STUDY ID#
SUBJECT BIRTHDATE-MONTH
SUBJECT BIRTHDATE-DAY
SUBJECT BIRTHDATE-YEAR
BASELINE - DATE ADMITTED - MONTH
BASELINE - DATE ADMITTED - DAY
BASELINE - DATE ADMITTED - YEAR
LEGAL STATUS UPON ADMISSION
BASELINE - DATE RELEASED - MONTH
BASELINE - DATE RELEASED - DAY
BASELINE - DATE RELEASED - YEAR
BASELINE ADMIT DX - AXIS I - DX# 1
BASELINE ADMIT DX - AXIS I - DX# 2
BASELINE ADMIT DX - AXIS I - DX# 3
BASELINE ADMIT DX - AXIS I - DX# 4
BASELINE ADMIT DX - AXIS I - DX# 5
AXIS I ADMIT DX - DX# 1 - DX TYPE
AXIS I ADMIT DX - DX# 2 - DX TYPE
AXIS I ADMIT DX - DX# 3 - DX TYPE
AXIS I ADMIT DX - DX# 4 - DX TYPE
AXIS I ADMIT DX - DX# 5 - DX TYPE
BASELINE ADMIT DX - AXIS II - DX# 1
BASELINE ADMIT DX - AXIS II - DX# 2
BASELINE ADMIT DX - AXIS II - DX# 3
BASELINE ADMIT DX - AXIS II - DX# 4
BASELINE ADMIT DX - AXIS II - DX# 5
AXIS II ADMIT DX - DX# 1 - DX TYPE
AXIS II ADMIT DX - DX# 2 - DX TYPE
AXIS II ADMIT DX - DX# 3 - DX TYPE
AXIS II ADMIT DX - DX# 4 - DX TYPE
AXIS II ADMIT DX - DX# 5 - DX TYPE
INTERVIEWER ID
SESSION ONE-DATE-MONTH
SESSION TWO-DATE-MONTH
SESSION THREE-DATE-MONTH
SESSION FOUR-DATE-MONTH
SESSION FIVE-DATE-MONTH
SESSION SIX-DATE-MONTH
SESSION ONE-DATE-DAY
SESSION TWO-DATE-DAY
SESSION THREE-DATE-DAY
SESSION FOUR-DATE-DAY
SESSION FIVE-DATE-DAY
SESSION SIX-DATE-DAY
SESSION ONE-DATE-YEAR
SESSION TWO-DATE-YEAR
SESSION THREE-DATE-YEAR
SESSION FOUR-DATE-YEAR
SESSION FIVE-DATE-YEAR
SESSION SIX-DATE-YEAR
SESSION 1-START HOUR
SESSION 2-START HOUR
SESSION 3-START HOUR
SESSION 4-START HOUR
SESSION 5-START HOUR
SESSION 6-START HOUR
SESSION 1-START MINUTE
SESSION 2-START MINUTE
SESSION 3-START MINUTE
SESSION 4-START MINUTE
SESSION 5-START MINUTE
SESSION 6-START MINUTE
SESSION 1-END HOUR
SESSION 2-END HOUR
SESSION 3-END HOUR
SESSION 4-END HOUR
SESSION 5-END HOUR
SESSION 6-END HOUR
SESSION 1-END MINUTE
SESSION 2-END MINUTE
SESSION 3-END MINUTE
SESSION 4-END MINUTE
SESSION 5-END MINUTE
SESSION 6-END MINUTE
SESSION 1-# OF BREAKS
SESSION 2-# OF BREAKS
SESSION 3-# OF BREAKS
SESSION 4-# OF BREAKS
SESSION 5-# OF BREAKS
SESSION 6-# OF BREAKS
SESSION 1-TOTAL BREAK TIME
SESSION 2-TOTAL BREAK TIME
SESSION 3-TOTAL BREAK TIME
SESSION 4-TOTAL BREAK TIME
SESSION 5-TOTAL BREAK TIME
SESSION 6-TOTAL BREAK TIME
SESSION 1-NET SESSION TIME-HOURS
SESSION 2-NET SESSION TIME-HOURS
SESSION 3-NET SESSION TIME-HOURS
SESSION 4-NET SESSION TIME-HOURS
SESSION 5-NET SESSION TIME-HOURS
SESSION 6-NET SESSION TIME-HOURS
SESSION 1-NET SESSION TIME-MINUTES
SESSION 2-NET SESSION TIME-MINUTES
SESSION 3-NET SESSION TIME-MINUTES
SESSION 4-NET SESSION TIME-MINUTES
SESSION 5-NET SESSION TIME-MINUTES
SESSION 6-NET SESSION TIME-MINUTES
INTERVIEW - TOTAL # OF SESSIONS
INTERVIEW - TOTAL # OF DAYS
DATE RECEIVED AT PRA-MONTH
DATE RECEIVED AT PRA-DAY
DATE RECEIVED AT PRA-YEAR
DATE ENTERED-MONTH
DATE ENTERED-DAY
DATE ENTERED-YEAR
PRA DATA ENTRY KEYPUNCH CODE
DATE VERIFIED-MONTH
DATE VERIFIED-DAY
DATE VERIFIED-YEAR
PRA VERIFIER CODE
SUBJECTS AGE
SUBJECTS GENDER
MARITAL STATUS
SUBJECTS RACE
SCHIZOPHRENIA (CURRENT)
BRIEF REACTIVE PSYCHOSIS (CURRENT)
SCHIZOPHRENIFORM DISORDER (CURRENT)
SCHIZOAFFECTIVE DISORDER (CURRENT)
DELUSIONAL (PARANOID) DISORDER (CURRENT)
ATYPICAL PSYCHOSIS (CURRENT)
DEPRESSION (CURRENT)
DYSTHYMIA (CURRENT)
MANIA (CURRENT)
CYCLOTHYMIA (CURRENT)
BIPOLAR (LIFETIME)
PSYCHOACTIVE SUBSTANCE DEPENDENCE (CURRENT)
PSYCHOACTIVE SUBSTANCE DEPENDENCE (LIFETIME)
PSYCHOACTIVE SUBSTANCE ABUSE (CURRENT)
PSYCHOACTIVE SUBSTANCE ABUSE (LIFETIME)
ALCOHOL DEPENDENCE (CURRENT)
ALCOHOL DEPENDENCE (LIFETIME)
ALCOHOL ABUSE (CURRENT)
ALCOHOL ABUSE (LIFETIME)
DRUG DEPENDENCE (CURRENT)
DRUG DEPENDENCE (LIFETIME)
DRUG ABUSE (CURRENT)
DRUG ABUSE (LIFETIME)
PRINCIPAL DIAGNOSIS
REASON(S) FOR DX - ONLY DX
REASON(S) FOR DX - EARLIEST ONSET
REASON(S) FOR DX - MOST IMPAIRING
REASON(S) FOR DX - ACCOUNTS FOR SYMPTOMS OF OTHER DXS
REASON(S) FOR DX - DX SUBJ SOUGHT TX FOR
REASON(S) FOR DX - DX SUBJ SEES AS MAJOR PROB
REASON(S) FOR DX - BEGAN BEFORE & PERSISTED AFTER OTHER SYMPTOMS
REASON(S) FOR DX - OTHER REASON(S) (SPECIFY)
SPECIFY OTHER REASON(S) FOR DX
ASSESSMENT OF OVERALL SEVERITY OF PRINCIPAL DX
PRINCIPAL DX AGREES W/CHART DX
1 OR MORE ADDL CATEGORY OF DXS ID AS NOT ON CHART
1 OR MORE CATEGORY OF CHART DXS EXAMINED BUT NOT CONFIRMED BY CKLST
1 OR MORE CHART DXS NOT EXAMINED B/C NOT ON CKLST
DX DIFFERED FROM CHART
DX REVIEWED BY CLINICIAN & CKLST DX CONFIRMED
DX REVIEWED BY CLINICIAN & CHANGED TO CHART DX
BELIEVE PEOPLE ARE SPYING ON YOU
EXAMPLE OF SPYING
BELIEVE PEOPLE SPYING ONLY WHEN HIGH
DELUSIONAL BELIEF - INTERVIEWER RATING
BELIEVE PEOPLE ARE/WERE FOLLOWING YOU
EXAMPLE OF FOLLOWING
BELIEVE PEOPLE FOLLOWING ONLY WHEN HIGH
BELIEVE TESTED/EXPERIMENTED ON
EXAMPLE OF BEING EXPERIMENTED ON
BELIEVE EXPERIMENTED ON ONLY WHEN HIGH
BELIEVE PEOPLE ARE/WERE PLOTTING AGAINST YOU
EXAMPLE OF PLOTTING
BELIEVE PEOPLE PLOTTING ONLY WHEN HIGH
BELIEVE PEOPLE ARE/WERE READING YOUR MIND
EXAMPLE OF MIND READING
BELIEVE PEOPLE READING MIND ONLY WHEN HIGH
BELIEVE YOU COULD HEAR OTHERS THOUGHTS
EXAMPLE OF HEARING OTHERS THOUGHTS
BELIEVE COULD HEAR OTHERS THOUGHTS ONLY WHEN HIGH
BELIEVE OTHERS COULD HEAR YOUR THOUGHTS
EXAMPLE OF OTHERS HEARING YOUR THOUGHTS
BELIEVE OTHERS COULD HEAR YOUR THOUGHTS ONLY WHEN HIGH
BELIEVE UNDER CONTROL OF OTHER PERSON/POWER/FORCE
EXAMPLE OF BEING UNDER CONTROL OF OTHERS
BELIEVE UNDER CONTROL OF OTHERS ONLY WHEN HIGH
BELIEVE THOUGHTS INSERTED INTO MIND
EXAMPLE OF THOUGHTS BEING INSERTED
BELIEVE THOUGHTS INSERTED ONLY WHEN HIGH
BELIEVE YOUR THOUGHTS COULD BE STOLEN
EXAMPLE OF THOUGHTS BEING STOLEN
BELIEVE THOUGHTS STOLEN ONLY WHEN HIGH
BELIEVE MESSAGES SENT TO YOU THROUGH TV/RADIO
EXAMPLE OF MESSAGES SENT
BELIEVE MESSAGES SENT ONLY WHEN HIGH
BELIEVE STRANGE FORCES WORKING ON YOU
EXAMPLE OF STRANGE FORCES
BELIEVE FORCES WORKING ON YOU ONLY WHEN HIGH
FELT WORTHLESS EVERY DAY FOR 2 OR MORE WEEKS
EXAMPLE OF WORTHLESS FEELINGS
FEEL WORTHLESS ONLY WHEN HIGH
BELIEVE YOU HAVE SPECIAL GIFT/POWERS
EXAMPLE OF SPECIAL GIFT/POWERS
BELIEVE YOU HAVE SPECIAL GIFT/POWERS ONLY WHEN HIGH
BELIEVE BODY PARTS CHANGED/NOT WORKING
EXAMPLE OF CHANGE IN BODY
BELIEVE YOUR BODY PARTS HAVE CHANGED ONLY WHEN HIGH
OTHER DELUSION VOLUNTEERED BY SUBJ
EXAMPLE OF OTHER DELUSION
HAVE OTHER DELUSION ONLY WHEN HIGH
THOUGHT THAT (CHART DELUSION)
EXAMPLE OF (CHART DELUSION)
BELIEVE (CHART DELUSION) ONLY WHEN HIGH
EXPERIENCED HEARING THINGS/VOICES MORE THAN ONCE
EXAMPLE OF HALLUCINATIONS (EXPERIENCE)
EXPERIENCE HALLUCINATIONS ONLY WHEN HIGH
EXAMPLE OF DELUSIONS RELATED TO HALLUCINATIONS (BELIEFS)
BELIEVE DELUSIONS ONLY WHEN HIGH
HEARD (CHART HALLUCINATION)
EXAMPLE OF (CHART HALLUCINATION)
EXPERIENCE (CHART HALLUCINATION) ONLY WHEN HIGH
DELUSIONS RELATED TO (CHART HALLUCINATION)
Delusions Present
Delusional Jealousy
Persecutory Delusion
Grandiose Delusion
Body/Mind Control
Thought Broadcasting
Delusion of Guilt
Somatic Delusion
Religious Delusion
Other Delusion
DK/NO INFO
Involves Others: Delusional Jealousy
Involves Others: Persecutory Delusion
Involves Others: Grandiose Delusion
Involves Others: Body/Mind Control
Involves Others: Thought Broadcasting
Involves Others: Delusion of Guilt
Involves Others: Somatic Delusion
Involves Others: Religious Delusion
Involves Others: Other Delusion
Has Violent Content: Delusional Jealousy
Has Violent Content: Persecutory Delusion
Has Violent Content: Grandiose Delusion
Has Violent Content: Body/Mind Control
Has Violent Content: Thought Broadcasting
Has Violent Content: Delusion of Guilt
Has Violent Content: Somatic Delusion
Has Violent Content: Religious Delusion
Has Violent Content: Other Delusion
Violence towards Others: Delusional Jealousy
Violence towards Others: Persecutory Delusion
Violence towards Others: Grandiose Delusion
Violence towards Others: Body/Mind Control
Violence towards Others: Thought Broadcasting
Violence towards Others: Delusion of Guilt
Violence towards Others: Somatic Delusion
Violence towards Others: Religious Delusion
Violence towards Others: Other Delusion
MMDAS PARTS COMPLETED
CHOICE OF BELIEF
DESCRIPTION OF SELECTED DELUSION - LINE 1
DESCRIPTION OF SELECTED DELUSION - LINE 2
HOW LONG BELIEVED - YEARS
HOW LONG BELIEVED - MONTHS
HOW LONG BELIEVED - WEEKS
HOW SURE ABOUT DELUSION - CURRENT
HOW SURE ABOUT DELUSION - WORST EVER
WHAT WOULD MAKE YOU UNSURE OF BELIEF
DO OTHERS BELIEVE IT - CURRENT
DO OTHERS BELIEVE IT - WORST EVER
WOULD OTHERS BELIEVE IT IF TOLD - CURRENT
WOULD OTHERS BELIEVE IT IF TOLD - WORST EVER
DOES BELIEF MAKE YOU HAPPY - CURRENT
DID BELIEF EVER MAKE YOU HAPPY
DOES BELIEF MAKE YOU UNHAPPY/DEPRESSED - CURRENT
DID BELIEF EVER MAKE YOU UNHAPPY/DEPRESSED
DOES BELIEF MAKE YOU TERRIFIED/FRIGHTENED - CURRENT
DID BELIEF EVER MAKE YOU TERRIFIED/FRIGHTENED
DOES BELIEF MAKE YOU ANXIOUS/TENSE - CURRENT
DID BELIEF EVER MAKE YOU ANXIOUS/TENSE
DOES BELIEF MAKE YOU ANGRY - CURRENT
DID BELIEF EVER MAKE YOU ANGRY
