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PTSD Form HTML

HTML icon PTSDTool-X-box-NoBG_V3.html — HTML, 44 kB (45139 bytes)

File contents

<html>
<head>

	<link rel="stylesheet" type="text/css" media="print" href="${oscar_image_path}JSMPC.css" />
	<!--<script language="javascript" type="text/javascript" media="print" src="${oscar_image_path}JSMPC.js"></script>	-->

<style type="text/css" media="print">
 .DoNotPrint {
	 display: none;
 }
 .noborder {
	 border : 0px;
	 background: transparent;
	 scrollbar-3dlight-color: transparent;
	 scrollbar-3dlight-color: transparent;
	 scrollbar-arrow-color: transparent;
	 scrollbar-base-color: transparent;
	 scrollbar-darkshadow-color: transparent;
	 scrollbar-face-color: transparent;
	 scrollbar-highlight-color: transparent;
	 scrollbar-shadow-color: transparent;
	 scrollbar-track-color: transparent;
	 background: transparent;
	 overflow: hidden;
 }
  .Show{
	visibility:visible;
	display:inline;
 }
 .Hide{
	visibility:hidden;
	display:none;
}
 </style>

<style type="text/css" media="screen">
 .Show{
	display:inline;
	visibility:visible;
 }
 .Hide{
	visibility:hidden;
	display:none;
}
</style>
<script language="javascript" type="text/javascript">
		/****************************
		startup functions 
		****************************/
		function startUp()
		{			
			setDocumentTitle('PTSD Scale',document.getElementById('PtName').value);
			setDefaults();			
		}
		
		function setDocumentTitle(Title,PtName)
		{
			// set document title
			document.title = Title + ' - ' + PtName;					
							
		}
		
		function setDefaults()
		{	            
			// check the newform flag to ensure this is the initial load of the form
			if (document.getElementById("newForm").value == 'True')
			{
				//document.getElementById('').value = 'X';	
			}   
		}

		/****************************
			submit and print functions 
		****************************/
		function printSubmit()
		{
			printLetter();
			releaseDirtyFlag();			
			submission();
		}

		function printLetter()
		{
			// hide the bottom buttons
			if (document.getElementById('BottomButtons').style.display == '')
				document.getElementById('BottomButtons').style.display = 'none';
			// print the letter
			window.print();
		} 

		function submission()
		{
			setFlag();
			setTimeout('document.FormName.submit()',1000);			
		}

		function setFlag()
		{
		// indicate that the form has been submitted
		if (document.getElementById("newForm").value == 'True')
			document.getElementById("newForm").value = 'False';
		}
		
		function showButtons()
		{
			//show the bottom buttons if they are hidden
			if (document.getElementById('BottomButtons').style.display == 'none')
				document.getElementById('BottomButtons').style.display = '';
		}
		
		/****************************
			checkbox functions 
		****************************/
		function changeValue(x)
		{
			if (document.getElementById(x).value == '')
				document.getElementById(x).value = 'X';
			else
				document.getElementById(x).value = '';
		}

		function displayKeyCode(evt,x)
		{
			var charCode = (evt.which) ? evt.which : event.keyCode
			// any key press except tab will constitute a value change to the checkbox
			if (charCode != 9)
			{
				changeValue(x);
				return false;
			}
		}
		</script>

<!-------Script to optimize window on loading----------->
<script language="JavaScript">

top.window.moveTo(0,0);
if (document.all) {
top.window.resizeTo(screen.availWidth,screen.availHeight);
}
else if (document.layers||document.getElementById) {
if (top.window.outerHeight<screen.availHeight||top.window.outerWidth<screen.availWidth){
top.window.outerHeight = screen.availHeight;
top.window.outerWidth = 900;
}
}
</script>
<!----------End optimize window script---------->


<!-- scripts to confirm closing of window if haven't saved yet -->
	<script language="javascript">
		//keypress events trigger dirty flag
		var needToConfirm = false;
		document.onkeyup=setDirtyFlag;
function setDirtyFlag()
		{
		needToConfirm = true;
		}
function releaseDirtyFlag()
		{
		needToConfirm = false; //Call this function if doesn't requires an alert.
		//this could be called when save button is clicked
		}
		window.onbeforeunload = confirmExit;
function confirmExit()
		{
		if (needToConfirm)
		{
		return "You have attempted to leave this page. If you have made any changes to the fields without clicking the Save button, your changes will be lost. Are you sure you want to exit this page?";
		}
		}
</script>

<script type="text/javascript" language="javascript">
function CriteriaAScore(){
	if ((document.getElementById("Life").value == '') || (document.getElementById("SeriousInj").value == '') || (document.getElementById("IntegrityThreat").value == '') || (document.getElementById("IntenseFear").value == ''))
		{document.getElementById("CriteriaA").value = 'NO';
		alert("Please designate Yes or No in sections 1 and 2.");
		return false;
		}

	var i = 0
	if (document.getElementById("Life").value == 'N'){i += 0;}
		else {i += 1;}
	if (document.getElementById("SeriousInj").value == 'N'){i += 0;}
		else {i += 1;}
	if (document.getElementById("IntegrityThreat").value == 'N'){i += 0;}
		else {i += 1;}

	if (i == 0  || (document.getElementById("IntenseFear").value == 'N'))
		{document.getElementById("CriteriaA").value = 'NO';
		alert("This patient does not meet the criteria for PTSD. Do not continue with interview.");  
		return false;
		}
		else 
		{document.getElementById("CriteriaA").value = 'YES';}
		}
</script>

