Psychiatric Initial visit Symptoms checker

[checkbox name="ADHD_inattention" memo="ADHD Inattention" value=""][checkbox name="ADHD_hyperactivity" memo="ADHD Hyperactivity" value=""][checkbox name="ADHD_combined" memo="ADHD Combined" value=""][checkbox name="depression" memo="Depression" value=""][checkbox name="anxiety" memo="Anxiety" value=""][checkbox name="bipolar_mania" memo="Bipolar Disorder (Mania)" value=""][checkbox name="bipolar_depression" memo="Bipolar Disorder (Depression)" value=""][checkbox name="PTSD" memo="PTSD" value=""][checkbox name="OCD" memo="OCD" value=""][checkbox name="panic_disorder" memo="Panic Disorder" value=""][checkbox name="social_anxiety" memo="Social Anxiety" value=""][checkbox name="ODD" memo="Oppositional Defiant Disorder" value=""][checkbox name="DMDD" memo="Disruptive Mood Dysregulation Disorder" value=""][checkbox name="conduct_disorder" memo="Conduct Disorder" value=""][checkbox name="schizophrenia" memo="Schizophrenia" value=""]

[conditional field="ADHD_inattention" condition="(ADHD_inattention).is('')"]
### ADHD (Inattention Type)    
ADHD Inattention Type symptoms reported include:
[checkbox value="careless mistakes|difficulty sustaining attention|not listening|failure to follow through|difficulty organizing tasks|avoiding tasks|forgetfulness|easily distracted|losing things necessary for tasks|difficulty with details|poor organizational skills|making repeated errors"]. 
[textarea memo="Additional information" rows="1"]
[/conditional]

[conditional field="ADHD_hyperactivity" condition="(ADHD_hyperactivity).is('')"]
### ADHD (Hyperactivity Type)    
ADHD Hyperactivity Type symptoms reported include:
[checkbox value="fidgeting|leaving seat|running or climbing excessively|unable to play quietly|talking excessively|interrupting others|difficulty waiting for turn|impulsivity|disruptive behavior|difficulty remaining seated|excessive movement|restlessness"]. 
[textarea memo="Additional information" rows="1"]
[/conditional]

[conditional field="ADHD_combined" condition="(ADHD_combined).is('')"]
### ADHD (Combined Type)    
ADHD Combined Type symptoms reported include:
[checkbox value="inattention|hyperactivity|impulsivity|difficulty sustaining attention|careless mistakes|difficulty organizing tasks|restlessness|fidgeting|talking excessively|difficulty remaining seated|interrupting others|difficulty waiting for turn|avoidance of tasks|forgetfulness|easily distracted|losing things necessary for tasks"]. 
[textarea memo="Additional information" rows="1"]
[/conditional]

[conditional field="depression" condition="(depression).is('')"]
### Depression    
Depression symptoms reported include:
[checkbox value="depressed mood|loss of interest|weight change|sleep disturbance|psychomotor agitation|fatigue|feelings of worthlessness|difficulty concentrating|recurrent thoughts of death|suicidal ideation|hopelessness"]. 
[textarea memo="Additional information" rows="1"]
[/conditional]

[conditional field="anxiety" condition="(anxiety).is('')"]
### Anxiety    
Anxiety symptoms reported include:
[checkbox value="excessive worry|restlessness|easily fatigued|difficulty concentrating|irritability|muscle tension|sleep disturbance|startle response|avoidance behaviors|panic attacks|feeling overwhelmed"]. 
[textarea memo="Additional information" rows="1"]
[/conditional]

[conditional field="bipolar_mania" condition="(bipolar_mania).is('')"]
### Bipolar Disorder (Mania)    
Bipolar Mania symptoms reported include:
[checkbox value="elevated mood|grandiosity|reduced need for sleep|talkativeness|racing thoughts|distractibility|increased goal-directed activity|excessive involvement in activities with high potential for painful consequences|impulsivity|irritability|hyperactivity|excessive energy"]. 
[textarea memo="Additional information" rows="1"]
[/conditional]

