Mood and Feelings Questionnaire: Child Self-Report Short Version

The Mood and Feelings Questionnaire (MFQ) is a screening tool that measures depressive symptoms in children and young adults. The Short Mood and Feelings Questionnaire (SMFQ) is a 13-item subscale from a longer 33-item MFQ questionnaire.

Mental Health - School Aged Screeners

Mood and Feelings Questionnaire: Parent Self-Report on Child Long Version

The Mood and Feelings Questionnaire (MFQ) Parent Self-Report is a 34 item screening tool that measures depressive symptoms in children and young adults.

Mental Health - School Aged Screeners

Mood and Feelings Questionnaire: Parent Self-Report Short Version

The Short Mood and Feelings Questionnaire (SMFQ) is a 13 item subscale from a longer 33-item questionnaire. The questions asked on the survey are based on the DSM criteria for depression. Ages 9-18.

Mental Health - School Aged Screeners

Mood Disorder Questionnaire (MDQ)

The MDQ screens for Bipolar Spectrum Disorder, (which includes Bipolar I, Bipolar II and Bipolar NOS).

Mental Health - Depression/Mood Disorders/Suicide

Multidimensional Behavioral Health Screen 2.0

A broad-band screening tool for behavioral health issues (e.g., depressive symptomatology, anxiety-related symptoms) designed specifically for use in primary medical care settings, including integrated care settings.

Mental Health - Depression/Mood Disorders/Suicide

Multidimensional Scale of Perceived Social Support (MSPSS)

Screener for assessment of an adult's social support from family, friends, and significant other.

Mental Health - Family/Environment

National Center for Medical Home Implementation

Medical Home Survey

General Medical - Medical Home Specific

NaviCare

Brief announcement about NaviCare Behavioral Health Navigator service that allows respondent to request contact by NaviCare to assist in obtaining mental health care for any family member or to request information.

Mental Health

Nine Item Avoidant/Restrictive Food Intake disorder screen (NIAS) - Child (NIAS Child)

Mental Health - Eating Disorders

Obesity Consult General Intake Form

Obesity Consult General Intake Form

General Medical - Healthy Habits/Fitness

Obsessive Compulsive Inventory- Child Version (OCI-CV)

21-item subjectively completed instrument for the quantitative assessment of OCS in children and adolescents aged from 7 to 17

Mental Health – Obsessive Compulsive

Obsessive Compulsive Inventory-Revised

The OCI-R is a short version of the OCD and is a self-report scale for assessing symptoms of Obsessive-Compulsive Disorder (OCD).

Mental Health - Obsessive Compulsive

Ogden Patient Demographics

General Medical - Data Collection

Okinawa/Developmental History

General Medical - Data Collection

Older Adult Self-Report (OASR)* Ages 60+

Developed with data from 12K+ adults 60-102 years. Has 127 items rated on a 3pt scale and descriptive items. Results grouped into the following DSM problem scales:  Depressive, Anxiety, Somatic, Dementia, Psychotic, Antisocial Personality

Mental Health - General Adult

One Year Injury History

General Medical - Data Collection

Opioid Risk Tool – 2 (ORT 2)

A brief tool to assess risk of opioid addiction.

Mental Health - General Adult

Oral Risk Assessment Tool - Parent/Clinician

This tool is intended for documenting caries risk of the child, however, two risk factors are based on the mother or primary caregiver's oral health. All other factors and findings should be documented based on the child.

General Medical - Healthy Habits/Fitness

Parent Check-In with Moods and Feelings Questionnaire: Short Version

A check-in on parent responses pertaining to teen's last annual medical visit and parent assessment of whether teen ever got help with issues of mood or feelings.

Mental Health - Depression/Mood Disorders/Suicide

Parent Observation Checklist (POC)

Parent Observation Checklist items (18- and 24-month only)

Development - Autism Screening

Parental Stress Scale

An 18-item self rated scale of parental stress. It includes positive aspects of parenting such as enjoyment spending time with children, as well as negative ones such as financial burden, and being embarrassed by the child's behavior.

