Library

PHQ-9

Patient Health Questionnaire-9 (PHQ-9)

9 scored items · total 0–27

Start assessment PHQ-9

Details of PHQ-9

Bands: Developer severity levels. Kroenke K, Spitzer RL. The PHQ-9: a new depression diagnostic and severity measure. Psychiatric Annals 2002;32:509-521, as reproduced in Table 4 of the PHQ and GAD-7 instruction manual.

Also asks: 1 unscored question
Safety question: PHQ-9 item 9. Rule: Any answer above "Not at all" (Forms Med default).
Given: By link · Handed to the patient in the office · Asked or rated by the clinician · Score entry from paper
Ages: None stated
Validated as: Self-report
Citation: Kroenke K, Spitzer RL, Williams JBW. The PHQ-9: Validity of a brief depression severity measure. J Gen Intern Med 2001;16:606-613.
Licence: Developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke and colleagues, with an educational grant from Pfizer Inc. No permission required to reproduce, translate, display or distribute.
Edition: PHQ-9, English, the one-page form published by the developers at phqscreeners.com as "PHQ-9_English.pdf" (nine items and the difficulty question).

GAD-7

7 scored items · total 0–21

Start assessment GAD-7

Details of GAD-7

Bands: Developer severity levels. PHQ and GAD-7 instruction manual, page 6, "GAD-7 Anxiety Severity". The manual's validation reference for the GAD-7 is Spitzer RL, Kroenke K, Williams JBW, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 2006;166:1092-1097.

Given: By link · Handed to the patient in the office · Asked or rated by the clinician · Score entry from paper
Ages: None stated
Validated as: Self-report
Citation: Spitzer RL, Kroenke K, Williams JBW, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 2006;166:1092-1097.
Licence: Developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke and colleagues, with an educational grant from Pfizer Inc. No permission required to reproduce, translate, display or distribute.
Edition: GAD-7, English, the one-page form published by the developers at phqscreeners.com as "GAD-7_English.pdf" (seven items; no difficulty question).

PHQ-A

PHQ-9 modified for Adolescents (PHQ-A)

9 scored items · total 0–27

Start assessment PHQ-A

Details of PHQ-A

Bands: Adolescent cut point of 11 (Richardson 2010, found on the adult PHQ-9). Richardson LP, McCauley E, Grossman DC, McCarty CA, Richards J, Russo JE, Rockhill C, Katon W. Evaluation of the Patient Health Questionnaire (PHQ-9) for Detecting Major Depression among Adolescents. Pediatrics. 2010 Nov 1;126(6):1117–1123. doi: 10.1542/peds.2010-0852

Also asks: 2 unscored questions
Safety question: PHQ-A item 9. Rule: Any answer above "Not at all" (Forms Med default).
Given: By link · Handed to the patient in the office · Score entry from paper
Ages: 13 to 17
Validated as: Self-report
Citation: Johnson JG, Harris ES, Spitzer RL, Williams JB. The patient health questionnaire for adolescents: validation of an instrument for the assessment of mental disorders among adolescent primary care patients. J Adolesc Health. 2002;30(3):196-204. doi:10.1016/s1054-139x(01)00333-0
Licence: Johnson JG, Harris ES, Spitzer RL, Williams JB. The patient health questionnaire for adolescents: validation of an instrument for the assessment of mental disorders among adolescent primary care patients. J Adolesc Health. 2002;30(3):196-204. doi:10.1016/s1054-139x(01)00333-0
Edition: PHQ-9 modified for Adolescents (PHQ-A), English, the nine-item form on the one-page PDF published by the National Institute of Mental Health as "PHQ-A_with_depression_questions_and_ASQ_PDF.pdf": items 1 to 9, the past-year question and the difficulty question. The ASQ printed on the lower half of that page is not part of this instrument and is not transcribed.

ASQ

Ask Suicide-Screening Questions (ASQ)

5 scored items · screen result

Start assessment ASQ

Details of ASQ

Bands: NIMH screening result (ASQ tool, 9/29/25). National Institute of Mental Health. Ask Suicide-Screening Questions (ASQ) Suicide Risk Screening Tool, dated 9/29/25, "Screening result and next steps". Horowitz LM et al., Arch Pediatr Adolesc Med 2012;166(12):1170-1176 (youth); Psychosomatics 2020 (adult medical inpatients).

