Aggress|on contro|

uomaln hyschosoclal PealLh (lll)

Classself conLrol (C)
Scale never demonsLraLed Lo conslsLenLly demonsLraLed (m)

Aggress|on Contro| Never
demonstrated
1
kare|y
demonstrated
2
Somet|mes
demonstrated
3
Cften
demonstrated
4
Cons|stent|y
demonstrated
S
8efralns from
verbal ouLbursLs
1 2 3 4 3
8efralns from
vlolaLlng oLher's
personal space
1 2 3 4 3
8efralns from
sLrlklng oLhers
1 2 3 4 3
8efralns from
harmlng anlmals
1 2 3 4 3
8efralns from
desLroLlng properLy
1 2 3 4 3
CommunlcaLes
needs approprleLly
1 2 3 4 3
verballzes conLrol
of lmpulses
1 2 3 4 3
ldenLlfles when
angry
1 2 3 4 3
ldenLlfles when
frusLaLed
1 2 3 4 3
ldenLlfles slLuaLlons
LhaL preclplLaLe
hosLlllLy
1 2 3 4 3
ldenLlfles
responslblllLy Lo
malnLaln conLrol
1 2 3 4 3
ldenLlfles when
feellng aggresslve
1 2 3 4 3
ldenLlfles
alLernaLlves Lo
aggresslons
1 2 3 4 3
ldenLlfles
alLernaLlves Lo
veral ouLbursL
1 2 3 4 3
venLs negaLlve
felllng
approprlaLely
1 2 3 4 3
Dpholds conLracL
Lo resLraln
aggresslve
behavlors
1 2 3 4 3
MalnLaln self
conLrol wlLhouL
supervlslon
1 2 3 4 3
oLher 1 2 3 4 3

Anx|ety Contro|
uomaln hyschosoclal PealLh (lll)
Classself conLrol (C)
Scale never demonsLraLed Lo conslsLenLly demonsLraLed (m)

Anx|ety Contro| Never
demonstrated
1
kare|y
demonstrated
2
Somet|mes
demonstrated
3
Cften
demonstrated
4
Cons|stent|y
demonstrated
S
MonlLors lnLenslLy
of anxleLy
1 2 3 4 3
LllmlnaLes
precursors of
anxleLy
1 2 3 4 3
uecreases
envlronmenL
menLal sLlmull
when anxlous
1 2 3 4 3
Seeks lnformaLlon
Lo reduce anxleLy
1 2 3 4 3
lans coplng
sLraLegles for
sLressful
1 2 3 4 3
Dses relaxaLlons
Lechnlques Lo
reduce anxleLy
1 2 3 4 3
8eporLs decreased
duraLlons of
eplsodes
1 2 3 4 3
8eporLs lncreased
lengLh of Llme
beLween eplsodes
1 2 3 4 3
MalnLaln role
performance
1 2 3 4 3
MalnLalns soclal 1 2 3 4 3
relaLlonshlp
MalnLalns
concenLraLlons
1 2 3 4 3
8eporLs absence of
sensory percepLual
dlsLorLlons
1 2 3 4 3
8eporLs adequaLe
sleep
1 2 3 4 3
8eporL physlcals
manlsfesLaLlons of
anxleLy
1 2 3 4 3
8ehavloral
manlsfesLaLlon of
anxleLy absenL
1 2 3 4 3
ConLrol anxleLy
response
1 2 3 4 3
oLher 1 2 3 4 3

Cop|ng
uomaln physlcosoclal healLh (lll)
Classhyslcosoclal AdapLlon (n)
Scalenever uemonsLraLed Lo conslsLenLly demonsLraLed (m)

Cop|ng Never
demonstrated
1
kare|y
demonstrated
2
Somet|mes
demonstrated
3
Cften
demonstrated
4
Cons|stent|y
demonstrated
S
ldenLlfles effecLlve
coplng
1 2 3 4 3
ldenLlfles
lneffecLlve coplng
paLLerns
1 2 3 4 3
verballzes sense of
conLrol
1 2 3 4 3
8eporLs decrease
ln sLress
1 2 3 4 3
verballzes
accepLance of
slLuaLlon
1 2 3 4 3
Seeks lnformaLlon 1 2 3 4 3
concernlng lllness
and LreaLmenL
Modlfles llfesLyle
as needed
1 2 3 4 3
AdapLs Lo
developmenLal
changes
1