Mental Health - General Adult

Parent’s Adolescent Health Screen

Parent's Adolescent health questionnaire for ages 13 and up that reviews TB risk, family history of cholesterol, and guns in the home

General Medical - Data Collection

Parent's Concerns

A two item questionnaire inquiring whether or not the parents have any concerns regarding their child's learning, development or behavior. It is part of the Survey of well-being of young children.

General Medical - Social Determinants of Health

Parents' Evaluation of Developmental Status (PEDS)*

The PEDS is a brief questionnaire assessing parents' appraisals of their children's development.

Development - Screening

Parents' Evaluation of Developmental Status Q12 (PEDS Q12) *

A surveillance and screening tool, for children 0 to 8 years, that elicits and addresses, with evidence-based support, parents’ concerns about development, behavior and mental health.

Development - Screening

Parents’ Evaluation of Developmental Status-Revised®

A surveillance and screening tool, for children 0 to 8 years, that elicits and addresses, with evidence-based support, parents’ concerns about development, behavior and mental health.

Development - Screening

Parents’ Evaluation of Developmental Status-Revised® Clinician Form

This is a clinician administered portion of the Parents’ Evaluation of Developmental Status-Revised®. It allows the provider to add their own concerns, and to categorize concerns from questions 1 and 12, into one of the other 10 categories.

Development - Screening

Parent's Observations of Social Interaction (POSI)

A brief questionnaire that screens for autism. It is part of the Survey of well-being of young children.

Development - Autism Screening

Parent's View of Child's Health Care

Quality Monitoring/Satisfaction

Partner Violence Screen (PVS)

Three-item screen for domestic violence

General Medical - Social Determinants of Health

Patient Annual Update

Patient Annual Update form used for annual physicals/well visits

General Medical - Data Collection

Patient Demographics - General

Intake tool.

General Medical - Data Collection

Patient Health Questionnaire 2 (PHQ-2)

The Patient Health Questionnaire 2 (PHQ-2) is a two-item screen for depression. Its items are the first two items in the nine item PHQ-9.

Mental Health - Depression/Mood Disorders/Suicide

Patient Health Questionnaire 4 (PHQ-4)

Its purpose is to allow for very brief and accurate measurement of depression and anxiety.

Mental Health - Anxiety

Patient Health Questionnaire 4 (PHQ-4)

4 item inventory rated on a 4 point Likert-type scale. Its items are drawn from the first two items of the 'Generalized Anxiety Disorder-7 scale' (GAD-7) and the 'Patient Health Questionnaire-8' (PHQ-8). Its purpose is to allow for very brief and accurate measurement of depression and anxiety.

Mental Health - Depression/Mood Disorders/Suicide

Patient Health Questionnaire 9 (PHQ-9 for Adults)

A 9 item screening tool for depression.

Mental Health - Depression/Mood Disorders/Suicide

Patient Health Questionnaire for Adolescents (PHQ-A)

Adolescent self-report measure which covers depression, anxiety, eating disorders, and substance abuse.

Mental Health - Depression/Mood Disorders/Suicide

Patient Health Questionnaire-9 Modified (PHQ-9-M CTS) (Columbia TeenScreen Scoring)

Adolescent self-report measure for depression.

Mental Health - Depression/Mood Disorders/Suicide

Patient Health Questionnaire-9 Modified (Cut Score > or = 8)

Adolescent self-report measure for depression.

Mental Health - Depression/Mood Disorders/Suicide

Patient Health Questionnaire-9 Modified (PHQ-9-M)

Adolescent self-report measure for depression.

Mental Health - Depression/Mood Disorders/Suicide

Patient Health Questionnaire-9 Modified (PHQ-9) MacArthur Scoring

Adolescent self-report measure for depression.

