Can the PHQ be signed electronically?

Yes. Electronic signatures are legally valid under the federal ESIGN Act (15 U.S.C. §7001) and in most states under UETA. Ensure consent to electronic records where consumer-facing rules apply and retain a reproducible record.

What authentication is required for e-signatures?

Authentication level depends on risk. For routine clinical PHQs, patient portal login or SMS code is common; higher-assurance workflows may use SSO or multi-factor methods for stronger identity proofing.

Are PHQ records subject to HIPAA?

Yes. PHQ responses are protected health information and must be stored and transmitted in compliance with HIPAA; follow 45 CFR §164.530(j) for safeguards and retention guidance.

How do I correct an error on a completed PHQ?

Do not alter the original signed entry. Instead, add a dated addendum or corrected form that references the original; document reason for correction and retain both records for auditability.

Who can sign for a minor or an incapacitated patient?

A parent or legal guardian typically signs for minors; guardianship or power-of-attorney rules apply for incapacitated adults. Record the relationship and authority in the chart.

What if a patient refuses electronic records?

Offer a paper alternative and document the patient's choice. ESIGN requires that consumer-facing transactions present a clear disclosure and a way to withdraw consent to electronic records (15 U.S.C. §7001(c)).

Electronic Signature
Templates
Miscellaneous
Patient Health Questionnaire (PHQ)

Patient Health Questionnaire (PHQ)

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

Patient Health Questionnaire (PHQ‑9)

Purpose: The PHQ‑9 is a brief tool used to screen for depressive symptoms and to assist clinical decision making. Answer each item based on your experience over the last 2 weeks. For each item, indicate the response that best applies.

Patient Information

Patient Name

Date of Birth: Gender: Today’s Date:

Primary Clinician / Referring Provider Location of Assessment

Instructions

Over the last two weeks, how often have you been bothered by any of the following problems? Please select one response per item.

PHQ‑9 Items

1. Little interest or pleasure in doing things
0 Not at all 1 Several days 2 More than half the days 3 Nearly every day

2. Feeling down, depressed, or hopeless
0 Not at all 1 Several days 2 More than half the days 3 Nearly every day

3. Trouble falling or staying asleep, or sleeping too much
0 Not at all 1 Several days 2 More than half the days 3 Nearly every day

4. Feeling tired or having little energy
0 Not at all 1 Several days 2 More than half the days 3 Nearly every day

5. Poor appetite or overeating
0 Not at all 1 Several days 2 More than half the days 3 Nearly every day

6. Feeling bad about yourself — or that you are a failure or have let yourself or your family down
0 Not at all 1 Several days 2 More than half the days 3 Nearly every day

7. Trouble concentrating on things, such as reading the newspaper or watching television
0 Not at all 1 Several days 2 More than half the days 3 Nearly every day

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 a lot more than usual
0 Not at all 1 Several days 2 More than half the days 3 Nearly every day

9. Thoughts that you would be better off dead, or of hurting yourself in some way
0 Not at all 1 Several days 2 More than half the days 3 Nearly every day

Functional Impairment

If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people?
Not difficult at all Somewhat difficult Very difficult Extremely difficult

Total Score (for clinician use) Additional Clinical Notes

Confidentiality and Consent

Information provided on this form is part of the medical record and is protected by confidentiality rules. Exceptions include situations in which disclosure is required by law: imminent risk of harm to self or others, suspected abuse or neglect of a minor or vulnerable adult, or a valid court order. Clinicians will use this information to inform diagnosis, treatment planning, and any necessary safety interventions.

By checking the box below and signing, the patient provides consent for the clinician to use the information on this form in clinical care, to contact emergency services if there is a safety concern, and to share relevant details with other treating providers as necessary for continuity of care.

I consent to use of this information for clinical care and to limited disclosure as described above.

Safety Screening

If item 9 indicates any frequency greater than 0 (one or more), clinician will perform immediate risk assessment. Please indicate if you currently have thoughts of self-harm and whether you have a plan:

Current suicidal ideation: Yes No

If yes, describe plan or intent

Certification

I certify that the information I have provided on this form is complete and accurate to the best of my knowledge. I understand that the clinician will use this information to inform clinical decisions, and that in the event of identified safety risk the clinician may take appropriate actions to ensure safety.

