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 : 6 17 36 17 22 3 5 1 20 17 16 0 17 24 35
T SCORE : 43 52 53 53 53 37 45 42 54 63 42 39 33 43 43
RESPONSE %: 100 97 94 100 97 98 98 100 96 96 100 100 97 98 100

CONTENT SCALES

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ANX FRS OBS DEP HEA BIZ ANG CYN ASP TPA LSE SOD FAM WRK TRT
RAW SCORE : 2 12 5 1 5 2 5 8 7 11 4 7 2 8 5
T SCORE : 40 65 48 39 49 52 47 48 52 60 49 49 39 50 51
RESPONSE %: 100 100 100 100 100 91 100 100 95 100 96 100 96 97 100

Name ______________________________________
dr. Aswia Maradjabessy SpS AGE ____
44 GENDER __
F
Address ______________________________________________________
Tidore Kepulauan
Occupation __________________________
Spesialis Neurologi Test Date ______________
30/09/2019
Education ______________________
S2 PPDS-1 Marital Status ______________
Kawin
Referred by _________________________Time
Komite Medis RSD TIKEP Start 09.00
_____________
Scorer's initials ___________________Time
IR Finish 11.00
_____________