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General
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Symptoms Include:
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Depression Symptoms
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Comments
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Anxiety Symptoms
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Comments
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Sleep
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Comments
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Mania Symptoms
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Comments
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Psychosis
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Comments
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Eating Disorder Symptoms
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Comments
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ADHD symptoms
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Comments
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Other
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Response to Medications and Medication Changes since last appointment:
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Comments
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Current Stressors
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Comments
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Substance Use:
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Highest number of drinks in one day
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Highest number of drinks in one week
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Comments
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Caffeine use
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Comments
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Nicotine use
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Comments
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Marijuana Use
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Comments
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Other substance use
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Comments
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New or Ongoing Health Concerns and Medical Treatment
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Health Concerns
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Recent lab work or other tests
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Therapy and Therapeutic Skills Used
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Seeing an outpatient therapist?
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Frequency of therapy appts
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Self directed use of skills/habits to manage symptoms:
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