Psychiatry
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The patient is a [text memo="age" size="2"]-year-old,[checkbox value=" white|African-American|Hispanic|Asian|"] [checkbox value="female|male|transgender female|transgender male|gender non-binary individual"] with past psychiatric history of
[checkbox value="depression|MDD|situational depression|anxiety|GAD|panic attacks|mood disorder|bipolar disorder|somatic symptoms|somatic symptom disorder|ADHD|PTSD|dementia|dementia with behavioral disturbances|OCD|psychosis|substance abuse|personality disorder|maladaotive personality traits|recurrent suicidal ideation|suicide attempt|schizoaffective disorder, bipolar type|schizoaffective disorder|schizophrenia|psychosis|unknown mental health diagnosis|severe persistent mental illness|psychiatric hospitalization|noncompliance with psychiatric medications/treatment"] [textarea memo=" " rows="5"].

Patient [select value="initially presented to emergency department|initially presented to outside emergency department "][select value=" alone| with family| with significant other| via EMS | via transfer from outside facility| by police||"] [select value=" for complaints of | due to report of | for higher level of care due to "][text memo="PRESENTING PROBLEM" size="20"]. Per ED records, [select value="the patient reported |family reported |friend reported|EMS reported |staff at the facility reported|it was reported |outside records indicated |police reported|"][textarea memo="history of presenting complaints" rows="3"]. In ED, work-up showed [textarea name="variable_1" default="sample text"].