Mental Health - Teen Administered

Patient Health Questionnaire-9 Modified-Less Suicide Questions (PHQ-9-M less suicide)

Adolescent self-report measure for depression.

Mental Health - Depression/Mood Disorders/Suicide

Patient Health Questionnaire-Modified

Adolescent self-report measure for depression.

Adolescent Self-Administered

Patient Health Questionnaire-9 with follow up questions (Cut Score > or = 8)

PHQ-9 with follow up

Adolescent Self-Administered

Patient Health Questionnaire-9 Modified (w/o MDD/Dysthymia)

A self-report depression screener for adolescents.

Adolescent Self-Administered

Patient Satisfaction Survey

A brief patient satisfaction survey.

Quality Monitoring/Satisfaction

PCL-5 Screener

The PCL-5 is a 20-item self-report measure that assesses the 20 DSM-5 symptoms of PTSD.

General Medical - Adult

PC-PTSD

A brief tool that screens for PTSD in adults.

Mental Health - Trauma

Pediatric ACEs and Related Life Events Screener - Child (Parent/Caregiver Report) - Deidentified

The PEARLS screens for a child’s exposure to Adverse Childhood Experiences (ACEs) and other potential risk factors for toxic stress (bullying, community violence, food or housing insecurity, etc.) that may increase a child’s risk for negative health outcomes.

General Medical - Social Determinants of Health

Pediatric ACEs and Related Life Events Screener - Child (Parent/Caregiver Report) - Identified

PEARLS screens for a child’s exposure to Adverse Childhood Experiences (ACEs) and other potential risk factors for toxic stress (bullying, community violence, food or housing insecurity, etc.) that may increase a child’s risk for negative health outcomes.

General Medical - Social Determinants of Health

Pediatric ACEs and Related Life Events Screener - Teen (Parent/Caregiver Report) - Deidentified

PEARLS screens for a child’s exposure to Adverse Childhood Experiences (ACEs) and other potential risk factors for toxic stress (bullying, community violence, food or housing insecurity, etc.) that may increase a child’s risk for negative health outcomes.

General Medical - Social Determinants of Health

Pediatric ACEs and Related Life Events Screener - Teen (Parent/Caregiver Report) - Identified (PEARLS)

PEARLS screens for a child’s exposure to Adverse Childhood Experiences (ACEs) and other potential risk factors for toxic stress (bullying, community violence, food or housing insecurity, etc.) that may increase a child’s risk for negative health outcomes.

General Medical - Social Determinants of Health

Pediatric ACEs and Related Life Events Screener - Teen (Self Report) - Deidentified

PEARLS screens for a child’s exposure to Adverse Childhood Experiences (ACEs) and other potential risk factors for toxic stress (bullying, community violence, food or housing insecurity, etc.) that may increase a child’s risk for negative health outcomes.

General Medical - Social Determinants of Health

Pediatric ACEs and Related Life Events Screener - Teen (Self Report) - Identified (PEARLS Teen)

PEARLS screens for a child’s exposure to Adverse Childhood Experiences (ACEs) and other potential risk factors for toxic stress (bullying, community violence, food or housing insecurity, etc.) that may increase a child’s risk for negative health outcomes.

General Medical - Social Determinants of Health

Pediatric Asthma Control & Communication Instrument (PACCI) 1.1, 2.0, 3.0

An instrument to assess the control of asthma in children and adolescents

General Medical - Asthma

Pediatric Symptom Checklist 17-item Parent Version

A 17-item psychosocial screen designed to facilitate the recognition of cognitive, emotional, and behavioral problems in children and adolescents

Mental Health - School Aged Screeners

Pediatric Symptom Checklist 17-item Youth Report

A 17 item self-reported psychosocial screen designed to facilitate the recognition of cognitive, emotional, and behavioral problems in adolescents

Mental Health - Teen Administered

Pediatric Symptom Checklist 35-item Parent Version

Screener assessing the range of emotional-behavioral problems in children and adolescents.

