Get Psychiatric Evaluation Questionnaire-children. Annexure B To Indian Passport Application Identity

Filling out the psychiatric evaluation questionnaire for children is an essential step in preparing for evaluation. This guide aims to provide clear, step-by-step instructions on completing the form accurately and efficiently, ensuring that all necessary information is submitted.

Follow the steps to complete the questionnaire.

1. Use the ‘Get Form’ button to access the form and open it in your preferred document editor.
2. Begin by entering the patient’s name in the designated field, followed by their date of birth and birthplace. Select the race category that best fits the patient from the specified options.
3. Indicate the sex of the patient, providing an option for 'Other' if applicable. Then, fill in the name of the person completing the form and their relationship to the child.
4. In the referral section, include the name of the individual or organization that referred the patient for evaluation. Following this, provide a detailed description of the issues prompting the evaluation.
5. Document when the problems began and whether any known stressors could have contributed to these issues, ensuring to describe any stressors if applicable.
6. If applicable, note any past outpatient or inpatient mental health treatments the patient has received, listing clinicians, dates, and types of treatments in the provided spaces.
7. Answer questions regarding any history of suicidal thoughts or attempts, along with any history of brain imaging or functional studies.
8. Fill in the family psychiatric history section, detailing any known mental health issues within immediate family members.
9. Provide information regarding the pregnancy and birthing history, including the mother's age, complications, and any issues the child may have faced at birth.
10. Discuss the developmental milestones, motor development, speech and language abilities, and self-help skills of the child.
11. Fill in the medical history section, including the pediatrician's name, any current medications, drug allergies, and current medical problems.
12. Address social history, including living arrangements, any experiences of abuse, hobbies and interests, and concerns about peer relationships.
13. Complete the school history section, providing the name of the current school and assessments of academic and behavioral performance.
14. Finally, outline any legal issues the child may have faced, potential substance use, and include any religious beliefs.
15. Once all sections are filled out, review the document for accuracy before saving changes, downloading, or printing the form.

Complete your psychiatric evaluation questionnaire online for a smooth evaluation process.