; or (C) you were directly affected by someone doing something or failing to do something that went against your moral code or values (e.g., being betrayed by someone you trusted).\n
\n
\n"], ["2486", "
\n|Keeping this experience in mind, please indicate how much you agree with the following statements\n in terms of the impact of this experience in the last month (select one choice for each item below).\n
\n
\n"], ["2487", "
\nHow much has this experience made it hard for you to function in each of the following areas\n (select one choice for each item below)? If an area is not applicable, select N/A.|\n
\n
\n"], ["2488", "
\nThe MIDAS (Migraine Disability Assessment) questionnaire was put together to help you measure the impact your headaches\n have on your life. The information on this questionnaire is also helpful for your primary care provider to determine\n the level of pain and disability caused by your headaches and to find the best treatment for you.\n||INSTRUCTIONS\n||Please answer the following questions about ALL of the headaches you have had over the last 3 months. Enter your answer\n in the box beneath each question. Enter zero if you did not have the activity in the last 3 months.\n
\n
\n"], ["2489", "
\n|What your Physician will need to know about your headache:\n
\n
\n"], ["249", "
\nThere are no questions to ask the patient.  Use this section to document details of the care management plan, especially if it has changed since the last assessment. \n
\n
\n"], ["2490", "
\nHIT is a tool used to measure the impact headaches have on your ability to function on the job, at school, at home \n and in social situations. Your score shows you the effect that headaches have on normal daily life and your ability\n to function. HIT was developed by an international team of headache experts from neurology and primary care medicine\n in collaboration with the psychometricians who developed the SF-36 health assessment tool. This questionnaire was\n designed to help you describe and communicate the way you feel and what you cannot do because of headaches.\n||To complete, please select one answer for each question.\n
\n
\n"], ["2493", "
\nDuring the past week, I have found that:\n
\n
\n"], ["2494", "
\nPlease select the appropriate response for each question.\n
\n
\n"], ["2495", "
\nGENERALIZED ANXIETY|\n|Below is a list of behaviors that people sometimes use to make themselves feel more comfortable.\n|For each behavior please pick the response that most accurately describes how often or frequently you engage in that behavior.\n
\n
\n"], ["2496", "
\nSOCIAL ANXIETY|\n|Below is a list of behaviors that people sometimes use to make themselves feel more comfortable.\n|For each behavior please pick the response that most accurately describes how often or frequently you engage in that behavior.\n
\n
\n"], ["2497", "
\nPANIC|\n|Below is a list of behaviors that people sometimes use to make themselves feel more comfortable.\n|For each behavior please pick the response that most accurately describes how often or frequently you engage in that behavior.\n
\n
\n"], ["2498", "
\nHEALTH ANXIETY|\n|Below is a list of behaviors that people sometimes use to make themselves feel more comfortable.\n|For each behavior please pick the response that most accurately describes how often or frequently you engage in that behavior.\n
\n
\n"], ["2499", "
\nSYMPTOM SEVERITY\n|Breathlessness\n|\n|Please answer the questions below to the best of your knowledge.\n|[Now] refers to how you feel now/this week (last 7 days).\n|[Pre-COVID] refers to how you were feeling prior to contracting the illness.\n|If you are unable to recall this, just select "Don't know".\n|\n|Rate the severity of each problem on a scale of 0-3:\n|\n
\n
\n"], ["25", "
\nPlease answer the following questions concerning your\nfeelings about health matters.\n
\n
\n"], ["250", "
\nThere are no questions to ask the patient.  Complete these summary items for the referring clinician if the patient is continuing in your care management panel.  Especially document any concerns    \nexpressed by the patient.  Then skip to section J. \n
\n
\n"], ["2500", "
\nCough / throat sensitivity / voice change\n
\n
\n"], ["2501", "
\nFatigue (tiredness not improved by rest)\n
\n
\n"], ["2502", "
\nSmell / taste\n
\n
\n"], ["2503", "
\nPain / discomfort\n
\n
\n"], ["2504", "
\nCognition\n
\n
\n"], ["2505", "
\nPalpitations / dizziness\n
\n
\n"], ["2506", "
\nPost-exertional malaise (worsening of symptoms)\n
\n
\n"], ["2507", "
\nAnxiety / mood\n
\n
\n"], ["2508", "
\nSleep\n
\n
\n"], ["2509", "
\nFUNCTIONAL ABILITY\n||Communication\n
\n
\n"], ["251", "
\nIf possible, this follow-up would be individualized to patient based on DCM/MH supervisor consultation. If treatment is being done by someone else (MH), PCP should consider having patient do PHQ9 in   \n MHA on subsequent visits so s/he can monitor depression improvement/worsening. \n
\n
\n"], ["2510", "
\nWalking or moving around\n
\n
\n"], ["2511", "
\nPersonal Care\n
\n
\n"], ["2512", "
\nOther activities of Daily Living\n
\n
\n"], ["2513", "
\nSocial role\n
\n
\n"], ["2514", "
\nOTHER SYMPTOMS\n
\n
\n"], ["2515", "
\nOVERALL HEALTH\n||For this question, a score of 10 means the BEST health you can imagine. 0 means the WORST health you can imagine.\n
\n
\n"], ["2516", "
\nEMPLOYMENT\n
\n
\n"], ["2517", "
\nPARTNER / FAMILY / CAREGIVER PERSPECTIVE\n
\n
\n"], ["2518", "
\nUnder each heading, please check the ONE choice that best describes your health TODAY.\n
\n
\n"], ["2519", "
\nWe would like to know how good or bad your health is TODAY.\n||Try to picture in your mind a scale that looks like a themometer.\n||The best health you can imagine is marked 100 at the top of the scale. The worst health you can imagine is marked 0 at the bottom.\n||Picture an X on the scale to indicate how your health is TODAY.\n||Please enter the number from 0 through 100 where you picture the X on the scale.\n
\n
\n"], ["252", "
\nDepression care managers contact patients six to eight times or more over the course of 24 weeks of depression care management, mostly by telephone.  The PHQ-9 (and AUDIT C for any patient previously  \nscreen-positive for alcohol abuse), should be completed during any call that follows a month or more after the most recent PHQ-9 (or AUDIT C).  These measures should be administered strictly  \naccording to protocol, to maintain reliability.  Other than the administration of standardized instruments, the follow-up assessment should be responsive to the individual patient's needs and  \nproblems.  The follow-up assessment is a conversation between the depression care manager and patient.  It is semi-structured, in the sense that specific content areas are covered in a certain order,  \nand some questions require selection from a set of specific response options.  You want to get the necessary information for clinical decision-making, but in the context of a supportive relationship   \n with the patient, not as a standardized interview where you ask questions exactly as prescribed in a script.  The depression care manager asks questions much in the way a patient's clinical problems  \nare reviewed during a clinic visit.  Providing patient education and encouraging patient activation/self-help are critical parts of each follow-up encounter.Before calling the  patient, check CPRS  \nfor compliance with PC and MH appointments and medication refills as relevant, and review the last assessment and current medical record notes.  Identify any particular care plan targets for the  \npatient (e.g., poor adherence, social isolation, difficulty sleeping, poor understanding of depression).  \n
\n
\n"], ["2520", "
\nStarting with the first question, please select yes or no for each \nquestion until there are no more questions to answer.\n
\n
\n"], ["2523", "
\nPlease answer each question to the best of your ability.\n||\nSection 1. Has there ever been a period of time when you were not your usual self and...\n|\n
\n
\n"], ["2524", "
\n|Section 2.\n
\n
\n"], ["2525", "
\n|Section 3.\n
\n
\n"], ["2526", "
\nAnswer the following questions on a scale from 0 to 10.\n
\n
\n"], ["2527", "
\nInstructions\n|This is a standard set of questions about alcohol and drug use since the last session. Please\n answer the requested items as accurately as possible and indicate the method of assessment\n in item B above. |\n
\n
\n"], ["2528", "
\n4. Since the last session, how many days did you use any of the following drugs: \n
\n
\n"], ["2529", "
\nPlease read each of the agitated behaviors, and check how often (1-5) they were manifested by the resident over the last 2 weeks; if more than one occurred within a group, add the occurrences. E.g. if hitting occurred on 3 days a week, and kicking occurred on 4 days a week, 3+4=7 days, circle 4 for 'once or several times a day.\n
\n
\n"], ["253", "
\nAt each follow-up, monitoring depression severity for evidence of progress toward recovery vs. ineffective treatment requiring adjustment or referral is essential.  It is also a point where education  \nabout depression can be reinforced.  Be sure to do the PHQ-9 in a manner consistent with previous administrations of the instrument.  \n
\n
\n"], ["2530", "
\nThese questions relate to distance visual activities. Remember if you use\na low vision device, adaptive device, or an adaptive technique to assist with the\nactivity then please respond as though you were using the device or technique.\n
\n
\n"], ["2531", "
\nThe following questions are about other daily living activities. Remember if you use\na low vision device, adaptive device, or an adaptive technique to assist with the\nactivity then please respond as though you were using the device or technique.\n
\n
\n"], ["2532", "
\nThe last set of questions deal with issues of mobility. Remember if you use\na low vision device, adaptive device, or an adaptive technique to assist with the\nactivity then please respond as though you were using the device or technique.\n
\n
\n"], ["2533", "
\nStep 3: Three Word Recall||Ask the person to recall the three words you stated in Step 1. Say: "What were the three words I asked you to remember?"\n||[A correct response is spontaneously recalled without cueing.]\n
\n
\n"], ["2534", "
\nStep 2: Clock Drawing||Say: "Next, I want you to draw a clock for me. First, put in all of the numbers where they go." When that is completed, say: "Now, set the hands to 10 past 11."||Use preprinted circle for this exercise.\n Repeat instructions as needed as this is not a memory test. Move to Step 3 if the clock is not complete within three minutes.||[A normal clock has all numbers placed in the correct sequence and approximately correct position\n (e.g., 12, 3, 6 and 9 are in anchor positions) with no missing or duplicate numbers. Hands are pointing to the 11 and 2 (11:10). Hand length is not scored.]\n
\n
\n"], ["2535", "
\nPlease rate how confident you are that you can do the following things at present despite the pain, where 0 is not at all confident and 6 is completely confident.\n Remember, these questions are not asking whether or not you have been doing these things, but rather how confident you are that you can do them at present, despite the pain.\n
\n
\n"], ["2536", "
\nPlease answer the following questions based on changes that have occurred since the patient first began to experience memory problems. Select "Yes" only if the symptom(s) has been present in\n the last month. Otherwise, select "No". For each item marked "Yes":||a) Rate the SEVERITY of the symptom (how it affects the patient).|b) Rate the DISTRESS you experience due to that symptom\n (how it affects you).||Please answer each question carefully. Ask for assistance if you have any questions.||Delusions\n
\n
\n"], ["2537", "
\nHallucinations\n
\n
\n"], ["2538", "
\nAgitation/Aggression\n
\n
\n"], ["2539", "
\nDepression/Dysphoria\n
\n
\n"], ["254", "
\nThis section is important for triage of patients who indicate possible suicide ideation.  Ask suicide questions if patient expressed current thoughts of suicide on PHQ-9 or if suicidal ideation is  \nnoted at other points in this or a previous assessment.  \n
\n
\n"], ["2540", "
\nAnxiety\n
\n
\n"], ["2541", "
\nElation/Euphoria\n
\n
\n"], ["2542", "
\nApathy/Indifference\n
\n
\n"], ["2543", "
\nDisinhibition\n
\n
\n"], ["2544", "
\nIrritability/Lability\n
\n
\n"], ["2545", "
\nMotor Disturbance\n
\n
\n"], ["2546", "
\nNighttime Behaviors\n
\n
\n"], ["2547", "
\nAppetite/Eating\n
\n
\n"], ["2549", "
\nThe following questionnaire is aimed at evaluating gambling symptoms. Please read the questions carefully before you answer.\n
\n
\n"], ["255", "
\nSince symptoms do not resolve immediately after antidepressant medication is started, patients may need encouragement to stick with the medication, or if taking it properly for a reasonable trial  \nperiod, may need a dosage or drug adjustment, or consideration of referral for psychotherapy or consultation.  Side effects require the same attention.  Patients may not realize side effects are  \ntemporary, or may suffer too long with a problem that can be alleviated or resolved by changing meds.  \n
\n
\n"], ["2550", "
\nTo screen for potential gambling-related problems, please complete the following\nquestions.\n
\n
\n"], ["2551", "
\nPlease answer the following question.\n
\n
\n"], ["2552", "
\nInstructions: Below is a list of problems that people sometimes have in response to a very stressful experience. Please read each problem and then select one of the options to indicate how much you have been bothered by that problem in the past \nday. The options include not at all, a little bit, moderately, quite a bit, and extremely. ||In the past day, how much were you bothered by:\n
\n
\n"], ["2553", "
\nFor these questions, please consider the most important things that you do, or wish to do, in your \n| daily life. [This might include having a job, managing your health and finances, spending time with\n| family and friends, or participating in leisure-time activities.]\n||If you are not sure which response to choose, please make your best guess.  \n||Over the past month, on average how often have you been:\n||Use the following scale\n|0    -    1    -    2    -    3    -    4    -    5    -    6    -    7    -    8    -    9    -    10\n|None of the Time                                                                    All of the time\n
\n
\n"], ["2555", "
\nPlease answer the following questions as accurately as possible.\n
\n
\n"], ["2556", "
\nInterviewer: Ask the first question as written. Use follow-up probes or qualifiers at your discretion.  Time frame refers to the last two weeks unless stipulated.||Note: The last item, # 9, is based on observations of the entire interview.\n
\n
\n"], ["2557", "
\nListed below are a number of difficult or stressful things that sometimes happen to people. For each event check one or more of the boxes to the right to indicate that: (a) <u>it happened to you</u> personally; (b) you <u>witnessed it</u> happen to someone else; (c) you <u>learned about it</u> happening to a close family member or close friend; (d) you were exposed to it as <u>part of your job</u> (for example, paramedic, police, military, or other first responder); (e) you're <u> not sure</u> if it fits; or (f) it <u>doesn't apply</u> to you. ||Be sure to consider your entire life (growing up as well as adulthood) as you go through the list of events.\n
\n
\n"], ["2558", "
\n|\n
\n
\n"], ["2559", "
\nKeeping this (or these) experience(s) in mind, please indicate how much you agree with the following statements in terms of the impact of this experience (or experiences) in the last month.\n
\n
\n"], ["256", "
\nThis section was covered at the initial assessment but should be repeated as needed.  Any exacerbations of co-morbid problems can interfere with depression treatment and response, and may require  \nreferral to other programs.  If drugs and alcohol were not already assessed in the risk assessment above, use the initial assessment, any previous follow-up assessments, and the medical record to  \ndecide whether alcohol, substance abuse or other mental health co-morbidities need re-assessment.  Any patient who was "screen positive" for substance abuse on the initial assessment should be  \nreassessed with the AUDIT C and counseled about substance use.  \n
\n
\n"], ["2560", "
\nSelect a rating from 0 (not at all) to 6 (very much) for each of the following questions.  If the question does not apply, select not applicable.||Overall in the past 30 days:\n
\n
\n"], ["2561", "
\nAs a child I was (or had):\n
\n
\n"], ["2562", "
\nAs a child in school I was (or had):\n
\n
\n"], ["2563", "
\nPlease answer the questions below, rating yourself on each of the criteria shown. As you answer each question, please select the answer that best describes how you have felt and conducted yourself over the past 6 months.\n
\n
\n"], ["2564", "
\nHere are a number of events that people sometimes experience in relation to their use of alcohol and other drugs. Read each one carefully and indicate how often each one has happened to you DURING THE PAST 30 DAYS by selecting the appropriate answer (Never, Once or a few times, etc.). If an item does not apply to you, mark Never.\n
\n
\n"], ["2566", "
\nHere are a number of events that people sometimes experience in relation to their use of alcohol and other drugs. Read each one carefully and indicate whether this has EVER happened to you (No or Yes). If an item does not apply to you, mark No\nand skip to the next question. If it\n has EVER happened to you, indicate how often it has happened to you DURING THE\n PAST 30 DAYS (Never, Once or a few times, etc.).\n|| \nI have been unhappy because of my drinking or drug use.\n
\n
\n"], ["2567", "
\nBecause of my drinking or drug use, I have lost weight or not eaten properly.\n
\n
\n"], ["2568", "
\nI have failed to do what is expected of me because of my drinking or drug use\n
\n
\n"], ["2569", "
\nWhen drinking or using drugs, my personality has changed for the worse.\n
\n
\n"], ["257", "
\nIf the patient is doing well at participating in self-help activities, different or additional options can be discussed to increase the activity level if desired.  If previous goals were too  \nambitious, goals can be reduced and simplified.  This section also guides review of education and information offered and changes in the patient's barriers to learning, and summarizes compliance with  \nany PC and MH appointments.  \n
\n
\n"], ["2570", "
\nI have taken foolish risks when I have been drinking or using drugs.\n
\n
\n"], ["2571", "
\nWhile drinking or using drugs, I have said harsh or cruel things to someone.\n
\n
\n"], ["2572", "
\nWhen drinking or using drugs, I have done impulsive things that I regretted later.\n
\n
\n"], ["2573", "
\nI have had money problems because of my drinking or drug use.\n
\n
\n"], ["2574", "
\nMy physical appearance has been harmed by my drinking or drug use.\n
\n
\n"], ["2575", "
\nMy family has been hurt by my drinking or drug use.\n
\n
\n"], ["2576", "
\nA friendship or close relationship has been damaged by my drinking or drug use.\n
\n
\n"], ["2577", "
\nI have lost interest in activities and hobbies because of my drinking or drug use.\n
\n
\n"], ["2578", "
\nMy drinking or drug use has gotten in the way of my growth as a person.\n
\n
\n"], ["2579", "
\nMy drinking or drug use has damaged my social life, popularity, or reputation.\n
\n
\n"], ["258", "
\nFamily interventions have been found to reduce relapse and improve adherence in the treatment of other psychiatric disorders (e.g., schizophrenia, bipolar depression).  Conversely, some studies have  \nfound that without intervention, families tend to discourage treatment adherence and attempt to maintain the patient within the informal network.  Previous research on care management programs shows  \nthat limited social support is a strong predictor of continued depression.  If you believe that involving family members in the patient's care will be beneficial, be sure to follow medical center and  \nHIPAA regulations regarding the disclosure of private information.  As a general rule, be sure to document contact with family members in the medical record and show that it was done with the  \npatient's knowledge and permission -- or conversely, document that the patient has asked that his information be kept strictly private.  \n
\n
\n"], ["2580", "
\nI have spent too much or lost a lot of money because of my drinking or drug use.\n
\n
\n"], ["2581", "
\nThe purpose of each item is to rate the severity of that abnormality in the patient. When several keys are given for a particular grade of severity, the presence of only one is required to qualify for that rating. The keys provided are guides. One can ignore the keys if that is necessary to indicate severity, although this  should be the exception rather than the rule.\n
\n
\n"], ["2582", "
\nThe administration of the Montreal Cognitive Assessment requires the use of a pencil-and-paper answer sheet. Please be familiar with the instructions and scoring of this instrument prior to administration. The subject's scores are recorded here so that the administration can be saved in VistA.\n
\n
\n"], ["2583", "
\n3. Draw a clock. Put in all the numbers and set the time to 10 past 11. \n
\n
\n"], ["2584", "
\n4. Naming pictured animal. \n
\n
\n"], ["2585", "
\nRead list of words to be recalled.||5. Attention\n
\n
\n"], ["2586", "
\n6. Language\n
\n
\n"], ["2587", "
\n8. Abstraction \n
\n
\n"], ["2588", "
\n9. Delayed Recall\n
\n
\n"], ["2589", "
\n10. Orientation\n
\n
\n"], ["259", "
\nThere are no questions to ask the patient.  Complete these summary items for the referring clinician if the patient is continuing in your care management panel.  Especially document any concerns  \nexpressed by the patient.  Then skip to section J.  \n
\n
\n"], ["2590", "
\nThe administration of the Montreal Cognitive Assessment requires the use of a pencil-and-paper answer sheet. Please be familiar with the instructions and scoring of this instrument prior to administration. The subject's scores are recorded here so that the administration can be saved in VistA.\n
\n
\n"], ["2591", "
\n3. Draw a clock. Put in all the numbers and set the time to 10 past 9.\n
\n
\n"], ["2592", "
\n4. Naming pictured animal. \n
\n
\n"], ["2593", "
\nRead list of words to be recalled.\n|\n|5. Attention\n
\n
\n"], ["2594", "
\n6. Language\n
\n
\n"], ["2595", "
\n8. Abstraction \n
\n
\n"], ["2596", "
\n9. Delayed Recall\n
\n
\n"], ["2597", "
\n10. Orientation\n
\n
\n"], ["2598", "
\n3. Draw a clock. Put in all the numbers and set the time to 5 past 10.\n
\n
\n"], ["2599", "
\n4. Naming pictured animal. \n
\n
\n"], ["26", "
\nFollowing are phrases which you will use in describing yourself.\nAnswer True if you consider the item to be generally descriptive\nof yourself at the present time. Answer False when an item does\nnot describe you or you doubt whether it applies.\n
\n
\n"], ["260", "
\nIf possible, this follow-up would be individualized to patient based on DCM/MH supervisor consultation. If treatment is being done by someone else (MH), PCP should consider having patient do PHQ9 in  \nMHA on subsequent visits so s/he can monitor depression improvement/worsening.  \n
\n
\n"], ["2600", "
\nRead list of words to be recalled.\n|\n|5. Attention\n
\n
\n"], ["2601", "
\n6. Language\n
\n
\n"], ["2602", "
\n8. Abstraction \n
\n
\n"], ["2603", "
\n9. Delayed Recall\n
\n
\n"], ["2604", "
\n10. Orientation\n
\n
\n"], ["2605", "
\nThe administration of the Montreal Cognitive Assessment requires the use of a pencil-and-paper answer sheet. Please be familiar with the instructions and scoring of this instrument prior to administration. The subject's scores are recorded here so that the administration can be saved in VistA.\n
\n
\n"], ["2606", "
\nThe administration of the Montreal Cognitive Assessment requires the use of a pencil-and-paper answer sheet. Please be familiar with the instructions and scoring of this instrument prior to administration. The subject's scores are recorded here so that the administration can be saved in VistA.\n|\nRead list of words to be recalled.\n|\n|1. Attention\n
\n
\n"], ["2607", "
\n2. Language\n
\n
\n"], ["2609", "
\n4. Abstraction\n
\n
\n"], ["261", "
