M3 Checklist

CPT: Call client services.
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Test Details

Use

The M3 Checklist is a 27-question validated assessment that queries for anxiety, bipolar disorder, depression and PTSD (Post Traumatic Stress Disorder) symptoms to help identify people at risk of a mental health condition.

Clinical Information

Special Instructions

An email address is required.

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
819972 M3 CHECKLIST 820180 Assessment Date/Time Not Available
819972 M3 CHECKLIST 819973 M3 Score Not Available
819972 M3 CHECKLIST 819975 M3 Gateway Not Available
819972 M3 CHECKLIST 819974 DIAGNOSIS RISK N/A
819972 M3 CHECKLIST 819976 Depression Dx Risk Not Available
819972 M3 CHECKLIST 819977 Bipolar Diagnosis Risk Not Available
819972 M3 CHECKLIST 819978 Anxiety Diagnosis Risk Not Available
819972 M3 CHECKLIST 819981 PTSD Diagnosis Risk Not Available
819972 M3 CHECKLIST 819982 GATEWAY QUESTIONS N/A
819972 M3 CHECKLIST 820039 Q5 Thoughts of suicide Not Available
819972 M3 CHECKLIST 819983 Q24 Impairs work school Not Available
819972 M3 CHECKLIST 819984 Q25 Impairs friends family Not Available
819972 M3 CHECKLIST 819985 Q26 Led to using alcohol Not Available
819972 M3 CHECKLIST 819986 Q27 Led to using drugs Not Available
819972 M3 CHECKLIST 819993 SYMPTOM (Sx) SEVERITY N/A
819972 M3 CHECKLIST 819994 M3 Depression Sx Subscore Not Available
819972 M3 CHECKLIST 819998 M3 Bipolar Sx Subscore Not Available
819972 M3 CHECKLIST 819999 M3 Anxiety Sx Subscore Not Available
819972 M3 CHECKLIST 820025 M3 PTSD Sx Subscore Not Available
819972 M3 CHECKLIST 820026 QUESTIONS N/A
819972 M3 CHECKLIST 820027 Q1 Feel sad, unhappy Not Available
819972 M3 CHECKLIST 820036 Q2 Can't concentrate/focus Not Available
819972 M3 CHECKLIST 820037 Q3 Nothing gives pleasure Not Available
819972 M3 CHECKLIST 820038 Q4 Tired, no energy Not Available
819972 M3 CHECKLIST 820040 Q6A Difficulty sleeping Not Available
819972 M3 CHECKLIST 820041 Q6B Sleeping too much Not Available
819972 M3 CHECKLIST 820042 Q7A Decreased appetite Not Available
819972 M3 CHECKLIST 820047 Q7B Increased appetite Not Available
819972 M3 CHECKLIST 820048 Q8 Tense anxious can't sit Not Available
819972 M3 CHECKLIST 820049 Q9 Worried or fearful Not Available
819972 M3 CHECKLIST 820056 Q10 Panic Attacks Not Available
819972 M3 CHECKLIST 820059 Q11 Dying losing control Not Available
819972 M3 CHECKLIST 820060 Q12 Nervous shaky social Not Available
819972 M3 CHECKLIST 820061 Q13 Nightmares, flashbacks Not Available
819972 M3 CHECKLIST 820062 Q14 Jumpy, startled easily Not Available
819972 M3 CHECKLIST 820063 Q15 Avoids places Not Available
819972 M3 CHECKLIST 820064 Q16 Dull numb or detached Not Available
819972 M3 CHECKLIST 820065 Q17 Can't get thoughts out Not Available
819972 M3 CHECKLIST 820066 Q18 Must repeat rituals Not Available
819972 M3 CHECKLIST 820067 Q19 Need to check/recheck Not Available
819972 M3 CHECKLIST 820068 Q20 More energy than usual Not Available
819972 M3 CHECKLIST 820069 Q21 Irritable angry Not Available
819972 M3 CHECKLIST 820070 Q22 Excited revved high Not Available
819972 M3 CHECKLIST 820071 Q23 Needed less sleep Not Available
819972 M3 CHECKLIST 820072 Comments: Not Available
819972 M3 CHECKLIST 820073 References: N/A
819972 M3 CHECKLIST 820074 Disclaimer: N/A
819972 M3 CHECKLIST 820157 PDF Image Not Available
819972 M3 CHECKLIST 820075 M3 CHECKLIST N/A

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CPT Statement/Profile Statement

The LOINC® codes are copyright © 1994-2017, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee. Permission is granted in perpetuity, without payment of license fees or royalties, to use, copy, or distribute the LOINC® codes for any commercial or non-commercial purpose, subject to the terms under the license agreement found at https://loinc.org/license/. Additional information regarding LOINC® codes can be found at LOINC.org, including the LOINC Manual, which can be downloaded at LOINC.org/downloads/files/LOINCManual.pdf