SUPPLEMENTARY SCALES Page : 2/3

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A R Es Do Re Mt PK MDS Ho OH MAC-R AAS APS GM GF
RAW SCORE : 13 17 32 14 21 16 20 5 29 12 24 1 21 38 26
T SCORE : 54 54 38 41 52 57 70 60 63 48 57 41 44 50 46
RESPONSE %: 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100

CONTENT SCALES

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ANX FRS OBS DEP HEA BIZ ANG CYN ASP TPA LSE SOD FAM WRK TRT
RAW SCORE : 14 4 8 13 6 4 6 22 12 4 2 18 2 9 9
T SCORE : 70 51 59 66 53 57 50 80 58 41 45 73 41 54 61
RESPONSE %: 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100

Name ______________________________________
dr. Aliwan Juniar Suratmaja AGE ____
31 GENDER __
M
Address ______________________________________________________
Tidore Kepulauan
Occupation __________________________
Dokter Umum Test Date ______________
28/09/2019
Education ______________________
S1 Kedokteran Marital Status ______________
Kawin
Referred by _________________________Time
Komite Medis RSD TIKEP Start 09.00
_____________
Scorer's initials ___________________Time
IR Finish 11.00
_____________