Initial Psychiatric Evaluation 2023 – WM

Identifying Information:
[text name="name" memo="Patient name" size="20"] is a [text memo="age" size="2"]-year-old, [text memo="ethnicity" size="20"], [checkbox value="single|married|partnered"] [checkbox value="female|male|transgender female|transgender male"][text memo="other gender" value="20"] who [select value="lives with their significant other |lives with their family |lives alone |is homeless|lives with their parents |lives with their children |lives with a roommate |lives in a grouphome |"][text size="20"] in [text memo="residing location" size="20"]. [select value="They are their own guardian|They have a DHS guardian |Their guardian is |"][text memo="guardian" size="20"]. [textarea memo="Additional presentation information" rows="5"]

History of Presenting Illness:
[var name="name"] [select value="presents in this initial outpatient appointment| "][select value=" alone| with family| with significant other| with DHHS worker| with case manager|"][text memo="names" size="20"][select value=" for evaluation and management of the chief complaint of | due to reports of |"][text memo="presenting problem" size="20"].[checkbox name="depression" memo="depression" value=""][checkbox name="anxiety" memo="anxiety" value=""][checkbox name="sleep" memo="sleep" value=""][checkbox name="mood" memo="mood" value=""][checkbox name="trauma" memo="trauma" value=""][checkbox name="adhd" memo="adhd" value=""][checkbox name="autism" memo="autism" value=""] 

[conditional field="depression" condition="(depression).is('')"][var name="name"]'s depression is characterized as [checkbox value="little interest or pleasure in doing things|hopelessness|self harm|helplessness|sleeping too much|difficulty getting to sleep|difficulty staying asleep|feeling tired or having little energy|poor appetite|overeating|feelings of inadequacy|irritability|poor concentration|psychomotor retardation|psychomotor agitation|suicidal ideation"]. [select value="Depressive symptoms are present most of the day, nearly every day for the past |Depressive symptoms are mostly present |"][text size="20"][select value=", are exacerbated by |"][text size="20][select value=", are improved by |"][text size="20]. [select value="Depressive symptoms impact|"][select value=" social/work functioning by | "][textarea rows="1"].[textarea memo="Additional Depression information" rows="5"]

[/conditional][conditional field="anxiety" condition="(anxiety).is('')"][var name="name"]'s anxiety generally presents as [checkbox value="feeling nervous or on edge|worry|panic|difficulty relaxing|feeling restless|difficulty getting to sleep|difficulty staying asleep|irritability|poor concentration|poor appetite|overeating"][text size="20]. [select value="Anxiety is present |"][select value="in the context of multiple different situations/events such as |primarily in social situations such as |no specific situation or event but always there |"][textarea rows="1"]. [select value="Anxiety usually last for approximately |Anxiety is present most of the time on most days "][text size="20"][comment memo="How long"][select value=", is brought on by |"][text size="20][select value=", is relieved by |"][text size="20]. [textarea memo="Additional Anxiety information" rows="5"]

[/conditional][conditional field="mood" condition="(mood).is('')"][select value=" Mood instability has been an issue since |"][text size="20"]. [select value="Disordered mood can present as |"][checkbox value="euphoria|excessive energy|excessive self-confidence|insomnia|irritability|agitation|racing thoughts|impulsive behavior|risk taking behavior|paranoia|delusions of grandeur|auditory hallucinations|visual hallucinations|tactile hallucinations|olfactory hallucinations|increased goal directed activity|homicidal ideation| depression|apathy|hopelessness|helplessness|suicidal thoughts|no motivation|hypersomnia"]. [select value="Mood lability is exacerbated by |There are no identified precipitating factors to mood lability|"][textarea rows="1"]. [textarea memo="additional information of mood lability" rows="4"]