Mental Health - School Aged Screeners

Pediatric Symptom Checklist 35-item Youth Report

A 35-item youth-self-report screener assessing the range of emotional-behavioral problems in adolescents

Mental Health - Teen Administered

Pediatric Symptom Checklist 35-item Youth Report with Suicide Related Questions

A 37-item youth-self-report screener assessing the range of emotional-behavioral problems in adolescents

Mental Health - Teen Administered

Pediatric Traumatic Stress Screening Tool (6-10) ©2020 Intermountain Healthcare

Mental Health - Trauma

Pediatric Traumatic Stress Screening Tool (11+)

Adolescent Self-Administered, Mental Health - Trauma

Pediatric Traumatic Stress Screening Tool - Clinician Action Documentation

Clinician Tools, Mental Health - Trauma

Pediatric TB Risk Assessment Form - Illinois

TB Risk Assessment

General Medical - EPSDT

PEDS: DM Questionnaire*

A surveillance and screening tool for children 0 – 8 that enables a swift view of children’s skills in development and mental health, including expressive and receptive language, fine and gross motor skills, self-help, academics, and social-emotional skills

Development - Screening

Personality Inventory for DSM-5 Adult

This Personality Inventory for DSM-5 (PID-5)-Adult is a 100 item self-rated personality trait assessment scale for adults age 18 and older. It assesses 25 personality trait facets

Mental Health - Personality Disorder

Personality Inventory for DSM-5 Brief Form (PID-100) - Adult

This Personality Inventory for DSM-5 (PID-100)-Adult is a 100 item self-rated personality trait assessment scale.

Mental Health - Personality Disorder

Personality Inventory for DSM-5 Brief Form (PID-5-BF) - Adult (PID-25)

This Personality Inventory for DSM-5—Brief Form (PID-5-BF)—Adult is a 25-item self-rated personality trait assessment scale.

Mental Health - Personality Disorder

Physical and Neurological Examination for Subtle Signs (PANESS)

Clinician Tools

Pictorial Pediatric Symptom Checklist 17-item Parent Version

A psychosocial screen designed to facilitate the recognition of cognitive, emotional, and behavioral problems.

Mental Health - School Aged Screeners

Pictorial Pediatric Symptom Checklist 17-item Youth Report

A psychosocial screen designed to facilitate the recognition of cognitive, emotional, and behavioral problems.

Mental Health - Teen Administered

Pictorial Pediatric Symptom Checklist 35-item

Screener assessing the range of emotional-behavioral problems in children.

Mental Health - Depression/Mood Disorders/Suicide

Pictorial Pediatric Symptom Checklist 35-item Youth Report

Youth self report screener assessing the range of emotional-behavioral problems.

Mental Health - Depression/Mood Disorders/Suicide

Positive Childhood Experiences (PCE)

Questionnaire about positive events during the parent's own childhood.

General Medical - Social Determinants of Health

Potential Stressors

Checklist of potential stressors & risk factors (financial problems, marital problems, etc.), derived from DSM-PC's 'environmental situations' list

Mental Health - Family/Environment

PRAPARE: Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences (PRAPARE)

Collects the data needed to better understand and act on their patients’ social determinants of health.

General Medical - Social Determinants of Health

Pre Appointment COVID Screener

Pre appointment screening questionnaire for COVID-19 risk.

General Medical - Data Collection

Prevaccination Checklist for COVID-19 Vaccines

COVID-19 screener

General Medical - Vaccine Information/Consent

Pre Camp Form

Gathers information to assist in completing specific camp forms. Information includes diet, physical activity restrictions, medications, sunblock, significant life events, devices such as glasses, and physical and other therapy.

General Medical - Consent

Pregnancy and Perinatal History

Collects information about the pregnancy, delivery and perinatal well being of the mother and the newborn

General Medical - Past History

Pregnancy, Birth and Development History

Intake form to be used for a developmental behavioral pediatric consult.