EVER TALKED TO ANYONE ABOUT BELIEF
TALKED ABOUT BELIEF IN PAST 2 MONTHS
EVER WRITTEN TO ANYONE ABOUT BELIEF
WRITTEN ABOUT BELIEF IN PAST 2 MONTHS
EVER TRIED TO STOP BELIEF FROM HAPPENING
TRIED TO STOP IN PAST 2 MONTHS
EVER TRIED TO PROTECT YOURSELF BECAUSE OF BELIEF
TRIED TO PROTECT SELF IN PAST 2 MONTHS
DOES BELIEF EVER MAKE YOU LOSE YOUR TEMPER
LOST TEMPER BECAUSE OF BELIEF IN PAST 2 MONTHS
EVER HAVE ARGUMENTS ABOUT BELIEF
HAD ARGUMENTS ABOUT BELIEF IN PAST 2 MONTHS
EVER BROKEN/DESTROYED BECAUSE OF BELIEF
BROKEN/DESTROYED IN PAST 2 MONTHS
EVER FELT LIKE HURTING SOMEONE BECAUSE OF BELIEF
FELT LIKE HURTING SOMEONE IN PAST 2 MONTHS
WHO EVER THOUGHT ABOUT HURTING B/C OF BELIEF
WHO THOUGHT ABOUT HURTING B/C OF BELIEF IN PAST 2 MONTHS
EVER TRIED TO HURT SOMEONE B/C OF BELIEF
TRIED TO HURT SOMEONE B/C OF BELIEF IN PAST 2 MONTHS
KNEW THE PERSON YOU TRIED TO HARM (EVER)
KNOW THE PERSON YOU TRIED TO HARM (IN PAST 2 MONTHS)
HOW HURT/TRIED TO HURT PERSON (EVER)
HOW HURT/TRIED TO HURT PERSON (IN PAST 2 MONTHS)
WAS THERE EVER LEVEL 2 VIOLENCE - INTERVIEWER RATING
LEVEL 2 VIOLENCE IN PAST 2 MONTHS - INTERVIEWER RATING
WAS THERE EVER LEVEL 1 VIOLENCE - INTERVIEWER RATING
LEVEL 1 VIOLENCE IN PAST 2 MONTHS - INTERVIEWER RATING
EVER TRIED TO HARM SELF BECAUSE OF BELIEF
TRIED TO HARM SELF IN PAST 2 MONTHS
HAS BELIEF EVER MADE YOU DO ANYTHING ELSE
HAS BELIEF MADE YOU DO ANYTHING ELSE IN THE PAST 2 MONTHS
SUMMARY OF POSITIVE ACTION ON BELIEFS - EVER - INTERVIEWER RATING
SUMMARY OF POSITIVE ACTION ON BELIEFS - PAST 2 MONTHS - INTERVIEWER RATING
HAS BELIEF EVER STOPPED YOU FROM MEETING FRIENDS
HAS BELIEF STOPPED FROM MEETING FRIENDS IN THE PAST 2 MONTHS
HAS BELIEF EVER STOPPED YOU FROM TV/RADIO
HAS BELIEF STOPPED FROM TV/RADIO IN THE PAST 2 MONTHS
HAS BELIEF EVER STOPPED YOU FROM EATING/DRINKING
HAS BELIEF STOPPED FROM EATING/DRINKING IN THE PAST 2 MONTHS
HAS BELIEF EVER STOPPED YOU FROM USING PUBLIC TRANS
HAS BELIEF STOPPED FROM USING PUBLIC TRANS IN THE PAST 2 MONTHS
HAS BELIEF EVER STOPPED YOU FROM GOING TO WORK
HAS BELIEF STOPPED FROM GOING TO WORK IN THE PAST 2 MONTHS
HAS BELIEF EVER STOPPED YOU FROM TAKING MEDICATION
HAS BELIEF STOPPED FROM TAKING MEDICATION IN THE PAST 2 MONTHS
HAS BELIEF EVER STOPPED YOU FROM GOING TO DR/HOSP ON AN OUTPT BASIS
HAS BELIEF STOPPED FROM GOING TO DR/HOSP IN THE PAST 2 MONTHS
ANYTHING ELSE BELIEF HAS STOPPED YOU FROM EVER DOING
ANYTHING ELSE BELIEF HAS STOPPED YOU FROM DOING IN THE PAST 2 MONTHS
HOW OFTEN DO YOU THINK ABOUT BELIEF
EVER THINK ABOUT BELIEF MORE THAN THAT
ARE YOU PSYCH UNWELL
DO YOU THINK TREATMENT MIGHT HELP/HAS HELPED YOU
REACTION TO HYPOTHETICAL QUESTION
PERVASIVENESS OF CHOSEN BELIEF
FLUIDITY OF CHOSEN BELIEF
SUBJ REPORTING BELIEFS ACCURATELY - INTERVIEWER RATING
CHOICE OF BELIEF FOR RATING OF THE DELUSION ASSOC W/VIOLENT INCIDENT
HOW SURE ABOUT DELUSION AT TIME OF INCIDENT
WHAT WOULD HAVE HAD TO HAPPEN AT TIME TO MAKE YOU UNSURE ABOUT DELUS
DID YOU FEEL AT THE TIME THAT OTHERS ALSO BELIEVED IT
WOULD OTHERS BELIEVE IT IF TOLD
DID BELIEF MAKE YOU HAPPY
DID BELIEF MAKE YOU UNHAPPY/DEPRESSED
DID BELIEF MAKE YOU TERRIFIED/FRIGHTENED
DID BELIEF MAKE YOU ANXIOUS/TENSE
DID BELIEF MAKE YOU ANGRY
HAD BELIEF EVER MADE YOU LOSE YOUR TEMPER
EVER HAD ARGUMENTS ABOUT BELIEF
WHO THOUGHT ABOUT HURTING B/C OF BELIEF
EVER TRIED TO HURT ANYONE
KNOW PERSON TRIED TO HARM
HOW HURT/TRIED TO HURT PERSON
HAD BELIEF EVER MADE YOU DO ANYTHING ELSE
SUMMARY OF POSITIVE ACTION ON BELIEFS - INTERVIEWER RATING
HAD BELIEF EVER STOPPED YOU FROM MEETING FRIENDS
HAD BELIEF EVER STOPPED YOU FROM TV/RADIO
HAD BELIEF EVER STOPPED YOU FROM EATING/DRINKING
HAD BELIEF EVER STOPPED YOU FROM USING PUBLIC TRANS
HAD BELIEF EVER STOPPED YOU FROM GOING TO WORK
HAD BELIEF EVER STOPPED YOU FROM TAKING MEDICATION
HAD BELIEF EVER STOPPED YOU FROM GOING TO DR/HOSP ON AN OUTPT BASIS
ANYTHING ELSE BELIEF HAD STOPPED YOU FROM EVER DOING
HOW OFTEN DID YOU THINK ABOUT DELUSION AT TIME OF INCIDENT
HEARD VOICES MORE THAN ONCE
HEAR SOUND/NOISES
HEAR ONE VOICE
HEAR MULTIPLE VOICES
HOW LONG HEARING THINGS - YEARS
HOW LONG HEARING THINGS - MONTHS
HOW LONG HEARING THINGS - WEEKS
HEARD THINGS IN LAST 2 MONTHS
HEARD THINGS IN LAST DAY
VOICES TALK IN A NEGATIVE WAY
VOICES TALK IN A NEUTRAL WAY
VOICES TALK IN A POSITIVE WAY
DO ANYTHING TO STOP VOICES
WHAT DO YOU DO TO STOP VOICES
DO VOICES TELL TO DO ANYTHING
HIGHEST LEVEL OF VIOLENCE
HAVE TO OBEY VOICES
EVER DONE WHAT VOICES SAY
LAST TIME DID WHAT VOICES SAID
OBEY VOICES IN FUTURE
EVER USED ALCOHOL
EVER USED MARIJUANA
EVER USED STIMULANTS
EVER USED SEDATIVES
EVER USED COCAINE
EVER USED HEROIN
EVER USED OPIATES
EVER USED PCP
EVER USED PSYCHEDELICS
EVER USED ANY OTHER DRUG(S)
USED ALCOHOL IN LAST 2 MONTHS
USED MARIJUANA IN LAST 2 MONTHS
USED STIMULANTS IN LAST 2 MONTHS
USED SEDATIVES IN LAST 2 MONTHS
USED COCAINE IN LAST 2 MONTHS
USED HEROIN IN LAST 2 MONTHS
USED OPIATES IN LAST 2 MONTHS
USED PCP IN LAST 2 MONTHS
USED PSYCHEDELICS IN LAST 2 MONTHS
USED ANY OTHER DRUG(S) IN LAST 2 MONTHS
# DAYS ALCOHOL LAST WEEK
# DAYS MARIJUANA LAST WEEK
# DAYS STIMULANTS LAST WEEK
# DAYS SEDATIVES LAST WEEK
# DAYS COCAINE LAST WEEK
# DAYS HEROIN LAST WEEK
# DAYS OPIATES LAST WEEK
# DAYS PCP LAST WEEK
# DAYS PSYCHEDELICS LAST WEEK
# DAYS OTHER DRUG(S) LAST WEEK
OTHER DRUGS USED (NOT IN GENERAL CLASSIFICATIONS)
EVER TALKED TO DR ABOUT MEMORY PROBLEMS
WHAT IS THE YEAR
WHAT IS THE SEASON
WHAT IS TODAYS DATE
WHAT IS THE DAY OF WEEK
WHAT IS THE MONTH
WHERE ARE WE
WHAT COUNTY ARE WE IN
WHAT CITY/TOWN ARE WE IN
WHAT FLOOR OF BLDG ARE WE ON
WHAT IS THE ADDRESS OF WHERE WE ARE
REPEAT: APPLE
REPEAT: TABLE
REPEAT: PENNY
COUNT BACKWARDS: 100-7 (93)
COUNT BACKWARDS: 93-7 (86)
COUNT BACKWARDS: 86-7 (79)
COUNT BACKWARDS: 79-7 (72)
COUNT BACKWARDS: 72-7 (65)
SPELL WORLD BACKWARDS
ASKED TO REMEMBER: APPLE
ASKED TO REMEMBER: TABLE
ASKED TO REMEMBER: PENNY
WHAT IS THIS CALLED (WATCH)
WHAT IS THIS CALLLED (PENCIL)
REPEAT PHRASE AFTER ME
READ WORDS ON PAGE AND DO WHAT THEY SAY
TAKES PAPER IN RIGHT HAND
FOLDS PAPER IN HALF
PUTS PAPER DOWN ON LAP
WRITE COMPLETE SENTENCE
SUBJ GIVEN DRAWING: PLEASE COPY DRAWING ON PAPER
LEARNING DISABILITY
HYPERACTIVITY
SCHOOL DIFFICULTIES
EVER BEEN KNOCKED OUT/FAINTED
KNOCK OUT/FAINT ALL DUE TO EXTERNAL STIMULI
EVER HAD A SEIZURE/CONVULSION
SEIZURE/CONVULS ALL DUE TO EXTERNAL STIMULI
ACCIDENT #1: TYPE
ACCIDENT #2: TYPE
ACCIDENT #3: TYPE
ACCIDENT #4: TYPE
ACCIDENT #5: TYPE
ACCIDENT #6: TYPE
ACCIDENT #7: TYPE
ACCIDENT #8: TYPE
ACCIDENT #9: TYPE
SPECIFY SPORT/OTHER ACCIDENT #1
SPECIFY SPORT/OTHER ACCIDENT #2
SPECIFY SPORT/OTHER ACCIDENT #3
SPECIFY SPORT/OTHER ACCIDENT #4
SPECIFY SPORT/OTHER ACCIDENT #5
SPECIFY SPORT/OTHER ACCIDENT #6
SPECIFY SPORT/OTHER ACCIDENT #7
SPECIFY SPORT/OTHER ACCIDENT #8
SPECIFY SPORT/OTHER ACCIDENT #9
WAS SUBJECT INJURED: ACCIDENT #1
WAS SUBJECT INJURED: ACCIDENT #2
WAS SUBJECT INJURED: ACCIDENT #3
WAS SUBJECT INJURED: ACCIDENT #4
WAS SUBJECT INJURED: ACCIDENT #5
WAS SUBJECT INJURED: ACCIDENT #6
WAS SUBJECT INJURED: ACCIDENT #7
WAS SUBJECT INJURED: ACCIDENT #8
WAS SUBJECT INJURED: ACCIDENT #9
AGE AT TIME OF HEAD INJURY-ACCIDENT #1
AGE AT TIME OF HEAD INJURY-ACCIDENT #2
AGE AT TIME OF HEAD INJURY-ACCIDENT #3
AGE AT TIME OF HEAD INJURY-ACCIDENT #4
AGE AT TIME OF HEAD INJURY-ACCIDENT #5
AGE AT TIME OF HEAD INJURY-ACCIDENT #6
AGE AT TIME OF HEAD INJURY-ACCIDENT #7
AGE AT TIME OF HEAD INJURY-ACCIDENT #8
AGE AT TIME OF HEAD INJURY-ACCIDENT #9
# MIN LOST CONSCIOUSNESS-ACCIDENT 1
# MIN LOST CONSCIOUSNESS-ACCIDENT 2
# MIN LOST CONSCIOUSNESS-ACCIDENT 3
# MIN LOST CONSCIOUSNESS-ACCIDENT 4
# MIN LOST CONSCIOUSNESS-ACCIDENT 5
# MIN LOST CONSCIOUSNESS-ACCIDENT 6
# MIN LOST CONSCIOUSNESS-ACCIDENT 7
# MIN LOST CONSCIOUSNESS-ACCIDENT 8
# MIN LOST CONSCIOUSNESS-ACCIDENT 9
# OF HRS LOST CONSCIOUSNESS-ACCIDENT 1
# OF HRS LOST CONSCIOUSNESS-ACCIDENT 2
# OF HRS LOST CONSCIOUSNESS-ACCIDENT 3
# OF HRS LOST CONSCIOUSNESS-ACCIDENT 4
# OF HRS LOST CONSCIOUSNESS-ACCIDENT 5
# OF HRS LOST CONSCIOUSNESS-ACCIDENT 6
# OF HRS LOST CONSCIOUSNESS-ACCIDENT 7
# OF HRS LOST CONSCIOUSNESS-ACCIDENT 8
# OF HRS LOST CONSCIOUSNESS-ACCIDENT 9
# DAYS LOST CONSCIOUSNESS-ACCIDENT 1
# DAYS LOST CONSCIOUSNESS-ACCIDENT 2
# DAYS LOST CONSCIOUSNESS-ACCIDENT 3
# DAYS LOST CONSCIOUSNESS-ACCIDENT 4
# DAYS LOST CONSCIOUSNESS-ACCIDENT 5
# DAYS LOST CONSCIOUSNESS-ACCIDENT 6
# DAYS LOST CONSCIOUSNESS-ACCIDENT 7
# DAYS LOST CONSCIOUSNESS-ACCIDENT 8
# DAYS LOST CONSCIOUSNESS-ACCIDENT 9
HOSPITALIZED-ACCIDENT 1
HOSPITALIZED-ACCIDENT 2
HOSPITALIZED-ACCIDENT 3
HOSPITALIZED-ACCIDENT 4
HOSPITALIZED-ACCIDENT 5
HOSPITALIZED-ACCIDENT 6
HOSPITALIZED-ACCIDENT 7
HOSPITALIZED-ACCIDENT 8
HOSPITALIZED-ACCIDENT 9
DID ANYONE EVER SEXUALLY ABUSE/ASSAULT YOU
ABUSIVE PERSON #1 (REL CODE)
ABUSIVE PERSON #2 (REL CODE)
ABUSIVE PERSON #3 (REL CODE)
HOW OLD WHEN FIRST HAPPENED - ABUSIVE PERSON #1
HOW OLD WHEN FIRST HAPPENED - ABUSIVE PERSON #2
