V2

[comment memo="99212 requires 1 HPI
99213 requires 1 HPI + pertinent ROS
99214 requires 4 HPI + pertinent ROS plus one other + 1 P/F/S hx
99215 requires 4 HPI + complete ROS + 2 P/F/S hx"]

Date and Time of Service:[date default="today"] [text size="8"]

Patient presents today for a new patient evaluation. Patient presents with a chief complaint of "[textarea memo="quotes" default="depression/anxiety" rows="1"] 
Patient endorses symptoms of [checkbox value=" depression| anxiety| ADHD| bipolar I| bipolar II| cyclothymic disorder| unspecified mood disorder| social anxiety| PTSD| panic disorder| eating disorder"][textarea memo="other" default="" rows="1"]. Patient reports onset of symptom [textarea memo="onset" default="" rows="1"]. Patient reports the following precipitating events and/or stressors: [textarea memo="cause" default="" rows="1"]. The patient has noticed the following exacerbating factors: [comment memo="Exacerbating factors"][checkbox value=" isolation| reminders of past| lack of control| conflict with others"][textarea memo="other" default="" rows="1"]. However, the patient also notices that it is improved by: [comment memo="Modifying factors"] [checkbox value=" talking to someone| being alone| doing something physical like walking| doing something that is distracting"][textarea memo="other" default="" rows="1"]. Associated symptoms include: [comment memo="Associated symptoms "][checkbox value="Pleasure/Interest|Extreme guilt|Low self-esteem/low-self worth|Energy|Increased appetite|Decreased appetite|HI|SI with plan and intent|SI with plan without intent|SI without plan and without intent|Thoughts of self-harm|Self-harm behaviors|Restlessness|Muscle tightness/tension|Racing thoughts|Chest tightness/pain|Tachycardia|Shortness of breath|Paresthesias|GI distress related to anxiety| Sweating| Lightheadedness/dizziness| Shaking| Agoraphobia| Distractibility| Grandiosity|Flight of ideas|Increased goal-directed activity|Decreased need for sleep|Talkativeness|Risky behaviors|Impulsive behaviors|Elevated mood|Binging|Purging|Restricting|Significant weight loss or gain|Difficulty with focus, concentration, inattention|Difficulty completing challenging tasks|Forgetfulness|Fidgeting|Difficulty with academic performance|Flashbacks|Nightmares|Avoidance|Feeling on edge|Dissociation|Auditory hallucinations|Visual hallucinations|History of harming animals|History of fire setting"][textarea memo="other" default="" rows="1"]. Patient reports their depression is a [select name="depression" value="0|1|2|3|4|5|6|7|8|9|10"]; reports their anxiety is a [select name="anxiety" value="0|1|2|3|4|5|6|7|8|9|10"]; and reports they are sleeping on average [select name="sleep" value="0|1|2|3|4|5|6|7|8|9|10"] hours per night. Patient [comment memo="sleeping"][checkbox value="reports difficulty falling asleep|reports difficulty staying asleep|denies issues with sleep"]. Patient [comment memo="apetite"][checkbox value="reports increased apetite| reports decreased apetite| reports weight gain| reports weight loss| denies apetite concerns| denies weight changes"]. Patient [comment memo="side effects"][checkbox value="denies medication side effects|endorses medication side effects|is not currently taking psychiatric medications"][textarea memo="other" default="" rows="1"]. Patient [comment memo=""][checkbox value="Denies SI/HI|denies psychotic symptoms including A/V hallucinations"][textarea memo="other" default="" rows="1"].