2
3 4 3
Dss avallable soclal
supporL
1 2 3 4 3
Lmploys behavlors
Lo reduce sLress
1 2 3 4 3
ldenLlfles mulLlple
coplng sLraLegles
1 2 3 4 3
Dses effecLlve
coplng sLraLegles
1 2 3 4 3
Avolds unduly
sLressful slLuaLlons
1 2 3 4 3
verballzes need for
asslsLance
1 2 3 4 3
Seeks professlonals
help as approprlaLe
1 2 3 4 3
8eporL decrease ln
negaLlve feellngs
1 2 3 4 3
8epoLs lncrease ln
psychologlcal
comforL
1 2 3 4 3
oLher 1 2 3 4 3








mpu|se Contro|
uomaln physlcosoclal healLh (lll)
Classhyslcosoclal AdapLlon (n)
Scalenever uemonsLraLed Lo conslsLenLly demonsLraLed (m)

mpu|se Contro|

Never
demonstrated
1
kare|y
demonstrated
2
Somet|mes
demonstrated
3
Cften
demonstrated
4
Cons|stent|y
demonstrated
S
ldenLlfles of
harmfull lmpulslve
behavlors
1 2 3 4 3
ldenLlfles feellngs
LhaL lead Lo
lmpulslve acLlons
1 2 3 4 3
ldenLlfles behavlors
LhaL lead Lo
lmpulslve acLlons
1 2 3 4 3
ldenLlfles
consequences of
lmpulslve acLlons
Lo self or oLhers
1 2 3 4 3
8ecognlze rlsks ln
envlronmenL
1 2 3 4 3
Avold hlgh rlsk ln
envlronmenL
1 2 3 4 3
verballzes conLrol
of lmpulslve
1 2 3 4 3
Seeks help when
exprelnclng
lmpulses
1 2 3 4 3
ldenLlfles soclal
supporL sysLems
1 2 3 4 3
AccepLs referrals
for LreaLmenL
1 2 3 4 3
Dpholds conLracL
Lo conLrol behavlor
1 2 3 4 3
MalnLalns self
conLrols wlLhouL
supervlslon
1 2 3 4 3
oLhers 1 2 3 4 3

Se|f Mut||at|on kestra|n
uomaln hyschosoclal PealLh (lll)
Classself conLrol (C)
Scale never demonsLraLed Lo conslsLenLly demonsLraLed (m)

Se|f Mut||at|on
kestra|n

Never
demonstrated
1
kare|y
demonstrated
2
Somet|mes
demonstrated
3
Cften
demonstrated
4
Cons|stent|y
demonstrated
S
8efralns from
gaLherlng means
for self ln[ury
1 2 3 4 3
Seeks help when
feellng urge Lo
ln[ure self
1 2 3 4 3
8equlres noL
LreaLmenL for self
ln[ures
1 2 3 4 3
Dpholds conLracL
Lo noL harm self
1 2 3 4 3
MalnLalns self
conLrol wlLhouL
supervlslon
1 2 3 4 3
uoes noL ln[ure self 1 2 3 4 3
oLher 1 2 3 4 3

Soc|a| nteract|ons Sk|||s
uomalnsychosoclal PealLh (lll)
ClassSoclal lnLeracLlon ()
Scalenone 1o LxLenslve (l)

Soc|a| nteract|on
Sk|||s
None
1
L|m|ted
2
Moderated
3
Substant|a|
4
Lxtens|ve
S
ulsclosure 1 2 3 4 3
8ecepLlveness 1 2 3 4 3
CooperaLlons 1 2 3 4 3
SenslLlvlLy 1 2 3 4 3
AsserLlveness 1 2 3 4 3
ConfronLaLlon 1 2 3 4 3
ConslderaLlon 1 2 3 4 3
enulneness 1 2 3 4 3
WarmLh 1 2 3 4 3
olse 1 2 3 4 3
8elaxaLlons 1 2 3 4 3
LngagemenL 1 2 3 4 3
1rusL 1 2 3 4 3
Compromlse 1 2 3 4 3
CLher 1 2 3 4 3

Acceptance nea|th Status
uomalnsychosoclal PealLh (lll)
ClassSoclal lnLeracLlon ()
Scalenone 1o LxLenslve (l)

Acceptance nea|th
Status

None
1
L|m|ted
2
Moderated
3
Substant|a|
4
Lxtens|ve
S
eacefulness 1 2 3 4 3
8ellnqulshmenL of
prevlous concepL
healLh
1 2 3 4 3
Calmness 1 2 3 4 3
uemonsLraLlon of
poslLlve selfregard
1 2 3 4 3
ueepenlng of
lnLlmacy
1 2 3 4 3
Lxpressed feellngs
abouL healLh sLaLus
1 2 3 4 3
8ecognlLlon of
reallLy of healLh
slLuaLlon
1 2 3 4 3
ursulL of
lnformaLlon
1 2 3 4 3
Coplng wlLh healLh
slLuaLlon
1 2 3 4 3
PealLhrelaLed
declslon maklng
1 2 3 4 3
ClarlflcaLlon of
values
1 2 3 4 3
8enewal of a sense
of eanlng
1 2 3 4 3
erformance of self 1 2 3 4 3
care Lasks
CLher 1 2 3 4 3