HOW OLD WHEN FIRST HAPPENED - ABUSIVE PERSON #3
WHICH BEST DESCRIBES WHAT HAPPENED - ABUSIVE PERSON #1
WHICH BEST DESCRIBES WHAT HAPPENED - ABUSIVE PERSON #2
WHICH BEST DESCRIBES WHAT HAPPENED - ABUSIVE PERSON #3
SPECIFY OTHER SEXUAL ABUSE - ABUSIVE PERSON #1
SPECIFY OTHER SEXUAL ABUSE - ABUSIVE PERSON #2
SPECIFY OTHER SEXUAL ABUSE - ABUSIVE PERSON #3
HOW OFTEN DID ABUSE OCCUR - ABUSIVE PERSON #1
HOW OFTEN DID ABUSE OCCUR - ABUSIVE PERSON #2
HOW OFTEN DID ABUSE OCCUR - ABUSIVE PERSON #3
SOMATIC CONCERN (BPRS-A)
ANXIETY (BPRS-A)
EMOTIONAL WITHDRAWAL (BPRS-A)
CONCEPTUAL DISORGANIZATION (BPRS-A)
GUILT FEELINGS (BPRS-A)
TENSION (BPRS-A)
MANNERISMS AND POSTURING (BPRS-A)
GRANDIOSITY (BPRS-A)
DEPRESSIVE MOOD (BPRS-A)
HOSTILITY (BPRS-A)
SUSPICIOUSNESS (BPRS-A)
HALLUCINATORY BEHAVIOR (BPRS-A)
MOTOR RETARDATION (BPRS-A)
UNCOOPERATIVENESS (BPRS-A)
UNUSUAL THOUGHT CONTENT (BPRS-A)
BLUNTED AFFECT (BPRS-A)
EXCITEMENT (BPRS-A)
DISORIENTATION (BPRS-A)
GAF SCORE - INTERVIEWER RATING
DID SUBJ SEEM TO UNDERSTAND QUES - INTERVIEWER RATING
SUBJ HONEST (1-5 SCALE) - DELUSIONS SECT
SUBJ HONEST (1-5 SCALE) - HALLUCINATIONS SECT
SUBJ HONEST (1-5 SCALE) - CHECKLIST SYMPTOMS SECT
SUBJ HONEST (1-5 SCALE) - ALCOHOL USE/ABUSE SECT
SUBJ HONEST (1-5 SCALE) - DRUG USE/ABUSE SECT
SUBJ HONEST (1-5 SCALE) - SEXUAL ABUSE SCREEN SECT
SUBJ HONEST (1-5 SCALE) - NEUROLOGY SCREEN SECT
TYPE OF RELEASE
SPECIFY OTHR TYPE OF RELEASE
RELEASE DATE - MONTH
RELEASE DATE - DAY
RELEASE DATE -YEAR
WHERE RELEASED TO
SPECIFY OTHR PLACE RELASED TO
FOLLOW UP
AXIS I DISCHARGE DX - DX# 1
AXIS I DISCHARGE DX - DX# 2
AXIS I DISCHARGE DX - DX# 3
AXIS I DISCHARGE DX - DX# 4
AXIS I DISCHARGE DX - DX# 5
AXIS I D/C DX - DX# 1 - DX TYPE
AXIS I D/C DX - DX# 2 - DX TYPE
AXIS I D/C DX - DX# 3 - DX TYPE
AXIS I D/C DX - DX# 4 - DX TYPE
AXIS I D/C DX - DX# 5 - DX TYPE
AXIS II DISCHARGE DX - DX# 1
AXIS II DISCHARGE DX - DX# 2
AXIS II DISCHARGE DX - DX# 3
AXIS II DISCHARGE DX - DX# 4
AXIS II DISCHARGE DX - DX# 5
AXIS II D/C DX - DX# 1 - DX TYPE
AXIS II D/C DX - DX# 2 - DX TYPE
AXIS II D/C DX - DX# 3 - DX TYPE
AXIS II D/C DX - DX# 4 - DX TYPE
AXIS II D/C DX - DX# 5 - DX TYPE
AXIS V DX (GAF)
D/C MEDICATION #1 (SEE MED CODES)
D/C MEDICATION #2 (SEE MED CODES)
D/C MEDICATION #3 (SEE MED CODES)
D/C MEDICATION #4 (SEE MED CODES)
D/C MEDICATION #5 (SEE MED CODES)
D/C MEDICATION #6 (SEE MED CODES)
D/C MEDICATION #1 - DOSAGE (MG)
D/C MEDICATION #2 - DOSAGE (MG)
D/C MEDICATION #3 - DOSAGE (MG)
D/C MEDICATION #4 - DOSAGE (MG)
D/C MEDICATION #5 - DOSAGE (MG)
D/C MEDICATION #6 - DOSAGE (MG)
D/C MEDICATION #1 - FREQUENCY
D/C MEDICATION #2 - FREQUENCY
D/C MEDICATION #3 - FREQUENCY
D/C MEDICATION #4 - FREQUENCY
D/C MEDICATION #5 - FREQUENCY
D/C MEDICATION #6 - FREQUENCY
TYPE OF INSURANCE
LEGAL STATUS AT DISCHARGE
REASON(S) FOR COMMITTMENT - DANGER TO SELF
REASON(S) FOR COMMITTMENT - DANGER TO OTHERS
REASON(S) FOR COMMITTMENT - GRAVELY DISABLED
REASON(S) FOR COMMITTMENT - NA (ADMIT WAS VOLUNTARY)
TOXIC SCREEN UPON ADMISSION
ALCOHOL RESULTS
DRUG RESULTS
HOW MANY PRIOR HOSP IN M/H FACILITIES (EVER)
TOTAL # DAYS HOSPITALIZED LAST YEAR
HISTORY OF VIOLENCE BY SUBJ TOWARD FAMILY
HISTORY OF VIOLENCE BY SUBJ TOWARD OTHERS
HISTORY OF FAMILY VIOLENCE TOWARD OTHERS
WAS SUBJ IN SECLUSION/RESTRAINT DURING THIS HOSP
NUMBER OF TIMES SECLUDED OR RESTRAINED
HISTORY OF ALCOHOL ABUSE
HISTORY OF DRUG ABUSE
HISTORY OF AGGRESSIVE BEHAVIOR
ANYTHING FROM CHART THAT WOULD MAKE INTERVIEWER UNCOMFORTABLE
ANY REASON TO DO TWO PERSON TEAM
ANY REASON NOT TO DO AT HOME
COMPLETED BY (RATER #)
MONTH FORM COMPLETED
DAY FORM COMPLETED
YEAR FORM COMPLETED
REASON(S) FOR CURRENT ADMIT (FROM CHART) - DEPRESSION
REASON(S) FOR CURRENT ADMIT (FROM CHART) - SUICIDE THREAT/IDEATION
REASON(S) FOR CURRENT ADMIT (FROM CHART) - SUICIDE ATTEMPT/SELF-HARM
REASON(S) FOR CURRENT ADMIT (FROM CHART) - MANIC SYMPTOMS
REASON(S) FOR CURRENT ADMIT (FROM CHART) - INCREASED ANXIETY
REASON(S) FOR CURRENT ADMIT (FROM CHART) - PARANOID SYMPTOMS
REASON(S) FOR CURRENT ADMIT (FROM CHART) - DELUSIONS
REASON(S) FOR CURRENT ADMIT (FROM CHART) - HALLUCINATIONS
REASON(S) FOR CURRENT ADMIT (FROM CHART) - BIZARRE BEHAVIOR
REASON(S) FOR CURRENT ADMIT (FROM CHART) - INCREASE IN SYMPTOMS/DECOMPENSATION
REASON(S) FOR CURRENT ADMIT (FROM CHART) - UNABLE TO CARE FOR SELF
REASON(S) FOR CURRENT ADMIT (FROM CHART) - NON-COMPLIANCE W/MEDS
REASON(S) FOR CURRENT ADMIT (FROM CHART) - MED CHANGE/ADJ/EVAL
REASON(S) FOR CURRENT ADMIT (FROM CHART) - SUBSTANCE ABUSE/INTOXICATION
REASON(S) FOR CURRENT ADMIT (FROM CHART) - PERSONAL PROBLEM
REASON(S) FOR CURRENT ADMIT (FROM CHART) - EVALUATION
REASON(S) FOR CURRENT ADMIT (FROM CHART) - COURT ORDER
REASON(S) FOR CURRENT ADMIT (FROM CHART) - OTHER NON-VIOLENT/NON-AGGRESSIVE BEHAVIOR
REASON(S) FOR CURRENT ADMIT (FROM CHART) - AGGRESSION AGAINST PROPERTY
REASON(S) FOR CURRENT ADMIT (FROM CHART) - ARGUMENT/THREAT
REASON(S) FOR CURRENT ADMIT (FROM CHART) - HOMICIDAL THREAT/IDEATION
REASON(S) FOR CURRENT ADMIT (FROM CHART) - VIOL TOWARD OTHERS - OBJECT THROWN
REASON(S) FOR CURRENT ADMIT (FROM CHART) - VIOL TOWARD OTHERS - PUSH/GRAB
REASON(S) FOR CURRENT ADMIT (FROM CHART) - VIOL TOWARD OTHERS - SLAP
REASON(S) FOR CURRENT ADMIT (FROM CHART) - VIOL TOWARD OTHERS - KICK/BITE/CHOKE
REASON(S) FOR CURRENT ADMIT (FROM CHART) - VIOL TOWARD OTHERS - HIT w FIST/OBJECT
REASON(S) FOR CURRENT ADMIT (FROM CHART) - VIOL TOWARD OTHERS - SEXUAL ASSAULT
REASON(S) FOR CURRENT ADMIT (FROM CHART) - VIOL TOWARD OTHERS - THREAT w LETHAL WEAPON
REASON(S) FOR CURRENT ADMIT (FROM CHART) - VIOL TOWARD OTHERS - USED GUN/KNIFE
REASON(S) FOR CURRENT ADMIT (FROM CHART) - VIOL TOWARD OTHERS - OTHER VIOL/AGGR BEH (SPECIFY)
OTHER VIOLENT AGGRESSIVE BEHAVIOR - SPECIFY
OTHER REASON FOR CURRENT ADMIT (FROM CHART)
OTHER REASON FOR ADMIT - SPECIFY
DONT KNOW REASON FOR ADMIT (FROM CHART)
CHART SUGGEST DELUSIONAL AT ADMISSION
VIOLENCE ASSOCIATED W/DELUSION(S) - FIRST TYPE
VIOLENCE ASSOCIATED W/DELUSION(S) - SECOND TYPE
VIOLENCE ASSOCIATED W/DELUSION(S) - THIRD TYPE
INTERVIEW MONTH
INTERVIEW DAY
INTERVIEW YEAR
EVER HOSPITALIZED
LAST RELEASE DATE FROM HOSP-MONTH
LAST RELEASE DATE FROM HOSP-DAY
LAST RELEASE DATE FROM HOSP-YEAR
HOSPITALIZED LAST 2 MOS
AGE AT FIRST HOSPITALIZATION
WHEN FIRST RECD MH SERVICES - MONTH
WHEN FIRST RECD MH SERVICES - YEAR
# TIMES HOSPITALIZED
REASON(S) FOR CURRENT ADMIT (FROM INT) - DEPRESSION
REASON(S) FOR CURRENT ADMIT (FROM INT) - SUICIDE THREAT/IDEATION
REASON(S) FOR CURRENT ADMIT (FROM INT) - SUICIDE ATTEMPT/SELF-HARM
REASON(S) FOR CURRENT ADMIT (FROM INT) - MANIC SYMPTOMS
REASON(S) FOR CURRENT ADMIT (FROM INT) - INCREASED ANXIETY
REASON(S) FOR CURRENT ADMIT (FROM INT) - PARANOID SYMPTOMS
REASON(S) FOR CURRENT ADMIT (FROM INT) - DELUSIONS
REASON(S) FOR CURRENT ADMIT (FROM INT) - HALLUCINATIONS
REASON(S) FOR CURRENT ADMIT (FROM INT) - BIZARRE BEHAVIOR
REASON(S) FOR CURRENT ADMIT (FROM INT) - INCREASE IN SYMPTOMS/DECOMPENSATION
REASON(S) FOR CURRENT ADMIT (FROM INT) - UNABLE TO CARE FOR SELF
REASON(S) FOR CURRENT ADMIT (FROM INT) - NON-COMPLIANCE W/MEDS
REASON(S) FOR CURRENT ADMIT (FROM INT) - MED CHANGE/ADJ/EVAL
REASON(S) FOR CURRENT ADMIT (FROM INT) - SUBSTANCE ABUSE/INTOXICATION
REASON(S) FOR CURRENT ADMIT (FROM INT) - PERSONAL PROBLEM
REASON(S) FOR CURRENT ADMIT (FROM INT) - EVALUATION
REASON(S) FOR CURRENT ADMIT (FROM INT) - COURT ORDER
REASON(S) FOR CURRENT ADMIT (FROM INT) - OTHER NON-VIOLENT/NON-AGGRESSIVE BEHAVIOR
REASON(S) FOR CURRENT ADMIT (FROM INT) - AGGRESSION AGAINST PROPERTY
REASON(S) FOR CURRENT ADMIT (FROM INT) - ARGUMENT/THREAT
REASON(S) FOR CURRENT ADMIT (FROM INT) - HOMICIDAL THREAT/IDEATION
REASON(S) FOR CURRENT ADMIT (FROM INT) - VIOL TOWARD OTHERS - OBJECT THROWN
REASON(S) FOR CURRENT ADMIT (FROM INT) - VIOL TOWARD OTHERS - PUSH/GRAB
REASON(S) FOR CURRENT ADMIT (FROM INT) - VIOL TOWARD OTHERS - SLAP
REASON(S) FOR CURRENT ADMIT (FROM INT) - VIOL TOWARD OTHERS - KICK/BITE/CHOKE
REASON(S) FOR CURRENT ADMIT (FROM INT) - VIOL TOWARD OTHERS - HIT w FIST/OBJECT
REASON(S) FOR CURRENT ADMIT (FROM INT) - VIOL TOWARD OTHERS - SEXUAL ASSAULT
REASON(S) FOR CURRENT ADMIT (FROM INT) - VIOL TOWARD OTHERS - THREAT w LETHAL WEAPON
REASON(S) FOR CURRENT ADMIT (FROM INT) - VIOL TOWARD OTHERS - USED GUN/KNIFE
REASON(S) FOR CURRENT ADMIT (FROM INT) - VIOL TOWARD OTHERS - OTHER VIOL/AGGR BEH (SPECIFY)
OTHER REASON FOR CURRENT ADMIT (FROM INT)
DONT KNOW REASON FOR ADMIT (FROM INT)
INCIDENT TYPE - INCIDENT 1
INCIDENT TYPE - INCIDENT 2
INCIDENT TYPE - INCIDENT 3
INCIDENT TYPE - INCIDENT 4
INCIDENT TYPE - INCIDENT 5
INCIDENT TYPE - INCIDENT 6
INCIDENT TYPE - INCIDENT 7
INCIDENT TYPE - INCIDENT 8
INCIDENT TYPE - INCIDENT 9
INCIDENT TYPE - INCIDENT 10
INCIDENT TYPE - INCIDENT 11
INCIDENT TYPE - INCIDENT 12
INCIDENT TYPE - INCIDENT 13
INCIDENT TYPE - INCIDENT 14
INCIDENT TYPE - INCIDENT 15
