Family Medicine Template

Anxiety Assessment GAD-7

A professional Family Medicine template for healthcare professionals.

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Subjective:
Chief Complaint:
Follow-up for diabetes and hypertension management

Patient Information:
- Patient Name: Jordan
- Date of Birth (DOB): 

GAD-7 Anxiety Assessment Tool:
1. Feeling nervous, anxious, or on edge: 0
2. Not being able to stop or control worrying: 0
3. Worrying too much about different things: 0
4. Trouble relaxing: 0
5. Being so restless that it is hard to sit still: 0
6. Becoming easily annoyed or irritable: 0
7. Feeling afraid, as if something awful might happen: 0

Objective:
Total GAD-7 Score:
0

Assessment:
Anxiety Severity:
- 0–4: Minimal anxiety

Anxiety Severity Level: Minimal anxiety

Impact on Daily Functioning:
Not difficult at all

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How to use this template

This comprehensive new patient template helps establish care by capturing complete medical history, current concerns, and baseline health status. Use this for patients during their initial visit to create a thorough medical record.

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