| RPT |
|Well-Being Signs Version 2 (WBS_V2)
| Gender: <.Patient_Gender.>
|
| WBS_V2 Average Score = <*Answer_7771*>
|
|
|Questions and Answers:
|
| Over the past month, on average how often have you been:
| Use the following scale:
| 0 - 1 - 2 - 3 - 4 - 5 - 6 - 7 - 8 - 9 - 10
|
| None of the Time All of the Time
|
|
| 1. Fully satisfied with how these things are going?
| <*Answer_9250*>
| 2. Regularly involved in things that are important to you?
| <*Answer_9251*>
| 3. Functioning your best in the most important things you do?
| <*Answer_9252*>
|
| Date Given: <.Date_Given.>
|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.>)
|
