YS*5.01*134 T10C4 (66)    MH INSTRUMENT EXCHANGE (601.95)

Name Value
NAME YS*5.01*134 T10C4
DATE CREATED 2018-07-30 01:22:34
SOURCE DELLINGER@CAMP MASTER
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ghtText":"Copyright  World Health Organization. 2009. All Rights Reserved. Measuring health and disability: manual for WHO Disability Assessment Schedule (WHODAS 2.0), World Health Organization, 2010, Geneva.","copyrighted":true,"dllDate":
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\r\n  Date Given: <.Date_Given.>|  Clinician: <.Staff_Ordered_By.> |\r\n  Location: <.Location.>|   |  Veteran: <.Patient_Name_Last_First.>|  \r\nSSN: <.Patient_SSN.>|  DOB: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)\r\n|  Gender: <.Patien
t_Gender.>   | | | \r\n GLOBAL DISABILITY SCORE: <*ANSWER_7771*>|  Scores range from 0-48, with\r\n higher scores indicating more severe disability.\r\n| |\r\n  Questions and Answers: | \r\n S1. Standing for long periods such as 30 minutes?
|      <*Answer_7810*>| \r\n S2. Taking care of your household responsibilities?|\r\n      <*Answer_7811*>|  S3. Learning a new task, for example, learning how\r\n to get to a new place? |       <*Answer_7812*>|  S4. How much of a\r\n probl
em did you have joining in community activities (for example,\r\n festivities, religious or other activities) in the same way\r\n as anyone else can?|      <*Answer_7813*>|  S5. How much have you\r\n been emotionally affected by your health
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k?|       <*Answer_7821*>|\r\n|  |Information contained in this note is based on a self-report \r\nassessment and is not sufficient to use alone for diagnostic purposes.\r\n Assessment results should be verified for accuracy and used in\r\n
 conjunction with other diagnostic activities.\r\n|  |Copyright  World Health Organization. 2009. All Rights Reserved. \r\nMeasuring health and disability: manual for WHO Disability Assessment\r\n Schedule (WHODAS 2.0), World Health Organi
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n|  KEY INDICATORS:\r\n|<*Answer_7774*>|<*Answer_7775*>|<*Answer_7776*>|\r\n|<*Answer_7777*>|<*Answer_7778*>|<*Answer_7779*>|||\r\n  Questions and Answers: ||\r\n  1. Over the past month, have you wished you were dead or wished you could go
 to sleep and not wake up?|   <*Answer_7801*>|\r\n  2. Over the past month, have you had any actual thoughts of killing yourself? |   <*Answer_7802*>|
\r\n  3. Over the past month, have you been thinking about how you might do this? |   <*Answer_7803*>|\r\n  4. Over the past month, have you had these thoughts and had some intention of acting on them?  |   <*Answer_7804*>|\r\n  5. Over the
 past month, have you started to work out or worked out the details of how to kill yourself?|   <*Answer_7805*>|\r\n  6. If yes, at any time in the past month did you intend to carry out this plan?|   <*Answer_7806*>|\r\n  7. In your lifeti
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es, was this within the past 3 months?|   <*Answer_7808*> ||\r\n \r\n|   |Columbia-Suicide Severity Rating Scale (C-SSRS)  2016 The Columbia Lighthouse Project. Scale may be reproduced without permission.\r\n \r\n|   |Information contained
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plate":"| | Patient Health Questionnaire-2 + Item9(PHQ-2+I9)|\r\n|   Date Given: <.Date_Given.>\r\n|   Clinician: <.Staff_Ordered_By.>\r\n|   Location:<.Patient_SSN.>\r\n|   DOB: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)\r\n|   Gender: <.
Patient_Gender.>|   |\r\n \r\n|   PHQ-2+I9 Depression Screening Score: <-Depression->\r\n|   <*Answer_7771*>|  <*Answer_7772*>|\r\n \r\n|   PHQ-2+I9 Suicide Screening Score: <-Suicide Ideation->\r\n|   <*Answer_7773*>| <*Answer_7774*>\r\n| 
| Questions and Answers|\r\n   1. Little interest or pleasure in doing things|       <*Answer_7799*>|\r\n   2. Feeling down, depressed, or hopeless|       <*Answer_7800*>|\r\n   3. Thoughts that you would be better off dead or of hurting yo
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urself |\r\n      in some way|       <*Answer_7788*>|\r\n \r\n| |Information contained in this note is based on a self-report assessment \r\n|and is not sufficient to use alone for diagnostic purposes. Assessment \r\n|results should be veri
fied for accuracy and used in conjunction with other \r\n|diagnostic activities.\r\n \r\n \r\n| |Developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke\r\n|and colleagues, with an educational grant from Pfizer Inc. No permis
sion\r\n|require to reproduce, translate, display or distribute.\r\n$~                       "},"scaleGroup":[{"grid1":0,"grid2":0,"grid3":0,"id":248,"instrument":224,"name":"PHQ-2+i9","ordInc":1,"ordMax":10,"ordMin":0,"ordTitle":"PHQ-2+i9"
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7803,"questionText":"Over the past month, have you been thinking about how you might do this? ","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":3},{"choice":[{"choiceId":3650,"choiceText":"Yes","ien":106330,"legac
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o people that are unusually or especially \r\nfrightening, horrible, or traumatic. For example:|  |\r\n               A serious accident or fire |\r\n               A physical or sexual assault or abuse|\r\n               An earthquake or f
lood|\r\n               A war|\r\n               Seeing someone be killed or seriously injured|\r\n               Having a loved one die through homicide or suicide|","max":1,"min":0,"questionDisplay":1470,"questionId":7793,"questionText":"
Have you ever experienced this kind of event?","required":true,"responseTypeId":1,"responseTypeText":"MCHOICE","sequence":1},{"choice":[{"choiceId":3640,"choiceText":"YES","ien":106310,"legacyValue":1,"sequence":1},{"choiceId":3641,"choiceT
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Text":"In the past month, have you...","max":null,"min":null,"questionDisplay":1470,"questionId":7794,"questionText":"Had nightmares about the event(s) or thought about the event(s) when you \r\ndid not want to?","required":true,"responseTy
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DESCRIPTION
788080 AND 788073
INSTALL HISTORY
  • INSTALL DATE:   2018-09-07 12:17:20
    INSTALLED BY:   USER,FIFTYFOUR