<script type="text/javascript" language="javascript">
function CriteriaBScore(){

	var i = 0
	if (document.getElementById("Recollections").value == 'Y'){i += 1;}
		else {i += 0;}
	if (document.getElementById("Dreams").value == 'Y'){i += 1;}
		else {i += 0;}
	if (document.getElementById("Recurrence").value == 'Y'){i += 1;}
		else {i += 0;}
	if (document.getElementById("IntenseFeelings").value == 'Y'){i += 1;}
		else {i += 0;}
	if (document.getElementById("PhysicalSx").value == 'Y'){i += 1;}
		else {i += 0;}

	if (i < 1)
		{document.getElementById("CriteriaB").value = 'NO';
		alert("This patient may not meet the criteria for PTSD. Consider alternate diagnosis.");  
		return false;
		}
		else 
		{document.getElementById("CriteriaB").value = 'YES';}
}
</script>

<script type="text/javascript" language="javascript">
function CriteriaCScore(){

	var i = 0
	if (document.getElementById("AvoidThoughts").value == 'Y'){i += 1;}
		else {i += 0;}
	if (document.getElementById("AvoidPlaces").value == 'Y'){i += 1;}
		else {i += 0;}
	if (document.getElementById("Remembering").value == 'Y'){i += 1;}
		else {i += 0;}
	if (document.getElementById("Interest").value == 'Y'){i += 1;}
		else {i += 0;}
	if (document.getElementById("Detachment").value == 'Y'){i += 1;}
		else {i += 0;}
	if (document.getElementById("RestrictedFeelings").value == 'Y'){i += 1;}
		else {i += 0;}
	if (document.getElementById("Foreshortened").value == 'Y'){i += 1;}
		else {i += 0;}

	if (i < 3)
		{document.getElementById("CriteriaC").value = 'NO';
		alert("This patient may not meet the criteria for PTSD. Consider alternate diagnosis.");  
		return false;
		}
		else 
		{document.getElementById("CriteriaC").value = 'YES';}
}
</script>

<script type="text/javascript" language="javascript">
function CriteriaDScore(){

	var i = 0
	if (document.getElementById("Sleep").value == 'Y'){i += 1;}
		else {i += 0;}
	if (document.getElementById("Irritability").value == 'Y'){i += 1;}
		else {i += 0;}
	if (document.getElementById("Concentration").value == 'Y'){i += 1;}
		else {i += 0;}
	if (document.getElementById("HyperVigilance").value == 'Y'){i += 1;}
		else {i += 0;}
	if (document.getElementById("Startle").value == 'Y'){i += 1;}
		else {i += 0;}

	if (i < 2)
		{document.getElementById("CriteriaD").value = 'NO';
		alert("This patient may not meet the criteria for PTSD. Consider alternate diagnosis.");  
		return false;
		}
		else 
		{document.getElementById("CriteriaD").value = 'YES';}
}
</script>

<script type="text/javascript" language="javascript">
function CriteriaEScore(){

	if ((document.getElementById("Duration").value == 'N') || (document.getElementById("Duration").value == ''))
		{document.getElementById("CriteriaE").value = 'NO';
		alert("This patient may not meet the criteria for PTSD. Consider alternate diagnosis.");  
		return false;
		}
		else 
		{document.getElementById("CriteriaE").value = 'YES';}
}
</script>

<script type="text/javascript" language="javascript">
function CriteriaFScore(){

	if ((document.getElementById("Distress").value == 'N') || (document.getElementById("Distress").value == ''))
		{document.getElementById("CriteriaF").value = 'NO';
		alert("This patient may not meet the criteria for PTSD. Consider alternate diagnosis.");  
		return false;
		}
		else 
		{document.getElementById("CriteriaF").value = 'YES';}
}
</script>

<script type="text/javascript">
function ChangeClass(i,c) { // i  = id name, c = class name
	document.getElementById(i).className = c;
}
function PopUp(i){
var a = document.getElementById(i);
var j = i + '_detail';
var k = document.getElementById(j);
	k.style.position = 'fixed';
	k.style.top = '150px';
	k.style.left = '100px';
	k.style.width = '700px';
	k.style.backgroundColor = "#eeeeee";
	k.style.outline = "thin solid";
	k.style.padding = '10px';
	k.style.margin = '10px';
	k.className = 'Show';
}
function ToggleCheckboxes(obj,Name){
var objName = document.getElementsByName(Name);
	if(obj.checked){
		CheckAll(objName);
	}else{
		UncheckAll(objName);
	}
}

function ToggleView(ID){
var obj = document.getElementById(ID);
	if (obj.className == 'Hide'){
		obj.className = 'Show';
	}else if (obj.className == 'Show'){
		obj.className = 'Hide';
	}
}

function CheckAll(field){
	if (!field.length){
		field.checked = true;
	} else {
		for (i = 0; i < field.length; i++)
			field[i].checked = true ;
	}
}
function UncheckAll(field){
if (!field.length){
	field.checked = false;
	} else {
	for (i = 0; i < field.length; i++)
		field[i].checked = false ;
	}
}
</script>


</head>

<body onload="startUp();" onMouseDown="showButtons();">

<form method="post" action="" name="FormName" id="FormName" >

<div id="page1" style="position:relative; left:0px; top:0px; width:850px;" class="pagebreak">

<span style="position:absolute; left:0px; top:20px; width:850px; font-family:sans-serif; font-weight:bold; font-size:20px; text-align:center;">Clinician-Administered PTSD Scale</span>
<span style="position:absolute; left:80px; top:60px; font-family:sans-serif; font-weight:bold; font-size:12px;">Note: This tool must only be used by an experienced clinician as part of a properly structured psychiatric interview.</span>

