Objective
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Objective observations:
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Mental Status Exam
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Appearance
• • •
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Comments
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Attitude
• • •
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Comments
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Behavior
• • •
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Comments
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Speech
• • •
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Comments
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Affect
• • •
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Comments
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Mood
• • •
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Comments
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Thought processes:
• • •
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Comments
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Thought content:
• • •
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Comments
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Load SI Risk Assessment
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Load HI Risk Assessment
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Perception
• • •
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Comments
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Orientation
• • •
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Comments
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Memory / Concentration
• • •
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Comments
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Insight / Judgment
• • •
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Comments
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SI Risk Assessment
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Does the patient have a history of suicide ideation/attempts?
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Comments:
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Does the patient have a history of self-harm?
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Comments:
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Does patient have a plan?
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Comments
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Does patient have active suicidal intent?
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Comments
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Does patient have access to means?
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Comments
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Is the patient able to contract for safety?
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Comments
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Load SI Safety Plan
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SI Safety Plan
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Patient's current location:
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Risk factors (previous history, environmental triggers, etc):
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Protective factors:
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Action plan:
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Emergency contacts:
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HI Risk Assessment
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Does the patient have a plan?
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Comments
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Does the patient have active homicidal intent?
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Comments
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Does the patient have access to means?
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Comments
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Is the patient able to contract for safety?
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Comments
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Load HI Safety Plan
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HI Safety Plan
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Patient's current location:
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Risk factors (previous history, environmental triggers, etc):
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Protective factors:
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Action plan:
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Emergency contacts:
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