ADULT SYMPTOM CHECKLIST PATIENT LABEL. Patient Name: Date: Please check the appropriate degree of any symptoms you have experienced in the last month. 1=Never. 2=Rarely. 3=Occasionally. 4=Frequently. 5=Usually. Constant sadness/depressed mood. 9 1 9 2 9 3 9 4 9 5 Dificulty falling asleep. 9 1 9 2 9 3 9 4 9 5 Fear of bridges/heights File Size: KB. Apr 23, · Find possible causes of symptoms in children and adults. See our Symptom Checker. Find possible causes of symptoms in children and adults. See our Symptom Checker. COVID What you need to know. Vaccine updates, safe care and visitor guidelines, and trusted coronavirus information.
Dec 22, · Anyone can have mild to severe symptoms. Older adults and people who have severe underlying medical conditions like heart or lung disease or diabetes seem to be at higher risk for developing more serious complications from COVID illness. This list does not include all possible symptoms. CDC will. Adult ADHD Self-Report Scale (ASRS) Symptom Checklist. Please answer the questions below, rating yourself on each of the criteria shown using the scale on the right side of the page. As you answer each question, place an X in the box that best describes how you have felt and conducted yourself over the past 6 months. Never Rarely Sometimes Often.
V. Somatic Symptoms Mild or greater LEVEL 2—Somatic Symptom—Adult (Patient Health Questionnaire 15 Somatic Symptom Severity [PHQ]) VI. Suicidal Ideation Slight or greater None VII. Psychosis Slight or greater None VIII. Sleep Problems Mild or greater LEVEL 2—Sleep Disturbance - Adult (PROMIS—Sleep Disturbance—Short Form)1 IX.