Templates › Forms › SEO page

Run: Columbia Suicide Severity Rating Scale Documentation

Document a C-SSRS screening, capture ideation and behavior responses, assign a risk level, and record the follow-up actions taken after the assessment.

Fill this out, get a PDF emailed to you. No account required. Want to run it with your team and track results? Sign up free →

Encounter Details

Screening date (required)

Screening time

Screening setting (required)

Screening method (required)

Clinician or screener name (required)

C-SSRS Ideation Severity

In the past month, have you wished you were dead or wished you could go to sleep and not wake up? (required)

In the past month, have you actually had any thoughts of killing yourself? (required)

Have you been thinking about how you might do this? (required)

Have you had these thoughts and had some intention of acting on them? (required)

Have you started to work out or worked out the details of how to kill yourself and intend to carry out this plan? (required)

Highest ideation severity level (required)

Suicidal Behavior and History

Has the person ever engaged in suicidal behavior or preparatory acts? (required)

Any suicidal behavior or interrupted/aborted attempt in the past 3 months? (required)

Behavior type

Most recent behavior date

Behavior notes

Document only clinically relevant details needed for risk assessment and follow-up.

Risk Factors and Protective Factors

Current acute risk factors

Protective factors

Access to lethal means (required)

Clinical summary

Briefly summarize the factors supporting the risk formulation.

Risk Level and Required Actions

Overall risk level (required)

Immediate action taken (required)

Were emergency services contacted?

Disposition (required)

Follow-up timeframe

Consent, Documentation, and Submission

Consent to screening obtained (required)

Confirm that the purpose of the screening and any limits to confidentiality were explained before administration.

Yes No N/A

Limits of confidentiality explained (required)

Yes No N/A

Patient informed of next steps (required)

Yes No N/A

Additional documentation notes

Include only information necessary for clinical continuity, safety, and the audit trail.

Get your results

Enter your email — we'll send you a PDF of your filled-out template, plus the occasional MangoScoop newsletter (templates, workflow tips, product updates). Unsubscribe anytime — link is in every email.

Email (required)

Your name (optional)

Generated with MangoApps Templates — browse 250+ free