St.

Paul University Philippines

Tuguegarao City, Cagayan 3500

School of Nursing and Allied Health

Sciences College of Nursing
2nd Semester, AY 2020-2021

HEADSS PSYCHOSOCIAL INTERVIEW QUESTIONNAIRE

Name of assessor/interviewer:
Name of the client:
Date of interview:

QUESTIONS:
HOME and 1.
ENVIRONMENT 2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
 QUESTIONS:
EDUCATION 1.
and 2.
EMPLOYMENT 3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.

QUESTIONS:
ACTIVITIES 1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
 QUESTIONS:
DRUGS and 1.
ALCOHOL 2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.

QUESTIONS:
SEXUALITY 1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
QUESTIONS:
SUICIDE/ 1.
DEPRESSION 2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.