# TIMES - INCIDENT 1
# TIMES - INCIDENT 2
# TIMES - INCIDENT 3
# TIMES - INCIDENT 4
# TIMES - INCIDENT 5
# TIMES - INCIDENT 6
# TIMES - INCIDENT 7
# TIMES - INCIDENT 8
# TIMES - INCIDENT 9
# TIMES - INCIDENT 10
# TIMES - INCIDENT 11
# TIMES - INCIDENT 12
# TIMES - INCIDENT 13
# TIMES - INCIDENT 14
# TIMES - INCIDENT 15
MONTH - INCIDENT 1
MONTH - INCIDENT 2
MONTH - INCIDENT 3
MONTH - INCIDENT 4
MONTH - INCIDENT 5
MONTH - INCIDENT 6
MONTH - INCIDENT 7
MONTH - INCIDENT 8
MONTH - INCIDENT 9
MONTH - INCIDENT 10
MONTH - INCIDENT 11
MONTH - INCIDENT 12
MONTH - INCIDENT 13
MONTH - INCIDENT 14
MONTH - INCIDENT 15
DAY - INCIDENT 1
DAY - INCIDENT 2
DAY - INCIDENT 3
DAY - INCIDENT 4
DAY - INCIDENT 5
DAY - INCIDENT 6
DAY - INCIDENT 7
DAY - INCIDENT 8
DAY - INCIDENT 9
DAY - INCIDENT 10
DAY - INCIDENT 11
DAY - INCIDENT 12
DAY - INCIDENT 13
DAY - INCIDENT 14
DAY - INCIDENT 15
YEAR - INCIDENT 1
YEAR - INCIDENT 2
YEAR - INCIDENT 3
YEAR - INCIDENT 4
YEAR - INCIDENT 5
YEAR - INCIDENT 6
YEAR - INCIDENT 7
YEAR - INCIDENT 8
YEAR - INCIDENT 9
YEAR - INCIDENT 10
YEAR - INCIDENT 11
YEAR - INCIDENT 12
YEAR - INCIDENT 13
YEAR - INCIDENT 14
YEAR - INCIDENT 15
LOCATION - INCIDENT 1
LOCATION - INCIDENT 2
LOCATION - INCIDENT 3
LOCATION - INCIDENT 4
LOCATION - INCIDENT 5
LOCATION - INCIDENT 6
LOCATION - INCIDENT 7
LOCATION - INCIDENT 8
LOCATION - INCIDENT 9
LOCATION - INCIDENT 10
LOCATION - INCIDENT 11
LOCATION - INCIDENT 12
LOCATION - INCIDENT 13
LOCATION - INCIDENT 14
LOCATION - INCIDENT 15
FIRST VICTIM - INCIDENT 1
FIRST VICTIM - INCIDENT 2
FIRST VICTIM - INCIDENT 3
FIRST VICTIM - INCIDENT 4
FIRST VICTIM - INCIDENT 5
FIRST VICTIM - INCIDENT 6
FIRST VICTIM - INCIDENT 7
FIRST VICTIM - INCIDENT 8
FIRST VICTIM - INCIDENT 9
FIRST VICTIM - INCIDENT 10
FIRST VICTIM - INCIDENT 11
FIRST VICTIM - INCIDENT 12
FIRST VICTIM - INCIDENT 13
FIRST VICTIM - INCIDENT 14
FIRST VICTIM - INCIDENT 15
SECOND VICTIM - INCIDENT 1
SECOND VICTIM - INCIDENT 2
SECOND VICTIM - INCIDENT 3
SECOND VICTIM - INCIDENT 4
SECOND VICTIM - INCIDENT 5
SECOND VICTIM - INCIDENT 6
SECOND VICTIM - INCIDENT 7
SECOND VICTIM - INCIDENT 8
SECOND VICTIM - INCIDENT 9
SECOND VICTIM - INCIDENT 10
SECOND VICTIM - INCIDENT 11
SECOND VICTIM - INCIDENT 12
SECOND VICTIM - INCIDENT 13
SECOND VICTIM - INCIDENT 14
SECOND VICTIM - INCIDENT 15
THIRD VICTIM - INCIDENT 1
THIRD VICTIM - INCIDENT 2
THIRD VICTIM - INCIDENT 3
THIRD VICTIM - INCIDENT 4
THIRD VICTIM - INCIDENT 5
THIRD VICTIM - INCIDENT 6
THIRD VICTIM - INCIDENT 7
THIRD VICTIM - INCIDENT 8
THIRD VICTIM - INCIDENT 9
THIRD VICTIM - INCIDENT 10
THIRD VICTIM - INCIDENT 11
THIRD VICTIM - INCIDENT 12
THIRD VICTIM - INCIDENT 13
THIRD VICTIM - INCIDENT 14
THIRD VICTIM - INCIDENT 15
SEX OF FIRST VICTIM - INCIDENT 1
SEX OF FIRST VICTIM - INCIDENT 2
SEX OF FIRST VICTIM - INCIDENT 3
SEX OF FIRST VICTIM - INCIDENT 4
SEX OF FIRST VICTIM - INCIDENT 5
SEX OF FIRST VICTIM - INCIDENT 6
SEX OF FIRST VICTIM - INCIDENT 7
SEX OF FIRST VICTIM - INCIDENT 8
SEX OF FIRST VICTIM - INCIDENT 9
SEX OF FIRST VICTIM - INCIDENT 10
SEX OF FIRST VICTIM - INCIDENT 11
SEX OF FIRST VICTIM - INCIDENT 12
SEX OF FIRST VICTIM - INCIDENT 13
SEX OF FIRST VICTIM - INCIDENT 14
SEX OF FIRST VICTIM - INCIDENT 15
SEX OF SECOND VICTIM - INCIDENT 1
SEX OF SECOND VICTIM - INCIDENT 2
SEX OF SECOND VICTIM - INCIDENT 3
SEX OF SECOND VICTIM - INCIDENT 4
SEX OF SECOND VICTIM - INCIDENT 5
SEX OF SECOND VICTIM - INCIDENT 6
SEX OF SECOND VICTIM - INCIDENT 7
SEX OF SECOND VICTIM - INCIDENT 8
SEX OF SECOND VICTIM - INCIDENT 9
SEX OF SECOND VICTIM - INCIDENT 10
SEX OF SECOND VICTIM - INCIDENT 11
SEX OF SECOND VICTIM - INCIDENT 12
SEX OF SECOND VICTIM - INCIDENT 13
SEX OF SECOND VICTIM - INCIDENT 14
SEX OF SECOND VICTIM - INCIDENT 15
SEX OF THIRD VICTIM - INCIDENT 1
SEX OF THIRD VICTIM - INCIDENT 2
SEX OF THIRD VICTIM - INCIDENT 3
SEX OF THIRD VICTIM - INCIDENT 4
SEX OF THIRD VICTIM - INCIDENT 5
SEX OF THIRD VICTIM - INCIDENT 6
SEX OF THIRD VICTIM - INCIDENT 7
SEX OF THIRD VICTIM - INCIDENT 8
SEX OF THIRD VICTIM - INCIDENT 9
SEX OF THIRD VICTIM - INCIDENT 10
SEX OF THIRD VICTIM - INCIDENT 11
SEX OF THIRD VICTIM - INCIDENT 12
SEX OF THIRD VICTIM - INCIDENT 13
SEX OF THIRD VICTIM - INCIDENT 14
SEX OF THIRD VICTIM - INCIDENT 15
MOST SERIOUS INJURY TO VICTIM - INCIDENT 1
MOST SERIOUS INJURY TO VICTIM - INCIDENT 2
MOST SERIOUS INJURY TO VICTIM - INCIDENT 3
MOST SERIOUS INJURY TO VICTIM - INCIDENT 4
MOST SERIOUS INJURY TO VICTIM - INCIDENT 5
MOST SERIOUS INJURY TO VICTIM - INCIDENT 6
MOST SERIOUS INJURY TO VICTIM - INCIDENT 7
MOST SERIOUS INJURY TO VICTIM - INCIDENT 8
MOST SERIOUS INJURY TO VICTIM - INCIDENT 9
MOST SERIOUS INJURY TO VICTIM - INCIDENT 10
MOST SERIOUS INJURY TO VICTIM - INCIDENT 11
MOST SERIOUS INJURY TO VICTIM - INCIDENT 12
MOST SERIOUS INJURY TO VICTIM - INCIDENT 13
MOST SERIOUS INJURY TO VICTIM - INCIDENT 14
MOST SERIOUS INJURY TO VICTIM - INCIDENT 15
DELUSIONAL AT TIME - INCIDENT 1
DELUSIONAL AT TIME - INCIDENT 2
DELUSIONAL AT TIME - INCIDENT 3
DELUSIONAL AT TIME - INCIDENT 4
DELUSIONAL AT TIME - INCIDENT 5
DELUSIONAL AT TIME - INCIDENT 6
DELUSIONAL AT TIME - INCIDENT 7
DELUSIONAL AT TIME - INCIDENT 8
DELUSIONAL AT TIME - INCIDENT 9
DELUSIONAL AT TIME - INCIDENT 10
DELUSIONAL AT TIME - INCIDENT 11
DELUSIONAL AT TIME - INCIDENT 12
DELUSIONAL AT TIME - INCIDENT 13
DELUSIONAL AT TIME - INCIDENT 14
DELUSIONAL AT TIME - INCIDENT 15
WEAPON TYPE - INCIDENT 1
WEAPON TYPE - INCIDENT 2
WEAPON TYPE - INCIDENT 3
WEAPON TYPE - INCIDENT 4
WEAPON TYPE - INCIDENT 5
WEAPON TYPE - INCIDENT 6
WEAPON TYPE - INCIDENT 7
WEAPON TYPE - INCIDENT 8
WEAPON TYPE - INCIDENT 9
WEAPON TYPE - INCIDENT 10
WEAPON TYPE - INCIDENT 11
WEAPON TYPE - INCIDENT 12
WEAPON TYPE - INCIDENT 13
WEAPON TYPE - INCIDENT 14
WEAPON TYPE - INCIDENT 15
WEAPON THREAT - INCIDENT 1
WEAPON THREAT - INCIDENT 2
WEAPON THREAT - INCIDENT 3
WEAPON THREAT - INCIDENT 4
WEAPON THREAT - INCIDENT 5
WEAPON THREAT - INCIDENT 6
WEAPON THREAT - INCIDENT 7
WEAPON THREAT - INCIDENT 8
WEAPON THREAT - INCIDENT 9
WEAPON THREAT - INCIDENT 10
WEAPON THREAT - INCIDENT 11
WEAPON THREAT - INCIDENT 12
WEAPON THREAT - INCIDENT 13
WEAPON THREAT - INCIDENT 14
WEAPON THREAT - INCIDENT 15
LEVEL 1 VIOLENCE - INCIDENT 1
LEVEL 1 VIOLENCE - INCIDENT 2
LEVEL 1 VIOLENCE - INCIDENT 3
LEVEL 1 VIOLENCE - INCIDENT 4
LEVEL 1 VIOLENCE - INCIDENT 5
LEVEL 1 VIOLENCE - INCIDENT 6
LEVEL 1 VIOLENCE - INCIDENT 7
LEVEL 1 VIOLENCE - INCIDENT 8
LEVEL 1 VIOLENCE - INCIDENT 9
LEVEL 1 VIOLENCE - INCIDENT 10
LEVEL 1 VIOLENCE - INCIDENT 11
LEVEL 1 VIOLENCE - INCIDENT 12
LEVEL 1 VIOLENCE - INCIDENT 13
LEVEL 1 VIOLENCE - INCIDENT 14
LEVEL 1 VIOLENCE - INCIDENT 15
LEVEL 1 INCIDENT
LEVEL 1 INCIDENT - INCIDENT NUMBER
WHAT BROUGHT SUBJ AND VICTIM TOGETHER
PROBLEM THAT LED TO INCIDENT
INCIDENT BECAUSE PERSON HAD SOMETHING YOU WANTED
DRINKING BEFORE INCIDENT
DRUGS BEFORE INCIDENT
DRUG CODE
WERE ANY PSYCH MEDS PRESCRIBED
TAKING MEDS AS PRESCRIBED
WHAT THINKING BEFORE INCIDENT
ANGRY BEFORE INCIDENT
HEARING VOICES BEFORE INCIDENT
ANYONE GO TO MED DR/HOSP AFTER INCIDENT
ANYONE TAKE TIME OFF WORK/SCHOOL AFTER INCIDENT
ARRESTED
GO TO PSYCH HOSP AFTER INCIDENT
HOW DID INCIDENT END
REASON WHY INCIDENT NOT WORSE
VIOLENCE IN SELF-DEFENSE - INTERVIEWER RATING
VIOLENCE UNPROVOKED - INTERVIEWER RATING
WAS MOST SERIOUSLY INJURED VICTIM THE INTENDED VICTIM
VICTIMS RELATIONSHIP TO SUBJECT
THIS ADMIT - FELT FREE TO DO WHAT WANTED ABOUT COMING TO HOSP (IRS-A)
THIS ADMIT - PEOPLE TRIED TO FORCE ME TO COME TO HOSP (IRS-A)
THIS ADMIT - HAD ENOUGH CHANCE TO SAY IF WANTED TO COME TO HOSP (IRS-A)
THIS ADMIT - I CHOSE TO COME TO HOSP (IRS-A)
THIS ADMIT - I GOT TO SAY WHAT I WANTED ABOUT COMING TO HOSP (IRS-A)
THIS ADMIT - SOMEONE THREATENED TO GET ME TO COME TO HOSP (IRS-A)
THIS ADMIT - IT WAS MY IDEA TO COME TO HOSP (IRS-A)
THIS ADMIT - SOMEONE PHYS TRIED TO MAKE COME TO HOSP (IRS-A)
THIS ADMIT - NOBODY WANTED TO KNOW IF I WANTED TO COME TO HOSP (IRS-A)
THIS ADMIT - I WAS THREATENED WITH COMMITTMENT (IRS-A)
THIS ADMIT - THEY SAID WOULD MAKE COME TO HOSP (IRS-A)
THIS ADMIT - NO ONE TRIED TO FORCE ME TO COME TO HOSP (IRS-A)
THIS ADMIT - MY OPINION ABOUT GOING TO HOSP DIDNT MATTER (IRS-A)
THIS ADMIT - I HAD A LOT OF CONTROL OVER ADMIT TO HOSP (IRS-A)
THIS ADMIT - I HAD MORE INFLUENCE THAN ANYONE OVER ADMIT DECISION (IRS-A)
HOW DID ADMIT MAKE FEEL - ANGRY (IRS-A)
HOW DID ADMIT MAKE FEEL - SAD (IRS-A)
HOW DID ADMIT MAKE FEEL - PLEASED (IRS-A)
HOW DID ADMIT MAKE FEEL - RELIEVED (IRS-A)
HOW DID ADMIT MAKE FEEL - CONFUSED (IRS-A)
HOW DID ADMIT MAKE FEEL - FRIGHTENED (IRS-A)
WHERE LIVING BEFORE ADMITTED TO HOSPITAL
LIVING W/RELATIVE
OTHER RESIDENCE - SPECIFY
HOW LONG LIVED THERE - YEARS
HOW LONG LIVED THERE - MONTHS
HOW LONG LIVED THERE - WEEKS
HOW LONG LIVED THERE - DAYS
LIVED THERE OFF AND ON OR STEADILY
WHO LIVED WITH YOU - FIRST NAME - PERSON 1
WHO LIVED WITH YOU - FIRST NAME - PERSON 2
WHO LIVED WITH YOU - FIRST NAME - PERSON 3