Also asks: 2 unscored questions
Safety question: ASQ question 1. Rule: "Yes" to any of questions 1 to 4 is a positive screen (NIMH) (publisher).
Safety question: ASQ question 2. Rule: "Yes" to any of questions 1 to 4 is a positive screen (NIMH) (publisher).
Safety question: ASQ question 3. Rule: "Yes" to any of questions 1 to 4 is a positive screen (NIMH) (publisher).
Safety question: ASQ question 4. Rule: "Yes" to any of questions 1 to 4 is a positive screen (NIMH) (publisher).
Safety question: ASQ question 5. Rule: "Yes" to question 5 is an acute positive screen (NIMH) (publisher).
Safety question: ASQ question 1. Rule: Refused, patient under 25 or age not known (NIMH: "For youth, refusal is considered a non-acute positive screen"; the age of 25 is a Forms Med default) (Forms Med default).
Safety question: ASQ question 2. Rule: Refused, patient under 25 or age not known (NIMH: "For youth, refusal is considered a non-acute positive screen"; the age of 25 is a Forms Med default) (Forms Med default).
Safety question: ASQ question 3. Rule: Refused, patient under 25 or age not known (NIMH: "For youth, refusal is considered a non-acute positive screen"; the age of 25 is a Forms Med default) (Forms Med default).
Safety question: ASQ question 4. Rule: Refused, patient under 25 or age not known (NIMH: "For youth, refusal is considered a non-acute positive screen"; the age of 25 is a Forms Med default) (Forms Med default).
Safety question: ASQ question 5. Rule: Refused, patient under 25 or age not known (NIMH: "For youth, refusal is considered a non-acute positive screen"; the age of 25 is a Forms Med default) (Forms Med default).
Given: Handed to the patient in the office · Asked or rated by the clinician · Score entry from paper
Ages: 8 and over
Validated as: Interview
Citation: Horowitz LM, Bridge JA, Teach SJ, Ballard E, Klima J, Rosenstein DL, Wharff EA, Ginnis K, Cannon E, Joshi P, Pao M. Ask Suicide-Screening Questions (ASQ): A Brief Instrument for the Pediatric Emergency Department. Arch Pediatr Adolesc Med. 2012;166(12):1170-1176.
Licence: Ask Suicide-Screening Questions (ASQ), Suicide Risk Screening Tool, National Institute of Mental Health (NIMH), 9/29/25. asQ Toolkit: www.nimh.nih.gov/asQ
Edition: Ask Suicide-Screening Questions (ASQ), English, the NIMH Toolkit "Suicide Risk Screening Tool" for youth and adults dated 9/29/25: questions 1 to 5, the recency boxes under question 4, the acuity instruction and the line to describe a "Yes" to question 5.

PCL-5

PTSD Checklist for DSM-5 (PCL-5)

20 scored items · total 0–80

Start assessment PCL-5

Details of PCL-5

Bands: VA suggested cut-point range, 31 to 33 (probable PTSD). National Center for PTSD. PTSD Checklist for DSM-5 (PCL-5), "Administration and Scoring"; and Using the PTSD Checklist for DSM-5 (PCL-5), page 2.

Also asks: 1 unscored question
Given: By link · Handed to the patient in the office · Score entry from paper
Ages: None stated
Validated as: Self-report
Citation: Weathers, F. W., Litz, B. T., Keane, T. M., Palmieri, P. A., Marx, B. P., & Schnurr, P. P. (2013). The PTSD Checklist for DSM-5 (PCL-5) – Standard [Measurement instrument]. Available from https://www.ptsd.va.gov/
Licence: Weathers, F. W., Litz, B. T., Keane, T. M., Palmieri, P. A., Marx, B. P., & Schnurr, P. P. (2013). The PTSD Checklist for DSM-5 (PCL-5) – Standard [Measurement instrument]. Available from https://www.ptsd.va.gov/
Edition: PTSD Checklist for DSM-5 (PCL-5), standard form, past month, English, as the VA's National Center for PTSD publishes it in "PCL5_Standard_form.pdf" (version date 29 August 2023; the form page is footed "PCL-5 (18 August 2023)"): the instructions, the "Your worst event" line and the 20 items. Not the past-week form, and not the forms with Criterion A or the LEC-5.