[checkbox name="depression" memo="depression" value=""][checkbox name="anxiety" memo="anxiety" value=""][checkbox name="sleep" memo="sleep" value=""][checkbox name="mood" memo="mood" value=""][checkbox name="ptsd" memo="ptsd" value=""][checkbox name="adhd" memo="adhd" value=""][checkbox name="autism" memo="autism" value=""][conditional field="depression" condition="(depression).is('')"] [var name="name"]'s depression is characterized as [checkbox value="little interest or pleasure in doing things|hopelessness|helplessness|sleeping too much|difficulty getting to sleep|difficulty staying asleep|feeling tired or having little energy|poor appetite|overeating|feelings of inadequacy|irritability|poor concentration|psychomotor retardation|psychomotor agitation|suicidal ideation"]. [select value="Depressive symptoms are present most of the day, nearly every day|Depressive symptoms are mostly present |"][text size="20"][select value=", are exacerbated by |"][text size="20][select value=", are improved by |"][text size="20]. [select value="Depressive symptoms impact|"][select value=" social/work functioning by | "][textarea rows="1"].[textarea memo="Additional Depression information" rows="5"][/conditional][conditional field="anxiety" condition="(anxiety).is('')"] The patient's anxiety generally presents as [checkbox value="feeling nervous or on edge|worry|difficulty relaxing|feeling restless|difficulty getting to sleep|difficulty staying asleep|irritability|poor appetite|overeating"][text size="20]. [select value="Anxiety is present |"][select value="in the context of multiple different situations/events such as |primarily in social situations such as | "][textarea rows="1"]. [select value="Anxiety usually last for approximately |Anxiety is present most of the time on most days"][text size="20"][select value=", is brought on by |"][text size="20][select value=", is relieved by |"][text size="20]. [textarea memo="Additional Anxiety information" rows="5"][/conditional][conditional field="mood" condition="(mood).is('')"][select value=" Mood instability has been an issue since |"][text size="20"]. [select value="Disordered mood can present as |"][checkbox value="euphoria|excessive energy|excessive self-confidence|insomnia|irritability|agitation|racing thoughts|impulsive behavior|risk taking behavior|paranoia|delusions of grandeur|auditory hallucinations|visual hallucinations|depression|apathy|hopelessness|helplessness|suicidal thoughts|no motivation|hypersomnia"]. [select value="Mood lability is exacerbated by |There are no identified precipitating factors to mood lability|"][textarea rows="1"]. [textarea memo="additional information of mood lability" rows="4"][/conditional][conditional field="autism" condition="(autism).is('')"]
[select value="Per patient,|Per family,|Per record,|"][text size="20"][select value=" they have been | patient has been |"][select value="diagnosed|undiagnosed|"][text size="20"][select value=" autism spectrum disorder "][textarea memo="details of diagnosis/symptom timeframe" rows="4"]. [var name="name"]'s symptoms present as persistent difficulty, in multiple contexts, with social communication and interaction including: [checkbox value="abnormal or failed back and forth conversation|failure to initiate or respond to social interactions|reduced sharing of interests/emotions|limited emotional affect|limited/incongruent nonverbal communication|difficulty with developing/maintaining/understanding relationships|difficulty sharing imaginative play|limited or absent interest in peers"]. They have demonstrated restricted/repetitive patterns of behavior, interests, or activities including: [checkbox value="repetitive motor movements|repetitive speech|infexible adherence to routines|ritualized patterns of verbal or nonverbal behavior|significant difficulty with transitions|rigid thinking patterns|highly restricted and fixated interests|hyper-reactivity to sensory input|hyporeactivity to some sensory input"]. Presentation is [select value="without|with"] intellectual impairment, and [select value="without|with"] language impairment. [textarea rows="4"][/conditional][conditional field="adhd" condition="(adhd).is('')"]
[var name="name"] has a pattern of [checkbox name=addtype value="inattention and hyperactivity/impulsivity|inattention|hyperactivity/impulsivity"] that interferes with functioning. [/conditional][conditional field="addtype" condition="(addtype).is('inattention and hyperactivity/impulsivity')||(addtype).is('inattention')"] Inattention manifests as [checkbox memo="At least 6 for ADHD" value="poor attention to details or careless mistakes in work or activities|difficulty sustaining attention|not seeming to listen when spoken to directly|not following through on instructions or failing to finish tasks|having difficulty organizing tasks and activities|avoiding tasks that require sustained mental effort|frequently losing things necessary for tasks|often easily distracted by extraneous stimuli|forgetfulness in daily activities"].[/conditional] [conditional field="addtype" condition="(addtype).is('inattention and hyperactivity/impulsivity')||(addtype).is('hyperactivity/impulsivity')"] [var name="name"]'s hyperactivity/impulsivity presents as [checkbox memo="six or more for ADHD" value="frequent fidgeting or squirming|often leaving seat when remaining seated is expected|frequently restless|difficulty engaging in leisure activities quietly|often seeming to be on the go or difficult to keep up with|excessive talking|blurting out answers before a question has been completed|difficulty waiting for their turn|interrupting or intruding on others"][/conditional][conditional field="adhd" condition="(adhd).is('')"]
These symptoms have been present since [text memo="before 12yo" size="20"], and are recognized in multiple settings including [text memo="2 or more" size="20"]. [textarea rows="3"][/conditional]
[conditional field="sleep" condition="(sleep).is('')"]Sleep is reported to be generally [select name="sleepq" value="poor |fair |good.|erratic |inconsistent |excessive|"][select value="with difficulty initiating sleep and staying asleep due to |with difficulty initiating sleep due to |with difficulty maintaining sleep due to |"][textarea rows="2"]. They estimate getting approximately [text size="4"] hours of [select value="broken |solid |"]sleep per night. [select value="Disturbed sleep has been an issue for |Disturbed sleep is a new issue within the last |"][textarea rows="1"]. [select value="There has been no workup for Sleep Apnea|There was a past workup for sleep apnea which indicated |"][textarea rows="1"]. [select value="Current attempts at improving sleep include |The patient is currently attempting no interventions to improve sleep|Current quality of sleep is dependent on |"][textarea rows="2"]. [select value="Past unsuccessful attempts at improving sleep include |There have been no past attempts at improving sleep|"][textarea rows="2"].[/conditional][conditional field="sleep" condition="(sleep).isNot('')"]Sleep is reported to be generally good. [/conditional][conditional field="depression" condition="(depression).isNot('')"]They deny any marked issues with depression. [/conditional][conditional field="anxiety" condition="(anxiety).isNot('')"]They deny any significant issues with anxiety. [/conditional][conditional field="mood" condition="(mood).isNot('')"]They deny a history of mania, excessive mood lability, grandiosity, or uncharacteristic risk taking behavior. [/conditional]

[select value="Current psychiatric medications include: |Patient is unable to recall current psychiatric medications|Unable to cover current psychiatric medications with patient due to symptomatic presentation|"][textarea rows="4"]. [select value="They are not currently receiving individual counseling/therapy|They are currently engaging in individual counseling with |"][textarea rows="1"]. [select value="They deny current suicidal ideation or thoughts of self harm|They report positive for |They deny suicidal ideation but state having thoughts of being better off dead"][textarea rows="1"]. [checkbox value="They are able to contract for safety.|They deny being able to contract for safety."][textarea rows="1"] [select value="They deny having access to guns|They report positive for having guns in the home |"][textarea rows="1"]. [checkbox value=" Explained that we ask this question because guns in the home increase the risk of suicide, homicide and accidental death, Provided education about the importance of keeping guns locked and separated from ammunition. Explained that should this provider feel that patient is unsafe to self or others, provider and patient will work together to develop a safe place to keep weapons to decrease risk of impulsive suicide or homicide."]


