GAD-7 ANXIETY SCREEN

Seen on: [Date and type of visit]
Client or patient: [Name or record number, age]
How given: [Self-completed on paper or a device, or read aloud; language and interpreter]
Why given: [New concern, routine screen, intake, or check on treatment]

RESULT
Answers to items 1 to 7: [Each answer as 0, 1, 2, or 3, in order]
GAD-7 total: [Sum out of 21]
Severity: [Minimal 0-4, mild 5-9, moderate 10-14, or severe 15-21]
Effect on daily life: [Answer to the difficulty question, if asked]
Highest items: [Symptoms that scored 2 or 3, such as worry that will not stop]

COMPARED WITH BEFORE
Earlier GAD-7 totals: [Each date with its total]
Direction: [Points gained or lost since the first score; meaningful change or remission if reached]

ASSESSMENT
What the interview found: [How long the worry has lasted, panic attacks, avoidance, trauma, sleep, physical causes checked]
Other screens: [PHQ-9 total with its item 9, alcohol or substance screen]
Working impression: [Diagnosis or screen result in words]

NEXT STEPS
Plan: [Therapy, medication, both, or monitoring; referrals]
Rescreen: [When the GAD-7 will be given again]

Recorded by: [Clinician name and role]