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:
Cognitive Function: Assess the patient's memory, attention, and problem-solving skills.
Patient's Environment: Evaluate the patient's home, school, and social environment for triggers or stressors.
Social Skills: Examine the patient's interpersonal skills and relationship building.
Physical Health: Evaluate the overall physical health of the patient, as it often impacts mental well-being.
Emotional State: Assess the patient's emotional stability and mood to determine potential mood disorders.
Behavioral Patterns: Evaluate the patient's behavior in various settings and situations.
Family History: Review the patient's family history of mental health disorders.
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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Evaluation Templates @ Template.net