[/conditional][conditional field="autism" condition="(autism).is('')"][select value="Per patient,|Per family,|Per record,|"][text size="20"][select value=" they have been | patient has been |"][select value="diagnosed|undiagnosed|"][text size="20"][select value=" autism spectrum disorder "][textarea memo="details of diagnosis/symptom timeframe" rows="4"]. [var name="name"]'s symptoms present as persistent difficulty, in multiple contexts, with social communication and interaction including: [checkbox value="abnormal or failed back and forth conversation|failure to initiate or respond to social interactions|reduced sharing of interests/emotions|limited emotional affect|limited/incongruent nonverbal communication|difficulty with developing/maintaining/understanding relationships|difficulty sharing imaginative play|limited or absent interest in peers"]. They have demonstrated restricted/repetitive patterns of behavior, interests, or activities including: [checkbox value="repetitive motor movements|repetitive speech|infexible adherence to routines|ritualized patterns of verbal or nonverbal behavior|significant difficulty with transitions|rigid thinking patterns|highly restricted and fixated interests|hyper-reactivity to sensory input|hyporeactivity to some sensory input"]. Presentation is [select value="without|with"] intellectual impairment, and [select value="without|with"] language impairment. [textarea rows="4"]

[/conditional][conditional field="adhd" condition="(adhd).is('')"][var name="name"] has a pattern of [checkbox name=addtype value="inattention and hyperactivity/impulsivity|inattention|hyperactivity/impulsivity"] that interferes with functioning. [/conditional][conditional field="addtype" condition="(addtype).is('inattention and hyperactivity/impulsivity')||(addtype).is('inattention')"] Inattention manifests as [checkbox memo="At least 6 for ADHD" value="poor attention to details or careless mistakes in work or activities|difficulty sustaining attention|not seeming to listen when spoken to directly|not following through on instructions or failing to finish tasks|having difficulty organizing tasks and activities|avoiding tasks that require sustained mental effort|frequently losing things necessary for tasks|often easily distracted by extraneous stimuli|forgetfulness in daily activities"].[/conditional] [conditional field="addtype" condition="(addtype).is('inattention and hyperactivity/impulsivity')||(addtype).is('hyperactivity/impulsivity')"] [var name="name"]'s hyperactivity/impulsivity presents as [checkbox memo="six or more for ADHD" value="frequent fidgeting or squirming|often leaving seat when remaining seated is expected|frequently restless|difficulty engaging in leisure activities quietly|often seeming to be on the go or difficult to keep up with|excessive talking|blurting out answers before a question has been completed|difficulty waiting for their turn|interrupting or intruding on others"].[/conditional][conditional field="adhd" condition="(adhd).is('')"] These symptoms have been present since [text memo="before 12yo" size="20"], and are recognized in multiple settings including [checkbox name="variable_1" value="at home|in public|work|school"][textarea rows="3"]

[/conditional][conditional field="sleep" condition="(sleep).is('')"]Sleep is reported to be generally [select name="sleepq" value="poor |fair |good.|erratic |inconsistent |excessive|"][select value="with difficulty initiating sleep and staying asleep due to |with difficulty initiating sleep due to |with difficulty maintaining sleep due to |Early-morning awakening with inability to retun to sleep"][textarea rows="2"]. They estimate getting approximately [text size="4"] hours of [select value="broken |solid |"]sleep per night. [select value="Disturbed sleep has been an issue for |Disturbed sleep is a new issue within the last |"][textarea rows="1"]. [select value="There has been no workup for Sleep Apnea |There was a past workup for sleep apnea which indicated |"][textarea rows="1"]. [select value="Current attempts at improving sleep include |The patient is currently attempting no interventions to improve sleep|Current quality of sleep is dependent on |"][textarea rows="2"]. [select value="Past unsuccessful attempts at improving sleep include |There have been no past attempts at improving sleep|"][textarea rows="2"].[/conditional][conditional field="sleep" condition="(sleep).isNot('')"]Sleep is reported to be generally good. [/conditional]
[conditional field="depression" condition="(depression).isNot('')"]They deny any marked issues with depression. [/conditional][conditional field="anxiety" condition="(anxiety).isNot('')"]They deny any significant issues with anxiety. [/conditional][select value="They are not currently receiving individual counseling/therapy |They are currently engaging in individual counseling with |"][textarea rows="1"]. [select value="They deny current suicidal ideation or thoughts of self harm|They report positive for |They deny suicidal ideation but state having thoughts of being better off dead"][textarea rows="1"]. [checkbox value="They are able to contract for safety.|They deny being able to contract for safety."][textarea rows="1"] [select value="They deny having access to guns|They report positive for having guns in the home |"][textarea rows="1"]. [checkbox value=" Explained that we ask this question because guns in the home increase the risk of suicide, homicide and accidental death, Provided education about the importance of keeping guns locked and separated from ammunition. Explained that should this provider feel that patient is unsafe to self or others, provider and patient will work together to develop a safe place to keep weapons to decrease risk of impulsive suicide or homicide."]


