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Signed all Consent Forms? ("..." bottom middle of your screen)
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New Outcome MD scores sent/completed?
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Length of Visit Today
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Insurance?
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Psychiatric Visit
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Telehealth?
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Telehealth Visit
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Patient currently in Florida or Iowa?
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Explain the format of the meeting?
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1st Visit?
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Repeat Visit?
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IDENTIFYING INFORMATION
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Race (select all that apply)
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Ethnicity
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Patient's Gender Identity
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Patient's Sexual Orientation
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Sex Assigned at Birth
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Affirmed Gender Pronouns
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Additional Information
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Employment Status
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Relationship Status
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Current Medications in system?
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Height and Weight added to Vitals section?
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Failed 2 or more antidepressant treatments?
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List Failed Treatments
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Spravato Candidate?
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For Spravato: Antidepressant Dates/Duration
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Provider info if not placed in Demographics
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PCP
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Psychiatric Provider
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Therapist(s)
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Specialist(s)
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Chief Complaint/Reason for Visit
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What brings you here today?
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Assessment Questions and Answers
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