Get Screening For Distress Form - Alberta Health Services

The Screening For Distress Form is an important tool used by Alberta Health Services to assess and address the emotional, physical, spiritual, and practical concerns of users. This guide will provide you with clear, step-by-step instructions on how to fill out the form effectively, ensuring a comprehensive understanding of your current state.

Follow the steps to accurately complete the form.

1. Click the ‘Get Form’ button to access the form and open it in your preferred digital editor.
2. Affix your patient label in the designated box at the top of the form to identify your information.
3. Indicate who completed the form by selecting one of the options: Patient, Family, Health Professional, or Assisted by family/health professional.
4. Enter the date in the format yyyy-Mon-dd to document when the form was filled out.
5. On the scale provided, circle the number that best describes how you feel right now for each specified area: pain, tiredness, drowsiness, nausea, lack of appetite, shortness of breath, depression, anxiety, and overall well-being.
6. Check all items that are currently concerns for you in the provided categories: Emotional, Spiritual, Practical, Physical, Social/Family, and Informational. Ensure you select all applicable options.
7. In the space provided for Other Concerns, write down any additional issues not listed that you are currently facing.
8. Have the relevant health care professional review the form, entering their name and signature, and date it in the format yyyy-Mon-dd.
9. Once you have filled out the form completely, you can save any changes, download the document, print it, or share it as needed.

Get started by completing your Screening For Distress Form online today!