QuickSCID-5 Assessment

QuickSCID-5

Structured Clinical Interview for DSM-5

Patient Information

Enter patient demographics to begin the assessment

Patient Name / ID

Date of Birth

Age

Health Card Number

Health Card Expiry

Biological Sex

Referring Clinician

Date of Assessment

Assessment Start Time

Assessor Name

A

Module Title

Section Title

Assessment Complete

Clinical Summary Report

📋 Safety Plan

Collaborative safety planning with patient

🚨 CRISIS CONTACTS - SUDBURY AREA

Crisis Line (24/7): 705-675-4760

Health Sciences North Emergency: 705-523-7100

Mobile Crisis Unit: 705-675-4760

Canada Suicide Prevention Service: 1-833-456-4566

Crisis Text Line: Text HOME to 686868

911 for immediate danger

1. Warning Signs

What thoughts, feelings, or situations might indicate a crisis is developing?

2. Internal Coping Strategies

Things I can do to distract myself without contacting another person:

3. Social Contacts for Distraction

People and places that provide distraction:

4. People I Can Ask for Help

Family or friends I can reach out to:

5. Professionals/Agencies to Contact

Mental health professionals or agencies:

6. Making the Environment Safe

Steps to remove or limit access to lethal means:

7. My Reasons for Living

What matters most to me and worth living for: