127 (127)    MH REPORT (601.93)

 PCL-5
| Gender: <.Patient_Gender.>
| 
| 
| PCL-5 Score:  <-PCL-5->
| 
| This measure assesses an individual's perception of the distress associated
| with possible PTSD symptoms. It is not used to diagnose PTSD. Symptoms are
| rated from 0-4 in terms of distress they cause the individual.  Scores that
| are greater than or equal to 31-33 suggest that the veteran may meet the
| criteria for a PTSD diagnosis. However, it is important to use caution when
| 
| using this cutoff since it is possible for some Veterans with scores lower
| than 31-33 to meet criteria for PTSD. 
| 
| Additional testing using a structured diagnostic interview, such as the
| Clinician Administered PTSD Scale for DSM-5, is recommended to confirm
| diagnostic status.
|
| Values range from 0 to 80 with higher scores indicating more probable PTSD.
| 
| 
| Date Given: <.Date_Given.>
| Questions and Answers: 
| 
|  1. Repeated, disturbing, and unwanted memories of the stressful experience?
|     <*Answer_6841*>
|  2. Repeated, disturbing dreams of the stressful experience?
|     <*Answer_6842*>
|  3. Suddenly feeling or acting as if the stressful experience were actually
|     happening again (as if you were actually back there reliving it)?
|     <*Answer_6843*>
|  4. Feeling very upset when something reminded you of the stressful 
| Clinician: <.Staff_Ordered_By.>
|     experience?
|     <*Answer_6844*>
|  5. Having strong physical reactions when something reminded you of the
|     stressful experience (for example, heart pounding, trouble breathing,
|     sweating)?
|     <*Answer_6845*>
|  6. Avoiding memories, thoughts, or feelings related to the stressful 
|     experience?
|     <*Answer_6846*>
|  7. Avoiding external reminders of the stressful experience (for example, 
| Location: <.Location.>
|     people, places, conversations, activities, objects, or situations)?
|     <*Answer_6847*>
|  8. Trouble remembering important parts of the stressful experience?
|     <*Answer_6848*>
|  9. Having strong negative beliefs about yourself, other people, or the
|     world (for example, having thoughts such as: I am bad, there is 
|     something seriously wrong with me, no one can be trusted, the world is
|     completely dangerous)?
|     <*Answer_6849*>
| 10. Blaming yourself or someone else for the stressful experience or what
| 
|     happened after it?
|     <*Answer_6850*>
| 11. Having strong negative feelings such as fear, horror, anger, guilt, or
|     shame?
|     <*Answer_6851*>
| 12. Loss of interest in activities that you used to enjoy?
|     <*Answer_6852*>
| 13. Feeling distant or cut off from other people?
|     <*Answer_6853*>
| 14. Trouble experiencing positive feelings (for example, being unable to
| Veteran: <.Patient_Name_Last_First.>
|     feel happiness or have loving feelings for people close to you)?
|     <*Answer_6854*>
| 15. Irritable behavior, angry outbursts, or acting aggressively?
|     <*Answer_6855*>
| 16. Taking too many risks or doing things that could cause you harm?
|     <*Answer_6856*>
| 17. Being "superalert" or watchful or on guard?
|     <*Answer_6857*>
| 18. Feeling jumpy or easily startled?
|     <*Answer_6858*>
| SSN: <.Patient_SSN.>
| 19. Having difficulty concentrating?
|     <*Answer_6859*>
| 20. Trouble falling or staying asleep?
|     <*Answer_6860*>
| 
| 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.
| DOB: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)