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GERIATRIC PSYCHIATRY COMMUNITY SERVICE BACKREST HOSPITAL INTAKE FORM Client Information Date of Referral / / D M Y Name m f Surname Given Name Gender Address: Street Edtech#: Intake Worker: apt. #
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How to fill out geriatric psychiatry intake form
How to fill out a geriatric psychiatry intake form?
01
Start by carefully reading the instructions and questions on the form. Pay attention to any specific details or requirements mentioned.
02
Provide accurate personal information in the designated sections. This may include your name, age, address, contact details, and demographic information.
03
Answer the questions regarding your medical history thoroughly. Be honest and transparent about any existing or previous psychiatric conditions, medications you're currently taking, and any past treatments or therapies.
04
If applicable, provide details about any recent life events or changes that may have contributed to your current mental health concerns.
05
In the section addressing symptoms, describe your current emotional, behavioral, and cognitive difficulties in detail. Include information about the onset and duration of these symptoms and the impact they have on your daily life.
06
Some forms may ask about your family's mental health history, so provide information about any known psychiatric conditions among your immediate family members.
07
If you have any specific concerns or goals for your treatment, use the space provided to express them clearly.
08
Review your completed form to ensure that all the required information has been provided. Make sure your handwriting is legible to avoid any misunderstandings.
09
If there are any sections or questions you are unsure about, don't hesitate to ask the healthcare provider or staff for clarification.
Who needs a geriatric psychiatry intake form?
01
Older adults who are seeking psychiatric evaluation or treatment for mental health concerns.
02
Individuals who may be experiencing age-related psychological or cognitive changes.
03
Those with a history of psychiatric disorders who require specialized care tailored to the needs of older adults.
04
Family members or caregivers seeking assistance or support for an elderly loved one with mental health issues.
05
Healthcare professionals who are referring an older adult to a geriatric psychiatry clinic for a comprehensive assessment.
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