WHO LIVED WITH YOU - FIRST NAME - PERSON 4
WHO LIVED WITH YOU - FIRST NAME - PERSON 5
WHO LIVED WITH YOU - FIRST NAME - PERSON 6
WHO LIVED WITH YOU - FIRST NAME - PERSON 7
WHO LIVED WITH YOU - FIRST NAME - PERSON 8
RELATIONSHIP CODE - PERSON 1
RELATIONSHIP CODE - PERSON 2
RELATIONSHIP CODE - PERSON 3
RELATIONSHIP CODE - PERSON 4
RELATIONSHIP CODE - PERSON 5
RELATIONSHIP CODE - PERSON 6
RELATIONSHIP CODE - PERSON 7
RELATIONSHIP CODE - PERSON 8
# PEOPLE IN HOUSE (INCL SELF)
WILL YOU RETURN TO RESIDENCE AFTER D/C FROM HOSP
EVER MARRIED
# OF TIMES MARRIED
FIRST MARRIAGE - YEARS
FIRST MARRIAGE - MONTHS
SECOND MARRIAGE - YEARS
SECOND MARRIAGE - MONTHS
THIRD MARRIAGE - YEARS
THIRD MARRIAGE - MONTHS
FOURTH MARRIAGE - YEARS
FOURTH MARRIAGE - MONTHS
BEFORE ADMIT LIVING W/SOMEONE AS THOUGH MARRIED
ANY CHILDREN
# OF CHILDREN
HOW OFTEN UPSET B/C OF AN UNEXPECTED OCCURENCE
HOW OFTEN FELT UNABLE TO CONTROL IMP THINGS IN LIFE
HOW OFTEN FELT NERVOUS/STRESSED
HOW OFTEN SUCCESSFULLY DEALT W/EVERYDAY HASSLES
HOW OFTEN FELT REALLY HANDLING IMP LIFE CHANGES
HOW OFTEN CONFIDENT ABOUT HANDLING PERS PROBS
HOW OFTEN FELT THINGS GOING YOUR WAY
HOW OFTEN FELT COULDNT COPE W/THINGS TO BE DONE
HOW OFTEN BEEN ABLE TO CONTROL IRRITATIONS
HOW OFTEN FELT ON TOP OF THINGS
HOW OFTEN ANGRY B/C OF THINGS YOU COULDNT CONTROL
HOW OFTEN THINK ABOUT THINGS TO ACCOMPLISH
HOW OFTEN ABLE TO CONTROL WAY YOU SPEND TIME
HOW OFTEN FELT DIFFICULTIES SO HIGH YOU COULDNT OVERCOME
HOW OFTEN FELT PEOPLE WHO WISHED TO DO YOU HARM
NEVER HESITATE TO GO OUT OF WAY TO HELP SOMEONE IN TROUBLE
SOMETIMES IRRITATED BY PEOPLE WHO ASK FAVORS
NEVER INTENSELY DISLIKED ANYONE
SOMETIMES TRY TO GET EVEN
SOMETIMES JEALOUS OF OTHERS GOOD FORTUNE
ALWAYS WILLING TO ADMIT WHEN MAKE MISTAKES
ALWAYS TRY TO PRACTICE WHAT YOU PREACH
OCCASIONALLY YOU HAVE TAKEN ADVANTAGE OF OTHERS
WOULD NEVER THINK OF LETTING OTHERS BE PUNISHED FOR YOUR WRONGS
NEVER RESENT BEING ASKED TO RETURN FAVORS
SOMETIMES THINK PEOPLE GET WHAT THEY DESERVE WHEN HAVE MISFORTUNE
SOMETIMES LIKE TO GOSSIP
NEVER BEEN ANNOYED WHEN OTHERS EXPRESS IDEA DIFFERENT FROM YOURS
NEVER DELIBERATELY SAID SOMETHING TO HURT ANOTHERS FEELINGS
SOMETIMES RESENTFUL WHEN DONT GET YOUR WAY
OCCUPATION (SEE OCC CODES)
WHAT KINDS OF JOBS HAVE YOU HAD (IF NO OCC LITSED) (SEE OCC CODES)
HAVE YOU WORKED IN THE PAST 2 MONTHS
# DAYS WORKED LAST 2 MONTHS
WERE YOU RETIRED
WERE YOU A HOMEMAKER
WERE YOU A STUDENT
FULL OR PART-TIME STUDENT
WERE YOU LAID OFF
WERE YOU HOSPITALIZED
WERE YOU DISABLED
WERE YOU INCARCERATED
DID YOU HAVE A JOB BUT WERE ON VACATION/LEAVE
WERE YOU UNEMPLOYED - SEEKING EMPLOYMENT
WERE YOU UNEMPLOYED - NOT SEEKING EMPLOYMENT
OTHER STATUS (SPECIFY)
WHAT WAS YOUR STATUS (OTHER)
DONT KNOW STATUS
WHAT WAS YOUR PRIMARY STATUS
SUBJECTS EDUCATION LEVEL
GED
LIVE W/BIOLOGICAL MOTHER UNTIL AT LEAST 15 YRS OLD
AGE OF SEPARATION FROM BIOLOGICAL MOTHER
LIVE W/BIOLOGICAL FATHER UNTIL AT LEAST 15 YRS OLD
AGE OF SEPARATION FROM BIOLOGICAL FATHER
WHO RAISED YOU - LINE 1
WHO RAISED YOU - LINE 2
WHO RAISED YOU - LINE 3
PARENTAL FIGURE 1 - FIRST NAME
PARENTAL FIGURE 1 - GENDER
PARENTAL FIGURE 1 - REL CODE
PARENTAL FIGURE 2 - FIRST NAME
PARENTAL FIGURE 2 - GENDER
PARENTAL FIGURE 2 - REL CODE
BEAT AS CHILD (12 & UNDER)
BEAT W/HARD OBJECT AS CHILD (12 & UNDER)
BEAT W/BELT AS CHILD (12 & UNDER)
INJURE W/WEAPON AS CHILD (12 & UNDER)
BEAT/NEEDED DOCTOR AS CHILD (12 & UNDER)
BEAT/ADMITTED TO HOSPITAL AS CHILD (12 & UNDER)
BEAT AS TEEN
BEAT W/HARD OBJECT AS TEEN
BEAT W/BELT AS TEEN
INJURE W/WEAPON AS TEEN
BEAT/NEEDED DOCTOR AS TEEN
BEAT/ADMITTED TO HOSPITAL AS TEEN
MOST SEVERE PUNISHMENT EVER RECEIVED
PARENTS HIT EACH OTHER
PARENTS EVER HAVE PHYSICAL FIGHTS W/PEOPLE OUTSIDE FAMILY
MOTHER (BIOLOGICAL) EVER ADMITTED TO PSYCH HOSP
MOTHER (NOT BIOLOGOCAL) EVER ADMITTED TO PSYCH HOSP
SUBJECTS AGE AT TIME OF MOTHERS (BIOLOGICAL) FIRST ADMIT
SUBJECTS AGE AT TIME OF MOTHERS (NOT BIOLOGICAL) FIRST ADMIT
DID MOTHER (BIOLOGICAL) EVER DRINK EXCESSIVELY
DID MOTHER (NOT BIOLOGICAL) EVER DRINK EXCESSIVELY
DID MOTHER (BIOLOGICAL) EVER USE DRUGS
DID MOTHER (NOT BIOLOGICAL) EVER USE DRUGS
DRUGS USED BY MOTHER (BIOLOGICAL) - DRUG 1
DRUGS USED BY MOTHER (NOT BIOLOGICAL) - DRUG 1
DRUGS USED BY MOTHER (BIOLOGICAL) - DRUG 2
DRUGS USED BY MOTHER (NOT BIOLOGICAL) - DRUG 2
DRUGS USED BY MOTHER (BIOLOGICAL) - DRUG 3
DRUGS USED BY MOTHER (NOT BIOLOGICAL) - DRUG 3
WAS MOTHER (BIOLOGICAL) EVER ARRESTED
WAS MOTHER (NOT BIOLOGICAL) EVER ARRESTED
MOST SERIOUS CHARGE MOTHER (BIOLOGICAL) ARRESTED FOR
MOST SERIOUS CHARGE MOTHER (NOT BIOLOGICAL) ARRESTED FOR
CRIME CLASSIFICATION FOR MOST SERIOUS CHARGE (BIOLOGICAL MOTHER)
CRIME CLASSIFICATION FOR MOST SERIOUS CHARGE (NOT BIOLOGICAL MOTHER)
WAS MOTHER (BIOLOGICAL) EVER INCARCERATED
WAS MOTHER (NOT BIOLOGICAL) EVER INCARCERATED
FATHER (BIOLOGICAL) EVER ADMITTED TO PSYCH HOSP
FATHER (NOT BIOLOGICAL) EVER ADMITTED TO PSYCH HOSP
SUBJECTS AGE AT TIME OF FATHERS (BIOLOGICAL) FIRST ADMIT
SUBJECTS AGE AT TIME OF FATHERS (NOT BIOLOGICAL) FIRST ADMIT
DID FATHER (BIOLOGICAL) EVER DRINK EXCESSIVELY
DID FATHER (NOT BIOLOGICAL) EVER DRINK EXCESSIVELY
DID FATHER (BIOLOGICAL) EVER USE DRUGS
DID FATHER (NOT BIOLOGICAL) EVER USE DRUGS
DRUGS USED BY FATHER (BIOLOGICAL) - DRUG 1
DRUGS USED BY FATHER (NOT BIOLOGICAL)-DRUG 1
DRUGS USED BY FATHER (BIOLOGICAL) - DRUG 2
DRUGS USED BY FATHER (NOT BIOLOGICAL) - DRUG 2
DRUGS USED BY FATHER (BIOLOGICAL) - DRUG 3
DRUGS USED BY FATHER (NOT BIOLOGICAL) - DRUG 3
WAS FATHER (BIOLOGICAL) EVER ARRESTED
WAS FATHER (NOT BIOLOGICAL) EVER ARRESTED
MOST SERIOUS CHARGE FATHER (BIOLOGICAL) ARRESTED FOR
MOST SERIOUS CHARGE FATHER (NOT BIOLOGICAL) ARRESTED FOR
CRIME CLASSIFICATION FOR MOST SERIOUS CHARGE (BIOLOGICAL FATHER)
CRIME CLASSIFICATION FOR MOST SERIOUS CHARGE (NOT BIOLOGICAL FATHER)
WAS FATHER (BIOLOGICAL) EVER INCARCERATED
WAS FATHER (NOT BIOLOGICAL) EVER INCARCERATED
HOW MANY BIOLOGICAL SIBLINGS
HOW MANY NON-BIOLOGICAL (STEP) SIBLINGS
ANY SIBLINGS EVER ARRESTED (BIOLOGICAL)
ANY SIBLINGS EVER ARRESTED (NOT BIOLOGICAL)
MOST SERIOUS CHARGE BIOLOGICAL SIBLINGS ARRESTED FOR
MOST SERIOUS CHARGE NON-BIOLOGICAL SIBLINGS ARRESTED FOR
CRIME CLASSIFICATION FOR MOST SERIOUS CHARGE (BIOLOGICAL SIBLING)
CRIME CLASSIFICATION FOR MOST SERIOUS CHARGE (NON-BIOLOGICAL SIBLING)
WERE SIBLINGS (BIOLOGICAL) EVER INCARCERATED
WERE SIBLINGS (NOT BIOLOGICAL) EVER INCARCERATED
THOUGHT OF HURTING SELF IN LAST TWO MONTHS
HOW OFTEN THOUGHT OF HURTING SELF
ATTEMPT TO HURT SELF IN LAST TWO MONTHS
HOW MANY ATTEMPTS TO HURT SELF
HOW TRY TO HURT SELF
DEGREE OF SELF-HARM SOUGHT
SPECIFY DEGREE OF SELF-HARM SOUGHT
ACTS IN ANTICIPATION OF DEATH
SPECIFY "THOUGHT ABOUT" ACTS
SPECIFY "DEFINITELY PLANNED" ACTS
ALTERATION/MANIPULATION OF ENVIRONMENT AS GOAL
SPECIFY ALT OF ENVIRON AS SECONDARY GOAL
SPECIFY ALT OF ENVIRON AS PRIMARY GOAL
DEGREE OF PREMEDITATION
ACTIVE PREPARATION
SPECIFY ACTIVE PREP - MIN TO MOD
SPECIFY ACTIVE PREP- EXTENSIVE
SELF-HARM NOTE
SELF INTERVENTION
PROBABILITY OF INTERVENTION
ISOLATION
SPECIFY ISOLATION - SOMEBODY NEARBY
SPECIFY ISOLATION - NO ONE NEARBY
PRECAUTIONS AGAINST DISCOVERY
SPECIFY PRECAUTIONS AGAINST DISCOVERY - PASSIVE
SPECIFY PRECAUTIONS AGAINST DISCOVERY - ACTIVE
DAYDREAMS ABOUT INJURING OTHERS
LAST TIME HAD A DAYDREAM
HOW OFTEN HAVE DAYDREAMS
WHEN DID DAYDREAMS START
DAYDREAMS - SAME OR DIFFERENT EACH TIME
SAME OR DIFFERENT PEOPLE
INJURIES SAME OR WORSE OVER TIME
DAYDREAM WHILE WITH PERSON
HAS ANYONE THROWN AT YOU
HAVE YOU THROWN AT ANYONE
# OF TIMES YOU HAVE THROWN
HAS ANYONE PUSHED YOU
HAVE YOU PUSHED ANYONE
# OF TIMES YOU HAVE PUSHED
HAS ANYONE SLAPPED YOU
HAVE YOU SLAPPED ANYONE
# OF TIMES YOU HAVE SLAPPED
HAS ANYONE KICKED/BITTEN/CHOKED YOU
HAVE YOU KICKED/BITTEN/CHOKED ANYONE
# OF TIMES YOU HAVE KICKED/BITTEN/CHOKED
HAS ANYONE HIT YOU W/FIST OR OBJECT
HAVE YOU HIT ANYONE W/FIST OR OBJECT
# OF TIMES YOU HAVE HIT W/FIST OR OBJECT
HAS ANYONE FORCED YOU TO HAVE SEX
HAVE YOU FORCED ANYONE TO HAVE SEX
# OF TIMES YOU HAVE FORCED SEX
HAS ANYONE THREATENED YOU W/WEAPON
HAVE YOU THREATENED ANYONE W/ WEAPON
# OF TIMES YOU HAVE THREATENED W/WEAPON
HAS ANYONE USED A KNIFE/GUN ON YOU
HAVE YOU USED A KNIFE/GUN ON ANYONE
# OF TIMES YOU HAVE USED A KNIFE/GUN ON SOMEONE
DONE ANYTHING ELSE VIOLENT
WHAT ELSE VIOLENT
# OF TIMES - OTHER VIOLENCE
INJURY TO VICTIM - INCIDENT 1
INJURY TO VICTIM - INCIDENT 2
INJURY TO VICTIM - INCIDENT 3
INJURY TO VICTIM - INCIDENT 4
INJURY TO VICTIM - INCIDENT 5
INJURY TO VICTIM - INCIDENT 6
INJURY TO VICTIM - INCIDENT 7
INJURY TO VICTIM - INCIDENT 8
INJURY TO VICTIM - INCIDENT 9
INJURY TO VICTIM - INCIDENT 10
INJURY TO VICTIM - INCIDENT 11
INJURY TO VICTIM - INCIDENT 12
INJURY TO VICTIM - INCIDENT 13
INJURY TO VICTIM - INCIDENT 14
INJURY TO VICTIM - INCIDENT 15
LEVEL 1 INCIDENT #1
LEVEL 1 INCIDENT #2
LEVEL 1 INCIDENT #3
LEVEL 1 INCIDENT #4
LEVEL 1 INCIDENT #5
LEVEL 1 INCIDENT #6
LEVEL 1 INCIDENT #7