PSYCHIATRIC HISTORY:
[select value="Previous psychiatric medication trials include but may not be limited to: |The patient has no history of taking psychiatric medications|We were unable to cover previous psychiatric medication trials due to symptomatic presentation|The patient is unable to recall past psychiatric medication trials|"][textarea rows="1"]. [select value="There is no history of psychiatric hospitalizations|They have been psychiatrically hospitalized |"][textarea rows="2"]. [select value="Previous psychiatric/counseling services includes |They have no history of psychiatric/counseling|History of psychotherapy/counseling was not addressed due to symptomatic presentation|"][textarea rows="2"]. [select value="They deny history of diagnosis/treatment for an eating disorder|They report positive for a history of diagnosis/treatment for an eating disorder including |Unable to assess for history of diagnosis/treatment of an eating disorder due to symptomatic presentation|History of diagnosis/treatment of an eating disorder was not assessed in this encounter|"][textarea rows="1"].[select value="They have no history of thoughts of self-harm|History of thoughts of self harm include |"][textarea rows="2"]. [select value="They have no history of attempting to hurt themself|History of self-harm includes |Unable to obtain history of self-harm due to symptomatic presentation"][textarea rows="2"]. [select value="They have no history of head injuries or traumatic brain injuries|They have a past history of traumatic brain injuries resulting from |They have an underlying cognitive impairment from |"][textarea rows="2"]. [select value="There is no history of trauma|They report having a history of trauma but did not want to elaborate|They report past traumatic experiences to include |Trauma history was not covered due to symptomatic presentation|"][textarea rows="2"]. [select value="They report positive for tobacco use consuming approximately |They report a past history of tobacco but quit approximately |They deny any tobacco use|"][textarea rows="1"]. [select value="They report positive for alcohol use consuming approximately |They report a history abuse quitting approximately |They deny any alcohol use|"][textarea rows="2"]. [select value="They deny a history of recreational substance use|They report utilizing cannabis approximately |They have a history of opiate use disorder |They report utilizing opiates recreationally in the form of |Substance use history was not covered due to symptomatic presentation|"][textarea rows="4"].

SOCIAL HISTORY:
Living situation: [select value="lives with significant other|lives with family|lives alone|is homeless|lives with parents|lives with children|lives with roommate|lives in a grouphome|is currently residing in SNF|lives in nursing facility|lives in an assistant living facility|is homeless, currently staying at shelter|is homeless, currently living transiently "][text size="20"] in [text memo="residing location" size="20"]
[var name="name"] identifies [checkbox value="having no one as|significant other|extended family|children|friends|church members"][textarea rows="1"] social-support network. They have [select value="0|1|2|3|4|5|6|7|"][textarea rows="1"] children. Their level of education is [select value="highschool|an undergraduate degree in |a graduate degree in |some highschool|some college|currently in grade school|currently in highschool|currently in college studying |currently in graduate school studying |"][textarea rows="1"]. They are [select value="currently on disability due to their mental health condition|currently on disability due to their medical condition|currently employed |currently retired from |"][textarea rows="1"]. Financially they [select value="have no immediate concerns|are burdened by healthcare costs|have concerns related to supporting their family|"][textarea rows="1"]. Their source of income is primarily [select value="disability|social security|unemployment|current employment|family support|"][textarea rows="1"]. They have [select value="no current housing concerns|a currently unstable housing situation related to |"][textarea rows="1"]. [select value="Spirituality was not addressed this visit|Spirituality is identified as |"][select value="|Christian|Catholic|Muslim|Jewish|Spiritual but not practicing|Athiest|Agnostic|"][textarea rows="1"]. Sexual orientation [select value="was not addressed this visit|is identified as |"][select value="|heterosexual|homosexual|bisexual|pansexual|asexual"][textarea rows="1"]. [select value="They have no military history|Military history includes |Military history was not addressed this visit|"][textarea rows="1"]. [select value="They have no current legal concerns|Legal concerns include |Legal concerns were not addressed due to symptomatic presentation"][textarea rows="1"].

