Follow-up Session

Session Information 
Date: [date name="date" default="today"]
Length: [select name="length" value="30 mins|45 mins|60 mins"]
Format: [select name="format" value="telehealth|in-person|phone"]
Attendees: [checkbox name="attendees" value="writer|client|other"]
Member confirmed they are in the state listed in their address: [select name="state_confirmed" value="confirmed|uncertain"]

Rx Compliance: [checkbox name="rx_compliance" value="taking as prescribed|stopped taking|not taking regularly|N/A"]
Current Rx | Recent Changes: 
[textarea name="current_rx" default="NA"]

Most recent PHQ9|GAD7: [date name="recent_tests" default="08-04-2023"]
PHQ9: [text name="phq9_recent" default="0"]
GAD7: [text name="gad7_recent" default="0"]

Treatment Goals: 
[textarea name="tx_goals" default=" "]

Progress/Session Content
**Assessment of symptom experience or pursuit of treatment plan goals

[textarea name="session" default="include quotes"]

Mental Status Evaluation
Affect: [checkbox name="affect" value="appropriate|congruent to mood|flat|blunted|anhedonic|labile"]
Mood: [checkbox name="mood" value="euthymic|euphoric|anxious|irritable|frustrated|angry|sad|depressed|crying|lethargic|withdrawn|disengaged"]
Thought Content: [checkbox name="thought_content" value="within normal limits|delusions|distortions|compulsions|frustrated|ruminations"]
Insight: [checkbox name="insight" value="logical and linear|good|fair|poor|other"]
Judgment: [checkbox name="judgment" value="appropriate to setting|impaired|inappropriate"]
Speech: [checkbox name="speech" value="WNL|goal-directed|impoverished|rapid|illogical|incoherent|blocking|illogical|circumstantial|perseverative|tangential|flight of ideas|word salad"]
Attention/Concentration: [checkbox name="attention" value="WNL|limited|distracted"]
Impulse Control: [checkbox name="impulse" value="WNL|inappropriate"]


Assessment of safety concerns 
Member’s overall assessed safety risk: [checkbox name="safety_overall" value="low|moderate|elevated|imminent"]
Suicide Risk: [checkbox name="suicide" value="denied|passive ideation|active ideation|active plan/means|imminent risk of harm"]
Homicide Risk: [checkbox name="homicide" value="denied|passive ideation|active ideation|active plan/means|imminent risk of harm"]
Other Risk: [checkbox name="other_risk" value="denied|self-harm|grave disability|other"]

Member was made aware of relevant safety resources such as:
National Suicide Hotline Number (800-273-8255)
National safety text line (Text HOME to 741741)
Calling 911
Emergency Room usage

Interventions conducted: 
[checkbox name="interventions" value="review baseline paperwork|history gathering|psychoeducation|problem-solving|skills-training|goal-setting|person-centered|crisis intervention|unified protocol|DBT|CBT|ACT|mindfulness|MI|other"]

Goals to pursue prior to next session: [checkbox name="next_session" value="complete next lesson|continue therapy|Rx compliance|practice sleep hygiene|explore hobbies and leisure|exercise regularly|practice mindfulness daily"]