Woman Abuse Screening Tool (WAST)

WAST (Woman Abuse Screening Tool) – self report
[select name="Q1" value="No tension|Some tension|A lot of tension"] <-- In general, how would you describe your relationship? 
[select name="Q2" value="No difficulty|Some difficulty|Great difficulty"] <-- Do you and your partner work out arguments with no difficulty, some difficulty, or great difficulty? 
[select name="Q3" value="Never|Sometimes|Often"] <-- Do arguments ever result in you feeling down or bad about yourself?
[select name="Q4" value="Never|Sometimes|Often"] <-- Do arguments ever result in hitting, kicking, or pushing?
[select name="Q5" value="Never|Sometimes|Often"] <-- Do you ever feel frightened about what your partner says or does?
[select name="Q6" value="Never|Sometimes|Often"] <-- Does your partner ever abuse you physically?
[select name="Q7" value="Never|Sometimes|Often"] <-- Does your partner ever abuse you emotionally?
[select name="Q8" value="Never|Sometimes|Often"] <-- Does your partner ever abuse you sexually?

The physician performs scoring subjectively, using clinical judgment.  Positive screens should be evaluated for risk with a tool such as the Danger Assessment at https://www.dangerassessment.org/DA.aspx
[checkbox memo="display/hide references" name="footnotes" value=""][conditional field="footnotes" condition="(footnotes).isNot('')"]
reference: [link url="https://www.ncbi.nlm.nih.gov/pubmed/8791071" memo="#1"] Brown JB, Lent B, Brett PJ, Sas G, Pederson LL. Development of the Woman Abuse Screening Tool for use in family practice. Fam Med. 1996 Jun;28(6):422-8.[/conditional]
WAST (Woman Abuse Screening Tool) – self report
<-- In general, how would you describe your relationship?
<-- Do you and your partner work out arguments with no difficulty, some difficulty, or great difficulty?
<-- Do arguments ever result in you feeling down or bad about yourself?
<-- Do arguments ever result in hitting, kicking, or pushing?
<-- Do you ever feel frightened about what your partner says or does?
<-- Does your partner ever abuse you physically?
<-- Does your partner ever abuse you emotionally?
<-- Does your partner ever abuse you sexually?

The physician performs scoring subjectively, using clinical judgment. Positive screens should be evaluated for risk with a tool such as the Danger Assessment at https://www.dangerassessment.org/DA.aspx
display/hide references

Result - Copy and paste this output:

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