PSYCHIATRY CONSULT PROGRESS NOTE

Date: / /

Interval History/Chief Concern: _

Pertinent Review of Systems (ROS):

Mental Status Examination

Appearance:
Behavior/Activity:
Speech:
Thought Form:
Thought Content:
Mood:
Affect:
Suicidal Ideation:
Homicidal Ideation:
Orientation:
Memory:
Judgment/Insight:
Attention/Concentration:
Other:

Medication:

Lab Findings:

Vital Signs:

Medical Decision Making (Note new problems, management options, dangerousness risks)
Assessment: _
Diagnoses: _
Recommendations: _

For Involuntary Patients:

[ ] Case and treatment plan discussed with:
[ ] ER Nursing
[ ] ER MD
[ ] ER Social Work
[ ] Psychiatry Nursing
[ ] Primary Medical Team
[ ] Primary Medical Team Social Work
[ ] Primary Medical Team Nursing

[ ] I have observed and evaluated this patient and have determined that he/she cannot be released from
involuntary treatment to accept treatment on a voluntary basis.

[ ] Patient will be converted to voluntary legal status