Nursing Home Psych Follow-Up with MSE, RBA, RBA statement, and consent

This nursing home psychiatric visit was conducted[select name="variable_1" value=" in person.| via telepsychiatry"] 
The pt was evaluated[select name="variable_1a" value=" in their room| in the dialysis suite| in the hall| in the dining hall| in the dayroom| at the nurses' station"] and privacy was secured and maintained.

Patient reports doing[select name="variable_2" value=" better| worse| well| good | slightly worse | slightly better| about the same"] since the last visit.[text name="variable_10953" default=""] 
Medication has[select name="variable_21" value=" helped with psychiatric symptoms.| no effect on psychiatric symptoms.| made psychiatric symptoms worse.| not changed psychiatric symptoms.| not helped psychiatric symptoms due to not taking the medication. | made psychiatric symptoms slightly worse.| somewhat of an effect."] [text name="variable_8231" default=""] 

The pt reported [textarea name="variable_134543" default=""]
Nursing reported [textarea name="variable_345341" default=""]

Psychiatric Exam:
The pt reported their Sleep as[select name="variable_2161" value=" adequate| inadequate| awful/bad| at baseline and good overall"]. [text name="variable_6241" default=""], their Appetite as[select name="variable_45671" value=" adequate| inadequate| awful/bad| at baseline and good overall"][text name="variable_5241" default=""], their Anxiety as [select name="variable_34731" value="nonexistent|mild|moderate|severe|better|worse"][text name="variable_39921" default=" "], Depression as [select name="variable_343001" value="nonexistent|mild|moderate|severe|better|worse"][text name="variable_39921" default=" "] 
Suicidal ideation:[select name="variable_431" value=" no suicidal ideation and contracts for safety.| suicidal ideation but contracts for safety and will not act on it.| suicidal ideation and can not contract for safety."][text name="variable_1" default=""]
Self-harm: [select name="variable_69691" value="no self-harm.||self-harm recently and does not contract for safety.| self-harm recently."][text name="variable_1" default=""] 
Homicidal ideation: [select name="variable_4561" value=" no homicidal ideation.| homicidal ideation.|"] 
The patient[select name="variable_7891" value=" denied hallucinations.| reported hallucinations in the form of | denied hallucinations but displayed symptoms consistent with reacting to internal stimuli.| nursing staff report that the pt displays symptoms consistent with reacting to internal stimuli."][text name="variable_52241" default=""] 
The patient[select name="variable_7791" value=" denied delusions.| had delusions in the form of| denied delusions but did display paranoia|"][text name="variable_52141" default=""] 
The patient reported[select name="variable_2561" value=" no mood swings.| having mood swings."][text name="variable_2881" default=""] 
The patient [select name="variable_2551" value="denied symptoms of mania.|denied symptoms of hypomania.|reported symptoms of hypomania.|reported symptoms of mania."][text name="variable_28181" default=""]
Concentration was[select name="variable_252251" value=" good.| worse| better| doing better with medication.| fair. | poor.|"][text name="variable_281811" default=""]