[conditional field="trauma" condition="(trauma).is('')"]
[var name="name"]'s Trauma symptoms generally presents as [checkbox value="Recurrent, unwanted distressing memories of the traumatic event|flashbacks|upsetting dreams/nightmares|severe emotional distress that reminds pt of trauma|physical reactions to something that reminds the pt of the traumatic event|Trying to avoid thinking or talking about the traumatic event|Avoiding places, activities or people that remind you of the traumatic event|negative thoughts about self|negative thoughts about other people|hopelessness about the future|memory disturbances r/t to not remembering important aspects of the trauma|difficulty maintaining close relationships|feeling detached from family and friends|lack of interest in activities they used to enjoy doing|difficulty experiencing positive emotions|feeling emotionally numb|easily startled|always being on guard for danger|self destructive behavior|difficulty sleeping|aggressive behavior|trouble concentrating|angry outbursts|overwhelming guilt|overwhelming shame"]The trauma is in the form of [checkbox name="variable_486531" value="psychological|physical|sexual|emotional"][textarea memo="Additional Trauma information" rows="5"][/conditional]





[textarea name="variable_4534688971" default=" "][checkbox memo= "Scales" name="scales" value=""][conditional field="scales" condition="(scales).is('')"]
Scales and Screening:
PHQ-9: [select value="unable to assess|N/A|declined|0|1|2|3|4|5|6|7|8|9|10|11|12|13|14|15|16|17|18|19|20|21|22|23|24|25|26|27|28|29|30"]
GAD-7: [select value="unable to assess|declined|N/A|0|1|2|3|4|5|6|7|8|9|10|11|12|13|14|15|16|17|18|19|20|21|22|23|24|25|26|27|28|29|30"]
MDQ: [select value="negative|unable to assess|N/A|declined|1|2|3|4|5|6|7|8|9|10|11|12|13|14|15|16|17|18|19|20|21|22|23|24|25|26|27|28|29|30"]
HITS:[select value="negative|unable to assess|N/A|declined|1|2|3|4|5|6|7|8|9|10|11|12|13|14|15|16|17|18|19|20|21|22|23|24|25|26|27|28|29|30"]
PC-PTSD:[select value="negative|N/A|unable to assess|declined|1|2|3|4"]
AUDIT:[select value="negative|unable to assess|N/A|declined|1|2|3|4|5|6|7|8|9|10|11|12|13|14|15|16|17|18|19|20|21|22|23|24|25|26|27|28|29|30"]
DAST-10:[select value="negative|unable to assess|N/A|declined|1|2|3|4|5|6|7|8|9|10|11|12|13|14|15|16|17|18|19|20|21|22|23|24|25|26|27|28|29|30"]
SLUMS:[select value="N/A|unable to assess|declined|1|2|3|4|5|6|7|8|9|10|11|12|13|14|15|16|17|18|19|20|21|22|23|24|25|26|27|28|29|30"][/conditional]

PAST PSYCHIATRIC HISTORY:
[select name="variable_1" value="The patient states a past diagnosis of|The patient denies a past psychiatric diagnosis"][textarea name="variable_1" default="sample text"][select value="There is no history of psychiatric hospitalizations|They have been psychiatrically hospitalized |"][textarea rows="2"]. [select value="When asked about psychotherapy the patient stated | no history of psychotherapy|history of psychotherapy/counseling|"][textarea rows="2"]. [select value="They deny history of diagnosis/treatment for an eating disorder|They report positive for a history of diagnosis/treatment for an eating disorder including |Unable to assess for history of diagnosis/treatment of an eating disorder due to symptomatic presentation|History of diagnosis/treatment of an eating disorder was not assessed in this encounter|"][textarea rows="1"].[select value="They have no history of thoughts of self-harm|History of thoughts of self harm include |"][textarea rows="2"]. [select value="They have no history of attempting to hurt themself|History of self-harm includes |Unable to obtain history of self-harm due to symptomatic presentation"][textarea rows="2"]. [select value="They have no history of hallucinations| They have a history hallucinations|Unable to obtain history of hallucinations due to symptomatic presentation"][textarea rows="2"] [select value="They have no history of delusions| They have a history delusions|Unable to obtain history of hallucinations due to symptomatic presentation"][textarea rows="2"][select value="They have no history of attempting suicide|They have a history of attempting suicide |Unable to obtain history of suicide attempt due to symptomatic presentation"][textarea rows="2"]. [select value="Previous psychiatric medication trials include but may not be limited to: |The patient has no history of taking psychiatric medications|We were unable to cover previous psychiatric medication trials due to symptomatic presentation|The patient is unable to recall past psychiatric medication trials|"][textarea rows="1"].

