Making a psychiatric evaluation is a complex task. But you can streamline your process with the Psychiatric Evaluation Form Template from WPForms.
This form template is a great tool for mental health professionals such as psychiatrists, psychologists, or clinical social workers, to gather comprehensive information about a patient’s mental health history and status.
What Goes Onto a Psychiatric Evaluation Form?
A Psychiatric Evaluation Form is a standardized tool used by mental health professionals to gather comprehensive information about a patient’s mental health status, history, symptoms, and functioning.
We’ve organized our Psychiatric Evaluation Form Template into five sections, each covering patient information, medical details, and authorizations.
- Patient Information: In this first section, the form user enters the psychiatric patient’s personal details. Information here includes the patient’s name, date of birth, and email address.
- Referral Information: Next, specific information related to a patient’s referral is entered. The name of the referring physician is provided, along with the reason for the referral.
- Patient History: In this section, your form user describes the patient’s medical history and uploads any related documents, followed by a description of the patient’s psychiatric history. This section also covers substance use history and current medications.
- Patient Status: Here, the form user indicates whether or not the psychiatric patient has completed a mental status exam. Then, the diagnostic impression, treatment plan, and recommendations are typed into the form.
- Authorization: Lastly, your form user provides the date of the psychiatric evaluation, along with the name of the evaluator and their own digital signature. And to take the guesswork out of utilizing a signature on your form, we’ve included some internal information within the form builder to guide you.
Get started with WPForms today to create and customize your own evaluation form. Signing up with WPForms gives you access to this and hundreds of other pre-made templates.