MSE
Orientation: alert and oriented [select name="variable_1dded" value="x 4|  "] [text name="variable_1ori" default=" to "]
Appearance: [select value=" normal| OBTUNDED| DISORIENTED| HYPERALERT"],[select name="variable_1o9oooi" value=" appropriately dressed, groomed, and/or kempt| INAPPROPRIATELY DRESSED, GROOMED, AND/OR KEMPT"],[select value=" normal posture| SLUMPED| RIGID| TENSE|-"].[textarea cols="20" rows="1"]
Behavior: [select value="calm|RESTLESS|AGITATED|RETARDED|PECULIAR|IMPULSIVE"],[select value=" interactive| WITHDRAWN| NONINTERACTIVE"],[select value=" eye contact good| eye contact AVOIDANT| eye contact INTENSE| eye contact FLEETING| eye contact FAIR"]. [textarea cols="20" rows="1"]
Attitude: [select value="cooperative|HOSTILE|OVERLY FRIENDLY|SECRETIVE|EVASIVE|SUSPICIOUS|APATHETIC|EASILY DISTRACTED|FOCUSED|DEFENSIVE|DEMANDING|SEDUCTIVE"]. [textarea cols="20" rows="1"]
Speech: [select name="spontn" value="spontaneous|NON-SPONTANEOUS|MUTISM"],[select name="rt" value=" normal reaction time| INCREASED REACTION TIME| DECREASED REACTION TIME| VARIABLE|-"],[select name="rate" value=" normal rate| SLOW| POVERTY| PAUCITY| RAPID| OVERTALKATIVE| PRESSURED|-"],[select name="vol" value=" normal volume| LOUD| SOFT| WHISPHER| MONOTONE|-"],[select name="rhythm" value=" clear rhythm| SLURRED| HESITANT| APHASIC| DYSPHASIC| DYSARTHRIC"].[textarea cols="20" rows="1"]
Mood was reported as: [textarea cols="20" rows="1"], inferred as[select value=" euthymic| NOT REPORTED| ANXIOUS| DEPRESSED| DYSPHORIC| IRRITABLE| ELEVATED| EXPANSIVE| ELATED| EUPHORIC| ANGRY| HOSTILE| INDIFFERENT| DETACHED| ANIMATED|-"]
Affect: [select value="euthymic|ANXIOUS|DEPRESSED|DYSPHORIC|IRRITABLE|ELEVATED|EXPANSIVE|ELATED|EUPHORIC|ANGRY|HOSTILE|INDIFFERENT|DETACHED|ANIMATED"], [select value=" range normal| BROAD| RESTRICTED|-"], [select value="intensity normal| EXPANSIVE| BLUNTED| FLAT| LABILE|-"], [select value=" congruent| INCONGRUENT"] 
Thought form: [select value="coherent|INCOHERENT|CANNOT BE ASSESSED"],[select value=" logical and goal-directed| DISORGANIZED| CIRCUMSTANTIAL| TANGENTIAL| LOOSENING| FLIGHT OF IDEAS"].[select value=" | NEOLOGISM| BLOCKING| VERBAL PERSEVERATION| CONFABULATION| CIRCUMFERENCIAL"]. [textarea cols="20" rows="1"]
Thought content: [select value="no delusions on current evaluation|DELUSIONS PRESENT|CANNOT BE ASSESSED"],[select value=" no active suicidal ideations at present| SUICIDAL IDEATIONS PRESENT| DEATH WISHES PRESENT| CANNOT BE ASSESSED"]. [textarea cols="20" rows="1"]
Perception: [select value="no hallucinations on current evaluation|HALLUCINATIONS|CANNOT BE ASSESSED|-"]. [textarea cols="20" rows="1"]
Insight: [select value="present|PARTIAL|POOR|MOSTLY BLAMES OTHERS|DIFFICULTY IN ACKNOWLEDGING PRESENCE OF PSYCHIATRIC SYMPTOMS|CANNOT BE ASSESSED"]. [textarea cols="20" rows="1"]
Judgment: [select value="intact|FAIR|IMPAIRED|CANNOT BE ASSESSED"]. [textarea cols="20" rows="1"]
Cognition: [select value="intact|ABNORMALITIES PRESENT|PENDING|CANNOT BE ASSESSED|-"]. [textarea default="normal attention, concentration, intact ability to recall recent and remote information, normal abstraction" cols="50" rows="3"]