\nDepression care managers contact patients six to eight times or more over the course of 24 weeks of depression care management, mostly by telephone.  The PHQ-9 (and AUDIT C for any patient previously  \nscreen-positive for alcohol abuse), should be completed during any call that follows a month or more after the most recent PHQ-9 (or AUDIT C).  These measures should be administered strictly  \naccording to protocol, to maintain reliability.  Other than the administration of standardized instruments, the follow-up assessment should be responsive to the individual patient's needs and   \nproblems.  The follow-up assessment is a conversation between the depression care manager and patient.  It is semi-structured, in the sense that specific content areas are covered in a certain order,  \nand some questions require selection from a set of specific response options.  You want to get the necessary information for clinical decision-making, but in the context of a supportive relationship  \nwith the patient, not as a standardized interview where you ask questions exactly as prescribed in a script.  The depression care manager asks questions much in the way a patient's clinical problems   \nare reviewed during a clinic visit.  Providing patient education and encouraging patient activation/self-help are critical parts of each follow-up encounter.Before calling the  patient, check CPRS   \nfor compliance with PC and MH appointments and medication refills as relevant, and review the last assessment and current medical record notes.  Identify any particular care plan targets for the   \npatient (e.g., poor adherence, social isolation, difficulty sleeping, poor understanding of depression).   \n
\n
\n"], ["2610", "
\n5. Delayed Recall\n
\n
\n"], ["2611", "
\n6. Orientation\n
\n
\n"], ["2612", "
\nThe ALSFRS-R measures 12 aspects of physical function, ranging from one's ability to swallow and use utensils to climbing stairs and breathing. Each function is scored from 4 (normal) to 0 (no ability), with a maximum total score of 48 and a minimum total score of 0.\n
\n
\n"], ["2613", "
\nPlease rate the following statements according to how strongly you agree or how strongly you disagree with each of them. Please respond about how you have felt or what you have experienced over the past week.\n
\n
\n"], ["2614", "
\nBelow you will find a list of statements. Please rate how true each statement is for you by selecting the number next to it.\n
\n
\n"], ["2615", "
\nThe questions in this questionnaire begin with a statement followed by two opposite answers. Numbers extend from one extreme answer to its opposite. Please select the number between 0 and 10 which is most true for you. There are no right or wrong answers. Completely honest answers will be most helpful.\n
\n
\n"], ["2616", "
\nRequired Core Elements|\nInformation may be gathered from medical record, assessment and if applicable, the patient/caregiver.  |\nBeyond protocols listed below, scoring should be based on your clinical judgment.\n
\n
\n"], ["2617", "
\nSymptom Report\n|Please rate the following symptoms with regard to how much they have disturbed you\nSINCE YOUR INJURY.  The purpose of this inventory is to track symptoms over time. Please do not attempt to score.\n
\n
\n"], ["262", "
\nThe PHQ-9 is administered at the beginning of the initial assessment and at every follow-up encounter.  This and other relevant measures (such as the AUDIT C and PTSD questionnaire) should be  \nadministered strictly according to protocol every time, to maintain reliability.  Other than the administration of these standardized instruments, however, the initial assessment should be responsive  \nto the individual patient's needs and problems.  \n
\n
\n"], ["263", "
\nThis section is important for triage of patients who indicate possible suicide ideation.  If a patient is actively suicidal, he or she is not suitable for care management and should be followed in  \nMental Health.  Ask suicide questions if patient expressed current thoughts of suicide on PHQ-9 or if suicidal ideation is noted at other points in this assessment. \n
\n
\n"], ["264", "
\nDepression history is important because patients who have had depression before, or whose current episode is chronic, should be considered potentially more severely ill than they appear on the PHQ-9.  \n This is especially true if there have been two or more prior episodes (could be in the process of relapsing).  Prior experience with treatments can guide anti-depressant choice.  This section also  \noffers opportunities to begin patient education about depression. \n
\n
\n"], ["265", "
\nSome patients may already be taking an antidepressant at the time of the initial assessment.  Such patients may be at a point of partial remission (which needs to be taken into consideration in  \ninterpreting the PHQ-9 score) or may not yet be responding to treatment.  The patient may need a treatment adjustment if the trial has been long enough or if there are significant side effects.  Or  \nthe patient may not be taking the medication properly.  Use this section to determine whether medication is being taken correctly and whether adjustment may be needed. \n
\n
\n"], ["266", "
\nSymptoms can overlap with, or be confused with side effects.  To help determine what might be causing or exacerbating depressive symptoms, ask whether the patient has been experiencing each of these  \nsymptoms.  You may already have some of this information from the PHQ-9 and previous question.  Refer to what patient has already said to get more information. \n
\n
\n"], ["267", "
\nIt is important to assess co-morbidities because some may mimic depression, trigger a depression, complicate a depression diagnosis, or be too dangerous in combination with depression to be followed  \nsafely in primary care.  Also, the medications for some illnesses may trigger depression, or interact unfavorably with antidepressants.  This section is important for determining the impact of such  \nfactors on the treatment and/or referral plan.  The questions pertaining to medical co-morbidities are optional, and some may be answerable from the medical record.  Questions on anxiety and bipolar  \ndisorder are required, as are the questions on alcohol use and PTSD unless related clinical reminders have been recently administered. \n
\n
\n"], ["268", "
\nThis section focuses on aspects of a patient's life that can be sources of support or stress during depression treatment.  Loss of work productivity, or loss of job can precipitate a downward spiral  \nof depression, and lack of social support is a risk factor for non-recovery.  Hobbies, volunteer work, and social engagement on the other hand, can help lift a person out of depression.  Information  \nabout the patient's possibilities for engagement in activities helps guide the DCM in offering self-help education.  Also, knowing whether the patient is married or living with other people is  \nimportant because others may answer the telephone.  You need to know whether you have permission to share information with others in the household. \n
\n
\n"], ["269", "
\nThere are no questions for the patient.  Use this section to document the patient's concerns and the care plan suggestions that you want included in the CPRS note.  The information gathered on the  \nrequired items above will suggest an evidence-based diagnosis that you can relay to the referring clinician.  Once the patient has a diagnosis, it is more likely that his or her symptoms will be  \nfollowed according to depression care guidelines.  Left untreated, depression can quickly worsen, causing increasingly impaired functioning and leading to more health care visits for seemingly  \nunrelated problems.  It is important to communicate the evidence-based "bottom line" initial treatment recommendations to the referring clinician.  As with the likely diagnosis, the assessment data  \ngathered should make the treatment recommendations relatively straight forward. \n
\n
\n"], ["27", "
\n2 Introduction\n
\n
\n"], ["270", "
\nThe care manager's plan should complement the evidence-based treatment recommendations to the referring clinician.  Be sure the patient understands the nature of your role -- to support the patient's  \nown actions to get better and monitor compliance with the treatment plan, and relaying information to the clinician as needed.  It may be helpful to ask the patient what his/her expectations of you  \nare and to reinforce that he/she is a partner in his/her care. \n
\n
\n"], ["271", "
\nThis section is an opportunity to educate the patient about his/her own role as a partner in his/her own depression management.  Educate about self-help and the role of activation in lifting  \ndepressed mood.  If it is your practice to mail a letter with education materials prior to the first call, check to see if the patient has read the materials, or if confidentiality is an issue, ask  \nfor permission to send such materials after this first call.  Use today's assessment to determine which materials this patient is likely to find useful. \n
\n
\n"], ["272", "
\nThis section is for recording useful logistic information both to reduce wasted DCM time trying to reach patients at inconvenient times, and to make sure the right referring providers get feedback on  \ntheir patients. Regular feedback to clinicians on the current panel status and outcomes of patients they have referred reinforces collaboration and serves as a reminder about TIDES.  The specific  \npatients who will be included in panel feedback reports to clinicians and mental health specialists must be identified. \n
\n
\n"], ["273", "
\nTIDES Initial Assessment:The purpose of the initial assessment is to gather and summarize information relevant to decision-making for a patient's depression care, and equally importantly, to begin  \nthe critical and essential process of patient education and activation.  The assessment is a balance between establishing rapport, educating the patient, and gathering information in a conversational  \nstyle and on the other hand, keeping the patient focused on narrow interview goals.  The interview is structured, in the sense that specific content areas are covered, and some questions require  \nselection from a set of specific response options.  The interview is not a therapy session.  Patients may require re-direction to keep focused on the initial assessment goals.  Along with the  \nreferring clinician, you will be able to help patients who need or want therapy to obtain it. \n
\n
\n"], ["274", "
\nThe PHQ-9 is administered at the beginning of the initial assessment and at every follow-up encounter.  This and other relevant measures (such as the AUDIT C and PTSD questionnaire) should be  \nadministered strictly according to protocol every time, to maintain reliability.  Other than the administration of these standardized instruments, however, the initial assessment should be responsive  \nto the individual patient's needs and problems. \n
\n
\n"], ["275", "
\nThis section is important for triage of patients who indicate possible suicide ideation.  If a patient is actively suicidal, he or she is not suitable for care management and should be followed in  \nMental Health.  Ask suicide questions if patient expressed current thoughts of suicide on PHQ-9 or if suicidal ideation is noted at other points in this assessment. \n
\n
\n"], ["276", "
\nDepression history is important because patients who have had depression before, or whose current episode is chronic, should be considered potentially more severely ill than they appear on the PHQ-9.  \n This is especially true if there have been two or more prior episodes (could be in the process of relapsing).  Prior experience with treatments can guide antidepressant choice.  This section also  \noffers opportunities to begin patient education about depression. \n
\n
\n"], ["277", "
\nSome patients may already be taking an antidepressant at the time of the initial assessment.  Such patients may be at a point of partial remission (which needs to be taken into consideration in  \ninterpreting the PHQ-9 score) or may not yet be responding to treatment.  The patient may need a treatment adjustment if the trial has been long enough or if there are significant side effects.  Or  \nthe patient may not be taking the medication properly.  Use this section to determine whether medication is being taken correctly and whether adjustment may be needed. \n
\n
\n"], ["278", "
\nSymptoms can overlap with, or be confused with side effects.  To help determine what might be causing or exacerbating depressive symptoms, ask whether the patient has been experiencing each of these  \nsymptoms.  You may already have some of this information from the PHQ-9 and previous question.  Refer to what patient has already said to get more information. \n
\n
\n"], ["279", "
\nIt is important to assess co-morbidities because some may mimic depression, trigger a depression, complicate a depression diagnosis, or be too dangerous in combination with depression to be followed  \nsafely in primary care.  Also, the medications for some illnesses may trigger depression, or interact unfavorably with antidepressants.  This section is important for determining the impact of such  \nfactors on the treatment and/or referral plan.  The questions pertaining to medical co-morbidities are optional, and some may be answerable from the medical record.  Questions on anxiety and bipolar  \ndisorder are required, as are the questions on alcohol use and PTSD unless related clinical reminders have been recently administered. \n
\n
\n"], ["28", "
\nFor each of the following items, select the one best answer.\n
\n
\n"], ["280", "
\nIn your life, any experiences so frightening, horrible or upsetting, that in past month you:  1. Have had nightmares about it or thought about it when you did not want to?  2. Tried hard not to think  \n about it or went out of your way to avoid situations that reminded you of it?  3. Were constantly on guard, watchful or easily startled?  4. Felt numb or detached from others, activities or your   \nsurroundings? \n
\n
\n"], ["281", "
\nThis section focuses on aspects of a patient's life that can be sources of support or stress during depression treatment.  Loss of work productivity, or loss of job can precipitate a downward spiral  \nof depression, and lack of social support is a risk factor for non-recovery.  Hobbies, volunteer work, and social engagement on the other hand, can help lift a person out of depression.  Information  \nabout the patient's possibilities for engagement in activities helps guide the DCM in offering self-help education.  Also, knowing whether the patient is married or living with other people is  \nimportant because others may answer the telephone.  You need to know whether you have permission to share information with others in the household. \n
\n
\n"], ["282", "
\nThere are no questions for the patient.  Use this section to document the patient's concerns and the care plan suggestions that you want included in the CPRS note.  The information gathered on the  \nrequired items above will suggest an evidence-based diagnosis that you can relay to the referring clinician.  Once the patient has a diagnosis, it is more likely that his or her symptoms will be  \nfollowed according to depression care guidelines.  Left untreated, depression can quickly worsen, causing increasingly impaired functioning and leading to more health care visits for seemingly  \nunrelated problems.  It is important to communicate the evidence-based "bottom line" initial treatment recommendations to the referring clinician.  As with the likely diagnosis, the assessment data  \ngathered should make the treatment recommendations relatively straight forward. \n
\n
\n"], ["283", "
\nThe care manager's plan should complement the evidence-based treatment recommendations to the referring clinician.  Be sure the patient understands the nature of your role -- to support the patient's  \nown actions to get better and monitor compliance with the treatment plan, and relaying information to the clinician as needed.  It may be helpful to ask the patient what his/her expectations of you  \nare and to reinforce that he/she is a partner in his/her care. \n
\n
\n"], ["284", "
\nThis section is an opportunity to educate the patient about his/her own role as a partner in his/her own depression management.  Educate about self-help and the role of activation in lifting  \ndepressed mood.  If it is your practice to mail a letter with education materials prior to the first call, check to see if the patient has read the materials, or if confidentiality is an issue, ask  \nfor permission to send such materials after this first call.  Use today's assessment to determine which materials this patient is likely to find useful. \n
\n
\n"], ["285", "
\nThis section is for recording useful logistic information both to reduce wasted DCM time trying to reach patients at inconvenient times, and to make sure the right referring providers get feedback on  \ntheir patients. Regular feedback to clinicians on the current panel status and outcomes of patients they have referred reinforces collaboration and serves as a reminder about TIDES.  The specific  \npatients who will be included in panel feedback reports to clinicians and mental health specialists must be identified. \n
\n
\n"], ["286", "
\nThis section is relevant when a patient is being discharged from active care management.  Relapse prevention should begin with the initial assessment and becomes a major focus of care manager calls  \nas the patient's symptoms improve and as the patient nears the end of the six month care manager treatment process or is otherwise leaving care manager care.  Use this section as a guide to review  \nrelapse prevention material before discharge.  Reinforce that the patient understands you will be calling or writing in three months to check on how things are going.  If on medication, reinforce  \ncontinuation of medication and review with patient the suggested length of time to continue.  The major options will be 6-9 months after resolution of symptoms if being treated for a single episode  \nof depression, or up to 2 years if the patient has dysthymia or multiple past episodes of depression.  Reinforce relapse prevention strategies and remind veterans to continue utilizing their coping  \nstrategies.  \n
\n
\n"], ["287", "
\n3. Depressive symptoms: \n
\n
\n"], ["288", "
\n5. Does the patient have this depressive symptom:  \n
\n
\n"], ["289", "
\n5. Does the patient have these nine depressive symptoms:  \n
\n
\n"], ["29", "
\nThis questionnaire is designed to explore the relationship between\ntwo people. While you respond to each item, imagine yourself\ntalking with complete honesty to your mate.\n
\n
\n"], ["290", "
\n3. Does the patient have these nine depressive symptoms:  \n
\n
\n"], ["291", "
\nWhich services below did your program provide for this veteran in the past six months (since date of IDF or last CPR)?  "Yes" if statement applied for a clinically significant period in past six  \nmonths. If terminated, count period involved in past six months. \n
\n
\n"], ["292", "
\nWhich services below did your program provide for this veteran in the past six months (since date of IDF or last CPR)?  "Yes" if statement applied for a clinically significant period in past six  \nmonths. If terminated, count period involved in past six months. \n
\n
\n"], ["293", "
\nThis form should be completed by the primary case manager or team for each MHICM veteran, within one week of the 6 && 12 month and then annual anniversaries of MHICM program entry based on the IDF  \ndate. Use the time period "since" IDF or last CPR time frame if less than six months.   \n
\n
\n"], ["294", "
\nWhich of the following, in your clinical judgement, are reasons why this veteran terminated involvement with your program, or never became significantly involved in the first place? ("Termination"  \ndoes NOT necessarily preclude efforts to contact veteran.) \n
\n
\n"], ["295", "
\nWhich services below did your program provide for this veteran in the past six months (since date of IDF or last CPR)?  "Yes" if statement applied for a clinically significant period in past six   \nmonths. If terminated, count period involved in past six months.  \n
\n
\n"], ["296", "
\nWhich of the patterns below best describes your team's typical frequency of contact with this veteran, his or her family, and others on his or her behalf in the past six months?   \n
\n
\n"], ["297", "
\nThe following items depict different ways you might think or feel about this veteran. Please review each statement, inserting the veteran's name in place of ____ in the text. Think about your    \nexperiences with this veteran over the past six months. Check the rating that best describes, all in all, how often you feel or think that way about ____ and your work together.   \n
\n
\n"], ["298", "
\nNote: MHICM veterans typically receive intensive services for at least a year or until they meet all criteria below.   \n
\n
\n"], ["299", "
\nWhich criteria for less intensive services did this veteran meet?   \n
\n
\n"], ["3", "
\nListed below are a variety of thoughts that pop into people's heads.\nPlease read each thought and indicate how frequently, if at all,\nthe thought occurred to you over the last week.  Please read\neach item carefully and indicate the appropriate number.\n
\n
\n"], ["30", "
\nPlease respond now to the following items.\n
\n
\n"], ["300", "
\nIn view of this veteran's stability, what treatment change was made?   \n
\n
\n"], ["301", "
\nWere intensive services restored as a result of:   \n
\n
\n"], ["302", "
\nWhat services does this veteran currently receive on a regular basis?   \n
\n
\n"], ["303", "
\nThis survey asks about how you are feeling and doing in different areas of life. Please check the item that best describes yourself during the PAST WEEK. Please answer every question. If you are    \nunsure about how to answer, please give the best answer you can. During the PAST WEEK, how much difficulty did you have. . .   \n
\n
\n"], ["304", "
\nThis form should be completed by the primary case manager or team for each MHICM veteran, within one week of the 6 && 12 month and then annual anniversaries of MHICM program entry based on the IDF  \ndate. Use the time period "since" IDF or last CPR time frame if less than six months.   \n
\n
\n"], ["305", "
\nWhich of the following, in your clinical judgement, are reasons why this veteran terminated involvement with your program, or never became significantly involved in the first place? ("Termination"  \ndoes NOT necessarily preclude efforts to contact veteran.) \n
\n
\n"], ["306", "
\nWhich services below did your program provide for this veteran in the past six months (since date of IDF or last CPR)?    \n
\n
\n"], ["307", "
\nWhich of the patterns below best describes your team's typical frequency of contact with this veteran, his or her family, and others on his or her behalf in the past six months?   \n
\n
\n"], ["308", "
\nThe fallowing items depict different ways you might think or feel about this veteran. Please review each statement, inserting the veteran's name in place of ____ in the text. Think about your  \nexperiences with this veteran over the past six months. Check the rating that best describes, all in all, how often you feel or think that way about ____ and your work together. \n
\n
\n"], ["309", "
\nNote: MHICM veterans typically receive intensive services for at least a year or until they meet all criteria below.   \n
\n
\n"], ["31", "
\n12 Introduction: \n
\n
\n"], ["310", "
\nWhich criteria for less intensive services did this veteran meet?   \n
\n
\n"], ["311", "
\nIn view of this veteran's stability, what treatment change was made?   \n
\n
\n"], ["312", "
\nWere intensive services restored as a result of:   \n
\n
\n"], ["313", "
\nWhat services does this veteran currently receive on a regular basis?   \n
\n
\n"], ["314", "
\nIntake Questionnaire \n
\n
\n"], ["315", "
\nIntake Questionnaire \n
\n
\n"], ["316", "
\n16. Please record your best recollection of the number of visits (occurring on different days) where you received the following types of care during the PAST FOUR MONTHS.Try not to "double count"  \nvisits under more than one type of care.           \n
\n
\n"], ["317", "
\nThe statements below express a variety of feelings and thoughts that some vets have reported having about their military experiences.  CHECK the one choice that best describes how you felt about each  \nstatement during the last 4 months. \n
