LOCUS SCORE SHEET Agency Name: Client Name/Number: Dimension Score
LOCUS SCORING SHEET Dimension 1: Risk of Harm Minimal Risk
Low Risk
1 a b c
Minimal Impairmnt
3 4 a a b b c c d d e Dimension 2: Functional Status
Low Impairment 1
a
Extreme Risk
5 a b c Dim: 1
Serious Impairment 3
Extreme Impairment 4
a a b b c c d d e e f Dimension 3: Co-Morbidity
5
a b c d e
Dim: 2
Minor Co-morbidity
Significant Co-morbidity
Major Co-morbidity
Severe Co-morbidity
2
3
4
5
1
a b c
a a a b b b c c c d d d e e e f Dimension IVA: Recovery Environment Stress Mildly Stressful
Low Stress 1
3/14/13
Moderate Impairment 2
a b c d
No Co-morbidity
a b c d e f
Serious Risk
2
a b
a b
Mod Risk
Moderately Stressful 2
a b c d e f
Highly Stressful 3
a b c d e f g
Extremely Stressful 4
a b c d e f g
Dim: 3
5
a b c d e f
Dim: IVA