RISK-BENEFIT ANALYSIS
[checkbox name="ssri" value="SSRI/SNRI"]
[conditional field="ssri" condition="(ssri).is('SSRI/SNRI')"][textarea name="variable_1" default="headaches, fatigue, ejaculatory delay, impotence, anorgasmia, GI distress, abnormal bleeding, SIADH (Citalopram: Dose-dependent QT interval prolongation -maximum dosage 20 mg> 65 y.o.), BLACK BOX WARNING: Increased risk of suicidal thoughts and behavior in pediatric and young adult patients taking antidepressants;"][/conditional]
[checkbox name="moods" value="Mood Stabilizers"]
[conditional field="moods" condition="(moods).is('Mood Stabilizers')"][textarea name="variable_2" default="hematological and liver abnormalities, GI upset, appetite changes, thrombocytopenia, BLACK BOX WARNING: VALPROIC ACID-rare but serious liver abnormalities LAMICTAL-rare but serious skin rash;"][/conditional]
[checkbox name="wellbutrin" value="Wellbutrin"]
[conditional field="wellbutrin" condition="(wellbutrin).is('Wellbutrin')"][textarea name="variable_3" default="insomnia, agitation, headaches, orthostatic hypotension, hypertension, seizures, rash (rare but serious); "][/conditional]
[checkbox name="APs" value="Antipsychotics"]
[conditional field="APs" condition="(APs).is('Antipsychotics')"][textarea name="variable_4" default="sedation, Parkinsonism, akathisia, akinesia, dystonia, tardive dyskinesia, blurred vision.dry mouth, constipation, urinary retention, metabolic syndrome, weight gain, neuroleptic malignant syndrome, stroke, cardiac arrest, priapism, respiratory suppression/aspiration, BLACK BOX WARNING: increased mortality in elderly;"][/conditional]
[checkbox name="remeron" value="Remeron"]
[conditional field="remeron" condition="(remeron).is('Remeron')"][textarea name="variable_5" default="agranulocytosis, sedation, QT-prolongation, serotonin syndrome, angle-closure glaucoma, increased appetite/weight gain, activation of mania/hypomania, elevated cholesterol/triglycerides, seizures, hyponatremia, and transaminitis; BLACK BOX WARNING: Increased risk of suicidal thoughts and behavior in pediatric and young adult patients taking antidepressants;"][/conditional]
[checkbox name="bzd" value="Benzos"]
[conditional field="bzd" condition="(bzd).is('Benzos')"][textarea name="variable_6" default="sedation, ataxia, memory loss, risk for dependence, abuse, and addiction, light-headedness, BLACK BOX WARNING: Concomitant use of benzodiazepines and opioids may result in profound sedation, respiratory depression, coma, and death. The continued use of benzodiazepines may lead to clinically significant physical dependence. The risks of dependence and withdrawal increase with longer treatment duration and higher daily dose. Abrupt discontinuation or rapid dosage reduction of benzodiazepines after continued use may precipitate acute withdrawal reactions, which can be life-threatening. To reduce the risk of withdrawal reactions, use a gradual taper to discontinue benzodiazepines or reduce the dosage;"][/conditional]
[checkbox name="anx" value="Hypnotics/Anxiolytics"]
[conditional field="anx" condition="(anx).is('Hypnotics/Anxiolytics')"][textarea name="variable_7" default="sedation, ataxia, paradoxical agitation, confusion, amnesia, addiction, respiratory suppression/aspiration, decreased motor skills, risk of falls;"][/conditional]
[checkbox name="li" value="Lithium"]
[conditional field="li" condition="(li).is('Lithium')"][textarea name="variable_8" default="GI upset, metallic taste, dizziness, increased appetite, fine tremor, polyuria, polydipsia, kidney damage, hypothyroidism BLACK BOX WARNING: toxicity;"][/conditional]
[checkbox name="tcas" value="Tricyclics"]
[conditional field="tcas" condition="(tcas).is('Tricyclics')"][textarea name="variable_9" default="dry mouth, blurred vision, constipation, sedation, urinary retention, impotence, tachycardia priapism, orthostatic hypotension;"][/conditional]
[checkbox name="stims" value="Stimulants"]
[conditional field="stims" condition="(stims).is('Stimulants')"][textarea name="variable_10" default="insomnia, agitation, headaches, GI upset, anorexia, hypertension, visual disturbances, irritability, seizures, blood dyscrasia BLACK BOX WARNING: addiction, psychosis;"][/conditional]
[checkbox name="achei" value="AChE Inhibitors"]
[conditional field="achei" condition="(achei).is('AChE Inhibitors')"][textarea name="variable_11" default="GI upset, muscle cramps, anorexia, orthostatic hypotension, syncope, seizures, GI bleeding;"][/conditional]
[checkbox name="nmda" value="NMDA Receptor Antagonists"]
[conditional field="nmda" condition="(nmda).is('NMDA Receptor Antagonists')"][textarea name="variable_12" default="dizziness, constipation, headaches, confusion."][/conditional]
[checkbox name="traz" value="Trazodone"]
[conditional field="traz" condition="(traz).is('Trazodone')"][textarea name="variable_15" default="dizziness, fatigue, headache, blurred vision, hypotension, diarrhea, constipation, weight changes, blurred vision;"][/conditional]
[checkbox name="nued" value="Nuedexta"]
[conditional field="nued" condition="(nued).is('Nuedexta')"][textarea name="variable_16" default="thrombocytopenia, QT-prolongation with potential for TdP, hepatotoxicity, dizziness, constipation, urinary retention, diarrhea, cough, drowsiness, restlessness;"][/conditional]

[checkbox name="statement" value="RBA Statement and Decision to Treat:"]
[conditional field="statement" condition="(statement).is('RBA Statement and Decision to Treat:')"][textarea name="variable_13" default="Based on the findings of my assessment, the above-stated goals/benefits of the recommended psychotropic drug intervention outweigh the primary risks, as noted above. I have given due consideration to this resident's available past medical history, and current medical comorbidities, including other prescribed medications, in reaching this conclusion. The resident's condition may worsen without intervention at this time. Medication intervention offers the potential to relieve the resident of severe emotional distress and improve functionality and quality of life."][/conditional]

[checkbox name="consent" value="INFORMED CONSENT FOR PSYCHOTROPIC MEDICATIONS:"]
[conditional field="consent" condition="(consent).is('INFORMED CONSENT FOR PSYCHOTROPIC MEDICATIONS:')"][textarea name="variable_14" default="The resident or the resident's medical decision-maker gave informed consent to the recommended psychotropic drug regimen. Information was discussed regarding the resident's current psychiatric condition, the nature and purpose of the proposed treatment, including the risks of treatment vs. its benefits, alternatives to treatment including their risks and benefits, along with the risks of no treatment."][/conditional]
This nursing home psychiatric visit was conducted
The pt was evaluated and privacy was secured and maintained.

Patient reports doing since the last visit.
Medication has

The pt reported
Nursing reported

Psychiatric Exam:
The pt reported their Sleep as. , their Appetite as, their Anxiety as , Depression as
Suicidal ideation:
Self-harm:
Homicidal ideation:
The patient
The patient
The patient reported
The patient
Concentration was

MSE
Orientation: alert and oriented
Appearance: ,,.
Behavior: ,,.
Attitude: .
Speech: ,,,,.
Mood was reported as: , inferred as
Affect: , , ,
Thought form: ,..
Thought content: ,.
Perception: .
Insight: .
Judgment: .
Cognition: .

RISK-BENEFIT ANALYSIS

































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Sandbox Metrics: Structured Data Index 0.58, 118 form elements, 89 boilerplate words, 14 text boxes, 29 text areas, 16 checkboxes, 43 drop downs, 16 conditionals, 102 total clicks
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