Suicide and Violence Risk Assessment

The patient is at a [select value="low|moderate|high"] acute and [select value="low|moderate|high"] chronic risk of suicide based on [checkbox value="lack of current suicidal ideation|current suicidal ideation|intent"] and [select value="well|moderately|poorly"] treated psychiatric symptoms at this time.  The patient has [checkbox value="no history of suicide attempts|a history of suicide attempts|a recent history of suicidal ideation|difficulty with supportive relationships|a minimal support system outside the hospital"]. They present as [checkbox value="future oriented|with plans for self-improvement|having a strong sense of personal responsibility|ambivalent about personal outcomes|pessimistic about personal outcomes"]. [textarea memo="additional information about suicide risk factors" rows="3"] 
The patient is at a [select value="low|moderate|high"] acute and [select value="low|moderate|high"] chronic risk of violence based on [checkbox value="lack of current violent ideation|current violent ideation|intent"] and [select value="well|moderately|poorly"] treated psychiatric symptoms at this time. The patient had [checkbox value="a lack of violent behaviors on the unit|agitated behaviors on the unit|agitated and violent behaviors on the unit|displayed adequate mood regulation|displayed difficulty with mood regulation"]. Prior to admission the patient had [checkbox value="no history of agitation and violence|a recent history of agitation and violence|difficulty with mood regulation|but has improved significantly with treatment|has made moderate improvement with treatment|has made minimal improvement with treatment|has made no improvement with treatment"]. [textarea memo="additional information about violence risk factors" rows="3"]