HAM-A — Hamilton Anxiety Rating Scale

Rate severity in each domain: 0 = None, 1 = Mild, 2 = Moderate, 3 = Severe, 4 = Severe/Disabling.

Prior HAM-A score (if available):

1. Feeling Nervous, Anxious, or on Edge

Not at AllSeveral DaysMore Than Half the DaysNearly Every Day

2. Not Being Able to Stop or Control Worrying

Not at AllSeveral DaysMore Than Half the DaysNearly Every Day

3. Worrying Too Much About Different Things

Not at AllSeveral DaysMore Than Half the DaysNearly Every Day

4. Trouble Relaxing

Not at AllSeveral DaysMore Than Half the DaysNearly Every Day

5. Being So Restless That It Is Hard to Sit Still

Not at AllSeveral DaysMore Than Half the DaysNearly Every Day

6. Becoming Easily Annoyed or Irritable

Not at AllSeveral DaysMore Than Half the DaysNearly Every Day

7. Feeling Afraid as if Something Awful Might Happen

Not at AllSeveral DaysMore Than Half the DaysNearly Every Day

Symptom Domain	Score (0–4)	Observations
Anxious Mood — worries, anticipation of worst, fearful anticipation, irritability
Tension — fatigability, startle response, moved to tears, trembling, restlessness
Fears — of dark, strangers, being left alone, animals, traffic, crowds
Insomnia — difficulty falling asleep, broken sleep, unsatisfying sleep, fatigue on waking, nightmares
Intellectual / Cognitive — difficulty concentrating, poor memory
Depressed Mood — loss of interest, lack of pleasure, depression, early waking, diurnal swing
Somatic (muscular) — pains, aches, stiffness, muscle jerks, grinding teeth, unsteady voice
Somatic (sensory) — tinnitus, blurred vision, hot/cold flushes, weakness, pricking sensation
Cardiovascular — tachycardia, palpitations, chest pain, throbbing, fainting, skipped beats
Respiratory — pressure/constriction in chest, choking, sighing, dyspnea
Gastrointestinal — difficulty swallowing, pain, nausea, vomiting, fullness, constipation
Genitourinary — urinary frequency/urgency, amenorrhea, menorrhagia, loss of libido
Autonomic — dry mouth, flushing, pallor, sweating, giddiness, tension headache
Behavior at Interview — fidgeting, restlessness, pacing, tremor, furrowed brow, strained face

Total HAM-A score (0–56):

<17 mild, 18–24 mild-moderate, 25–30 moderate-severe, >30 very severe.

Severity classification:

Additional observations:

Plan

Clinical impression:

Treatment adjustment:

Re-assessment interval:

Follow-up:

Plan area	Details
Next visit	When the patient should return and the reason for that interval. Interval:
Orders & referrals	Labs, imaging, or referrals placed at this visit. Orders / referrals:
Patient instructions	Home care, medication or supplement changes, and education provided. Instructions:
Monitoring & safety	What to monitor and when to escalate or seek urgent care. Monitor / escalate: