Mental Status Assessment Yes No Yes No Attitude Orientation Person Cooperative Place Guarded Time Withdrawn Situation Hostile Memory/ Appearance Immediate intact Cognitive Neat Short term intact Performance Unkempt Long term intact Disheveled Distractible/inattentive Unusual dress Slow processing Normal eye contact Impaired judgment Intense eye contact Limited awareness Poor/no eye contact Speech Mood Clear Euthymic Slurring Irritable Incoherent Elevated Slowed Depressed Pressured Anxious Loud Labile Soft Affect Normal/congruent Excessive Inappropriate/incongruent Minimal Constricted Nonverbal Flat Thought Psychomotor Normal Goal directed and logical content/ /Mobility Slowed Disorganized processing Involuntary movement/tics Hallucinating (visual, auditory, tactile) Compulsive/Repetitive behaviors/fidgeting Paranoid Normal posture Delusional Grandiose Slumped Obsessive thoughts Tangential Danger to Communication Suicidal ideation Verbal self/others Without plan method Sign language With plan Gestures Homicidal ideation Typing/handwriting Without plan Pictures/electronic device With plan Lip reading Other (explain in comments) Interpreter Braille Comments or additional observations: PART 5: Activities of Daily Living
Mental Status Assessment Yes No Yes No Orientation Person Place Time Situation Attitude Cooperative Guarded Withdrawn Hostile Appearance Neat Unkempt Disheveled Unusual dress Normal eye contact Intense eye contact Poor/no eye contact Memory/ Cognitive Performance Immediate intact Short term intact Long term intact Distractible/inattentive Slow processing Impaired judgment Limited awareness Mood Euthymic Irritable Elevated Depressed Anxious Labile Speech Clear Slurring Incoherent Slowed Pressured Loud Soft Excessive Minimal Nonverbal Affect Normal/congruent Inappropriate/incongruent Constricted Flat Psychomotor /Mobility Normal Slowed Involuntary movement/tics Compulsive/Repetitive behaviors/fidgeting Normal posture Slumped Thought content/ processing Goal directed and logical Disorganized Hallucinating (visual, auditory, tactile) Paranoid Delusional Grandiose Obsessive thoughts Tangential Communication method Verbal Sign language Gestures Typing/handwriting Pictures/electronic device Lip reading Interpreter Braille Danger to self/others Suicidal ideation Without plan With plan Homicidal ideation Without plan With plan Other (explain in comments) Comments or additional observations: PART 5: Activities of Daily Living
ComprehensiveEvaluation.docx