Psych Review Note

[text name="Role" default="ROLE" name=“variable_1"] note ([text name="Author" default="NAME" name=“variable_2"    size="50"])

[textarea name=“variable_3"    memo="HPC"]

MHA status: [text name=“variable_4"]

Past psych background: [checkbox value="No prior psych contacts" name=“variable_5"]
[textarea name=“variable_6"]
Past medical history: [checkbox value="No known significant medical history" name=“variable_7"]
[textarea memo="check EMR, previous summaries, clinic notes" name=“variable_8"]
[checkbox name="variable_9" value="Current GP: "][conditional field="variable_9" condition="(variable_9).is('')"][text name=“variable_10" size="50"][/conditional][text name=“variable_164"]
[checkbox memo="AHD?" name="variable_11" value=""][conditional field="variable_11" condition="(variable_11).is('')"][checkbox value="Patient has AHD in place. " name=“variable_12"][textarea name=“variable_13"][/conditional]

Medications: [checkbox value="No regular medications" name=“variable_14"]
[checkbox memo="Psych meds" name="variable_15" value=""][conditional field="variable_15" condition="(variable_15).is('')"][textarea sortable=true name=“variable_16"][/conditional][checkbox memo="other meds" name="variable_16" value=""][conditional field="variable_16" condition="(variable_16).is('')"][textarea sortable=true name=“variable_17"][/conditional]

[select name=“variable_18" value="|Medication list obtained from patient.|Medication list obtained from medical record. " memo="info from"]
[select name=“variable_19" value="|Patient appears compliant with medications|Known history of non-compliance|Suspected to be non-compliant" memo="compliance"]
[checkbox name=“variable_20" memo="Monitored medication checked" value=""][conditional field="variable_20" condition="(variable_20).is('')"][checkbox value="QScript checked - no recent dispensing records" name=“variable_21"][textarea][/conditional]

Allergies: [checkbox memo="yes" name="variable_22" value=""][conditional field="variable_22" condition="(variable_22).is('')"][textarea name=“variable_23"][/conditional][checkbox value="NKDA" name=“variable_24"]

On review today:
[checkbox value="Introductions made, role and purpose of review explained."]
[textarea name=“variable_25" size="120"]

Social history:
[comment  memo_color="powderblue" memo="Living situation"][select value="|Lives alone |Lives with partner |Lives with family |Nil fixed abode |Rest home resident |Dementia care resident " name=“variable_134"][text name=“variable_135"]
[comment  memo_color="powderblue" memo="Occupation"][select value="|Full-time. |Part-time. |Casual. |Retired. |Unemployed. |Student. " name=“variable_136"][text name=“variable_137"]
[comment  memo_color="powderblue" memo="Income"][select value="|Centrelink - NewStart|Centrelink - JobSeekers|DSP" name=“variable_138"][text name=“variable_139"]
[comment  memo_color="powderblue" memo="ADLs"][select name="ADLs" value="|Fully independent with iADLs. |Independent with " name=“variable_140"][text  name=“variable_141"][checkbox value="Requires assistance with: " name=“variable_142"][text  name=“variable_143]
[textarea memo="accom / current relationships / work / income / stressors / ADLs / support" name=“variable_34"]

[checkbox value="Personal history:" name="variable_35"][conditional field="variable_35" condition="(variable_35).is('')"][textarea name=“variable_36"][/conditional] 
[checkbox value="Premorbid function:" name="variable_37"][conditional field="variable_37" condition="(variable_37).is('')"][textarea name=“variable_38"][/conditional] 

[checkbox value="ATODs history:"] [checkbox value="not explored" name=“variable_26"][checkbox value="denies ATOD use" name=“variable_27"]
[checkbox memo="yes" name="variable_28" value=""][conditional field="variable_28" condition="(variable_28).is('')"][textarea memo="frequency, quantity, duration, last use, prev. withdrawals" fillable="true" name=“variable_29"]Alcohol - ******
Tobacco - ******
Cannabis - ******
Methamphetamines - ******
Other - ******[/textarea][/conditional]

[checkbox value="Forensic / legal history:"] [checkbox value="not explored" name=“variable_30"][checkbox value="denies forensic history of legal trouble" name=“variable_31"]
[checkbox memo="yes" name="variable_32" value=""][conditional field="variable_32" condition="(variable_32).is('')"][textarea name=“variable_33"][/conditional]

Mental State:
Appearance: [text name=“variable_39"]-year-old [text name=“variable_40"] appearing [select value="stated age|older than stated age|younger than stated age" name=“variable_41"], [select value="neat|disheveled" name=“variable_42"], dressed [text name=“variable_43"], [textarea rows="1" name=“variable_44"]
Behaviour: [textarea rows="1" name=“variable_45"][checkbox value=", normal eye contact/gait/posturing"][select name=“variable_46" value=", no psychomotor changes evident|, psychomotor agitation evident|, psychomotor retardation evident|"][textarea name=“variable_47" rows="1"]
Mood: [text name=“variable_48"] obj. [select value="euthymic|depressed|anxious|angry|irritable|happy|fluctuating|" name=“variable_49"][textarea rows="1" name=“variable_50"] Affect: [select value="|appears congruent/reactive|restricted|blunted|flat" name=“variable_51"][textarea rows="1" name=“variable_52"]
Speech: [select value="Normal rate, rhythm, tone, volume|" name=“variable_53"][textarea rows="1" name=“variable_54"]
Thoughts/perceptions: [select value="logical, linear|circumstantial|tangiental|flights of idea|" name=“variable_55"][textarea rows="1"  name=“variable_56"]. [textarea rows="1" name=“variable_57" memo="thought    content"]. [select value="no suicidal ideation or intentions, |"  name=“variable_58"][select value="no homicidal ideation or intentions|" name=“variable_59"][textarea rows="1"  name=“variable_60"][select value="denies perceptual disturbance|"  name=“variable_61"][textarea    row="1"][select value=", not witnessed responding to internal stimuli|" name=“variable_62"][textarea rows="1"  name=“variable_63"]
Orientation: [select value="NFA but appears grossly orientated|orientated to TTP|appears disoriented|"  name=“variable_64"][textarea rows="1" name=“variable_65"]
Insight: [select value="fair|good|poor|" name=“variable_66"][textarea rows="1" name=“variable_67"]
Judgment: [select value="fair|good|poor|impulsive|" name=“variable_68"][textarea rows="1"  name=“variable_69"]