\n
\n"], ["318", "
\nScore only as decline from previous usual level due to cognitive loss, not impairment due to other factors.  \n
\n
\n"], ["319", "
\n16. Please record your best recollection of the number of visits (occurring on different days) where you received the following types of care during the PAST FOUR MONTHS.Try not to "double count"  \nvisits under more than one type of care.           \n
\n
\n"], ["32", "
\nThis inventory contains a list of statements that people use to describe\nT for true.  If you disagree or decide that it does not describe you, answer\nF for false.  Try to mark every statement even if you are not sure of your\nchoice.  If you have tried your best and still cannot decide, answer the\nquestion F for false.\n \nThere is no time limit for completing this inventory, but it is best to\nwork as rapidly as is comfortable for you.\nthemselves.  They are presented here to help you in describing your\nfeelings and attitudes.  Try and be as honest and serious as you can\nin answering the statements since the results will be used by your doctor\nin learning about your problems and in planning to help you.\n \nDo not be concerned that a few of the statements seem unusual to you;\nthey are included to describe people with many different types of problems.\nWhen you agree with a statement or decide that it describes you, answer\n
\n
\n"], ["320", "
\nThe statements below express a variety of feelings and thoughts that some vets have reported having about their military experiences.  CHECK the one choice that best describes how you felt about each  \nstatement during the last 4 months. \n
\n
\n"], ["321", "
\n30. Below is a list of problems and complaints that veterans sometimes have in response to stressful military experiences.  Please read each one carefully, then CHECK one of the boxes to the right to  \nindicate how much you have been bothered by that problem IN THE PAST MONTH. \n
\n
\n"], ["322", "
\n32. Over the last 2 weeks, how often have you been bothered by any of the following problems? \n
\n
\n"], ["323", "
\nThe following questions relate to your usual sleep habits during the past month only.  Your answers should indicate the most accurate reply for the majority of days and nights in the past month. \n
\n
\n"], ["324", "
\n32. Over the last 2 weeks, how often have you been bothered by any of the following problems? \n
\n
\n"], ["325", "
\nThe following questions relate to your usual sleep habits during the past month only.  Your answers should indicate the most accurate reply for the majority of days and nights in the past month. \n
\n
\n"], ["326", "
\n43. During the past 4 months, about how often has this happened to you? \n
\n
\n"], ["327", "
\n47. During the past 4 months, about how often has this happened to you? \n
\n
\n"], ["328", "
\n32. Over the last 2 weeks, how often have you been bothered by any of the following problems? \n
\n
\n"], ["329", "
\nThe following questions relate to your usual sleep habits during the past month only.  Your answers should indicate the most accurate reply for the majority of days and nights in the past month. \n
\n
\n"], ["33", "
\nA list of statements will be presented to help you in describing your\n \nThere is no time limit for completing the inventory, but it is best to\nwork as rapidly as is comfortable for you.\nfeelings and attitudes. Try to be as honest and serious as you can.\n \nDo not be concerned if a few statements seem unusual; they are included\nto describe people with many types of problems. If you agree with a\nstatement or decide that it describes you, answer True. If you disagree\nor decide that it does not describe you, answer False. Try to mark every\nstatement, even if you are not sure of your choice. If you have tried\nyour best and still cannot decide, answer False.\n
\n
\n"], ["330", "
\n43. During the past 4 months, about how often has this happened to you? \n
\n
\n"], ["331", "
\n47. During the past 4 months, about how often has this happened to you? \n
\n
\n"], ["332", "
\n32. Over the last 2 weeks, how often have you been bothered by any of the following problems? \n
\n
\n"], ["333", "
\nThe following questions relate to your usual sleep habits during the past month only.  Your answers should indicate the most accurate reply for the majority of days and nights in the past month. \n
\n
\n"], ["334", "
\n43. During the past 4 months, about how often has this happened to you? \n
\n
\n"], ["335", "
\n47. During the past 4 months, about how often has this happened to you? \n
\n
\n"], ["336", "
\nFor each statement below, check the choice that comes closest to describing the role that religion/spirituality plays in your life. \n
\n
\n"], ["337", "
\n32. Over the last 2 weeks, how often have you been bothered by any of the following problems? \n
\n
\n"], ["338", "
\nThe following questions relate to your usual sleep habits during the past month only.  Your answers should indicate the most accurate reply for the majority of days and nights in the past month. \n
\n
\n"], ["339", "
\n43. During the past 4 months, about how often has this happened to you? \n
\n
\n"], ["34", "
\nPlease answer the following questions concerning your attitudes\nabout your health.\n
\n
\n"], ["340", "
\n47. During the past 4 months, about how often has this happened to you? \n
\n
\n"], ["341", "
\nFor each statement below, check the choice that comes closest to describing the role that religion/spirituality plays in your life. \n
\n
\n"], ["342", "
\nThese questions concern your social life with others, aside from the people you live with. \n
\n
\n"], ["343", "
\nThe following is a list of some things that you may have done when you had a quarrel with someone else, INCLUDING people you are living with. \n
\n
\n"], ["344", "
\n83. How do you feel about: \n
\n
\n"], ["345", "
\nThe questions in this section ask about your expectations of the services that you will receive from the specialized PTSD program during your treatment at the VA.  For each question, please check the  \none box that best describes your expectations about your treatment. \n
\n
\n"], ["346", "
\n32. Over the last 2 weeks, how often have you been bothered by any of the following problems? \n
\n
\n"], ["347", "
\nThe following questions relate to your usual sleep habits during the past month only.  Your answers should indicate the most accurate reply for the majority of days and nights in the past month. \n
\n
\n"], ["348", "
\n43. During the past 4 months, about how often has this happened to you? \n
\n
\n"], ["349", "
\n47. During the past 4 months, about how often has this happened to you? \n
\n
\n"], ["35", "
\nPlease answer the following questions concerning your attitudes\nabout your health.\n
\n
\n"], ["350", "
\nFor each statement below, check the choice that comes closest to describing the role that religion/spirituality plays in your life. \n
\n
\n"], ["351", "
\nThese questions concern your social life with others, aside from the people you live with. \n
\n
\n"], ["352", "
\nThe following is a list of some things that you may have done when you had a quarrel with someone else, INCLUDING people you are living with. \n
\n
\n"], ["353", "
\n83. How do you feel about: \n
\n
\n"], ["354", "
\nThe questions in this section ask about your expectations of the services that you will receive from the specialized PTSD program during your treatment at the VA.  For each question, please check the  \none box that best describes your expectations about your treatment. \n
\n
\n"], ["355", "
\nIntake Questionnaire  \n
\n
\n"], ["356", "
\n16. Please record your best recollection of the number of visits (occurring on different days) where you received the following types of care during the PAST FOUR MONTHS.Try not to "double count"   \nvisits under more than one type of care.            \n
\n
\n"], ["357", "
\nThe statements below express a variety of feelings and thoughts that some vets have reported having about their military experiences.  CHECK the one choice that best describes how you felt about each  \n statement during the last 4 months.  \n
\n
\n"], ["358", "
\n30. Below is a list of problems and complaints that veterans sometimes have in response to stressful military experiences.  Please read each one carefully, then CHECK one of the boxes to the right to  \n indicate how much you have been bothered by that problem IN THE PAST MONTH.  \n
\n
\n"], ["359", "
\n32. Over the last 2 weeks, how often have you been bothered by any of the following problems?  \n
\n
\n"], ["36", "
\nPlease answer the following questions concerning your attitudes\nabout your health.\n
\n
\n"], ["360", "
\nThe following questions relate to your usual sleep habits during the past month only.  Your answers should indicate the most accurate reply for the majority of days and nights in the past month.  \n
\n
\n"], ["361", "
\n43. During the past 4 months, about how often has this happened to you?  \n
\n
\n"], ["362", "
\n47. During the past 4 months, about how often has this happened to you?  \n
\n
\n"], ["363", "
\nFor each statement below, check the choice that comes closest to describing the role that religion/spirituality plays in your life.  \n
\n
\n"], ["364", "
\nThese questions concern your social life with others, aside from the people you live with.  \n
\n
\n"], ["365", "
\nThe following is a list of some things that you may have done when you had a quarrel with someone else, INCLUDING people you are living with.  \n
\n
\n"], ["366", "
\n83. How do you feel about:  \n
\n
\n"], ["367", "
\nThe questions in this section ask about your expectations of the services that you will receive from the specialized PTSD program during your treatment at the VA.  For each question, please check the  \n one box that best describes your expectations about your treatment.  \n
\n
\n"], ["368", "
\nFollow-Up Questionnaire   \n
\n
\n"], ["369", "
\n1. Please record your best recollection of the number of visits (occurring on different days) where you received the following types of care during the PAST FOUR MONTHS.Try not to "double count"    \nvisits under more than one type of care.             \n
\n
\n"], ["37", "
\n2 Introduction: \n
\n
\n"], ["370", "
\n1. Please record your best recollection of the number of visits (occurring on different days) where you received the following types of care during the PAST FOUR MONTHS.Try not to "double count"    \nvisits under more than one type of care.             \n
\n
\n"], ["371", "
\nThe following questions pertain to your treatment by the specialized PTSD program during the last four months.  For each question, please check the one box for each item that best describes your  \nfeeling about your treatment. \n
\n
\n"], ["372", "
\n1. Please record your best recollection of the number of visits (occurring on different days) where you received the following types of care during the PAST FOUR MONTHS.Try not to "double count"    \nvisits under more than one type of care.             \n
\n
\n"], ["373", "
\nThe following questions pertain to your treatment by the specialized PTSD program during the last four months.  For each question, please check the one box for each item that best describes your  \nfeeling about your treatment. \n
\n
\n"], ["374", "
\n20. Below is a list of problems and complaints that veterans sometimes have in response to stressful military experiences.  Please read each one carefully, then CHECK one of the boxes to the right to  \n  indicate how much you have been bothered by that problem IN THE PAST MONTH.   \n
\n
\n"], ["375", "
\n22. Over the last 2 weeks, how often have you been bothered by any of the following problems?   \n
\n
\n"], ["376", "
\n32. During the past 4 months, about how often has this happened to you?   \n
\n
\n"], ["377", "
\n35. During the past 4 months, about how often has this happened to you?   \n
\n
\n"], ["378", "
\n32. During the past 4 months, about how often has this happened to you?   \n
\n
\n"], ["379", "
\n35. During the past 4 months, about how often has this happened to you?   \n
\n
\n"], ["38", "
\nEnter the number that best describes how you feel about each statement\n
\n
\n"], ["380", "
\n71. How do you feel about:   \n
\n
\n"], ["381", "
\n5. Cause of injury: \n
\n
\n"], ["382", "
\n5. Cause of injury: \n
\n
\n"], ["383", "
\n5. Cause of injury: \n
\n
\n"], ["384", "
\n10. Please rate the following symptoms with regard to how much they have disturbed you SINCE YOUR INJURY. Use the following scale:  None 0 - Rarely if ever present; not a problem at all  Mild 1 -   \nOccasionally present, but it does not disrupt activities;  I can usually continue what I'm doing; doesn't really concern me.  Moderate 2 - Often present, occasionally disrupts my activities;  I can   \nusually continue what I'm doing with some effort;  I somewhat concerned.  Severe 3 - Frequently present and disrupts activities;  I can only do things that are fairly simple or take little effort;  I  \n feel like I need help.  Very Severe 4 - Almost always present and I have been unable to perform at work, school, or home due to this problem; I probably cannot function without help  \n
\n
\n"], ["385", "
\n5. Cause of injury: \n
\n
\n"], ["386", "
\n10. Please rate the following symptoms with regard to how much they have disturbed you SINCE YOUR INJURY. Use the following scale:  None 0 - Rarely if ever present; not a problem at all  Mild 1 -   \nOccasionally present, but it does not disrupt activities;  I can usually continue what I'm doing; doesn't really concern me.  Moderate 2 - Often present, occasionally disrupts my activities;  I can   \nusually continue what I'm doing with some effort;  I somewhat concerned.  Severe 3 - Frequently present and disrupts activities;  I can only do things that are fairly simple or take little effort;  I  \n feel like I need help.  Very Severe 4 - Almost always present and I have been unable to perform at work, school, or home due to this problem; I probably cannot function without help  \n
\n
\n"], ["387", "
\n5. Cause of injury: \n
\n
\n"], ["388", "
\n10. Please rate the following symptoms with regard to how much they have disturbed you SINCE YOUR INJURY. Use the following scale:  None 0 - Rarely if ever present; not a problem at all  Mild 1 -   \nOccasionally present, but it does not disrupt activities;  I can usually continue what I'm doing; doesn't really concern me.  Moderate 2 - Often present, occasionally disrupts my activities;  I can   \nusually continue what I'm doing with some effort;  I somewhat concerned.  Severe 3 - Frequently present and disrupts activities;  I can only do things that are fairly simple or take little effort;  I  \n feel like I need help.  Very Severe 4 - Almost always present and I have been unable to perform at work, school, or home due to this problem; I probably cannot function without help  \n
\n
\n"], ["389", "
\nThe FAST scale is a functional scale designed to evaluate patients at the more moderate-severe stages of dementia when the MMSE no longer can reflect changes in a meaningful clinical way. In the  \nearly stages the patient may be able to participate in the FAST administration but usually the information should be collected from a caregiver or, in the case of nursing home care, the nursing home  \nstaff.  \n
\n
\n"], ["39", "
\nPlease read each statement carefully and decide whether it is true\nas applied to you or false as applied to you.\n \nIf a statement is true or mostly true, as applied to you, answer '1'.\nIf a statement is false or not usually true, as applied to you, answer\n'2'.\n \nRemember to give your own opinion of yourself.\n
\n
\n"], ["390", "
\nThis survey asks about how you are feeling and doing in different areas of life. Please check the item that best describes yourself during the PAST WEEK. Please answer every question. If you are   \nunsure about how to answer, please give the best answer you can. During the PAST WEEK, how much difficulty did you have. . .   \n
\n
\n"], ["391", "
\nDuring the PAST WEEK, how much of the time did you. . .  \n
\n
\n"], ["392", "
\nDuring the PAST WEEK, how often did you. . . \n
\n
\n"], ["393", "
\nDuring the PAST WEEK, how often. . . \n
\n
\n"], ["394", "
\nScore only as decline from previous usual level due to cognitive loss, not impairment due to other factors.  \n
\n
\n"], ["395", "
\nScore only as decline from previous usual level due to cognitive loss, not impairment due to other factors.  \n
\n
\n"], ["396", "
\nSome of the substances listed may be prescribed by a doctor (like amphetamines, sedatives, pain|medications). Do not record medications that are used as prescribed by your doctor. However, if you  \nhave taken such medications for reasons other than  prescription, or taken them more frequently or at higher doses than prescribed, please record that. While we are also interested in knowing about  \nyour use of various illicit drugs, please be assured that information on such use will be treated as strictly confidential. \n
\n
\n"], ["397", "
\nQuestion 1:   In your life, which of the following substances have you ever used? (NON-MEDICAL USE ONLY) \n
\n
\n"], ["398", "
\nQuestion 2: In the past three months, how often have you used the substances you mentioned (FIRST DRUG, SECOND DRUG, ETC)? \n
\n
\n"], ["399", "
\nSome of the substances listed may be prescribed by a doctor (like amphetamines, sedatives, pain|medications). Do not record medications that are used as prescribed by your doctor. However, if you  \nhave taken such medications for reasons other than  prescription, or taken them more frequently or at higher doses than prescribed, please record that. While we are also interested in knowing about  \nyour use of various illicit drugs, please be assured that information on such use will be treated as strictly confidential. \n
\n
\n"], ["4", "
\nPlease read each item carefully and select the correct answer for you.\n
\n
\n"], ["40", "
\nPlease read each statement carefully and decide whether it is true\nas applied to you or false as applied to you.\n \nIf a statement is true or mostly true, as applied to you, answer '1'.\nIf a statement is false or not usually true, as applied to you, answer\n'2'.\n \nRemember to give your own opinion of yourself.\n
\n
\n"], ["400", "
\nQuestion 1:   In your life, which of the following substances have you ever used? (NON-MEDICAL USE ONLY) \n
\n
\n"], ["401", "
\nQuestion 2: In the past three months, how often have you used the substances you mentioned (FIRST DRUG, SECOND DRUG, ETC)? \n
\n
\n"], ["402", "
\nQuestion 3:  During the past three months, how often have you had a strong desire or urge to use (FIRST DRUG, SECOND DRUG, ETC)? \n
\n
\n"], ["403", "
\nQuestion 4:  During the past three months, how often has your use of (FIRST DRUG, SECOND DRUG, ETC) led to health, social, legal or financial problems? \n
\n
\n"], ["404", "
\nQuestion 5: During the past three months, how often have you failed to do what was normally expected of you because of your use of (FIRST DRUG, SECOND DRUG, ETC)? \n
\n
\n"], ["405", "
\nQuestion 1:  In your life, which of the following substances have you ever used? (Do not count medication taken as prescribed, but do record it here if taken more often, or at high doses, than  \nprescribed.) \n
\n
\n"], ["406", "
\nQuestion 2: In the past three months, how often have you used the substances you mentioned (FIRST DRUG, SECOND DRUG, ETC)?  \n
\n
\n"], ["407", "
\nQuestion 3: During the past three months, how often have you had a strong desire or urge to use (FIRST DRUG, SECOND DRUG, ETC)?  \n
\n
\n"], ["408", "
\nQuestion 4: During the past three months, how often has your use of (FIRST DRUG, SECOND DRUG, ETC) led to health, social, legal or financial problems?  \n
\n
\n"], ["409", "
\nQuestion 5: During the past three months, how often have you failed to do what was normally expected of you because of your use of (FIRST DRUG, SECOND DRUG, ETC)?  \n
\n
\n"], ["41", "
\nPlease read each item carefully and give the answer that best corresponds\n \nThere are no right or wrong answers, and you need not be an "expert" to\ncomplete this questionnaire.  Describe yourself honestly and state your\nopinions as accurately as possible.\nto your agreement or disagreement.\n \nType 1 if the statement is definitely false or if you strongly disagree.\nType 2 if the statement is mostly false or if you disagree.\nType 3 if the statement is about equally true or false, if you cannot\ndecide, or if you are neutral on the statement.\nType 4 if the statement is mostly true or if you agree.\nType 5 if the statement is definitely true or if you strongly agree.\n
\n
\n"], ["410", "
\nQuestion 1:  In your life, which of the following substances have you ever used? (Do not count medication taken as prescribed, but do record it here if taken more often, or at high doses, than  \nprescribed.) \n
\n
\n"], ["411", "
\nQuestion 2: In the past three months, how often have you used the substances you mentioned (FIRST DRUG, SECOND DRUG, ETC)?  \n
\n
\n"], ["412", "
\nQuestion 3: During the past three months, how often have you had a strong desire or urge to use (FIRST DRUG, SECOND DRUG, ETC)?  \n
\n
\n"], ["413", "
\nQuestion 4: During the past three months, how often has your use of (FIRST DRUG, SECOND DRUG, ETC) led to health, social, legal or financial problems?  \n
\n
\n"], ["414", "
\nQuestion 5: During the past three months, how often have you failed to do what was normally expected of you because of your use of (FIRST DRUG, SECOND DRUG, ETC)?  \n
\n
\n"], ["415", "
\nQuestion 6:  Has a friend or relative or anyone else ever expressed concern about your use of|(FIRST DRUG, SECOND DRUG, ETC.)? \n
\n
\n"], ["416", "
\nQuestion 1:  In your life, which of the following substances have you ever used? (Do not count medication taken as prescribed, but do record it here if taken more often, or at high doses, than  \nprescribed.) \n
\n
\n"], ["417", "
\nQuestion 2: In the past three months, how often have you used the substances you mentioned (FIRST DRUG, SECOND DRUG, ETC)?  \n
\n
\n"], ["418", "
\nQuestion 3: During the past three months, how often have you had a strong desire or urge to use (FIRST DRUG, SECOND DRUG, ETC)?  \n
\n
\n"], ["419", "
\nQuestion 4: During the past three months, how often has your use of (FIRST DRUG, SECOND DRUG, ETC) led to health, social, legal or financial problems?  \n
\n
\n"], ["42", "
\nRead each statement and decide if it is an accurate statement about you.\n \nType a 1 if the statement is FALSE, NOT AT ALL TRUE.\nType a 2 if the statement is SLIGHTLY TRUE.\nType a 3 if the statement is MAINLY TRUE.\nType a 4 if the statement is VERY TRUE.\n \nGive your own opinion of yourself.  Be sure to answer every statement.\n
\n
\n"], ["420", "
\nQuestion 5: During the past three months, how often have you failed to do what was normally expected of you because of your use of (FIRST DRUG, SECOND DRUG, ETC)?  \n
\n
\n"], ["421", "
\nQuestion 6:  Has a friend or relative or anyone else ever expressed concern about your use of|(FIRST DRUG, SECOND DRUG, ETC.)? \n
\n
\n"], ["422", "
\nQuestion 7:  Have you ever tried and failed to control, cut down or stop using (FIRST DRUG, SECOND DRUG, ETC.)? \n
\n
\n"], ["423", "
\nQuestion 1:  In your life, which of the following substances have you ever used? (Do not count medication taken as prescribed, but do record it here if taken more often, or at high doses, than  \nprescribed.) \n
\n
\n"], ["424", "
\nQuestion 2: In the past three months, how often have you used the substances you mentioned (FIRST DRUG, SECOND DRUG, ETC)?  \n
\n
\n"], ["425", "
\nQuestion 3: During the past three months, how often have you had a strong desire or urge to use (FIRST DRUG, SECOND DRUG, ETC)?  \n
\n
\n"], ["426", "
\nQuestion 4: During the past three months, how often has your use of (FIRST DRUG, SECOND DRUG, ETC) led to health, social, legal or financial problems?  \n
\n
\n"], ["427", "
\nQuestion 5: During the past three months, how often have you failed to do what was normally expected of you because of your use of (FIRST DRUG, SECOND DRUG, ETC)?  \n
\n
\n"], ["428", "
\nQuestion 6:  Has a friend or relative or anyone else ever expressed concern about your use of|(FIRST DRUG, SECOND DRUG, ETC.)? \n
\n
\n"], ["429", "
\nQuestion 7:  Have you ever tried and failed to control, cut down or stop using (FIRST DRUG, SECOND DRUG, ETC.)? \n
