My Blog

[Solved] CPE1

Written by

admin

in

✓ Verified Academic Solution Available

Executive Solution Overview

– a year ago **files (3)** – ## CPETEMPLATE.docx – Screenshot2025-05-26at14.09.52.png – CPERUBRIC.docx **## CPETEMPLATE.docx** ![page1image3861729600](https://www.sweetstudy.com/questions/cpe1) **Comprehensive Psychiatric Evaluation Template** **With Psychotherapy Note** Encounter date: ______…

Instant Solution Download

$6.99

Immediate access to the full model answer, formatted citations, and rubric breakdown.

Need a Fresh Custom Paper?

Have this question answered from scratch according to your specific instructions and deadline.

Order on TutorsGallery →

Assignment Prompt & Instructions

– a year ago

**files (3)**

– ## CPETEMPLATE.docx

– Screenshot2025-05-26at14.09.52.png
– CPERUBRIC.docx

**## CPETEMPLATE.docx**

![page1image3861729600](https://www.sweetstudy.com/questions/cpe1)

**Comprehensive Psychiatric Evaluation Template**

**With Psychotherapy Note**

Encounter date: ________________________

Patient Initials: ______ Gender: M/F/Transgender ____ Age: _____ Race: _____ Ethnicity ____

Reason for Seeking Health Care: ______________________________________________

**HPI**:_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

**SI/HI:** _______________________________________________________________________________

**Sleep:**_________________________________________
**Appetite:**\_\_\______________________

**Allergies**(Drug/Food/Latex/Environmental/Herbal): ___________________________________

**Current perception of Health**: Excellent Good Fair Poor

**Psychiatric History:**

**_Inpatient hospitalizations:_**

| | | | |
| — | — | — | — |
| **_Date_** | **_Hospital_** | **_Diagnoses_** | **_Length of Stay_** |
| | | | |
| | | | |

**_Outpatient psychiatric treatment:_**

| | | | |
| — | — | — | — |
| **_Date_** | **_Hospital_** | **_Diagnoses_** | **_Length of Stay_** |
| | | | |
| | | | |

**_Detox/Inpatient substance treatment:_**

| | | | |
| — | — | — | — |
| **_Date_** | **_Hospital_** | **_Diagnoses_** | **_Length of Stay_** |
| | | | |
| | | | |

**_History of suicide attempts and/or self injurious behaviors:_**\_\_\__________________________________

**Past Medical History**

· Major/Chronic Illnesses____________________________________________________

· Trauma/Injury ___________________________________________________________

· Hospitalizations __________________________________________________________

**Past Surgical History**\_\_\_________________________________________________________

**_Current psychotropic medications:_**

\_\_\_______________________________________ ________________________________

\_\_\_______________________________________ ________________________________

\_\_\_______________________________________ ________________________________

**_Current prescription medications:_**

\_\_\_______________________________________ ________________________________

\_\_\_______________________________________ ________________________________

\_\_\_______________________________________ ________________________________

**_OTC/Nutritionals/Herbal/Complementary therapy:_**

\_\_\_______________________________________ ________________________________

\_\_\_______________________________________ ________________________________

**_Substance use_** _:_(alcohol, marijuana, cocaine, caffeine, cigarettes)

| | | | |
| — | — | — | — |
| **_Substance_** | **_Amount_** | **_Frequency_** | **_Length of Use_** |
| | | | |
| | | | |
| | | | |
| | | | |

**Family Psychiatric History:** _____________________________________________________

**Social History**

**Lives**: Single family House/Condo/ with stairs: ___________
**Marital Status**:________

**Education**:____________________________

**Employment Status**: ______
**Current/Previous occupation type**: _________________

**Exposure to:** ___Smoke____ ETOH ____Recreational Drug Use: __________________

**Sexual Orientation:** _______ Sexual Activity: ____
**Contraception Use**: ____________

**Family Composition:** Family/Mother/Father/Alone
**: _____________________________**

**Other: (Place of birth, childhood hx, legal, living situations, hobbies, abuse hx, trauma, violence, social network, marital hx):_________________________________**

**\_\_\______________________________________________________________________**

**Health Maintenance**

**Screening Tests (submit with SOAP note): Depression, Anxiety, ADHD, Autism, Psychosis, Dementia**

**Exposures:**

**Immunization HX:**

**Review of Systems (at least 3 areas per system):**

General:

HEENT:

Neck:

Lungs:

Cardiovascular:

Breast:

GI:

Male/female genital:

GU:

Neuro:

Musculoskeletal:

Activity & Exercise:

Psychosocial:

Derm:

Nutrition:

Sleep/Rest:

LMP:

STI Hx:

**Physical Exam**

BP________TPR_____ HR: _____ RR: ____Ht. _____ Wt. ______ BMI (
**percentile**) _____

General:

HEENT:

Neck:

Pulmonary:

Cardiovascular:

Breast:

GI:

Male/female genital:

GU:

Neuro:

Musculoskeletal:

Derm:

Psychosocial:

Misc.

