If YES continue, If NO proceed to Section 3
If both inpatient and outpatient mental health consults present: Select the consult that occurs first.
If YES continue, If NO proceed to Section 3
Location consult:	0 = Inpatient	1 = Outpatient	99 = Unk/not doc
HISTORY AND MENTAL STATUS EXAM:
Depression Assessment (PHQ‐9/Diagnostic symptoms):
a. Low mood (dysphoria)/feeling down/depressed	0 = No	1 = Yes	99 = Unknown/not doc
b. Low interest (anhedonia)/little pleasure	0 = No	1 = Yes	99 = Unknown/not doc
c. Change in sleep (insomnia)/trouble falling asleep or staying asleep	0 = No	1 = Yes	99 = Unknown/not doc
d. Change in energy/ feeling tired/little energy	0 = No	1 = Yes	99 = Unknown/not doc
e. Change in guilt/feeling bad about yourself	0 = No	1 = Yes	99 = Unknown/not doc
f. Change in concentration/trouble concentrating on television or newspaper	0 = No	1 = Yes	99 = Unknown/not doc
g. Change in appetite/poor appetite/overeating	0 = No	1 = Yes	99 = Unknown/not doc
h. Change in psychomotor activity/moving slowly/speaking slowly or very restless/can't sit still.	0 = No	1 = Yes	99 = Unknown/not doc
i. Suicidal ideation	0 = No	1 = Yes	99 = Unknown/not doc
PTSD ASSESSMENT:C2, C4, C5, C6, C7, D1, and D5
Criterion A: Was a trauma history elicited?	0 = No	1 = Yes	99 = Unknown/not doc
Criterion C: Avoidance and numbing.
a. Avoidance of thoughts, feelings, and conversations	0 = No	1 = Yes	99 = Unknown/not doc
b. Greatly reduced interest in related activities	0 = No	1 = Yes	99 = Unknown/not doc
c. Detachment or estrangement feelings	0 = No	1 = Yes	99 = Unknown/not doc
d. Restricted range of affect	0 = No	1 = Yes	99 = Unknown/not doc
e. Sense of a foreshortened future	0 = No	1 = Yes	99 = Unknown/not doc
Criterion D: Arousal
f. Difficulty sleeping	0 = No	1 = Yes	99 = Unknown/not doc
g. Exaggerated startled response	0 = No	1 = Yes	99 = Unknown/not doc