|
INTERVAL HISTORY: Mr or Ms
|
Man or Woman
|
|
Chief complaint is,
• • •
|
|
|
Patient states that ________
|
Denies any side effects from meds
|
|
Any other comments
|
|
|
MENTAL STATUS EXAMINATION
|
Comments
|
|
APPEARANCE
|
|
|
Groomed
|
|
|
Dress
|
If inappropriately, how?
|
|
Weight
|
|
|
ATTITUDE
• • •
|
MOTOR
|
|
CONSCIOUSNESS
• • •
|
|
|
SPEECH
|
|
|
Tone
|
Speed
|
|
MOOD
• • •
|
|
|
AFFECT
|
If inappropriately, how?
|
|
THOUGHT PROCESS
• • •
|
|
|
THOUGHT CONTENT
|
|
|
If Normal Delusions, which?
|
If Obsessions, which?
|
|
If Suicidal Ideas, Plan?
|
If Homicidal Ideas, Plan?
|
|
JUDGEMENT
|
INSIGHT
|
|
ATTENTION
|
Repeat 5 words
|
|
CONCENTRATION
|
|
|
MEMORY
|
|
|
Immediate
|
Repeat 5 words in 5 minutes
|
|
Recent
|
Repeat events
|
|
Remote
|
Remote events
|
