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Psychiatrist Template

Psychiatric Collateral Information

A professional Psychiatrist template for healthcare professionals.
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About this template

Effortlessly gather comprehensive background information for psychiatric evaluations with our "Psychiatric Collateral Information" template. Ideal for psychiatrists, mental health nurses, and therapists, this template streamlines the documentation of vital details from family members or other involved parties. Capture presenting problems, psychiatric and substance histories, medical context, family dynamics, and personal milestones in a structured format. Heidi's AI scribe intelligently populates this template from your conversations, ensuring no critical details are missed when assessing a patient's mental health. Enhance your clinical workflow and provide thorough, well-informed patient care with this essential psychiatric collateral information template.

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Psychiatrist Note - 1 November 2024 Collateral Information: Ms. Sarah Jenkins, (07700 900333, sarah.jenkins@example.com), patient's mother. Presenting Problems: Ms. Jenkins reports increasing concerns about her daughter, Emily, aged 16. Emily has been exhibiting significant mood swings over the past six months, alternating between periods of intense sadness and irritability. She has withdrawn from her usual social activities, stopped attending sports clubs, and her academic performance has declined noticeably. Ms. Jenkins is particularly worried about Emily's recent comments about feeling "hopeless" and her difficulty sleeping. These issues appear to have intensified following the family's recent relocation. Psychiatric History: Emily had a brief period of anxiety symptoms around age 12, following a change in schools, which resolved without formal intervention. No prior diagnoses of psychiatric disorders. No history of self-harm or suicidal ideation reported by Ms. Jenkins, though she expressed concern about Emily's recent "hopeless" statements. Substance History: Ms. Jenkins denies any known history of substance use for Emily. She reports no concerns regarding alcohol, illicit drugs, or misuse of prescription medication. Medical History: Emily has a history of childhood asthma, well-controlled with inhalers as needed. No other significant past medical conditions, surgeries, or chronic illnesses. Currently not on any regular medications apart from her asthma inhaler. Family History: Ms. Jenkins reports a family history of depression on her side, with her mother (Emily's maternal grandmother) having been treated for depression in adulthood. No known family history of other psychiatric disorders or substance use. Forensic History: No known history of legal issues, arrests, convictions, or involvement with the criminal justice system. Personal History: Emily was a full-term, uncomplicated birth. Achieved developmental milestones within normal limits. Historically, she was an excellent student, engaged in extracurricular activities. Her academic performance began to decline in the last six months, corresponding with the onset of mood symptoms. She had a strong peer group prior to the family's relocation, but has struggled to form new friendships. Significant life event: recent family relocation six months ago due to father's work. Patient Diagnosis Information: Ms. Jenkins expressed concern that Emily might be experiencing depression, citing the family history and Emily's current symptoms. Future Plan Discussion: Ms. Jenkins hopes for a comprehensive assessment of Emily's mood and behavioural changes. She is open to psychotherapy and medication if deemed necessary. She also expressed interest in strategies to support Emily with social integration in their new environment.
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Use this template

Specialty

Psychiatrist

Used

11 times

Type

Note

Last edited

2026-03-19

Created by

Dr ME Paruk

Note

ER psych consult

Ryan Knebel

Psychiatrist, Canada

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