MDM - Suicidal Ideations (Discharge)

[##]-year-old [male/female] with [depression/suicidal ideations] with history and exam consistent with likely [presumptive diagnosis].

Initial consideration in this patient included major depressive disorder, adjustment disorder, suicide attempt (intentional overdose and self-injury amongst others), alcohol or other substance related mood disorders, and organic causes of altered mental status among others.

Patient presented to the ED [due to concerns over suicidal thoughts/after police were called due to suicidal comments/after his coworkers/supervisor noted suicidal comments].  On initial exam the patient was noted to be hemodynamically stable [with/without] evidence of intoxication.  Patient noted to have [no] evidence of [likely] self-injury [specify].  Labs [were/were not] ordered [and unremarkable as noted above/notable for elevated ethanol level without other evidence of overdose, illicit drugs or significant toxins].  The patient expressed [passive suicidal ideations/no suicidal ideations] in the ED [without/and no specific] plan [specify].

The patient was considered to be [low/moderate] risk for suicide based on consideration of risk factors, including [absence of suicidal plan/report of good social support].  Prior to discharge the patient [and family/bystanders] were questioned on access to firearms, which was [denied/planned for removal/secured].

The patient demonstrated a willingness to form a safety contract prior to discharge, as detailed in the discharge instructions below.  Return precautions for any concerns for safety were discussed, as well as follow up with [Mental Health] on [date] with the patient demonstrating understanding and agreement prior to discharge.

http://www.emdocs.net/medical-clearance-of-psychiatric-patients-pearls-pitfalls/
https://edsmartchart.blogspot.com/2020/06/physical-exam-psychiatric-mental-status.html
https://edsmartchart.blogspot.com/2020/06/discharge-instructions-contract-for.html