FAMILY PSYCHIATRIC HISTORY
[select value="They deny knowledge of a family history of mental illness|Family history of mental health problems is positive for |Unable to cover family history of psychiatric issues due to symptomatic presentation"][textarea rows="4"]. [select value="There is no known history of suicides or self-harm in the patient's family|Family history of suicides/self-harm includes |Unable to cover family history of suicides/self-harm due to symptomatic presentation|"][textarea rows="2"]. [select value="There is no known family history of substance use issues|Family history of substance use is positive for |Unable to cover family history of substance use issues due to symptomatic presentation|"][textarea rows="4"].

[text name="variable_1" default="Constitutional: "][select name="variable_1" value="White female, |White male,|African-American female,|African American male,|Hispanic female, |Hispanic male,|Asian female, |Asian male, |Black male,|Black female,| "][checkbox name="variable_1" value="in no apparent distress|looks given age|looks older than given age|looks younger than given age|well developed|chronically ill appearing|good attention to hygiene|breathing comfortably|cachectic|disheveled|comfortable|cooperative|distressed|frail|malnourished|moderately overweight|moderately uncomfortable|morbidly obese|non-toxic|overweight|petite|pleasant|pregnant|sleepy|somewhat tired|thin|uncomfortable appearing|undernourished|with a pleasant expression|with anasarca"].

[text name="variable_2" default="Musculoskeltal: "][checkbox name="variable_2" value="erect posture with smooth, coordinated gait, stable station|muscle strength for upper/lower extremities intact bilaterally with appropriate muscle tone and symmetry|full range of motion for all joints without crepitation or instability appreciated|bilateral muscle weakness in upper/lower extremities appreciated as a result of medical status|bilateral limitation of motion and stiffness appreciated as a result of current medical condition"].

[text name="variable_3" default="Patient Related Activities: "][checkbox name="variable_3" value="reviewed available records in Cerner|obtained history from collateral person|obtained and reviewed outside records|reviewed TN CSMD profile"].[comment memo="Text that will not show up in output"][comment memo="Text that will not show up in output"][comment memo="Text that will not show up in output"]
Follow-up visit for [checkbox name="variable_1" value="suicidal ideation|suicide attempt|depression|anxiety|mood disorder|bipolar disorder|somatic symptoms|agitation|delirium|dementia|dementia with behavioral disturbances|AMS|psychosis|substance abuse|substance withdrawal|patient on 6404|patient on 6401|re-evaluation of capacity|re-evaluation of need for geripsych|re-evaluation of need for emergency psychiatric hospitalization"].
[checkbox name="variable_2" value="First time seeing patient, case discussed with handing off provider."]
Chart/labs/imaging/assessments reviewed. Interval events discussed with staff. [select name="variable_2" value="In the past 24 hours|In the past 48 hours|Since admission"], patient [select name="variable_3" value="has|has not"] required psychiatric PRNs [textarea name="variable_2" default="-"], [select name="variable_4" value="has|has not"] required restraints[textarea name="variable_3" default=""], [select name="variable_5" value="has|has not"] endorsed suicidal ideation [textarea name="variable_4" default=""], and [select name="variable_6" value="has|has not"] required involvement of security [textarea name="variable_5" default=""].

[select name="variable_1" value="Per nursing|Per tech| Per staff|Per report from primary team |Per case management|Per attending|Reportedly|Per review of interval notes"],[textarea name="variable_1" default=" today the patient has been appropriate, cooperative with care and treatment, eating/drinking OK, not agitated and not appearing to respond to internal stimuli."]

[checkbox name="variable_3" value="Patient seen for follow-up in hospital room on medical floor|Patient seen for follow-up on unit| Dr. Sharpe also in attendance| RN present during interview|sitter at bedside, but steps out for interview|sitter at bedside during interview|security present during interview"]. Family/friends [select name="variable_7" value="are at bedside|are not currently at bedside but were reportedly here earlier|are not at bedside|are not at beside and have reportedly not been involved during admission"].

