Template library · Assessments & screeners
PTSD Functional Impact Assessment template
Evaluate the impact of PTSD symptoms on daily functioning.
Assessment of PTSD-related functional impairment
- 17 fields across 4 sections
- Included with MyWellOps
- Edit it, or save your own version
What’s in it
Assessment Details
- Client NameText
- Date of BirthDate
- Client ID / MRNText
- Date of AssessmentDate
- Clinician / CoachText
- Location / ModalityText
Functional Impact
- 1. Work or school performanceChoice
- 2. Relationships with familyChoice
- 3. Relationships with friendsChoice
- 4. Ability to concentrateChoice
- 5. Ability to enjoy leisure activitiesChoice
- 6. Sleep qualityChoice
Notes
- Specific functional impairments described by clientText
Signatures
- Clinician SignatureSignature
- Date signed (clinician)Date
- Client SignatureSignature
- Date signed (client)Date
When to use it
Use an assessment at the start of work to set a baseline, then repeat it at review points so you and the client can see what has changed.
How it works in MyWellOps
- Pick it from Documents.
- Send it to the client to complete, or fill it in together during a session.
- Each completed copy is kept on the client’s record, so earlier results are there to compare.
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