Get the free Patient Health Survey

This document is a health survey for patients visiting the City Employee Medical Clinic, designed to gather information about their health concerns and medical history to assist their healthcare provider.

How to fill out patient health survey

How to fill out Patient Health Survey

1. Begin by reading the instructions carefully at the top of the survey.
2. Answer each question honestly based on your feelings and experiences over the past two weeks.
3. Use the rating scale provided to indicate the frequency or severity of your symptoms.
4. Take your time to reflect on each question to ensure accurate responses.
5. Review your answers before submitting the survey to make sure you've completed all sections.

Who needs Patient Health Survey?

1. Individuals experiencing symptoms of depression or anxiety.
2. Patients seeking mental health evaluations.
3. Healthcare providers looking to assess patient well-being.
4. Research participants in psychological studies.

People Also Ask about

Is the patient health questionnaire free?

The PHQ-9 also has been used in many studies in primary care settings, as well as with older individuals and with those who have physically disabling conditions. It is free to users and available in English and over 30 other languages.

What is a Patient Health Questionnaire?

The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as “0” (not at all) to “3” (nearly every day).

What does a PHQ score of 15 mean?

Thus, the total PHQ-15 score ranges from 0 to 30 and scores of ≥5, ≥10, ≥15 represent mild, moderate and severe levels of somatization. The reliability and validity of the PHQ-15 are high in clinical and occupational health care settings [2,7,11].

What is the patient health questionnaire used for?

The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as “0” (not at all) to “3” (nearly every day).

What do PHQ and GAD stand for?

Patient Health Questionnaire and General Anxiety Disorder. (PHQ-9 and GAD-7) Date Patient Name:__ Date of Birth: __

What does a PHQ score of 12 mean?

Scores are rated as normal (0-2), mild (3-5), moderate (6-8), and severe (9-12). Total score ≥3 for first 2 questions suggests anxiety. Total score ≥3 for last 2 questions suggests depression. Reprinted with permission from Kroenke K, Spitzer RL, Williams JB, Löwe B.

What is the health questionnaire?

The Health Assessment Questionnaire is a survey designed to gather information about an individual's health status. The survey consists of four sections, including personal information, lifestyle, medical history, and mental health.

For pdfFiller’s FAQs

What is Patient Health Survey?

The Patient Health Survey is a standardized questionnaire used to assess a patient's mental health and well-being, particularly focusing on symptoms of depression and anxiety.

Who is required to file Patient Health Survey?

Healthcare providers, clinics, and hospitals may require patients to fill out the Patient Health Survey to monitor and evaluate their mental health status.

How to fill out Patient Health Survey?

To fill out the Patient Health Survey, individuals typically need to answer a series of questions regarding their mood, thoughts, and behaviors over the past few weeks, following the provided instructions.

What is the purpose of Patient Health Survey?

The purpose of the Patient Health Survey is to identify mental health issues in patients, facilitate early intervention, and track changes in mental health over time.

What information must be reported on Patient Health Survey?

The information that must be reported on the Patient Health Survey includes the frequency of depressive symptoms, anxiety levels, and overall emotional well-being of the patient.