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Wide Screening Tool

This wide screening tool is a combination of validated brief screens and symptom-related questions. It may be used to assist the clinician in recommending a course of action. Please answer all questions as honestly and openly as possible. If you are taking this on behalf of a loved one, please note that all of these questions will be phrased as if that person were taking this screening. If suggested, contact us as soon as you can.

Please note, this screening does not serve as a diagnosis tool but can aid your clinician in determining our recommended course of action.

SCORE

0 > None-minimal

ACTION – None

0 – .99 > Mild

ACTION – Please schedule a consultation with Dr. Cruz or your physician.

1 or higher > Moderate/Severe Treatment Recommended

ACTION – Please schedule a consultation with Dr. Cruz or your physician.

Sources

1. PHQ-4 Kroenke K, Spitzer RL, Williams JBW, Löwe B. An ultra-brief screening scale for anxiety and depression: the PHQ-4 Psychosomatics 2009; 50:613-621. Cage-AID Brown RL, Rounds LA.

2. Conjoint screening questionnaires for alcohol and other drug abuse: Criterion validity in a primary care practice. Wis Med J 1995; 94:135-140. PC-PTSD-5 Prins, A., Bovin, M. J., Kimerling, R., Kaloupek, D. G, Marx, B. P., Pless Kaiser, A., & Schnurr, P. P. (2015).

3. The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) [Measurement instrument]. Available from http://www.ptsd.va.gov