ROUNDS SHORT VERSION

Date and Time of Service: [date default=timestamp]

PATIENT NAME and room#: [textarea memo="NAME" default="" rows="1"]

CC: [checkbox value="follow up|depression|anxiety|bipolar|mood disorder|psychosis|behavioral|PTSD"] [textarea name="variable_2" default=" " rows="1"] 

Met with guest today, and they reports mood as "[checkbox value="ok|good|fair|poor|so-so"][textarea memo="mood" default="" rows="1"]." Guest reports sleeping [checkbox value="well|is fair| is poor"]. Reports appetite is [checkbox value="good|fair|poor"]. Guest reports their anxiety as [select value="0|1|2|3|4|5|6|7|8|9|10|declined to answer|UTA, nonverbal"]/10, and reports depression as [select value="0|1|2|3|4|5|6|7|8|9|10|declined to answer|W=UTA, nonverbal"]/10. 
[textarea memo="hpi comments" default="" rows="3"] [checkbox value="Guest reports medications are working well|They report physical therapy is going well.|Denies any issues or concerns."] [textarea memo="denies issues" name="variable_11" default=" " rows="3"] [checkbox value="Guest reports they are not doing well| Reports continued symptoms."] [checkbox value="Guest complains of the following symptoms"] [textarea memo="Guest c/o" default=" " rows="3"] [textarea memo="symptoms" default=" " rows="1"] [checkbox value="Guest denies any AH/VH/SI/HI/DTS/DTO."][comment memo="****"]
[checkbox value="Guest denies |auditory or visual hallucinations| hallucination|visual hallucinations|racing thoughts|excessive worry|suicidal ideation|homicidal ideation|thoughts of self-harm or self-injury|thoughts of harm to others"] [textarea memo="other" default="" rows="1"] [checkbox value="Guest was provided support and therapeutic listening to reduce anxiety and depression."] [checkbox value="No reports of any mood fluctuations by guest or staff."]

PSYCHIATRIC MEDICATIONS: [textarea memo="Current Rx" default="" rows="2"]

MENTAL STATUS: GENERAL: [select value="Alert|Sleepy"]
ORIENTATION: [select value="Alert and oriented with appropriate responses|Person|Place|Date|Situation|with appropriate responses|Disoriented"]
EYE CONTACT: [select value="appropriate|good|poor"]
SPEECH: [select value="normal rate, tone, volume|slow rate|rapid speech|low volume|loud volume|non verbal"] [select value="|slow rate|rapid speech|low volume|loud volume|non verbal"]
MEMORY/CONCENTRATION/COGNITION: [select value="Intact|Forgetful|Disoriented|Impaired"]
THOUGHT PROCESS AND CONTENT: [select value="Intact, Linear W/O disorder|logical, Goal-Directed|illogical at times|Paranoia| Delusions|disorganized|tangential"] [select value="|Intact, Linear W/O disorder|logical, Goal-Directed|illogical at times|Paranoia|Delusions|disorganized|tangential"]
INSIGHT/JUDGMENT: [select value="Intact|Good|Fail|Poor"] 
AFFECT and MOOD: [select value="Euthymic|Depressed|Neutral|Manic|Angry|Anxious"] [select value="|Euthymic|Smiling|Neutral|Appropriate to mood|Not appropriate|Blunted|Flat|Labile|irritable|tearful"][textarea name="other" default=" " rows="1"]

Dx: [var name="variable_30"] [textarea memo="ICD 10" default="" rows="1"]
PLAN: [select value=" Continue current medication regimen. |Medication change|Continue to follow and monitor."] [textarea name="variable_12" default="" rows="2"][comment memo="med change"] [checkbox value="Discussed med changes."] [select value="|Guest denies concerns about discharge plan.|Guest reports anxiety about discharge plans.| Guest reports concerns about discharge plans. Will follow up with CM.|"]