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