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[text name="text1" default="insert MRN"]
[select name="Q1" value="select one|male|female"] <-- Gender
--Over the past 2 weeks, have you been bothered by:
[select name="Q2" value="no|yes"] <--1. Feeling nervous, anxious, or on edge?
[select name="Q3" value="no|yes"] <--2. Not being able to stop or control
[select name="Q4" value="no|yes"] <--3. Little interest or pleasure in doing things?
[select name="Q5" value="no|yes"] <--4. Feeling down, depressed, or hopeless?
--Over the past 12 months:
5. Have you used marijuana, other illegal drugs or taken a prescription medication for non-medical reasons? [select name="Q6" value="no|yes"]
[conditional field="Q1" condition="(Q1).is('male')"]
How many times have you had 5 or more drinks in one day? [select name="Q7" value="None in the past 12 months|1|2|3 or more"] [/conditional]
[conditional field="Q1" condition="(Q1).is('female')"] How many times have you had 4 or more drinks in one day? [select name="Q8" value="None in the past 12 months|1|2|3 or more"] [/conditional]
[calc value="score=(Q9b);score>0?'***********Brief Intervention: SI***********':''" memo="-"]

[conditional field="Q2|Q3" condition="(Q2).is('yes')||(Q3).is('yes')"][html]<hr>[/html]GAD-7 Calculator
[html]<em>Generalized Anxiety Disorder diagnosis tool.</em>[/html]
[select name="Q1a" value="Not at all (0 points)=0|Several days (1 points)=1|More than half the days (2 points)=2|Nearly everyday (3 points)=3"] <-- Feeling nervous, anxious or on edge (over the last two weeks)?
[select name="Q2a" value="Not at all (0 points)=0|Several days (1 points)=1|More than half the days (2 points)=2|Nearly everyday (3 points)=3"] <-- Being unable to stop or control worrying (over the last two weeks)?
[select name="Q3a" value="Not at all (0 points)=0|Several days (1 points)=1|More than half the days (2 points)=2|Nearly everyday (3 points)=3"] <-- Worrying too much about different things (over the last two weeks)?
[select name="Q4a" value="Not at all (0 points)=0|Several days (1 points)=1|More than half the days (2 points)=2|Nearly everyday (3 points)=3"] <-- Having trouble relaxing (over the last two weeks)?
[select name="Q5a" value="Not at all (0 points)=0|Several days (1 points)=1|More than half the days (2 points)=2|Nearly everyday (3 points)=3"] <-- Being so restless that it is hard to sit still (over the last two weeks)?
[select name="Q6a" value="Not at all (0 points)=0|Several days (1 points)=1|More than half the days (2 points)=2|Nearly everyday (3 points)=3"] <-- Becoming easily annoyed or irritable (over the last two weeks)?
[select name="Q7a" value="Not at all (0 points)=0|Several days (1 points)=1|More than half the days (2 points)=2|Nearly everyday (3 points)=3"] <-- Feeling afraid, as if something awful might happen (over the last two weeks)?
Score --> [calc value="score=(Q1a)+(Q2a)+(Q3a)+(Q4a)+(Q5a)+(Q6a)+(Q7a)" memo="score"] out of 21 points
Interpretation --> [calc value="score=(Q1a)+(Q2a)+(Q3a)+(Q4a)+(Q5a)+(Q6a)+(Q7a);score>8?'suggestive of anxiety or panic disorder':score>0?'mild symptoms':'asymptomatic'" memo="interpretation"][/conditional]

[conditional field="Q4|Q5" condition="(Q4).is('yes')||(Q5).is('yes')"][html]<hr>[/html]Patient Health Questionnaire PHQ-9 - Depression Screen