<span id="Instructions" style="position:absolute; left:750px; top:60px; font-family:sans-serif; font-size:12px; font-weight:bold; color:blue; cursor:pointer; text-decoration:underline;" onclick="PopUp(this.id);">Instructions</span>


<span style="position:absolute; left:25px; top:87px; font-family:sans-serif; font-weight:bold; font-size:14px;">Patient name:</span>
<input name="PtName" id="PtName" type="text" class="noborder" style="position:absolute; left:121px; top:85px; width:200px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:16px; text-align:left; background-color:transparent;" oscarDB=first_last_name>

<span style="position:absolute; left:325px; top:87px; font-family:sans-serif; font-weight:bold; font-size:14px;">Date of test:</span>
<input name="today" type="text" class="noborder" style="position:absolute; left:410px; top:85px; width:100px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:16px; text-align:center; background-color:transparent;" oscarDB=today>

<span style="position:absolute; left:525px; top:87px; font-family:sans-serif; font-weight:bold; font-size:14px;">Administered by:</span>
<input name="AdministeredBy" type="text" class="noborder" style="position:absolute; left:650px; top:85px; width:200px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:16px; text-align:left; background-color:transparent;" oscarDB=current_user>

<span style="position:absolute; left:25px; top:122px; font-family:sans-serif; font-weight:bold; font-size:14px;">Traumatic event:</span>
<textarea name="Trauma" type="text" style="position:absolute; left:140px; top:120px; width:181px; height:57px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:16px; text-align:left; background-color:transparent;" value=""></textarea>

<span style="position:absolute; left:325px; top:122px; font-family:sans-serif; font-weight:bold; font-size:14px;">Date of event:</span>
<input name="DOE" type="text" class="noborder" style="position:absolute; left:420px; top:120px; width:100px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:16px; text-align:center; background-color:transparent;" value="">

<span style="position:absolute; left:525px; top:122px; font-family:sans-serif; font-weight:bold; font-size:14px;">Interval:</span>

<input name="weeks" type="text" class="noborder" style="position:absolute; left:580px; top:120px; width:30px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:16px; text-align:center; background-color:transparent;" value="">
<span style="position:absolute; left:610px; top:122px; font-family:sans-serif; font-weight:bold; font-size:14px;">weeks</span>

<input name="years" type="text" class="noborder" style="position:absolute; left:660px; top:120px; width:30px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:16px; text-align:center; background-color:transparent;" value="">
<span style="position:absolute; left:690px; top:122px; font-family:sans-serif; font-weight:bold; font-size:14px;">years</span>

<!-- Drop Down -->
<textarea name="Past1" id="Past1" style="position:absolute; left:25px; top:181px; width:105px; height:20px; font-family:sans-serif; font-style:italic; font-size:16px; font-weight:bold; text-align:left; background-color:lightgreen;" class="noborder"></textarea>
<textarea name="Past2" id="Past2" style="position:absolute; left:165px; top:181px; width:100px; height:20px; font-family:sans-serif; font-style:italic; font-size:16px; font-weight:bold; text-align:center; background-color:lightgreen;" class="noborder"></textarea>
<select style="position:absolute; left:145px; top:205px; width:130px;" class="DoNotPrint">
	<option onClick="document.FormName.Past1.value = ''; document.FormName.Past2.value = ''">please choose
	<option onClick="document.FormName.Past1.value = 'In the past'; document.FormName.Past2.value = 'days'">In the past days
	<option onClick="document.FormName.Past1.value = 'In the past'; document.FormName.Past2.value = 'weeks'">In the past weeks
	<option onClick="document.FormName.Past1.value = 'In the past'; document.FormName.Past2.value = 'months'">In the past months
	<option onClick="document.FormName.Past1.value = 'Since your'; document.FormName.Past2.value = 'last visit'">Since last visit
</select>
<input name="PastNumber" type="text" class="noborder" style="position:absolute; left:130px; top:182px; width:35px; height:20px; font-family:sans-serif; font-style:normal; font-weight:bold; font-size:16px; text-align:center; background-color:lightgreen;" value="">
<span style="position:absolute; left:265px; top:182px; height:20px; font-family:sans-serif; font-style:italic; font-weight:bold; font-size:16px; background-color:lightgreen;">  have you had or experienced any of the following?</span>

<span class="DoNotPrint" style="position:absolute; left:285px; top:208px; font-family:sans-serif; font-style:italic; font-weight:normal; font-size:14px; background-color:transparent; color:#6495ED;">Please indicate the time frame for which the answers below apply.</span>


<!-- Group A -->
<span style="position:absolute; left:25px; top:227px; font-family:sans-serif; font-style:normal; font-weight:bold; font-size:14px;">Criteria Group A (BOTH 1 & 2 required):</span>

<span style="position:absolute; left:25px; top:247px; font-family:sans-serif; font-weight:normal; font-size:14px;">(1) &nbsp Life threat?</span>
<!-- Drop Down -->
<textarea name="Life" id="Life" style="position:absolute; left:180px; top:244px; width:25px; height:16px; font-family:Arial; font-size:16px; font-weight:bold;" class="noborder"></textarea>
<select style="position:absolute; left:200px; top:244px; width:40px;" class="DoNotPrint">
	<option onClick="document.FormName.Life.value = ''">
	<option onClick="document.FormName.Life.value = 'N'">N
	<option onClick="document.FormName.Life.value = 'Y'">Y
</select>

