| RPT |
|PHQ-Item 9 + Columbia Suicide Severity Rating Scale (I9+C-SSRS) ||
|<*Answer_7772*>
|<*Answer_7773*>|
|SCREENING INDICATORS:
|<*Answer_7774*>
|<*Answer_7777*>
|<*Answer_7778*>|
Questions and Answers: ||
1. Over the past 2 weeks, how often have you had thoughts that you would be better off dead or of hurting yourself in some way?| <*Answer_8004*>|
2. Over the past month, have you wished you were dead or wished you could go to sleep and not wake up?| <*Answer_8005*>|
3. Over the past month, have you had any actual thoughts of killing yourself?| <*Answer_8006*>|
Date Given: <.Date_Given.>|Clinician: <.Staff_Ordered_By.> |
4. Over the past month, have you been thinking about how you might do this?| <*Answer_8007*>|
5. Over the past month, have you had these thoughts and had some intention of acting on them? | <*Answer_8008*>|
6. Over the past month, have you started to work out or worked out the details of how to kill yourself?| <*Answer_8009*>|
7. If yes, at any time in the past month did you intend to carry out this plan?| <*Answer_8010*>|
8. In your lifetime, have you ever done anything, started to do anything, or prepared to do anything to end your life (for example, collected pills, obtained a gun, gave away valuables, went to the roof but didn't jump)?| <*Answer_8011*>|
9. If yes, was this within the past 3 months?| <*Answer_8012*> ||
| |Columbia-Suicide Severity Rating Scale (C-SSRS) 2016 The Columbia Lighthouse Project. Scale may be reproduced without permission.
| |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
Location: <.Location.>| |Veteran: <.Patient_Name_Last_First.>|
conjunction with other diagnostic activities. $~
SSN: <.Patient_SSN.>|DOB: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)
|Gender: <.Patient_Gender.> |
|PRIMARY SUICIDE RISK SCREEN (PHQ-I9)|
The results of this administration indicate a <*Answer_7775*> primary screen for risk of suicide over the past two weeks.|
|<*Answer_7776*>
|<*Answer_7771*>
|
