Vanderbilt Scale Form PDF Details

Are you looking for an efficient and effective way to measure the severity of your patient's peripheral neuropathic pain? Vanderbilt Scale Form is one solution that can help healthcare professionals, such as nurses, therapists and physicians, assess Neuropathic Pain Discomfort Index (NPDI) of their patients quickly and accurately. This scale form was designed to be a reliable tool for diagnosing pain levels in individuals experiencing peripheral neuropathy. In this blog post, we'll explore the components of this scale form, discuss its features and benefits, delve into who should use it and why it is gaining increased recognition among health practitioners globally. Read on for more!

Question	Answer
Form Name	Vanderbilt Scale Form
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	vanderbilt assessment scale, vanderbilt forms, vanderbilt form, vanderbilt adhd forms

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NICHQ Vanderbilt Assessment Scale—TEACHER Informant

TeacherÕs Name: _______________________________ Class Time: ___________________ Class Name/Period: ________________

TodayÕs Date: ___________ ChildÕs Name: _______________________________ Grade Level: _______________________________

Directions: Each rating should be considered in the context of what is appropriate for the age of the child you are rating and should reflect that child’s behavior since the beginning of the school year. Please indicate the number of weeks or months you have been able to evaluate the behaviors: ___________.

Is this evaluation based on a time when the child		☐ was on medication ☐ was not on medication ☐ not sure?

Symptoms			Never	Occasionally	Often	Very Often
1.	Fails to give attention to details or makes careless mistakes in schoolwork		0	1	2	3

2.	Has difficulty sustaining attention to tasks or activities		0	1	2	3

3.	Does not seem to listen when spoken to directly		0	1	2	3

4.	Does not follow through on instructions and fails to finish schoolwork		0	1	2	3
	(not due to oppositional behavior or failure to understand)

5.	Has difficulty organizing tasks and activities		0	1	2	3

6.	Avoids, dislikes, or is reluctant to engage in tasks that require sustained		0	1	2	3
	mental effort

7.	Loses things necessary for tasks or activities (school assignments,		0	1	2	3
	pencils, or books)

8.	Is easily distracted by extraneous stimuli		0	1	2	3

9.	Is forgetful in daily activities		0	1	2	3

10.	Fidgets with hands or feet or squirms in seat		0	1	2	3

11.	Leaves seat in classroom or in other situations in which remaining		0	1	2	3
	seated is expected

12.	Runs about or climbs excessively in situations in which remaining		0	1	2	3
	seated is expected

13.	Has difficulty playing or engaging in leisure activities quietly		0	1	2	3

14.	Is Òon the goÓ or often acts as if Òdriven by a motorÓ		0	1	2	3

15.	Talks excessively		0	1	2	3

16.	Blurts out answers before questions have been completed		0	1	2	3

17.	Has difficulty waiting in line		0	1	2	3

18.	Interrupts or intrudes on others (eg, butts into conversations/games)		0	1	2	3

19.	Loses temper		0	1	2	3

20.	Actively defies or refuses to comply with adultÕs requests or rules		0	1	2	3

21.	Is angry or resentful		0	1	2	3

22.	Is spiteful and vindictive		0	1	2	3

23.	Bullies, threatens, or intimidates others		0	1	2	3

24.	Initiates physical fights		0	1	2	3

25.	Lies to obtain goods for favors or to avoid obligations (eg,ÒconsÓ others)		0	1	2	3

26.	Is physically cruel to people		0	1	2	3

27.	Has stolen items of nontrivial value		0	1	2	3

28.	Deliberately destroys othersÕproperty		0	1	2	3

29.	Is fearful, anxious, or worried		0	1	2	3

30.	Is self-conscious or easily embarrassed		0	1	2	3

31.	Is afraid to try new things for fear of making mistakes		0	1	2	3

The recommendations in this publication do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circum- stances, may be appropriate.

Adapted from the Vanderbilt Rating Scales developed by Mark L. Wolraich, MD.

