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    PCL-5

    Created by

    Michael Lee

    Specialty

    Psychiatrist

    Last edited

    10/20/2026

    Uses

    0 times

    Tags

    Psychiatrist

    About this template

    This template structures the assessment of PTSD-related symptoms using the PCL-5 response scale. It covers trauma-related memories, avoidance, mood and cognition changes, arousal, reactivity, and sleep, while recording only explicitly provided or selected information.

    Preview template

    Your Worst Event

    High-speed MVA on 14/11/2023 resulting in brief LOC, rib fractures, and prolonged vehicle extrication.

    In the past month, how much were you bothered by

    1. Repeated, disturbing, and unwanted memories of the stressful experience? [x] 3 - Quite a bit

    2. Repeated, disturbing dreams of the stressful experience? [x] 2 - Moderately

    3. Suddenly feeling or acting as if the stressful experience were actually happening again (as if you were back there reliving it)? [x] 1 - A little bit

    4. Feeling very upset when something reminded you of the stressful experience? [x] 3 - Quite a bit

    5. Having strong physical reactions when something reminded you of the stressful experience (e.g., heart pounding, trouble breathing, sweating)? [x] 3 - Quite a bit

    6. Avoiding memories, thoughts, or feelings related to the stressful experience? [x] 3 - Quite a bit

    7. Avoiding external reminders of the stressful experience (e.g., people, places, conversations, activities, objects, or situations)? [x] 4 - Extremely

    8. Trouble remembering important parts of the stressful experience? [x] 1 - A little bit

    9. Having strong negative beliefs about yourself, other people, or the world (e.g., "I am bad," "No one can be trusted," "The world is completely dangerous")? [x] 2 - Moderately

    10. Blaming yourself or someone else for the stressful experience or its aftermath? [x] 3 - Quite a bit

    11. Having strong negative feelings such as fear, horror, anger, guilt, or shame? [x] 3 - Quite a bit

    12. Loss of interest in activities that you used to enjoy? [x] 2 - Moderately

    13. Feeling distant or cut off from other people? [x] 2 - Moderately

    14. Trouble experiencing positive feelings (e.g., unable to feel happiness or have loving feelings)? [x] 1 - A little bit

    15. Irritable behavior, angry outbursts, or acting aggressively? [x] 2 - Moderately

    16. Taking too many risks or doing things that could cause you harm? [x] 0 - Not at all

    17. Being “superalert” or watchful or on guard? [x] 4 - Extremely

    18. Feeling jumpy or easily startled? [x] 3 - Quite a bit

    19. Having difficulty concentrating? [x] 2 - Moderately

    20. Trouble falling or staying asleep? [x] 3 - Quite a bit

    How to use this template

    This template can be used to assist with various tasks in the medical field. You can use it to generate notes, manage patient information, or assist with diagnosis and the Assessment and Plan. To use this template, simply click the “Use Template” button above. If you have any questions or need assistance, feel free to reach out to the support team or refer to the description and example output provided above.

    Tags

    Psychiatrist