PC-PTSD-5

Primary Care PTSD Screen for DSM-5 (PC-PTSD-5)

5 scored items · total 0–5

Start assessment PC-PTSD-5

Details of PC-PTSD-5

Bands: VA cut-point of 4 (VA primary care patients). National Center for PTSD. Primary Care PTSD Screen for DSM-5 (PC-PTSD-5), "Scoring" (the measure's page, and page 1 of the form, version date 2022). The VA cites Prins et al. 2016, J Gen Intern Med 31:1206-1211, and Bovin et al. 2021, JAMA Netw Open 4(2):e2036733, which were not read.

Also asks: 1 unscored question
Given: By link · Score entry from paper
Ages: None stated
Validated as: Self-report
Citation: Prins, A. Bovin, M. J., Kimerling, R., Kaloupek, D. G., Marx, B. P., Pless Kaiser, A. & Schnurr, P. P. (2015). Primary Care PTSD Screen for DSM-5 (PC-PTSD-5). [Measurement instrument]. Available from https://www.ptsd.va.gov
Licence: Prins, A. Bovin, M. J., Kimerling, R., Kaloupek, D. G., Marx, B. P., Pless Kaiser, A. & Schnurr, P. P. (2015). Primary Care PTSD Screen for DSM-5 (PC-PTSD-5). [Measurement instrument]. Available from https://www.ptsd.va.gov
Edition: Primary Care PTSD Screen for DSM-5 (PC-PTSD-5), English, the form on page 2 of the VA's "pc-ptsd-5-v6.pdf" (version date 2022): the lead-in with its examples, the exposure question and items 1 to 5.

AUDIT

Alcohol Use Disorders Identification Test (AUDIT)

10 scored items · total 0–40

Start assessment AUDIT

Details of AUDIT

Bands: WHO zones (AUDIT manual, Box 6). Babor TF, Higgins-Biddle JC, Saunders JB, Monteiro MG. AUDIT: The Alcohol Use Disorders Identification Test. Guidelines for Use in Primary Care, second edition. World Health Organization, 2001 (WHO/MSD/MSB/01.6a).

Given: By link · Handed to the patient in the office · Score entry from paper
Ages: None stated
Validated as: Self-report, on paper
Citation: © World Health Organization 2001. Babor TF, Higgins-Biddle JC, Saunders JB, Monteiro MG. AUDIT: The Alcohol Use Disorders Identification Test. Guidelines for Use in Primary Care, second edition.
Edition: The Alcohol Use Disorders Identification Test (AUDIT), English, self-report version (Box 10, Appendix B) of WHO's "AUDIT: Guidelines for Use in Primary Care", second edition, 2001 (WHO/MSD/MSB/01.6a): the lead-in and questions 1 to 10.

CGI-S

Clinical Global Impressions – Severity of Illness (CGI-S)

1 rating · 1–7

Start assessment CGI-S

Details of CGI-S

Bands: ECDEU ratings (CGI-S, 1 to 7). Guy W. ECDEU Assessment Manual for Psychopharmacology, Revised 1976. Rockville, MD: U.S. Department of Health, Education, and Welfare, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, National Institute of Mental Health, Psychopharmacology Research Branch; 1976. DHEW Publication No. (ADM) 76-338.

Given: Asked or rated by the clinician · Score entry from paper
Ages: None stated
Validated as: Clinician rating, on paper
Citation: Guy W. ECDEU Assessment Manual for Psychopharmacology, Revised 1976. Rockville, MD: U.S. Department of Health, Education, and Welfare, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, National Institute of Mental Health, Psychopharmacology Research Branch; 1976. DHEW Publication No. (ADM) 76-338.
Licence: Guy W. ECDEU Assessment Manual for Psychopharmacology, Revised 1976. Rockville, MD: U.S. Department of Health, Education, and Welfare, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, National Institute of Mental Health, Psychopharmacology Research Branch; 1976. DHEW Publication No. (ADM) 76-338.
Edition: Clinical Global Impressions – Severity of Illness (CGI-S), English, form 028 "Clinical Global Impressions" of the ECDEU Assessment Manual for Psychopharmacology, revised 1976 (Guy), page 218.

CGI-I

Clinical Global Impressions – Global Improvement (CGI-I)

1 rating · 1–7

Start assessment CGI-I

Details of CGI-I

Bands: ECDEU ratings (CGI-I, 1 to 7). Guy W. ECDEU Assessment Manual for Psychopharmacology, Revised 1976. Rockville, MD: U.S. Department of Health, Education, and Welfare, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, National Institute of Mental Health, Psychopharmacology Research Branch; 1976. DHEW Publication No. (ADM) 76-338.