Constitutional/General:
Confirms: [checkbox name="symp_Constitutional_confirms" value=" fatigue|fever|chills|malaise|generalized weakness|diffuse pain|sleeping problems|night sweats|weight changes"]
Denies: [checkbox name="symp_Constitutional_denies" value=" fatigue|fever|chills|malaise|generalized weakness|diffuse pain|sleeping problems|night sweats|weight changes"]

Head:
Confirms: [checkbox name="symp_head_confirms" value="headaches|dizziness|syncope|sinus pain|LOC"]
Denies: [checkbox name="symp_head_denies" value="headaches|dizziness|syncope|sinus pain|LOC"]

Eyes:
Confirms: [checkbox name="symp_eyes_confirms" value="vision loss|blurriness|blind spots|floaters|diplopia|photophobia|eye pain|halos|erythemia|drainage|change in appearance|dryness"]
Denies: [checkbox name="symp_eyes_denies" value="vision loss|blurriness|blind spots|floaters|diplopia|photophobia|eye pain|halos|erythemia|drainage|change in appearance|dryness"]

Ears:
Confirms: [checkbox name="symp_ears_confirms" value="ear pain|tinnitus|hearing loss|fullness in ears|drainage|drainage|vertigo|frequent infections"]
Denies: [checkbox name="symp_ears_denies" value="ear pain|tinnitus|hearing loss|fullness in ears|drainage|drainage|vertigo|frequent infections"]

Nose,Mouth, and Throat:
Confirms: [checkbox name="symp_nose_confirms" value="loss of smell|obstruction|epistaxis|drainage|congestion|tenderness|sinus pain|lesions"]
Denies: [checkbox name="symp_nose_denies" value="loss of smell|obstruction|epistaxis|drainage|congestion|tenderness|sinus pain|lesions"]
Confirms: [checkbox name="symp_mouth_confirms" value="hoarseness|change in voice B|sore throat|bleeding in mouth|hemoptysis|swollen gums|recent abscess |recent extractions|soreness in mouth|soreness in tongue|ulcers|change in taste"]
Denies: [checkbox name="symp_mouth_denies" value="hoarseness|change in voice|sore throat|bleeding in mouth|hemoptysis|swollen gums|recent abscess |recent extractions|soreness in mouth|soreness in tongue|ulcers|change in taste"]

Skin:
Confirms: [checkbox name="symp_skin_confirms" value="diagnosed skin conditions|new lesions|rashes|discoloration|dryness|hair changes"]
Denies: [checkbox name="symp_skin_denies" value="diagnosed skin conditions|new lesions|rashes|discoloration|dryness|hair changes"]
Neck:
Confirms: [checkbox name="symp_neck_confirms" value="neck pain|stiffness|edema"]
Denies: [checkbox name="symp_neck_denies" value="neck pain|stiffness|edema"]

Cardiac:
Confirms: [checkbox name="symp_cardiac_confirms" value="chest pain|dyspnea| orthopnea|edema|palpitations|shortness of breath with activities|loss of consciousness|paroxysmal nocturnal dyspnea|need to elevate head at night due to SOB"]
Denies: [checkbox name="symp_cardiac_denies" value="chest pain|dyspnea| orthopnea|edema|palpitations|shortness of breath with activities|loss of consciousness|paroxysmal nocturnal dyspnea|need to elevate head at night due to SOB"].
Confirms: [checkbox name="symp_cardiac2_confirms" value="claudication|color changes in extremities|parathesias|coldness in extremities|tendency to bruise"]
Denies: [checkbox name="symp_cardiac2_denies" value="claudication|color changes in extremities|parathesias|coldness in extremities"]

Respiratory:
Confirms: [checkbox name="symp_resp_confirms" value="Pain with Respiration|Dyspnea|Cyanosis|Coughing|Wheezing|Sputum|Hemoptysis|Night Sweats|shortness of breath|exercise intolerance with activity"]
Denies: [checkbox name="symp_resp_denies" value="Pain with Respiration|Dyspnea|Cyanosis|Coughing|Wheezing|Sputum|Hemoptysis|Night Sweats|shortness of breath|exercise intolerance with activity"]

Gastrointestinal:
Confirms: [checkbox name="symp_gastro_confirms" value="appetite changes|heartburn|dysphagia|abdominal pain|nausea|vomiting|diarrhea|constipation|change in stools|flatulence|anorexia|hematemesis |intolerance to foods|painful bowel movements|bloating|cramping|anorexia|bright red blood per rectum|foul smelling dark black tarry stools|tenesmus"]
Denies: [checkbox name="symp_gastro_denies" value="appetite changes|heartburn|dysphagia|abdominal pain|nausea|vomiting|diarrhea|constipation|change in stools|flatulence|anorexia|hematemesis |intolerance to foods|painful bowel movements|bloating|cramping|anorexia|bright red blood per rectum|foul smelling dark black tarry stools|tenesmus"]