MEDICAL HISTORY:
Other Providers: [text name="variable_4111631" default="sample text"]
Illness: [text name="variable_4631" default="sample text"]
Surgeries: [text name="variable_43631" default="sample text"]
Allergies: [text name="variable_463451" default="sample text"]
Head Injuries: [select value="They have no history of head injuries or traumatic brain injuries|They have a past history of traumatic brain injuries resulting from |They have an underlying cognitive impairment from |"][textarea rows="2"].
Seizures: [select value="They denied having seizures|They have a past history of seizures|"][textarea rows="2"].
[select value="Current psychiatric medications include: |They are not currently taking any psychiatric medications|Patient is unable to recall current medications|Unable to cover current psychiatric medications with patient due to symptomatic presentation|"][textarea rows="4"].[select name="medmed" value=" Other medical medications include: | Other medical medications are noted below."][conditional field="medmed" condition="(medmed).isNot(' Other medical medications are noted below.')"][textarea rows="3"].[/conditional][select value=" Medication list obtained from patient.| Medication list obtained from medical record.| Medication list obtained from patient's guardian. | Medication list confirmed with patient's pharmacy.| Medication list confirmed with patient's grouphome.| "]

SOCIAL HISTORY:
[var name="name"] identifies [checkbox value="having no one |significant other |extended family |children |friends |church members "][textarea rows="1"] as their social-support network. The patient has [select value="0|1|2|3|4|5|6|7|"][textarea rows="1"] children. The patients level of education is [select value="highschool|an undergraduate degree in |a graduate degree in |a doctorate degree in |some highschool|some college|currently in grade school|currently in highschool|currently in college.|currently in graduate school|"][textarea rows="1"]. The patient is[select value=" currently on disability due to their mental health condition| currently on disability due to their medical condition| currently employed | currently unemployed |currently retired from |"][textarea rows="1"].Financially the patient has[select value=" no immediate concerns| been burdened by healthcare costs| concerns related to supporting their family|"][textarea rows="1"].The patient source of income is primarily [select value=" disability| social security| unemployment| child support| current employment| family support| retirement|"][textarea rows="1"].The patient has [select value=" no current housing concerns| a currently unstable housing situation related to |"][textarea rows="1"]. [select name="spirituality" value="Spirituality was not addressed this visit|Spirituality is identified as |"][conditional field="spirituality" condition="(spirituality).is('Spirituality is identified as ')"][select value="Christian|Catholic|Muslim|Jewish|Spiritual but not practicing|Athiest|Satanism|Agnostic|Spiritual but no specific religion|Hinduism|"][textarea rows="1"][/conditional]. [select value="Cultural considerations important to care include: |"][textarea rows="1"].Sexual orientation [select name="sexuality" value="is identified as |was not addressed this visit|"][conditional field="sexuality" condition="(sexuality).is('is identified as ')"][select value="heterosexual|homosexual|bisexual|pansexual|asexual|"][textarea rows="1"][/conditional].[select value="No past history of military service|Military history includes |Military history was not addressed this visit|"][textarea rows="1"]. [select value="At this current time the patient has no current legal concerns|At this time the patient has legal concerns which include |legal concerns at this time were not addressed due to symptomatic presentation"][textarea rows="1"].
[select value="The patient reports positive for tobacco use consuming approximately |The patient reports a past history of tobacco but quit approximately |The patient denies any tobacco use|"][textarea rows="1"].[select value="The patient reports positive for alcohol use consuming approximately |The patient reports a history of alcohol abuse quitting approximately |The patient denies any alcohol use|"][textarea rows="2"]. [select value="They deny a history of recreational substance use|The patient reports utilizing cannabis approximately |The patient has a history of substance abuse in the form of |They report utilizing opiates recreationally in the form of |Substance use history was not covered due to symptomatic presentation|"][textarea rows="4"].DEVELOPMENTAL HISTORY:
[select value="There is no known issue with meeting expected developmental milestones.|All developmental milestones were met with exception to |There were some notable issues with developmental milestones including |"][textarea name="variable_236321" default="sample text"]. Their primary language includes [select name="language" value="English|"][conditional field="language" condition="(language).is('')"][text memo="language" size="15"][/conditional] and utilizes [select name="comskill" value="written and verbal communication|primarily verbal communication|primarily textual communication and sign language| "][textarea rows="1"].FAMILY HISTORY:
[var name="name"] was born in [text memo="place of birth" size="20"] [select value="to an intact family |to a family structure consisting of |"][textarea rows="1"].
[select value="They deny knowledge of a family history of mental illness|Family history of mental health problems is positive for |Unable to cover family history of psychiatric issues due to symptomatic presentation"]
[textarea rows="4"].[select value="There is no known history of suicides or self-harm in the patient's family|Family history of suicides/self-harm includes |Unable to cover family history of suicides/self-harm due to symptomatic presentation|"][textarea rows="2"].[select value="There is no known family history of substance use issues|Family history of substance use is positive for |Unable to cover family history of substance use issues due to symptomatic presentation|"][textarea rows="4"].

