NRNP/PRAC 6645 Comprehensive Psychiatric Evaluation Note Template CC(chief complaint): HPI: Past Psychiatric History: General Statement: Caregivers (if applicable): Hospitalizations:

NRNP/PRAC 6645 Comprehensive Psychiatric

Evaluation Note Template

CC(chief complaint):

HPI:

Past Psychiatric History:

• General Statement:
• Caregivers (if applicable):
• Hospitalizations:
• Medication trials:
• Psychotherapy orPrevious Psychiatric Diagnosis:

Substance Current Use and History:

Family Psychiatric/Substance Use History:

Psychosocial History:

Medical History:

• Current Medications:
• Allergies:
• Reproductive Hx:

ROS:

• GENERAL:
• HEENT:
• SKIN:
• CARDIOVASCULAR:
• RESPIRATORY:
• GASTROINTESTINAL:
• GENITOURINARY:
• NEUROLOGICAL:
• MUSCULOSKELETAL:
• HEMATOLOGIC:
• LYMPHATICS:
• ENDOCRINOLOGIC:

Physical exam:if applicable

Diagnostic results:

Assessment

Mental Status Examination:

Differential Diagnoses:

Case Formulation and Treatment Plan:

Reflections:

References

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