PCL-5 RESULT

Date: [Date]
Patient: [Name or ID, age]
Reason: [Screen after a trauma, intake, session check, or end of treatment]

EVENT AND VERSION
Version: [Past month or past week; standard, with Criterion A, or with the LEC-5]
How completed: [On their own on paper or a device, or read aloud in person or by phone; language and interpreter]
Index event: [A few words naming the worst event the answers are about, and how long ago it happened]
Criterion A: [How exposure was established, or still to confirm]

SCORES
Items 1 to 20: [Each answer 0 to 4, in order]
Missing items: [None, or which ones and what was done]
Total: [0 to 80]
Cutoff used: [31, 32, 33, or your service's own; total below, within, or above it]
Clusters: [B items 1 to 5, C items 6 and 7, D items 8 to 14, E items 15 to 20, each as a subtotal]
Rated 2 or more: [Count per cluster; DSM-5 pattern of 1 B, 1 C, 2 D, and 2 E met or not met]
Item 16: [Answer, and what the risky behavior is if 2 or more]

OVER TIME
Earlier totals: [Dates or session numbers, totals, and the version each time]
Change: [Points since the first score; 10 or more is the usual mark of response]

INTERVIEW
Diagnostic interview: [CAPS-5 or clinical interview: done, booked, or not needed, and the result]
Duration and impact: [How long symptoms have lasted, and their effect on work, home, and relationships]
Other conditions: [Depression, alcohol or drug use, sleep, pain, head injury; other screens with scores]
Impression: [Negative screen, probable PTSD, confirmed PTSD, or another explanation]

PLAN
Treatment: [Trauma-focused therapy offered or under way, medication, or monitoring]
Referral: [Trauma service, psychology, psychiatry, or none]
Next PCL-5: [Date or session, and which version]

Clinician: [Name, credentials]