LEVEL 1 INCIDENT #8
LEVEL 1 INCIDENT #9
LEVEL 1 INCIDENT #10
LEVEL 1 INCIDENT #11
LEVEL 1 INCIDENT #1 - INCIDENT NUMBER
LEVEL 1 INCIDENT #2 - INCIDENT NUMBER
LEVEL 1 INCIDENT #3 - INCIDENT NUMBER
LEVEL 1 INCIDENT #4 - INCIDENT NUMBER
LEVEL 1 INCIDENT #5 - INCIDENT NUMBER
LEVEL 1 INCIDENT #6 - INCIDENT NUMBER
LEVEL 1 INCIDENT #7 - INCIDENT NUMBER
LEVEL 1 INCIDENT #8 - INCIDENT NUMBER
LEVEL 1 INCIDENT #9 - INCIDENT NUMBER
LEVEL 1 INCIDENT #10 - INCIDENT NUMBER
LEVEL 1 INCIDENT #11 - INCIDENT NUMBER
WHAT BROUGHT SUBJ AND VICTIM TOGETHER - INCIDENT 1
WHAT BROUGHT SUBJ AND VICTIM TOGETHER - INCIDENT 2
WHAT BROUGHT SUBJ AND VICTIM TOGETHER - INCIDENT 3
WHAT BROUGHT SUBJ AND VICTIM TOGETHER - INCIDENT 4
WHAT BROUGHT SUBJ AND VICTIM TOGETHER - INCIDENT 5
WHAT BROUGHT SUBJ AND VICTIM TOGETHER - INCIDENT 6
WHAT BROUGHT SUBJ AND VICTIM TOGETHER - INCIDENT 7
WHAT BROUGHT SUBJ AND VICTIM TOGETHER - INCIDENT 8
WHAT BROUGHT SUBJ AND VICTIM TOGETHER - INCIDENT 9
WHAT BROUGHT SUBJ AND VICTIM TOGETHER - INCIDENT 10
WHAT BROUGHT SUBJ AND VICTIM TOGETHER - INCIDENT 11
PROBLEM THAT LED TO INCIDENT - INCIDENT 1
PROBLEM THAT LED TO INCIDENT - INCIDENT 2
PROBLEM THAT LED TO INCIDENT - INCIDENT 3
PROBLEM THAT LED TO INCIDENT - INCIDENT 4
PROBLEM THAT LED TO INCIDENT - INCIDENT 5
PROBLEM THAT LED TO INCIDENT - INCIDENT 6
PROBLEM THAT LED TO INCIDENT - INCIDENT 7
PROBLEM THAT LED TO INCIDENT - INCIDENT 8
PROBLEM THAT LED TO INCIDENT - INCIDENT 9
PROBLEM THAT LED TO INCIDENT - INCIDENT 10
PROBLEM THAT LED TO INCIDENT - INCIDENT 11
INCIDENT BECAUSE PERSON HAD SOMETHING YOU WANTED - INCIDENT 1
INCIDENT BECAUSE PERSON HAD SOMETHING YOU WANTED - INCIDENT 2
INCIDENT BECAUSE PERSON HAD SOMETHING YOU WANTED - INCIDENT 3
INCIDENT BECAUSE PERSON HAD SOMETHING YOU WANTED - INCIDENT 4
INCIDENT BECAUSE PERSON HAD SOMETHING YOU WANTED - INCIDENT 5
INCIDENT BECAUSE PERSON HAD SOMETHING YOU WANTED - INCIDENT 6
INCIDENT BECAUSE PERSON HAD SOMETHING YOU WANTED - INCIDENT 7
INCIDENT BECAUSE PERSON HAD SOMETHING YOU WANTED - INCIDENT 8
INCIDENT BECAUSE PERSON HAD SOMETHING YOU WANTED - INCIDENT 9
INCIDENT BECAUSE PERSON HAD SOMETHING YOU WANTED - INCIDENT 10
INCIDENT BECAUSE PERSON HAD SOMETHING YOU WANTED - INCIDENT 11
DRINKING BEFORE INCIDENT - INCIDENT 1
DRINKING BEFORE INCIDENT - INCIDENT 2
DRINKING BEFORE INCIDENT - INCIDENT 3
DRINKING BEFORE INCIDENT - INCIDENT 4
DRINKING BEFORE INCIDENT - INCIDENT 5
DRINKING BEFORE INCIDENT - INCIDENT 6
DRINKING BEFORE INCIDENT - INCIDENT 7
DRINKING BEFORE INCIDENT - INCIDENT 8
DRINKING BEFORE INCIDENT - INCIDENT 9
DRINKING BEFORE INCIDENT - INCIDENT 10
DRINKING BEFORE INCIDENT - INCIDENT 11
DRUGS BEFORE INCIDENT - INCIDENT 1
DRUGS BEFORE INCIDENT - INCIDENT 2
DRUGS BEFORE INCIDENT - INCIDENT 3
DRUGS BEFORE INCIDENT - INCIDENT 4
DRUGS BEFORE INCIDENT - INCIDENT 5
DRUGS BEFORE INCIDENT - INCIDENT 6
DRUGS BEFORE INCIDENT - INCIDENT 7
DRUGS BEFORE INCIDENT - INCIDENT 8
DRUGS BEFORE INCIDENT - INCIDENT 9
DRUGS BEFORE INCIDENT - INCIDENT 10
DRUGS BEFORE INCIDENT - INCIDENT 11
DRUG CODE - INCIDENT 1
DRUG CODE - INCIDENT 2
DRUG CODE - INCIDENT 3
DRUG CODE - INCIDENT 4
DRUG CODE - INCIDENT 5
DRUG CODE - INCIDENT 6
DRUG CODE - INCIDENT 7
DRUG CODE - INCIDENT 8
DRUG CODE - INCIDENT 9
DRUG CODE - INCIDENT 10
DRUG CODE - INCIDENT 11
WERE ANY PSYCH MEDS PRESCRIBED - INCIDENT 1
WERE ANY PSYCH MEDS PRESCRIBED - INCIDENT 2
WERE ANY PSYCH MEDS PRESCRIBED - INCIDENT 3
WERE ANY PSYCH MEDS PRESCRIBED - INCIDENT 4
WERE ANY PSYCH MEDS PRESCRIBED - INCIDENT 5
WERE ANY PSYCH MEDS PRESCRIBED - INCIDENT 6
WERE ANY PSYCH MEDS PRESCRIBED - INCIDENT 7
WERE ANY PSYCH MEDS PRESCRIBED - INCIDENT 8
WERE ANY PSYCH MEDS PRESCRIBED - INCIDENT 9
WERE ANY PSYCH MEDS PRESCRIBED - INCIDENT 10
WERE ANY PSYCH MEDS PRESCRIBED - INCIDENT 11
TAKING MEDS AS PRESCRIBED - INCIDENT 1
TAKING MEDS AS PRESCRIBED - INCIDENT 2
TAKING MEDS AS PRESCRIBED - INCIDENT 3
TAKING MEDS AS PRESCRIBED - INCIDENT 4
TAKING MEDS AS PRESCRIBED - INCIDENT 5
TAKING MEDS AS PRESCRIBED - INCIDENT 6
TAKING MEDS AS PRESCRIBED - INCIDENT 7
TAKING MEDS AS PRESCRIBED - INCIDENT 8
TAKING MEDS AS PRESCRIBED - INCIDENT 9
TAKING MEDS AS PRESCRIBED - INCIDENT 10
TAKING MEDS AS PRESCRIBED - INCIDENT 11
WHAT THINKING BEFORE INCIDENT - INCIDENT 1
WHAT THINKING BEFORE INCIDENT - INCIDENT 2
WHAT THINKING BEFORE INCIDENT - INCIDENT 3
WHAT THINKING BEFORE INCIDENT - INCIDENT 4
WHAT THINKING BEFORE INCIDENT - INCIDENT 5
WHAT THINKING BEFORE INCIDENT - INCIDENT 6
WHAT THINKING BEFORE INCIDENT - INCIDENT 7
WHAT THINKING BEFORE INCIDENT - INCIDENT 8
WHAT THINKING BEFORE INCIDENT - INCIDENT 9
WHAT THINKING BEFORE INCIDENT - INCIDENT 10
WHAT THINKING BEFORE INCIDENT - INCIDENT 11
ANGRY BEFORE INCIDENT - INCIDENT 1
ANGRY BEFORE INCIDENT - INCIDENT 2
ANGRY BEFORE INCIDENT - INCIDENT 3
ANGRY BEFORE INCIDENT - INCIDENT 4
ANGRY BEFORE INCIDENT - INCIDENT 5
ANGRY BEFORE INCIDENT - INCIDENT 6
ANGRY BEFORE INCIDENT - INCIDENT 7
ANGRY BEFORE INCIDENT - INCIDENT 8
ANGRY BEFORE INCIDENT - INCIDENT 9
ANGRY BEFORE INCIDENT - INCIDENT 10
ANGRY BEFORE INCIDENT - INCIDENT 11
HEARING VOICES BEFORE INCIDENT - INCIDENT 1
HEARING VOICES BEFORE INCIDENT - INCIDENT 2
HEARING VOICES BEFORE INCIDENT - INCIDENT 3
HEARING VOICES BEFORE INCIDENT - INCIDENT 4
HEARING VOICES BEFORE INCIDENT - INCIDENT 5
HEARING VOICES BEFORE INCIDENT - INCIDENT 6
HEARING VOICES BEFORE INCIDENT - INCIDENT 7
HEARING VOICES BEFORE INCIDENT - INCIDENT 8
HEARING VOICES BEFORE INCIDENT - INCIDENT 9
HEARING VOICES BEFORE INCIDENT - INCIDENT 10
HEARING VOICES BEFORE INCIDENT - INCIDENT 11
ANYONE GO TO MED DR/HOSP AFTER INCIDENT - INCIDENT 1
ANYONE GO TO MED DR/HOSP AFTER INCIDENT - INCIDENT 2
ANYONE GO TO MED DR/HOSP AFTER INCIDENT - INCIDENT 3
ANYONE GO TO MED DR/HOSP AFTER INCIDENT - INCIDENT 4
ANYONE GO TO MED DR/HOSP AFTER INCIDENT - INCIDENT 5
ANYONE GO TO MED DR/HOSP AFTER INCIDENT - INCIDENT 6
ANYONE GO TO MED DR/HOSP AFTER INCIDENT - INCIDENT 7
ANYONE GO TO MED DR/HOSP AFTER INCIDENT - INCIDENT 8
ANYONE GO TO MED DR/HOSP AFTER INCIDENT - INCIDENT 9
ANYONE GO TO MED DR/HOSP AFTER INCIDENT - INCIDENT 10
ANYONE GO TO MED DR/HOSP AFTER INCIDENT - INCIDENT 11
ANYONE TAKE TIME OFF WORK/SCHOOL AFTER INCIDENT - INCIDENT 1
ANYONE TAKE TIME OFF WORK/SCHOOL AFTER INCIDENT - INCIDENT 2
ANYONE TAKE TIME OFF WORK/SCHOOL AFTER INCIDENT - INCIDENT 3
ANYONE TAKE TIME OFF WORK/SCHOOL AFTER INCIDENT - INCIDENT 4
ANYONE TAKE TIME OFF WORK/SCHOOL AFTER INCIDENT - INCIDENT 5
ANYONE TAKE TIME OFF WORK/SCHOOL AFTER INCIDENT - INCIDENT 6
ANYONE TAKE TIME OFF WORK/SCHOOL AFTER INCIDENT - INCIDENT 7
ANYONE TAKE TIME OFF WORK/SCHOOL AFTER INCIDENT - INCIDENT 8
ANYONE TAKE TIME OFF WORK/SCHOOL AFTER INCIDENT - INCIDENT 9
ANYONE TAKE TIME OFF WORK/SCHOOL AFTER INCIDENT - INCIDENT 10
ANYONE TAKE TIME OFF WORK/SCHOOL AFTER INCIDENT - INCIDENT 11
ARRESTED - INCIDENT 1
ARRESTED - INCIDENT 2
ARRESTED - INCIDENT 3
ARRESTED - INCIDENT 4
ARRESTED - INCIDENT 5
ARRESTED - INCIDENT 6
ARRESTED - INCIDENT 7
ARRESTED - INCIDENT 8
ARRESTED - INCIDENT 9
ARRESTED - INCIDENT 10
ARRESTED - INCIDENT 11
GO TO PSYCH HOSP AFTER INCIDENT - INCIDENT 1
GO TO PSYCH HOSP AFTER INCIDENT - INCIDENT 2
GO TO PSYCH HOSP AFTER INCIDENT - INCIDENT 3
GO TO PSYCH HOSP AFTER INCIDENT - INCIDENT 4
GO TO PSYCH HOSP AFTER INCIDENT - INCIDENT 5
GO TO PSYCH HOSP AFTER INCIDENT - INCIDENT 6
GO TO PSYCH HOSP AFTER INCIDENT - INCIDENT 7
GO TO PSYCH HOSP AFTER INCIDENT - INCIDENT 8
GO TO PSYCH HOSP AFTER INCIDENT - INCIDENT 9
GO TO PSYCH HOSP AFTER INCIDENT - INCIDENT 10
GO TO PSYCH HOSP AFTER INCIDENT - INCIDENT 11
HOW DID INCIDENT END - INCIDENT 1
HOW DID INCIDENT END - INCIDENT 2
HOW DID INCIDENT END - INCIDENT 3
HOW DID INCIDENT END - INCIDENT 4
HOW DID INCIDENT END - INCIDENT 5
HOW DID INCIDENT END - INCIDENT 6
HOW DID INCIDENT END - INCIDENT 7
HOW DID INCIDENT END - INCIDENT 9
INCIDENT END-INC 9
HOW DID INCIDENT END - INCIDENT 10
HOW DID INCIDENT END - INCIDENT 11
WHY INCIDENT NOT WORSE - FIRST REASON - INCIDENT 1
WHY INCIDENT NOT WORSE - FIRST REASON - INCIDENT 2
WHY INCIDENT NOT WORSE - FIRST REASON - INCIDENT 3
WHY INCIDENT NOT WORSE - FIRST REASON - INCIDENT 4
WHY INCIDENT NOT WORSE - FIRST REASON - INCIDENT 5
WHY INCIDENT NOT WORSE - FIRST REASON - INCIDENT 6
WHY INCIDENT NOT WORSE - FIRST REASON - INCIDENT 7
WHY INCIDENT NOT WORSE - FIRST REASON - INCIDENT 8
WHY INCIDENT NOT WORSE - FIRST REASON - INCIDENT 9
WHY INCIDENT NOT WORSE - FIRST REASON - INCIDENT 10
WHY INCIDENT NOT WORSE - FIRST REASON - INCIDENT 11
WHY INCIDENT NOT WORSE - SECOND REASON - INCIDENT 1
WHY INCIDENT NOT WORSE - SECOND REASON - INCIDENT 2
WHY INCIDENT NOT WORSE - SECOND REASON - INCIDENT 3
WHY INCIDENT NOT WORSE - SECOND REASON - INCIDENT 4
WHY INCIDENT NOT WORSE - SECOND REASON - INCIDENT 5
WHY INCIDENT NOT WORSE - SECOND REASON - INCIDENT 6
WHY INCIDENT NOT WORSE - SECOND REASON - INCIDENT 7