\n
\n"], ["43", "
\nBelow is a list of problems and complaints that people sometimes\nhave in response to stressful life experiences. Please read each\none carefully and indicate how much you have been bothered by that\nproblem IN THE PAST MONTH.\n
\n
\n"], ["430", "
\nINSTRUCTIONS: Below is a list of potentially stressful situations that active duty|members who served in the Gulf war have experienced. Please read each one|carefully, then check the box to the right  \nto indicate your exposure to each of|these situations. \n
\n
\n"], ["431", "
\nINSTRUCTIONS: Below is a list of potentially stressful situations that active duty|members who served in the Gulf war have experienced. Please read each one|carefully, then check the box to the right  \nto indicate your exposure to each of|these situations.  \n
\n
\n"], ["432", "
\nINSTRUCTIONS: Below is a list of potentially stressful situations that active duty|members who served in the Gulf war have experienced. Please read each one|carefully, then check the box to the right  \nto indicate your exposure to each of|these situations. \n
\n
\n"], ["433", "
\nPlease pick the answer that best describes your experience. \n
\n
\n"], ["434", "
\nPlease pick the answer that best describes your experience.  \n
\n
\n"], ["435", "
\nInstructions|This is a standard set of questions about several areas of your life such as your health, alcohol and drug use, etc. The questions generally ask about the past 30 days. Please consider  \neach question and answer as accurately as possible. \n
\n
\n"], ["436", "
\n7. In the past 30 days, how many days did you use any of the following drugs: \n
\n
\n"], ["437", "
\n4. Please remember these five objects. I will ask you what they are later.  APPLE   PEN   TIE   HOUSE   CAR \n
\n
\n"], ["438", "
\n5. You have $100 and you go to the store and buy a dozen apples for $3 and a tricycle for $20. \n
\n
\n"], ["439", "
\n8. I am going to give you a series of numbers and I would like you to give them to me backwards. For example, if I say 42, you would say 24. \n
\n
\n"], ["44", "
\nBelow is a list of problems and complaints that people sometimes\nhave in response to stressful military experiences. Please read each\none carefully and indicate how much you have been bothered by that\nproblem IN THE PAST MONTH.\n
\n
\n"], ["440", "
\n9. Draw a circle for the patient. This is a clock face. Please put in the hour markers and the time at ten minutes to eleven o'clock. \n
\n
\n"], ["441", "
\n10. Draw a square, triangle and rectangle, all of the same height for the patient. The rectange should be half the width of the square. \n
\n
\n"], ["442", "
\n11. I am going to tell you a story. Please listen carefully because afterwards, I'm going to ask you some questions about it. \n
\n
\n"], ["443", "
\n5. You have $100 and you go to the store and buy a dozen apples for $3 and a tricycle for $20.  \n
\n
\n"], ["444", "
\n8. I am going to give you a series of numbers and I would like you to give them to me backwards. For example, if I say 42, you would say 24.  \n
\n
\n"], ["445", "
\n9. Draw a circle for the patient. This is a clock face. Please put in the hour markers and the time at ten minutes to eleven o'clock.  \n
\n
\n"], ["446", "
\n10. Draw a square, triangle and rectangle, all of the same height for the patient. The rectange should be half the width of the square.  \n
\n
\n"], ["447", "
\n11. I am going to tell you a story. Please listen carefully because afterwards, I'm going to ask you some questions about it.  \n
\n
\n"], ["448", "
\nOver the last 2 weeks, how often have you been bothered by the following problems? \n
\n
\n"], ["449", "
\nChoose the best answer for how you have felt over the past week:  \n
\n
\n"], ["45", "
\nOver the past 2 weeks, how often have you been bothered by any of the following problems? Please read each item carefully and give your best response.\n
\n
\n"], ["450", "
\nFor each area of functioning listed below, check description that applies. (The word "assistance" means supervision, direction of personal assistance.)  \n
\n
\n"], ["451", "
\nBelow is a list of problems and complaints that people sometimes have in response to stressful life experiences. Please read each one carefully and indicate how much you have been bothered by that  \nproblem IN THE PAST MONTH. \n
\n
\n"], ["452", "
\nIf time is unknown, please approximate.  \n
\n
\n"], ["453", "
\n1. Some of the questions in this questionnaire refer to your "significant other." A significant other is a person with whom you feel closest. This includes anyone that you relate to on a regular or  \ninfrequent basis. It is very important that you identify someone as your "significant other." \n
\n
\n"], ["454", "
\nIn the following 20 questions, you will be asked to describe your pain and how it affects your life. Under each question is a scale to record your answer. Read each question carefully and then select  \nthe number on the scale to indicate how that specific question applies to you. You can click on the number with the mouse or enter the number on the key board. \n
\n
\n"], ["455", "
\n1. Some of the questions in this questionnaire refer to your "significant other." A significant other is a person with whom you feel closest. This includes anyone that you relate to on a regular or  \ninfrequent basis. It is very important that you identify someone as your "significant other." \n
\n
\n"], ["456", "
\nIn the following 20 questions, you will be asked to describe your pain and how it affects your life. Under each question is a scale to record your answer. Read each question carefully and then select  \nthe number on the scale to indicate how that specific question applies to you. You can click on the number with the mouse or enter the number on the key board. \n
\n
\n"], ["457", "
\nIn this section, we are interested in knowing how your significant other (this refers to the person you indicated above) responds to you when he or she knows you are in pain. On the scale listed  \nbelow each question, indicate HOW OFTEN your significant other generally responds to you in that particular way WHEN YOU ARE IN PAIN. \n
\n
\n"], ["458", "
\n1. Some of the questions in this questionnaire refer to your "significant other." A significant other is a person with whom you feel closest. This includes anyone that you relate to on a regular or  \ninfrequent basis. It is very important that you identify someone as your "significant other."  \n
\n
\n"], ["459", "
\nIn the following 20 questions, you will be asked to describe your pain and how it affects your life. Under each question is a scale to record your answer. Read each question carefully and then select  \nthe number on the scale to indicate how that specific question applies to you. You can click on the number with the mouse or enter the number on the key board.  \n
\n
\n"], ["46", "
\nThis is a questionnaire to find out the way in which certain important\nPlease answer these items carefully but do not spend too much time on\nany one item. Indicate your choice by typing the number 1 or 2.\n \nIn some instances you may discover that you believe both statements or\nneither one. In such cases, be sure to select the one you most strongly\nbelieve to be the case. Also, try to respond to each item independently\nwhen making your choice; do not be influenced by your previous choices.\nevents in our society affect different people. Each item consists of a\npair of alternatives numbered 1 or 2. Please select the one statement of\neach pair (and only one) which you more strongly believe to be the case,\nas far as you're concerned. Be sure to select the one you actually believe\nto be more true rather than the one you think you should choose or the one\nyou would like to be true. This is a measure of personal belief; obviously\nthere are no right or wrong answers.\n \n
\n
\n"], ["460", "
\nIn this section, we are interested in knowing how your significant other (this refers to the person you indicated above) responds to you when he or she knows you are in pain. On the scale listed  \nbelow each question, indicate HOW OFTEN your significant other generally responds to you in that particular way WHEN YOU ARE IN PAIN.  \n
\n
\n"], ["461", "
\n1. Some of the questions in this questionnaire refer to your "significant other." A significant other is a person with whom you feel closest. This includes anyone that you relate to on a regular or  \ninfrequent basis. It is very important that you identify someone as your "significant other."  \n
\n
\n"], ["462", "
\nIn the following 20 questions, you will be asked to describe your pain and how it affects your life. Under each question is a scale to record your answer. Read each question carefully and then select  \nthe number on the scale to indicate how that specific question applies to you. You can click on the number with the mouse or enter the number on the key board.  \n
\n
\n"], ["463", "
\nIn this section, we are interested in knowing how your significant other (this refers to the person you indicated above) responds to you when he or she knows you are in pain. On the scale listed  \nbelow each question, indicate HOW OFTEN your significant other generally responds to you in that particular way WHEN YOU ARE IN PAIN.  \n
\n
\n"], ["464", "
\nListed below are 18 common daily activities. Please indicate HOW OFTEN you do each of these activities by selecting a number on the scale below each activity. Please complete ALL 18 questions.  \n
\n
\n"], ["465", "
\n1. Some of the questions in this questionnaire refer to your "significant other." A significant other is a person with whom you feel closest. This includes anyone that you relate to on a regular or  \ninfrequent basis. It is very important that you identify someone as your "significant other."  \n
\n
\n"], ["466", "
\nIn the following 20 questions, you will be asked to describe your pain and how it affects your life. Under each question is a scale to record your answer. Read each question carefully and then select  \nthe number on the scale to indicate how that specific question applies to you. You can click on the number with the mouse or enter the number on the key board.  \n
\n
\n"], ["467", "
\nIn this section, we are interested in knowing how your significant other (this refers to the person you indicated above) responds to you when he or she knows you are in pain. On the scale listed  \nbelow each question, indicate HOW OFTEN your significant other generally responds to you in that particular way WHEN YOU ARE IN PAIN.  \n
\n
\n"], ["468", "
\nListed below are 18 common daily activities. Please indicate HOW OFTEN you do each of these activities by selecting a number on the scale below each activity. Please complete ALL 18 questions.  \n
\n
\n"], ["469", "
\nInstructions|This is a standard set of questions about several areas of your life such as your health, alcohol and drug use, etc. The questions generally ask about the past 30 days. Please consider  \neach question and answer as accurately as possible.  \n
\n
\n"], ["47", "
\nReligious Resource Index:1-6\n
\n
\n"], ["470", "
\n7. In the past 30 days, how many days did you use any of the following drugs:  \n
\n
\n"], ["471", "
\nThe FAST scale is a functional scale designed to evaluate patients at the more moderate-severe stages of dementia when the MMSE no longer can reflect changes in a meaningful clinical way. In the  \nearly stages the patient may be able to participate in the FAST administration but usually the information should be collected from a caregiver or, in the case of nursing home care, the nursing home  \nstaff.  \n
\n
\n"], ["472", "
\nFor each area of functioning listed below, check description that applies. (The word "assistance" means supervision, direction of personal assistance.)  \n
\n
\n"], ["473", "
\nInstructions|This is a standard set of questions about several areas of your life such as your health, alcohol and drug use, etc. The questions generally ask about the past 30 days. Please consider  \neach question and answer as accurately as possible.|  \n
\n
\n"], ["474", "
\n7. In the past 30 days, how many days did you use any of the following drugs:  \n
\n
\n"], ["475", "
\nOn the following pages there are sentences that describe some of the different ways a person might think or feel about his or her therapist (counsellor). As you read the sentences mentally insert the  \nname of your therapist (counsellor) in place of _____________in the text. If the statement describes the way you always feel (or think) circle the number 7; if it never applies to you circle the  \nnumber 1. Use the numbers in between to describe the variations between these extremes. Work fast, your first impressions are the ones we would like to see. (PLEASE DON'T FORGET TO RESPOND TO EVERY  \nITEM.) \n
\n
\n"], ["476", "
\nWe are going to use the term "mental illness" in the rest of this questionnaire, but please think of it as whatever you feel is the best term for it.  \n
\n
\n"], ["477", "
\nWe are going to use the term "mental illness" in the rest of this questionnaire, but please think of it as whatever you feel is the best term for it.  \n
\n
\n"], ["478", "
\nWe are going to use the term "mental illness" in the rest of this questionnaire, but please think of it as whatever you feel is the best term for it.  \n
\n
\n"], ["479", "
\n5. You have $100 and you go to the store and buy a dozen apples for $3 and a tricycle for $20.  \n
\n
\n"], ["48", "
\nSpiritual Injury Scale: 7-14\n
\n
\n"], ["480", "
\n8. I am going to give you a series of numbers and I would like you to give them to me backwards. For example, if I say 42, you would say 24.  \n
\n
\n"], ["481", "
\n9. Draw a circle for the patient. This is a clock face. Please put in the hour markers and the time at ten minutes to eleven o'clock.  \n
\n
\n"], ["482", "
\n10. Draw a square, triangle and rectangle, all of the same height for the patient. The rectange should be half the width of the square.  \n
\n
\n"], ["483", "
\n11. I am going to tell you a story. Please listen carefully because afterwards, I'm going to ask you some questions about it.  \n
\n
\n"], ["484", "
\n5. You have $100 and you go to the store and buy a dozen apples for $3 and a tricycle for $20.  \n
\n
\n"], ["485", "
\n8. I am going to give you a series of numbers and I would like you to give them to me backwards. For example, if I say 42, you would say 24.  \n
\n
\n"], ["486", "
\n9. Draw a circle for the patient. This is a clock face. Please put in the hour markers and the time at ten minutes to eleven o'clock.  \n
\n
\n"], ["487", "
\n10. Draw a square, triangle and rectangle, all of the same height for the patient. The rectange should be half the width of the square.  \n
\n
\n"], ["488", "
\n11. I am going to tell you a story. Please listen carefully because afterwards, I'm going to ask you some questions about it.  \n
\n
\n"], ["489", "
\n1. Some of the questions in this questionnaire refer to your "significant other." A significant other is a person with whom you feel closest. This includes anyone that you relate to on a regular or  \ninfrequent basis. It is very important that you identify someone as your "significant other."  \n
\n
\n"], ["49", "
\nThis is a list of problems people sometimes have. Please read each\none carefully, and select the answer that best describes HOW MUCH THAT\nPROBLEM HAS DISTRESSED OR BOTHERED YOU DURING THE PAST 7 DAYS INCLUDING\nTODAY.\n
\n
\n"], ["490", "
\nIn the following 20 questions, you will be asked to describe your pain and how it affects your life. Under each question is a scale to record your answer. Read each question carefully and then select  \nthe number on the scale to indicate how that specific question applies to you. You can click on the number with the mouse or enter the number on the key board.  \n
\n
\n"], ["491", "
\nIn this section, we are interested in knowing how your significant other (this refers to the person you indicated above) responds to you when he or she knows you are in pain. On the scale listed  \nbelow each question, indicate HOW OFTEN your significant other generally responds to you in that particular way WHEN YOU ARE IN PAIN.  \n
\n
\n"], ["492", "
\nListed below are 18 common daily activities. Please indicate HOW OFTEN you do each of these activities by selecting a number on the scale below each activity. Please complete ALL 18 questions.  \n
\n
\n"], ["493", "
\nSome of the questions in this questionnaire refer to your "significant other." A significant other is a person with whom you feel closest. This includes anyone that you relate to on a regular or  \ninfrequent basis. It is very important that you identify someone as your "significant other."  \n
\n
\n"], ["494", "
\nIn the following 20 questions, you will be asked to describe your pain and how it affects your life. Under each question is a scale to record your answer. Read each question carefully and then select  \nthe number on the scale to indicate how that specific question applies to you. You can click on the number with the mouse or enter the number on the key board.  \n
\n
\n"], ["495", "
\nIn this section, we are interested in knowing how your significant other (this refers to the person you indicated above) responds to you when he or she knows you are in pain. On the scale listed  \nbelow each question, indicate HOW OFTEN your significant other generally responds to you in that particular way WHEN YOU ARE IN PAIN.  \n
\n
\n"], ["496", "
\nListed below are 18 common daily activities. Please indicate HOW OFTEN you do each of these activities by selecting a number on the scale below each activity. Please complete ALL 18 questions.  \n
\n
\n"], ["497", "
\nQuestion 1: In your life, which of the following substances have you ever used? (Do not count medication taken as prescribed, but do record it here if taken more often, or at higher doses, than  \nprescribed.)  \n
\n
\n"], ["498", "
\nQuestion 2: In the past three months, how often have you used the substances you mentioned (FIRST DRUG, SECOND DRUG, ETC)?  \n
\n
\n"], ["499", "
\nQuestion 3: During the past three months, how often have you had a strong desire or urge to use (FIRST DRUG, SECOND DRUG, ETC)?  \n
\n
\n"], ["5", "
\nPlease read each item carefully and select the correct answer for you.\n
\n
\n"], ["50", "
\n \n
\n
\n"], ["500", "
\nQuestion 4: During the past three months, how often has your use of (FIRST DRUG, SECOND DRUG, ETC) led to health, social, legal or financial problems?  \n
\n
\n"], ["501", "
\nQuestion 5: During the past three months, how often have you failed to do what was normally expected of you because of your use of (FIRST DRUG, SECOND DRUG, ETC)?  \n
\n
\n"], ["502", "
\nQuestion 6: Has a friend or relative or anyone else EVER expressed concern about your use of|(FIRST DRUG, SECOND DRUG, ETC.)?  \n
\n
\n"], ["503", "
\nQuestion 7: Have you EVER tried and failed to control, cut down or stop using (FIRST DRUG, SECOND DRUG, ETC.)?  \n
\n
\n"], ["504", "
\nQuestion 1: In your life, which of the following substances have you ever used? (Do not count medication taken as prescribed, but do record it here if taken more often, or at higher doses, than  \nprescribed.)  \n
\n
\n"], ["505", "
\nQuestion 2: In the past three months, how often have you used the substances you mentioned (FIRST DRUG, SECOND DRUG, ETC)?  \n
\n
\n"], ["506", "
\nQuestion 3: During the past three months, how often have you had a strong desire or urge to use (FIRST DRUG, SECOND DRUG, ETC)?  \n
\n
\n"], ["507", "
\nQuestion 4: During the past three months, how often has your use of (FIRST DRUG, SECOND DRUG, ETC) led to health, social, legal or financial problems?  \n
\n
\n"], ["508", "
\nQuestion 5: During the past three months, how often have you failed to do what was normally expected of you because of your use of (FIRST DRUG, SECOND DRUG, ETC)?  \n
\n
\n"], ["509", "
\nQuestion 6: Has a friend or relative or anyone else EVER expressed concern about your use of|(FIRST DRUG, SECOND DRUG, ETC.)?  \n
\n
\n"], ["51", "
\n Following are statements concerning personal attitudes\n and traits. Read each item and decide whether the\n statement is True or False as it pertains to you\n personally.\n
\n
\n"], ["510", "
\nQuestion 7: Have you EVER tried and failed to control, cut down or stop using (FIRST DRUG, SECOND DRUG, ETC.)?  \n
\n
\n"], ["511", "
\nOver the last 2 weeks, how often have you been bothered by the following problems?  \n
\n
\n"], ["512", "
\nFor each item, select the best description of the patient's signs or symptom. Rate on just the apparent relationship to opiate withdrawal. For example, if heart rate is increased because the patient  \nwas jogging just prior to assessment, the increase pulse rate would not add to the score.  \n
\n
\n"], ["513", "
\nQuestion 1: In your life, which of the following substances have you ever used? (Do not count medication taken as prescribed, but do record it here if taken more often, or at higher doses, than  \nprescribed.)  \n
\n
\n"], ["514", "
\nQuestion 2: In the past three months, how often have you used the substances you mentioned (FIRST DRUG, SECOND DRUG, ETC)?  \n
\n
\n"], ["515", "
\nQuestion 3: During the past three months, how often have you had a strong desire or urge to use (FIRST DRUG, SECOND DRUG, ETC)?  \n
\n
\n"], ["516", "
\nQuestion 4: During the past three months, how often has your use of (FIRST DRUG, SECOND DRUG, ETC) led to health, social, legal or financial problems?  \n
\n
\n"], ["517", "
\nQuestion 5: During the past three months, how often have you failed to do what was normally expected of you because of your use of (FIRST DRUG, SECOND DRUG, ETC)?  \n
\n
\n"], ["518", "
\nQuestion 6: Has a friend or relative or anyone else EVER expressed concern about your use of|(FIRST DRUG, SECOND DRUG, ETC.)? \n
\n
\n"], ["519", "
\nQuestion 7: Have you EVER tried and failed to control, cut down or stop using (FIRST DRUG, SECOND DRUG, ETC.)?  \n
\n
\n"], ["52", "
\nThis survey asks for your views about your health.  This information\nwill help keep track of how you feel and how well you are able to do your\nusual activities.\n \nAnswer every question by making the appropriate selection.  If you are\nunsure about how to answer a question, please give the best answer you can.\n
\n
\n"], ["520", "
\nSelf-directed violence is behavior that is self-directed and deliberately results in injury or the potential for injury to oneself. Please note: Behavior that is potentially harmful (e.g. holding a  \nloaded gun in one's mouth) should be classified as self-directed violence. \n
\n
\n"], ["521", "
\nSuicidal intent: There is past or present evidence (explicit and/or implicit) that the patient wished to die, meant to kill him/herself, and understands the probable consequences of his/her actions  \nor potential actions. Suicidal intent can be determined retrospectively \n
\n
\n"], ["522", "
\nSelf-directed violence is behavior that is self-directed and deliberately results in injury or the potential for injury to oneself. Please note: Behavior that is potentially harmful (e.g. holding a  \nloaded gun in one's mouth) should be classified as self-directed violence.  \n
\n
\n"], ["523", "
\nSuicidal intent: There is past or present evidence (explicit and/or implicit) that the patient wished to die, meant to kill him/herself, and understands the probable consequences of his/her actions  \nor potential actions. Suicidal intent can be determined retrospectively  \n
\n
\n"], ["524", "
\nSelf-directed violence is behavior that is self-directed and deliberately results in injury or the potential for injury to oneself. Please note: Behavior that is potentially harmful (e.g. holding a  \nloaded gun in one's mouth) should be classified as self-directed violence. \n
\n
\n"], ["525", "
\nSuicidal intent: There is past or present evidence (explicit and/or implicit) that the patient wished to die, meant to kill him/herself, and understands the probable consequences of his/her actions  \nor potential actions. Suicidal intent can be determined retrospectively \n
\n
\n"], ["526", "
\nSelf-directed violence is behavior that is self-directed and deliberately results in injury or the potential for injury to oneself. Please note: Behavior that is potentially harmful (e.g. holding a  \nloaded gun in one's mouth) should be classified as self-directed violence.  \n
\n
\n"], ["527", "
