Geriatric Mental Health Assessment
Patient Information
Full Name
Date of Birth
Gender
Male
Female
Other
Contact Information
Assessment Details
Referring Physician
Assessment Date
Presenting Concerns
Summary
History
Psychiatric History
Medical History
Current Medications
Substance Use
Family Psychiatric History
Social History
Mental Status Examination
Appearance & Behavior
Mood
Affect
Speech
Thought Process
Thought Content
Perceptions
Cognition
Insight
Judgment
Risk Assessment
Risks
Self-harm
Suicide
Violence
Self-neglect
Risk Notes
Summary and Plan
Summary
Plan / Recommendations