| RPT |
|.|.|Patient Safety Screener 3 (PSS-3) |
depressed, or hopeless? | <*Answer_7789*>| 2. Over the past 2 weeks,
have you had thoughts of killing yourself? | <*Answer_7790*>| 3. In
your lifetime, have you ever attempted to kill yourself? |
<*Answer_7791*>|
3.1. If "Yes": When was the last time you attempted to kill yourself?
| <*Answer_7792*>| |
| |Information contained in this note is based on a self-report
assessment and is not sufficient to use alone for diagnostic purposes.
| Date Given: <.Date_Given.>| Clinician: <.Staff_Ordered_By.>|
Assessment results should be verified for accuracy and used in
conjunction with other diagnostic activities.
| |Copyright 2016. Emergency Medicine Network. Reproduced with Permission of author.
$~
Location: <.Location.>| | Veteran: <.Patient_Name_Last_First.>|
SSN: <.Patient_SSN.>| DOB: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)
| Gender: <.Patient_Gender.>| | | Depressed Mood Scale |
<*Answer_7771*>||
Active Suicidal Ideation Scale| <*Answer_7772*>||
Recent Suicide Attempt Scale| <*Answer_7773*>||
Questions and Answers:| 1. Over the past 2 weeks, have you felt down,
|