MSE:
[radio name="variable_18265305" value="General Appearance: Appears stared age.
Behavior/ Attitude: Cooperative.
Psychomotor Activity: Normal.
Speech: All Normal.
Mood: Normal.
Affect: Normal.
Thought Process: Normal.
Thought Content: Normal.
Orientation: Normal
Recent & Remote Memory: Normal.
Concentration: Normal.
Fund of Knowledge: Good.
Insight: Normal.
Judgment: Normal.
Musculoskeletal; Normal.
Grooming: Well Groomed.
Alertness: Alert."]

PDMP Checked:[select name="variable_098482" value="Yes|No"]

[textarea name="variable_785421" default="Tx Plan:"]


[date name="variable_3319081" default="01-24-2023"]

[comment memo="additional dx's"][comment memo="AUD"]
[comment memo="must have two listed below"]
When asked about any alcohol habits the patient[select name="variable_316341" value=" denied having a problem but had a problematic pattern of alcohol use which included the following symptoms over:| stated having a problem with alcohol which included the patient's following symptoms, occurring over:|"][text name="variable_1201291875" default="how long"] [checkbox name="variable_4333241" value="Alcohol is often taken in larger amounts or over a longer period than was intended|there is a persistent desire or unsuccessful efforts to cut down or control alcohol use|a great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects|craving, or a strong desire or urge to use alcohol|recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.|continued alcohol use despite having persistent social or interpersonal problems caused or exacerbated by the effects of alcohol|Important social, occupational, or recreational activities are given up or reduced because of alcohol use|Recurrent alcohol use in situations in which it is physically hazardous|Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol|Tolerance|Withdrawal symptoms"].
[textarea name="variable_58008311" default="include how long,how much"].

[comment memo="SUD"]
[comment memo="must have two listed below"]
When asked about any substance use habits the patient[select name="variable_31216341" value=" denied having a problem but had a problematic pattern of substance use which included the following symptoms over:| stated having a problem with substance use which included the patient's following symptoms, occurring over:|"][text name="variable_12154375" default="how long"] [checkbox name="variable_19588541" value="often taken in larger amounts or over a longer period than was intended|a persistent desire and/or unsuccessful efforts to cut down or control use|craving to use the substance|recurrent use resulting in a failure to fulfill major role obligations at work, school, or home|continued use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by its effects|important social, occupational, or recreational activities are given up or reduced because of use|recurrent substance use in situations in which it is physically hazardous|continued use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance|tolerance|withdrawal symptoms"].
[textarea name="variable_58652231" default="include how long,how much"].


[comment memo="BED"]
[comment memo="must have three listed below"]
When asked about binge eating the patient[select name="variable_300341" value=" denied having a problem but had a problematic pattern of binge eating which included the following symptoms:| stated having a problem with binge eating which included a problematic pattern by the patient's following symptoms:|"] [checkbox name="variable_1649241" value="consuming an amount of food in a discrete period of time that is definitely larger than what most people would eat in a similar amount of time under similar circumstances.|eating more rapidly than normal|eating until feeling uncomfortably full|eating large amounts of food when not feeling physically hungry|eating alone because of embarrassment by the amount of food consumed|feeling disgusted with oneself, depressed, or guilty after overeating"].
[text name="variable_3211" default="Episodes occur, on average, at least once a week for three months, and no regular use of inappropriate compensatory behaviors
[comment memo="(R/O purging, fasting, or excessive exercise any of these does not meet dx for BED)"]
[textarea name="variable_5821" default="include how long"].

