| RPT |
| | PTSD Screen - (PC-PTSD-5)
| PC-PTSD-5 Screening Score: <-PTSD5->|
|<*Answer_7771*>|<*Answer_7772*>| |
Questions and Answers|
Sometimes things happen to people that are unusually or especially|
frightening, horrible, or traumatic. For example:|
A serious accident or fire|
A physical or sexual assault or abuse|
An earthquake or flood|
A war|
| Date Given: <.Date_Given.>
Seeing someone be killed or seriously injured|
Having a loved one die through homicide or suicide| |
1. Have you ever experienced this kind of event? | <*Answer_7793*>|
2. Had nightmares about the event(s) when you did not want to?| <*Answer_7794*>|
3. Tried hard not to think about the event(s) or went out of your way to|
avoid situations that remind you of the event(s)?| <*Answer_7795*>|
4. Been constantly on guard, watchful, or easily startled?| <*Answer_7796*>|
5. Felt numb or detached from people, activities, or your surroundings?| <*Answer_7797*>|
6. Felt guilty or unable to stop blaming yourself or others for the|
event(s) or any problems the event(s) may have caused?| <*Answer_7798*>|
| Clinician: <.Staff_Ordered_By.>
| |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.
| |PC-PTSD-5, 2015, National Center for PTSD
$~
| Location: <.Location.>
| | Veteran: <.Patient_Name_Last_First.>
| SSN: <.Patient_SSN.>
| DOB: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)
| Gender: <.Patient_Gender.>| |
|
