DEPRESSION PATIENT CARE FLOW SHEET

Document Sample
DEPRESSION PATIENT CARE FLOW SHEET Powered By Docstoc
					                                                       BRITISH
                                                                                 Guidelines &
                                                                                 Protocols                            DEPRESSION
                                                                                 Advisory
                                                                                                                PATIENT CARE FLOW SHEET
                                                     COLUMBIA
                                                       MEDICAL
                                                   ASSOCIATION                   Committee

                                                  NAME OF PATIENT                                                                                                            BIRTHDATE


                                                  DIAGNOSIS                                                                                                                  TELEPHONE NUMBER
                                                                      Single episode  Recurrent episode           Chronic episode
                                                  COMORBID CONDITIONS                                                                                                        PHN

                                                  PSYCHIATRIC:        Alcohol/drugs          Mania/Hypomania       Past suicide attempt    Anxiety disorder
                                                                                                                                                                             EMPLOYMENT STATUS
                                                                      Other:     _______________________
                                                                                                                                                                               Employed  Unemployed
                                                  MEDICAL:            Respiratory        Neurological disorder      Cancer       Hypertension         Other endocrine     Student    Retired
                                                                      Diabetes           Kidney disease             Arthritis    Heart disease        Liver disease       Homemaker

                                                                      Other:    _______________________
                                                                                                                                                     DATE (YY/MM/DD)




                                                    PSYCHOTHERAPY
                                                                                        Referral made 
                                                    (CBT/IPT/PST                             Ongoing        

                                                                                     Medication/Dose 
                                                    ANTIDEPRESSANTS

                                                                            Side effects monitored 
   ACUTE TREATMENT (8-16 WEEKS)




                                                                                        Referral made 
                                                    PSYCHIATRY
                                                                                              Ongoing 
                                                                                              Assessed 
                                                    SUICIDE RISK
                                                                                     Management plan
                                                                                         documented 
                                                    PHQ-9                       Q1 Score                    
                                                   (Remission: <5)              Q2 Result                   
                                                    SELF-MANAGEMENT
                                                    (education/community,        Goals set and/or
                                                    resources, social
                                                    supports)                    reviewed 
                                                    ER VISIT OR           Follow-up visit
                                                    HOSPITALIZATION       (within 7 days) 
                                                                                 W (weekly)
                                                    PLANNED FOLLOW-UP            B (Bi-weekly)
                                                                                 O (other) 
                                                    RISK FACTORS FOR  Y (cont. meds 2 yrs)
                                                    RELAPSE           N (cont. meds 6 mos) 
MAINTENANCE TREATMENT (6 MOS - 2 YRS OR LONGER)




                                                                                     Medication/Dose 

                                                    ANTIDEPRESSANTS
                                                                                Side effects monitored 

                                                                                 Tapering Plan
                                                                                 (discont symp discussed)   


                                                    PSYCHIATRY
                                                                                        Referral made 
                                                                                               Ongoing 

                                                    PHQ-9
                                                                                Q1 Score                    
                                                   (Remission: <5)              Q2 Result                   
                                                    SELF-MANAGEMENT
                                                    (incl discussion of          Goals set and/or
                                                    relapse prevention)          reviewed 
                                                    PLANNED FOLLOW-UP                        M (monthly)
                                                                                             6 (6 mos)
                                                                                             O (other) 
HLTH-BCMA 6004 (Rev. 2007)

				
DOCUMENT INFO