**Mental Status Exam**

Appearance:

Behavior:

Speech:

Mood:

Affect:

Thought Content:

Thought Process:

Cognition/Intelligence:

Clinical Insight:

Clinical Judgment:

| |
| — |
| **Psychotherapy Note** |
| **Therapeutic Technique Used:** |
| **Session Focus and Theme:** |
| **Intervention Strategies Implemented:** |
| **Evidence of Patient Response**: |

**Plan:**

**Differential Diagnoses**

**1.**

**2.**

**Principal Diagnoses**

**1.**

**2.**

**Plan:**

**Diagnosis #1**

**Diagnostic Testing/Screening:**

**Pharmacological Treatment:**

**Non-Pharmacological Treatment:**

**Patient/Family Education:**

**Referrals:**

**Follow-up:**

**Anticipatory Guidance:**

**Diagnosis #2**

**Diagnostic Testing/Screening Tool:**

**Pharmacological Treatment:**

**Non-Pharmacological Treatment:**

**Patient/Family Education:**

**Referrals:**

**Follow-up:**

**Anticipatory Guidance:**

**Signature (with appropriate credentials): __________________________________________**

**Cite current evidenced based guideline(s) used to guide care (Mandatory)_______________**

**DEA#: 101010101 STU Clinic LIC# 10000000**

**Tel: (000) 555-1234 FAX: (000) 555-12222**

Patient Name: (Initials)______________________________ Age ___________

Date: _______________

**RX ______________________________________**

**SIG:**

**Dispense**: ___________
**Refill:** _________________

**No Substitution**

**Signature:** ____________________________________________________________

**Rev. 2272022 LM**

## image1.png

**Screenshot2025-05-26at14.09.52.png**

This file is too large to display. [View in new window](https://www.sweetstudy.com/files/screenshot2025-05-26at14-09-52-png)

**CPERUBRIC.docx**

This file is too large to display. [View in new window](https://www.sweetstudy.com/files/cperubric-docx)

**CPERUBRIC.docx**

This file is too large to display. [View in new window](https://www.sweetstudy.com/files/cperubric-docx)

**## CPETEMPLATE.docx**

![page1image3861729600](https://www.sweetstudy.com/questions/cpe1)

**Comprehensive Psychiatric Evaluation Template**

**With Psychotherapy Note**

Encounter date: ________________________

Patient Initials: ______ Gender: M/F/Transgender ____ Age: _____ Race: _____ Ethnicity ____

Reason for Seeking Health Care: ______________________________________________

**HPI**:_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

**SI/HI:** _______________________________________________________________________________

**Sleep:**_________________________________________
**Appetite:**\_\_\______________________

**Allergies**(Drug/Food/Latex/Environmental/Herbal): ___________________________________

**Current perception of Health**: Excellent Good Fair Poor

**Psychiatric History:**

**_Inpatient hospitalizations:_**

| | | | |
| — | — | — | — |
| **_Date_** | **_Hospital_** | **_Diagnoses_** | **_Length of Stay_** |
| | | | |
| | | | |

**_Outpatient psychiatric treatment:_**

| | | | |
| — | — | — | — |
| **_Date_** | **_Hospital_** | **_Diagnoses_** | **_Length of Stay_** |
| | | | |
| | | | |

**_Detox/Inpatient substance treatment:_**

| | | | |
| — | — | — | — |
| **_Date_** | **_Hospital_** | **_Diagnoses_** | **_Length of Stay_** |
| | | | |
| | | | |

**_History of suicide attempts and/or self injurious behaviors:_**\_\_\__________________________________

**Past Medical History**

· Major/Chronic Illnesses____________________________________________________

· Trauma/Injury ___________________________________________________________

· Hospitalizations __________________________________________________________

**Past Surgical History**\_\_\_________________________________________________________

**_Current psychotropic medications:_**

\_\_\_______________________________________ ________________________________

\_\_\_______________________________________ ________________________________

\_\_\_______________________________________ ________________________________

**_Current prescription medications:_**

\_\_\_______________________________________ ________________________________

\_\_\_______________________________________ ________________________________

\_\_\_______________________________________ ________________________________

**_OTC/Nutritionals/Herbal/Complementary therapy:_**

\_\_\_______________________________________ ________________________________

\_\_\_______________________________________ ________________________________

**_Substance use_** _:_(alcohol, marijuana, cocaine, caffeine, cigarettes)

| | | | |
| — | — | — | — |
| **_Substance_** | **_Amount_** | **_Frequency_** | **_Length of Use_** |
| | | | |
| | | | |
| | | | |
| | | | |

