Psychological Medicine
Association
香港社區精神醫學會
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(Disclaimer: This checklist is not meant to be exhaustive and acts only as an aid to
clinical acumen. Clinical judgement for individual patient is always important.)
Disorder:
Symptoms: __________
Diagnosis: __________
Mental Capacity: __________
Disability:
Primary: __________
Secondary: __________
Severity: __________
Permanency: __________
Handicaps: __________
Assets: __________
Associated Factors:
Predisposing: __________
Precipitating: __________
Perpetuating: __________
Risk Assessment:
Dangerousness: Personal: Past behaviour: ____
Personality trait: ____
Illness related: Psychotic symptoms: ____
Substance abuse: ____
Poor compliance: ____
No insight: ____
Current mental status: Unstable mood: ____
Targeted victim: ____
Plans: ____
Suicide: Intention: Thoughts: ____
Plan: ____
Action: ____
Risk factors: __________
Past history: ____
Psychiatric disorder: __________
Need for consultation and referral: Doctor consulted: ____
Doctor referred: ____
Referral letter given: ____
Family members involved: ____
Explanation to patient: Illness: ____
Treatment: ____
Side effects: ____
DD usage: ____
October 2004
Information by Prof. Mak Ki Yan