<span style="position:absolute; left:285px; top:247px; font-family:sans-serif; font-weight:normal; font-size:14px;">[self</span>
<input name="LifeThreatSelf" id="LifeThreatSelf" type="text" style="position:absolute; left:315px; top:247px; width:14px; height:14px; border:1px solid #000000; font-weight:bold; font-size:14px; text-align:center; background-color:transparent;" onkeypress="javascript:return displayKeyCode(event,this.id);" onmousedown="changeValue(this.id);" onkeypress="javascript:return displayKeyCode(event,this.id);">

<span style="position:absolute; left:340px; top:247px; font-family:sans-serif; font-weight:normal; font-size:14px;">other(s)</span>
<input name="LifeThreatOther" id="LifeThreatOther" type="text" style="position:absolute; left:393px; top:247px; width:14px; height:14px; border:1px solid #000000; font-weight:bold; font-size:14px; text-align:center; background-color:transparent;" onkeypress="javascript:return displayKeyCode(event,this.id);" onmousedown="changeValue(this.id);" onkeypress="javascript:return displayKeyCode(event,this.id);">
<span style="position:absolute; left:410px; top:247px; font-family:sans-serif; font-weight:normal; font-size:14px;">]</span>
<span style="position:absolute; left:435px; top:247px; font-family:sans-serif; font-style:italic; font-weight:bold; font-size:14px;">and/or</span>

<span style="position:absolute; left:53px; top:264px; font-family:sans-serif; font-weight:normal; font-size:14px;">Serious injury?</span>
<!-- Drop Down -->
<textarea name="SeriousInj" id="SeriousInj" style="position:absolute; left:180px; top:261px; width:25px; height:16px; font-family:Arial; font-size:16px; font-weight:bold;" class="noborder"></textarea>
<select style="position:absolute; left:200px; top:261px; width:40px;" class="DoNotPrint">
	<option onClick="document.FormName.SeriousInj.value = ''">
	<option onClick="document.FormName.SeriousInj.value = 'N'">N
	<option onClick="document.FormName.SeriousInj.value = 'Y'">Y
</select>

<span style="position:absolute; left:285px; top:264px; font-family:sans-serif; font-weight:normal; font-size:14px;">[self</span>
<input name="SeriousInjSelf" id="SeriousInjSelf" type="text" style="position:absolute; left:315px; top:264px; width:14px; height:14px; border:1px solid #000000; font-weight:bold; font-size:14px; text-align:center; background-color:transparent;" onkeypress="javascript:return displayKeyCode(event,this.id);" onmousedown="changeValue(this.id);" onkeypress="javascript:return displayKeyCode(event,this.id);">

<span style="position:absolute; left:340px; top:264px; font-family:sans-serif; font-weight:normal; font-size:14px;">other(s)</span>
<input name="SeriousInjOther" id="SeriousInjOther" type="text" style="position:absolute; left:393px; top:264px; width:14px; height:14px; border:1px solid #000000; font-weight:bold; font-size:14px; text-align:center; background-color:transparent;" onkeypress="javascript:return displayKeyCode(event,this.id);" onmousedown="changeValue(this.id);" onkeypress="javascript:return displayKeyCode(event,this.id);">
<span style="position:absolute; left:410px; top:264px; font-family:sans-serif; font-weight:normal; font-size:14px;">]</span>
<span style="position:absolute; left:435px; top:264px; font-family:sans-serif; font-style:italic; font-weight:bold; font-size:14px;">and/or</span>

<span style="position:absolute; left:53px; top:281px; font-family:sans-serif; font-weight:normal; font-size:14px;">Integrity threat?</span>
<!-- Drop Down -->
<textarea name="IntegrityThreat" id="IntegrityThreat" style="position:absolute; left:180px; top:278px; width:25px; height:16px; font-family:Arial; font-size:16px; font-weight:bold;" class="noborder"></textarea>
<select style="position:absolute; left:200px; top:278px; width:40px;" class="DoNotPrint">
	<option onClick="document.FormName.IntegrityThreat.value = ''">
	<option onClick="document.FormName.IntegrityThreat.value = 'N'">N
	<option onClick="document.FormName.IntegrityThreat.value = 'Y'">Y
</select>

<span style="position:absolute; left:285px; top:281px; font-family:sans-serif; font-weight:normal; font-size:14px;">[self</span>
<input name="IntegrityThreatSelf" id="IntegrityThreatSelf" type="text" style="position:absolute; left:315px; top:281px; width:14px; height:14px; border:1px solid #000000; font-weight:bold; font-size:14px; text-align:center; background-color:transparent;" onkeypress="javascript:return displayKeyCode(event,this.id);" onmousedown="changeValue(this.id);" onkeypress="javascript:return displayKeyCode(event,this.id);">

<span style="position:absolute; left:340px; top:281px; font-family:sans-serif; font-weight:normal; font-size:14px;">other(s)</span>
<input name="IntegrityThreatOther" id="IntegrityThreatOther" type="text" style="position:absolute; left:393px; top:281px; width:14px; height:14px; border:1px solid #000000; font-weight:bold; font-size:14px; text-align:center; background-color:transparent;" onkeypress="javascript:return displayKeyCode(event,this.id);" onmousedown="changeValue(this.id);" onkeypress="javascript:return displayKeyCode(event,this.id);">
<span style="position:absolute; left:410px; top:281px; font-family:sans-serif; font-weight:normal; font-size:14px;">]</span>
<span style="position:absolute; left:435px; top:281px; font-family:sans-serif; font-style:italic; font-weight:bold; font-size:14px;">and/or</span>

<textarea name="CriteriaAComment" style="position:absolute; left:525px; top:244px; width:325px; height:60px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:16px; text-align:left; background-color:transparent;" value="">Comment: </textarea>