\nSuicidal intent: There is past or present evidence (explicit and/or implicit) that the patient wished to die, meant to kill him/herself, and understands the probable consequences of his/her actions  \nor potential actions. Suicidal intent can be determined retrospectively  \n
\n
\n"], ["528", "
\nSelf-directed violence is behavior that is self-directed and deliberately results in injury or the potential for injury to oneself. Please note: Behavior that is potentially harmful (e.g. holding a  \nloaded gun in one's mouth) should be classified as self-directed violence.  \n
\n
\n"], ["529", "
\nSuicidal intent: There is past or present evidence (explicit and/or implicit) that the patient wished to die, meant to kill him/herself, and understands the probable consequences of his/her actions  \nor potential actions. Suicidal intent can be determined retrospectively  \n
\n
\n"], ["53", "
\nThe following items are about activities you might do during a typical\nday.  Does YOUR HEALTH NOW LIMIT YOU in the activities? If so, how much?\n
\n
\n"], ["530", "
\nSelf-directed violence is behavior that is self-directed and deliberately results in injury or the potential for injury to oneself. Please note: Behavior that is potentially harmful (e.g. holding a  \nloaded gun in one's mouth) should be classified as self-directed violence. \n
\n
\n"], ["531", "
\nSuicidal intent: There is past or present evidence (explicit and/or implicit) that the patient wished to die, meant to kill him/herself, and understands the probable consequences of his/her actions  \nor potential actions. Suicidal intent can be determined retrospectively \n
\n
\n"], ["532", "
\nSelf-directed violence is behavior that is self-directed and deliberately results in injury or the potential for injury to oneself. Please note: Behavior that is potentially harmful (e.g. holding a  \nloaded gun in one's mouth) should be classified as self-directed violence.  \n
\n
\n"], ["533", "
\nSuicidal intent: There is past or present evidence (explicit and/or implicit) that the patient wished to die, meant to kill him/herself, and understands the probable consequences of his/her actions  \nor potential actions. Suicidal intent can be determined retrospectively  \n
\n
\n"], ["534", "
\nInstructions|This is a standard set of questions about several areas of your life such as your health, alcohol and drug use, etc. The questions generally ask about the past 30 days. Please consider  \neach question and answer as accurately as possible.|  \n
\n
\n"], ["535", "
\n7. In the past 30 days, how many days did you use any of the following drugs:  \n
\n
\n"], ["536", "
\n5. You have $100 and you go to the store and buy a dozen apples for $3 and a tricycle for $20. \n
\n
\n"], ["537", "
\n8. I am going to give you a series of numbers and I would like you to give them to me backwards. For example, if I say 42, you would say 24. \n
\n
\n"], ["538", "
\n9. Draw a circle for the patient. This is a clock face. Please put in the hour markers and the time at ten minutes to eleven o'clock. \n
\n
\n"], ["539", "
\n10. Draw a square, triangle and rectangle, all of the same height for the patient. The rectangle should be half the width of the square. \n
\n
\n"], ["54", "
\nDuring the PAST 4 WEEKS, have you had any of the following problems with\nyour work or other regular daily activities AS A RESULT OF YOUR PHYSICAL\nHEALTH?\n
\n
\n"], ["540", "
\n11. I am going to tell you a story. Please listen carefully because afterwards, I'm going to ask you some questions about it. \n
\n
\n"], ["541", "
\nWe are going to use the term "mental illness" in the rest of this questionnaire, but please think of it as whatever you feel is the best term for it.  \n
\n
\n"], ["542", "
\n5. You have $100 and you go to the store and buy a dozen apples for $3 and a tricycle for $20.  \n
\n
\n"], ["543", "
\n8. I am going to give you a series of numbers and I would like you to give them to me backwards. For example, if I say 42, you would say 24.  \n
\n
\n"], ["544", "
\n9. (Draw a circle for the patient.) This is a clock face. Please put in the hour markers and the time at ten minutes to eleven o'clock.  \n
\n
\n"], ["545", "
\n10. (Draw a square, triangle and rectangle, all of the same height for the patient. The rectangle should be half the width of the square.)  \n
\n
\n"], ["546", "
\n11. I am going to tell you a story. Please listen carefully because afterwards, I'm going to ask you some questions about it.  \n
\n
\n"], ["547", "
\nSelf-directed violence is behavior that is self-directed and deliberately results in injury or the potential for injury to oneself. Please note: Behavior that is potentially harmful (e.g. holding a  \nloaded gun in one's mouth) should be classified as self-directed violence.  \n
\n
\n"], ["548", "
\nSuicidal intent: There is past or present evidence (explicit and/or implicit) that the patient wished to die, meant to kill him/herself, and understands the probable consequences of his/her actions  \nor potential actions. Suicidal intent can be determined retrospectively  \n
\n
\n"], ["549", "
\nInstructions|This is a standard set of questions about several areas of your life such as your health, alcohol and drug use, etc. The questions generally ask about the past 30 days. Please consider  \neach question and answer as accurately as possible.|  \n
\n
\n"], ["55", "
\nDuring the PAST 4 WEEKS, have you had any of the following problems with\nyour work or other regular daily activities AS A RESULT OF ANY EMOTIONAL\nPROBLEMS (such as feeling depressed or anxious)?\n
\n
\n"], ["550", "
\n7. In the past 30 days, how many days did you use any of the following drugs:  \n
\n
\n"], ["551", "
\nSelf-directed violence is behavior that is self-directed and deliberately results in injury or the potential for injury to oneself. Please note: Behavior that is potentially harmful (e.g. holding a  \nloaded gun in one's mouth) should be classified as self-directed violence.  \n
\n
\n"], ["552", "
\nSuicidal intent: There is past or present evidence (explicit and/or implicit) that the patient wished to die, meant to kill him/herself, and understands the probable consequences of his/her actions  \nor potential actions. Suicidal intent can be determined retrospectively  \n
\n
\n"], ["553", "
\nSelf-directed violence is behavior that is self-directed and deliberately results in injury or the potential for injury to oneself. Please note: Behavior that is potentially harmful (e.g. holding a  \nloaded gun in one's mouth) should be classified as self-directed violence.  \n
\n
\n"], ["554", "
\nSuicidal intent: There is past or present evidence (explicit and/or implicit) that the patient wished to die, meant to kill him/herself, and understands the probable consequences of his/her actions  \nor potential actions. Suicidal intent can be determined retrospectively  \n
\n
\n"], ["555", "
\nSelf-directed violence is behavior that is self-directed and deliberately results in injury or the potential for injury to oneself. Please note: Behavior that is potentially harmful (e.g. holding a  \nloaded gun in one's mouth) should be classified as self-directed violence. \n
\n
\n"], ["556", "
\nSuicidal intent: There is past or present evidence (explicit and/or implicit) that the patient wished to die, meant to kill him/herself, and understands the probable consequences of his/her actions  \nor potential actions. Suicidal intent can be determined retrospectively \n
\n
\n"], ["557", "
\nThis survey asks about how you are feeling and doing in different areas of life. Please check the item that best describes yourself during the PAST WEEK. Please answer every question. If you are   \nunsure about how to answer, please give the best answer you can. During the PAST WEEK, how much difficulty did you have. . .   \n
\n
\n"], ["558", "
\nDuring the PAST WEEK, how much of the time did you. . .  \n
\n
\n"], ["559", "
\nDuring the PAST WEEK, how often did you. . .  \n
\n
\n"], ["56", "
\nThese questions are about how you feel and how things have been with you\nDURING THE PAST 4 WEEKS.  For each question, please give the one answer\nthat comes closest to the way you have been feeling.\n \nHow much of the time during the PAST 4 WEEKS:\n
\n
\n"], ["560", "
\nDuring the PAST WEEK, how often. . .  \n
\n
\n"], ["561", "
\nThis survey asks about how you are feeling and doing in different areas of life. Please check the item that best describes yourself during the PAST WEEK. Please answer every question. If you are   \nunsure about how to answer, please give the best answer you can. During the PAST WEEK, how much difficulty did you have. . .   \n
\n
\n"], ["562", "
\nDuring the PAST WEEK, how much of the time did you. . .  \n
\n
\n"], ["563", "
\nDuring the PAST WEEK, how often did you. . .  \n
\n
\n"], ["564", "
\nDuring the PAST WEEK, how often. . .  \n
\n
\n"], ["565", "
\nThis survey asks about how you are feeling and doing in different areas of life. Please check the item that best describes yourself during the PAST WEEK. Please answer every question. If you are   \nunsure about how to answer, please give the best answer you can. During the PAST WEEK, how much difficulty did you have. . . \n
\n
\n"], ["566", "
\nDuring the PAST WEEK, how much of the time did you. . . \n
\n
\n"], ["567", "
\nDuring the PAST WEEK, how often did you. . . \n
\n
\n"], ["568", "
\nDuring the PAST WEEK, how often. . . \n
\n
\n"], ["569", "
\nThis survey asks about how you are feeling and doing in different areas of life. Please check the item that best describes yourself during the PAST WEEK. Please answer every question. If you are   \nunsure about how to answer, please give the best answer you can. During the PAST WEEK, how much difficulty did you have. . . \n
\n
\n"], ["57", "
\nHow TRUE or FALSE is each of the following statements for you?\n
\n
\n"], ["570", "
\nDuring the PAST WEEK, how much of the time did you. . . \n
\n
\n"], ["571", "
\nDuring the PAST WEEK, how often did you. . . \n
\n
\n"], ["572", "
\nDuring the PAST WEEK, how often. . . \n
\n
\n"], ["573", "
\nThis survey asks about how you are feeling and doing in different areas of life. Please check the item that best describes yourself during the PAST WEEK. Please answer every question. If you are   \nunsure about how to answer, please give the best answer you can. During the PAST WEEK, how much difficulty did you have. . .  \n
\n
\n"], ["574", "
\nDuring the PAST WEEK, how much of the time did you. . .  \n
\n
\n"], ["575", "
\nDuring the PAST WEEK, how often did you. . .  \n
\n
\n"], ["576", "
\nDuring the PAST WEEK, how often. . .  \n
\n
\n"], ["577", "
\nThis survey asks about how you are feeling and doing in different areas of life. Please check the item that best describes yourself during the PAST WEEK. Please answer every question. If you are   \nunsure about how to answer, please give the best answer you can. During the PAST WEEK, how much difficulty did you have. . .  \n
\n
\n"], ["578", "
\nDuring the PAST WEEK, how much of the time did you. . .  \n
\n
\n"], ["579", "
\nDuring the PAST WEEK, how often did you. . .  \n
\n
\n"], ["58", "
\nPlease read each item carefully and select the correct answer for you.\n
\n
\n"], ["580", "
\nDuring the PAST WEEK, how often. . .  \n
\n
\n"], ["581", "
\nInstructions|This is a standard set of questions about several areas of your life such as your health, alcohol and drug use, etc. The questions generally ask about the past 30 days. Please consider  \neach question and answer as accurately as possible.|  \n
\n
\n"], ["582", "
\n7. In the past 30 days, how many days did you use any of the following drugs:  \n
\n
\n"], ["583", "
\nEach item below is a belief statement about your medical condition with which you may agree or disagree. Each statement has a scale which ranges from strongly disagree (1) to strongly agree (6). For  \neach item we would like you to pick the number that represents the extent to which you agree or disagree with that statement. The more you agree with a statement, the higher will be the number you  \npick. The more you disagree with a statement, the lower will be the number you pick. Please make sure that you answer EVERY ITEM. This is a measure of your personal beliefs; obviously, there are no  \nright or wrong answers. \n
\n
\n"], ["584", "
\nThe FAST scale is a functional scale designed to evaluate patients at the more moderate-severe stages of dementia when the MMSE no longer can reflect changes in a meaningful clinical way. In the \nearly stages the patient may be able to participate in the FAST administration but usually the information should be collected from a caregiver or, in the case of nursing home care, the nursing home \nstaff. The FAST Stage is the highest consecutive level of disability.  For clinical purposes, in addition to staging the level of disability, additional, non-ordinal (nonconsecutive) deficits should \nbe noted, since these additional deficits are of clear clinical relevance.\n
\n
\n"], ["585", "
\nSome of the questions in this questionnaire refer to your "significant other." A significant other is a person with whom you feel closest. This includes anyone that you relate to on a regular or  \ninfrequent basis. It is very important that you identify someone as your "significant other."  \n
\n
\n"], ["586", "
\nIn the following 20 questions, you will be asked to describe your pain and how it affects your life. Under each question is a scale to record your answer. Read each question carefully and then select  \nthe number on the scale to indicate how that specific question applies to you. You can click on the number with the mouse or enter the number on the key board.  \n
\n
\n"], ["587", "
\nIn this section, we are interested in knowing how your significant other (this refers to the person you indicated above) responds to you when he or she knows you are in pain. On the scale listed  \nbelow each question, indicate HOW OFTEN your significant other generally responds to you in that particular way WHEN YOU ARE IN PAIN.  \n
\n
\n"], ["588", "
\nListed below are 18 common daily activities. Please indicate HOW OFTEN you do each of these activities by selecting a number on the scale below each activity. Please complete ALL 18 questions.  \n
\n
\n"], ["589", "
\nInstructions: Below is a list of statements and questions about experiences people might have with their therapy or therapist. Think about your experience in therapy, and decide which category best  \ndescribes your own experience. Please click on your choice or use a number key to indicate your answer. IMPORTANT!!! Please take your time to consider each question carefully. \n
\n
\n"], ["59", "
\nA number of statements which people have used to describe themselves\nwill be given.  Read each statement and indicate how you feel Right\nnow, that is, At This Moment.  There are no right or wrong answers.\nDo not spend too much time on any one statement, but give the answer\nwhich seems to describe your present feelings best.\n
\n
\n"], ["590", "
\nBelow is a list of problems and complaints that people sometimes have in response to stressful life experiences. Please read each one carefully and indicate how much you have been bothered by that  \nproblem IN THE PAST MONTH.  \n
\n
\n"], ["591", "
\nBelow is a list of problems and complaints that people sometimes have in response to stressful life experiences. Please read each one carefully and indicate how much you have been bothered by that  \nproblem IN THE PAST MONTH. \n
\n
\n"], ["592", "
\nBelow is a list of problems and complaints that people sometimes have in response to stressful life experiences. Please read each one carefully and indicate how much you have been bothered by that  \nproblem IN THE PAST MONTH.  \n
\n
\n"], ["593", "
\nInstructions: Below is a list of statements and questions about experiences people might have with their therapy or therapist. Think about your experience in therapy, and decide which category best  \ndescribes your own experience. Please click on your choice or use a number key to indicate your answer. IMPORTANT!!! Please take your time to consider each question carefully.  \n
\n
\n"], ["594", "
\nBelow is a list of problems and complaints that people sometimes have in response to stressful life experiences. Please read each one carefully and indicate how much you have been bothered by that  \nproblem IN THE PAST MONTH.  \n
\n
\n"], ["595", "
\nInstructions: Below is a list of statements and questions about experiences people might have with their therapy or therapist. Think about your experience in therapy, and decide which category best  \ndescribes your own experience. Please click on your choice or use a number key to indicate your answer. IMPORTANT!!! Please take your time to consider each question carefully.  \n
\n
\n"], ["596", "
\nInstructions: Below is a list of statements and questions about experiences people might have with their therapy or therapist. Think about your experience in therapy, and decide which category best  \ndescribes your own experience. Please click on your choice or use a number key to indicate your answer. IMPORTANT!!! Please take your time to consider each question carefully.  \n
\n
\n"], ["597", "
\nSelf-directed violence is behavior that is self-directed and deliberately results in injury or the potential for injury to oneself. Please note: Behavior that is potentially harmful (e.g. holding a  \nloaded gun in one's mouth) should be classified as self-directed violence.  \n
\n
\n"], ["598", "
\nSuicidal intent: There is past or present evidence (explicit and/or implicit) that the patient wished to die, meant to kill him/herself, and understands the probable consequences of his/her actions  \nor potential actions. Suicidal intent can be determined retrospectively  \n
\n
\n"], ["599", "
\nDuring the past 4 weeks, how much have you been bothered by any of the following problems? \n
\n
\n"], ["6", "
\nPlease read each item carefully and select the correct answer for you.\n
\n
\n"], ["60", "
\nA number of statements which people have used to describe themselves\nwill be given.  Read each statement and indicate how you Generally\nfeel.  There are no right or wrong answers.  Do not spend too much\ntime on any one statement, but give the answer which seems to describe\nhow you generally feel.\n
\n
\n"], ["600", "
\nBelow you will find a list of statements. Please rate how true each statement is for you. \n
\n
\n"], ["601", "
\nPlease rate each of the following statements using the scale provided.  Select the number that best describes your own opinion of what is generally true for you. \n
\n
\n"], ["602", "
\nPlease answer the items according to how you've felt in the last week.  || Select AGREE if you mostly agree that the item describes you; | Select DISAGREE if you mostly\ndisagree that the item describes you.\n
\n
\n"], ["603", "
\n1. I am going to give you a name and address. After I have said it, I want you to repeat it. Remember this name and address because I am going to ask you to tell it to me again in a few minutes: John  \nBrown, 42 West Street, Kensington. (Allow a maximum of 4 attempts to memorize.) \n
\n
\n"], ["604", "
\nWhat was the name and address I asked you to remember? \n
\n
\n"], ["605", "
\n1. I am going to give you a name and address. After I have said it, I want you to repeat it. Remember this name and address because I am going to ask you to tell it to me again in a few minutes: John  \nBrown, 42 West Street, Kensington. (Allow a maximum of 4 attempts to memorize.)  \n
\n
\n"], ["606", "
\nWhat was the name and address I asked you to remember?  \n
\n
\n"], ["607", "
\nI am going to give you a name and address. After I have said it, I want you to repeat it. Remember this name and address because I am going to ask you to tell it to me again in a few minutes: John  \nBrown, 42 West Street, Kensington. (Allow a maximum of 4 attempts to memorize.)  \n
\n
\n"], ["608", "
\nWhat was the name and address I asked you to remember?  \n
\n
\n"], ["609", "
\nInstruct the patient to listen carefully and repeat the following:|APPLE  WATCH  PENNY \n
\n
\n"], ["61", "
\nThe following statements describe attitudes toward the role\nof women in society that different people have. There are\nno right or wrong answers, only opinions.\n
\n
\n"], ["610", "
\nStep 1: Three Word Registration||Look directly at person and say, "Please listen carefully. I am going to say three words that I want you to repeat back\n to me now and try to remember. The words are [select a list of words from the versions below]. Please say them for me now." If the person is unable to repeat the words after three attempts, move on to Step 2 (clock drawing).\n||The following and other word lists have been used in one or more clinical studies. For repeated administrations, use of an alternative word list is recommended.|\n|Version 1: Banana, Sunrise, Chair|Version 2: Leader, Season, Table|Version 3: Village, Kitchen, Baby|Version 4: River, Nation, Finger|Version 5: Captain, Garden, Picture|Version 6: Daughter, Heaven, Mountain\n
\n
\n"], ["611", "
\nThe administration of the Montreal Cognitive Assessment requires the use of a pencil-and-paper answer sheet. This instrument is used to record the clinician's scores of the administration which will  \nbe saved in Vista for reports. \n
\n
\n"], ["612", "
\n3. Draw a clock. Put in all the numbers and set the time to 10 past 11. \n
\n
\n"], ["613", "
\n4. Naming pictured animal. \n
\n
\n"], ["614", "
\nRead list of words to be recalled.||5. Attention \n
\n
\n"], ["615", "
\n6. Language \n
\n
\n"], ["616", "
\n8. Abstraction \n
\n
\n"], ["617", "
\n9. Delayed Recall \n
\n
\n"], ["618", "
\n10. Orientation \n
\n
\n"], ["619", "
\nThe administration of the Montreal Cognitive Assessment requires the use of a pencil-and-paper answer sheet. Please be familiar with the instructions and scoring of this instrument proir to  \nadministration. The subject's scores are recorded here so that the administration can saved in Vista. \n
\n
\n"], ["62", "
\nIntroduction for 2. \n
\n
\n"], ["620", "
\n3. Draw a clock. Put in all the numbers and set the time to 10 past 11. \n
\n
\n"], ["621", "
\n4. Naming pictured animal. \n
\n
\n"], ["622", "
\nRead list of words to be recalled.||5. Attention \n
\n
\n"], ["623", "
\n6. Language \n
\n
\n"], ["624", "
\n8. Abstraction \n
\n
\n"], ["625", "
\n9. Delayed Recall \n
\n
\n"], ["626", "
\n10. Orientation \n
\n
\n"], ["627", "
\nThe administration of the Montreal Cognitive Assessment requires the use of a pencil-and-paper answer sheet. Please be familiar with the instructions and scoring of this instrument proir to  \nadministration. The subject's scores are recorded here so that the administration can saved in Vista.  \n
\n
\n"], ["628", "
\n3. Draw a clock. Put in all the numbers and set the time to 10 past 11.  \n
\n
\n"], ["629", "
\n4. Naming pictured animal.  \n
\n
\n"], ["63", "
\n Following are statements about wards. Please decide which statements\n are true of your ward and which are not.\n
\n
\n"], ["630", "
\nRead list of words to be recalled.||5. Attention  \n
\n
\n"], ["631", "
\n6. Language  \n
\n
\n"], ["632", "
\n8. Abstraction  \n
\n
\n"], ["633", "
\n9. Delayed Recall  \n
\n
\n"], ["634", "
\n10. Orientation  \n
\n
\n"], ["635", "
\n1. Orientation. I would now like to examine your memory and related items. Please relax, pay attention to the questions I am asking, and answer them as best as you can. \n
\n
\n"], ["636", "
\n2. Attention \n
\n
\n"], ["637", "
\n4. Calculation \n
\n
\n"], ["638", "
\n5. Abstraction \n
\n
\n"], ["639", "
\n6. Draw a clock face showing 11:15. \n
\n
\n"], ["64", "
\nRead each statement and indicate how you generally feel.\n
\n
\n"], ["640", "
\n1. Orientation. I would now like to examine your memory and related items. Please relax, pay attention to the questions I am asking, and answer them as best as you can. \n
\n
\n"], ["641", "
\n2. Attention \n
\n
\n"], ["642", "
\n4. Calculation \n
\n
\n"], ["643", "
\n5. Abstraction \n
\n
\n"], ["644", "
\n6. Draw a clock face showing 11:15. \n
\n
\n"], ["645", "
\n1. Orientation. I would now like to examine your memory and related items. Please relax, pay attention to the questions I am asking, and answer them as best as you can. \n
\n
\n"], ["646", "
\n2. Attention \n
\n
\n"], ["647", "
\n4. Calculation \n
\n
\n"], ["648", "
\n5. Abstraction \n
\n
\n"], ["649", "
\n6. Draw a clock face showing 11:15. \n
\n
\n"], ["65", "
