MH Review 7
COMMUNITY MENTAL HEALTH PATIENT REVIEW REVIEW / MANAGEMENT -- Summary of Treatment Provided Since Last Review -- [text name="variable_1" default="The patient"] is a [text name="variable_2" default="age"] year-old [select value="Female|Male"] with a primary diagnosis of: [textarea name="variable_1" default="Dx"] and has been a community mental health outpatient since [text name="variable_3" default="year"]. [select value="She|He"] is currently being treated with: [checklist name="variable_1" value="Psychopharmacological|Psychosocial|Psychological"] intervention(s). -- Date / Time of Review -- Date: [text name="variable_4" default="Date"] Time: [text name="variable_5" default="Time"] -- Issues / Problems Identified at Assessment -- My assessment also revealed difficulties with: [checkbox value="symptom severity|intrusive thoughts|physical illness|bereavement|family health difficulties|adjusting to stage of life|substance withdrawal|upheaval of lifestyle|substance misuse|divorce|separation from partner|relationship problems|imprisonment|poverty|personal injury|marital discord|dismissal from work|marital reconciliation|retirement|change in health of a family member|pregnancy|sexual difficulties|gain a new family member|business readjustment|change in financial status|arguments with others|mortgage|debt|work stress|child leaving home|trouble with in-laws|lack of achievement|partner's employment status|school starting|school ending|change in living conditions|revision of personal habits|trouble with the boss|trouble with parents|change in work hours|change in work conditions|education pressure|change in residence|change in school|church|religion|change in social activities|addictions|money worries|change in sleep habits|change in family structure|change in eating habits|vacation|holiday stress|legal problems|problems with the weather|academic underachievement|target of bullying|discord with teachers|stressful work schedule|under-employment|hazardous work conditions|exposure to toxins|inadequate housing|homelessness|discord with lodgers|discord with neighbours|discord with landlord|insufficient welfare support|low self-esteem|physical abuse|sexual abuse|emotional abuse|a traumatic experience|parental pressure|unusual parenting practices|discord with healthcare professional|legal problems|victim of crime|immigrant status|minority status|marginalization|social withdrawal and isolation|unable to make friends"] [textarea name="variable_2" default=""]. -- Reason for Referral -- [text name="variable_6" default="The patient"] was referred to Community Mental Health for: assessment, treatment, monitoring, care planning, advocacy and linking with rehabilitation and support services. -- Other Issues / Problems -- Current factors impacting on recovery include: [checkbox value="low motivation to change|denial of the mental health diagnosis|personality factors|poor coping skills|poor rapport with our service|unrealistic expectations for recovery|lack of community based services|difficulty coping with symptoms|unpleasant side effects from medication|poor compliance with medication|missing scheduled appointments|avoiding service contact|not hopefully about the future|unwilling to play an active role in recovery|identifies with the sick role|impulse control difficulties|does not derive benefit from their treatment|social isolation|lack of family support|continual substance abuse|feels stigmatized|engages in splitting behaviours|is hostile towards our service|has a shy and inhibited temperament|poor cohesion between services supporting patient|co-morbid medical problems|has a history of childhood adversity|co-morbid mental health concerns|intellectual difficulties|secondary gains from illness|poor rapport with the case manager"] [textarea name="variable_4" default=""] -- Summary of Progress -- At our last contact I would rate the severity of [text default="the patient's"] illness as [select value="stable and without symptoms|fully recovered|mildly ill|moderately ill|severely ill|among the most extremely ill patients"]. Compared to their condition on admission, I rate [text default="the patient's"] progress as: [select value="very much improved|much improved|minimally improved|no change|minimally worse|much worse|very much worse|unable to be assessed"]. -- Consumer View of Progress -- When asked to rate their progress, [text default="the patient"] reported [select value="very much improved|much improved|minimally improved|no change|minimally worse|much worse|very much worse|they don't know"]. -- Reason for Review -- [select value="13-Week Review|Risk Re-Assessment"] MEDICATIONS: [textarea name="variable_5" default=""] ASSESSMENT OF RISKS: [textarea name="variable_5" default="No current risks identified"] IMPRESSION AND PLAN -- Formulation -- [text default="The patient"] presents with a diagnosis of [textarea cols=30 rows=1 default=""] that includes symptoms of [textarea cols=80 rows=1 default=""]. The current treatment is [textarea cols=30 rows=1 default=""]. Recovery progress to date has been [select value="good|fair|static|minimal"] which is likely due to [textarea cols=80 rows=1 default=""]. -- Diagnosis -- [text name="variable_17" default="Dx"] -- Action Plan Following The Review -- [textarea name="variable_6" default="Continue with current treatment"] -- Clinicians Involved In The Review -- [textarea name="variable_7" default=""]
There are 32 form elements.