Psychiatric Admission Evaluation
Psychiatric Admission Evaluation
Psychiatric Admission Evaluation
Patient Name:
MRN:
Date of Birth:
Admission Date:
Date of Service:
STRENGTHS:
1. Good family and social support.
2. Access to healthcare.
WEAKNESSES:
1. Limited insight.
2. Poor coping skills.
DIAGNOSES:
Psychiatric:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Medical:______________________________________________________________________
______________________________________________________________________________
Psychosocial/Context:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
PLAN:
1. Admit to PHP/IOP_________(track) and begin therapy per protocol ____ days/week
______ hours/day. Therapies may include but are not limited to CBT, DBT, Process, and
Psychoeducational.
2. Medication:_____________________________________________________________.
Patient has been educated on this risks and benefits associated with the use of these
medications and has acknowledged this education.
3. Labs/Studies/Records:______________________________________________________
4. Safety Plan: Patient has been educated on the need to report any new or worsening
symptoms which are medication and/or diagnosis related. Patient has also been educated
on the following resources: the suicide prevention hotline 1-800-273-talk, 911 for
emergency services, and to report to the nearest ER for emergency services.
5. The following changes need to occur in order for the patient to function in a less
restrictive setting:
a. Attitude: Maintain a positive attitude toward treatment
b. Behaviors: (avoid cutting, outbursts, etc.)
c. Treatment plan goals to be met: (What goals does the patient want to meet?).