28 (28)    MH REPORT (601.93)

.|.|Neurobehavioral Symptom Inventory||Date Given: <.Date_Given.>|Clinician: <.Staff_Ordered_By.>|Location: <.Location.>||Veteran: <.Patient_Name_Last_First.>|SSN: <.Patient_SSN.>|DOB: 
activities.      $~
<.Patient_Date_Of_Birth.> (<.Patient_Age.>)|Gender: <.Patient_Gender.>||Questions and Answers||1. Feeling dizzy:|    <*Answer_3868*>|2. Loss of balance:|    <*Answer_3881*>|3. Poor coordination, 
clumsy:|    <*Answer_3882*>|4. Headaches:|    <*Answer_3883*>|5. Nausea:|    <*Answer_3884*>|6. Vision problems, blurring, trouble seeing:|    <*Answer_3885*>|7. Sensitivity to light:|    
<*Answer_3886*>|8. Hearing difficulty:|    <*Answer_3887*>|9. Sensitivity to noise:|    <*Answer_3888*>|10. Numbness or tingling on parts of my body:|    <*Answer_3889*>|11. Change in taste and/or 
smell:|    <*Answer_3890*>|12. Loss of appetite or increase appetite:|    <*Answer_3891*>|13. Poor concentration, can't pay attention, easily distracted:|    <*Answer_3892*>|14. Forgetfulness, can't 
remember things:|    <*Answer_3893*>|15. Difficulty making decisions:|    <*Answer_3894*>|16. Slowed thinking, difficulty getting organized, can't finish things:|    <*Answer_3895*>|17. Fatigue, loss 
of energy, getting tired easily:|    <*Answer_3896*>|18. Difficulty falling or staying asleep:|    <*Answer_3897*>|19. Feeling anxious or tense:|    <*Answer_3898*>|20. Feeling depressed or sad:|    
<*Answer_3900*>|21. Irritability, easily annoyed:|    <*Answer_3901*>|22. Poor frustration tolerance, feeling easily overwhelmed by things:|    <*Answer_3902*>||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