Psychiatric Clerking & Screening Template

PHQ-9 (Depression)

GAD-7 (Anxiety)

ASQ (Suicide Risk)

MDQ (Bipolar)

MDD Checklist

0 / 9

Tick if present ≥2 weeks

Depressed mood (Core) Loss of interest (Anhedonia) (Core) Weight/appetite change Sleep disturbance Psychomotor change Fatigue Worthlessness / guilt Poor concentration Suicidal ideation

Duration ≥ 2 weeks? Functional impairment?

Result: Pending

GAD Checklist

0 / 6

Needs excessive worry + 3 symptoms for ≥6 months

Excessive worry (Core) Difficulty controlling worry (Core)

Restlessness Fatigue Poor concentration Irritability Muscle tension Sleep disturbance

Duration ≥ 6 months? Functional impairment?

Result: Pending

Bipolar / Mania Checklist

0 / 7

Core mood + ≥3 symptoms (or ≥4 if mood is only irritable) lasting ≥1 week or requiring hospitalization

Elevated/irritable mood (Core) Increased activity/energy (Core)

Grandiosity Decreased need for sleep

Talkative / Pressured speech Flight of ideas / Racing thoughts Distractibility Risky behavior

Result: Pending

Management Plan

1. Safety Plan: Safety advice given. TCA ED if to overwhelm, have thought to harm self or other. 2. Psychoeducation: Patient educated regarding symptoms, possible diagnosis, treatment options, recovery process, relapse warning signs and when to seek urgent help.

3. Non-Pharmacological Plan:

Supportive counselling CBT strategies Behavioural activation Sleep hygiene Stress management Family support Psychologist referral Social intervention

4. Medication Plan:

5. Investigation:

6. Social and Functional Plan: Function at home/work/study assessed. Family/carer involvement discussed with consent. Social issues addressed. Referral to social worker/OT/other services if needed.

7. Referral:

Psychiatry Psychology Counselling Medical team Social worker Emergency service

8. Follow-Up:

Review in . Monitor symptoms, risk, function, medication adherence, side effects and psychosocial stressors. Earlier review if symptoms worsen.

9. Additional / Other Plan (Optional):

Refer To:

Reason for Referral:

Psychiatric Clerking Template

📝 1. Identification & Presenting Complaint

🧾 2. Screening Tools Scores

🧠 3. DSM-5 Checklists

MDD Checklist

GAD Checklist

Bipolar / Mania Checklist

🧩 4. Anxiety Subtype Differentiation

⚡ Panic Pattern

👥 Social Anxiety

🎯 Specific Phobia

🚪 Agoraphobia

🔁 OCD Features

💥 Trauma-Related

👁️ 5. Psychosis Screening

Hallucinations

Delusions

⚖️ 6. Risk Assessment

📚 7. Psychiatric & Basic History

🧾 8. Mental State Examination (MSE)

Appearance & Behavior

Speech

Mood & Affect

Thought & Perception

Cognition & Insight

💡 9. Provisional Diagnosis & Plan

Management Plan

✉️ 10. Automated Referral Letter

Questionnaire

Psychiatric Clerking Template

📝 1. Identification & Presenting Complaint

🧾 2. Screening Tools Scores

🧠 3. DSM-5 Checklists

MDD Checklist

GAD Checklist

Bipolar / Mania Checklist

🧩 4. Anxiety Subtype Differentiation

⚡ Panic Pattern

👥 Social Anxiety

🎯 Specific Phobia

🚪 Agoraphobia

🔁 OCD Features

💥 Trauma-Related

👁️ 5. Psychosis Screening

Hallucinations

Delusions

⚖️ 6. Risk Assessment

📚 7. Psychiatric & Basic History

🧾 8. Mental State Examination (MSE)

Appearance & Behavior

Speech

Mood & Affect

Thought & Perception

Cognition & Insight

💡 9. Provisional Diagnosis & Plan

Management Plan

✉️ 10. Automated Referral Letter