| RPT |
.| .| 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.|
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