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Week (enter week #): (Enter assignment title)
Student Name
College of Nursing-PMHNP, Walden University
NRNP 6645: Psychopathology and Diagnostic Reasoning
Faculty Name
Assignment Due Date
NRNP/PRAC 6645 Comprehensive Psychiatric
Evaluation Note Template
CC (chief complaint):
HPI:
Past Psychiatric History:
·
            General Statement: 
·
            Caregivers (if applicable):
        
·
            Hospitalizations: 
·
            Medication trials: 
·
            Psychotherapy or
            Previous Psychiatric Diagnosis:
        
Substance Current Use and History:
Family Psychiatric/Substance Use History:
Psychosocial History:
Medical History:
·
            Current Medications: 
·
            Allergies:
             
        
·
            Reproductive Hx:
             
        
ROS:
· GENERAL:
· HEENT:
· SKIN:
· CARDIOVASCULAR:
· RESPIRATORY:
· GASTROINTESTINAL:
· GENITOURINARY:
· NEUROLOGICAL:
· MUSCULOSKELETAL:
· HEMATOLOGIC:
· LYMPHATICS:
· ENDOCRINOLOGIC:
Physical exam: if applicable
Diagnostic results:
Assessment
Mental Status Examination:
Differential Diagnoses:
Case Formulation and Treatment Plan:
Reflections:
References
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