[select name="Q1b" value="not at all (0 points)=0|several days (1 point)=1|more than half the days (2 points)=2|nearly every day (3 points)=3"] <-- #1 Little interest or pleasure in doing things over the last 2 weeks
[select name="Q2b" value="not at all (0 points)=0|several days (1 point)=1|more than half the days (2 points)=2|nearly every day (3 points)=3"] <-- #2 Feeling down, depressed or hopeless over the last 2 weeks
[select name="Q3b" value="not at all (0 points)=0|several days (1 point)=1|more than half the days (2 points)=2|nearly every day (3 points)=3"] <-- #3 Trouble falling or staying asleep, or sleeping too much over the last weeks
[select name="Q4b" value="not at all (0 points)=0|several days (1 point)=1|more than half the days (2 points)=2|nearly every day (3 points)=3"] <-- #4 Feeling tired or having little energy over the last 2 weeks
[select name="Q5b" value="not at all (0 points)=0|several days (1 point)=1|more than half the days (2 points)=2|nearly every day (3 points)=3"] <-- #5 Poor appetite or overeating over the last 2 weeks
[select name="Q6b" value="not at all (0 points)=0|several days (1 point)=1|more than half the days (2 points)=2|nearly every day (3 points)=3"] <-- #6 Feeling bad about self-or are a failure or have let self or family down over the last 2 weeks
[select name="Q7b" value="not at all (0 points)=0|several days (1 point)=1|more than half the days (2 points)=2|nearly every day (3 points)=3"] <-- #7 Trouble concentrating on things, such as reading the newspaper or watching television over the last 2 weeks
[select name="Q8b" value="not at all (0 points)=0|several days (1 point)=1|more than half the days (2 points)=2|nearly every day (3 points)=3"] <-- #8 Moving or speaking so slowly that other people have noticed. Or the opposite-being so fidgety or restless that has been moving around a lot more than usual over the last 2 weeks
[select name="Q9b" value="not at all (0 points)=0|several days (1 point)=1|more than half the days (2 points)=2|nearly every day (3 points)=3"] <-- #9 Thoughts that would be better off dead or of hurting self in some way over the last 2 weeks

[select name="Q10b" value="NOT difficult at all|SOMEWHAT difficult|VERY difficult|EXTREMELY difficult"] <-- #10 How difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?
Score --> [calc value="score=(Q1b)+(Q2b)+(Q3b)+(Q4b)+(Q5b)+(Q6b)+(Q7b)+(Q8b)+(Q9b)" memo="score"] out of 27 points
Interpretation --> [calc value="score=(Q1b)+(Q2b)+(Q3b)+(Q4b)+(Q5b)+(Q6b)+(Q7b)+(Q8b)+(Q9b);score>20?'Severe':score>14?'Moderately Severe':score>9?'Mild':score>4?'Minimal Symptoms':'Asymptomatic'" memo="interpretation"][/conditional]

[conditional field="Q6" condition="(Q6).is('yes')"]Drug Use Questionnaire (DAST - 10)
[comment memo="The following questions concern information about your possible involvement with drugs not including alcoholic beverages during the past 12 months.

In the statements *drug abuse* refers to (1) the use of prescribed or over the counter drugs may include: cannabis (e.g. marijuana, hash), solvents, tranquilizers (e.g. Valium), barbiturates, cocaine, stimulants (e.g. speed), hallucinogens (e.g. LSD) or narcotics (e.g. heroin). Remember that the questions do not include alcoholic beverages.

Please answer every question. If you have difficulty with a statement, then choose the response that is mostly right."]

These questions refer to the past 12 months.

[select name="Q1c" value="no=0|yes=1"] <-- 1. Have you used drugs other than those required for medical reasons?
[select name="Q2c" value="no=0|yes=1"] <-- 2. Do you abuse more than one drug at a time?
[select name="Q3c" value="no=1|yes=0"] <-- 3. Are you always able to stop using drugs when you want to?
[select name="Q4c" value="no=0|yes=1"] <-- 4. Have you had "blackouts" or "flashbacks" as a result of drug use?
[select name="Q5c" value="no=0|yes=1"] <-- 5. Do you ever feel bad or guilty about your drug use?
[select name="Q6c" value="no=0|yes=1"] <-- 6. Does your spouse (or parents ) ever complain about your involvement with drugs?
[select name="Q7c" value="no=0|yes=1"] <-- 7. Have you neglected your family because of your use of drugs?
[select name="Q8c" value="no=0|yes=1"] <-- 8. Have you ever engaged in illegal activities in order to obtain drugs?
[select name="Q9c" value="no=0|yes=1"] <-- 9. have you ever experienced withdrawal symptoms (felt sick) when you stopped taking drugs?
[select name="Q10c" value="no=0|yes=1"] <-- 10. Have you had medical problems as a result of your drug use (e.g. memory loss, hepatitis, convulsions, bleeding, etc.)?

