A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance). [checkbox name="a" value="yes|no"]
B. The individual finds it difficult to control the worry. [checkbox name="b" value="yes|no"]
C. The anxiety and worry are associated with three (or more) of the following six symptom:
(with at least some symptoms having been present for more days than not for the
past 6 months);
Note: Only one item is required in children.
[checkbox name="c" value="1. Restlessness or feeling keyed up or on edge.=1|2. Being easily fatigued.=1|3. Difficulty concentrating or mind going blank.=1|4. Irritability.=1|5. Muscle tension.=1|6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfyingsleep).=1"]
D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. [checkbox name="d" value="yes|no"]
E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism). [checkbox name="e" value="yes|no"]
F. The disturbance is not better explained by another mental disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder [social phobia], contamination or other obsessions in obsessive-compulsive
disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety
disorder, or the content of delusional beliefs in schizophrenia or delusional disorder). [checkbox name="f" value="yes|no"]
There are 7 form elements.
Result - Copy and paste this output: