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Depression Assessment
Over the last 2 weeks, how often have you been bothered by
1. Little interest or pleasure doing things
2. Feeling down / depressed / hopeless
3. Trouble falling or staying asleep, or sleeping too much
4. Feeling tired and having little energy
5. Poor appetite or over eating
6. Feeling bad about yourself/feeling a failure/feeling you have let people down:
7. Trouble concentrating on things, such as reading the newspaper/watching television
8. Moving/Speaking so slow that other people could have noticed/the opposite
9. Thoughts that you would be better off dead or of hurting yourself in someway
If Yes, Explain:
Depression Score
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Anxiety Assessment
Over the last 2 weeks, how often have you been bothered by the following problems?
1. Feeling nervous, anxious or on edge
2. Not being able to stop or control worrying
3. Worrying too much about different things
4. Trouble relaxing
5. Being so restless that it is hard to sit still
6. Becoming easily annoyed or irritable
7. Feeling afraid as if something awful might happen
Anxiety Score
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SOAP ONPATIENT SAFE KEEPING 2025 Medical Form

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Published: Jan. 7, 2025, 1:31 p.m.
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