Академический Документы
Профессиональный Документы
Культура Документы
History
1. Intro
o
o
o
Initials:
Age:
Gender:
o
o
o
Marital status:
Occupation:
Location:
Date:
o
o
Admission history:
o Year:
o Reason:
o Length of admission:
o Involuntary/voluntary
ECT history:
Self-harm
o How many times:
o When the first episode:
o When the most recent:
o Forms of self harm:
Stitches / Medical attentions
after self-harm:
5. Family history
5.1. Parental history
Father (age & occupation):
Mother (age & occupation):
Relationship:
5.2. Siblings
Number:
Age range:
Relationship:
Illicit drugs:
Smoking:
9. Personal history
9.1.
Birth and development
Full term?:
Complications:
Breastfed/bottlefed
Dev. Milestone:
9.2.
9.3.
Age start:
Age
finish:
9.4.
Bullying/truancy?:
Qualification/certificate:
Academic performance:
Read/write
Last work:
Disability allowance?
Occupational history
Age start:
Type of jobs:
Problems?:
9.5.
Relationship history
9.6.
Psychosocial history
10.
Forensic history
11.
Premorbid personality
5. Perception
Hallucinations / Depersonalization / Derealization
6. Cognition
Year
Season
Date
Day
Month
7. Insight
Apple
Table
Penny
D
L
Floor
Hospital
Town/city
County
R
O
W
Apple
State
Table
Penny
Wristwatch
Pen
No ifs, ands, or buts
Take the paper in your right
hand
Fold it in half
Put it on the floor
Read this and do what it says
Make up and write a
sentence
Please copy this picture
Total (30)