HAMILTON ANXIETY RATING

Rating date: [Date]
Patient: [Name or record number, age]
Rater: [Name, role, and HAM-A training]
Interview: [Unstructured or SIGH-A guide; in person or video; minutes taken]
Period rated: [Past week, or the period your protocol sets]
Condition tracked: [Generalized anxiety disorder, panic disorder, health anxiety, mixed anxiety and depression, or other]

ITEM RATINGS
Items 1 to 14: [Each rating 0 to 4, in order]
Rated 3 or 4: [Symptom areas rated severe or very severe]

TOTALS
HAM-A total: [0 to 56]
Severity band: [Mild 0-17, mild to moderate 18-24, moderate to severe 25-30, or severe 31-56; name the set if different]
Psychic subscore: [Items 1 to 6 and 14, out of 28]
Somatic subscore: [Items 7 to 13, out of 28]

SINCE BASELINE
Baseline rating: [Date, total, subscores, and who rated it]
Change: [Points and percent; response at a 50% fall, remission at 7 or less]
Same rater and method: [Yes, or what changed]

CONTEXT
Physical causes checked: [Thyroid, heart, lungs, caffeine, alcohol, stimulants, side effects of current medicines]
Mood and safety: [Depression rating or screen, suicide risk]
Patient's account: [Self-report scores such as the GAD-7, and what the patient says has changed]

DECISION
Treatment: [Continue, raise dose, switch, add therapy, or step down]
Referral: [Psychology, psychiatry, medical workup, or none]
Next HAM-A: [Date or weeks from now, same rater if possible]

Rated by: [Clinician name, credentials]