Psychiatry
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Previous Psych Meds:
[textarea name="variable_1" default="sample text"]
Past Psychiatric Medication Trials Include:
[textarea name="variable_1" default="sample text"]
[checkbox name="variable_1" value="Has Taken Psych Meds Before, Cannot Recall Name|x"]
[textarea name="variable_1" default="sample text"]

Alprazolam (Xanax)
Amitriptyline (Elavil)
Amoxapine (Asenden)
Aripiprazole (Abilify)
Aripiprazole (Abilify Maintena Injectable)
Aripiprazole Lauroxil (Aristada Injectable)
Asenapine (Saphris)
Atomoxetine (Strattera)
Benzotropine (Cogentin)
Brexpiprazole (Rexulti )
Bupropion (Wellbutrin)
Buspirone (Buspar)
Carbamazepine (Tegretol)
Clonidine For Adhd (Catapres)
Chlordiazepoxide (Librium)
Chlorpromazine (Thorazine)
Citalopram (Celexa)
Clomipramine (Anafranil)
Clonazepam (Klonopin)
Clorazepate (Tranxene)
Clozapine (Clozaril)
Diphenhydramine (Benadryl)
Desipramine (Norpramin)
Desvenlafaxine (Pristiq)
Dextroamphetamine (Adderall)/Dexedrine)
Dexmethylphenidate (Focalin)
Diazepam (Valium)
Donepezil (Aricept)
Doxepin (Sinequan)
Duloxetine (Cymbalta)
Escitalopram (Lexapro)
Folic Acid
Fluoxetine (Prozac)
Fluoxetine + Olanzapine (Symbyax)
Fluphenazine (Prolixin)
Fluphenazine (Prolixin Injectable)
Fluvoxamine (Luvox)
Gabapentin (Neurontin) For Anxiety/Mood
Galantamine (Razadyne)
Guanfacine For Adhd (Intuniv/Tenex)
Haloperidol (Haldol)
Haldol Decanoate Injectable
Hydroxyzine (Atarax/Vistaril)
Imipramine (Tofranil)
L-Methylfolate (Deplin)
Lamotrigine (Lamictal)
Lisdexamfetamine (Vyvanse)
Lithium (Lithobid)
Lorazepam (Ativan)
Loxapine (Loxitane)
Lurasidone (Latuda)
Maprotiline (Ludiomil)
Melatonin (Otc)
Memantine (Namenda)
Mesoridazine (Serentil)
Methylphenidate (Ritalin/Concerta/Metadate/Daytrana)
Milnacipran (Savella)
Mirtazapine (Remeron)
Modafinil (Provigil)
Molindone (Moban)
Nefazodone (Serzone)
Nortriptyline (Pamelor)
Olanzapine (Zyprexa)
Olanzapine Pamoate (Zyprexa Relprevv Injectable)
Oxazepam (Serax)
Oxcarbazepine (Trileptal)
Paliperidone (Invega Sustenna Injectable)
Paliperidone (Invega Trinza Injectable)
Paroxetine (Paxil)
Pemoline (Cylert)
Perphenazine (Trilafon)
Phenelzine (Nardil)
Prazepam (Centrax)
Prazosin (For Nightmares)
Prochlorperazine (Compazine)
Protriptyline (Vivactil)
Quetiapine (Seroquel)
Risperidone (Risperdal)
Risperidone (Risperdal Consta Injectible)
Rivastigmine (Exelon)
Selegiline(Emsam)
Sertraline (Zoloft)
Temazepam (Restoril)
Derealization (Mellaril)
Topiramate (Topamax)
Tranylcypromine (Parnate)
Trazodone (Desyrel)
Trifluoperazine (Stelazine)
Trimipramine) Or Multiple)
Valproic Acid (Depakene/Depakote)
Venlafaxine (Effexor)
Vilazodone (Viibryd)
Vortioxetine (Trintellix)
Zaleplon (Sonata)
Ziprasidone (Geodon)
Zolpidem (Ambien)
Zopiclone (Lunesta)
[textarea name="variable_1" default="sample text"]

Medication List:
[textarea name="variable_1" default="sample text"]
Allergies:
[textarea name="variable_1" default="sample text"]

