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    NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Template

    Week (enter week #): (Enter assignment title)

    Student Name

    NRNP 6635: Psychopathology and Diagnostic Reasoning

    Faculty Name

    Assignment Due Date

    Subjective:

    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:

    Objective:

    Physical exam: if applicable

    Diagnostic results:

    Assessment:

    Mental Status Examination:

    Differential Diagnoses:

    Reflections:

    References

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