96 (96)    MH REPORT (601.93)

.|      .|      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*>|      |