Given: Asked or rated by the clinician · Score entry from paper
Ages: None stated
Validated as: Clinician rating, on paper
Citation: Guy W. ECDEU Assessment Manual for Psychopharmacology, Revised 1976. Rockville, MD: U.S. Department of Health, Education, and Welfare, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, National Institute of Mental Health, Psychopharmacology Research Branch; 1976. DHEW Publication No. (ADM) 76-338.
Licence: Guy W. ECDEU Assessment Manual for Psychopharmacology, Revised 1976. Rockville, MD: U.S. Department of Health, Education, and Welfare, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, National Institute of Mental Health, Psychopharmacology Research Branch; 1976. DHEW Publication No. (ADM) 76-338.
Edition: Clinical Global Impressions – Global Improvement (CGI-I), English, form 028 "Clinical Global Impressions" of the ECDEU Assessment Manual for Psychopharmacology, revised 1976 (Guy), page 218.

AIMS

Abnormal Involuntary Movement Scale (AIMS)

12 scored items · total 0–42

Start assessment AIMS

Details of AIMS

Given: Asked or rated by the clinician · Score entry from paper
Ages: None stated
Validated as: Clinician rating, on paper
Citation: Guy W. ECDEU Assessment Manual for Psychopharmacology, Revised 1976. Rockville, MD: U.S. Department of Health, Education, and Welfare, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, National Institute of Mental Health, Psychopharmacology Research Branch; 1976. DHEW Publication No. (ADM) 76-338.
Licence: Guy W. ECDEU Assessment Manual for Psychopharmacology, Revised 1976. Rockville, MD: U.S. Department of Health, Education, and Welfare, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, National Institute of Mental Health, Psychopharmacology Research Branch; 1976. DHEW Publication No. (ADM) 76-338.
Edition: Abnormal Involuntary Movement Scale (AIMS), English, form 117 "Abnormal Involuntary Movement Scale (AIMS)" (MH-9-117, 11-74) of the ECDEU Assessment Manual for Psychopharmacology, revised 1976 (Guy), pages 534 to 537.

HAM-A

Hamilton Anxiety Scale (HAM-A)

14 scored items · total 0–56

Start assessment HAM-A

Details of HAM-A

Given: Asked or rated by the clinician · Score entry from paper
Ages: None stated
Validated as: Clinician rating, on paper
Citation: Guy W. ECDEU Assessment Manual for Psychopharmacology, Revised 1976. Rockville, MD: U.S. Department of Health, Education, and Welfare, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, National Institute of Mental Health, Psychopharmacology Research Branch; 1976. DHEW Publication No. (ADM) 76-338.
Licence: Guy W. ECDEU Assessment Manual for Psychopharmacology, Revised 1976. Rockville, MD: U.S. Department of Health, Education, and Welfare, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, National Institute of Mental Health, Psychopharmacology Research Branch; 1976. DHEW Publication No. (ADM) 76-338.
Edition: Hamilton Anxiety Scale (HAM-A), English, form 048 "Hamilton Anxiety Scale" (HAMA; MH-9-48, 6-73) of the ECDEU Assessment Manual for Psychopharmacology, revised 1976 (Guy), pages 193 to 198.

BPRS-18

Brief Psychiatric Rating Scale (BPRS-18)

18 scored items · total 18–126

Start assessment BPRS-18

Details of BPRS-18

Given: Asked or rated by the clinician · Score entry from paper
Ages: None stated
Validated as: Clinician rating, on paper
Citation: Guy W. ECDEU Assessment Manual for Psychopharmacology, Revised 1976. Rockville, MD: U.S. Department of Health, Education, and Welfare, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, National Institute of Mental Health, Psychopharmacology Research Branch; 1976. DHEW Publication No. (ADM) 76-338.
Licence: Guy W. ECDEU Assessment Manual for Psychopharmacology, Revised 1976. Rockville, MD: U.S. Department of Health, Education, and Welfare, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, National Institute of Mental Health, Psychopharmacology Research Branch; 1976. DHEW Publication No. (ADM) 76-338.
Edition: Brief Psychiatric Rating Scale (BPRS-18), English, form 047 "Brief Psychiatric Rating Scale (Overall and Gorham)" (BPRS; MH-9-47, 6-73) of the ECDEU Assessment Manual for Psychopharmacology, revised 1976 (Guy), pages 157 to 160.