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