| RPT |
.|.|Combat Exposure Scale||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.>||CES Scale: <-CES Scale->|| 0-8 Light exposure to combat| 9-16 Light to Moderate| 17-24 Moderate| 25-32 Moderate to Heavy| 33-41
Heavy exposure to combat||Questions and Answers||1. Did you ever go on combat patrols or have other dangerous duty?| <*Answer_4350*>|2. Were you ever under enemy fire?| <*Answer_4351*>|3. Were
you ever surrounded by the enemy?| <*Answer_4352*>|4. What percentage of the soldiers in your unit were killed (KIA), wounded or missing in action (MIA)?| <*Answer_4353*>|5. How often did you
fire rounds at the enemy?| <*Answer_4354*>|6. How often did you see someone hit by incoming or outgoing rounds?| <*Answer_4355*>|7. How often were you in danger of being injured or killed
(i.e., being pinned down, overrun, ambushed, near miss, etc.)?| <*Answer_4403*>|||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 and procedures.| $~
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