Revised - 1102

NICHQ Vanderbilt Assessment Scale—TEACHER Informant

TeacherÕs Name: _______________________________ Class Time: ___________________ Class Name/Period: ________________

TodayÕs Date: ___________ ChildÕs Name: _______________________________ Grade Level: _______________________________

Symptoms (continued)Never Occasionally Often Very Often

32.	Feels worthless or inferior		0	1	2	3

33.	Blames self for problems; feels guilty		0	1	2	3

34.	Feels lonely, unwanted, or unloved; complains that Òno one loves him or herÓ 0			1	2	3

35.	Is sad, unhappy, or depressed		0	1	2	3

					Somewhat
Performance				Above	of a
ACA DEMIC PERFORMANCE		Excellent	Average	Average	Problem	Problematic

36.	Reading	1	2	3	4	5

37.	Mathematics	1	2	3	4	5

38.	Written expression	1	2	3	4	5

					Somewhat
			Above		of a
CLASSROOM BEHAVIORAL PERFORMANCE		Excellent	Average	Average	Problem	Problematic

39.	Relationship with peers	1	2	3	4	5

40.	Following directions	1	2	3	4	5

41.	Disrupting class	1	2	3	4	5

42.	Assignment completion	1	2	3	4	5

43.	Organizational skills	1	2	3	4	5

Comments:

Please return this form to: __________________________________________________________________________________

Mailing address: __________________________________________________________________________________________

________________________________________________________________________________________________________

Fax number:______________________________________________________________________________________________

For Office Use Only

Total number of questions scored 2 or 3 in questions 1Ð9: ____________________________

Total number of questions scored 2 or 3 in questions 10Ð18:__________________________

Total Symptom Score for questions 1Ð18: ____________________________________________

Total number of questions scored 2 or 3 in questions 19Ð28:__________________________

Total number of questions scored 2 or 3 in questions 29Ð35:__________________________

Total number of questions scored 4 or 5 in questions 36Ð43:__________________________

Average Performance Score: ______________________________________________

How to Edit Vanderbilt Scale Form Online for Free

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1. The vanderbilt forms pdf will require specific details to be inserted. Ensure that the following fields are completed:

vanderbilt assessment scale conclusion process clarified (portion 1)

2. After filling out the last section, head on to the subsequent step and fill in all required particulars in these fields - Is forgetful in daily activities, Fidgets with hands or feet or, Leaves seat in classroom or in, seated is expected, Runs about or climbs excessively, seated is expected, Has difficulty playing or, Is on the go or often acts as if, Talks excessively, Blurts out answers before, Has difficulty waiting in line, Interrupts or intrudes on others, Loses temper, Actively defies or refuses to, and Is angry or resentful.

Part number 2 for filling in vanderbilt assessment scale

Always be really attentive when filling out seated is expected and Fidgets with hands or feet or, because this is the part where a lot of people make some mistakes.

3. Your next stage is generally easy - fill in all of the fields in NICHQ Vanderbilt Assessment, Teachers Name Class Time Class, Todays Date Childs Name Grade, Symptoms continued, Feels worthless or inferior, Blames self for problems feels, Feels lonely unwanted or unloved, Is sad unhappy or depressed, Performance Academic Performance, Reading, Mathematics, Written expression, Classroom Behavioral Performance, Relationship with peers, and Following directions to complete this process.

vanderbilt assessment scale conclusion process described (part 3)

4. All set to fill in this fourth portion! In this case you've got all of these Assignment completion, Organizational skills, Comments, Please return this form to, Mailing address, Fax number, For Office Use Only, Total number of questions scored, Total number of questions scored, Total Symptom Score for questions, Total number of questions scored, and Total number of questions scored blank fields to complete.

Part # 4 of filling out vanderbilt assessment scale

5. This pdf must be completed with this particular area. Below you will notice a comprehensive listing of form fields that require accurate details for your document submission to be complete: Total number of questions scored, Total number of questions scored, and Average Performance Score.

vanderbilt assessment scale conclusion process outlined (part 5)

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Vanderbilt Scale Form – Fill Out and Use This PDF

Vanderbilt Scale Form PDF Details

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Vanderbilt Scale Form – Fill Out and Use This PDF

Vanderbilt Scale Form PDF Details

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