Psych Eval

Demographics [textarea name="variable_1" default=""]
CC [textarea name="variable_1" default=""]
Current Medications/Therapies [textarea name="variable_1" default=""]
HPI [textarea name="variable_1" default=""]
[select name="variable_1" value="No SI|Passive SI|SI with intent/plan"]
[select name="variable_1" value="No history of violence or HI|Reports HI|Reports HI with intent/plan; duty to warn"]
[checkbox name="variable_1" value="Able to contract for safety|Unable to contract for safety and must be screened"]
Psychiatric ROS [checkbox name="variable_1" value="Neurovegetative Sxs"][textarea name="variable_1" default="Sleep; Appetite; Libido"][checkbox name="variable_1" value="Mood"][textarea name="variable_1" default="Depression; Mania/Hypomania"]
[checkbox name="variable_1" value="Anxiety"][textarea name="variable_1" default=""]
[checkbox name="variable_1" value="Psychosis"][textarea name="variable_1" default=""]
[checkbox name="variable_1" value="Obsessive-Compulsive"][textarea name="variable_1" default=""]
[checkbox name="variable_1" value="Trauma"][textarea name="variable_1" default=""]
[checkbox name="variable_1" value="Behavioral"][textarea name="variable_1" default=""]
[checkbox name="variable_1" value="Medical"][textarea name="variable_1" default=""]
PAST PSYCH HISTORY [textarea name="variable_1" default=""]
SUBSTANCE ABUSE HISTORY [textarea name="variable_1" default=""]
DEVELOPMENTAL HISTORY [textarea name="variable_1" default=""]
SOCIAL HISTORY [textarea name="variable_1" default=""]
FAMILY HISTORY [textarea name="variable_1" default=""]
ALLERGIES [textarea name="variable_1" default=""]
MEDICAL HISTORY [textarea name="variable_1" default=""]
CURRENT MEDICATIONS [textarea name="variable_1" default=""]
LMP [date name="variable_1" default=""]
CONTRACEPTIVE METHOD [text name="variable_1" default=""]
MED TRIALS [textarea name="variable_1" default=""]
[comment memo="OBJECTIVE (ENTER DIRECTLY INTO EHR)"]
[comment memo="ASSESSMENT - RISK/DIAGONSES - ENTER DIRECTLY INTO EHR"]
RECOMMENDATIONS [textarea name="variable_1" default=""]
CLINICAL INTERPRETATION [textarea name="variable_1" default=""]
Demographics

CC

Current Medications/Therapies

HPI




Psychiatric ROS







PAST PSYCH HISTORY

SUBSTANCE ABUSE HISTORY

DEVELOPMENTAL HISTORY

SOCIAL HISTORY

FAMILY HISTORY

ALLERGIES

MEDICAL HISTORY

CURRENT MEDICATIONS

LMP
CONTRACEPTIVE METHOD
MED TRIALS

OBJECTIVE (ENTER DIRECTLY INTO EHR)
ASSESSMENT - RISK/DIAGONSES - ENTER DIRECTLY INTO EHR
RECOMMENDATIONS

CLINICAL INTERPRETATION

Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 0.33, 38 form elements, 33 boilerplate words, 1 text boxes, 23 text areas, 1 dates, 9 checkboxes, 2 drop downs, 2 comments, 37 total clicks
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