[comment memo="OCD"]
[comment memo="Mind-based thinking,Unwanted,Resistant,Distressing,Ego-dystonic,Recurrent MURDER"]When asked about symptoms of OCD the patient states presence of
[checkbox name="variable_17654362" value="Recurrent and persistent thoughts/urges that cause marked anxiety|recurrent intrusive images that cause anxiety| resistant of obsessional thinking |compulsions that patient feels driven to perform in response to the obsession|obsessions are time consuming (more than 1 hour per day)|compulsions are time consuming (more than 1 hour per day)|obsessional thoughts that are upsetting or distressing and cause impairment in functioning|ego-dystonic|compulsions that decrease obsessions"].[textarea name="variable_58231" default="include how long"].

[comment memo="Schizophrenia"]
[comment memo="two or more symptoms for dx however must have at least one of the first three"]

When going over symptoms of schizophrenia the patient presented with
[checkbox name="variable_13285262" value="delusions|hallucinations| disorganized speech |catatonic behavior|grossly disorganized behavior|affective flattening|poverty of speech|avolition"]. A significant portion of the time since the onset of the disturbance, have affected the functioning of[checkbox name="variable_11655421" value="work|interpersonal relations|self-care"]. Continuous signs of the disturbance persist for at least six months. The disturbance is not due to the direct physiological effects of a substance use or a general medical condition.
[textarea name="variable_512731" default="include how long have to be at least 6 months but at least 1 month of symptoms"].

[comment memo="Schizoaffective dx include dx of mania symptoms or major depression listed below"]
[comment memo="two or more symptoms"][checkbox name="variable_185262" value="delusions for two or more weeks in the absence of a major mood episode|hallucinations for two or more weeks in the absence of a major mood episode| disorganized speech |catatonic behavior |grossly disorganized|affective flattening|poverty of speech|avolition"]. Symptoms that meet the criteria for a major mood episode are present for most of the total duration of both the active and residual portions of the illness.[comment memo=" mania vs hypomania (severe vs severe for I v II"]When asked about mania symptoms the patient stated the following symptoms [checkbox name="variable_19295292" value="grandiosity|decrease sleep and feeling rested| more talkative |flight of ideas|distractability |increased goal directed activity|excessive involvement in activities|The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning.|The episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization."]. The symptoms have been prominent for at least [text name="variable_1" default="how long"] and present most of the day, nearly every day. The episode is not attributable to the physiological effects of a substance use or medical condition.[textarea name="variable_67571" default="sample text"]

[comment memo="BPD"]
[comment memo="5 or more symptoms"]
Symptoms that are found in borderline personality disorder were asked and the patient stated the following symptoms [checkbox name="variable_1777882" value="Affective instability|Inappropriate anger| Impulsivity that is self damaging |Unstable relationships |Feelings of emptiness|Paranoia |dissociation |Identity disturbance |Abandonment fears |Suicidality or self-injury"]. The symptoms have been prominent for at least 1 week and present most of the day, nearly every day. The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning. The episode is not attributable to the physiological effects of a substance use or medical condition.[textarea name="variable_8951841" default="sample text"]

[comment memo="Dependent Personality Disorder-DPD"]
[comment memo="At least 5 symptoms"]When asked about symptoms of Dependent Personality Disorder the patient states presence of
[checkbox name="variable_10550362" value="difficulty making everyday decisions without excessive reassurance and advice from others|needs others to assume responsibility for most major areas of their life| difficulty expressing disagreement with others due to fear of loss of support or approval |difficulty initiating projects or doing things on their own due to lack of self-confidence|goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering for unpleasant tasks|Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for themselves|urgently seeks another relationship as a source of care and support when a close relationship ends|unrealistically preoccupied with fears of being left to take care of themselves"].[textarea name="variable_940561" default="The excessive need for others and submissive behavior is not due to a general medical condition or a substance abuse disorder. The excessive need for others and submissive behavior is not better explained by another mental disorder."]