[checkbox value="Has taken psych meds before, cannot recall name| Alprazolam (Xanax)| amitriptyline (Elavil)| amoxapine (Asenden)| aripiprazole (Abilify)| Aripiprazole (Abilify Maintena Injectable)| Aripiprazole lauroxil (Aristada Injectable)|asenapine (Saphris)|atomoxetine (Strattera)|benzotropine (Cogentin)| brexpiprazole (Rexulti )| bupropion (Wellbutrin)| buspirone (BuSpar)| carbamazepine (Tegretol)| clonidine for ADHD (Catapres)| chlordiazepoxide (Librium)| chlorpromazine (Thorazine)| citalopram (Celexa)| clomipramine (Anafranil)| clonazepam (Klonopin)| clorazepate (Tranxene)| clozapine (Clozaril)| diphenhydramine (Benadryl)| desipramine (Norpramin)| desvenlafaxine (Pristiq)| dextroamphetamine (Adderall)/Dexedrine)| dexmethylphenidate (Focalin)| diazepam (Valium)| donepezil (Aricept)|doxepin (Sinequan)| duloxetine (Cymbalta)| escitalopram (Lexapro)| folic acid| fluoxetine (Prozac)|fluoxetine + olanzapine (Symbyax)| fluphenazine (Prolixin)| fluphenazine (Prolixin Injectable)| fluvoxamine (Luvox)| gabapentin (Neurontin) for anxiety/mood| galantamine (Razadyne)| guanfacine for ADHD (Intuniv/Tenex)| haloperidol (Haldol)| Haldol Decanoate Injectable| hydroxyzine (Atarax/Vistaril)| imipramine (Tofranil)| L-methylfolate (Deplin)| lamotrigine (Lamictal)| lisdexamfetamine (Vyvanse)| lithium (Lithobid)| Lorazepam (Ativan)| loxapine (Loxitane)| lurasidone (Latuda)| maprotiline (Ludiomil)| melatonin (OTC)| memantine (Namenda)| mesoridazine (Serentil)| methylphenidate (Ritalin/Concerta/Metadate/Daytrana)|milnacipran (Savella)| mirtazapine (Remeron)| modafinil (Provigil)| molindone (Moban)| nefazodone (Serzone)| nortriptyline (Pamelor)| olanzapine (Zyprexa)| Olanzapine pamoate (Zyprexa Relprevv Injectable)| oxazepam (Serax)| oxcarbazepine (Trileptal)| Paliperidone (Invega Sustenna Injectable)| Paliperidone (Invega Trinza Injectable)| paroxetine (Paxil)| pemoline (Cylert)| perphenazine (Trilafon)| phenelzine (Nardil)| prazepam (Centrax)| prazosin (for nightmares)| prochlorperazine (Compazine)| protriptyline (Vivactil)| quetiapine (Seroquel)| risperidone (Risperdal)| Risperidone (Risperdal Consta Injectible)| rivastigmine (Exelon)| selegiline(Emsam)| sertraline (Zoloft)| temazepam (Restoril)| derealization (Mellaril)| topiramate (Topamax)| tranylcypromine (Parnate)| trazodone (Desyrel)| trifluoperazine (Stelazine)| trimipramine) or multiple)| valproic acid (Depakene/Depakote)| venlafaxine (Effexor)| vilazodone (Viibryd)| vortioxetine (Trintellix)| zaleplon (Sonata)| ziprasidone (Geodon)| zolpidem (Ambien)| zopiclone (Lunesta)|"]
Previous Psych Meds:

Past Psychiatric Medication Trials Include:




Alprazolam (Xanax)
Amitriptyline (Elavil)
Amoxapine (Asenden)
Aripiprazole (Abilify)
Aripiprazole (Abilify Maintena Injectable)
Aripiprazole Lauroxil (Aristada Injectable)
Asenapine (Saphris)
Atomoxetine (Strattera)
Benzotropine (Cogentin)
Brexpiprazole (Rexulti )
Bupropion (Wellbutrin)
Buspirone (Buspar)
Carbamazepine (Tegretol)
Clonidine For Adhd (Catapres)
Chlordiazepoxide (Librium)
Chlorpromazine (Thorazine)
Citalopram (Celexa)
Clomipramine (Anafranil)
Clonazepam (Klonopin)
Clorazepate (Tranxene)
Clozapine (Clozaril)
Diphenhydramine (Benadryl)
Desipramine (Norpramin)
Desvenlafaxine (Pristiq)
Dextroamphetamine (Adderall)/Dexedrine)
Dexmethylphenidate (Focalin)
Diazepam (Valium)
Donepezil (Aricept)
Doxepin (Sinequan)
Duloxetine (Cymbalta)
Escitalopram (Lexapro)
Folic Acid
Fluoxetine (Prozac)
Fluoxetine + Olanzapine (Symbyax)
Fluphenazine (Prolixin)
Fluphenazine (Prolixin Injectable)
Fluvoxamine (Luvox)
Gabapentin (Neurontin) For Anxiety/Mood
Galantamine (Razadyne)
Guanfacine For Adhd (Intuniv/Tenex)
Haloperidol (Haldol)
Haldol Decanoate Injectable
Hydroxyzine (Atarax/Vistaril)
Imipramine (Tofranil)
L-Methylfolate (Deplin)
Lamotrigine (Lamictal)
Lisdexamfetamine (Vyvanse)
Lithium (Lithobid)
Lorazepam (Ativan)
Loxapine (Loxitane)
Lurasidone (Latuda)
Maprotiline (Ludiomil)
Melatonin (Otc)
Memantine (Namenda)
Mesoridazine (Serentil)
Methylphenidate (Ritalin/Concerta/Metadate/Daytrana)
Milnacipran (Savella)
Mirtazapine (Remeron)
Modafinil (Provigil)
Molindone (Moban)
Nefazodone (Serzone)
Nortriptyline (Pamelor)
Olanzapine (Zyprexa)
Olanzapine Pamoate (Zyprexa Relprevv Injectable)
Oxazepam (Serax)
Oxcarbazepine (Trileptal)
Paliperidone (Invega Sustenna Injectable)
Paliperidone (Invega Trinza Injectable)
Paroxetine (Paxil)
Pemoline (Cylert)
Perphenazine (Trilafon)
Phenelzine (Nardil)
Prazepam (Centrax)
Prazosin (For Nightmares)
Prochlorperazine (Compazine)
Protriptyline (Vivactil)
Quetiapine (Seroquel)
Risperidone (Risperdal)
Risperidone (Risperdal Consta Injectible)
Rivastigmine (Exelon)
Selegiline(Emsam)
Sertraline (Zoloft)
Temazepam (Restoril)
Derealization (Mellaril)
Topiramate (Topamax)
Tranylcypromine (Parnate)
Trazodone (Desyrel)
Trifluoperazine (Stelazine)
Trimipramine) Or Multiple)
Valproic Acid (Depakene/Depakote)
Venlafaxine (Effexor)
Vilazodone (Viibryd)
Vortioxetine (Trintellix)
Zaleplon (Sonata)
Ziprasidone (Geodon)
Zolpidem (Ambien)
Zopiclone (Lunesta)


Medication List:

Allergies:


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