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PEDIATRIC SYMPTOM CHECKLIST 17 (PSC17) Name: DOB: Date: Historian: Relationship to Patient: NEVER 1. Fidgety, unable to sit still 2. Feels sad, unhappy 3. Daydreams too much 4. Refuses to share 5.

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The Pediatric Symptom Checklist (PSC) is a brief screening questionnaire used by pediatricians and other health professionals to recognize psychosocial problems and improve treatment in children.

Understanding the PSC Report Ages 6-16: A score of 28 or higher means that he/she has more problems than most other children of that age. Most children in this group with a score of 28 or higher would benefit from further assessment of their psychosocial functioning.

Who completes the PSC-17? The checklist is completed by the biological, adoptive, or foster parent, or guardian on behalf of the child.

What is the PSC–17? The Pediatric Symptom Checklist (PSC) is brief screening questionnaire that is used to improve the recognition and treatment of psychosocial problems in children ages 4 to 17 years. It is used in place of the PHQ-9 for Health Home beneficiaries within this age group.

The PSC-17 consists of 17 items that are rated as “Never,” “Sometimes, ” or “Often” present. A value of 0 is assigned to “Never”, 1 to “Sometimes,” and 2 to “Often”. The total score is calculated by adding together the score for each of the 17 items. Items that are left blank are simply ignored (i.e., score equals 0).

A total PSC-17 score of 15 or higher suggests the presence of significant behavioural or emotional problems requiring comprehensive assessment. There are also cutoff scores for three subscales that suggest a more comprehensive assessment is advisable: Internalising Subscale (Clinical cutoff = 5 or higher).

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232