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MSE Template Patient Information Name: ___ Date of Birth: ___ Patient ID: ___Mental Status Examination Observations Appearance: Neat Disheveled Inappropriate Bizarre Other: ___ Speech: Normal Tangential Pressured Impoverished Other:
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mse derealization homicidality euthymic suicidality depersonalization avoidant cognition tangential ideation labile clinician dishevelled stereotyped constricted designation tics hyperactive template euphoric grandiose auditory impoverished pressured diso

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