[comment memo="OCD"]
[comment memo="Mind-based thinking,Unwanted,Resistant,Distressing,Ego-dystonic,Recurrent MURDER"]When asked about symptoms of OCD the patient states presence of
[checkbox name="variable_17654362" value="Recurrent and persistent thoughts/urges that cause marked anxiety|recurrent intrusive images that cause anxiety| resistant of obsessional thinking |compulsions that patient feels driven to perform in response to the obsession|obsessions are time consuming (more than 1 hour per day)|compulsions are time consuming (more than 1 hour per day)|obsessional thoughts that are upsetting or distressing and cause impairment in functioning|ego-dystonic|compulsions that decrease obsessions"].[textarea name="variable_58231" default="include how long"].

[comment memo="Tourettes"]When talking about symptoms of Tourette's we discussed that tics first appeared at the age of [text name="variable_223981665" default="NEEDS to be age before 18"]. The tics occur many times a day, nearly every day for the past [text name="variable_1200951" default="AT LEAST ONE YEAR"]. The presence of multiple motor tics and phonic tics have been present[text name="variable_774532911"default="what kind of motor/phonic tics and was it concurrently"]The following have changed overtime in regards to tics [checkbox name="variable_321121" value="Anatomical location|number of tics|frequency|type|complexity|severity|"].[textarea name="variable_1459443521" default="describe"].The tics have been witnessed by a reliable examiner which is this prescriber.Involuntary movements and noises are not be explained by another medical condition or by the physiological effects of substances.

[comment memo="Bulimia"]
[comment memo="5 or more symptoms"]
Bulimics symptoms were asked and the patient stated the following symptoms [checkbox name="variable_375061" value="eating in a discrete period of time an amount of food this is definitely larger than most people would eat during similar circumstances|recurrent inappropriate compensatory behavior to prevent weight gain such as|drinking excessive amount of water or non-caloric beverages |Use of laxatives |Use of diuretics|Use of enemas|fasting|excessive exercise|. repeated episodes of binge eating occurring on average at least once a week for at least three months |Self evaluation is mainly influenced by body shape and weight|forceful vomiting after binge eating|forceful purging after binge eating |fear of eating in public places with others |stealing or hoarding food"]. The symptoms do not occur exclusively during episodes of anorexia nervosa.
[textarea name="variable_20208380196" default="sample text"]

[comment memo="Anorexia"]
[comment memo="If bulimia is seen with anorexia it is anorexia with Binge/Purge"]
Anorexia symptoms were asked and the patient stated the following symptoms [checkbox name="variable_8452676551" value="Restriction of food intake leading to weight loss | a failure to gain weight resulting in a significantly low body weight of what is expected for this patients age, sex, and height |fear of becoming fat |fear of gaining weight | distorted view of themselves and of their condition"]
[textarea name="variable_280088096" default="sample text"]

[comment memo="Somatic Symptom Disorder"]When going over somatic symptoms disorder the following symptoms were present[checkbox name="variable_27584362" value=" A history of physical complaints beginning before the age of 30 that occur over a period of several years that result in treatment being sought out which has significant impairment in important areas of functioning such as social and occuptional.|Persistently high level of anxiety about health or symptoms. |Excessive time and energy devoted to these symptoms or health concerns.|the state of symptoms are persistent|symptoms are distressing|symptoms result in significant disruption of daily life"]. The current severity is [select name="variable_143" value="mild.|moderate.|severe."][comment memo="Specify current severity:
Mild: Only one of the symptoms specified in Criterion B is fulfilled.
Moderate: Two or more of the symptoms specified in Criterion B are fulfilled.
Severe: Two or more of the symptoms specified in Criterion B are fulfilled, plus there are multiple somatic complaints (or one very severe somatic symptom)."]

[comment memo="Gender Dysphoria"]
[comment memo="at least two or more of the following:"]When going over symptoms of gender dysphoria the following symptoms were present with this patient with a marked incongruence between one’s experienced/expressed gender and assigned gender, of at least six months’ duration, as manifested by [checkbox name="variable_21584162" value=" marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics|A strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked incongruence with one’s experienced/expressed gender |A strong desire for the primary and/or secondary sex characteristics of the other gender|A strong desire to be of the other gender|A strong desire to be treated as the other gender|A strong conviction that one has the typical feelings and reactions of the other gender"]. The condition is associated with clinically significant distress in [checkbox name="variable_6774037751" value="social|occupational"] areas of functioning.