<span style="position:absolute; left:25px; top:311px; font-family:sans-serif; font-weight:normal; font-size:14px;">(2) &nbsp Intense Fear/Helplessness/Horror?</span>
<!-- Drop Down -->
<textarea name="IntenseFear" id="IntenseFear" style="position:absolute; left:285px; top:308px; width:25px; height:16px; font-family:Arial; font-size:16px; font-weight:bold;" class="noborder"></textarea>
<select style="position:absolute; left:305px; top:308px; width:40px;" class="DoNotPrint">
	<option onClick="document.FormName.IntenseFear.value = ''">
	<option onClick="document.FormName.IntenseFear.value = 'N'">N
	<option onClick="document.FormName.IntenseFear.value = 'Y'">Y
</select>

<input class="NoBorder" type="button" name="CriteriaA_Score" style="position:absolute; left:525px; top:308px; width:100px; font-size:12px; background-color:yellow;" onclick="CriteriaAScore();"  value="Criteria A met?">
<input name="CriteriaA" id="CriteriaA" type="text" class="noborder" style="position:absolute; left:650px; top:308px; width:50px; font-family:sans-serif; font-style:normal; font-weight:bold; font-size:16px; text-align:center; background-color:transparent;">

<!-- Group B -->
<span style="position:absolute; left:25px; top:341px; font-family:sans-serif; font-style:normal; font-weight:bold; font-size:14px;">Criteria Group B (Re-experiencing of event; ONE required):</span>

<span style="position:absolute; left:25px; top:361px; font-family:sans-serif; font-weight:normal; font-size:14px;">(1) &nbsp Recurrent, intrusive, distressing RECOLLECTIONS of the event:</span>
<textarea name="Recollections" id="Recollections" style="position:absolute; left:525px; top:358px; width:25px; height:16px; font-family:Arial; font-size:16px; font-weight:bold;" class="noborder"></textarea>
<select style="position:absolute; left:545px; top:358px; width:40px;" class="DoNotPrint">
	<option onClick="document.FormName.Recollections.value = ''">
	<option onClick="document.FormName.Recollections.value = 'N'">N
	<option onClick="document.FormName.Recollections.value = 'Y'">Y
</select>

<span style="position:absolute; left:25px; top:378px; font-family:sans-serif; font-weight:normal; font-size:14px;">(2) &nbsp Recurrent, distressing DREAMS of the event:</span>
<textarea name="Dreams" id="Dreams" style="position:absolute; left:525px; top:375px; width:25px; height:16px; font-family:Arial; font-size:16px; font-weight:bold;" class="noborder"></textarea>
<select style="position:absolute; left:545px; top:375px; width:40px;" class="DoNotPrint">
	<option onClick="document.FormName.Dreams.value = ''">
	<option onClick="document.FormName.Dreams.value = 'N'">N
	<option onClick="document.FormName.Dreams.value = 'Y'">Y
</select>

<span style="position:absolute; left:25px; top:395px; font-family:sans-serif; font-weight:normal; font-size:14px;">(3) &nbsp A sense that the event(s) is/are happening to you all over again:*</span>
<textarea name="Recurrence" id="Recurrence" style="position:absolute; left:525px; top:392px; width:25px; height:16px; font-family:Arial; font-size:16px; font-weight:bold;" class="noborder"></textarea>
<select style="position:absolute; left:545px; top:392px; width:40px;" class="DoNotPrint">
	<option onClick="document.FormName.Recurrence.value = ''">
	<option onClick="document.FormName.Recurrence.value = 'N'">N
	<option onClick="document.FormName.Recurrence.value = 'Y'">Y
</select>

<span style="position:absolute; left:25px; top:412px; font-family:sans-serif; font-weight:normal; font-size:14px;">(4) &nbsp Intense and distressing feeling or emotions in response to cues:**</span>
<textarea name="IntenseFeelings" id="IntenseFeelings" style="position:absolute; left:525px; top:409px; width:25px; height:16px; font-family:Arial; font-size:16px; font-weight:bold;" class="noborder"></textarea>
<select style="position:absolute; left:545px; top:409px; width:40px;" class="DoNotPrint">
	<option onClick="document.FormName.IntenseFeelings.value = ''">
	<option onClick="document.FormName.IntenseFeelings.value = 'N'">N
	<option onClick="document.FormName.IntenseFeelings.value = 'Y'">Y
</select>

<span style="position:absolute; left:25px; top:429px; font-family:sans-serif; font-weight:normal; font-size:14px;">(5) &nbsp Physical symptoms, e.g. shaking, nausea, etc., in response to cues:**</span>
<textarea name="PhysicalSx" id="PhysicalSx" style="position:absolute; left:525px; top:426px; width:25px; height:16px; font-family:Arial; font-size:16px; font-weight:bold;" class="noborder"></textarea>
<select style="position:absolute; left:545px; top:426px; width:40px;" class="DoNotPrint">
	<option onClick="document.FormName.PhysicalSx.value = ''">
	<option onClick="document.FormName.PhysicalSx.value = 'N'">N
	<option onClick="document.FormName.PhysicalSx.value = 'Y'">Y
</select>

<textarea name="CriteriaBComment" style="position:absolute; left:585px; top:358px; width:265px; height:83px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:16px; text-align:left; background-color:transparent;" value="">Comment: </textarea>

<input class="NoBorder" type="button" name="CriteriaB_Score" style="position:absolute; left:525px; top:446px; width:100px; font-size:12px; background-color:yellow;" onclick="CriteriaBScore();"  value="Criteria B met?">
<input name="CriteriaB" id="CriteriaB" type="text" class="noborder" style="position:absolute; left:650px; top:444px; width:50px; font-family:sans-serif; font-style:normal; font-weight:bold; font-size:16px; text-align:center; background-color:transparent;">