WHY INCIDENT NOT WORSE - SECOND REASON - INCIDENT 8
WHY INCIDENT NOT WORSE - SECOND REASON - INCIDENT 9
WHY INCIDENT NOT WORSE - SECOND REASON - INCIDENT 10
WHY INCIDENT NOT WORSE - SECOND REASON - INCIDENT 11
VIOLENCE IN SELF-DEFENSE - INTERVIEWER RATING - INCIDENT 1
VIOLENCE IN SELF-DEFENSE - INTERVIEWER RATING - INCIDENT 2
VIOLENCE IN SELF-DEFENSE - INTERVIEWER RATING - INCIDENT 3
VIOLENCE IN SELF-DEFENSE - INTERVIEWER RATING - INCIDENT 4
VIOLENCE IN SELF-DEFENSE - INTERVIEWER RATING - INCIDENT 5
VIOLENCE IN SELF-DEFENSE - INTERVIEWER RATING - INCIDENT 6
VIOLENCE IN SELF-DEFENSE - INTERVIEWER RATING - INCIDENT 7
VIOLENCE IN SELF-DEFENSE - INTERVIEWER RATING - INCIDENT 8
VIOLENCE IN SELF-DEFENSE - INTERVIEWER RATING - INCIDENT 9
VIOLENCE IN SELF-DEFENSE - INTERVIEWER RATING - INCIDENT 10
VIOLENCE IN SELF-DEFENSE - INTERVIEWER RATING - INCIDENT 11
VIOLENCE UNPROVOKED - INTERVIEWER RATING - INCIDENT 1
VIOLENCE UNPROVOKED - INTERVIEWER RATING - INCIDENT 2
VIOLENCE UNPROVOKED - INTERVIEWER RATING - INCIDENT 3
VIOLENCE UNPROVOKED - INTERVIEWER RATING - INCIDENT 4
VIOLENCE UNPROVOKED - INTERVIEWER RATING - INCIDENT 5
VIOLENCE UNPROVOKED - INTERVIEWER RATING - INCIDENT 6
VIOLENCE UNPROVOKED - INTERVIEWER RATING - INCIDENT 7
VIOLENCE UNPROVOKED - INTERVIEWER RATING - INCIDENT 8
VIOLENCE UNPROVOKED - INTERVIEWER RATING - INCIDENT 9
VIOLENCE UNPROVOKED - INTERVIEWER RATING - INCIDENT 10
VIOLENCE UNPROVOKED - INTERVIEWER RATING - INCIDENT 11
WAS MOST SERIOUSLY INJ VICTIM THE INTENDED VICTIM - INCIDENT 1
WAS MOST SERIOUSLY INJ VICTIM THE INTENDED VICTIM - INCIDENT 2
WAS MOST SERIOUSLY INJ VICTIM THE INTENDED VICTIM - INCIDENT 3
WAS MOST SERIOUSLY INJ VICTIM THE INTENDED VICTIM - INCIDENT 4
WAS MOST SERIOUSLY INJ VICTIM THE INTENDED VICTIM - INCIDENT 5
WAS MOST SERIOUSLY INJ VICTIM THE INTENDED VICTIM - INCIDENT 6
WAS MOST SERIOUSLY INJ VICTIM THE INTENDED VICTIM - INCIDENT 7
WAS MOST SERIOUSLY INJ VICTIM THE INTENDED VICTIM - INCIDENT 8
WAS MOST SERIOUSLY INJ VICTIM THE INTENDED VICTIM - INCIDENT 9
WAS MOST SERIOUSLY INJ VICTIM THE INTENDED VICTIM - INCIDENT 10
WAS MOST SERIOUSLY INJ VICTIM THE INTENDED VICTIM - INCIDENT 11
REL CODE OF INTENDED VICTIM - INCIDENT 1
REL CODE OF INTENDED VICTIM - INCIDENT 2
REL CODE OF INTENDED VICTIM - INCIDENT 3
REL CODE OF INTENDED VICTIM - INCIDENT 4
REL CODE OF INTENDED VICTIM - INCIDENT 5
REL CODE OF INTENDED VICTIM - INCIDENT 6
REL CODE OF INTENDED VICTIM - INCIDENT 7
REL CODE OF INTENDED VICTIM - INCIDENT 8
REL CODE OF INTENDED VICTIM - INCIDENT 9
REL CODE OF INTENDED VICTIM - INCIDENT 10
REL CODE OF INTENDED VICTIM - INCIDENT 11
DIFFICULTY DOING HOUSEWORK
DIFFICULTY SHOPPING
DIFFICULTY MANAGING MONEY
DIFFICULTY USING TRANSPORTATION
DIFFICULTY COOKING
DIFFICULTY DOING LAUNDRY
HELPS W/HOUSEHOLD TASKS - PERSON 1 (FROM SNI)
HELPS W/HOUSEHOLD TASKS - PERSON 2 (FROM SNI)
HELPS W/HOUSEHOLD TASKS - PERSON 3 (FROM SNI)
HELPS W/HOUSEHOLD TASKS - PERSON 4 (FROM SNI)
TOTAL # OF PEOPLE WHO HELP W/HOUSEHOLD TASKS
HELP GETTING THROUGH HARD TIME - PERSON 1 (FROM SNI)
HELP GETTING THROUGH HARD TIME - PERSON 2 (FROM SNI)
HELP GETTING THROUGH HARD TIME - PERSON 3 (FROM SNI)
HELP GETTING THROUGH HARD TIME - PERSON 4 (FROM SNI)
TOTAL # OF PEOPLE WHO HELP GET THROUGH HARD TIME
TALK ABOUT IMPORTANT THINGS WITH - PERSON 1 (FROM SNI)
TALK ABOUT IMPORTANT THINGS WITH - PERSON 2 (FROM SNI)
TALK ABOUT IMPORTANT THINGS WITH - PERSON 3 (FROM SNI)
TALK ABOUT IMPORTANT THINGS WITH - PERSON 4 (FROM SNI)
TOTAL # OF PEOPLE TO TALK ABOUT IMPORTANT THINGS WITH
OTHER IMPORTANT/HELPFUL PEOPLE - PERSON 1 (FROM SNI)
OTHER IMPORTANT/HELPFUL PEOPLE - PERSON 2 (FROM SNI)
OTHER IMPORTANT/HELPFUL PEOPLE - PERSON 3 (FROM SNI)
OTHER IMPORTANT/HELPFUL PEOPLE - PERSON 4 (FROM SNI)
TOTAL # OF OTHER IMPORTANT/HELPFUL PEOPLE
PROFESSIONAL HELPERS - PERSON 1 (FROM SNI)
PROFESSIONAL HELPERS - PERSON 2 (FROM SNI)
TOTAL # OF PROFESSIONAL HELPERS
PEOPLE WHO ASK TOO MUCH OF YOU - PERSON 1 (FROM SNI)
PEOPLE WHO ASK TOO MUCH OF YOU - PERSON 2 (FROM SNI)
TOTAL # OF PEOPLE WHO ASK TOO MUCH OF YOU
PEOPLE WHO TURN YOU AWAY - PERSON 1 (FROM SNI)
PEOPLE WHO TURN YOU AWAY - PERSON 2 (FROM SNI)
TOTAL # OF PEOPLE WHO TURN YOU AWAY
PEOPLE YOU DONT GET ALONG WITH - PERSON 1 (FROM SNI)
PEOPLE YOU DONT GET ALONG WITH - PERSON 2 (FROM SNI)
TOTAL # OF PEOPLE YOU DONT GET ALONG WITH
PEOPLE WHO DONT LIKE YOU - PERSON 1 (FROM SNI)
PEOPLE WHO DONT LIKE YOU - PERSON 2 (FROM SNI)
TOTAL # OF PEOPLE WHO DONT LIKE YOU
PEOPLE YOU DONT GET ALONG WITH (NOT MENTIONED BEFORE) - PERSON 1 (FROM SNI)
PEOPLE YOU DONT GET ALONG WITH (NOT MENTIONED BEFORE) - PERSON 2 (FROM SNI)
DO YOU EVER HAVE CONTACT WITH THOSE PEOPLE
DO YOU GET INVITED TO SPECIAL EVENTS
WHO DO YOU HAVE HOLIDAYS WITH - PERSON 1 (FROM SNI)
WHO DO YOU HAVE HOLIDAYS WITH - PERSON 2 (FROM SNI)
PERSON MOST LIKELY TO TRUST FOR ADVICE (FROM SNI)
OTHER PERSON (NON-RELATIVE) TRUST FOR ADVICE (FROM SNI)
WHO CARES MOST ABOUT YOU REGARDLESS OF WHAT HAPPENS (FROM SNI)
RELATIVES YOU SEE AT LEAST 1X/MO - PERSON 1 (FROM SNI)
RELATIVES YOU SEE AT LEAST 1X/MO - PERSON 2 (FROM SNI)
RELATIVES YOU SEE AT LEAST 1X/MO - PERSON 3 (FROM SNI)
RELATIVES YOU SEE AT LEAST 1X/MO - PERSON 4 (FROM SNI)
RELATIVES YOU SEE AT LEAST 1X/MO - PERSON 5 (FROM SNI)
RELATIVES YOU SEE AT LEAST 1X/MO - PERSON 6 (FROM SNI)
CLOSE FRIENDS WHO YOU SEE AT LEAST 1X/MO - PERSON 1 (FROM SNI)
CLOSE FRIENDS WHO YOU SEE AT LEAST 1X/MO - PERSON 2 (FROM SNI)
CLOSE FRIENDS WHO YOU SEE AT LEAST 1X/MO - PERSON 3 (FROM SNI)
CLOSE FRIENDS WHO YOU SEE AT LEAST 1X/MO - PERSON 4 (FROM SNI)
CLOSE FRIENDS WHO YOU SEE AT LEAST 1X/MO - PERSON 5 (FROM SNI)
CLOSE FRIENDS WHO YOU SEE AT LEAST 1X/MO - PERSON 6 (FROM SNI)
VISITORS/MAIL/PHONE CALLS WHILE IN HOSP
VISITORS - PERSON 1 (FROM SNI)
VISITORS - PERSON 2 (FROM SNI)
TOTAL # OF PEOPLE WHO VISIT
FIRST MOST IMPORTANT PERSON (FROM SNI)
SECOND MOST IMPORTANT PERSON (FROM SNI)
THIRD MOST IMPORTANT PERSON (FROM SNI)
FOURTH MOST IMPORTANT PERSON (FROM SNI)
FIFTH MOST IMPORTANT PERSON (FROM SNI)
RESIDENCE-FIRST PERSON
RESIDENCE-SECOND PERSON
RESIDENCE-THIRD PERSON
RESIDENCE-FOURTH PERSON
RESIDENCE-FIFTH PERSON
HOW LONG KNOWN FIRST PERSON
HOW LONG KNOWN SECOND PERSON
HOW LONG KNOWN THIRD PERSON
HOW LONG KNOWN FOURTH PERSON
HOW LONG KNOWN FIFTH PERSON
CONTACT WITH FIRST PERSON
CONTACT WITH SECOND PERSON
CONTACT WITH THIRD PERSON
CONTACT WITH FOURTH PERSON
CONTACT WITH FIFTH PERSON
LEND THINGS TO FIRST PERSON
LEND THINGS TO SECOND PERSON
LEND THINGS TO THIRD PERSON
LEND THINGS TO FOURTH PERSON
LEND THINGS TO FIFTH PERSON
LEND IF ASKED TO FIRST PERSON
LEND IF ASKED TO SECOND PERSON
LEND IF ASKED TO THIRD PERSON
LEND IF ASKED TO FOURTH PERSON
LEND IF ASKED TO FIFTH PERSON
DOES FIRST PERSON LEND TO YOU
DOES SECOND PERSON LEND TO YOU
DOES THIRD PERSON LEND TO YOU
DOES FOURTH PERSON LEND TO YOU
DOES FIFTH PERSON LEND TO YOU
WOULD FIRST PERSON LEND IF ASKED
WOULD SECOND PERSON LEND IF ASKED
WOULD THIRD PERSON LEND IF ASKED
WOULD FOURTH PERSON LEND IF ASKED
WOULD FIFTH PERSON LEND IF ASKED
FEELINGS ABOUT FIRST PERSON - INTERVIEWER RATING
FEELINGS ABOUT SECOND PERSON - INTERVIEWER RATING
FEELINGS ABOUT THIRD PERSON - INTERVIEWER RATING
FEELINGS ABOUT FOURTH PERSON - INTERVIEWER RATING
FEELINGS ABOUT FIFTH PERSON - INTERVIEWER RATING
HOW DO YOU FEEL ABOUT FIRST PERSON
HOW DO YOU FEEL ABOUT SECOND PERSON
HOW DO YOU FEEL ABOUT THIRD PERSON
HOW DO YOU FEEL ABOUT FOURTH PERSON
HOW DO YOU FEEL ABOUT FIFTH PERSON
BL-SNI PERSON 1 - FIRST NAME
BL-SNI PERSON 2 - FIRST NAME
BL-SNI PERSON 3 - FIRST NAME
BL-SNI PERSON 4 - FIRST NAME
BL-SNI PERSON 5 - FIRST NAME
BL-SNI PERSON 6 - FIRST NAME
BL-SNI PERSON 7 - FIRST NAME
BL-SNI PERSON 8 - FIRST NAME
BL-SNI PERSON 9 - FIRST NAME
BL-SNI PERSON 10 - FIRST NAME
BL-SNI PERSON 11 - FIRST NAME
BL-SNI PERSON 12 - FIRST NAME
BL-SNI PERSON 13 - FIRST NAME
BL-SNI PERSON 14 - FIRST NAME
BL-SNI PERSON 15 - FIRST NAME
BL-SNI PERSON 16 - FIRST NAME
BL-SNI PERSON 17 - FIRST NAME
BL-SNI PERSON 18 - FIRST NAME
BL-SNI PERSON 19 - FIRST NAME
BL-SNI PERSON 20 - FIRST NAME
BL-SNI PERSON 21 - FIRST NAME
BL-SNI PERSON 22 - FIRST NAME
BL-SNI PERSON 23 - FIRST NAME
BL-SNI PERSON 24 - FIRST NAME
BL-SNI PERSON 25 - FIRST NAME
BL-SNI PERSON 26 - FIRST NAME
BL-SNI PERSON 27 - FIRST NAME
BL-SNI PERSON 28 - FIRST NAME
BL-SNI PERSON 29 - FIRST NAME
BL-SNI PERSON 30 - FIRST NAME
BL-SNI PERSON 31 - FIRST NAME
BL-SNI PERSON 32 - FIRST NAME
BL-SNI PERSON 33 - FIRST NAME
BL-SNI PERSON 34 - FIRST NAME
BL-SNI PERSON 35 - FIRST NAME
BL-SNI PERSON 36 - FIRST NAME
BL-SNI PERSON 37 - FIRST NAME
BL-SNI PERSON 38 - FIRST NAME
BL-SNI PERSON 39 - FIRST NAME
BL-SNI PERSON 40 - FIRST NAME
BL-SNI PERSON 1 - REL CODE
BL-SNI PERSON 2 - REL CODE
BL-SNI PERSON 3 - REL CODE
BL-SNI PERSON 4 - REL CODE
BL-SNI PERSON 5 - REL CODE
BL-SNI PERSON 6 - REL CODE
BL-SNI PERSON 7 - REL CODE
BL-SNI PERSON 8 - REL CODE
BL-SNI PERSON 9 - REL CODE
