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CLIENT’S MENTAL HEALTH STATUS
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Sleep
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Client Sleep
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Hard to fall asleep
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Sleep - How many hours
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Hard to get back to sleep
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Sleep - Additional Information
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Appetite/Dietary Habits
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Appetite/Dietary Habits
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Appetite/Dietary
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Appetite/Dietary Habits Duration
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Appetite/Dietary Comments
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Energy level
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Energy Level
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Libido
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Sexually active
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Libido
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Practice Safe Sex
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Suicidal/homicidal
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Suicidal/homicidal
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Narrative
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Reliability
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Reliability-Clinician perception
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Appearance
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Client Appearance
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Client Appearance - Other
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Personal Hygiene
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Personal Hygiene Multi-select
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Client personal hygiene other
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Behavior
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Client Behavior
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Clothing
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Client Clothing
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Clothing (Describe if striking)
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Eye Contact
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Client - Eye Contact
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Change during interview (describe)
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Speech
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Client Speech
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Psycho motor Activity
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Client - Psycho motor Activity
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Interaction during interview
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Client Interaction during interv
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Mood, Temperament & Emotional
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Emotional Range
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Client Emotional
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Client Mood
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Affect
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Client - Affect
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Perceptual disturbances
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Client - Perceptual disturbances
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Any history of psychosis?
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Current psychosis?
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Details if needed
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Thought processes
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Client - Thought processes
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Content of thought
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Client Content of thought
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Information and intelligence
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Appropriate to age and education
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Orientation to
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Client Orientation to
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Able to concentrate
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Able to follow instructions
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Memory
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Client Memory
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Narrative
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Judgment & Insight
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Client Judgment & Insight
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Support Systems
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Narrative
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CRISIS & RISK ASSESSMENT
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Crisis Assessment 1 -10
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Risk to harm self
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Risk Assessment 1 (low)-10 (High
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Risk to harm to others
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Given Crisis Number
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Client Needs Crisis intervention
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Crisis plan necessary
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Client's Strengths
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Client's Challenges
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Summary
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SUMMARY - Patient Concerns (past/current)
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SUMMARY - Any past or current services
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SUMMARY - Recommendations
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SUMMARY - PDMP Review
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