| RPT |
.| .| Brief Symptom Inventory 18| | Date Given: <.Date_Given.>| Clinician: <.Staff_Ordered_By.>| Location: <.Location.>| | Veteran: <.Patient_Name_Last_First.>| SSN: <.Patient_SSN.>| DOB:
<.Patient_Date_Of_Birth.> (<.Patient_Age.>)| Gender: <.Patient_Gender.>| | | <.DLL_String.>| | | Community Norms| Somatization: <-Somatization->| Depression: <-Depression->| Anxiety:
<-Anxiety->| Global Severity Index: <-Global Severity Index->| | Oncology Norms| Somatization (oncology): <-Somatization (oncology)->| Depression (oncology): <-Depression (oncology)->|
Anxiety (oncology): <-Anxiety (oncology)->| Global Severity Index (oncology): <-Global Severity Index (oncology)->| | 1 <*Answer_450*>| 2 <*Answer_451*>| 3 <*Answer_452*>| 4 <*Answer_453*>| 5
<*Answer_454*>| 6 <*Answer_455*>| 7 <*Answer_456*>| 8 <*Answer_457*>| 9 <*Answer_458*>| 10 <*Answer_459*>| 11 <*Answer_460*>| 12 <*Answer_461*>| 13 <*Answer_462*>| 14 <*Answer_463*>| 15
<*Answer_464*>| 16 <*Answer_465*>| 17 <*Answer_466*>| 18 <*Answer_467*>| | Copyright (c) 2000, 2001 LEONARD R. DEROGATIS, PhD.| | Information contained in this note is based on a self-report
assessment and is not sufficient to use alone for diagnostic purposes. Assessment results should be verified for accuracy and used in conjunction with other diagnostic activities and procedures.| $~
|
