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Generalized Anxiety Disorder (GAD-2) (SLP301613-DT)

Generalized Anxiety Disorder (GAD-2) (SLP301613-DT) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Questionnaires



Patient Name

DOB:

MR #

Index to Questionnaire-Health\Encounter

SLP301613-DT (Rev. 12/12/16) GENERALIZED ANXIETY DISORDER (GAD-2)

Wisconsin Sleep
6001 Research Park Blvd., Madison, WI 53719
GENERALIZED ANXIETY DISORDER (GAD-2)








Over the last 2 weeks, how often have you been
bothered by the following problems?
(Use “” to indicate your answer)
Not
at all
Several days
More than
half the days
Nearly
every day

1. Feeling nervous, anxious, or on the edge

0 1 2 3
2. Not being able to stop or control worrying 0 1 2 3































Each question is scored on a scale of 0 through 3. Thus the minimum score is 0 and the maximum is 6.
There are two possible results:
Pass. A score in the range of 0 through 2.
Fail. A score in the range of 3 through 6.


Developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke and colleagues, with an educational grant from Pfizer Inc. No
permission required to reproduce, translate, display or distribute.

Signature of Patient/Representative ________________________________Date: ___________ Time: _________AM/PM

If signed by person other than the patient, print name and state relationship and authority to do so.

Print Name: _____________________________________Relationship: __________________________________

Patient is:  Minor  Incompetent / Incapacitated
Legal Authority:  Legal Guardian  Parent of Minor
 Health Care Agent  Other _____________________

Reviewed by: __________________________________________ Date: _________________ Time: __________AM/PM