GHQ-15 - Somatic Symptom Severity
MedaFile - 21 point modification

       ID:         DATE:           TIME (24hr): 


During the past 4 weeks, how much have you been bothered by any of the following problems?


Fill in one answer per item NOT BOTHERED AT ALL BOTHERED A LITTLE BOTHERED A LOT
0 1 2 3 4 5 6 7 8 9 10
1.   Stomach Pain
2.   bringsBack Pain
3.   Pain in your arms, legs,or joints (knees, hips, etc.)
4.   Menstrual cramps or other problems with your periods (Women only)
5.   Headaches
6.   Chest pain
7.   Dizzinness
8.   Fainting Spells
9.   Feeling your heart pound or head race
10. Shortness of breath
11. Pain or problems breathing
12. Constipation, loose bowels, or diarrhea
13. Nausea, gas, or indigestion
14. Feeling tired or having low energy
15. Trouble sleeping

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