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[613]1DVBCWPG3 ;ALB/RLC - REVIEW EXAM PTSD WORKSHEET TEXT ; 05/18/2006 12:00pm
2 ;;2.7;AMIE;**87**;Apr 10, 1995;Build 6
3 ;Per VHA Directive 10-92-142, this routine should not be modified
4 ;
5TXT ;
6 ;;
7 ;;M. Effects of PTSD on Occupational and Social Functioning
8 ;;
9 ;;Evaluation of PTSD is based on its effects on occupational and social
10 ;;functioning. Select the appropriate assessment of the veteran from the
11 ;;choices below:
12 ;;
13 ;; - Total occupational and social impairment due to PTSD signs and symptoms.
14 ;;
15 ;; Provide examples and pertinent symptoms, including those already reported.
16 ;;
17 ;; OR
18 ;;
19 ;; - PTSD signs and symptoms result in deficiencies in most of the following
20 ;; areas:
21 ;; work, school, family relations, judgment, thinking, and mood.
22 ;;
23 ;; Provide examples and pertinent symptoms, including those already
24 ;; reported for each affected area.
25 ;;TOF
26 ;; OR
27 ;;
28 ;; - There is reduced reliability and productivity due to PTSD signs and
29 ;; symptoms.
30 ;;
31 ;; Provide examples and pertinent symptoms, including those already reported.
32 ;;
33 ;; OR
34 ;;
35 ;; - There is occasional decrease in work efficiency or there are intermittent
36 ;; periods of inability to perform occupational tasks due to signs and
37 ;; symptoms, but generally satisfactory functioning (routine behavior,
38 ;; self-care, and conversation normal).
39 ;;
40 ;; Provide examples and pertinent symptoms, including those already reported.
41 ;;
42 ;; OR
43 ;;
44 ;; - There are PTSD signs and symptoms that are transient or mild and
45 ;; decrease work efficiency and ability to perform occupational tasks
46 ;; only during periods of significant stress.
47 ;;
48 ;; Provide examples and pertinent symptoms, including those already reported.
49 ;;
50 ;; OR
51 ;;
52 ;; - PTSD symptoms require continuous medication.
53 ;;
54 ;; OR
55 ;;
56 ;; - Select all that apply.
57 ;; - PTSD symptoms are not severe enough to require continuous medication.
58 ;; - PTSD symptoms are not severe enough to interfere with occupational
59 ;; and social functioning.
60 ;;
61 ;;
62 ;; Include your name; your credentials, (i.e., board certified psychiatrist,
63 ;; licensed psychologist, psychiatry resident or psychology intern,
64 ;; LCSW, or NP); circumstances under which you performed the examination,
65 ;; if applicable (i.e., under the close supervision of an attending
66 ;; psychiatrist or psychologist); name of supervising psychiatrist or
67 ;; psychologist, if applicable.
68 ;;
69 ;;
70 ;;Signature: Date:
71 ;;
72 ;;
73 ;;Signature of Supervising
74 ;;psychiatrist or psychologist: Date:
75 ;;END
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