Patient Health Questionnaire-9 Template

Patient Information:  
- Patient Name: John Doe  
- Date of Birth (DOB): 15 March 1985  
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PHQ-9 Clinical Scoring:  
1. Little interest or pleasure in doing things: 2 = More than half the days  
2. Feeling down, depressed, or hopeless: 3 = Nearly every day  
3. Trouble falling asleep, staying asleep, or sleeping too much: 1 = Several days  
4. Feeling tired or having little energy: 2 = More than half the days  
5. Poor appetite or overeating: 1 = Several days  
6. Feeling bad about yourself – or that you are a failure or have let yourself or your family down: 2 = More than half the days  
7. Trouble concentrating on things, such as reading the newspaper or watching television: 1 = Several days  
8. Moving or speaking so slowly that other people could have noticed. Or the opposite – being so fidgety or restless that you have been moving around a lot more than usual: 0 = Not at all  
9. Thoughts that you would be better off dead or of hurting yourself in some way: 1 = Several days  
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Total PHQ-9 Score: 13  
Depression Severity:  
- 1–4: Minimal depression  
- 5–9: Mild depression  
- 10–14: Moderate depression  
- 15–19: Moderately severe depression  
- 20–27: Severe depression  
Depression Severity Level: Moderate depression
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Functional Impact of Symptoms:  
How difficult have the above problems made it for the patient to do their work, take care of things at home, or get along with other people? Somewhat difficult