<!-- Group C -->
<span style="position:absolute; left:25px; top:477px; font-family:sans-serif; font-style:normal; font-weight:bold; font-size:14px;">Criteria Group C (Avoidance of stimuli associated with traumatic event; THREE required):</span>

<span style="position:absolute; left:25px; top:499px; font-family:sans-serif; font-weight:normal; font-size:14px;">(1) &nbsp Efforts to avoid thoughts, feelings, conversations about the traumatic event:</span>
<textarea name="AvoidThoughts" id="AvoidThoughts" style="position:absolute; left:525px; top:496px; width:50px; height:16px; font-family:Arial; font-size:16px; font-weight:bold;" class="noborder"></textarea>
<select style="position:absolute; left:545px; top:496px; width:40px;" class="DoNotPrint">
	<option onClick="document.FormName.AvoidThoughts.value = ''">
	<option onClick="document.FormName.AvoidThoughts.value = 'N'">N
	<option onClick="document.FormName.AvoidThoughts.value = 'Y'">Y
</select>

<span style="position:absolute; left:25px; top:516px; font-family:sans-serif; font-weight:normal; font-size:14px;">(2) &nbsp Efforts to avoid places, activities, or situations that remind you of the event:</span>
<textarea name="AvoidPlaces" id="AvoidPlaces" style="position:absolute; left:525px; top:513px; width:50px; height:16px; font-family:Arial; font-size:16px; font-weight:bold;" class="noborder"></textarea>
<select style="position:absolute; left:545px; top:513px; width:40px;" class="DoNotPrint">
	<option onClick="document.FormName.AvoidPlaces.value = ''">
	<option onClick="document.FormName.AvoidPlaces.value = 'N'">N
	<option onClick="document.FormName.AvoidPlaces.value = 'Y'">Y
</select>

<span style="position:absolute; left:25px; top:533px; font-family:sans-serif; font-weight:normal; font-size:14px;">(3) &nbsp Difficulty </span>
<span style="position:absolute; left:110px; top:533px; font-family:sans-serif; font-weight:normal; font-style:italic; font-size:14px; background-color:pink;">remembering </span>
<span style="position:absolute; left:197px; top:533px; font-family:sans-serif; font-weight:normal; font-size:14px;">some important part of the traumatic event: </span>
<textarea name="Remembering" id="Remembering" style="position:absolute; left:525px; top:530px; width:50px; height:16px; font-family:Arial; font-size:16px; font-weight:bold;" class="noborder"></textarea>
<select style="position:absolute; left:545px; top:530px; width:40px;" class="DoNotPrint">
	<option onClick="document.FormName.Remembering.value = ''">
	<option onClick="document.FormName.Remembering.value = 'N'">N
	<option onClick="document.FormName.Remembering.value = 'Y'">Y
</select>

<span style="position:absolute; left:25px; top:550px; font-family:sans-serif; font-weight:normal; font-size:14px;">(4) &nbsp Loss of interest in engaging in previously enjoyed activities:</span>
<textarea name="Interest" id="Interest" style="position:absolute; left:525px; top:547px; width:50px; height:16px; font-family:Arial; font-size:16px; font-weight:bold;" class="noborder"></textarea>
<select style="position:absolute; left:545px; top:547px; width:40px;" class="DoNotPrint">
	<option onClick="document.FormName.Interest.value = ''">
	<option onClick="document.FormName.Interest.value = 'N'">N
	<option onClick="document.FormName.Interest.value = 'Y'">Y
</select>

<span style="position:absolute; left:25px; top:567px; font-family:sans-serif; font-weight:normal; font-size:14px;">(5) &nbsp Feelings of</span>
<span style="position:absolute; left:127px; top:567px; font-family:sans-serif; font-weight:normal; font-style:italic; font-size:14px; background-color:pink;">detachment</span>
<span style="position:absolute; left:205px; top:567px; font-family:sans-serif; font-weight:normal; font-size:14px;">from others: </span>
<textarea name="Detachment" id="Detachment" style="position:absolute; left:525px; top:564px; width:50px; height:16px; font-family:Arial; font-size:16px; font-weight:bold;" class="noborder"></textarea>
<select style="position:absolute; left:545px; top:564px; width:40px;" class="DoNotPrint">
	<option onClick="document.FormName.Detachment.value = ''">
	<option onClick="document.FormName.Detachment.value = 'N'">N
	<option onClick="document.FormName.Detachment.value = 'Y'">Y
</select>

<span style="position:absolute; left:25px; top:584px; font-family:sans-serif; font-weight:normal; font-size:14px;">(6) &nbsp Restricted range of feelings or emotions:</span>
<textarea name="RestrictedFeelings" id="RestrictedFeelings" style="position:absolute; left:525px; top:581px; width:50px; height:16px; font-family:Arial; font-size:16px; font-weight:bold;" class="noborder"></textarea>
<select style="position:absolute; left:545px; top:581px; width:40px;" class="DoNotPrint">
	<option onClick="document.FormName.RestrictedFeelings.value = ''">
	<option onClick="document.FormName.RestrictedFeelings.value = 'N'">N
	<option onClick="document.FormName.RestrictedFeelings.value = 'Y'">Y
</select>

<span style="position:absolute; left:25px; top:601px; font-family:sans-serif; font-weight:normal; font-size:14px;">(7) &nbsp Sense of foreshortened future:</span>
<textarea name="Foreshortened" id="Foreshortened" style="position:absolute; left:525px; top:598px; width:50px; height:16px; font-family:Arial; font-size:16px; font-weight:bold;" class="noborder"></textarea>
<select style="position:absolute; left:545px; top:598px; width:40px;" class="DoNotPrint">
	<option onClick="document.FormName.Foreshortened.value = ''">
	<option onClick="document.FormName.Foreshortened.value = 'N'">N
	<option onClick="document.FormName.Foreshortened.value = 'Y'">Y
</select>