[conditional field="bipolar_depression" condition="(bipolar_depression).is('')"]
### Bipolar Disorder (Depression)    
Bipolar Depression symptoms reported include:
[checkbox value="depressed mood|loss of interest|weight change|sleep disturbance|psychomotor agitation|fatigue|feelings of worthlessness|difficulty concentrating|recurrent thoughts of death|suicidal ideation|hopelessness|sadness|low energy|feelings of guilt"]. 
[textarea memo="Additional information" rows="1"]
[/conditional]

[conditional field="PTSD" condition="(PTSD).is('')"]
### PTSD    
PTSD symptoms reported include:
[checkbox value="intrusive memories|flashbacks|nightmares|avoidance of reminders|negative changes in mood|detachment from others|increased arousal|hypervigilance|startle response|difficulty sleeping|irritability|difficulty concentrating"]. 
[textarea memo="Additional information" rows="1"]
[/conditional]

[conditional field="OCD" condition="(OCD).is('')"]
### OCD    
OCD symptoms reported include:
[checkbox value="obsessions|compulsions|intrusive thoughts|repetitive behaviors|rituals|difficulty controlling thoughts or behaviors|significant distress or impairment|avoidance behaviors|time-consuming rituals"]. 
[textarea memo="Additional information" rows="1"]
[/conditional]

[conditional field="panic_disorder" condition="(panic_disorder).is('')"]
### Panic Disorder    
Panic Disorder symptoms reported include:
[checkbox value="recurrent panic attacks|palpitations|sweating|trembling|shortness of breath|feeling of choking|chest pain|nausea|dizziness|chills|fear of losing control|fear of dying|numbness|tingling"]. 
[textarea memo="Additional information" rows="1"]
[/conditional]

[conditional field="social_anxiety" condition="(social_anxiety).is('')"]
### Social Anxiety    
Social Anxiety symptoms reported include:
[checkbox value="intense fear of social situations|worry about being embarrassed or judged|avoidance of social interactions|physical symptoms of anxiety in social situations|fear of being scrutinized|difficulty making eye contact|excessive self-consciousness|trembling|sweating"]. 
[textarea memo="Additional information" rows="1"]
[/conditional]

[conditional field="ODD" condition="(ODD).is('')"]
### Oppositional Defiant Disorder (ODD)    
ODD symptoms reported include:
[checkbox value="angry mood|argumentative behavior|defiant behavior|spiteful behavior|vindictiveness|actively refusing to comply with requests|deliberately annoying others|blaming others for mistakes"]. 
[textarea memo="Additional information" rows="1"]
[/conditional]

[conditional field="DMDD" condition="(DMDD).is('')"]
### Disruptive Mood Dysregulation Disorder (DMDD)    
DMDD symptoms reported include:
[checkbox value="severe temper outbursts|frequent irritability|angry mood|difficulty regulating emotions|verbal or physical aggression|difficulty maintaining friendships|outbursts out of proportion to situation|chronic irritability"]. 
[textarea memo="Additional information" rows="1"]
[/conditional]

[conditional field="conduct_disorder" condition="(conduct_disorder).is('')"]
### Conduct Disorder    
Conduct Disorder symptoms reported include:
[checkbox value="aggression toward people or animals|destruction of property|deceitfulness|theft|serious violation of rules|bullying|physical fights|using weapons|breaking laws|truancy|running away from home"]. 
[textarea memo="Additional information" rows="1"]
[/conditional]

[conditional field="schizophrenia" condition="(schizophrenia).is('')"]
### Schizophrenia    
Schizophrenia symptoms reported include:
[checkbox value="delusions|hallucinations|disorganized speech|grossly disorganized behavior|catatonia|negative symptoms|social withdrawal|reduced emotional expression|difficulty with daily functioning|cognitive impairments"]. 
[textarea memo="Additional information" rows="1"]
[/conditional]