brevaDepression follow-up
Encounter
Patient name: [ ] Date of birth: [ ] Date and time of encounter: [ ] Clinician: [ ]
Interval history
Changes since the previous visit: [ ] Symptoms and functional impact as reported: [ ] Sleep, appetite and energy as reported: [ ] Stressors and supports: [ ]
Measures
Screening tool used, score and date: [ ] Previous score and date for comparison: [ ]
Safety
Suicide risk screening method and result: [ ] Safety plan reviewed or updated, if applicable: [ ] Access to lethal means discussed, if applicable: [ ]
Treatment
Medication use as reported, response and adverse effects: [ ] Therapy or counseling engagement: [ ]
Assessment and plan
Current status and reasoning: [ ] Medication decisions and rationale: [ ] Therapy referral or coordination: [ ] Crisis resources provided: [ ]
Follow-up
Follow-up timing and purpose: [ ] Return precautions discussed: [ ] Patient questions and understanding: [ ]