|
Medication compliance is good
|
If no, Explain
|
|
Eating well
|
If no, Explain
|
|
Sleeping well
|
If no, Explain
|
|
Caring for personal needs
|
If no, Explain
|
|
Taking care of responsibilities, i.e. housework, home, or school
|
if no, Explain
|
|
Presence of suicidal thoughts
• • •
|
ARNP Comments
|
|
Acute and Dynamic Risk Factors
• • •
|
ARNP Comments
|
|
Static Risk Factors
• • •
|
ARNP Comments
|
|
Protective Factors
• • •
|
ARNP Comments
|
|
Suicide Risk Level
|
ARNP Comments
|
|
Treatment changes made for moderate or high risk
• • •
|
ARNP Comments
|
|
Assessment
• • •
|
|
|
CLIENT’S MENTAL HEALTH STATUS
|
|
|
Cognitive Functioning:
|
Functional Finding
|
|
Tobacco Cessation Counseling
|
|
|
Tobacco use amount
• • •
|
Interested in Quitting
|
|
Symptomatic
|
Motivational Counseling
• • •
|
|
Recommended Resources
• • •
|
Medication
• • •
|
|
Current Medications/Adjustments:
|
|
|
ICD 10 Codes
• • •
|
Billing Code
|