**Family Psychiatric History:** _____________________________________________________

**Social History**

**Lives**: Single family House/Condo/ with stairs: ___________
**Marital Status**:________

**Education**:____________________________

**Employment Status**: ______
**Current/Previous occupation type**: _________________

**Exposure to:** ___Smoke____ ETOH ____Recreational Drug Use: __________________

**Sexual Orientation:** _______ Sexual Activity: ____
**Contraception Use**: ____________

**Family Composition:** Family/Mother/Father/Alone
**: _____________________________**

**Other: (Place of birth, childhood hx, legal, living situations, hobbies, abuse hx, trauma, violence, social network, marital hx):_________________________________**

**\_\_\______________________________________________________________________**

**Health Maintenance**

**Screening Tests (submit with SOAP note): Depression, Anxiety, ADHD, Autism, Psychosis, Dementia**

**Exposures:**

**Immunization HX:**

**Review of Systems (at least 3 areas per system):**

General:

HEENT:

Neck:

Lungs:

Cardiovascular:

Breast:

GI:

Male/female genital:

GU:

Neuro:

Musculoskeletal:

Activity & Exercise:

Psychosocial:

Derm:

Nutrition:

Sleep/Rest:

LMP:

STI Hx:

**Physical Exam**

BP________TPR_____ HR: _____ RR: ____Ht. _____ Wt. ______ BMI (
**percentile**) _____

General:

HEENT:

Neck:

Pulmonary:

Cardiovascular:

Breast:

GI:

Male/female genital:

GU:

Neuro:

Musculoskeletal:

Derm:

Psychosocial:

Misc.

**Mental Status Exam**

Appearance:

Behavior:

Speech:

Mood:

Affect:

Thought Content:

Thought Process:

Cognition/Intelligence:

Clinical Insight:

Clinical Judgment:

| |
| — |
| **Psychotherapy Note** |
| **Therapeutic Technique Used:** |
| **Session Focus and Theme:** |
| **Intervention Strategies Implemented:** |
| **Evidence of Patient Response**: |

**Plan:**

**Differential Diagnoses**

**1.**

**2.**

**Principal Diagnoses**

**1.**

**2.**

**Plan:**

**Diagnosis #1**

**Diagnostic Testing/Screening:**

**Pharmacological Treatment:**

**Non-Pharmacological Treatment:**

**Patient/Family Education:**

**Referrals:**

**Follow-up:**

**Anticipatory Guidance:**

**Diagnosis #2**

**Diagnostic Testing/Screening Tool:**

**Pharmacological Treatment:**

**Non-Pharmacological Treatment:**

**Patient/Family Education:**

**Referrals:**

**Follow-up:**

**Anticipatory Guidance:**

**Signature (with appropriate credentials): __________________________________________**

**Cite current evidenced based guideline(s) used to guide care (Mandatory)_______________**

**DEA#: 101010101 STU Clinic LIC# 10000000**

**Tel: (000) 555-1234 FAX: (000) 555-12222**

Patient Name: (Initials)______________________________ Age ___________

Date: _______________

**RX ______________________________________**

**SIG:**

**Dispense**: ___________
**Refill:** _________________

**No Substitution**

**Signature:** ____________________________________________________________

**Rev. 2272022 LM**

## image1.png

**Screenshot2025-05-26at14.09.52.png**

This file is too large to display. [View in new window](https://www.sweetstudy.com/files/screenshot2025-05-26at14-09-52-png)

**CPERUBRIC.docx**

This file is too large to display. [View in new window](https://www.sweetstudy.com/files/cperubric-docx)

**## CPETEMPLATE.docx**

![page1image3861729600](https://www.sweetstudy.com/questions/cpe1)

**Comprehensive Psychiatric Evaluation Template**

**With Psychotherapy Note**

Encounter date: ________________________

Patient Initials: ______ Gender: M/F/Transgender ____ Age: _____ Race: _____ Ethnicity ____

Reason for Seeking Health Care: ______________________________________________

**HPI**:_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

**SI/HI:** _______________________________________________________________________________

**Sleep:**_________________________________________
**Appetite:**\_\_\______________________

**Allergies**(Drug/Food/Latex/Environmental/Herbal): ___________________________________

**Current perception of Health**: Excellent Good Fair Poor

**Psychiatric History:**

**_Inpatient hospitalizations:_**

| | | | |
| — | — | — | — |
| **_Date_** | **_Hospital_** | **_Diagnoses_** | **_Length of Stay_** |
| | | | |
| | | | |

**_Outpatient psychiatric treatment:_**

| | | | |
| — | — | — | — |
| **_Date_** | **_Hospital_** | **_Diagnoses_** | **_Length of Stay_** |
| | | | |
| | | | |

**_Detox/Inpatient substance treatment:_**

| | | | |
| — | — | — | — |
| **_Date_** | **_Hospital_** | **_Diagnoses_** | **_Length of Stay_** |
| | | | |
| | | | |

