NR 548 Week 6 Psychiatric Interview Documentation Assignment Template (Initials; Ken Smith)

enter text. text. to enter text. Name: motivation habit as anal attentive Review of Systems (ROS): Address all body systems that may help rule in or out a differential diagnosis Check the box next to each positive symptom and provide additional details. Include all provided information. If not assessed leave blank or select “other” if not applicable to the client. Constitutional Skin HEENT If patient denies all symptoms for this If patient denies all symptoms for this If patient denies all symptoms for this system, check system, check here: ☒ system, check here: ☒ here: ☒ ☐ Fatigue Click or tap here to enter text. ☐ Diplopia Click or tap here to enter text. ☐ Weakness Click or tap here to enter ☐ Rashes Click or tap here to enter ☐ Vision changes Click or tap here to enter text. text. text. ☐ Photophobia Click or tap here to enter text. ☐ Fever/Chills Click or tap here to enter ☐ Other: ☐ Earache Click or tap here to enter text. text. Click or tap here to enter text. ☐ Tinnitus Click or tap here to enter text. ☐ Weight Gain Click or tap here to enter ☐ Epistaxis Click or tap here to enter text. text. ☐ Vertigo Click or tap here to enter text. ☐ Weight Loss Click or tap here to enter ☐ Hearing Changes Click or tap here to enter text. text. ☐ Other: ☒Trouble Sleeping In the past Click or tap Click or tap here to enter text. here to enter text. ☐ Night Sweats Click or tap here to enter text. ☐ Other: Click or tap here to enter text. Respiratory Neuro Cardiac MSK If patient denies all symptoms for this If patient denies all symptoms If patient denies all symptoms for this If patient denies all symptoms system, check here: ☒ for this system, check here: system, check here: ☒ for this system, check here: ☒ ☒ ☐ Cough Click or tap here to ☐ Syncope or ☐ Chest pain Click or tap here to ☐ Pain Click or tap enter text. Lightheadedness Click or tap enter text. here to enter text. ☐ Hemoptysis Click or tap here to enter text. ☐ SOB Click or tap here to enter ☐Limited ROM here to enter text. ☐ Headache Click or tap text. Previous cardiac history Click or ☐ Dyspnea Click or tap here to here to enter text. tap here to enter text. ☐ Redness Click or tap enter text. ☐ Numbness Click or tap Name: text. ☐ Tingling Click or tap Click or tap here to enter text. ☐ Pain on Inspiration Click or tap here to enter text. ☐ Other: Click or tap here to enter text. ☐ Sensation Changes here to enter text. ☐ Snoring : Click or tap here to enter text. ☐ Speech Deficits Click ☐ Other: or tap here to enter text. Click or tap here to enter text. ☐ Other: Click or tap here to enter text. Hematology/Lymphatics