Inpatient Psychiatric Nurse Assessment Form
Complete this assessment to document the patient's initial psychiatric status and presenting concerns during inpatient intake.
Presenting Problem
*
Mental Status Examination
*
Rows
Normal
Abnormal
Appearance
1
2
Behavior
3
4
Speech
5
6
Thought Process
7
8
Mood/Affect
9
10
Mood Assessment (Rate the patient's current mood)
*
Very Depressed
1
2
3
4
5
6
Very Elevated
7
1 is Very Depressed, 7 is Very Elevated
Risk Assessment
*
Suicidal Ideation
Homicidal Ideation
Self-Harm Behaviors
None Reported
Level of Insight
*
Good
Fair
Poor
Orientation
*
Oriented x3 (Person, Place, Time)
Disoriented
Sleep Pattern (Past 48 hours)
*
Normal
Insomnia
Hypersomnia
Interrupted
Substance Use (Past 30 days)
*
Alcohol
Cannabis
Stimulants
Opioids
None Reported
Current Psychotropic Medications
Nurse's Clinical Impression (Brief summary)
*
Submit Assessment
Should be Empty: