Efficiency App | Library

Does the patient have new psychiatric condition?

Any history of active medical illness needing evaluation?

Any abnormal vital signs prior to transfer?

Temperature >101F
Pulse outside of 50 to 120 beats/minute
Blood pressure systolic < 90 or > 200; diastolic > 120
Respiratory rate > 24 breaths/minute

(For a pediatric patient, vital signs indices outside the normal range for his/her age and sex)

Any abnormal physical exam (unclothed)?
a. Absence of significant part of body, eg, limb
b. acute and chronic trauma (including signs of victimization/abuse)
c. Breath sounds
d. Cardiac dysrhythmia, murmurs
e. Skin and vascular signs: diaphoresis, pallor, cyanosis, edema
f. Abdominal distention, bowel sounds
g. Neurological with particular focus on:
i. ataxia ii. pupil symmetry, size iii. nystagmus iv. paralysis v. meningeal signs vi. reflexes

Any abnormal mental status indicating medical illness such as lethargic, stuporous, comatose, spontaneously fluctuating mental status?

ALL PATIENTS ARE TO HAVE BLOOD COUNT, ELECTROLYTES, PREGNANCY TEST AND DRUG SCREEN PERFORMED.

Was there any medical treatment needed by the patient prior to medical clearance?

Has the patient been medically cleared in the ED?

Any acute medical condition that was adequately treated in the emergency department that allows transfer to a state operated psychiatric facility (SOF)?

Current medications and last administered?

Diagnoses:

Psychiatric

Medical

Substance abuse

Medical follow-up or treatment required on psych floor or at SOF:

I have had adequate time to evaluate the patient and the patient's medical condition is sufficiently stable that transfer to floor does not pose a significant risk of deterioration.

Psychiatric Medical Clearance Checklist