\nFor the following 20 items, please select the choice that best\ndescribes how you have felt over the past week:\n
\n
\n"], ["650", "
\n8. Information \n
\n
\n"], ["651", "
\n9. Recall words \n
\n
\n"], ["652", "
\n1. Orientation. I would now like to examine your memory and related items. Please relax, pay attention to the questions I am asking, and answer them as best as you can.  \n
\n
\n"], ["653", "
\n2. Attention  \n
\n
\n"], ["654", "
\n3. Immediate recall   \n
\n
\n"], ["655", "
\n4. Calculation  \n
\n
\n"], ["656", "
\n5. Abstraction  \n
\n
\n"], ["657", "
\n6. Draw a clock face showing 11:15.  \n
\n
\n"], ["658", "
\n8. Information  \n
\n
\n"], ["659", "
\n9. Recall words  \n
\n
\n"], ["66", "
\nIntroduction for 2. \n
\n
\n"], ["660", "
\n1. Orientation. I would now like to examine your memory and related items. Please relax, pay attention to the questions I am asking, and answer them as best as you can.  \n
\n
\n"], ["661", "
\n2. Attention  \n
\n
\n"], ["662", "
\n3. Immediate recall   \n
\n
\n"], ["663", "
\n4. Calculation  \n
\n
\n"], ["664", "
\n5. Abstraction  \n
\n
\n"], ["665", "
\n6. Draw a clock face showing 11:15.  \n
\n
\n"], ["666", "
\n8. Information  \n
\n
\n"], ["667", "
\n9. Recall words  \n
\n
\n"], ["668", "
\nInstructions: This questionnaire asks for your views about your health.  This information will help keep track of how you feel and how well you are able to do your usual activities. Answer every  \nquestion by marking the answer as indicated.  If you are unsure how to answer a question, please give the best answer you can. \n
\n
\n"], ["669", "
\n2. The following questions are about activities you might do during a typical day. Does your health now limit you in these activities?  If so, how much? \n
\n
\n"], ["67", "
\nFollowing are items concerning the way in which certain important events\nin our society affect different people.\n \nEach item consists of a pair of alternatives numbered 1 and 2. Please\nselect the one statement of each pair which you more strongly believe to\nbe the case as far as you're concerned.\n
\n
\n"], ["670", "
\n3. During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as a result of your physical health? \n
\n
\n"], ["671", "
\n4. During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as a result of any emotional problems (such as feeling depressed or anxious)? \n
\n
\n"], ["672", "
\n6.  How much of the time during the past 4 weeks: \n
\n
\n"], ["673", "
\nNow, we'd like to ask you some questions about how your health may have changed. \n
\n
\n"], ["674", "
\nInstructions: This questionnaire asks for your views about your health. This information will help keep track of how you feel and how well you are able to do your usual activities. Answer every  \nquestion by marking the answer as indicated. If you are unsure how to answer a question, please give the best answer you can.  \n
\n
\n"], ["675", "
\n2. The following questions are about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much?  \n
\n
\n"], ["676", "
\n3. During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as a result of your physical health?  \n
\n
\n"], ["677", "
\n4. During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as a result of any emotional problems (such as feeling depressed or anxious)?  \n
\n
\n"], ["678", "
\n6. How much of the time during the past 4 weeks:  \n
\n
\n"], ["679", "
\nNow, we'd like to ask you some questions about how your health may have changed.  \n
\n
\n"], ["68", "
\nIntroduction for 2. \n
\n
\n"], ["680", "
\nInstructions: This questionnaire asks for your views about your health. This information will help keep track of how you feel and how well you are able to do your usual activities. Answer every \nquestion by marking the answer as indicated. If you are unsure how to answer a question, please give the best answer you can.  \n
\n
\n"], ["681", "
\n2. The following questions are about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much?  \n
\n
\n"], ["682", "
\n3. During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as a result of your physical health?  \n
\n
\n"], ["683", "
\n4. During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as a result of any emotional problems (such as feeling depressed or anxious)?  \n
\n
\n"], ["684", "
\n6. How much of the time during the past 4 weeks:  \n
\n
\n"], ["685", "
\nNow, we'd like to ask you some questions about how your health may have changed.  \n
\n
\n"], ["686", "
\nThe administration of the Montreal Cognitive Assessment requires the use of a pencil-and-paper answer sheet. Please be familiar with the instructions and scoring of this instrument proir to  \nadministration. The subject's scores are recorded here so that the administration can saved in Vista.  \n
\n
\n"], ["687", "
\n3. Draw a clock. Put in all the numbers and set the time to 10 past 11.  \n
\n
\n"], ["688", "
\n4. Naming pictured animal.  \n
\n
\n"], ["689", "
\nRead list of words to be recalled.||5. Attention  \n
\n
\n"], ["69", "
\nHave you ever had any experience that was so frightening, horrible\n or upsetting that, IN THE PAST MONTH, you:\n
\n
\n"], ["690", "
\n6. Language  \n
\n
\n"], ["691", "
\n8. Abstraction  \n
\n
\n"], ["692", "
\n9. Delayed Recall  \n
\n
\n"], ["693", "
\n10. Orientation  \n
\n
\n"], ["694", "
\nThe administration of the Montreal Cognitive Assessment requires the use of a pencil-and-paper answer sheet. Please be familiar with the instructions and scoring of this instrument proir to  \nadministration. The subject's scores are recorded here so that the administration can saved in Vista.  \n
\n
\n"], ["695", "
\n3. Draw a clock. Put in all the numbers and set the time to 5 past 4.  \n
\n
\n"], ["696", "
\n4. Naming pictured animal.  \n
\n
\n"], ["697", "
\nRead list of words to be recalled.||5. Attention  \n
\n
\n"], ["698", "
\n6. Language  \n
\n
\n"], ["699", "
\n8. Abstraction  \n
\n
\n"], ["7", "
\nThis questionnaire has been designed to help people better understand\nsome of the many factors associated with drinking.  In order for the\nquestionnaire to serve this purpose for you, it is important that you\nanswer the questions as accurately as you can.  This may be difficult\nfor some of the questions.  In such cases simply do your best to\nprovide the most accurate answer you can.  Answer all questions.\n
\n
\n"], ["70", "
\nIntroduction for 2. \n
\n
\n"], ["700", "
\n9. Delayed Recall  \n
\n
\n"], ["701", "
\n10. Orientation  \n
\n
\n"], ["702", "
\nThe administration of the Montreal Cognitive Assessment requires the use of a pencil-and-paper answer sheet. Please be familiar with the instructions and scoring of this instrument proir to  \nadministration. The subject's scores are recorded here so that the administration can saved in Vista.  \n
\n
\n"], ["703", "
\n3. Draw a clock. Put in all the numbers and set the time to 10 past 11.  \n
\n
\n"], ["704", "
\n4. Naming pictured animal.  \n
\n
\n"], ["705", "
\nRead list of words to be recalled.||5. Attention  \n
\n
\n"], ["706", "
\n6. Language  \n
\n
\n"], ["707", "
\n8. Abstraction  \n
\n
\n"], ["708", "
\nTerms used in the next item. COMPLETELY LIMITED: Unresponsive (doesn't moan, flinch, or gasp) to painful stimuli due to diminished level of consciousness or sedation or limited ability to feel pain \nover most of body. VERY LIMITED: Responds only to painful stimuli. Cannot communicate discomfort except by moaning or restlessness or has a sensory impairment that limits the ability to feel pain or \ndiscomfort over half of body. SLIGHTLY LIMITED: Responds to verbal commands, but cannot always communicate discomfort of the need to be turned or has some sensory impairment that limits ability to \nfeel pain or discomfort in one or two extremities. NO IMPAIRMENT: Responds to verbal commands. Has no sensory deficit that would limit ability to feel pain or voice pain or discomfort.\n
\n
\n"], ["709", "
\n9. Delayed Recall  \n
\n
\n"], ["71", "
\nIntroduction for 2. \n
\n
\n"], ["710", "
\n10. Orientation  \n
\n
\n"], ["711", "
\nThe administration of the Montreal Cognitive Assessment requires the use of a pencil-and-paper answer sheet. Please be familiar with the instructions and scoring of this instrument proir to  \nadministration. The subject's scores are recorded here so that the administration can saved in Vista.  \n
\n
\n"], ["712", "
\n3. Draw a clock. Put in all the numbers and set the time to 10 past 9.  \n
\n
\n"], ["713", "
\n4. Naming pictured animal.  \n
\n
\n"], ["714", "
\nRead list of words to be recalled.||5. Attention  \n
\n
\n"], ["715", "
\n6. Language  \n
\n
\n"], ["716", "
\n8. Abstraction  \n
\n
\n"], ["717", "
\n9. Delayed Recall  \n
\n
\n"], ["718", "
\n10. Orientation  \n
\n
\n"], ["719", "
\nThe administration of the Montreal Cognitive Assessment requires the use of a pencil-and-paper answer sheet. Please be familiar with the instructions and scoring of this instrument proir to  \nadministration. The subject's scores are recorded here so that the administration can saved in Vista.  \n
\n
\n"], ["72", "
\nDuring the PAST WEEK, how much of the time did you. . . \n
\n
\n"], ["720", "
\n3. Draw a clock. Put in all the numbers and set the time to 5 past 4.  \n
\n
\n"], ["721", "
\n4. Naming pictured animal.  \n
\n
\n"], ["722", "
\nRead list of words to be recalled.||5. Attention  \n
\n
\n"], ["723", "
\n6. Language  \n
\n
\n"], ["724", "
\n8. Abstraction  \n
\n
\n"], ["725", "
\n9. Delayed Recall  \n
\n
\n"], ["726", "
\n10. Orientation  \n
\n
\n"], ["727", "
\nThe administration of the Montreal Cognitive Assessment requires the use of a pencil-and-paper answer sheet. Please be familiar with the instructions and scoring of this instrument proir to  \nadministration. The subject's scores are recorded here so that the administration can saved in Vista.  \n
\n
\n"], ["728", "
\n3. Draw a clock. Put in all the numbers and set the time to 10 past 9.  \n
\n
\n"], ["729", "
\n4. Naming pictured animals.  \n
\n
\n"], ["73", "
\nDuring the PAST WEEK, how often did you. . .\n
\n
\n"], ["730", "
\nRead list of words to be recalled.||5. Attention  \n
\n
\n"], ["731", "
\n6. Language  \n
\n
\n"], ["732", "
\n8. Abstraction  \n
\n
\n"], ["733", "
\n9. Delayed Recall  \n
\n
\n"], ["734", "
\n10. Orientation  \n
\n
\n"], ["735", "
\nChoose the scoring point for the statement that most closely corresponds to the patient's current level of ability for each of the following 10 items. Record actual, not potential, functioning.  \nInformation can be obtained from the patient's self-report, from a separate party who is familiar with the patient's abilities (such as a relative), or from observation. \n
\n
\n"], ["736", "
\nThis questionnaire asks about difficulties due to health conditions. Health conditions include diseases or illnesses, other health problems that may be short or long lasting, injuries, mental or \nemotional problems, and problems with alcohol or drugs.|Think back over the past 30 days and answer these questions, thinking about how much difficulty you had doing the following activities. In the \npast 30 days, how much DIFFICULTY did you have in: \n
\n
\n"], ["737", "
\nBelow is a list of statements that describe how people sometimes feel about themselves and their lives.  Please read each one carefully and indicate the response that best describes the extent to  \nwhich you agree or disagree with the statement. \n
\n
\n"], ["738", "
\nBelow is a list of statements that describe how people sometimes feel about themselves and their lives. Please read each one carefully and indicate the response that best describes the extent to  \nwhich you agree or disagree with the statement.  \n
\n
\n"], ["739", "
\nPPS may be used for several purposes. First, it is an excellent communication tool for quickly describing a patient's current functional level. Second, it may have value in criteria for work load  \nassessment or other measurements and comparisons. Finally, it appears to have prognostic value.||First choose the appropriate ambulation level then continue responding to each question until all are  \nanswered. All five questions must be answered before assigning the actual PPS for that patient. The first questions answered are 'stronger' determinants and generally take precedence over  the others  \nin assigning a PPS score. \n
\n
\n"], ["74", "
\nDuring the PAST WEEK, how often. . .\n
\n
\n"], ["740", "
\nPPS may be used for several purposes. It is an excellent communication tool for quickly describing a patient's current functional level. Additionally, it may have value in criteria for work load  \nassessment or other measurements and comparisons. Finally, it appears to have prognostic value.||First choose the appropriate ambulation level then continue responding to each question until all are  \nanswered. All five questions must be answered before assigning the actual PPS for that patient. The first questions answered are 'stronger' determinants and generally take precedence over  the others  \nin assigning a PPS score. \n
\n
\n"], ["741", "
\nPPS scores are determined by reading horizontally at each level to find a 'best fit' for the patient which is then|assigned as the PPS% score.|2. Begin at the left column and read downwards until the  \nappropriate ambulation level is reached, then read across|to the next column and downwards again until the activity/evidence of disease is located. These steps are|repeated until all five columns are  \ncovered before assigning the actual PPS for that patient. In this way, 'leftward'|columns (columns to the left of any specific column) are 'stronger' determinants and generally take precedence|over  \nothers. \n
\n
\n"], ["742", "
\nPPS scores are determined by answering questions from the first to last to find a 'best fit' for the patient which is then assigned as the PPS% score.  Enter the appropriate ambulation level and then  \nrespoind with the activity/evidence of disease. After all questions are answered the actual PPS score can be assigned for that patient. \n
\n
\n"], ["743", "
\nIntroduction:  \n
\n
\n"], ["744", "
\nPPS scores are determined by answering questions from the first to last to find a 'best fit' for the patient which is then assigned as the PPS% score.  Enter the appropriate ambulation level and then  \nrespoind with the activity/evidence of disease. After all questions are answered the actual PPS score can be assigned for that patient. \n
\n
\n"], ["745", "
\nIntroduction:  \n
\n
\n"], ["746", "
\nIntroduction:  \n
\n
\n"], ["747", "
\nPPS scores are determined by responding to each question as asked to find a 'best fit' for the patient which is then assigned as the PPS% score.  Begin with the first question, Ambulation, and then  \ncontinue with the Activity/evidence of disease. Respond to each question until all have been completed.  In this way, questions that are 'stronger' determinants and generally take precedence over  \nothers are asked first.  Once all questions have been answered a PPS score can be assigned.  \n
\n
\n"], ["748", "
\nPPS scores are determined by responding to each question as asked to find a 'best fit' for the patient which is then assigned as the PPS% score.  Begin with the first question, Ambulation, and then  \ncontinue with the Activity/evidence of disease. Respond to each question until all have been completed.  In this way, questions that are 'stronger' determinants and generally take precedence over  \nothers are asked first.  Once all questions have been answered a PPS score can be assigned.  \n
\n
\n"], ["749", "
\nPPS scores are determined by responding to each question as asked to find a 'best fit' for the patient which is then assigned as the PPS% score.  Begin with the first question, Ambulation, and then  \ncontinue with the Activity/evidence of disease. Respond to each question until all have been completed.  In this way, questions that are 'stronger' determinants and generally take precedence over  \nothers are asked first.  Once all questions have been answered a PPS score can be assigned.  \n
\n
\n"], ["75", "
\nThis text is an example of an introduction\n
\n
\n"], ["750", "
\nPPS scores are determined by responding to each question as asked to find a 'best fit' for the patient which is then assigned as the PPS% score. Begin with the first question, Ambulation, and then   \ncontinue with the Activity/evidence of disease. Respond to each question until all have been completed. In this way, questions that are 'stronger' determinants and generally take precedence over   \nothers are asked first. Once all questions have been answered a PPS score can be assigned.  \n
\n
\n"], ["751", "
\nPPS scores are determined by responding to each question as asked to find a 'best fit' for the patient which is then assigned as the PPS% score. Begin with the first question, Ambulation, and then   \ncontinue with the Activity/evidence of disease. Respond to each question until all have been completed. In this way, questions that are 'stronger' determinants and generally take precedence over   \nothers are asked first. Once all questions have been answered a PPS score can be assigned.  \n
\n
\n"], ["752", "
\nPPS scores are determined by responding to each question as asked to find a 'best fit' for the patient which is then assigned as the PPS% score. Begin with the first question, Ambulation, and then   \ncontinue with the Activity/evidence of disease. Respond to each question until all have been completed. In this way, questions that are 'stronger' determinants and generally take precedence over   \nothers are asked first. Once all questions have been answered a PPS score can be assigned.  \n
\n
\n"], ["753", "
\nPPS scores are determined by responding to each question as asked to find a 'best fit' for the patient which is then assigned as the PPS% score.  Begin with the first question, Ambulation, and then   \ncontinue with the Activity/evidence of disease. Respond to each question until all have been completed. In this way, questions that are 'stronger' determinants and generally take precedence over   \nothers are asked first. Once all questions have been answered a PPS score can be assigned.  \n
\n
\n"], ["754", "
\nPPS scores are determined by responding to each question as asked to find a 'best fit' for the patient which is then assigned as the PPS% score.  Begin with the first question, Ambulation, and then   \ncontinue with the Activity/evidence of disease. Respond to each question until all have been completed. In this way, questions that are 'stronger' determinants and generally take precedence over   \nothers are asked first. Once all questions have been answered a PPS score can be assigned.  \n
\n
\n"], ["755", "
\nPPS scores are determined by responding to each question as asked to find a 'best fit' for the patient which is then assigned as the PPS% score. Begin with the first question, Ambulation, and then   \ncontinue with the Activity/evidence of disease. Respond to each question until all have been completed. In this way, questions that are 'stronger' determinants and generally take precedence over   \nothers are asked first. Once all questions have been answered a PPS score can be assigned.  \n
\n
\n"], ["756", "
\nPPS scores are determined by responding to each question as asked to find a 'best fit' for the patient which is then assigned as the PPS% score. Begin with the first question, Ambulation, and then   \ncontinue with the Activity of disease. Respond to each question until all have been completed. In this way, questions that are 'stronger' determinants and generally take precedence over  others are  \nasked first. Once all questions have been answered a PPS score can be assigned. \n
\n
\n"], ["757", "
\nRate and fill out each item according to how you feel right now. Then rank in order of importance 1 to 5 (1=most important to 5=least important) for the first five questions. \n
\n
\n"], ["758", "
\nRate and fill out each item according to how you feel right now. Then rank in order of importance 1 to 5 (1 \n
\n
\n"], ["759", "
\nRate and fill out each item according to how you feel right now. Then rank in order of importance 1 to 5 (1 is most important, 5 is least important) the first five questions. \n
\n
\n"], ["76", "
\nIntroduction for 2. \n
\n
\n"], ["760", "
\nRate and fill out each item according to how you feel right now. Then rank in order of importance 1 to 5 (1 is most important, 5 is least important) the first five questions.  \n
\n
\n"], ["761", "
\nPPS scores are determined by responding to each question as asked to find a 'best fit' for the patient which is then assigned as the PPS% score. Begin with the first question, Ambulation, and then   \ncontinue with the Activity of disease. Respond to each question until all have been completed. In this way, questions that are 'stronger' determinants and generally take precedence over others are   \nasked first. Once all questions have been answered a PPS score can be assigned.  \n
\n
\n"], ["762", "
\nPPS scores are determined by responding to each question as asked to find a 'best fit' for the patient which is then assigned as the PPS% score. Begin with the first question, Ambulation, and then   \ncontinue with the Activity of disease. Respond to each question until all have been completed. In this way, questions that are 'stronger' determinants and generally take precedence over others are   \nasked first. Once all questions have been answered a PPS score can be assigned. \n
\n
\n"], ["763", "
\nPPS scores are determined by responding to each question as asked to find a 'best fit' for the patient which is then assigned as the PPS% score. Begin with the first question, Ambulation, and then   \ncontinue with the Activity of disease. Respond to each question until all have been completed. In this way, questions that are 'stronger' determinants and generally take precedence over others are   \nasked first. Once all questions have been answered a PPS score can be assigned. \n
\n
\n"], ["764", "
\nPPS scores are determined by responding to each question as asked to find a 'best fit' for the patient which is then assigned as the PPS% score. Begin with the first question, Ambulation, and then   \ncontinue with the Activity of disease. Respond to each question until all have been completed. In this way, questions that are 'stronger' determinants and generally take precedence over others are   \nasked first. Once all questions have been answered a PPS score can be assigned.  \n
\n
\n"], ["765", "
\nPPS scores are determined by responding to each question as asked to find a 'best fit' for the patient which is then assigned as the PPS% score. Begin with the first question, Ambulation, and then   \ncontinue with the Activity of disease. Respond to each question until all have been completed. In this way, questions that are 'stronger' determinants and generally take precedence over others are   \nasked first. Once all questions have been answered a PPS score can be assigned.  \n
\n
\n"], ["766", "
\nPPS scores are determined by responding to each question as asked to find a 'best fit' for the patient which is then assigned as the PPS% score. Begin with the first question, Ambulation, and then   \ncontinue with the Activity of disease. Respond to each question until all have been completed. In this way, questions that are 'stronger' determinants and generally take precedence over others are   \nasked first. Once all questions have been answered a PPS score can be assigned.  \n
\n
\n"], ["767", "
\nPPS scores are determined by responding to each question as asked to find a 'best fit' for the patient which is then assigned as the PPS% score. Begin with the first question, Ambulation, and then   \ncontinue with the Activity of disease. Respond to each question until all have been completed. In this way, questions that are 'stronger' determinants and generally take precedence over others are   \nasked first. Once all questions have been answered a PPS score can be assigned.  \n
\n
\n"], ["768", "
\nPPS scores are determined by responding to each question as asked to find a 'best fit' for the patient which is then assigned as the PPS% score. Begin with the first question, Ambulation, and then   \ncontinue with the Activity of disease. Respond to each question until all have been completed. In this way, questions that are 'stronger' determinants and generally take precedence over others are   \nasked first. Once all questions have been answered a PPS score can be assigned.  \n
