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Psychiatric Evaluation
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Chief Complaint
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HISTORY OF PRESENTING PROBLEM
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HPI
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HISTORY
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PCP, Referring Provider (as on file)
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Allergies
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Medical History
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Psychiatric History include Psych Meds
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Family Medical History
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Family Psych History
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Living Arrangement Comments:
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Occupation/Employment Comments:
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Childhood: (ACEs,traumas,life-events)
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Education Level: (highest,difficulties)
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Legal: (incarceration/charges/felonies)
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Military: (service/discharge/rank/traumas)
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Substance Use History
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MENTAL STATUS EXAM
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Appearance
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Eye Contact
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Speech
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Motor Activity
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Affect
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Mood
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Orientation Impairment
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Memory Impairment
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Thought Process
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Attention
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Hallucinations
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Delusions
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Behavior
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Suicidality
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Homicidality
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Insight
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Judgement
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Diagnosis
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New Short Text Field
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Plan/Referrals
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1. Pharmacologic Interventions
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2. Therapy / Behavioral Interventions
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3. Labs
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Lab Comments
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4. Follow Up
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5. Reviewed r/b/se
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6. Pertinent History, Records, Reviewed
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7. General Instructions
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8. Referrals
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Discharge Criteria
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Med Mgmt Policy Reviewed
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General Instruction Comments
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