Mental Status Examination into PDF

Mental Status Examination

Patient Name Age Sex MaleFemaleOther Address Presenting Complaints

1. Appearance & Behavior

Well groomed Unkempt Restless Cooperative Uncooperative

Other observations

2. Speech

Spontaneous Slow Pressured Mutism

Other observations

3. Mood & Affect

Describe mood/affect

4. Thought

Stream Form Content

5. Perception

Hallucinations, illusions, etc.

6. Cognition

Orientation Memory Attention & Concentration

7. Insight & Judgment

Insight Judgment

Consultation

Doctor Name Consultant Psychologist