Mental Health Treatment Plan Patient Assessment

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GP MENTAL HEALTH TREATMENT PLAN
PATIENT ASSESSMENT
Patient’s Name
Date of Birth
Address
Phone
YES 
Carer details and/or
Other care plan
emergency contact(s)
Eg GPMP / TCA
NO
GP Name / Practice
AHP or nurse
Medical
currently involved in
Records No.
patient care
PRESENTING ISSUE(S)
What are the patient’s
current mental health
issues
PATIENT HISTORY
Record relevant biological
psychological and social
history including any family
history of mental disorders
and any relevant
substance abuse or
physical health problems
MEDICATIONS
(attach information if
required)
ALLERGIES
ANY OTHER RELEVANT
INFORMATION
RESULTS OF MENTAL
STATE EXAMINATION
Record after patient has
been examined
RISKS AND
CO-MORBIDITIES
Note any associated risks
and co-morbidities
including risks of self harm
&/or harm to others
OUTCOME TOOL USED
RESULTS
DIAGNOSIS

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