| RPT |
.|.|Enhancing Quality of Care in Psychosis||Date Given: <.Date_Given.>|Clinician: <.Staff_Ordered_By.>|Location: <.Location.>||Veteran: <.Patient_Name_Last_First.>|SSN: <.Patient_SSN.>|DOB:
your doctor for mental health problems?| <*Answer_4429*>|26. Do you know the names of your medications that you are prescribed?| <*Answer_4430*>|27. Here is a list of medications you may be
prescribed. Check all of the medications that you are currently prescribed.| <*Answer_4431*>|28. Over the past month, to what extent have you taken the medications prescribed by your doctor for
mental health problems?| <*Answer_4432*>|29. What is your height: How many feet?| <*Answer_4433*>|How many inches:| <*Answer_4434*>|30. What is your weight in pounds?| <*Answer_4435*>|31.
Have you been weighing yourself every week at home?| <*Answer_4436*>|32. Over the past month, have you gained or lost weight or stayed the same?| <*Answer_4437*>|33. How much weight have you
gained?| <*Answer_4438*>|34. How much weight have you lost?| <*Answer_4439*>|35. Has your doctor recently talked with you about changing to medication that does not cause weight gain?|
<*Answer_4440*>|36. Has your doctor recently recommended that you go to wellness or weight loss groups?| <*Answer_4441*>|37. How many times in the past month did you attend wellness or weight loss
groups?| <*Answer_4442*>|39. Have you changed your diet in order to lose weight?| <*Answer_4443*>|40. Have you increased your physical activity recently in order to lose weight?|
<*Answer_4444*>|41. Have you ever had angina, a heart attack, or a stroke?| <*Answer_4445*>|42. Do you currently have diabetes or hypertension, or are you being treated for diabetes or
hypertension?| <*Answer_4455*>|43. Are you currently working in a job for pay?| <*Answer_4446*>|44. How many weeks have you worked at this job?| <*Answer_4447*>|45. How many hours a week do
you usually work?| <*Answer_4448*>|46. Is this a job that anyone can apply for, or is it only for disabled people?| <*Answer_4449*>|47. How many dollars did you earn last month?|
<.Patient_Date_Of_Birth.> (<.Patient_Age.>)|Gender: <.Patient_Gender.>|||Questions and Answers||1. Managing your day-to-day life?| <*Answer_4405*>|2. Coping with problems in your life?|
<*Answer_4450*>|48. Is this the total gross income from the job, or the amount of take-home pay from the job?| <*Answer_4456*>|49. Would you be interested in working at a paying job if it would
not affect your benefits too much and you could get the support you need?| <*Answer_4451*>|50. Has your doctor recently recommended that you go to the VA's work program---called "IPS" or
"supported employment" ?| <*Answer_4452*>|51. How many times in the past month did you attend the VA's work program called IPS or supported employment?| <*Answer_4453*>|52. During the past
month, how many job interviews have you gone to?| <*Answer_4454*>| |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. $~
<*Answer_4406*>|3. Concentrating?| <*Answer_4407*>|4. Get along with people in your family?| <*Answer_4408*>|5. Get along with people outside your family?| <*Answer_4409*>|6. Get along well
in social situations?| <*Answer_4410*>|7. Feel close to another person?| <*Answer_4411*>|8. Feel like you had someone to turn to if you needed help?| <*Answer_4412*>|9. Feel confident in
yourself?| <*Answer_4413*>|10. Feel sad or depressed?| <*Answer_4414*>|11. Think about ending your life?| <*Answer_4415*>|12. Feel nervous?| <*Answer_4416*>|13. Have thoughts racing
through your head?| <*Answer_4417*>|14. Think you had special powers?| <*Answer_4418*>|15. Hear voices or see things?| <*Answer_4419*>|16. Think people were watching you?|
<*Answer_4420*>|17. Think people were against you?| <*Answer_4421*>|18. Have mood swings?| <*Answer_4422*>|19. Feel short-tempered?| <*Answer_4423*>|20. Think about hurting yourself?|
<*Answer_4424*>|21. Did you have an urge to drink alcohol or take street drugs?| <*Answer_4425*>|22. Did anyone talk to you about your drinking or drug use?| <*Answer_4426*>|23. Did you try to
hide your drinking or drug use?| <*Answer_4427*>|24. Did you have problems from your drinking or drug use?| <*Answer_4428*>|25. Over the past month have you been prescribed any medication by
|
