Guide to the Psychiatric History

IDENTIFICATION

MODE OF ADMISSION (MOA)

REASON FOR REFERRAL (RFR)

CHIEF COMPLAINT (CC)

SOURCE

HISTORY OF PRESENTING ILLNESS (HPI)

<u>Situation</u>

<u>Stressors</u>

<u>Symptoms</u>

<u>Substance</u>

<u>Safety</u>

<u>Supports</u>

PAST PSYCHIATRIC HISTORY

PAST MEDICAL HISTORY

FAMILY HISTORY

MEDICATIONS

ALLERGIES

PERSONAL HISTORY