Total Score --> [calc memo="number" value="score1=(Q1c)+(Q2c)+(Q3c)+(Q4c)+(Q5c)+(Q6c)+(Q7c)+(Q8c)+(Q9c)+(Q10c)"] / 10
Interpretation --> [calc memo="result" value="score2=(Q1c)+(Q2c)+(Q3c)+(Q4c)+(Q5c)+(Q6c)+(Q7c)+(Q8c)+(Q9c)+(Q10c);score2>8?'Severe':score2>5?'Substantial':score2>2?'Intermediate':score2>0?'Low':'None'"][/conditional]

[conditional field="Q7|Q8" condition="(Q7).isNot('None in the past 12 months')||(Q8).isNot('None in the past 12 months')"][html]<hr>[/html]
The Alcohol Use Disorders Identification Test (AUDIT)
[html]<img src="http://www.niaaa.nih.gov/sites/default/files/just_drinks_for_web2.jpg" alt="standard drinks" width="600" height="250">[/html]
[select name="Q1d" value="Never=0|Monthly or less=1|2 to 4 times a month=2|2 to 3 times a week=3|4 or more times a week=4"] <-- How often do you have a drink containing alcohol?[/conditional]
[conditional field="Q1d" condition="(Q1d).isNot('Never=0')"]
[select name="Q2d" value="1 or 2=0|3 or 4=1|5 or 6=2|7, 8, or 9=3|10 or more=4"] <-- How many drinks containing alcohol do you have on a typical day when you are drinking?
[select name="Q3d" value="Never=0|Less than monthly=1|Monthly=2|Weekly=3|Daily or almost daily=4"] <-- How often do you have six or more drinks on one occasion?
[select name="Q4d" value="Never=0|Less than monthly=1|Monthly=2|Weekly=3|Daily or almost daily=4"] <-- How often during the last year have you found that you were not able to stop drinking once you had started?
[select name="Q5d" value="Never=0|Less than monthly=1|Monthly=2|Weekly=3|Daily or almost daily=4"] <-- How often during the last year have you failed to do what was normally expected from you because of drinking?
[select name="Q6d" value="Never=0|Less than monthly=1|Monthly=2|Weekly=3|Daily or almost daily=4"] <-- How often during the last year have you been unable to remember what happened the night before because you had been drinking?
[select name="Q7d" value="Never=0|Less than monthly=1|Monthly=2|Weekly=3|Daily or almost daily=4"] <-- How often during the last year have you needed an alcoholic drink first thing in the morning to get yourself going after a night of heavy drinking?
[select name="Q8d" value="Never=0|Less than monthly=1|Monthly=2|Weekly=3|Daily or almost daily=4"] <-- How often during the last year have you had a feeling of guilt or remorse after drinking?[/conditional]
[conditional field="Q7|Q8" condition="(Q7).isNot('None in the past 12 months')||(Q8).isNot('None in the past 12 months')"][select name="Q9d" value="No=0|Yes, but not in the last year=2|Yes, during the last year=4"] <-- Have you or someone else been injured as a result of your drinking?
[select name="Q10d" value="No=0|Yes, but not in the last year=2|Yes, during the last year=4"] <-- Has a relative, friend, doctor, or another health professional expressed concern about your drinking or suggested you cut down?

Total Score --> [calc memo="number" value="score1=(Q1d)+(Q2d)+(Q3d)+(Q4d)+(Q5d)+(Q6d)+(Q7d)+(Q8d)+(Q9d)+(Q10d)"]
Interpretation --> [calc memo="result" value="score2=(Q1d)+(Q2d)+(Q3d)+(Q4d)+(Q5d)+(Q6d)+(Q7d)+(Q8d)+(Q9d)+(Q10d);score2>7?'Harmful drinking behavior':'Negative screen'"][/conditional]

<-- Gender
--Over the past 2 weeks, have you been bothered by:
<--1. Feeling nervous, anxious, or on edge?
<--2. Not being able to stop or control
<--3. Little interest or pleasure in doing things?
<--4. Feeling down, depressed, or hopeless?
--Over the past 12 months:
5. Have you used marijuana, other illegal drugs or taken a prescription medication for non-medical reasons?


-score=(Q9b);score>0?'***********Brief Intervention: SI***********':''









Result - Copy and paste this output: