source: FOIAVistA/tag/r/AUTOMATED_MED_INFO_EXCHANGE-DVBA-DVBC/DVBCWPF3.m@ 628

DVBCWPF3 ;ALB/RLC - INITIAL EVAL PTSD WORKSHEET TEXT ; 05/18/2006 11:00am
 ;;2.7;AMIE;**87**;Apr 10, 1995;Build 6
 ;Per VHA Directive 10-92-142, this routine should not be modified
 ;
TXT ;
 ;;
 ;;N.  Effects of PTSD on Occupational and Social Functioning
 ;;
 ;;Evaluation of PTSD is based on its effects on occupational and social
 ;;functioning.  Select the appropriate assessment of the veteran from the
 ;;choices below:
 ;;
 ;;     - Total occupational and social impairment due to PTSD signs and
 ;;       symptoms.
 ;;
 ;;       Provide examples and pertinent symptoms, including those
 ;;       already reported.
 ;;
 ;;                             OR
 ;;
 ;;     - PTSD signs and symptoms result in deficiencies in most of the
 ;;       following areas:
 ;;       work, school, family relations, judgement, thinking, and mood.
 ;;
 ;;       Provide examples and pertinent symptoms, including those already
 ;;       reported for each affected area.
 ;;
 ;;                             OR
 ;;
 ;;     - There is reduced reliability and productivity due to PTSD signs and
 ;;       symptoms.
 ;;
 ;;       Provide examples and pertinent symptoms, including those already
 ;;       reported.
 ;;TOF
 ;;                             OR
 ;;
 ;;     - There is occasional decrease in work efficiency or there are
 ;;       intermittent periods of inability to perform occupational tasks due
 ;;       to signs and symptoms, but generally satisfactory functioning
 ;;       (routine behavior, self-care, and conversation normal).
 ;;
 ;;       Provide examples and pertinent symptoms, including those already
 ;;       reported.
 ;;
 ;;                             OR
 ;;
 ;;     - There are PTSD signs and symptoms that are transient or mild and
 ;;       decrease work efficiency and ability to perform occupational tasks
 ;;       only during periods of significant stress.
 ;;
 ;;       Provide examples and pertinent symptoms, including those already
 ;;       reported.
 ;;
 ;;                             OR
 ;;
 ;;     - PTSD symptoms require continuous medication.
 ;;
 ;;                             OR
 ;;
 ;;     - Select all that apply:
 ;;     - PTSD symptoms are not severe enough to require continuous medication.`
 ;;     - PTSD symptoms are not severe enough to interfere with occupational
 ;;       and social functioning. 
 ;;
 ;;
 ;;     Include your name; your credentials (i.e., board certified psychiatrist,
 ;;     a licensed psychologist, a psychiatry resident or a psychology intern);
 ;;     and circumstances under which you performed the examination, if applicable
 ;;     (i.e., under the close supervision of an attending psychiatrist or
 ;;     psychologist); include name of supervising psychiatrist or psychologist.
 ;;
 ;;
 ;;Signature of Examiner:                                        Date:
 ;;
 ;;Signature of Supervising
 ;;psychiatrist or psychologist:                                 Date:
 ;;END