<textarea name="CriteriaCComment" style="position:absolute; left:585px; top:496px; width:265px; height:118px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:16px; text-align:left; background-color:transparent;" value="">Comment: </textarea>

<input class="NoBorder" type="button" name="CriteriaC_Score" style="position:absolute; left:525px; top:618px; width:100px; font-size:12px; background-color:yellow;" onclick="CriteriaCScore();"  value="Criteria C met?">
<input name="CriteriaC" id="CriteriaC" type="text" class="noborder" style="position:absolute; left:650px; top:618px; width:50px; font-family:sans-serif; font-style:normal; font-weight:bold; font-size:16px; text-align:center; background-color:transparent;">

<!-- Group D -->
<span style="position:absolute; left:25px; top:651px; font-family:sans-serif; font-style:normal; font-weight:bold; font-size:14px;">Criteria Group D (Hyper-arousal not present prior to event; TWO required):</span>

<span style="position:absolute; left:25px; top:671px; font-family:sans-serif; font-weight:normal; font-size:14px;">(1) &nbsp Difficulty falling or staying asleep:</span>
<textarea name="Sleep" id="Sleep" style="position:absolute; left:525px; top:668px; width:50px; height:16px; font-family:Arial; font-size:16px; font-weight:bold;" class="noborder"></textarea>
<select style="position:absolute; left:545px; top:668px; width:40px;" class="DoNotPrint">
	<option onClick="document.FormName.Sleep.value = ''">
	<option onClick="document.FormName.Sleep.value = 'N'">N
	<option onClick="document.FormName.Sleep.value = 'Y'">Y
</select>

<span style="position:absolute; left:25px; top:688px; font-family:sans-serif; font-weight:normal; font-size:14px;">(2) &nbsp Irritability - quick to anger:</span>
<textarea name="Irritability" id="Irritability" style="position:absolute; left:525px; top:685px; width:50px; height:16px; font-family:Arial; font-size:16px; font-weight:bold;" class="noborder"></textarea>
<select style="position:absolute; left:545px; top:685px; width:40px;" class="DoNotPrint">
	<option onClick="document.FormName.Irritability.value = ''">
	<option onClick="document.FormName.Irritability.value = 'N'">N
	<option onClick="document.FormName.Irritability.value = 'Y'">Y
</select>

<span style="position:absolute; left:25px; top:705px; font-family:sans-serif; font-weight:normal; font-size:14px;">(3) &nbsp Difficulty concentrating:</span>
<textarea name="Concentration" id="Concentration" style="position:absolute; left:525px; top:702px; width:50px; height:16px; font-family:Arial; font-size:16px; font-weight:bold;" class="noborder"></textarea>
<select style="position:absolute; left:545px; top:702px; width:40px;" class="DoNotPrint">
	<option onClick="document.FormName.Concentration.value = ''">
	<option onClick="document.FormName.Concentration.value = 'N'">N
	<option onClick="document.FormName.Concentration.value = 'Y'">Y
</select>

<span style="position:absolute; left:25px; top:722px; font-family:sans-serif; font-weight:normal; font-size:14px;">(4) &nbsp Hyper-vigilance - on edge:</span>
<textarea name="HyperVigilance" id="HyperVigilance" style="position:absolute; left:525px; top:719px; width:50px; height:16px; font-family:Arial; font-size:16px; font-weight:bold;" class="noborder"></textarea>
<select style="position:absolute; left:545px; top:719px; width:40px;" class="DoNotPrint">
	<option onClick="document.FormName.HyperVigilance.value = ''">
	<option onClick="document.FormName.HyperVigilance.value = 'N'">N
	<option onClick="document.FormName.HyperVigilance.value = 'Y'">Y
</select>

<span style="position:absolute; left:25px; top:739px; font-family:sans-serif; font-weight:normal; font-size:14px;">(5) &nbsp Exaggerated startle response:***</span>
<textarea name="Startle" id="Startle" style="position:absolute; left:525px; top:736px; width:50px; height:16px; font-family:Arial; font-size:16px; font-weight:bold;" class="noborder"></textarea>
<select style="position:absolute; left:545px; top:736px; width:40px;" class="DoNotPrint">
	<option onClick="document.FormName.Startle.value = ''">
	<option onClick="document.FormName.Startle.value = 'N'">N
	<option onClick="document.FormName.Startle.value = 'Y'">Y
</select>

<textarea name="CriteriaDComment" style="position:absolute; left:585px; top:668px; width:265px; height:83px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:16px; text-align:left; background-color:transparent;" value="">Comment: </textarea>

<input class="NoBorder" type="button" name="CriteriaD_Score" style="position:absolute; left:525px; top:756px; width:100px; font-size:12px; background-color:yellow;" onclick="CriteriaDScore();"  value="Criteria D met?">
<input name="CriteriaD" id="CriteriaD" type="text" class="noborder" style="position:absolute; left:650px; top:756px; width:50px; font-family:sans-serif; font-style:normal; font-weight:bold; font-size:16px; text-align:center; background-color:transparent;">

<!-- Group E -->
<span style="position:absolute; left:25px; top:789px; font-family:sans-serif; font-style:normal; font-weight:bold; font-size:14px;">Criteria Group E (Persistence of symptoms):</span>

