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INSTRUCTIONS
1. Repeated, disturbing memories, thoughts, or images of a stressful experience from the past?
2. Repeated, disturbing dreams of a stressful experience from the past?
3. Suddenly acting or feeling as if a stressful experience were happening again (as if you were reliving it)?
4. Feeling very upset when something reminded you of a stressful experience from the past?
5. Having physical reactions (e.g., heart pounding, trouble breathing, or sweating) when something reminded you of a stressful e
6. Avoid thinking about or talking about a stressful experience from the past or avoid having feelings related to it?
7. Avoid activities or situations because they remind you of a stressful experience from the past?
8. Trouble remembering important parts of a stressful experience from the past?
9. Loss of interest in things that you used to enjoy?
10. Feeling distant or cut off from other people?
11. Feeling emotionally numb or being unable to have loving feelings for those close to you?
12. Feeling as if your future will somehow be cut short?
13. Trouble falling or staying asleep?
14. Feeling irritable or having angry outbursts?
15. Having difficulty concentrating?
16. Being `super alert` or watchful on guard?
17. Feeling jumpy or easily startled?
Scoring: Whilst the checklist may be scored with a final score of up to 85, where the higher the score, the greater the impact o
At least 1 answer of 3, 4 or 5 points at questions 1 to 5?
At least 3 answers of 3, 4 or 5 points at q?uestions 6 to 12
At least 2 answers of 3, 4 or 5 points at questions 13 to 17

PTSD CHECKLIST Medical Form

Nurse Practitioner

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Published: Aug. 26, 2022, 12:43 p.m.
Doctor: Dr. History Physical
Rating: 0   /

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