MENTAL HEALTH HISTORY

MENTAL HEALTH HISTORY
Family Mental Health History:
[select name="famhist" value="Client denied family history of mental health concerns or attempted suicide| Client endorsed family history of mental health concerns. Client shared"][text name="familyhis" default="sample text""].

Past Suicide Attempts:
[select name="pastsuic" value="Client denied any history of suicidal ideation or attempted suicide|Client endorsed history of attempted suicide. Client shared"][text name="pastattempt" default="sample text""].

Psychiatric Hospitalizations:
[select name="pasthosp" value="Client denied any past psychiatric hospitalizations|Client endorsed hospitalization for a previous psychiatric concern(s). Client reported"][text name="pasthosp" default="sample text""].

Past Psychiatric Medications
[select name="pastmeds" value="Client denied any past use of psychiatric medications|Client reported previous use of the following psychiatric medication(s):"] [select name="pastmedlist" value="|fluoxetine (Prozac)|sertraline (Zoloft)|escitalopram (Lexapro)|citalopram (Celexa)|Vilazodone (Viibryd)|Aripiprazole (Abilify)|Duloxetine Cymbalta)"][text name="andpastmed" default="sample text""].

Past Psychotherapy: 
[select name="pastpsych" value="Client denied any past mental health treatment or psychotherapy| Client endorsed receiving previous psychotherapy from"] [text name="pastpsych" default="sample text""].




MENTAL HEALTH HISTORY
Family Mental Health History:
.

Past Suicide Attempts:
.

Psychiatric Hospitalizations:
.

Past Psychiatric Medications
.

Past Psychotherapy:
.




Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 0.55, 11 form elements, 17 boilerplate words, 5 text boxes, 6 drop downs, 11 total clicks
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