| RPT |
|Brief Inventory of Psychosocial Functioning (B-IPF)
| Gender: <.Patient_Gender.>
|
| B-IPF Total Score = <-B-IPF Total-> (<*Answer_7772*>)
|
|
|Questions and Answers:
|
| 1. I had trouble in my romantic relationship with my spouse or partner.
| <*Answer_8643*>
| 2. I had trouble in my relationship with my children.
|
| <*Answer_8644*>
| 3. I had trouble with my family relationships.
| <*Answer_8645*>
| 4. I had trouble with my friendships and socializing.
| <*Answer_8646*>
| 5. I had trouble at work.
| <*Answer_8647*>
| 6. I had trouble with my training and education.
| <*Answer_8648*>
| 7. I had trouble with day to day activities, such as doing household
| Date Given: <.Date_Given.>
| chores, running errands and managing my medical care.
| <*Answer_8649*>
|
|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.
| Clinician: <.Staff_Ordered_By.>
| Location: <.Location.>
|
| Veteran: <.Patient_Name_Last_First.>
| SSN: <.Patient_SSN.>
| DOB: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)
|
