AM Initial Note

NAME:

DATE:

CC:

ALLEGRIES:

CURRENT MEDICATION:

HISTORY OF PRESENT ILLNESS:

PSYCHIATRIC HISTORY:

PAST MEDICATION:

MEDICAL HISTORY:

DEVELOPEMENTAL HISTORY:

FAMILY HISTORY:

SOCIAL HISTORY/LEGAL HISTORY:

DRUG, ALCOHOL, NICOTINE USE:

HISTORY OF SUICIDAL IDEATION, THREATS, GESTURES, ATTEMPTS/SELF MUTILATION:

ROS

All other Systems Reviewed and are Negative

Apearance:

Musculoskeletal:

VITALS:

MENTAL STATUS EXAM:

AXIS I:

AXIS II:

AXIS III:

AXIS IV:

AXIS V:

PLAN:

MEDICATION SIDE EFFECTS OBSERVED

CRISIS INTERVENTION DISCUSSED

INFORMED CONSENT GIVEN