Writer [select name="duh" value="met face-to-face with|met via Zoom with|called|emailed|had text (SMS) exchange with"][select name="Who" value="client|parent|family|MHCC|social worker"] to [select name="dooo" value="conduct case management|schedule services|conduct family session|conduct parent session|conduct individual/parent session|request_____"].
When asked to rate how things have been over the last week, client reported that [select name="Q1" value="things have been unremarkable.|there have been some difficulties.|life has been pretty good.|"][conditional field="Q1" condition="(Q1).is('there have been some difficulties.')"] When asked to elaborate, client reported concerns with: [conditional field="Q1" condition="(Q1).is('there have been some difficulties.')"][checkbox name="lastweek" value="the primary support group|the social environment|education|work|housing|finances|access to health care services|legal justice system|psycho-social functioning and their environment"].[/conditional] [textarea cols=80 rows=5 default="additional comments"]
Client reported [select name="test" value="one|two|three|four|five|six|seven|eight|nine|ten"] hours of [select value="good|fair|poor|terrible"] sleep a night.
Client rated appetite as [select value="good|fair|poor|terrible"], and reported eating [select value="every other day|once per day|twice per day|three times per day"] with [select value="easy|moderate|hard|no"] access to food.
Client reported that overall mood is [text name="variable_1" default="sample text"]
Client reported [select name="variable_1" value="no issues|issues"] with medication and taking it [select name="variable_1" value="as prescribed|not as prescribed"].
Affect: [select value="Appropriate|Labile|Restricted|Blunted|Flat"] Mood: [select value="Euthymic|Anxious|Angry|Apathy|Ashamed|Prideful|Sad|Irritable|Hostile|Pessimistic|Depressed|Hypomanic|Euphoric"] -- [text name="field_name" default="other"] Mood rated out of 10: [select value="Not rated|1|2|3|4|5|6|7|8|9|10"]
-- Thought and Language --
Speech flow: [select value="Normal|Mute|Loud|Blocked|Paucity|Pressured|Flight of ideas"] Thought content: [select value="Congruent with mood and circumstances|Incongruent Congruent with mood and circumstances|Personalizations|Persecutions|Indecisions|Suspicions|Delusions|Ideas of reference|Ideas of influence|Illusions"] Thought organisation: [select value="logical and goal directed|Circumstantial|Tangential|Loose associations|Flight of ideas|Neologisms|Blocking|Obsessive"] Preoccupations: [select value="Nil|Phobias|Somatic|Suicide|Homicidal|Guilt|Religion"] - Other: [text name="field_name" default="Nil"] Hallucinations: [select value="Nil|Auditory|Visual"] Hallucination content: [text name="HalCon" default="N/A"]