| RPT |
|Brief Biosocial Gambling Screen (BBGS)
| Gender: <.Patient_Gender.>
|
| BBGS Screen: <*Answer_7771*>
|
|
|Questions and Answers:
|
| 1. During the past 12 months, have you become restless irritable
| or anxious when trying to stop/cut down on gambling?
| <*Answer_9226*>
|
| 2. During the past 12 months, have you tried to keep your family
| or friends from knowing how much you gambled?
| <*Answer_9227*>
| 3. During the past 12 months did you have such financial trouble
| as a result of your gambling that you had to get help with
| living expenses from family, friends or welfare?
| <*Answer_9228*>
|
|Information contained in this note is based on a self-report assessment
|and is not sufficient to use alone for diagnostic purposes. Assessment
| Date Given: <.Date_Given.>
|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.>)
|
