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MENTAL STATUS EXAM - PGU

MENTAL STATUS EXAM Date:_____ Client Name: _____ Age:_____ Sex:____ Ethnicity:_____ Partner STATUS _____ Occupation _____ Sexual Orientation _____ Number of children _____Living Circumstances _____ GENERAL Appearance Hygiene Average Unclean Body odor Unusual Clothing-Grooming Average, Appropriate Unkempt, Disheveled Atypical Physical Characteristics Weight: Average, , Health: Good, Frail Unusual Unique marks (tattoos) Body type-build Physical Disabilities General Behavior & Mood Eye contact: Yes Appropriate Sometimes No Inappropriate: staring Posture: Relaxed Slumped Rigid Motor Activity Agitated, Fidgety Restless, Pacing, Decreased, Slowed.

Partner Status _____ Occupation _____ Sexual Orientation _____ ... Mini-Mental State: A practical method for grading the state of patients for the clinician. In Journal of Psychiatric Research, 12: 189-198. Grwoth- Marnat G. (2003). Handbook of Psychological Assessment. Hoboken, New Jersey: John Wiley & Sons, Inc.

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