Adolescent Psychiatric Evaluation

[YOUR COMPANY NAME]

Date: [DATE]

Introduction: This assessment aims to evaluate the mental health status of adolescent patients, providing valuable insights into their psychiatric conditions.

Overview: This evaluation form covers key psychiatric aspects essential for a comprehensive understanding of adolescents' mental well-being, aiding in accurate diagnosis and effective treatment planning.

Rating Guide:

• 1: Indicates severe impairment or dysfunction.

• 2: Indicates moderate impairment or dysfunction.

• 3: Indicates mild impairment or dysfunction.

• 4: Indicates functional or slightly above-average performance.

• 5: Indicates exceptional or outstanding performance.

Evaluation Criteria:

1. Cognitive Function: Assess the patient's memory, attention, and problem-solving skills.

2. Patient's Environment: Evaluate the patient's home, school, and social environment for triggers or stressors.

3. Social Skills: Examine the patient's interpersonal skills and relationship building.

4. Physical Health: Evaluate the overall physical health of the patient, as it often impacts mental well-being.

5. Emotional State: Assess the patient's emotional stability and mood to determine potential mood disorders.

6. Behavioral Patterns: Evaluate the patient's behavior in various settings and situations.

7. Family History: Review the patient's family history of mental health disorders.

8. Risk Assessment: Assess the patient's risk of self-harm or harm to others.

Evaluation Table:

Evaluation Aspect	Criteria	Rating (1-5)
Cognitive Function	Memory, attention, problem-solving skills
Social Skills	Interpersonal skills, relationship building
Physical Health	Overall physical health
Emotional State	Emotional stability, mood
Behavioral Patterns	Behavior in various settings and situations
Risk Assessment	Risk of self-harm or harm to others

Additional Comments and Notes:

Evaluation Aspect	Criteria	Comments and Notes:
Patient's Environment	Home, school, social environment
Family History	History of mental health disorders in the family

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