1.

Introduction, roles, purpose of interview

2. Why are you here? HPI
3. Timeline of events
4. Psych history
a. Diagnoses
b. Hospitalizations
c. Medications
d. ROS
i. Depression - SI
ii. Anxiety – worrier, panic attacks, rating
iii. PTSD – flashbacks (reliving), nightmares, physical rxn to thoughts,
avoiding places/people/activities bc it reminds you, hypervigilance
iv. Mania – period of euphoria/irritability, distractible, impulsive/regrettable
behavior, grandiosity, flight of ideas, talking faster
v. Psychosis – paranoia, AVH, IOR
vi. Eating d/o
vii. Learning d/o
5. Medical Hx
a. Dx
b. Allergies
c. Surgeries
d. Medications
6. Family History
a. Medical
b. Psych – dx, hospitalizations, SI/SA, substances
7. Social History
a. b/r, childhood, siblings, parents
b. school
c. Job – how long there?
d. Current relationships, sexual orientation, spouse (how long? occupation?), prior
marriages, children, pets, who living in house
e. Military, legal, religion
8. Substances
9. Safety
a. SI currently, past SI or SA, ever thought about, passive SI
b. HI
c. Firearms
d. Abuse – physical, sexual, emotional, feel safe in relationship now?
10. Anything else to add?