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G.P. Mental Health Plan

Doctors NameProvider Number  Surgery Address   The R.E.A.D. Clinic      GP MENTAL HEALTH PLAN  PATIENT DETAILS   Name                                                                   DOB   Address     Phone numbers   Date of assessment   Medicare #   (Please  appropriate categories)DIAGNOSIS  ASSESSMENT TOOL RESULTS (If applicable) Depression   Bipolar disorder   Phobic disorder   Sleep problems   Neurasthenia   Panic disorder   Schizophrenia   Conduct disorder   Eating disorders   Sexual disorders   Mixed anxiety and depression   Chronic psychotic disorders   Bereavement disorder   Adjustment disorder   Alcohol use disorders   Generalised anxiety disorder   Acute psychotic disorders   Drug use disorders   Enuresis (non-organic)   Post-traumatic stress disorder   Obsessive Compulsive Disorder   Hyperkinetic (attention deficit) disorder   Dissociative (conversion) disorder   Unexplained somatic complaints         TOOL  SCORE   K10   DASS42 Depression   Anxiety   Stress   Other        Mental Status Examination   Normal[  X  ] Details Appearance and General Behaviour       Mood/Affect         Thinking     Perception     Cognition     Attention     Memory     Insight       Clinical observations   History - may include significant organic problems, past history and medication        Treatment Goals             Risk Assessment Key family contact/support Risk of Self Harm  Extreme   High   Moderate  Low(Circle one)   Risk to Others Extreme   High   Moderate  Low(Circle one) REFERRAL  Source Details Psychologist   The READ Clinic 54 Hills Street GosfordPh 4324 6633 Psychiatrist      Mental Health Team        Suggested Psychological Strategies  Strategy   Strategy Assessment     Relaxation techniques   CBT     Skills training:   Interpersonal Therapy     Problem solving Anger Management Communication Parenting skills Stress management Conflict resolution Assertiveness     Psycho-education including motivational interviewing      Other    Additional Notes                      NB This plan should be reviewed regularly. A report is required from the treating psychologist after six (6) sessions.