between 0 and 1. this is the cover page of the asi composite score manual. an example has been depicted in the composite score manual. in the medical sections, three questions are included in the composite score calculation: a. how many days have you experienced medical problems in the last 30? (maximum value = 30) b. how troubled or bothered have you been by your medical problems in the past 30 days? (maximum value = 4 (patient's rating)) c. how important to you now is treatment for these medical problems? (maximum value = 4 (patient's rating)) if the answer recorded for the three questions were 15 days for a, a rating of 3/4 for b and a rating of 4/4 for c. the score would be calculated using the equation below: ( 15 / 30 ) / 3 + ( 3 / 4 ) / 3 + ( 4 / 4 ) / 3 = 0.750 although the css are a measure of problem severity, with high scores indicating higher severity, their intrinsic value would have little meaning and they could not be compared between different aspects probed. css are advised to be only used for measuring changes in various time-points of treatments or relative outcomes between groups. confidence rating there are 2 possible scores that could be given to each of the 2 questions in the confidence rating (0= no and 1= yes). factors ranging from unjustified contradiction of information to lack of confidence in answering, patients' misrepresentation to poor understanding of questions due to reasons including but not limited to language barrier and illiteracy all contribute to poor confidence rating. interviewers are encouraged to recognize and reconcile the aforementioned issues. but the interview would be terminated and rescheduled should the problems would not be resolved. ongoing improvement of asi a graphical demonstration of reliability and validity in statistical analysis. as clinicians gained more experience with the use of asi-5 in real-life practice, it was pointed out that some questions in the questionnaire might be overlapping with information collected during admission. in a bid to avoid duplication and wasting medical resources, a condensed form of asi, asi-lite was introduced in 1997. modifications were done including the removal of interviewer severity rating, removal of questions pertaining to family/genetic heritability and emotional problems and the inclusions of research-oriented questions. it consists of 111 items and requires 30–40 minutes to complete. since most key elements are retained, asi-lite and asi-5 showed similar reliability and validity. asi-5 and asi-lite are continued to be used during clinical admission until the 21st century. yet, a useful instrument should be reviewed and re-evaluated overtime to keep up with the advance in technology and change in social norms, coupled with the wider use of the asi outside of clinical and research purposes, fundamental changes are brought to the development of a newer asi, the asi-6. the principle of the revision is to add more content in each domain while shortening training and testing time, as well as retaining the essential element in asi. the addition of new content such as queries on the date of most recent occurrence of more severe symptoms, days of hospitalizations for mental health problems and recent patients' status ranging from homelessness to pregnancy, tobacco use to gambling aimed to provide wider coverage. in addition, a time frame of 6-month was added for cost-related questions on top of the lifetime and past 30-day time frames in view of increased popularity in use cost-effectiveness analysis. in view of the additional content, "skip-outs" could be employed on screening questions to keep the interview within an hour. in terms of data analysis, confirmatory non-linear analysis was added to better meet the new application of asi-6. all in all, the asi-6 is supported to be used clinically and in research with acceptable scalability, reliability and concurrent validity. the asi would continued to be improved with reference to the updating knowledge in psychology and the ever-changing socioeconomic factors in the society.