139 (139)    MH REPORT (601.93)

.| .| Family Assessment Device| | Date Given: <.Date_Given.>| Clinician: <.Staff_Ordered_By.>| Location: <.Location.>| | Veteran: <.Patient_Name_Last_First.>| SSN: <.Patient_SSN.>| DOB: 
<*Answer_6755*>| 19. Some of us just don't respond emotionally.|     <*Answer_6756*>| 20. We know what to do in an emergency.|     <*Answer_6757*>| 21. We avoid discussing our fears and concerns.|    
 <*Answer_6758*>| 22. It is difficult to talk to each other about tender feelings.|     <*Answer_6759*>| 23. We have trouble meeting our bills.|     <*Answer_6760*>| 24. After our family tries to 
solve a problem, we usually discuss whether it worked or not.|     <*Answer_6761*>| 25. We are too self-centered.|     <*Answer_6762*>| 26. We can express feelings to each other.|     
<*Answer_6763*>| 27. We have no clear expectations about toilet habits.|     <*Answer_6764*>| 28. We do not show our love for each other.|     <*Answer_6765*>| 29. We talk to people directly rather 
than through go-betweens.|     <*Answer_6766*>| 30. Each of us has particular duties and responsibilities.|     <*Answer_6767*>| 31. There are lots of bad feelings in the family.|     
<*Answer_6768*>| 32. We have rules about hitting people.|     <*Answer_6769*>| 33. We get involved with each other only when something interest us.|     <*Answer_6770*>| 34. There's little time to 
explore personal interests.|     <*Answer_6771*>| 35. We often don't say what we mean.|     <*Answer_6772*>| 36. We feel accepted for what we are.|     <*Answer_6773*>| 37. We show interest in each 
other when we can get something out of it personally.|     <*Answer_6774*>| 38. We resolve most emotional upsets that come up.|     <*Answer_6775*>| 39. Tenderness takes second place to other things 
in our family.|     <*Answer_6776*>| 40. We discuss who is to do household jobs.|     <*Answer_6777*>| 41. Making decisions is a problem for our family.|     <*Answer_6778*>| 42. Our family shows 
interest in each other only when they can get something out of it.|     <*Answer_6779*>| 43. We are frank with each other.|     <*Answer_6780*>| 44. We don't hold to any rules or standards.|     
<.Patient_Date_Of_Birth.> (<.Patient_Age.>)| Gender: <.Patient_Gender.>| | | <.DLL_String.>| | | Questions and Answers| | 1. Planning family activities is difficult because we misunderstand each 
<*Answer_6781*>| 45. If people are asked to do something, they need reminding.|     <*Answer_6782*>| 46. We are able to make decisions about how to solve problems.|     <*Answer_6783*>| 47. If the 
rules are broken, we don't know what to expect.|     <*Answer_6784*>| 48. Anything goes in our family.|     <*Answer_6785*>| 49. We express tenderness.|     <*Answer_6786*>| 50. We confront problems 
involving feelings.|     <*Answer_6787*>| 51. We don't get along well together.|     <*Answer_6788*>| 52. We don't talk to each other when we are angry.|     <*Answer_6789*>| 53. We are generally 
dissatisfied with the family duties assigned to us.|     <*Answer_6790*>| 54. Even though we mean well, we intrude too much into each others lives.|     <*Answer_6791*>| 55. There are rules about 
dangerous situations.|     <*Answer_6792*>| 56. We confide in each other.|     <*Answer_6793*>| 57. We cry openly.|     <*Answer_6794*>| 58. We don't have reasonable transport.|     <*Answer_6795*>| 
59. When we don't like what someone has done, we tell them.|     <*Answer_6796*>| 60. We try to think of different ways to solve problems.|     <*Answer_6797*>| | | 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.|  $~
other.|     <*Answer_6738*>| 2. We resolve most everyday problems around the house.|     <*Answer_6739*>| 3. When someone is upset the others know why.|     <*Answer_6740*>| 4. When you ask someone 
to do something, you have to check that they did it.|     <*Answer_6741*>| 5. If someone is in trouble, the others become too involved.|     <*Answer_6742*>| 6. In times of crisis we can turn to each 
other for support.|     <*Answer_6743*>| 7. We don't know what to do when an emergency comes up.|     <*Answer_6744*>| 8. We sometimes run out of things that we need.|     <*Answer_6745*>| 9. We are 
reluctant to show our affection for each other.|     <*Answer_6746*>| 10. We make sure members meet their family responsibilities.|     <*Answer_6747*>| 11. We cannot talk to each other about the 
sadness we feel.|     <*Answer_6748*>| 12. We usually act on our decisions regarding problems.|     <*Answer_6749*>| 13. You only get the interest of others when something is important to them.|     
<*Answer_6750*>| 14. You can't tell how a person is feeling from what they are saying.|     <*Answer_6751*>| 15. Family tasks don't get spread around enough.|     <*Answer_6752*>| 16. Individuals are 
accepted for what they are.|     <*Answer_6753*>| 17. You can easily get away with breaking the rules.|     <*Answer_6754*>| 18. People come right out and say things instead of hinting at them.|