[checkbox value="Investigations:" name="variable_70"][conditional field="variable_70" condition="(variable_70).is('')"][textarea name=“variable_71"][/conditional]
[comment  memo_color="plum" memo="FBC"][checkbox value=" Hb: " name=“variable_71"][text rows="1" size="5"  name=“variable_72"][checkbox value=" Hct: " name=“variable_73"][text rows="1" size="5"  name=“variable_74"][checkbox value=" MCV: " name=“variable_75"][text rows="1" size="5" name=“variable_76"][checkbox value=" MCH: " name=“variable_77"][text rows="1" size="5" name=“variable_78"][checkbox value=" Plt: " name=“variable_79"][text rows="1" size="5" name=“variable_80"][checkbox value=" WBC: " name=“variable_81"][text rows="1" size="5" name=“variable_82"][checkbox value=" Neuts: " name=“variable_83"][text rows="1" size="5" name=“variable_84"][text name=“variable_85"]
[comment  memo_color="plum" memo="UEC"][checkbox value=" Na: " name=“variable_86"][text rows="1" size="5" name=“variable_87"][checkbox value=" K+: " name=“variable_88"][text rows="1" size="5" name=“variable_89"][checkbox value=" Glu: " name=“variable_90"][text rows="1" size="5" name=“variable_91"][checkbox value=" Creat: " name=“variable_92"][text rows="1" size="5" name=“variable_93"][checkbox value=" eGFR: " name=“variable_94"][text rows="1" size="5" name=“variable_95"][text name=“variable_96"]
[comment  memo_color="plum" memo="LFTs"][checkbox value=" Pro: " name=“variable_97"][text rows="1" size="5" name=“variable_98"][checkbox value=" Alb: " name=“variable_99"][text rows="1" size="5" name=“variable_100"][checkbox value=" Bili (total/direct): " name=“variable_101"][text rows="1" size="5"  name=“variable_102"][checkbox value=" Urate: " name=“variable_103"][text rows="1" size="5" name=“variable_104"][checkbox value=" ALP: " name=“variable_105"][text rows="1" size="5"  name=“variable_106"][checkbox value=" GGT: " name=“variable_107"][text rows="1" size="5"  name=“variable_108"][checkbox value=" ALT: "  name=“variable_109"][text rows="1" size="5" name=“variable_110"][checkbox value=" AST: " name=“variable_111"][text rows="1" size="5"  name=“variable_112"][checkbox value=" LD: " name=“variable_113"][text rows="1" size="5" name=“variable_114"][checkbox value=" LFTs NAD" name=“variable_115"][text rows="1" size="5" name=“variable_116"][checkbox value=" mildly deranged LFTs" name=“variable_117"][text rows="1" size="5" name=“variable_118"]
[comment  memo_color="plum" memo="boneprof"][checkbox value=" Ca(corrected): " name=“variable_119"][text rows="1" size="5" name=“variable_120"][checkbox value=" Phos: " name=“variable_121"][text rows="1" size="5" name=“variable_122"][checkbox value=" Mg: " name=“variable_123"][text rows="1" size="5" name=“variable_124"][text name=“variable_125"]
[checkbox  memo_color="plum" value=" Coags: " name=“variable_126"][text rows="1" size="5"  name=“variable_127"]
[text rows="1" name=“variable_128"]
[checkbox  memo_color="plum" value="Urine: " memo="urine"  name=“variable_129"][text rows="1" size="10"  name=“variable_130"]
[checkbox  memo_color="plum" value="ECG: " name=“variable_130"][text rows="1" 10size="5"  name=“variable_131"]
[text memo="imaging"]

Impression / risks:
[textarea name=“variable_132"]

Plan:
[select value="Admit to MH|Discharge|Remain in ED|"  name=“variable_144"][text name=“variable_145"]
[checkbox value="visual obs 15/60" name=“variable_146"][text  name=“variable_147"]
[checkbox value="UDS - form in file" name=“variable_148"]
[checkbox value="Alcohol withdrawal chart" name=“variable_149"]
[checkbox value="Amphetamine withdrawal chart" name=“variable_150"]
[checkbox value="Cannabis withdrawal chart" name=“variable_151"]
[checkbox value="Physical obs " name=“variable_152"][text name=“variable_153"]
[checkbox value="Food and fluid chart" name=“variable_154"]
[checkbox value="BSLs QID" name=“variable_155"]
[checkbox value="Regular medications charted" name=“variable_156"][text name=“variable_157"]
[checkbox value="PRNs for agitation / analgesia charted" name=“variable_158"][text name=“variable_159"]
[checkbox value="Baseline ECG ASAP" name=“variable_160"][text name=“variable_161"]
[checkbox value="RMO to please complete physical" name=“variable_162"][text name=“variable_163"]
[textarea name=“variable_133"]
[comment memo="Variable 165"]