| RPT |
.| .| Perceived Stress Scale| | Date Given: <.Date_Given.>| Clinician: <.Staff_Ordered_By.>| Location: <.Location.>| | Veteran: <.Patient_Name_Last_First.>|
| 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.| $~
SSN: <.Patient_SSN.>| DOB: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)| Gender: <.Patient_Gender.>| | | PSS Score: <-PSS->| | A high score indicates a high level of
stress: the range is 0 to 40.| | | Questions and Answers| | 1. In the last month, how often have you been upset because of something that happened unexpectedly?|
<*Answer_6567*>| 2. In the last month, how often have you felt that you were unable to control the important things in your life?| <*Answer_6568*>| 3. In the last month, how often
have you felt nervous and stressed?| <*Answer_6569*>| 4. In the last month, how often have you felt confident about your ability to handle your personal problems?|
<*Answer_6570*>| 5. In the last month, how often have you felt that things were going your way?| <*Answer_6571*>| 6. In the last month, how often have you found that you could not
cope with all the things that you had to do?| <*Answer_6572*>| 7. In the last month, how often have you been able to control irritations in your life?| <*Answer_6573*>| 8.
In the last month, how often have you felt that you were on top of things?| <*Answer_6574*>| 9. In the last month, how often have you been angered because of things that were outside of
your control?| <*Answer_6575*>| 10. In the last month, how often have you felt difficulties were piling up so high that you could not overcome them?| <*Answer_6576*>| |
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