Gr|ef keso|ut|on
uomalnsycosoclal AdapLaLlon (lll)
Class sychosoclal AdapLaLlon (n)
ScalenoL aL all Lo 1o a very greaL exLenL (e)

Gr|ef keso|ut|on

Not At A||
1
1o a S||ght
Lxtent
1o a
Moderate
Lxtent
3
1o a Great
Lxtent

4
1o a Very
Great Lxtent

S
Lxpresses feellngs
abouL loss
1 2 3 4 3
Lxpresses splrlLuals
bellefs abouLh deaLh
1 2 3 4 3
verballzes reallLy
loss
1 2 3 4 3
verballzes
accepLance of loss
1 2 3 4 3
uescrlbe meanlng of
Lhe loss or deaLh
1 2 3 4 3
arLlclpaLes ln
plannlng funeral
1 2 3 4 3
MalnLalns currenL
wlll
1 2 3 4 3
MalnLalns advanced
dlrecLlves
1 2 3 4 3
ulscussed
unresolved confllcL
1 2 3 4 3
8eporLs absence of
somaLlc dlsLress
1 2 3 4 3
8eporLs decreased
preoccupaLlonal
wlLh loss
1 2 3 4 3
MalnLalns llvlng
envlronmenL
1 2 3 4 3
MalnLalns groomlng
and hyglene
1 2 3 4 3
8eporLs absence of
sleep dlsLurbance
1 2 3 4 3
8eporLs adequaLe
nuLrlLlonal lnLake
1 2 3 4 3
8eporLs normal
sexual deslre
1 2 3 4 3
Seeks soclal supporL 1 2 3 4 3
Shares loss wlLh
slgnlflcanL oLhers
1 2 3 4 3
8eporLs lnvolmenL
ln soclal acLlvlLles
1 2 3 4 3
rogresses Lrhough
sLages of grlef
1 2 3 4 3
Lxpresses poslLlve
expecLaLlons abouL
fuLure
1 2 3 4 3
CLher 1 2 3 4 3

Nutr|t|ona| Status 8|ochem|ca| Meassures
uomalnsychosoclal PealLh (lll)
ClassnuLrlLlon (k)
ScaleLxLreme devlaLlon from expecLed range Lo no devlaLlon from expecLed range (b)

Nutr|t|ona| Status
8|ochem|ca|
Meassures

Lxtreme
Dev|at|on
1
Substant|a|
dev|at|on
from
expected
range
2
Moderated
dev|at|on
from
expected
range
3
M||d
dev|at|on
from
expected
range
4
No dev|at|on
from
expected
range
S
Serum albumln 1 2 3 4 3
Serum prealbumln 1 2 3 4 3
PemaLocrlL 1 2 3 4 3
Pemoglobln 1 2 3 4 3
1oLal lron blndlng
capaclLy
1 2 3 4 3
LymphocyLe counL 1 2 3 4 3
8lood glucose 1 2 3 4 3
8lood cholesLerol 1 2 3 4 3
8lood Lrlglycerldes 1 2 3 4 3
Serum Lranferrln 1 2 3 4 3
4 hour urlnary
creaLlnlne
1 2 3 4 3
Drlnary urea
nlLrogen
1 2 3 4 3
oLher 1 2 3 4 3
9sychosoc|a| Ad[usment L|fe Change
uomalnsychosoclal PealLh (lll)
ClassSoclal AdapLaLlon ()
Scalenone 1o LxLenslve (l)

9sychosoc|a|
Ad[usment L|fe
Change

None
1
L|m|ted
2
Moderated
3
Substant|a|
4
Lxtens|ve
S
8eallsLlc goal 1 2 3 4 3
MalnLenance of self
esLeem
1 2 3 4 3
Lxpresses of
producLlvlLy
1 2 3 4 3
Lxpresses of
usefulness
1 2 3 4 3
Lxpresslons of
opLlmlsm abouL
presenL
1 2 3 4 3
Lxpresslons of
opLlmlsm abouL
fuLure
1 2 3 4 3
Lxpresslons of
feellng empowered
1 2 3 4 3
ldenLlflcaLlons of
mulLlple coplng
sLraLegles
1 2 3 4 3
LffecLlve flnanclal
managemenL
1 2 3 4 3
Lxpresslons of
sLaLlsflcaLlon wlLh
llvlng arrangemenLs
1 2 3 4 3
Lxpresslons of
feellng soclally
engaged
1 2 3 4 3
Lxpresslons of
adequaLe soclal
supporL
1 2 3 4 3
arLlclpaLlon ln
lelsure lnLeresLs
1 2 3 4 3
CLher 1 2 3 4 3