[comment memo="DID"]When going over symptoms of dissociative identity disorder the following symptoms were present: [checkbox name="variable_300594112" value=" Disruption of identity characterized by two or more distinct personality states. The disruption in identity involves marked discontinuity in sense of self and sense of agency, accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning.|Recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting. |The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.|The disturbance is not a normal part of a broadly accepted cultural or religious practice.|The symptoms are not attributable to the physiological effects of a substance (e.g., blackouts or chaotic behavior during alcohol intoxication) or other medical condition (e.g., complex partial seizures)"].

[comment memo="Nicotine dependence, unspecified, uncomplicated"]When going over symptoms of tobacco use the following symptoms were present with this patient with a problematic pattern of tobacco use leading to clinically significant impairment or distress, occurring within a 12-month period as manifested by [checkbox name="variable_566192" value=" Tobacco is often taken in larger amounts or over a longer period than was intended.|There is a persistent desire or unsuccessful efforts to cut down or control tobacco use.|A great deal of time is spent in activities necessary to obtain or use tobacco|Craving, or a strong desire or urge to use tobacco.|Recurrent tobacco use resulting in a failure to fulfill major role obligations at work, school, or home.|Continued tobacco use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of tobacco|Important social, occupational, or recreational activities are given up or reduced because of tobacco use.|Recurrent tobacco use in situations in which it is physically hazardous.|Tobacco use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by tobacco."]. Tolerance is defined for this patient as[checkbox name="variable_425805764" value="a need for markedly increased amounts of tobacco to achieve the desired effect.|a markedly diminished effect with continued use of the same amount of tobacco."] Withdrawal as manifested by[checkbox name="variable_2335664" value="the characteristic withdrawal syndrome for tobacco |Tobacco (or a closely related substance, such as nicotine) is taken to relieve or avoid withdrawal symptoms."]
The condition is associated with clinically significant distress in [checkbox name="variable_6774037751" value="social|occupational"] areas of functioning.

[comment memo="Insomnia Disorder"]
[comment memo="at least two or more of the following:"]When going over symptoms of insomnia the patient presented with a predominant complaint of dissatisfaction with sleep [checkbox name="variable_13965559" value="quantity|quality"] with the following symptoms[checkbox name="variable_26388912" value=" difficulty initiating sleep|difficulty maintaining sleep, characterized by frequent awakenings |difficulty maintaining sleep due to problems returning to sleep after awakenings.|Early-morning awakening with inability to return to sleep"]. The sleep disturbance causes clinically significant distress/impairment [checkbox name="variable_45656431" value="social|occupational|educational|academic"].
[comment memo="Next section both must be chosen for dx"]
[checkbox name="variable_34543947" value="The sleep difficulty occurs despite adequate opportunity for sleep |and is not better explained by and does not occur exclusively during the course of another sleep-wake disorder"][comment memo="Specify one of the three"]These symptoms present with [checkbox name="variable_1290434" value="nonsleep disorder mental comorbidity|other medical comorbidity|other sleep disorder"]The sleeping difficulty has been present for
[text name="variable_7542108" default="dx criteria is at least three months and at least three nights per week"]

[comment memo="OCPD"]
[comment memo="Obsessive Compulsive Personality Disorder"]When asked about symptoms that are seen in OCPD the patient states presence of
[checkbox name="variable_2127362" value="Preoccupation with details, rules, and lists, often to the extent that the main goal of a task or activity is overshadowed |Perfectionism that leads to an excessive focus on precision, making it difficult to complete tasks efficiently |
Devotion to work and productivity at the expense of leisure activities, hobbies, and social relationships |Rigid adherence to personal moral and ethical codes, often leading to a strong sense of righteousness |Reluctance to delegate tasks to others, as they are convinced that only their approach is correct|Hoarding of money or objects, even when they have no practical or emotional value|Inflexibility and difficulty in adjusting to changes in plans or circumstances.|Difficulty in discarding worn-out or worthless items, resulting in clutter and disorganization |
Unwillingness to compromise or consider alternative viewpoints, leading to conflicts in relationships |Tendency to be overly critical and judgmental of oneself and others, especially when tasks or projects do not meet their high standards"].[textarea name="variable_51437761" default="include how long"].