Reason For Inpatient Visit
[checkbox name="reason" value="SI: active/passive plan status post overdose/other suicide attempt|HI: active/passive plan status post xxx|Aggression|Bizarre behavior|Self-Neglect|Other psychiatric problem:|Acute exacerbation of chronic psychosis|Acute exacerbation of chronic mood disorder|Acute exacerbation of chronic mental illness due to substance use|Acute intoxication with alcohol or other substances (list them)
[checkbox name="ChiefComplaint" value="Delusional thinking leading to homicidal ideation|Delusional thinking leading to suicidal ideation with plan to jump out of the window|Auditory hallucinations leading to homicidal ideation|Mood disorder leading to self-neglect"].
[checkbox name="HPI" value="Quality: depression/psychosis/irritability/mood swings/specific type of delusions/hallucinations|Example: bizarre delusions as evidenced by; command type auditory hallucinations as evidenced by|Duration: days/weeks/months|Timing: constant/intermittent (for psychotic processes recommend intermittent)|Severity:|Interferes with daily functioning: describe (self-isolating, diminished libido, unable to handle stress of job)|Interfering with safety of self or others as evidenced by her suicide attempt|Causing self-neglect: describe (neglect personal grooming, not brushing hair/teeth, neglecting personal hygiene, not bathing, not getting health maintenance as advised, failing to get medical checkups for children)|Context: precipitating stressor for reason for admission (lost a job, broke up with girlfriend, house in foreclosure)|Modifying Factors:
Aggravating Factors: psychosocial stressors (homelessness, unemployment, poor social support, work stressors, marital problems, interpersonal conflict, legal issues, poor access to health care)|Alleviating Factors: hospitalization, compliance with meds, sleeping|Associated Signs and Symptoms: sleep disturbances, poor appetite, anhedonia
HPI paragraph:|Collateral information obtained:"].