<Letterhead>

Date: <TodaysDate>

Name: <PtName>

HoNOS Completed by: <DrName>

Enter the severity rating for each item in the corresponding item box to the right item. Rate 9 if not known or not applicable.

HoNOS Score Sheet

HoNOS Score Sheet	
		Rate 9 if not known	RATE	
1	Overactive, aggressive, disruptive behaviour	0  1  2  3  4 		
2	Non-accidental self injury	0  1  2  3  4		
3	Problem-drinking or drug-taking	0  1  2  3  4		
4	Cognitive problems	0  1  2  3  4		
5	Physical illness or disability problems	0  1  2  3  4		
6	Problems with hallucinations and delusions	0  1  2  3  4		
7	Problems with depressed mood	0  1  2  3  4		
(Specify Disorder A,B,C,D,E,F,G<H<I, or J)	
8	Other mental & behavioural problems	0  1  2  3  4		
9	Problems with relationships	0  1  2  3  4		
10	Problems with activities of daily living	0  1  2  3  4		
11	Problems with living conditions	0  1  2  3  4		
12	Problems with occupation and activities	0  1  2  3  4		
	Total	0-48