Endocrine:
Confirms: [checkbox name="symp_endo_confirms" value="thyroid tenderness|thyroid enlargement|excessive thirst|excessive hunger/excessive urination|heat intolerance|cold intolerance|unexplained Weight changes|changes in face or body hair|striae|increased hat or glove size|mood swings|sweaty|diarrhea|oligomenorrhoea|tremor, palpitations|visual disturbances|feeling slow|feeling tired|depression thin hair| croaky voice|heavy periods|constipation|dry skin|orthostatic symptoms, darkening of skin in non-sun exposed places"]
Denies: [checkbox name="symp_endo_denies" value="thyroid tenderness|thyroid enlargement|excessive thirst|excessive hunger/excessive urination|heat intolerance|cold intolerance|unexplained Weight changes|changes in face or body hair|striae|increased hat or glove size|mood swings|sweaty|diarrhea|oligomenorrhoea|tremor, palpitations|visual disturbances|feeling slow|feeling tired|depression thin hair| croaky voice|heavy periods|constipation|dry skin|orthostatic symptoms, darkening of skin in non-sun exposed places"]

Hematological/Lymphatic:
Confirms: [checkbox name="symp_hema_confirms" value="anemia|purpura|petechia| prolonged or excessive bleeding after dental extraction/injury|bruising|blood clots|enlarged lymph nodes|tender lymph nodes"]
Denies: [checkbox name="symp_hema_denies" value="anemia|purpura|petechia| prolonged or excessive bleeding after dental extraction/injury|bruising|blood clots|enlarged lymph nodes|tender lymph nodes"]

Genitourinary:
Confirms: [checkbox name="symp_gastro_confirms" value="dysuria|urinary frequency|urinary urgency| hematuria|flank pain|suprapubic pain|nocturia|polyuria|dark or discolored Urine|hesitancy|terminal dribbling|loss of force of stream|loss or urine with laughing, coughing, sneezing, exercise, position changes|loss of sensation|loss of control"]
Denies: [checkbox name="symp_gastro_denies" value="dysuria|urinary frequency|urinary urgency| hematuria|flank pain|suprapubic pain|nocturia|polyuria|dark or discolored Urine|hesitancy|terminal dribbling|loss of force of stream|loss or urine with laughing, coughing, sneezing, exercise, position changes|loss of sensation|loss of control"]

Reproductive (female):
Confirms: [checkbox name="symp_repro_f_confirms" value="change in cycle duration and frequency|vaginal bleeding irregularities|vaginal discharge|vaginal pain|menstrual pain|changes in sexual arousal or libido|infertility|painful intercourse"]
Denies: [checkbox name="symp_repro_f_denies" value="change in cycle duration and frequency|vaginal bleeding irregularities|vaginal discharge|vaginal pain|menstrual pain|changes in sexual arousal or libido|infertility|painful intercourse"]
Gravida (been pregnant):
Para (Full Term):
Premature Births:
Abortus (Non Viable pregnancies):
Last Mestral Period:
Pregnant: [select name="symp_female1_prego" value="No=1|Maybe=2|Yes=3"]

Reproductive (male):
Confirms: [checkbox name="symp_repro_m_confirms" value="difficulty with erection|difficulty with sexual arousal|lack of stamina|difficulty with emissions|testicular pain|hernias"]
Denies: [checkbox name="symp_repro_m_denies" value="difficulty with erection|difficulty with sexual arousal|lack of stamina|difficulty with emissions|testicular pain|hernias"]

Musculoskeletal:
Confirms: [checkbox name="symp_musk_confirms" value="joint pain or tenderness|joint swelling|muscles pain|ROM changes|stiffness |bony deformity|misalignment"]
Denies: [checkbox name="symp_musk_denies" value="joint pain or tenderness|joint swelling|muscles pain|ROM changes|stiffness |bony deformity|misalignment"]

Integument:
Confirms: [checkbox name="symp_inte_confirms" value="pruritis|rashes|stria|lesions|wounds|pigmentation changes|acanthosis nigricans|nodules|lumps/bumps|excessive dryness|discoloration|texture changes|eruptions"]
Denies: [checkbox name="symp_inte_denies" value="pruritis|rashes|stria|lesions|wounds|pigmentation changes|acanthosis nigricans|nodules|lumps/bumps|excessive dryness|discoloration|texture changes|eruptions"]