\n
\n"], ["769", "
\nPPS scores are determined by responding to each question as asked to find a 'best fit' for the patient which is then assigned as the PPS% score. Begin with the first question, Ambulation, and then   \ncontinue with the Activity of disease. Respond to each question until all have been completed. In this way, questions that are 'stronger' determinants and generally take precedence over others are   \nasked first. Once all questions have been answered a PPS score can be assigned.  \n
\n
\n"], ["77", "
\nPlease read each question carefully!\n
\n
\n"], ["770", "
\nPPS scores are determined by responding to each question as asked to find a 'best fit' for the patient which is then assigned as the PPS% score. Begin with the first question, Ambulation, and then   \ncontinue with the Activity of disease. Respond to each question until all have been completed. In this way, questions that are 'stronger' determinants and generally take precedence over others are   \nasked first. Once all questions have been answered a PPS score can be assigned.  \n
\n
\n"], ["771", "
\nPPS scores are determined by responding to each question as asked to find a 'best fit' for the patient which is then assigned as the PPS% score. Begin with the first question, Ambulation, and then   \ncontinue with the Activity of disease. Respond to each question until all have been completed. In this way, questions that are 'stronger' determinants and generally take precedence over others are   \nasked first. Once all questions have been answered a PPS score can be assigned.  \n
\n
\n"], ["772", "
\nPPS scores are determined by responding to each question as asked to find a 'best fit' for the patient which is then assigned as the PPS% score. Begin with the first question, Ambulation, and then   \ncontinue with the Activity of disease. Respond to each question until all have been completed. In this way, questions that are 'stronger' determinants and generally take precedence over others are   \nasked first. Once all questions have been answered a PPS score can be assigned.  \n
\n
\n"], ["773", "
\nPPS scores are determined by responding to each question as asked to find a 'best fit' for the patient which is then assigned as the PPS% score. Begin with the first question, Ambulation, and then   \ncontinue with the Activity of disease. Respond to each question until all have been completed. In this way, questions that are 'stronger' determinants and generally take precedence over others are   \nasked first. Once all questions have been answered a PPS score can be assigned.  \n
\n
\n"], ["774", "
\nPPS scores are determined by responding to each question as asked to find a 'best fit' for the patient which is then assigned as the PPS% score. Begin with the first question, Ambulation, and then   \ncontinue with the Activity of disease. Respond to each question until all have been completed. In this way, questions that are 'stronger' determinants and generally take precedence over others are   \nasked first. Once all questions have been answered a PPS score can be assigned.  \n
\n
\n"], ["775", "
\nPPS scores are determined by responding to each question as asked to find a 'best fit' for the patient which is then assigned as the PPS% score. Begin with the first question, Ambulation, and then   \ncontinue with the Activity of disease. Respond to each question until all have been completed. In this way, questions that are 'stronger' determinants and generally take precedence over others are   \nasked first. Once all questions have been answered a PPS score can be assigned.  \n
\n
\n"], ["776", "
\nPPS scores are determined by responding to each question as asked to find a 'best fit' for the patient which is then assigned as the PPS% score. Begin with the first question, Ambulation, and then   \ncontinue with the Activity of disease. Respond to each question until all have been completed. In this way, questions that are 'stronger' determinants and generally take precedence over others are   \nasked first. Once all questions have been answered a PPS score can be assigned.  \n
\n
\n"], ["777", "
\nPPS scores are determined by responding to each question as asked to find a 'best fit' for the patient which is then assigned as the PPS% score. Begin with the first question, Ambulation, and then   \ncontinue with the Activity of disease. Respond to each question until all have been completed. In this way, questions that are 'stronger' determinants and generally take precedence over others are   \nasked first. Once all questions have been answered a PPS score can be assigned.  \n
\n
\n"], ["778", "
\nPPS scores are determined by responding to each question as asked to find a 'best fit' for the patient which is then assigned as the PPS% score. Begin with the first question, Ambulation, and then   \ncontinue with the Activity of disease. Respond to each question until all have been completed. In this way, questions that are 'stronger' determinants and generally take precedence over others are   \nasked first. Once all questions have been answered a PPS score can be assigned.  \n
\n
\n"], ["779", "
\nPPS scores are determined by responding to each question as asked to find a 'best fit' for the patient which is then assigned as the PPS% score. Begin with the first question, Ambulation, and then   \ncontinue with the Activity of disease. Respond to each question until all have been completed. In this way, questions that are 'stronger' determinants and generally take precedence over others are   \nasked first. Once all questions have been answered a PPS score can be assigned.  \n
\n
\n"], ["78", "
\n1. Some of the questions in this questionnaire refer to your "significant other." A significant other is a person with whom you feel closest. This includes anyone that you relate to on a regular or i \nnfrequent basis. It is very important that you identify someone as your "significant other."\n
\n
\n"], ["780", "
\nPPS scores are determined by responding to each question as asked to find a 'best fit' for the patient which is then assigned as the PPS% score. Begin with the first question, Ambulation, and then   \ncontinue with the Activity of disease. Respond to each question until all have been completed. In this way, questions that are 'stronger' determinants and generally take precedence over others are   \nasked first. Once all questions have been answered a PPS score can be assigned.  \n
\n
\n"], ["781", "
\nPPS scores are determined by responding to each question as asked to find a 'best fit' for the patient which is then assigned as the PPS% score. Begin with the first question, Ambulation, and then   \ncontinue with the Activity of disease. Respond to each question until all have been completed. In this way, questions that are 'stronger' determinants and generally take precedence over others are   \nasked first. Once all questions have been answered a PPS score can be assigned.  \n
\n
\n"], ["782", "
\nPPS scores are determined by responding to each question as asked to find a 'best fit' for the patient which is then assigned as the PPS% score. Begin with the first question, Ambulation, and then   \ncontinue with the Activity of disease. Respond to each question until all have been completed. In this way, questions that are 'stronger' determinants and generally take precedence over others are   \nasked first. Once all questions have been answered a PPS score can be assigned.  \n
\n
\n"], ["783", "
\nPPS scores are determined by responding to each question as asked to find a 'best fit' for the patient which is then assigned as the PPS% score. Begin with the first question, Ambulation, and then   \ncontinue with the Activity of disease. Respond to each question until all have been completed. In this way, questions that are 'stronger' determinants and generally take precedence over others are   \nasked first. Once all questions have been answered a PPS score can be assigned.  \n
\n
\n"], ["784", "
\nPPS scores are determined by responding to each question as asked to find a 'best fit' for the patient which is then assigned as the PPS% score. Begin with the first question, Ambulation, and then   \ncontinue with the Activity of disease. Respond to each question until all have been completed. In this way, questions that are 'stronger' determinants and generally take precedence over others are   \nasked first. Once all questions have been answered a PPS score can be assigned.  \n
\n
\n"], ["785", "
\nHEALTH is being physically fit, not sick, and without pain or disability.| \n
\n
\n"], ["786", "
\nHEALTH is being physically fit, not sick, and without pain or disability. \n
\n
\n"], ["787", "
\nTerms used in next item. CONSTANTLY MOIST: Skin is kept moist almost constantly by perspiration, urine, etc. Dampness is detected every time patient is moved or turned. VERY MOIST: Skin is often, but \n not always, moist. Linen must be changed at least once a shift. OCCASIONALLY MOIST: Skin is occasionally moist, requiring an extra linen change about once a day. RARELY MOIST: Skin is usually dry;  \nlinen requires changing at routine intervals.\n
\n
\n"], ["788", "
\nTerms used in next item. BEDFAST: Confined to bed. CHAIR FAST: Ability to walk severely limited or nonexistent. Cannot bear own weight or must be assisted into chair or wheelchair. WALKS  \nOCCASIONALLY: Walks occasionally during day but for very short distances, with or without assistance. Spends most of each shift in bed or chair. WALKS FREQUENTLY: Walks outside room at least twice a  \nday and inside room at least once every 2 hours during waking hours.\n
\n
\n"], ["789", "
\nTerms used in next item. COMPLETLY IMMOBILE:  Doesn't make even slight changes in body or extremity position without assistance. VERY LIMITED: Makes occasional slight changes in body or extremity \nposition but can't make frequent or significant  changes independently. SLIGHTLY LIMITED: Makes frequent though slight changes in body or extremity position independently. NO LIMITATION: Makes major \nand frequent changes in position without  assistance.\n
\n
\n"], ["79", "
\nIn this section, we are interested in knowing how your significant other (this refers to the person you indicated above) responds to you when he or she knows you are in pain. On the scale listed belo \nw each question, indicate HOW OFTEN your significant other generally responds to you in that particular way WHEN YOU ARE IN PAIN.\n
\n
\n"], ["790", "
\nTerms used in next item. PROBLEM: Requires moderate to maximum assistance \nsufficient muscle strength to lift up completely during move. Maintains\ngood position in bed or chair.\nin moving. Complete lifting without sliding against sheets is impossible.\nFrequently slides down in bed or chair, requiring  frequent respositioning\nwith maximum assistance. Spasticity, contractures, or agitation leads to \nalmost constant friction. POTENTIAL PROBLEM: Moves feebly or requires \nminimum assistance. During a  move, skin probably slides to some extent\nagainst sheets, chair, restraints or other devices. Maintains relatively\ngood position in chair or bed most of the time but occasionally slides\ndown. NO APPARENT PROBLEM: Moves in bed and in chair independently and has\n
\n
\n"], ["791", "
\nSELF-ESTEEM means liking and respecting yourself in light of your strengths and weaknesses, successes and failures, and ability to handle problems. \n
\n
\n"], ["792", "
\nGOAL-AND-VALUES are your beliefs about what matters most in life and how you should live, both now and in the future. This includes your goals in life, what you think is right or wrong, and the  \npurpose or meaning of life as you see it. \n
\n
\n"], ["793", "
\nMONEY is made up of three things. It is the money you earn, the things you own (like a car or furniture), and believing that you will have the money and things that you need in the future. \n
\n
\n"], ["794", "
\nHEALTH is being physically fit, not sick, and without pain or disability. \n
\n
\n"], ["795", "
\nSELF-ESTEEM means liking and respecting yourself in light of your strengths and weaknesses, successes and failures, and ability to handle problems. \n
\n
\n"], ["796", "
\nGOAL-AND-VALUES are your beliefs about what matters most in life and how you should live, both now and in the future. This includes your goals in life, what you think is right or wrong, and the  \npurpose or meaning of life as you see it. \n
\n
\n"], ["797", "
\nMONEY is made up of three things. It is the money you earn, the things you own (like a car or furniture), and believing that you will have the money and things that you need in the future. \n
\n
\n"], ["798", "
\nWORK means your career or how you spend most of your time. You may work at a job, at home taking care of your family, or at school as a student. WORK includes your duties on the job, the money you  \nearn (if any), and the people you work with. (If you are unemployed, retired, or can't work, you can still answer these questions.) \n
\n
\n"], ["799", "
\nPLAY is what you do in your free time to relax, have fun, or improve yourself. This could include watching movies, visiting friends, or pursuing a hobby like sports or gardening. \n
\n
\n"], ["8", "
\nA list of common symptoms of anxiety will be presented. Please read each item\ncarefully. Indicate how much you have been bothered by each symptom during\nthe PAST WEEK, INCLUDING TODAY.\n
\n
\n"], ["80", "
\nIntroduction for 2. \n
\n
\n"], ["800", "
\nLEARNING means gaining new skills or information about things that interest you. LEARNING can come from reading books or taking classes on subjects like history, car repair, or using a computer. \n
\n
\n"], ["801", "
\nCREATIVITY is using your imagination to come up with new and clever ways to solve everyday problems or to pursue a hobby like painting, photography, or needlework. This can include decorating your  \nhome, playing the guitar, or finding a new way to solve a problem at work. \n
\n
\n"], ["802", "
\nHELPING means helping others in need or helping to make your community a better place to live. HELPING can be done on your own or in a group like a church, a neighborhood association, or a political  \nparty. HELPING can include doing volunteer work at a school or giving money to a good cause. HELPING means helping people who are not your friends or relatives. \n
\n
\n"], ["803", "
\nHEALTH is being physically fit, not sick, and without pain or disability. \n
\n
\n"], ["804", "
\nSELF-ESTEEM means liking and respecting yourself in light of your strengths and weaknesses, successes and failures, and ability to handle problems. \n
\n
\n"], ["805", "
\nGOAL-AND-VALUES are your beliefs about what matters most in life and how you should live, both now and in the future. This includes your goals in life, what you think is right or wrong, and the  \npurpose or meaning of life as you see it. \n
\n
\n"], ["806", "
\nMONEY is made up of three things. It is the money you earn, the things you own (like a car or furniture), and believing that you will have the money and things that you need in the future. \n
\n
\n"], ["807", "
\nWORK means your career or how you spend most of your time. You may work at a job, at home taking care of your family, or at school as a student. WORK includes your duties on the job, the money you  \nearn (if any), and the people you work with. (If you are unemployed, retired, or can't work, you can still answer these questions.) \n
\n
\n"], ["808", "
\nPLAY is what you do in your free time to relax, have fun, or improve yourself. This could include watching movies, visiting friends, or pursuing a hobby like sports or gardening. \n
\n
\n"], ["809", "
\nLEARNING means gaining new skills or information about things that interest you. LEARNING can come from reading books or taking classes on subjects like history, car repair, or using a computer. \n
\n
\n"], ["81", "
\nIntroduction for 2. \n
\n
\n"], ["810", "
\nCREATIVITY is using your imagination to come up with new and clever ways to solve everyday problems or to pursue a hobby like painting, photography, or needlework. This can include decorating your  \nhome, playing the guitar, or finding a new way to solve a problem at work. \n
\n
\n"], ["811", "
\nHELPING means helping others in need or helping to make your community a better place to live. HELPING can be done on your own or in a group like a church, a neighborhood association, or a political  \nparty. HELPING can include doing volunteer work at a school or giving money to a good cause. HELPING means helping people who are not your friends or relatives. \n
\n
\n"], ["812", "
\nLOVE is a very close romantic relationship with another person. LOVE usually includes sexual feelings and feeling loved, cared for, and understood. (If you do not have a LOVE relationship, you can  \nstill answer these questions.) \n
\n
\n"], ["813", "
\nFRIENDS are people (not relatives) you know well and care about who have interests and opinions like yours. FRIENDS have fun together, talk about personal problems, and help each other out. (If you  \nhave no FRIENDS, you can still answer these questions.) \n
\n
\n"], ["814", "
\nCHILDREN means how you get along with your child (or children). Think of how you get along as you care for, visit, or play with your child. (If you do not have CHILDREN, you can still answer these  \nquestions.) \n
\n
\n"], ["815", "
\nRELATIVES means how you get along with your parents, grandparents, brothers, sisters, aunts, uncles, and in-laws. Think about how you get along when you are doing things together like visiting,  \ntalking on the telephone, or helping each other out. (If you have no living RELATIVES, answer question 25 as "Not Important" and do not answer question 26). \n
\n
\n"], ["816", "
\nHOME is where you live. It is your house or apartment and the yard around it. Think about how nice it looks, how big it is, and your rent or house payment. \n
\n
\n"], ["817", "
\nNEIGHBORHOOD is the area around your home. Think about how nice it looks, the amount of crime in the area, and how well you like the people. \n
\n
\n"], ["818", "
\nCOMMUNITY is the whole city, town, or rural area where you live (it is not just your neighborhood). COMMUNITY includes how nice the area looks, the amount of crime, and how well you like the people.  \nIt also includes places to go for fun like parks, concerts, sporting events, and restaurants. You may also consider the cost of things you need to buy, the availability of jobs, the government,  \nschools, taxes, and pollution. \n
\n
\n"], ["819", "
\nHEALTH is being physically fit, not sick, and without pain or disability.  \n
\n
\n"], ["82", "
\nIntroduction for 2. \n
\n
\n"], ["820", "
\nSELF-ESTEEM means liking and respecting yourself in light of your strengths and weaknesses, successes and failures, and ability to handle problems.  \n
\n
\n"], ["821", "
\nGOAL-AND-VALUES are your beliefs about what matters most in life and how you should live, both now and in the future. This includes your goals in life, what you think is right or wrong, and the   \npurpose or meaning of life as you see it.  \n
\n
\n"], ["822", "
\nMONEY is made up of three things. It is the money you earn, the things you own (like a car or furniture), and believing that you will have the money and things that you need in the future.  \n
\n
\n"], ["823", "
\nWORK means your career or how you spend most of your time. You may work at a job, at home taking care of your family, or at school as a student. WORK includes your duties on the job, the money you   \nearn (if any), and the people you work with. (If you are unemployed, retired, or can't work, you can still answer these questions.)  \n
\n
\n"], ["824", "
\nPLAY is what you do in your free time to relax, have fun, or improve yourself. This could include watching movies, visiting friends, or pursuing a hobby like sports or gardening.  \n
\n
\n"], ["825", "
\nLEARNING means gaining new skills or information about things that interest you. LEARNING can come from reading books or taking classes on subjects like history, car repair, or using a computer.  \n
\n
\n"], ["826", "
\nCREATIVITY is using your imagination to come up with new and clever ways to solve everyday problems or to pursue a hobby like painting, photography, or needlework. This can include decorating your   \nhome, playing the guitar, or finding a new way to solve a problem at work.  \n
\n
\n"], ["827", "
\nHELPING means helping others in need or helping to make your community a better place to live. HELPING can be done on your own or in a group like a church, a neighborhood association, or a political   \nparty. HELPING can include doing volunteer work at a school or giving money to a good cause. HELPING means helping people who are not your friends or relatives.  \n
\n
\n"], ["828", "
\nLOVE is a very close romantic relationship with another person. LOVE usually includes sexual feelings and feeling loved, cared for, and understood. (If you do not have a LOVE relationship, you can   \nstill answer these questions.)  \n
\n
\n"], ["829", "
\nFRIENDS are people (not relatives) you know well and care about who have interests and opinions like yours. FRIENDS have fun together, talk about personal problems, and help each other out. (If you   \nhave no FRIENDS, you can still answer these questions.)  \n
\n
\n"], ["83", "
\nIntroduction for 2. \n
\n
\n"], ["830", "
\nCHILDREN means how you get along with your child (or children). Think of how you get along as you care for, visit, or play with your child. (If you do not have CHILDREN, you can still answer these   \nquestions.)  \n
\n
\n"], ["831", "
\nRELATIVES means how you get along with your parents, grandparents, brothers, sisters, aunts, uncles, and in-laws. Think about how you get along when you are doing things together like visiting,   \ntalking on the telephone, or helping each other out. (If you have no living RELATIVES, answer question 25 as "Not Important" and do not answer question 26). \n
\n
\n"], ["832", "
\nHOME is where you live. It is your house or apartment and the yard around it. Think about how nice it looks, how big it is, and your rent or house payment.  \n
\n
\n"], ["833", "
\nNEIGHBORHOOD is the area around your home. Think about how nice it looks, the amount of crime in the area, and how well you like the people.  \n
\n
\n"], ["834", "
\nCOMMUNITY is the whole city, town, or rural area where you live (it is not just your neighborhood). COMMUNITY includes how nice the area looks, the amount of crime, and how well you like the people.   \nIt also includes places to go for fun like parks, concerts, sporting events, and restaurants. You may also consider the cost of things you need to buy, the availability of jobs, the government,   \nschools, taxes, and pollution.  \n
\n
\n"], ["835", "
\nHEALTH is being physically fit, not sick, and without pain or disability.  \n
\n
\n"], ["836", "
\nSELF-ESTEEM means liking and respecting yourself in light of your strengths and weaknesses, successes and failures, and ability to handle problems.  \n
\n
\n"], ["837", "
\nGOAL-AND-VALUES are your beliefs about what matters most in life and how you should live, both now and in the future. This includes your goals in life, what you think is right or wrong, and the   \npurpose or meaning of life as you see it.  \n
\n
\n"], ["838", "
\nMONEY is made up of three things. It is the money you earn, the things you own (like a car or furniture), and believing that you will have the money and things that you need in the future.  \n
\n
\n"], ["839", "
\nWORK means your career or how you spend most of your time. You may work at a job, at home taking care of your family, or at school as a student. WORK includes your duties on the job, the money you   \nearn (if any), and the people you work with. (If you are unemployed, retired, or can't work, you can still answer these questions.)  \n
\n
\n"], ["84", "
\nIntroduction for 2. \n
\n
\n"], ["840", "
\nPLAY is what you do in your free time to relax, have fun, or improve yourself. This could include watching movies, visiting friends, or pursuing a hobby like sports or gardening.  \n
\n
\n"], ["841", "
\nLEARNING means gaining new skills or information about things that interest you. LEARNING can come from reading books or taking classes on subjects like history, car repair, or using a computer.  \n
\n
\n"], ["842", "