<span style="position:absolute; left:25px; top:809px; font-family:sans-serif; font-weight:normal; font-size:14px;">Duration of symptoms endorsed in B, C, and D is greater than 1 month.</span>
<textarea name="Duration" id="Duration" style="position:absolute; left:525px; top:806px; width:50px; height:16px; font-family:Arial; font-size:16px; font-weight:bold;" class="noborder"></textarea>
<select style="position:absolute; left:545px; top:806px; width:40px;" class="DoNotPrint">
	<option onClick="document.FormName.Duration.value = ''">
	<option onClick="document.FormName.Duration.value = 'N'">N
	<option onClick="document.FormName.Duration.value = 'Y'">Y
</select>

<input class="NoBorder" type="button" name="CriteriaE_Score" style="position:absolute; left:525px; top:826px; width:100px; font-size:12px; background-color:yellow;" onclick="CriteriaEScore();"  value="Criteria E met?">
<input name="CriteriaE" id="CriteriaE" type="text" class="noborder" style="position:absolute; left:650px; top:826px; width:50px; font-family:sans-serif; font-style:normal; font-weight:bold; font-size:16px; text-align:center; background-color:transparent;">

<!-- Group F -->
<span style="position:absolute; left:25px; top:859px; font-family:sans-serif; font-style:normal; font-weight:bold; font-size:14px;">Criteria Group F:</span>

<span style="position:absolute; left:25px; top:879px; font-family:sans-serif; font-weight:normal; font-size:14px;">The symptoms cause significant distress and impairment of function.</span>
<textarea name="Distress" id="Distress" style="position:absolute; left:525px; top:876px; width:50px; height:16px; font-family:Arial; font-size:16px; font-weight:bold;" class="noborder"></textarea>
<select style="position:absolute; left:545px; top:876px; width:40px;" class="DoNotPrint">
	<option onClick="document.FormName.Distress.value = ''">
	<option onClick="document.FormName.Distress.value = 'N'">N
	<option onClick="document.FormName.Distress.value = 'Y'">Y
</select>

<input class="NoBorder" type="button" name="CriteriaF_Score" style="position:absolute; left:525px; top:896px; width:100px; font-size:12px; background-color:yellow;" onclick="CriteriaFScore();"  value="Criteria F met?">
<input name="CriteriaF" id="CriteriaF" type="text" class="noborder" style="position:absolute; left:650px; top:896px; width:50px; font-family:sans-serif; font-style:normal; font-weight:bold; font-size:16px; text-align:center; background-color:transparent;">

<!-- Specifiers -->
<span style="position:absolute; left:25px; top:929px; font-family:sans-serif; font-style:normal; font-weight:bold; font-size:14px;">Specifiers:</span>

<span style="position:absolute; left:25px; top:949px; font-family:sans-serif; font-weight:normal; font-size:14px;">The symptoms have been present for:</span>
<textarea name="Specifier" id="Specifier" style="position:absolute; left:525px; top:945px; width:100px; height:22px; font-family:Arial; font-size:16px; font-weight:bold;" class="noborder"></textarea>
<select style="position:absolute; left:265px; top:949px; width:180px; font-family:sans-serif; font-size:14px;" class="NoBorder">
	<option onClick="document.FormName.Specifier.value = ''">
	<option onClick="document.FormName.Specifier.value = 'Acute'">less than 3 months
	<option onClick="document.FormName.Specifier.value = 'Chronic'">longer than 3 months
</select>

<span style="position:absolute; left:25px; top:979px; font-family:sans-serif; font-weight:normal; font-size:14px;">* Includes "flash backs", hallucinations, and similar episodes.</span>
<span style="position:absolute; left:25px; top:996px; font-family:sans-serif; font-weight:normal; font-size:14px;">** "Cues" are internal or external symbols or situations that resemble some aspect of the traumatic event.</span>
<span style="position:absolute; left:25px; top:1013px; font-family:sans-serif; font-weight:normal; font-size:14px;">*** e.g. door slamming, car back-firing, etc.</span>

<textarea name="Comments" type="text" style="position:absolute; left:25px; top:1050px; width:825px; height:57px; font-family:sans-serif; font-style:normal; font-weight:normal; font-size:16px; text-align:left; background-color:transparent;" value="">Additional Comments: </textarea>

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</div>

<!-- Pop Up Information ---->
<div id="Instructions_detail" class="Hide">
<ul>
	<li>This instrument is intended to assist the clinician in the orderly collection and documentation of symptoms that may 
	lead to a diagnosis of PTSD. As such, it should be used during a structured psychiatric interview, keeping in mind the following points:
	<br><br>
		<ul>
			<li>The clinician should be experienced in performing a structured psychiatric interview.</li>
			<li>As far as possible, <b>"open-ended"</b> questions should be asked, in an effort to avoid suggesting the "right" answer to the patient.</li>
			<li>The interviewer should take care to frame the interview so as to avoid a pre-conceived expectation of a diagnosis of PTSD.</li>
			<li>The interviewer should be alert for other Axis I diagnoses, especially substance abuse, which can confound the diagnosis; as well as for Axis II (personality) disorders or traits.</li>
			<li>The interviewer should be sensitive to how their own perceptions of described experiences may differ from those of he patient.  It is the perception of the patient that matters.</li>
			<li>The caveats in DSM IV regarding the applicability of the criteria in children should be observed.</li>
		</ul>
	
</ul>
<ul>
	<li>Based on DSM-IV listed criteria and the Clinician-Assisted PTSD Scale (CAPS) developed by Blake et al.</li>
</ul>	
<p><span style="color:blue; cursor:pointer;" onclick="ChangeClass('Instructions_detail','Hide')">Close</span></p>
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