**_History of suicide attempts and/or self injurious behaviors:_**\_\_\__________________________________

**Past Medical History**

· Major/Chronic Illnesses____________________________________________________

· Trauma/Injury ___________________________________________________________

· Hospitalizations __________________________________________________________

**Past Surgical History**\_\_\_________________________________________________________

**_Current psychotropic medications:_**

\_\_\_______________________________________ ________________________________

\_\_\_______________________________________ ________________________________

\_\_\_______________________________________ ________________________________

**_Current prescription medications:_**

\_\_\_______________________________________ ________________________________

\_\_\_______________________________________ ________________________________

\_\_\_______________________________________ ________________________________

**_OTC/Nutritionals/Herbal/Complementary therapy:_**

\_\_\_______________________________________ ________________________________

\_\_\_______________________________________ ________________________________

**_Substance use_** _:_(alcohol, marijuana, cocaine, caffeine, cigarettes)

| | | | |
| — | — | — | — |
| **_Substance_** | **_Amount_** | **_Frequency_** | **_Length of Use_** |
| | | | |
| | | | |
| | | | |
| | | | |

**Family Psychiatric History:** _____________________________________________________

**Social History**

**Lives**: Single family House/Condo/ with stairs: ___________
**Marital Status**:________

**Education**:____________________________

**Employment Status**: ______
**Current/Previous occupation type**: _________________

**Exposure to:** ___Smoke____ ETOH ____Recreational Drug Use: __________________

**Sexual Orientation:** _______ Sexual Activity: ____
**Contraception Use**: ____________

**Family Composition:** Family/Mother/Father/Alone
**: _____________________________**

**Other: (Place of birth, childhood hx, legal, living situations, hobbies, abuse hx, trauma, violence, social network, marital hx):_________________________________**

**\_\_\______________________________________________________________________**

**Health Maintenance**

**Screening Tests (submit with SOAP note): Depression, Anxiety, ADHD, Autism, Psychosis, Dementia**

**Exposures:**

**Immunization HX:**

**Review of Systems (at least 3 areas per system):**

General:

HEENT:

Neck:

Lungs:

Cardiovascular:

Breast:

GI:

Male/female genital:

GU:

Neuro:

Musculoskeletal:

Activity & Exercise:

Psychosocial:

Derm:

Nutrition:

Sleep/Rest:

LMP:

STI Hx:

**Physical Exam**

BP________TPR_____ HR: _____ RR: ____Ht. _____ Wt. ______ BMI (
**percentile**) _____

General:

HEENT:

Neck:

Pulmonary:

Cardiovascular:

Breast:

GI:

Male/female genital:

GU:

Neuro:

Musculoskeletal:

Derm:

Psychosocial:

Misc.

**Mental Status Exam**

Appearance:

Behavior:

Speech:

Mood:

Affect:

Thought Content:

Thought Process:

Cognition/Intelligence:

Clinical Insight:

Clinical Judgment:

| |
| — |
| **Psychotherapy Note** |
| **Therapeutic Technique Used:** |
| **Session Focus and Theme:** |
| **Intervention Strategies Implemented:** |
| **Evidence of Patient Response**: |

**Plan:**

**Differential Diagnoses**

**1.**

**2.**

**Principal Diagnoses**

**1.**

**2.**

**Plan:**

**Diagnosis #1**

**Diagnostic Testing/Screening:**

**Pharmacological Treatment:**

**Non-Pharmacological Treatment:**

**Patient/Family Education:**

**Referrals:**

**Follow-up:**

**Anticipatory Guidance:**

**Diagnosis #2**

**Diagnostic Testing/Screening Tool:**

**Pharmacological Treatment:**

**Non-Pharmacological Treatment:**

**Patient/Family Education:**

**Referrals:**

**Follow-up:**

**Anticipatory Guidance:**

**Signature (with appropriate credentials): __________________________________________**

**Cite current evidenced based guideline(s) used to guide care (Mandatory)_______________**

**DEA#: 101010101 STU Clinic LIC# 10000000**

**Tel: (000) 555-1234 FAX: (000) 555-12222**

Patient Name: (Initials)______________________________ Age ___________

Date: _______________

**RX ______________________________________**

**SIG:**

**Dispense**: ___________
**Refill:** _________________

**No Substitution**

**Signature:** ____________________________________________________________

**Rev. 2272022 LM**

## image1.png

**Screenshot2025-05-26at14.09.52.png**

This file is too large to display. [View in new window](https://www.sweetstudy.com/files/screenshot2025-05-26at14-09-52-png)

**CPERUBRIC.docx**

This file is too large to display. [View in new window](https://www.sweetstudy.com/files/cperubric-docx)

Comments

Leave a Reply

Your email address will not be published. Required fields are marked *

More posts