V3

[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 symptoms  [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="decreased pleasure/interest|Extreme guilt|Low self-esteem/low-self worth|high energy|low energy|normal energy|increased appetite|decreased appetite|normal 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="appetite"][checkbox value="reports increased appetite| reports decreased appetite| reports weight gain| reports weight loss| denies appetite 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"].