Free Adolescent Psychiatric Evaluation Template
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:
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1: Indicates severe impairment or dysfunction.
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2: Indicates moderate impairment or dysfunction.
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3: Indicates mild impairment or dysfunction.
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4: Indicates functional or slightly above-average performance.
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5: Indicates exceptional or outstanding performance.
Evaluation Criteria:
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Cognitive Function: Assess the patient's memory, attention, and problem-solving skills.
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Patient's Environment: Evaluate the patient's home, school, and social environment for triggers or stressors.
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Social Skills: Examine the patient's interpersonal skills and relationship building.
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Physical Health: Evaluate the overall physical health of the patient, as it often impacts mental well-being.
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Emotional State: Assess the patient's emotional stability and mood to determine potential mood disorders.
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Behavioral Patterns: Evaluate the patient's behavior in various settings and situations.
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Family History: Review the patient's family history of mental health disorders.
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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 |
|
