| Depression Assessment Report |
| Patient ID Number: 12345 |
| Assessment Date: 08/06/2000 |
| Date: 08/08/2000 |
| Fax to: Physician Name |
| Hospital Anxiety and Depression Scale (HADS) |
| 11 |
| 14 |
| 3 |
| 1 |
| 4 |
| 4 |
| 2 |
| Depression Subscale (0 - 21)............................................................................ |
| 9 |
| Anxiety Subscale (0 - 21)................................................................................. |
| Work And Social Adjustment Scale (WSAS) |
| Total (0 -40)...................................... |
| Item 1. Work (0 - 8)........................................................................................ |
| Item 2. Home Management (0 - 8)................................................................. |
| Item 3. Social Leisure Activities (0 - 8)......................................................... |
| Item 4. Private Leisure Activities (0 - 8)....................................................... |
| Item 5. Close Relationships (0 - 8)................................................................. |
| Key for Scales : |
| HADS Subscales*: |
| 0-3 Normal Range |
| 4-7 Subclinical |
| 8-10 Mild |
| 11-14 Moderate |
| 15-21 Severe |
| * Applies to both Anxiety and |
| Depression Subscales |
| 0-5 Not Significantly Impaired |
| 6-12 Slightly Impaired |
| 13-25 Definitely Impaired |
| 26-35 Markedly Impaired |
| 36-40 Very Severely Impaired |
| This report is not a substitute for clinical diagnosis, but is an adjunctive tool. |
| Healthcare Technology Systems, Inc. • 7617 Mineral Point Road, Suite 300 • Madison, WI 53717 |
| Phone : (608) 827-2440 • Fax (608) 827-2444 |
| www.healthtechsys.com |
| © 2000 Healthcare Technology Systems, Inc. |
| If you have any questions about this fax, please call 1-800-316-2414 |
| WSAS (total) : |