Neurological:
Confirms: [checkbox name="symp_neuro_confirms" value="change in sight|changes in smell|change in hearing|changes in taste|change in sensation|faints|fits|funny turns|headache|paraesthesias|numbness|paralysis|limb weakness|poor balance|loss of coordination|speech problems|seizures|dizziness|headaches|tremors|memory loss"]
Denies: [checkbox name="symp_neuro_denies" value="change in sight|changes in smell|change in hearing|changes in taste|change in sensation|faints|fits|funny turns|headache|paraesthesias|numbness|paralysis|limb weakness|poor balance|loss of coordination|speech problems|seizures|dizziness|headaches|tremors|memory loss"]

Psychiatric:
Confirms: [checkbox name="symp_psych_confirms" value="depression|change in sleep patterns|anxiety|difficulty concentrating|difficulty paying attention|change in body image|changes in work and school performance|paranoia|anhedonia|lack of energy|episodes of mania|episodic change in personality|sexual or financial binges|irritability|tension|suicidal thoughts|homicidal thoughts"]
Denies: [checkbox name="symp_psych_denies" value="depression|change in sleep patterns|anxiety|difficulty concentrating|difficulty paying attention|change in body image|changes in work and school performance|paranoia|anhedonia|lack of energy|episodes of mania|episodic change in personality|sexual or financial binges|irritability|tension|suicidal thoughts|homicidal thoughts"]

Social:
Confirms: [checkbox name="symp_social_confirms" value="change in home|relationships|employment|substance use|exercise|exposure"]
Denies: [checkbox name="symp_social_denies" value="change in home|relationships|employment|substance use|exercise|exposure"]

Function:
Confirms: [checkbox name="symp_funct_confirms" value="change in activities of daily living|memory|capacity"]
Denies: [checkbox name="symp_funct_denies" value="change in activities of daily living|memory|capacity"]

Breasts:
Confirms: [checkbox name="symp_breast_confirms" value="breast pain/soreness|discharge|lumps"]
Denies: [checkbox name="symp_breast_denies" value="breast pain/soreness|discharge|lumps"]
The patient is a age-year-old, with past psychiatric history of
.

Patient PRESENTING PROBLEM. Per ED records, history of presenting complaints. In ED, work-up showed .

depression anxiety sleep mood ptsd adhd autism


. . . .


PSYCHIATRIC HISTORY:
. . . .. . . . . . .

SOCIAL HISTORY:
Living situation: in residing location
name identifies social-support network. They have children. Their level of education is . They are . Financially they . Their source of income is primarily . They have . . Sexual orientation . . .

FAMILY PSYCHIATRIC HISTORY
. . .

.

.

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Follow-up visit for .

Chart/labs/imaging/assessments reviewed. Interval events discussed with staff. , patient required psychiatric PRNs , required restraints, endorsed suicidal ideation , and required involvement of security .

,

. Family/friends .

Constitutional/General:
Confirms:
Denies:

Head:
Confirms:
Denies:

Eyes:
Confirms:
Denies:

Ears:
Confirms:
Denies:

Nose,Mouth, and Throat:
Confirms:
Denies:
Confirms:
Denies:

Skin:
Confirms:
Denies:
Neck:
Confirms:
Denies:

Cardiac:
Confirms:
Denies: .
Confirms:
Denies:

Respiratory:
Confirms:
Denies:

Gastrointestinal:
Confirms:
Denies:

Endocrine:
Confirms:
Denies:

Hematological/Lymphatic:
Confirms:
Denies:

Genitourinary:
Confirms:
Denies:

Reproductive (female):
Confirms:
Denies:
Gravida (been pregnant):
Para (Full Term):
Premature Births:
Abortus (Non Viable pregnancies):
Last Mestral Period:
Pregnant:

Reproductive (male):
Confirms:
Denies:

Musculoskeletal:
Confirms:
Denies:

Integument:
Confirms:
Denies:

Neurological:
Confirms:
Denies:

Psychiatric:
Confirms:
Denies:

Social:
Confirms:
Denies:

Function:
Confirms:
Denies:

Breasts:
Confirms:
Denies:

Result - Copy and paste this output: