Are you currently in any physical pain?
Over the last two weeks, how often have you been bothered by any of the following problems? 1. Little interest or pleasure in doing things. 2. Feeling down, depressed, or hopeless. 3. Trouble falling or staying asleep, or sleeping too much. 4. Feeling tired or having little energy. 5. Poor appetite or overeating. 6.
Thoughts that you would be better off dead, or hurting yourself in some way. 1. Feeling nervous, anxious or on edge. 2. Not being able to stop or control worrying. 3. Worrying too much about different things. 4. Trouble relaxing. 5. Being so restless that it is hard to sit still. 6. Becoming easily annoyed or irritable. 7.
Patient Stress Questionnaire* BHC Adult NP Packet (ages 18 & older) Name: Date of Birth: Date of visit: Over the last two weeks , how often have you been bothered by any of the following problems? (please circle your answer & check the boxes that apply to you) 1. Little interest or pleasure in doing things 0 1 2 3 2.
Over the last two weeks, how often have you been bothered by any of the following problems? 1. Little interest or pleasure in doing things. 2. Feeling down, depressed, or hopeless. 3. Trouble falling or staying asleep, or sleeping too much. 4. Feeling tired or having little energy. 5. Poor appetite or overeating. 6.
Over the last two weeks, how often have you been bothered by any of the following problems? 1. Little interest or pleasure in doing things. 2. Feeling down, depressed, or hopeless. 3. Trouble falling or staying asleep, or sleeping too much. 3. Trouble falling or staying asleep, or sleeping too much. 4. Feeling tired or having little energy. 5.
Purpose Consisting of 30 items, the PSQ was developed as an instrument for assessing the stressful life events and circumstances that tend to trigger or exacerbate disease symptoms.
The Patient Stress Survey (PSS) on the reverse side is a 24-item behavioral health screening tool that is a collection of twelve (12) separate “ultrabrief” screening tools.
Thoughts that you would be better off dead or of hurting yourself in some way. If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?
PATIENT STRESS QUESTIONNAIRE SCORING PHQ-9 and PHQ Modified for Teens • Annual Depression Screening given at all physicals for patients 12 and older- Bill G0444 • Depression assessment and follow up (outside of annual physical) - Bill 96127 • To assess major depression a 2 or a 3 must be score on one of the first 2 questions-
- Some results have been removed