MH CONTINUED

Follow up appointment with [text name="variable_1" default="sample text"]. Completed today's visit [checkbox name="ll" value="in office.|via telehealth.|via audio only.|Patient and/or Guardian verified being in the state of Kentucky gave verbal consent to be treated via telehealth/telephone consultation. Patient and/or Guardian provided full consent to use this technology."] Patient and/or guardian was advised of the limitations of a visit via telehealth/telephone. Provider completed this visit within his/her office. Patient location during visit: [text name="home"]
Patient reports [select name="COMPL" value="taking medication as prescribed |has been taking as prescribed but admits missing occasionally|struggles with remembering to take medications |has not been taking medications"] Side effects: [checklist name="SE" value="Denies.|Has been having a few side effects.|Has been experiencing bothersome symptoms including"] [text name="SEE"].   
 Has been [checklist name="PROGRESS" value="doing ok    |feeling fine|feeling better|feeling worse|has not been doing well|great|bad"] since last visit. 
Medication [checklist name="med" value="has been helping with symptoms|has not been working|could be better||has been doing great and has been feeling better|has not been taking "]. Anxiety is [checklist name="anx" value="has been decreasing|has increased|has not been as bothersome|is well managed |n/a|resolved|is managable|"]. [textarea name="anxxx"]. [checklist name="anx" value="reports has had episodes of panic since last visit|Denies episodes of panic.|N/A|Resolved|manageable with medications|reduction in frequency and intensity"] [textarea name="panicsym"]   
Depression [checklist name="deppp" value="has been decreasing|has been increasing|has not been as bothersome|is well managed |n/a|resolved|is occasionally down but not every day."] [textarea name="dep"]. [checklist name="sihi" value="Denies SI/HI|Endorses SI but denies plan or intent|Endorses SI with plan|Endorses HI "]  [textarea name="siplans"] Contracts for safety [checklist name="contract" value="yes|no"]. Self-injurious behaviors [checklist name="selfinj" value="yes|no"] [textarea name="siplan"]. Sleep [checklist name="sleeep" value="has improved|has been good|has been poor reporting waking often during the night|has been poor reporting difficulty initiating sleep|has been interrupted by nightmares|has been interrupted by pain|has been fair"] Sleeping about [text name="sleephours"] hours nightly. Appetite is [checklist name="sleeep" value="good|fair|poor|reporting does not feel hungry|overactive reporting overeating"]
Symptoms of psychosis reported: . Mood swings [checkbox name="mood" value="N/A|absent |increasing|decreasing|manageable"]. Focus and concentration: [checklist name="focus" value="Good.|fair.|poor.|improved with medication.|could better.|denies any concerns."] During visit provided active listening, reflection, summarization, and reframing. Therapeutic support provided including normalization, validation, and psycho education. Encouraged to use positive self talk and to stay connected to positive and energy producing people and activities. Any changes to treatment or medications noted below. 
