PPS and IO: Mobile Notes - Note Templates - Intake Notes

This article applies to the Private Practice Suite and Valant IO

Expand the following lists:

Child Intake Note

  1. Header
  2. Persons Present
  3. Chief Complaint
  4. HPI
  5. Measure Review - Child Symptom Screener
  6. Measure Review - PHQ-9
  7. Measure Review - HDCL-C
  8. Measure Review - GAD-7
  9. Measure Review - Agoraphobia Sub-Scale
  10. Measure Review - MoodDQ
  11. Measure Review - IPDS
  12. Measure Review - SCARED - Parent
  13. Measure Review - SCARED - Child
  14. Measure Review - PCL-C
  15. Measure Review - EDE-Q6
  16. Measure Review - Vanderbilt - Parent
  17. Measure Review - AUDIT
  18. Measure Review (Any measures that are assigned to the patient will be included here for review.)
  19. Stressors
  20. Review of Systems
  21. Substance Abuse Hx
  22. Substance Treatment Hx
  23. Substance Use Consequences
  24. Inpatient Hx
  25. Outpatient Hx
  26. Suicide/Self-Harm Hx
  27. Violence Hx
  28. Past Medical Hx
  29. Psychiatric Med Hx
  30. Patient Allergies
  31. Meds & Allergies
  32. Family Hx
  33. Developmental and Educational Hx
  34. General Social Hx
  35. Menstruation and Pregnancy Hx
  36. Vital Signs
  37. Exam
  38. Review of Measures
  39. Lab Results
  40. Sources of Information
  41. Assessment - Sources of Risk
  42. Measure Review - Suicide Ideation Subscale
  43. Suicide Risk Factors
  44. Suicide Protective Factors
  45. Suicide Prevention Plan
  46. Assessment - Diagnoses
  47. Assessment - Impression
  48. Assessment - Alternatives Considered
  49. Assessment - Informed Consent
  50. Counseling and Coordination of Care
  51. Psychotherapy
  52. Plan
  53. Plan - Med Changes
  54. Plan - Labs Ordered
  55. Plan - Next Appointment
  56. Review

Notes: Many of these sections are available to be assigned to patients with Patient Portal using the "Clinical History Form" in the Measures section in the patient chart portion of the core EMR. The sections will appear in the patient's Patient Portal and, once submitted, the content will prepopulate the equivalent sections in your Intake Note or Child Intake Note (which you can then edit while completing the note).



Child Intake Note - Comprehensive

  1. General Header
  2. Persons Present
  3. CIN - Introductory Information
  4. CIN - Chief Complaint
  5. CIN - Current Behavior
  6. HPI
  7. Measure Review - Child Symptom Screener
  8. Measure Review
  9. (Any measures that are assigned to the patient will be included here for review.)
  10. CIN - Caregiver Comments
  11. CIN - Interview with Child
  12. Review of Systems
  13. CIN - Mental Health Treatment/Evaluation History
  14. Psychiatric Medication History
  15. CIN - Medical History
  16. Meds & Allergies
  17.  Social History - Menstruation & Pregnancy
  18. CIN - Family Mental Health/Social History
  19. CIN - Family Medical History
  20. CIN - Prenatal Development and Birth History
  21.  CIN - Developmental History
  22. CIN - Current Living Situation
  23. CIN - Family Relationships
  24. CIN - Educational History
  25.  CIN - Social History
  26. CIN - Lifestyle Health
  27.  CIN - Legal History
  28.  CIN - Trauma/Stressors
  29.  CIN - Risk Assessment
  30.  CIN - Spiritual Orientation
  31.  Vital Signs
  32. DBP Physical Exam 2
  33.  Mental Status Exam
  34.  Psychotherapy Plan
  35.  Review of Measures
  36. Assessment - Impression
  37. Assessment - Diagnoses
  38. Treatment Plan
  39.  Plan
  40.  DBP Time Spent
  41.  Plan - Next Appointment 
  42.  Review

Notes: Many of these sections are available to be assigned to patients with Patient Portal using the "Comprehensive Child Clinical History Form" in the Measures section in the patient chart portion of the core EMR. The sections will appear in the patient's Patient Portal and, once submitted, the content will prepopulate the equivalent sections in your Child Intake Note - Comprehensive (which you can then edit while completing the note).



Intake Note

  1. Header
  2. Persons Present
  3. Chief Complaint
  4. HPI
  5. Measure Review - Adult Symptom Screener
  6. Measure Review - PHQ-9
  7. Measure Review - QUIDS
  8. Measure Review - GAD-7
  9. Measure Review - Agoraphobia Sub-Scale
  10. Measure Review - PDSS
  11. Measure Review - SPIN
  12. Measure Review - PCL-C
  13. Measure Review - MoodDQ
  14. Measure Review - EDE-Q6
  15. Measure Review - ASRS-V1.1
  16. Measure Review - AUDIT
  17. Measure Review - IPDS
  18. Measure Review
  19. (Any measures that are assigned to the patient will be included here for review.)
  20. Stressors
  21. Review of Systems
  22. Substance Abuse Hx
  23. Substance Treatment Hx
  24. Substance Use Consequences
  25. Inpatient Hx
  26. Outpatient Hx
  27. Suicide/Self-Harm Hx
  28. Violence Hx
  29. Past Medical Hx
  30. Psychiatric Med Hx
  31. Patient Allergies
  32. Meds & Allergies
  33. Family Hx
  34. Developmental and Educational Hx
  35. General Social Hx
  36. Menstruation and Pregnancy Hx
  37. Vital Signs
  38. Exam
  39. Review of Measures
  40. Lab Results
  41. Sources of Information
  42. Assessment - Sources of Risk
  43. Measure Review - Suicide Ideation Subscale
  44. Suicide Risk Factors
  45. Suicide Protective Factors
  46. Suicide Prevention Plan
  47. Assessment - Diagnoses
  48. Assessment - Impression
  49. Assessment - Alternatives Considered
  50. Assessment - Informed Consent
  51. Counseling and Coordination of Care
  52. Psychotherapy
  53. Plan
  54. Plan - Med Changes
  55. Plan - Labs Ordered
  56. Plan - Next Appointment
  57. Review

Notes: Many of these sections are available to be assigned to patients with Patient Portal using the "Clinical History Form" in the Measures section in the patient chart portion of the core EMR. The sections will appear in the patient's Patient Portal and, once submitted, the content will prepopulate the equivalent sections in your Intake Note or Child Intake Note (which you can then edit while completing the note).



Marriage and Family Therapy Intake Note

(Designed in partnership with and endorsed by the American Association for Marriage and Family Therapy (AAMFT))

  1. Header
  2. Referral
  3. Relationship Information
  4. Presenting Problem - Intake
  5. Measure Review (Any measures that are assigned to the patient will be included here for review)
  6. Family of Origin History
  7. Substance Abuse Hx
  8. Substance Treatment Hx
  9. Substance Use Consequences
  10. Inpatient Hx
  11. Outpatient Hx
  12. Suicide/Self-Harm Hx
  13. Violence Hx
  14. Past Medical Hx
  15. Psychiatric Med Hx
  16. Developmental and Educational Hx
  17. General Social Hx
  18. Menstruation and Pregnancy Hx
  19. Family Background
  20. External Systems
  21. Review

Notes: These sections are available to be assigned to patients with Patient Portal using the "MFT Clinical History Form" in the Measures section in the patient chart portion of the core EMR. The sections will appear in the patient's Patient Portal and, once submitted, the content will prepopulate the equivalent sections in your Marriage and Family Therapy Intake Note (which you can then edit while completing the note). 





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