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Answer Questions 1 & 2:
In the past month...
1) Have you wished you were dead or wished you could go to sleep and not wake up?
YES = Low Risk
2) Have you actually had any thoughts of killing yourself?
YES = Low Risk
If YES to question 2, answer questions 3, 4, 5, and 6
If NO to question 2, go directly to question 6
3) Have you been thinking about how you might do this?
YES = Moderate Risk
4) Have you had these thoughts and had some intention of acting on them?
YES = High Risk
5) Have you started to work out or worked out the details of how to kill yourself? Do you intend to carry out this plan?
YES = High Risk
ALWAYS ask Question 6:
6) Have you done anything, started to do anything, or prepared to do anything to end your life?
YES = Moderate Risk
If YES, was this in the past 3 months?
YES = High Risk
If YES to 2 or 3, seek behavioral healthcare for evaluation.
If YES to question 4, 5, or 6: IMMEDIATE & EMERGENT care needed.

C-SSRS Scale Medical Form

Nurse Practitioner

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Published: July 9, 2026, 11:51 a.m.
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Sunnyvale, CA 94089

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