PRMA SKALA 5/2001

PERKHIDMATAN RAWATAN AKUT DI RUMAH PESAKIT MENTAL

PENILAIAN KEPERLUAN ASAS CAMBERWELL (CANSAS)
Nama Pesakit :
Tarikh
R/N :
Nama Pegawai Penilai:..

Needs rating:

0 = no problem

2 = unmet need

Assessment number
Circle who is interviewed
Date of assessment
Initials of assessor
1.

12
.
13
.
14
.
15
.
16
.
17
.
18
.
19
.
20
.
21
.
22
.
23
.

Accommodation
What kind of place do you live in?
Food
Do you get enough to eat?
Looking after the home
Are you able to look after your home
Self-care
Do you have problems keeping clean and tidy?
Daytime activities
How do you spend your dayy?
Physical health
How well do you feel physically?
Psychotic symptoms
Do you ever hear voices or have problems with your thoughts
Information on condition and treatment
Have you been given clear information about medication?
Psychological distress
Have you recently felt very sad or low?
Safety to self
Do you ever have thought of harming yourself
Safety to others
Do you think you could be a danger to other peoples safety
Alcohol
Does drinking cause you any problems?
Drugs
Do you take any drugs that arent prescribed?
Company
Are you happy with your social life?
Intimate relationships
Do you have a partner?
Sexual expression
How is you sex life?
Child Care
Do you have any children under 18?
Basic education
Any difficulty in reading, writing or understanding English?
Telephone
Do you know how to use a telephone?
Transport
How do you find using the bus, tube or train?
Money
How do you find budgeting you money?
Benefits
Are you getting all the money you entitled to?
Spiritual
Do you have any specific belief and practices?

A
B
C

Met need count the number of 1s in the column

Unmet need count the number of 2s in the column
Total number of needs add together A + B

2.
3.
4.
5.
6.
7.
8.
9.
10
.
11.

1 = met need

9 = not known
1
U/S/C

2
U/S/C

3
U/S/C

4
U/S/C