| RPT |
|Suicide-Related Coping Scale (SRCS)
| Gender: <.Patient_Gender.>
|
| SRCS Total Score = <-SRCS Total->
| Internal Coping = <-External Coping->
| External Coping = <-Internal Coping->
|
|
|Questions and Answers:
|
| 1. I have contact information for at least one health care professional
|
| (such as doctor or therapist) whom I can call during a suicidal
| crisis.
| <*Answer_8614*>
| 2. I cannot do anything to control my suicidal thoughts.
| <*Answer_8615*>
| 3. I know which friends and/or family members to contact to help take
| my mind off my suicidal feelings.
| <*Answer_8616*>
| 4. I know the nearest hospital or urgent care facility where I can go
| if I cannot handle my suicidal feelings.
| Date Given: <.Date_Given.>
| <*Answer_8617*>
| 5. When I feel suicidal, there are places I can go (such as a coffee
| shop, the gym, place of worship, or shopping mall) to help me take
| my mind off my problems.
| <*Answer_8618*>
| 6. I have several things I can do to get through a suicidal crisis.
| <*Answer_8619*>
| 7. I am able to confide in someone, such as a friend, family member,
| supervisor, or spiritual advisor when I am experiencing a crisis.
| <*Answer_8620*>
| Clinician: <.Staff_Ordered_By.>
| 8. Seeking help from health care professionals is a good way to keep
| myself safe when I am feeling suicidal.
| <*Answer_8621*>
| 9. I know it is important to limit access to weapons or other ways to
| hurt myself when I am feeling suicidal.
| <*Answer_8622*>
| 10. Even if I am alone, there are things I can do to take mind off my
| suicidal feelings and thoughts for at least a while.
| <*Answer_8623*>
| 11. I do not think there is anything that I can do to help myself when
| Location: <.Location.>
| I am feeling suicidal.
| <*Answer_8624*>
| 12. It is useless to talk to anyone about my suicidal thoughts.
| <*Answer_8625*>
| 13. When I am suicidal, I know of things to do by myself that help me
| feel less suicidal.
| <*Answer_8626*>
| 14. I can distract myself by doing other things or thinking about other
| things when I am feeling suicidal.
| <*Answer_8627*>
|
| 15. If one way of trying to cope with suicidal feelings does not work,
| I have other ways to try.
| <*Answer_8628*>
| 16. I am at the mercy of my suicidal thoughts.
| <*Answer_8629*>
| 17. I feel that I have no one to turn to when I am feeling suicidal.
| <*Answer_8630*>
|
|Information contained in this note is based on a self-report assessment
|and is not sufficient to use alone for diagnostic purposes. Assessment
| Veteran: <.Patient_Name_Last_First.>
|results should be verified for accuracy and used in conjunction with
|other diagnostic activities.
| SSN: <.Patient_SSN.>
| DOB: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)
|