BL-SNI PERSON 10 - REL CODE
BL-SNI PERSON 11 - REL CODE
BL-SNI PERSON 12 - REL CODE
BL-SNI PERSON 13 - REL CODE
BL-SNI PERSON 14 - REL CODE
BL-SNI PERSON 15 - REL CODE
BL-SNI PERSON 16 - REL CODE
BL-SNI PERSON 17 - REL CODE
BL-SNI PERSON 18 - REL CODE
BL-SNI PERSON 19 - REL CODE
BL-SNI PERSON 20 - REL CODE
BL-SNI PERSON 21 - REL CODE
BL-SNI PERSON 22 - REL CODE
BL-SNI PERSON 23 - REL CODE
BL-SNI PERSON 24 - REL CODE
BL-SNI PERSON 25 - REL CODE
BL-SNI PERSON 26 - REL CODE
BL-SNI PERSON 27 - REL CODE
BL-SNI PERSON 28 - REL CODE
BL-SNI PERSON 29 - REL CODE
BL-SNI PERSON 30 - REL CODE
BL-SNI PERSON 31 - REL CODE
BL-SNI PERSON 32 - REL CODE
BL-SNI PERSON 33 - REL CODE
BL-SNI PERSON 34 - REL CODE
BL-SNI PERSON 35 - REL CODE
BL-SNI PERSON 36 - REL CODE
BL-SNI PERSON 37 - REL CODE
BL-SNI PERSON 38 - REL CODE
BL-SNI PERSON 39 - REL CODE
BL-SNI PERSON 40 - REL CODE
BL-SNI PERSON 1 - EVER IN MH CENTER FOR SIMILAR PROBS
BL-SNI PERSON 2 - EVER IN MH CENTER FOR SIMILAR PROBS
BL-SNI PERSON 3 - EVER IN MH CENTER FOR SIMILAR PROBS
BL-SNI PERSON 4 - EVER IN MH CENTER FOR SIMILAR PROBS
BL-SNI PERSON 5 - EVER IN MH CENTER FOR SIMILAR PROBS
BL-SNI PERSON 6 - EVER IN MH CENTER FOR SIMILAR PROBS
BL-SNI PERSON 7 - EVER IN MH CENTER FOR SIMILAR PROBS
BL-SNI PERSON 8 - EVER IN MH CENTER FOR SIMILAR PROBS
BL-SNI PERSON 9 - EVER IN MH CENTER FOR SIMILAR PROBS
BL-SNI PERSON 10 - EVER IN MH CENTER FOR SIMILAR PROBS
BL-SNI PERSON 11 - EVER IN MH CENTER FOR SIMILAR PROBS
BL-SNI PERSON 12 - EVER IN MH CENTER FOR SIMILAR PROBS
BL-SNI PERSON 13 - EVER IN MH CENTER FOR SIMILAR PROBS
BL-SNI PERSON 14 - EVER IN MH CENTER FOR SIMILAR PROBS
BL-SNI PERSON 15 - EVER IN MH CENTER FOR SIMILAR PROBS
BL-SNI PERSON 16 - EVER IN MH CENTER FOR SIMILAR PROBS
BL-SNI PERSON 17 - EVER IN MH CENTER FOR SIMILAR PROBS
BL-SNI PERSON 18 - EVER IN MH CENTER FOR SIMILAR PROBS
BL-SNI PERSON 19 - EVER IN MH CENTER FOR SIMILAR PROBS
BL-SNI PERSON 20 - EVER IN MH CENTER FOR SIMILAR PROBS
BL-SNI PERSON 21 - EVER IN MH CENTER FOR SIMILAR PROBS
BL-SNI PERSON 22 - EVER IN MH CENTER FOR SIMILAR PROBS
BL-SNI PERSON 23 - EVER IN MH CENTER FOR SIMILAR PROBS
BL-SNI PERSON 24 - EVER IN MH CENTER FOR SIMILAR PROBS
BL-SNI PERSON 25 - EVER IN MH CENTER FOR SIMILAR PROBS
BL-SNI PERSON 26 - EVER IN MH CENTER FOR SIMILAR PROBS
BL-SNI PERSON 27 - EVER IN MH CENTER FOR SIMILAR PROBS
BL-SNI PERSON 28 - EVER IN MH CENTER FOR SIMILAR PROBS
BL-SNI PERSON 29 - EVER IN MH CENTER FOR SIMILAR PROBS
BL-SNI PERSON 30 - EVER IN MH CENTER FOR SIMILAR PROBS
BL-SNI PERSON 31 - EVER IN MH CENTER FOR SIMILAR PROBS
BL-SNI PERSON 32 - EVER IN MH CENTER FOR SIMILAR PROBS
BL-SNI PERSON 33 - EVER IN MH CENTER FOR SIMILAR PROBS
BL-SNI PERSON 34 - EVER IN MH CENTER FOR SIMILAR PROBS
BL-SNI PERSON 35 - EVER IN MH CENTER FOR SIMILAR PROBS
BL-SNI PERSON 36 - EVER IN MH CENTER FOR SIMILAR PROBS
BL-SNI PERSON 37 - EVER IN MH CENTER FOR SIMILAR PROBS
BL-SNI PERSON 38 - EVER IN MH CENTER FOR SIMILAR PROBS
BL-SNI PERSON 39 - EVER IN MH CENTER FOR SIMILAR PROBS
BL-SNI PERSON 40 - EVER IN MH CENTER FOR SIMILAR PROBS
I PLAN TASKS CAREFULLY (BIS)
I DO THINGS W/O THINKING (BIS)
I AM HAPPY-GO-LUCKY (BIS)
I HAVE RACING THOUGHTS (BIS)
I PLAN TRIPS WELL AHEAD OF TIME (BIS)
I AM SELF-CONTROLLED (BIS)
I CONCENTRATE EASILY (BIS)
I SAVE REGULARLY (BIS)
HARD TO SIT STILL FOR A LONG TIME (BIS)
I AM A CAREFUL THINKER (BIS)
I PLAN FOR JOB SECURITY (BIS)
I SAY THINGS W/O THINKING (BIS)
I LIKE TO THINK ABOUT COMPLEX PROBS (BIS)
I CHANGE JOBS (BIS)
I ACT ON IMPULSE (BIS)
EASILY BORED WHEN SOLVING THOUGHT PROBS (BIS)
I HAVE REGULAR MEDICAL/DENTAL CHECK-UPS (BIS)
I ACT ON SPUR OF MOMENT (BIS)
I AM A STEADY THINKER (BIS)
I CHANGE WHERE I LIVE (BIS)
I BUY THINGS ON IMPULSE (BIS)
I FINISH WHAT I START (BIS)
I WALK/MOVE FAST (BIS)
I SOLVE PROBS BY TRIAL AND ERROR (BIS)
I SPEND/CHARGE MORE THAN I EARN (BIS)
I TALK FAST (BIS)
I HAVE OUTSIDE THOUGHTS WHEN THINKING (BIS)
MORE INTERESTED IN PRESENT THAN FUTURE (BIS)
I AM RESTLESS AT LECTURES/TALKS (BIS)
I PLAN FOR THE FUTURE (BIS)
I NOTICE ANNOYANCES RIGHT AWAY (NAS-A)
ONCE MADE ANGRY I KEEP THINKING ABOUT IT (NAS-A)
EVERY WEEK MEET SOMEONE I DISLIKE (NAS-A)
I KNOW PEOPLE TALKING ABOUT ME BEHIND BACK (NAS-A)
SOME WOULD SAY I AM A HOTHEAD (NAS-A)
WHEN GET ANGRY STAY ANGRY FOR HOURS (NAS-A)
MUSCLES FEEL TIGHT/WOUND-UP (NAS-A)
WALK AROUND IN BAD MOOD (NAS-A)
TEMPER IS QUICK & HOT (NAS-A)
WHEN SOMEONE YELLS I YELL BACK (NAS-A)
HAVE HAD TO BE ROUGH W/PEOPLE WHO BOTHERED ME (NAS-A)
FEEL LIKE SMASHING THINGS (NAS-A)
WHEN SOMEONE OFFENDS I STOP LISTENING (NAS-A)
CANT SLEEP WHEN WRONGED (NAS-A)
IF DONT LIKE SOMEONE DOESNT BOTHER ME TO HURT FEELINGS (NAS-A)
PEOPLE CAN BE TRUSTED TO DO WHAT THEY SAY (NAS-A)
WHEN GET ANGRY GET REALLY ANGRY (NAS-A)
WHEN THINK ABOUT ANGER OBJECT GET EVEN ANGRIER (NAS-A)
FEEL AGITATED/UNABLE TO RELAX (NAS-A)
GET ANNOYED WHEN SOMEONE INTERRUPTS (NAS-A)
IF BOTHERED I REACT FIRST THINK LATER (NAS-A)
IF DONT LIKE SOMEONE I TELL THEM OFF (NAS-A)
WHEN GET MAD CAN EASILY HIT SOMEONE (NAS-A)
WHEN ANGRY I THROW/SLAM THINGS (NAS-A)
IF PERSON DOES NASTY THING IT STICKS IN MIND (NAS-A)
WHEN MADE ANGRY I THINK ABOUT GETTING EVEN (NAS-A)
IF CHEATED I MAKE PERSON SORRY (NAS-A)
PEOPLE ACT HONEST BUT REALLY HAVE THINGS TO HIDE (NAS-A)
WHEN GET ANGRY FEEL LIKE SMASHING THINGS (NAS-A)
SOME GET ANGRY & OVER IT - IT TAKES ME LONG TIME (NAS-A)
HAVE TROUBLE SLEEPING/FALLING ASLEEP (NAS-A)
A LOT OF LITTLE THINGS BOTHER ME (NAS-A)
HAVE FIERY TEMPER THAT RISES INSTANTANEOUSLY (NAS-A)
SOME PEOPLE NEED TO BE TOLD GET LOST (NAS-A)
IF SOMEONE HITS FIRST I HIT BACK (NAS-A)
WHEN ANGRY I TAKE IT OUT ON WHOMEVER AROUND (NAS-A)
ONCE ANGRY I HAVE TROUBLE CONCENTRATING (NAS-A)
FEEL LIKE GETTING RAW DEAL FROM LIFE (NAS-A)
WHEN DONT LIKE SOMEONE NO POINT TO BEING NICE (NAS-A)
WHEN PERSON DOES NICE THING WONDER ABOUT HIDDEN REASON (NAS-A)
MAKES BLOOD BOIL TO BE MADE FUN OF (NAS-A)
WHEN GET MAD GIVE PERSON SILENT TREATMENT (NAS-A)
HEAD ACHES WHEN OTHERS ANNOY ME (NAS-A)
BOTHERS ME WHEN OTHERS DO THINGS WRONG WAY (NAS-A)
WHEN ANGRY FLY OFF HANDLE BEFORE KNOW IT (NAS-A)
WHEN ARGUE W/SOMEONE DONT STOP UNTIL THEY DO (NAS-A)
SOME PEOPLE NEED TO GET KNOCKED AROUND (NAS-A)
IF SOMEONE MAKES ANGRY I TELL OTHERS (NAS-A)
BEING CRITICIZED IN FRONT OF OTHERS (NAS-B)
SEEING SOMEONE BULLY A SMALLER/WEAKER PERSON (NAS-B)
TRYING TO CONCENTRATE & SOMEONE KEEPS MAKING NOISE (NAS-B)
PEOPLE WHO ACT LIKE THEY KNOW IT ALL (NAS-B)
BEING SLOWED BY ANOTHERS MISTAKES (NAS-B)
IN LINE & SOMEONE CUTS IN FRONT OF YOU (NAS-B)
NOT BEING RECOGNIZED FOR GOOD WORK (NAS-B)
WATCHING TV & SOMEONE SWITCHES CHANNEL (NAS-B)
PEOPLE WHO DONT REALLY LISTEN WHEN TALKED TO (NAS-B)
GETTING COLD SOUP/VEGETABLES FOR DINNER (NAS-B)
SOMEONE LOOKING OVER SHOULDER WHILE WORKING (NAS-B)
BEING OVERCHARGED FOR REPAIR (NAS-B)
NEED TO HURRY & GET STUCK IN TRAFFIC (NAS-B)
PEOPLE WHO THINK THEY ARE BETTER THAN YOU (NAS-B)
CARRYING COFFEE & SOMEONE BUMPS INTO YOU (NAS-B)
SOMEONE MAKING FUN OF YOUR CLOTHES (NAS-B)
BEING SINGLED OUT WHEN OTHERS DOING SAME THING (NAS-B)
MAKING PLANS & OTHERS BACK OUT LAST MINUTE (NAS-B)
PEOPLE WHO THINK THEY ARE ALWAYS RIGHT (NAS-B)
SOMEONE GIVING HARD TIME JUST AFTER WAKING UP (NAS-B)
SOMEONE LOOKS THROUGH THINGS W/O PERMISSION (NAS-B)
BEING ACCUSED OF SOMETHING YOU DIDNT DO (NAS-B)
YOU LEND & PERSON FAILS TO RETURN (NAS-B)
SOMEONE WHO ALWAYS CONTRADICTS YOU (NAS-B)
HUNGRY/MEALTIME & SOMEONE PLAYS JOKE (NAS-B)
SUBJ HONEST (1-5 SCALE) - PRIOR HOSP/ADMIT SECT
SUBJ HONEST (1-5 SCALE) - RESIDENCE SECT
SUBJ HONEST (1-5 SCALE) - PERCEIVED STRESS SECT
SUBJ HONEST (1-5 SCALE) - WORK SECT
SUBJ HONEST (1-5 SCALE) - FAMILY HISTORY SECT
SUBJ HONEST (1-5 SCALE) - SUICIDE SECT
SUBJ HONEST (1-5 SCALE) - FANTASIES SECT
SUBJ HONEST (1-5 SCALE) - THREATS/VIOLENCE SECT
SUBJ HONEST (1-5 SCALE) - ADL / LEVEL OF FUNCTIONING SECT
SUBJ HONEST (1-5 SCALE) - SOCIAL SUPPORT SECT
DID SUBJ MISREPORT VIOLENCE - INTERVIEWER RATING
BIS - MOTOR SCALE - BASELINE
BIS - NON-PLANNING SCALE - BASELINE
BIS - COGNITIVE SCALE - BASELINE
BIS - TOTAL SCORE - BASELINE
NAS-A - COGNITIVE SCALE - BASELINE
NAS-A - AROUSAL SCALE - BASELINE
NAS-A - BEHAVIOR SCALE - BASELINE
Socioeconomic Status
Prior Arrest for Crimes Against Property
Prior Arrest for Crimes Against Person
Number of People in SN
Proportion of Social Network that are Mental Health Prof.
Proportion of Social Network that are Family
BPRS Activation
BPRS Total Score
BPRS Thought Disturbance
BPRS Hostile-Suspiciousness
BPRS Anergia
BPRS Anxiety-Depression
Presence of Delusions
Schedule of Imagined Violence
Mac Dx Categories
Baseline (prior 2Mo) Violence
Number of Violent Acts Only
Total Number of Violence and OAA
Prior Arrests - Seriousness
Prior Arrests - Frequency
MMDAS - Conviction
MMDAS - Preoccupation
MMDAS - Pervasiveness
MMDAS - Action
MMDAS - Inaction
MMDAS - Negative Affect
IQ - Verbal
Age
Sex - Male