|
Date of onset:
|
Date of onset:
|
|
2 OCD Medication Trials (8 weeks with adequate dose - ineffective OR intolerance)
|
|
|
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?
|
|
Medication Name
|
Medication Dose
|
|
Dates of Medication Trial
|
Ineffective? or Side Effects?
|
|
Diagnosis
|
Other or Additional Diagnosis
|
|
YBOCS Score
|
YBOCS Score:
|
|
Previous/ Current Therapist
|
Therapist Name & Licensure (if applicable)
|
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Ineffective Therapy Trial
|
|
|
Risk/ Benefits Statement
|
Other Considerations?
|
