58 (58)    MH REPORT (601.93)

Name Value
REPORT NUMBER 58
INSTRUMENT ZBI SCREEN
RPT
.|.|Zarit Burden Interview: Screening version||Date Given: <.Date_Given.>|Clinician: <.Staff_Ordered_By.>|Location: <.Location.>||Veteran: <.Patient_Name_Last_First.>|SSN: <.Patient_SSN.>|DOB: 
<.Patient_Date_Of_Birth.> (<.Patient_Age.>)|Gender: <.Patient_Gender.>||ZBI Screening Score: <-Score->|  A score of 8 or higher reflects a high burden and needs followup.||Questions and Answers||1. 
Do you feel that because of the time you spend with your relative that you dont have enough time for yourself?|    <*Answer_5224*>|2. Do you feel stressed between caring for your relative and trying 
to meet other responsibilities (work/family)?|    <*Answer_5257*>|3. Do you feel strained when you are around your relative?|    <*Answer_5258*>|4. Do you feel uncertain about what to do about your 
relative?|    <*Answer_5259*>||Copyright (c) 1983 Steven Zarit$~