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Get CA Pediatric Symptom Checklist (PSC-35) Scoring Sheet - San Francisco 2021-2024

Date of Birth: Assessment Date (mm/dd/yyyy): Item No. 4 7 8 9 14 PSC-35 Filled out by: Name of Care Provider/Clinician/ Case Manager: Attention subscale items Fidgety, unable to sit still Acts as if driven by a motor Daydreams too much Distracted easily Has trouble concentrating Never (0), Sometimes (1), or Often (2) Enter score Enter score Enter score Enter score Enter score 0 Attention subscale score: Item No. 11 13 19 22 27 Internalizing subscale items Feels sad, unhappy Feels hopeless.

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