Discussed in today's session: 
[checkbox name="txplan" value="Discussed options including psychiatry/psychology available as well as family and/or other supports for counseling. Educated client/guardian of benefits/importance of compliance with individual therapy and medication management appointments. Medications, if any, included in today's visit to be monitored and titration/discontinuation dependent on the response. If applicable risks, benefits, and side effects of medications were reviewed and discussed in detail with client/guardian including the black box warnings. Discussed alternative treatment options with patient/guardian. Advised patient/guardian medication information also available in print per request. Encouraged to review medication insert provided by pharmacy, if applicable. Patient agreed to alert others and to seek help promptly if they would experience any intensification of their previous passive thoughts of life not being worth living. Patient agreed that the potential benefit of continuation of medication outweighs acknowledged risks. Client will be seen by provider every 1-3 months, or more often as needed, to evaluate progress/stability. Monitor changes in mood, behavior, emotional and cognitive functioning and abstain from substance/chemical use. Client/Guardian advised to call if any problems that arise and return to clinic.|Reviewed KASPER as appropriate. |Discussed importance of maintaining physical health yearly check-ups, preventative screenings, and follow up appointments for active management of any acute medical illness or chronic management of medical diagnosis. Advised client to contact primary care provider as needed to discuss physical health concerns. Client provided MCCC Crisis line contact number 1-800-422-1060 and advised accessible 24 hours day/7 days a week.|Counseled on possible risks and concerns associated with taking medication during pregnancy. Agrees to alert provider immediately if becomes pregnant.|Discussed with patient possible adverse effects of antipsychotic medications can range from relatively minor tolerability issues (e.g., mild sedation or dry mouth) to very unpleasant (e.g., constipation, akathisia, sexual dysfunction) to painful (e.g., acute dystonias) to disfiguring (e.g., weight gain, tardive dyskinesia) to life threatening (e.g., myocarditis, agranulocytosis). Some adverse effects have little short‐term clinical implications (e.g., increased prolactin or serum lipid levels), but may involve long‐term risk of medical complications. Pt educated and aware of risks and reports possible benefit outweighs risk.|Discussed sleep hygiene. Go to bed and wake up at the same time each day.  Lie down to sleep only when sleepy. If you can't sleep after 20 minutes, get out of bed and go to another room; return to the bedroom when you are tired; repeat as necessary. If you're trying to make yourself more tired, go to a room with soft light and read or do something on paper until your eyes are tired (and avoid phone/ipad/computer/tv in bed). Use bedroom for sleep and sex only. Don't do things in bed that might keep you awake, like watching television, reading, talking on the phone, or worrying. Avoid caffeine, nicotine, or alcohol for at least four to six hours before bedtime. Avoid strenuous exercise within four hours of bedtime. Avoid daytime napping. Relax before going to bed. Avoid eating large meals or drinking a lot of water or other liquids in the evening. Try chamomile tea or warm milk at bedtime. Keep the bedroom a comfortable temperature (65 to 68 F or 18-20 C). Use earplugs if noise is a problem. Expose yourself to daytime light for at least 30 minutes each morning.|Advised patient to avoid driving or operating heavy machinery when taking benzodiazepines.   Provider will continue to encourage patient to engage in individual therapy sessions to address and strengthen coping skills. Advised patient/guardian taking benzodiazepine medications can be dangerous because it can lead to overdose which can stop breathing.  Benzodiazepines can intensify some issues in regards to other medical conditions and people with balance or movement issues may be more prone to falls.  Benzodiazaepine medications can make you sleepy, dizzy, slow thinking and impair motor skills. Advised patient/guardian to avoid opiate or other sedating/CNS depressant medications and alcohol as taking them together can lead to life threatening side effects such as sedation, slow or ineffective breathing, coma, dizziness, confusion, or death. Taking benzodiazepines daily can lead to physical dependence. Advised not to abruptly stop taking benzodiazepines as they may experience withdrawal symptoms. Advised patient not to take more benzodiazepine medication than prescribed. Advised not to share benzodiazepine with others and keep in a safe place away from pets and children. Advised patient/guardian urine drug screen scheduled and random will occur while prescribed benzodiazepine medications. Advised patient may be contacted periodically for random pill counts and refills will be monitored utilizing Kasper.|Provider discussed risks associated with taking benzodiazepine medications while also prescribed opiate pain medications and/or other drugs that depress the central nervous system (CNS).  Patients/caregiver advised that patients taking opioids with benzodiazepines, other CNS depressant medicines, or alcohol should seek medical attention immediately if they or someone they experience symptoms of unusual dizziness or lightheadedness, extreme sleepiness, slowed or difficult breathing, or sedation/unresponsiveness, coma. Research shows that people who use opioids and benzodiazepines concurrently are at higher risk of visiting the emergency department, being admitted to a hospital for a drug-related emergency, and dying of drug overdose. Advised patient to avoid driving or operating heavy machinery.  Provider will continue to encourage patient to engage in individual therapy sessions to address and strengthen coping skills.|"]