341 (341)    MH REPORT (601.93)

|SHORT INVENTORY OF PROBLEMS - AD - Version 2 (SIP-AD-30_V2)
|   Gender: <.Patient_Gender.>
|  
|
|SIP-AD-30_V2 Total Score = <-PAST 30 DAY TOTAL SCORE->
| 
|Past 30-day total scores range from 0-45. Higher scores indicate more
|negative consequences associated with drinking or drug use within the
|past 30 days. 
|  
|Questions and Answers:
|  
|  
|   1.  I have been unhappy because of my drinking or drug use.
|       <*Answer_9350*>
|   2.  Because of my drinking or drug use, I have lost weight or not 
|       eaten properly.
|       <*Answer_9351*>
|   3.  I have failed to do what is expected of me because of my drinking 
|       or drug use.
|       <*Answer_9352*>
|   4.  When drinking or using drugs, my personality has changed for the 
|   Date Given: <.Date_Given.>
|       worse.
|       <*Answer_9353*>
|   5.  I have taken foolish risks when I have been drinking or using drugs.
|       <*Answer_9354*>
|   6.  While drinking or using drugs, I have said harsh or cruel things 
|       to someone.
|       <*Answer_9355*>
|   7.  When drinking or using drugs, I have done impulsive things that I
|       regretted later.
|       <*Answer_9356*>
|   Clinician: <.Staff_Ordered_By.>
|   8.  I have had money problems because of my drinking or drug use.
|       <*Answer_9357*>
|   9.  My physical appearance has been harmed by my drinking or drug use.
|       <*Answer_9358*>
|  10.  My family has been hurt by my drinking or drug use.
|       <*Answer_9359*>
|  11.  A friendship or close relationship has been damaged by my drinking 
|       or drug use.
|       <*Answer_9360*>
|  12.  I have lost interest in activities and hobbies because of my drinking 
|   Location:  <.Location.>
|       or drug use.
|       <*Answer_9361*>
|  13.  My drinking or drug use has gotten in the way of my growth as a 
|       person.
|       <*Answer_9362*>
|  14.  My drinking or drug use has damaged my social life, popularity, or 
|       reputation.
|       <*Answer_9363*>
|  15.  I have spent too much or lost a lot of money
|       <*Answer_9364*>
|  
|  
|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.
|   Veteran:  <.Patient_Name_Last_First.>
|   SSN: <.Patient_SSN.>
|   DOB: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)