Trauma Informed Care Reporting

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This is the form being used by LMHPCO's VA Task Force for Reporting the Monthly Numbers of Veterans Screened through our Trauma Informed Care Initiative. We do ask that these numbers be input monthly for tracking purposes.

How Many Veterans Were Screened by your Agency during the past month for Trauma Issues? (PTSD, Moral Injury, or Suicidal Ideation) *

Of of the Veterans Screened, how many screened positive for Post Traumatic Stress? *

Of the Veterans Screened, how many screened positive for Moral Injury? *

Of the Veterans Screened, how many screened positive for suicidal ideation? *

Name of Practitioner or Agency Reporting *

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