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Date of onset:
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Date of onset:
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2 OCD Medication Trials (4 weeks, accepted doses, no improvement)
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Accepted OCD Meds: SSRI, SNRI, TCA, Buproprion, Mirtazapine
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Medication Name
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Medication Dose
|
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Dates of Medication Trial
|
Ineffective? or Side Effects?
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Medication Name
|
Medication Dose
|
|
Dates of Medication Trial
|
Ineffective? or Side Effects?
|
|
Medication Name
|
Medication Dose
|
|
Dates of Medication Trial
|
Ineffective? or Side Effects?
|
|
Medication Name
|
Medication Dose
|
|
Dates of Medication Trial
|
Ineffective? or Side Effects?
|
|
Diagnosis
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Other or Additional Diagnosis
|
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YBOCS Score
|
YBOCS Score:
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Previous/ Current Therapist
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Therapist Name & Licensure (if applicable)
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Ineffective Therapy Trial
|
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Risk/ Benefits Statement
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Other Considerations?
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