Development - History

Preschool Pediatric Symptom Checklist (PPSC)

A short questionnaire that screens for behavioral problems. It is part of the Survey of well-being of young children.

Mental Health - Preschool Screeners

PRIME-MD PHQ-2

This tool is known variously as the Patient Health Questionnaire-2 or PHQ-2 or PRIME-MD or 2 Question Screener.

Mental Health - Depression/Mood Disorders/Suicide

Pro-PHDS 3-9 months

A questionnaire to assess quality of medical care of children

Quality Monitoring/Satisfaction

Pro-PHDS 10-18 Months

A questionnaire to assess quality of medical care of children

Quality Monitoring/Satisfaction

Pro-PHDS 19-48 Months

A questionnaire to assess quality of medical care of children

Quality Monitoring/Satisfaction

Problem Behavior Checklist

Parent report of frequency and severity of problem behaviors

Mental Health - School Aged Screeners

Problematic and Risky Internet Use Screening Scale 18 (PRIUSS-18)

An 18 item screen to assess problematic internet use in adolescents.

Mental Health - General Adult

Problematic and Risky Internet Use Screening Scale 3 and 18 (PRIUSS 3 and 18)

An 18 item screen to assess problematic internet use in adolescents. It consists of a 3 item prescreen, which may be followed by a 15 item screen.

Mental Health - General Adult

PROMIS®

Set of person-centered measures that evaluates and monitors physical, mental, and social health in adults and children. It can be used with the general population and with individuals living with chronic conditions.

General Medical - Adult

Protective Factors Survey (PFS)

20-item measure designed for use with caregivers receiving child maltreatment prevention services such as home visiting, parent education, and family support.

Mental Health - Family/Environment

PSI-4 Short Form

The PSI-4-SF is a 36 item tool divided into three domains: Parental Distress (PD), Parent-Child Dysfunctional Interaction (P-CDI), and Difficult Child (DC), which combine to form a Total Stress scale.

Mental Health - Parenting

Psycho-social Screener

A brief questionnaire regarding psychological and social issues that can affect the child and their family.

General Medical - Social Determinants of Health

PTSD Checklist for DSM-5 with Life Events Checklist for DSM-5

The PTSD Checklist for DSM-5 (PCL-5) is a 20-item self-report measure of the DSM-5 symptoms of PTSD, and their severity. Also included is the Life Events Checklist for DSM-5.

Mental Health - Trauma

Q-CHAT/POSI

It is an Autism specific screen that has been shown in 18 month olds to be significantly more sensitive, but just as specific and no different, in positive predictive value PPV than the M-CHAT even with follow-up interview. It does not require a follow-up interview.

Development - Autism Screening

Q-CHAT/POSI-O

The Q-CHAT/POSI-O is an autism parent report screening tool that was developed through studies aimed at improving on limitations of the M-CHAT at the 18 month visit by selecting items that ask “how much” with a five point range of options rather than the yes/no format of M-CHAT.

Development - Autism Screening

Quantitative Checklist for Autism in Toddlers (10 items, includes graphics)

The Q-CHAT consists of 10 questions focusing on behaviors that reflect autistic traits in very early childhood. This version of the tools includes illustrations of the behaviors described in each question.

Development - Autism Screening

Quantitative Checklist for Autism in Toddlers (10 items, includes graphics) - revised Ordinal scoring

Development - Autism Screening

Quantitative Checklist for Autism in Toddlers (25 items, includes graphics)

25 questions focusing on behaviors that reflect autistic traits in very early childhood. This version of the tools includes illustrations of the behaviors described in each question.

Development - Autism Screening

Questionnaire for Parents or Caregivers, © 2010 by Western Psychological Services (CARS2-QPC, to be used with the CARS2-ST or CARS2-HF)*

The CARS helps to identify children (2 years and older with Autism, specifically, distinguishing them from developmentally handicapped children who are not Autistic. In addition, it distinguishes between mid-to-moderate and severe Autism.

Development - Autism Diagnostic