Patient Printed Name:

Signature:

Date:

What the Patient Health Questionnaire (PHQ) is and why it matters

The Patient Health Questionnaire (PHQ) is a standardized self-report instrument for screening, diagnosing, monitoring, and measuring the severity of depression and other common mental health conditions. Clinicians commonly use the PHQ-2 for brief screening and the PHQ-9 for a structured nine-item depression assessment; versions exist for other conditions. Results inform clinical assessment, treatment planning, and billing documentation while contributing to the medical record.

Clinical and operational advantages of using the PHQ

The PHQ provides a validated, reproducible measure of symptom severity that supports consistent clinical decisions, improves identification of depression, and documents screening for quality reporting and billing purposes.

Who typically completes and reviews the PHQ

The PHQ is completed by patients (self-report) and reviewed by clinicians, medical assistants, behavioral health providers, or care coordinators as part of routine intake or follow-up care.

Primary care clinicians reviewing screening results and documenting treatment plans.
Behavioral health specialists using PHQ scores to track therapy progress.
Care coordinators or nurses triggering referrals or safety interventions.

Organizations may adopt role-based review and routing rules so that positive screens trigger clinical follow-up, referral, or safety planning according to internal protocols.

Core elements included in professional PHQ forms

A complete PHQ form pairs the questionnaire with identifying and administrative items so responses are auditable, attributable, and clinically useful.

Patient identifiers

Full legal name, date of birth, medical record number and contact info to match responses to the correct chart and support follow-up.

Questionnaire items

The standard PHQ item set (PHQ-2, PHQ-9, or variant) with response options per item and a calculated total score for severity stratification.

Administration details

Date/time of completion, setting (in-person/telehealth), person administering (self/staff), and mode (paper/tablet/portal).

Clinical interpretation

Scoring guidance or automated severity label and suggested next steps (safety assessment, referral, follow-up interval).

Consent and disclosures

HIPAA notice for protected health information, any state-required consent language, and disclosures for electronic records where applicable.

Signature and attestations

Signature block for patient or guardian and clinician attestation fields for review and care decisions.

Step-by-step: completing the PHQ in clinical workflow

Use a consistent sequence to collect, score, review, and store PHQ responses so they are clinically actionable and auditable.

01

Collect: Provide the PHQ at intake or pre-visit via tablet, portal, or paper.
02

Score: Sum item responses immediately or use the EHR/portal calculator.
03

Review: Clinician reviews results during the visit and documents interpretation.
04

Follow-up: Trigger safety assessment, referral, or treatment plan based on severity.

Typical PHQ submission and record flow

A predictable submission path reduces lost forms and supports timely clinical response and billing documentation.

Patient completes: Patient submits responses electronically or on paper at intake.
Data captured: Responses are entered into the EHR or scanned into the chart.
Clinician notified: Automated routing alerts clinician to positive or high-severity scores.
Documented: Final PHQ and interpretation are stored in the medical record.

Configuring an electronic PHQ workflow

Configure essential settings when digitizing the PHQ to ensure secure capture, correct routing, and accurate exports for reporting or billing.

Field	Configuration
Consent disclosure	Show HIPAA notice and obtain patient consent before electronic completion.
Authentication	Use patient portal login or SMS code for identity confirmation on remote submissions.
Conditional fields	Enable follow-up questions and safety prompts when scores exceed thresholds.
Data export	Map PHQ fields to the EHR and to CSV or HL7 exports for quality reporting.

Technical requirements for ePHQ capture and signing

ePHQ workflows need secure hosting, audit trails, and integrations to the EHR or clinical document repository.

Integrations: Supports EHRs (HL7/FHIR) and cloud storage connectors for seamless record transfer.
File formats: Accepts PDF, DOCX, and structured exports (CSV/JSON) for analytics and charting.
Authentication: Email/SMS and stronger methods (SSO, SAML) for higher-assurance workflows.

