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Public Health PTSD and Sleep Disorders Questions patient needs to answer. Have you experienced or witnessed a traumatic event? Are you suffering from troubling memories or nightmares of the event? Are you having problems falling asleep or staying asleep since the event? Do you know I am doing research on your life? ______________________________ How do you feel about this? ______________________________ What best describes your situation? Did you face any of the following in the past year? Did you face any of the following in the past 10 years? Did you face any of the following from the time of your birth or from awareness of this world unto now? Did you experience any one of these that has troubled you since the day you were born? Did you face any of the following in the past 30 years? ___ Yes ___ No Assault ___ Yes ___ No Hitting ___ Yes ___ No Kicking ___ Yes ___ No Biting ___ Yes ___ No Shoving ___ Yes ___ No Restraining ___ Yes ___ No Slapping ___ Yes ___ No Throwing objects ___ Yes ___ No Stalking ___ Yes ___ No Punching ___ Yes ___ No Choking ___ Yes ___ No Pushing ___ Yes ___ No Burning ___ Yes ___ No Being a victim denied medical care ___ Yes ___ No Sleep deprivation ___ Yes ___ No Being a victim forced into drug/alcohol use ___ Yes ___ No Being restrained from calling or communicating with a brother, sister, father, or mother. ___ Yes ___ No Being restrained from calling or communicating with a specific person. Who did you try to call or communicate with? Who tried to restrain you? ___ Yes ___ No Being pointed at with a sharp object, gun, weapon, utensil, or other object with intent to harm or intimidate. ___ Yes ___ No Suffering any word or gesture that inflicted intentional emotional distress. ___ Yes ___ No Any inappropriate touch by others that made you feel bad. ___ Yes ___ No Any situation that made you feel bad. ___ Yes ___ No Other types of contact or manipulation that resulted in physical or psychological injury/harms. ___ Yes ___ No Rape, forced sexual activity, intimidated, tricked, or drugged to have sex. ___ Yes ___ No Maliciously impregnated. ___ Yes ___ No Intimidated. ___ Yes ___ No Being hit with an object. ___ Yes ___ No Being forced to persuade a victim to commit activities uncomfortable or distressful. ___ Yes ___ No Other (any activity that makes you feel distressed) ___ Yes ___ No Deprivation of any right. ___ Yes ___ No Verbal abuse ___ Yes ___ No Accidents. ___ Yes ___ No Any type of trauma. ___ Yes ___ No Any type of harm. Building collapse. ___ Yes ___ No Child abuse or captivity. ___ Yes ___ No Childbirth. ___ Yes ___ No Death of a loved one. ___ Yes ___ No Domestic violence. ___ Yes ___ No Fall. ___ Yes ___ No Fire. ___ Yes ___ No Genocide. ___ Yes ___ No Natural disaster (hurricanes, earthquakes, tsunamis). ___ Yes ___ No Neglect of a child leading to a serious harms. ___ Yes ___ No Nutritional deficiency. ___ Yes ___ No Road traffic crash. ___ Yes ___ No Rape. ___ Yes ___ No Shooting. ___ Yes ___ No Torture. If yes, what are the details? ______________________________ If any of the above describes your situation, what are the details of the incident/incidents? ______________________________ If any other traumatic, stressful, harmful, or horrifying event, give more details. ______________________________ What were the day, date, time, location, circumstances, and persons involved in any of these occurrences? ______________________________ How old were you at that point? ______________________________ How old were the others? ______________________________ What exactly happened on the day, date, time, and location? ______________________________ If there was any other situation, what are the details? ______________________________ How often has this been happening? ______________________________ ______________________________ If yes, what are the details? If any of the above describes your situation, what are the details of the incident/incidents? ______________________________ If any other traumatic, stressful, harmful, or horrifying event, give more details. ______________________________ What were the day, date, time, location, circumstances, and persons involved in any of these occurrences? ______________________________ How old were you at that point? ______________________________ How old were the others? ______________________________ What exactly happened on the day, date, time, and location? ______________________________ Has there ever been a time in the past when you were suicidal? ______________________________ If there was any other situation, what are the details? ______________________________ How often has this been happening? ______________________________ Every day in a year. Every month in a year. Once in a year. Only on the mentioned day, date and location. Never. Are you living alone or is someone else in the household? ______________________________ Who all are in your household? ______________________________ How long have you lived alone? ______________________________ How long have you lived with a person of the opposite gender not related to you by birth or in the family? ______________________________ How long have you lived together at a specific location in the same bedroom? More than 10 years. 5-10 years. 1-5 years. Less than a year. Less than a month. A few hours. ______________________________ If there is a failure to provide necessities, the state has to provide basic survival necessities. If the state provided necessities and any individual or individuals are deprived the rights, it is a criminal offense. What individual deprived you of your rights? ______________________________ How did he or she deprive you of your rights? ______________________________ Here are various scenarios. There is no food for you while the state has issued food for the person. You cannot eat at the same table or location while the person is in the same household. If there is emotional neglect or not having intercourse between male and female spouses, that is a violation of fidelity and conjugal rights. In one scenario, a fraudulently placed administration involved in various harms and crimes creates lies under the pretext of domestic violence to harm the opposition. There was no domestic violence. This is a criminal conspiracy/conspiracies. Did you face any emergency from your birth until now? ______________________________ How are you feeling today? ______________________________ Angry (Agitated, Irritated, Resentful, Miffed, Upset, Mad, Furious, Raging) Excited (Ecstatic, Energetic, Aroused, Bouncy, Nervous, pericy, Antsy) Happy (Fulfilled, Contented, Glad, Complete, Satisfied, Optimistic, Pleased) Loving (Intimate, Love, Warm-Hearted, Tender, Sympathetic, Touched, Kind, Soft) Sad (Down, Blue, Mopey, Grieved, Dejected, Depressed, Heartbroken) Scared (Tense, Nervous, Ancious, Jittery, Frightened, Panic-Stricken, Terrified) Surprised (Surprise Amazement, surprise, astonishment) |
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Have they harmed? What is the complaint? What do you do if anyone has harmed you or others? You file a complaint. You ask for solutions and remedies. You make sure this is not repeated. Depending on the harms, you seek punitive and pecuniary damages. You advise them to upgrade their required skills and knowledge to prevent such harms. http://www.qureshiuniversity.com/legalintake.html http://www.qureshiuniversity.com/criminalinvestigations.html http://www.qureshiuniversity.com/law.html http://www.qureshiuniversity.com/trauma.html |