\nCREATIVITY is using your imagination to come up with new and clever ways to solve everyday problems or to pursue a hobby like painting, photography, or needlework. This can include decorating your   \nhome, playing the guitar, or finding a new way to solve a problem at work.  \n
\n
\n"], ["843", "
\nHELPING means helping others in need or helping to make your community a better place to live. HELPING can be done on your own or in a group like a church, a neighborhood association, or a political   \nparty. HELPING can include doing volunteer work at a school or giving money to a good cause. HELPING means helping people who are not your friends or relatives.  \n
\n
\n"], ["844", "
\nLOVE is a very close romantic relationship with another person. LOVE usually includes sexual feelings and feeling loved, cared for, and understood. (If you do not have a LOVE relationship, you can   \nstill answer these questions.)  \n
\n
\n"], ["845", "
\nFRIENDS are people (not relatives) you know well and care about who have interests and opinions like yours. FRIENDS have fun together, talk about personal problems, and help each other out. (If you   \nhave no FRIENDS, you can still answer these questions.)  \n
\n
\n"], ["846", "
\nCHILDREN means how you get along with your child (or children). Think of how you get along as you care for, visit, or play with your child. (If you do not have CHILDREN, you can still answer these   \nquestions.)  \n
\n
\n"], ["847", "
\nRELATIVES means how you get along with your parents, grandparents, brothers, sisters, aunts, uncles, and in-laws. Think about how you get along when you are doing things together like visiting,   \ntalking on the telephone, or helping each other out. (If you have no living RELATIVES, answer question 25 as "Not Important" and do not answer question 26). \n
\n
\n"], ["848", "
\nHOME is where you live. It is your house or apartment and the yard around it. Think about how nice it looks, how big it is, and your rent or house payment.  \n
\n
\n"], ["849", "
\nNEIGHBORHOOD is the area around your home. Think about how nice it looks, the amount of crime in the area, and how well you like the people.  \n
\n
\n"], ["85", "
\nIntroduction for 2.   \n
\n
\n"], ["850", "
\nCOMMUNITY is the whole city, town, or rural area where you live (it is not just your neighborhood). COMMUNITY includes how nice the area looks, the amount of crime, and how well you like the people.   \nIt also includes places to go for fun like parks, concerts, sporting events, and restaurants. You may also consider the cost of things you need to buy, the availability of jobs, the government,   \nschools, taxes, and pollution.  \n
\n
\n"], ["851", "
\nHEALTH is being physically fit, not sick, and without pain or disability.  \n
\n
\n"], ["852", "
\nSELF-ESTEEM means liking and respecting yourself in light of your strengths and weaknesses, successes and failures, and ability to handle problems.  \n
\n
\n"], ["853", "
\nGOAL-AND-VALUES are your beliefs about what matters most in life and how you should live, both now and in the future. This includes your goals in life, what you think is right or wrong, and the   \npurpose or meaning of life as you see it.  \n
\n
\n"], ["854", "
\nMONEY is made up of three things. It is the money you earn, the things you own (like a car or furniture), and believing that you will have the money and things that you need in the future.  \n
\n
\n"], ["855", "
\nWORK means your career or how you spend most of your time. You may work at a job, at home taking care of your family, or at school as a student. WORK includes your duties on the job, the money you   \nearn (if any), and the people you work with. (If you are unemployed, retired, or can't work, you can still answer these questions.)  \n
\n
\n"], ["856", "
\nPLAY is what you do in your free time to relax, have fun, or improve yourself. This could include watching movies, visiting friends, or pursuing a hobby like sports or gardening.  \n
\n
\n"], ["857", "
\nLEARNING means gaining new skills or information about things that interest you. LEARNING can come from reading books or taking classes on subjects like history, car repair, or using a computer.  \n
\n
\n"], ["858", "
\nCREATIVITY is using your imagination to come up with new and clever ways to solve everyday problems or to pursue a hobby like painting, photography, or needlework. This can include decorating your   \nhome, playing the guitar, or finding a new way to solve a problem at work.  \n
\n
\n"], ["859", "
\nHELPING means helping others in need or helping to make your community a better place to live. HELPING can be done on your own or in a group like a church, a neighborhood association, or a political   \nparty. HELPING can include doing volunteer work at a school or giving money to a good cause. HELPING means helping people who are not your friends or relatives. \n
\n
\n"], ["86", "
\nIntroduction for 2. \n
\n
\n"], ["860", "
\nLOVE is a very close romantic relationship with another person. LOVE usually includes sexual feelings and feeling loved, cared for, and understood. (If you do not have a LOVE relationship, you can   \nstill answer these questions.)  \n
\n
\n"], ["861", "
\nFRIENDS are people (not relatives) you know well and care about who have interests and opinions like yours. FRIENDS have fun together, talk about personal problems, and help each other out. (If you   \nhave no FRIENDS, you can still answer these questions.)  \n
\n
\n"], ["862", "
\nCHILDREN means how you get along with your child (or children). Think of how you get along as you care for, visit, or play with your child. (If you do not have CHILDREN, you can still answer these   \nquestions.)  \n
\n
\n"], ["863", "
\nRELATIVES means how you get along with your parents, grandparents, brothers, sisters, aunts, uncles, and in-laws. Think about how you get along when you are doing things together like visiting,   \ntalking on the telephone, or helping each other out. (If you have no living RELATIVES, answer question 25 as "Not Important" and do not answer question 26). \n
\n
\n"], ["864", "
\nHOME is where you live. It is your house or apartment and the yard around it. Think about how nice it looks, how big it is, and your rent or house payment.  \n
\n
\n"], ["865", "
\nNEIGHBORHOOD is the area around your home. Think about how nice it looks, the amount of crime in the area, and how well you like the people.  \n
\n
\n"], ["866", "
\nCOMMUNITY is the whole city, town, or rural area where you live (it is not just your neighborhood). COMMUNITY includes how nice the area looks, the amount of crime, and how well you like the people.   \nIt also includes places to go for fun like parks, concerts, sporting events, and restaurants. You may also consider the cost of things you need to buy, the availability of jobs, the government,   \nschools, taxes, and pollution. \n
\n
\n"], ["867", "
\nHEALTH is being physically fit, not sick, and without pain or disability.  \n
\n
\n"], ["868", "
\nSELF-ESTEEM means liking and respecting yourself in light of your strengths and weaknesses, successes and failures, and ability to handle problems.  \n
\n
\n"], ["869", "
\nGOAL-AND-VALUES are your beliefs about what matters most in life and how you should live, both now and in the future. This includes your goals in life, what you think is right or wrong, and the \npurpose or meaning of life as you see it.\n
\n
\n"], ["87", "
\nIntroduction for 2. \n
\n
\n"], ["870", "
\nMONEY is made up of three things. It is the money you earn, the things you own (like a car or furniture), and believing that you will have the money and things that you need in the future.  \n
\n
\n"], ["871", "
\nWORK means your career or how you spend most of your time. You may work at a job, at home taking care of your family, or at school as a student. WORK includes your duties on the job, the money you \nearn (if any), and the people you work with. (If you are unemployed, retired, or can't work, you can still answer these questions.)\n
\n
\n"], ["872", "
\nPLAY is what you do in your free time to relax, have fun, or improve yourself. This could include watching movies, visiting friends, or pursuing a hobby like sports or gardening.  \n
\n
\n"], ["873", "
\nLEARNING means gaining new skills or information about things that interest you. LEARNING can come from reading books or taking classes on subjects like history, car repair, or using a computer.  \n
\n
\n"], ["874", "
\nCREATIVITY is using your imagination to come up with new and clever ways to solve everyday problems or to pursue a hobby like painting, photography, or needlework. This can include decorating your \nhome, playing the guitar, or finding a new way to solve a problem at work.\n
\n
\n"], ["875", "
\nHELPING means helping others in need or helping to make your community a better place to live. HELPING can be done on your own or in a group like a church, a neighborhood association, or a political   \nparty. HELPING can include doing volunteer work at a school or giving money to a good cause. HELPING means helping people who are not your friends or relatives. \n
\n
\n"], ["876", "
\nLOVE is a very close romantic relationship with another person. LOVE usually includes sexual feelings and feeling loved, cared for, and understood. (If you do not have a LOVE relationship, you can \nstill answer these questions.)\n
\n
\n"], ["877", "
\nFRIENDS are people (not relatives) you know well and care about who have interests and opinions like yours. FRIENDS have fun together, talk about personal problems, and help each other out. (If you \nhave no FRIENDS, you can still answer these questions.)\n
\n
\n"], ["878", "
\nCHILDREN means how you get along with your child (or children). Think of how you get along as you care for, visit, or play with your child. (If you do not have CHILDREN, you can still answer these \nquestions.)\n
\n
\n"], ["879", "
\nRisk Factor\n
\n
\n"], ["88", "
\nIntroduction for 2. \n
\n
\n"], ["880", "
\nRisk Factor\n
\n
\n"], ["881", "
\nRELATIVES means how you get along with your parents, grandparents, brothers, sisters, aunts, uncles, and in-laws. Think about how you get along when you are doing things together like visiting, \ntalking on the telephone, or helping each other out.(If you have no living RELATIVES, answer question 25 as "Not Important" and do not answer question 26). \n
\n
\n"], ["882", "
\nRisk Factor\n
\n
\n"], ["883", "
\nRisk Factor\n
\n
\n"], ["884", "
\nRisk Factor\n
\n
\n"], ["885", "
\nRisk Factor\n
\n
\n"], ["886", "
\nRisk Factor\n
\n
\n"], ["887", "
\nHOME is where you live. It is your house or apartment and the yard around it. Think about how nice it looks, how big it is, and your rent or house payment.  \n
\n
\n"], ["888", "
\nNEIGHBORHOOD is the area around your home. Think about how nice it looks, the amount of crime in the area, and how well you like the people.  \n
\n
\n"], ["889", "
\nCOMMUNITY is the whole city, town, or rural area where you live (it is not just your neighborhood). COMMUNITY includes how nice the area looks, the amount of crime, and how well you like the people. \nIt also includes places to go for fun like parks,concerts, sporting events, and restaurants. You may also consider the cost of things you need to buy, the availability of jobs, the government,  \nschools, taxes, and pollution.\n
\n
\n"], ["89", "
\nIntroduction for 2. \n
\n
\n"], ["890", "
\nTerms used in next item. VERY POOR: Never eats a complete meal. Rarely eats more than half of any food offered. Eats two servings or less of protein (meat or dairy products) per day. Takes fluids \npoorly. Doesn't take a liquid dietary supplement or is N.P.O. or maintained on clear liquids or I.V. solution for more than 5 days. PROBABLY INADEQUATE: Rarely eats a complete meal and generally eats \nonly about half of any food offered. Eats three servings of protein (meat or dairy products) per day. Occasionally will take a dietary supplement or receives less than optimum amount of liquid diet \nor tube feeding. ADEQUATE: Eats over half of most meals. Eats four servings of protein (meat or dairy products) per day. Occasionally will refuse a meal, but will usually take a supplement when \noffered or is on a tube feeding or total parenteral nutrition regime that probably meets most of nutritional needs. EXCELLENT: Eats most every meal. Never refuses a meal. Eats four or more servings \nof protein (meat or dairy products) per day. Occasionally eats between meals. Doesn't require supplementations.\n
\n
\n"], ["891", ""], ["892", ""], ["893", ""], ["894", ""], ["895", ""], ["896", ""], ["897", "
\nRisk Factor\n
\n
\n"], ["898", ""], ["899", "
\nIntroduction: \n
\n
\n"], ["9", "
\nFollowing are groups of statements.  After reading each group carefully,\nselect the statement in each group which BEST describes the way you\nhave been feeling the PAST WEEK, INCLUDING TODAY.  Be sure to read\nall the statements in each group before you make your choice.\n
\n
\n"], ["90", "
\nIntroduction for 2. \n
\n
\n"], ["900", "
\nIntroduction: \n
\n
\n"], ["901", ""], ["902", "
\nIntroduction: \n
\n
\n"], ["903", "
\nInstructions|This is a standard set of questions about several areas of your life such as your health, alcohol and drug use, etc. The questions generally ask about the past 30 days. Please consider   \neach question and answer as accurately as possible.|  \n
\n
\n"], ["904", "
\n7. In the past 30 days, how many days did you use any of the following drugs:  \n
\n
\n"], ["905", "
\nIntroduction for fourth: \n
\n
\n"], ["906", "
\nInstructions|This is a standard set of questions about several areas of your life such as your health, alcohol and drug use, etc. The questions ask about the past 30 days. Please consider  each  \nquestion and answer as accurately as possible.|  \n
\n
\n"], ["907", "
\nIntroduction for third: \n
\n
\n"], ["908", "
\nIntro for 3:\n
\n
\n"], ["909", "
\nIntro for 3:\n
\n
\n"], ["91", "
\nIntroduction for 2. \n
\n
\n"], ["910", "
\nIntro for 3:\n
\n
\n"], ["911", "
\nIntro for 3:\n
\n
\n"], ["912", "
\nIntro for 3:\n
\n
\n"], ["913", "
\nIntroduction: Please read each item\n
\n
\n"], ["914", "
\nPlease read eah item carefully you slob! \n
\n
\n"], ["915", "
\nPlease read eah item carefully you slob! \n
\n
\n"], ["916", "
\nPlease read eah item carefully you slob! \n
\n
\n"], ["917", "
\nPlease read eah item carefully you slob! \n
\n
\n"], ["918", "
\n7-9. Service connected disability \n
\n
\n"], ["919", "
\n7-9. Service Connected Disability\n
\n
\n"], ["92", "
\nIntroduction 1: \n
\n
\n"], ["920", "
\n7-9. Service Connected Disability\n
\n
\n"], ["921", "
\n10-11. Percent service connected \n
\n
\n"], ["922", "
\n10-11. Percent service connected (Leave blank if not service connected)\n
\n
\n"], ["923", "
\n25-35. Please indicate below your own diagnostic impression of the veteran as as other previously well-established diagnoses for the current disorder. \n
\n
\n"], ["924", "
\n25-35. Please indicate below your own diagnostic impression of the veteran as well as other well-established diagnoses for the current disorder.\n
\n
\n"], ["925", "
\n25-35. Please indicate below your own diagnostic impression of the veteran as well as other well-established diagnoses for the current disorder. \n
\n
\n"], ["926", "
\n25-35. Please indicate below your own diagnostic impression of the veteran as well as other well-established diagnoses for the current disorder.\n
\n
\n"], ["927", "
\n25-35. Please indicate below your own diagnostic impression of the veteran as well as other well-established diagnoses for the current disorder.\n
\n
\n"], ["928", "
\nTest text: can be removed.\n
\n
\n"], ["929", "
\nTest text: can be removed.\n
\n
\n"], ["93", "
\nIntroduction 1: \n
\n
\n"], ["930", "
\nIntroduction: Can be deleted\n
\n
\n"], ["931", "
\nIntroduction: Can be deleted\n
\n
\n"], ["932", "
\nDelete this Introduction later\n
\n
\n"], ["933", "
\nDelete this Introduction later\n
\n
\n"], ["934", "
\nDelete this Introduction later\n
\n
\n"], ["935", "
\nErase this Introduction \n
\n
\n"], ["936", "
\nIntroduction: \n
\n
\n"], ["937", "
\nIntroduction: \n
\n
\n"], ["938", "
\nIntroduction: \n
\n
\n"], ["939", "
\nIntroduction: \n
\n
\n"], ["94", "
\nIntroduction 1: \n
\n
\n"], ["940", "
\n13A. Since September 11, 2001 (9/11), did the veteran serve in the United States military in:\n
\n
\n"], ["941", "
\n13A. Since September 11, 2001 (9/11), did the veteran serve in the United States military in:\n
\n
\n"], ["942", "
\n13A. Since September 11, 2001 (9/11), did the veteran serve in the United States military in:\n
\n
\n"], ["943", "
\n13A. Since September 11, 2001 (9/11), did the veteran serve in the United States military in:\n
\n
\n"], ["944", "
\n13A. Since September 11, 2001 (9/11), did the veteran serve in the United States military in:\n
\n
\n"], ["945", "
\n13A. Since September 11, 2001 (9/11), did the veteran serve in the United States military in:\n
\n
\n"], ["946", "
\n13A. Since September 11, 2001 (9/11), did the veteran serve in the United States military in:\n
\n
\n"], ["947", "
\n13A. Since September 11, 2001 (9/11), did the veteran serve in the United States military in:\n
\n
\n"], ["948", "
\n13A. Since September 11, 2001 (9/11), did the veteran serve in the United States military in:\n
\n
\n"], ["949", "
\n13A. Since September 11, 2001 (9/11), did the veteran serve in the United States military in:\n
\n
\n"], ["95", "
\nIntroduction 1: \n
\n
\n"], ["950", "
\n13A. Since September 11, 2001 (9/11), did the veteran serve in the United States military in:\n
\n
\n"], ["951", "
\n13A. Since September 11, 2001 (9/11), did the veteran serve in the United States military in:\n
\n
\n"], ["952", "
\n13A. Since September 11, 2001 (9/11), did the veteran serve in the United States military in:\n
\n
\n"], ["953", "
\n13A. Since September 11, 2001 (9/11), did the veteran serve in the United States military in:\n
\n
\n"], ["954", "
\n13A. Since September 11, 2001 (9/11), did the veteran serve in the United States military in:\n
\n
\n"], ["955", "
\nIntroduction: Please read each item carefully\n
\n
\n"], ["956", "
\nIntroduction: Please read each item carefully\n
\n
\n"], ["957", "
\nIntroduction: \n
\n
\n"], ["958", "
\nIntroduction: \n
\n
\n"], ["959", "
\n4. In the past 30 days, how many days did you use any of the following drugs:  \n
\n
\n"], ["96", "
\nIntroduction 1: \n
\n
\n"], ["960", "
\nOver the past two weeks, how often have you been bothered by the following problems?\n
\n
\n"], ["961", "
\nIntroduction: \n
\n
\n"], ["962", "
\nOver the past two weeks, how often have you been bothered by the following problems?\n
\n
\n"], ["963", "
\nOver the past two weeks, how often have you been bothered by the following problems?\n
\n
\n"], ["964", "
\nOver the past two weeks, how often have you been bothered by the following problems?\n
\n
\n"], ["965", "
\nOver the past two weeks, how often have you been bothered by the following problems?\n
\n
\n"], ["966", "
\nOver the past two weeks, how often have you been bothered by the following problems?\n
\n
\n"], ["967", "
\nFor each item, select the best description of the patient's signs or symptom. Rate on just the apparent relationship to opiate withdrawal. For example, if heart rate is increased because the patient \nwas jogging just prior to assessment, the increase pulse rate would not add to the score.\n
\n
\n"], ["968", "
\nFor each item, select the best description of the patient's signs or symptom. Rate on just the apparent relationship to opiate withdrawal. For example, if heart rate is increased because the patient \nwas jogging just prior to assessment, the increase pulse rate would not add to the score.\n
\n
\n"], ["969", "
\nFor each item, select the best description of the patient's signs or symptom. Rate on just the apparent relationship to opiate withdrawal. For example, if heart rate is increased because the patient \nwas jogging just prior to assessment, the increase pulse rate would not add to the score.\n
\n
\n"], ["97", "
\nIntroduction 1: \n
\n
\n"], ["970", "
\nFor each item, select the best description of the patient's signs or symptom. Rate on just the apparent relationship to opiate withdrawal. For example, if heart rate is increased because the patient \nwas jogging just prior to assessment, the increase pulse rate would not add to the score.\n
\n
\n"], ["971", "
\nFor each item, select the best description of the patient's signs or symptom. Rate on just the apparent relationship to opiate withdrawal. For example, if heart rate is increased because the patient \nwas jogging just prior to assessment, the increase pulse rate would not add to the score.\n
\n
\n"], ["972", "
\nFor each item, select the best description of the patient's signs or symptom. Rate on just the apparent relationship to opiate withdrawal. For example, if heart rate is increased because the patient \nwas jogging just prior to assessment, the increase pulse rate would not add to the score.\n
\n
\n"], ["973", "
\nFor each item, select the best description of the patient's signs or symptom. Rate on just the apparent relationship to opiate withdrawal. For example, if heart rate is increased because the patient \nwas jogging just prior to assessment, the increase pulse rate would not add to the score.\n
\n
\n"], ["974", "
\nFor each item, select the best description of the patient's signs or symptom. Rate on just the apparent relationship to opiate withdrawal. For example, if heart rate is increased because the patient \nwas jogging just prior to assessment, the increase pulse rate would not add to the score.\n
\n
\n"], ["975", "
\nFor each item, select the best description of the patient's signs or symptom. Rate on just the apparent relationship to opiate withdrawal. For example, if heart rate is increased because the patient \nwas jogging just prior to assessment, the increase pulse rate would not add to the score.\n
\n
\n"], ["976", "
\nFor each item, select the best description of the patient's signs or symptom. Rate on just the apparent relationship to opiate withdrawal. For example, if heart rate is increased because the patient \nwas jogging just prior to assessment, the increase pulse rate would not add to the score.\n
\n
\n"], ["977", "
\nFor each item, select the best description of the patient's signs or symptom. Rate on just the apparent relationship to opiate withdrawal. For example, if heart rate is increased because the patient \nwas jogging just prior to assessment, the increase pulse rate would not add to the score.\n
\n
\n"], ["978", "
\nFor each item, select the best description of the patient's signs or symptom. Rate on just the apparent relationship to opiate withdrawal. For example, if heart rate is increased because the patient \nwas jogging just prior to assessment, the increase pulse rate would not add to the score.\n
\n
\n"], ["979", "
\nIntroduction: \n
\n
\n"], ["98", "
\nWhich of the following, in your clinical judgement, are reasons why this veteran terminated involvement with your program, or never became significantly involved in the first place? ["Termination" \ndoes NOT necessarily preclude efforts to contact veteran.]\n
\n
\n"], ["980", "
\nIntroduction for track bar\n
\n
\n"], ["981", "
\nIntroduction for track bar\n
\n
\n"], ["982", "
\nBelow you will find a list of statements. Please rate how true each statement is for you.  \n
\n
\n"], ["983", "
\nIntroduction for track bar\n
\n
\n"], ["984", "
\nInstructions|This is a standard set of questions about alcohol and drug use in the past 30 days. Please answer the requested items as accurately as possible and indicate the method of assessment in  \nitem B above.|  \n
\n
\n"], ["985", "
\nIntroduction for track bar\n
\n
\n"], ["986", "
\nIntroduction for track bar\n
\n
\n"], ["987", "
\nIntroduction for track bar\n
\n
\n"], ["988", "
\nIntroduction for track bar\n
\n
\n"], ["989", "
\nIntroduction for track bar\n
\n
\n"], ["99", "
\nWhich services below did your program provide for this veteran in the past six months (since date of IDF or last CPR)? \n
\n
\n"], ["990", "
\nIntroduction for radio 2\n
\n
\n"], ["991", "
\nIntroduction for track bar\n
\n
\n"], ["992", "
\nIntroduction for track bar\n
\n
\n"], ["993", "
\nIntroduction for track bar\n
\n
\n"], ["994", "
\nIntroduction for track bar\n
\n
\n"], ["995", "
\nIntroduction for track bar\n
\n
\n"], ["996", "
\nIntroduction for track bar\n
\n
\n"], ["997", "
\nIntroduction for track bar\n
\n
\n"], ["998", "
\nIntroduction for track bar\n
\n
\n"], ["999", "
\nIntroduction for track bar\n
\n
\n"]]}