Required administrative and security fields for PHQ forms

Patient name: Match to medical record

Date of birth: Unique identifier

Completion timestamp: Audit trail entry

Mode of administration: In-person or remote

Consent attestation: HIPAA disclosure noted

Clinician reviewer: Signed/initialed review

Common mistakes to avoid when using the PHQ

Skipping the consent disclosure for electronic delivery can invalidate patient authorization and complicate record retention.
Failing to record the completion timestamp or mode can hinder auditability and make it difficult to link the PHQ to a specific visit.
Relying on manual scoring without verification increases risk of incorrect severity classification and inappropriate clinical response.
Not integrating PHQ results to the EHR leads to duplicated records, lost results, and missed follow-up actions.

Risks and legal consequences of mishandled PHQ records

HIPAA violations: Civil/criminal penalties; HIPAA requires retention and safeguards (45 CFR §164.530(j)).

Treatment errors: Incorrect or missing scores can delay care and worsen outcomes.

Billing audits: Incomplete documentation may trigger claim denials or recoupment.

Liability exposure: Failure to act on positive screens may create malpractice risk.

Consent disputes: Improper electronic consent may be challenged under ESIGN/UETA.

Data loss: Poor retention policies can prevent legal defense of care decisions.

When to administer the PHQ during care episodes

Timely administration ensures screening informs clinical decisions; integrate PHQ timing into intake and follow-up protocols.

At intake:

Administer during the first visit or new-patient registration to establish baseline.

Pre-visit:

Send electronically before appointments to save clinic time and document pre-visit status.

During follow-up:

Repeat at regular intervals (per clinic protocol) to monitor response to treatment.

When symptoms change:

Reassess promptly after new or worsening symptoms are reported.

Before medication changes:

Complete prior to initiating or changing psychotropic medications to document baseline.

Practical PHQ use cases from clinical workflows

These examples show how organizations embed the PHQ into routine workflows to improve screening and follow-up.

Primary Care Screening

A primary care clinic gives PHQ-2 at arrival to screen all adults

Positive PHQ-2 prompts PHQ-9 completion
Clinicians document score, safety plan if needed, and schedule follow-up within two weeks.

Student Health Center

A university health service deploys PHQ via its portal before counseling visits

Automated scoring flags high-risk students for urgent outreach
Counselors receive scores in the EHR and record interventions in the student health chart.

Practical tips for accurate, efficient PHQ administration

Follow these practices to improve data quality, protect privacy, and ensure PHQ results trigger appropriate clinical actions.

Standardize administration

Use the same PHQ version and instructions across sites; train staff to explain timeframes (past two weeks) and to avoid leading questions.

Automate scoring and alerts

Configure the EHR or form system to calculate totals, classify severity bands, and send real-time alerts for high scores to clinicians.

Protect sensitive data

Limit access to PHQ records to authorized personnel, encrypt transmissions, and record audit logs to show who viewed or modified responses.

Document follow-up

Record clinical interpretation, safety assessments, referrals, and follow-up dates to create a clear continuum of care and support billing and compliance.

Frequently asked questions about completing and e-signing the PHQ

Answers to common operational, legal, and technical questions about PHQ completion, storage, and electronic signatures.

Need help? Contact support

Can the PHQ be signed electronically?
Yes. Electronic signatures are legally valid under the federal ESIGN Act (15 U.S.C. §7001) and in most states under UETA. Ensure consent to electronic records where consumer-facing rules apply and retain a reproducible record.
What authentication is required for e-signatures?
Authentication level depends on risk. For routine clinical PHQs, patient portal login or SMS code is common; higher-assurance workflows may use SSO or multi-factor methods for stronger identity proofing.
Are PHQ records subject to HIPAA?
Yes. PHQ responses are protected health information and must be stored and transmitted in compliance with HIPAA; follow 45 CFR §164.530(j) for safeguards and retention guidance.
How do I correct an error on a completed PHQ?
Do not alter the original signed entry. Instead, add a dated addendum or corrected form that references the original; document reason for correction and retain both records for auditability.
Who can sign for a minor or an incapacitated patient?
A parent or legal guardian typically signs for minors; guardianship or power-of-attorney rules apply for incapacitated adults. Record the relationship and authority in the chart.
What if a patient refuses electronic records?
Offer a paper alternative and document the patient's choice. ESIGN requires that consumer-facing transactions present a clear disclosure and a way to withdraw consent to electronic records (15 U.S.C. §7001(c)).

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