PHQ-9 Depression Screening and Scoring Form
PHQ-9 Depression Screening and Scoring Form for intake and follow-up visits. Capture symptom responses, calculate a total score, and document next steps with clear consent and follow-up fields.
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Overview
This PHQ-9 Depression Screening and Scoring Form template is built to collect the standard symptom responses, calculate a total score, and document the clinical interpretation in one place. It includes a screening context section for the date, screening type, patient identifier, staff member who completed it, and consent acknowledgement, followed by the PHQ-9 symptom items and a scoring section for severity and follow-up notes.
Use this template when you need a repeatable depression screening workflow at intake, during treatment follow-up, or before a visit where mood symptoms may affect care planning. It is especially useful when multiple staff members administer screenings and you need consistent scoring and an audit trail. The structure also supports progressive disclosure, so you can keep the form focused while still capturing the follow-up needed when the suicidal ideation item is positive.
Do not use this as a standalone diagnostic tool or as a broad mental health intake form. If your workflow needs trauma history, substance use, or detailed psychiatric history, those belong in separate sections or separate forms. Keep the form limited to the PHQ-9 items and only the additional fields you will actually use, so you avoid unnecessary PII and reduce completion burden.
Standards & compliance context
- Collect only the minimum necessary patient data and avoid adding extra identifiers unless they are needed for care, matching, or audit trail purposes.
- If the form is patient-facing, include clear consent or disclosure language for any PII collected and explain how the result will be used.
- Use accessible labels, logical field order, and keyboard-friendly controls to support WCAG 2.1 AA expectations for public-facing forms.
- If the screening is part of a regulated clinical workflow, preserve the scoring trail and follow-up documentation so the record supports clinical review and audit needs.
General regulatory context for orientation only — verify current requirements with counsel or the relevant agency before relying on this template for compliance.
What's inside this template
Screening Context
This section matters because it ties the result to the right patient, visit type, and consent trail before any symptom data is collected.
- Screening date
- Screening type
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Patient ID
Use the organization’s internal identifier. Do not collect SSN or other unnecessary PII.
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Completed by
Optional staff name or role for audit trail purposes.
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Consent and disclosure acknowledged
Confirm that the patient was informed this screening collects health information for care coordination, documentation, and clinical review.
PHQ-9 Symptom Questions
This section matters because the standardized symptom items are what make the score comparable across visits and across staff.
- 1. Little interest or pleasure in doing things
- 2. Feeling down, depressed, or hopeless
- 3. Trouble falling or staying asleep, or sleeping too much
- 4. Feeling tired or having little energy
- 5. Poor appetite or overeating
- 6. Feeling bad about yourself — or that you are a failure or have let yourself or your family down
- 7. Trouble concentrating on things, such as reading the newspaper or watching television
- 8. Moving or speaking so slowly that other people could have noticed. Or the opposite — being so fidgety or restless that you have been moving around a lot more than usual
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9. Thoughts that you would be better off dead, or of hurting yourself in some way
If this item is positive, follow your organization’s safety protocol immediately.
Scoring and Clinical Interpretation
This section matters because it turns the responses into an actionable severity level and captures any follow-up needed for safety or care planning.
- PHQ-9 total score
- Severity level
- Suicidal ideation follow-up completed
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Clinical notes
Document any relevant observations, treatment changes, or follow-up plan. Avoid unnecessary PII.
How to use this template
- 1. Set up the screening context fields so the form captures the screening date, screening type, patient ID, completed by, and consent acknowledgement before any symptom questions are shown.
- 2. Configure each PHQ-9 item as a single-choice field with the standard response scale so the scoring logic can total the answers without manual re-entry.
- 3. Assign the form to the patient or staff member responsible for administration and make sure the instructions explain what happens after submission.
- 4. Review the total score, severity level, and suicidal ideation follow-up fields together so the result is interpreted in context rather than by score alone.
- 5. Record clinical notes and any next-step action immediately after review so the screening result becomes part of the care record.
Best practices
- Keep the screening_date as a date picker and the symptom items as structured choice fields, not free text.
- Mark only the truly necessary fields as required so the form stays usable at intake and follow-up.
- Use conditional logic to reveal the suicidal ideation follow-up section only when the relevant item indicates concern.
- State clearly what happens after submission, including who reviews the result and how urgent responses are handled.
- Limit patient_id and other identifiers to the minimum necessary for matching the result to the chart.
- Use the same scoring rules every time so follow-up visits can be compared reliably.
- Document whether the screening was self-completed or administered by staff when that distinction matters for your workflow.
What this template typically catches
Issues teams running this template most often surface in practice:
Common use cases
Frequently asked questions
When should this PHQ-9 template be used?
Use it at intake when you need a standardized depression screen and again at follow-up visits to compare symptom changes over time. It works best when the same workflow is used consistently so score trends are easy to review. It is not a substitute for a full diagnostic evaluation when a patient needs one.
Who should complete the form?
The patient can complete the symptom questions directly, or a clinician or care coordinator can administer them and record the responses. The completed_by field helps distinguish self-report from staff-administered screening. If your workflow allows proxy completion, document that clearly in the clinical notes.
How often should PHQ-9 screening be repeated?
Many clinics use it at intake, during treatment follow-up, and whenever symptoms change or a care plan is reviewed. The right cadence depends on the care setting and the reason for screening. Keep the screening_type field specific so you can tell baseline, follow-up, and ad hoc screenings apart.
What should happen if the suicidal ideation item is positive?
The form should route the user to a documented follow-up workflow instead of ending at the score. Use the suicidal_ideation_followup field to record the immediate action taken, such as escalation, safety assessment, or referral. Do not rely on the total score alone when this item is positive.
Does this form replace a clinical diagnosis of depression?
No. The PHQ-9 is a screening and severity-tracking tool, not a standalone diagnosis. It helps standardize symptom capture and supports clinical interpretation, but diagnosis should come from a qualified clinician using the full clinical context.
What are the most common mistakes when using this template?
Common mistakes include leaving the screening date blank, mixing up intake and follow-up screenings, and recording a total score without checking the item responses. Another frequent issue is skipping the follow-up workflow when suicidal thoughts are indicated. The template works best when required fields are limited to the essentials and the scoring logic is reviewed before rollout.
Can this template be customized for different clinics or specialties?
Yes. You can add clinic-specific instructions, language preferences, interpreter fields, or a referral destination field without changing the core PHQ-9 structure. If you collect any additional PII, keep it limited to what you actually use and make the purpose clear.
How does this fit into an EHR or intake workflow?
It can be used as a standalone form or mapped into an EHR, patient portal, or care management workflow. The patient_id and screening_date fields make it easier to match the result to the chart and track changes over time. If you integrate it, preserve the scoring logic and the follow-up note trail.
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