<noteTO>
                  <id>35006015</id>
                  <timestamp>3140211.13</timestamp>
                  <localTitle>C&amp;P MENTAL DISORDERS</localTitle>
                  <standardTitle>C &amp; P EXAMINATION NOTE</standardTitle>
                  <author>
                    <id>2926</id>
                    <name>DOUGLAS,DAVID M</name>
                  </author>
                  <location>
                    <id>648</id>
                    <name>PORTLAND VA MEDICAL CENTER</name>
                  </location>
                  <text>
 LOCAL TITLE: C&amp;P MENTAL DISORDERS                               
STANDARD TITLE: C &amp; P EXAMINATION NOTE                          
DATE OF NOTE: FEB 11, 2014@13:00     ENTRY DATE: MAR 06, 2014@14:27:39      
      AUTHOR: DOUGLAS,DAVID M      EXP COSIGNER:                           
     URGENCY:                            STATUS: COMPLETED                     

COMPENSATION AND PENSION EXAMINATION
MENTAL DISORDERS (EXCEPT PTSD AND EATING DISORDERS)
===================================================


MEDICAL HISTORY
===============
  IS THIS EXAMINATION FOR REVIEW OF AN ALREADY SERVICE-CONNECTED MENTAL DISORDER?
  Yes

PAST MEDICAL HISTORY

--------------------

  TREATMENT
  ---------
    WAS THERE OUTPATIENT TREATMENT FOR A MD DISORDER: No

  HOSPITALIZATION(S)
  ------------------
    WERE THERE ONE/MORE HOSPITALIZATIONS FOR A MD DISORDER: No

PRESENT MEDICAL HISTORY
-----------------------
  ARE THERE MEDICAL AND/OR PSYCHIATRIC SYMPTOMS (OTHER THEN PTSD) PRESENT DURING
  PAST YEAR? Yes
  IS THERE CURRENT TREATMENT FOR A MENTAL DISORDER? No
  FREQUENCY, SEVERITY, AND DURATION OF NON-PTSD PSYCHIATRIC/MEDICAL SYMPTOMS:
    this is only a test

PSYCH EXAM
==========
  GENERAL APPEARANCE:
    Neatly groomed

  PSYCHOMOTOR ACTIVITY:
    Repetitive Acts

  SPEECH:
    Rapid

  ATTITUDE TOWARD EXAMINER:
    Attentive

  AFFECT:
    Inappropriate

  MOOD:
Happy, Expansive

  ATTENTION:
    Attention Disturbance (Easily Distracted)
      ABLE TO DO SERIAL 7'S? Yes
      ABLE TO SPELL A WORD FORWARD AND BACKWARD? Yes

  ORIENTATION:
    INTACT TO PERSON: Yes

    INTACT TO TIME: Yes

    INTACT TO PLACE: Yes

  THOUGHT PROCESS:
    Paucity of ideas

  THOUGHT CONTENT:
    Phobias

  DELUSIONS:
    Nihilistic delusions (part of body is missing)
      ARE DELUSIONS PERSISTENT? Yes

  JUDGMENT: Does not understand outcome of behavior

  INTELLIGENCE: Average

  INSIGHT: Patient partially understands that he/she has a problem.

  DOES THE PATIENT HAVE SLEEP IMPAIRMENT? Yes

TYPE OF HALLUCINATIONS:
    Olfactory
      ARE HALLUCINATIONS PERSISTENT? Yes

  DOES THE PATIENT HAVE INAPPROPRIATE BEHAVIOR? No

  INTERPRETS PROVERBS APPROPRIATELY? No

  DOES THE PATIENT HAVE OBSESSIVE/RITUALISTIC BEHAVIOR? Yes

  DOES THE PATIENT HAVE PANIC ATTACKS? Yes

  IS THERE PRESENCE OF SUICIDAL THOUGHTS? Yes

  EXTENT OF IMPULSE CONTROL: Fair
  EPISODES OF VIOLENCE: Yes

  ABILITY TO MAINTAIN MINIMUM PERSONAL HYGIENE? No

  IS THERE PROBLEM WITH ACTIVITIES OF DAILY LIVING: No

  MEMORY
  ------
      REMOTE MEMORY: Normal
      RECENT MEMORY: Mildly Impaired
      IMMEDIATE MEMORY: Normal
        EXAMPLE(S) OF MEMORY DISORDER:
          this is only a test


TESTS
=====
  PSYCHOLOGICAL TESTING
  ---------------------
    NAME(S) OF PSYCHOLOGICAL TESTING CARRIED OUT AND DESCRIPTION OF RESULTS:
      rohrschach
    COMMENT ON VALIDITY OF TEST RESULTS:
      Valid
    WERE RESULTS OF TESTING TAKEN INTO ACCOUNT IN THE EXAMINATION REPORT? Yes

  SOCIAL WORK SURVEY
  ------------------
    WERE SOCIAL WORK SURVEY RESULTS TAKEN INTO CONSIDERATION IN THE
    DIAGNOSIS/ASSESSMENT? Yes
      COMMENTS ON SOCIAL WORK SURVEY:
        this is only a test
    WERE ALL TESTS RESULTS INCLUDED ON THE EXAM REPORT? Yes
    

DIAGNOSIS
=========

  MENTAL DISORDER: MENTAL COMPETENCY
  ----------------------------------
    DOES THE VETERAN KNOW THE AMOUNT OF THEIR BENEFIT PAYMENT? No
    DOES THE VETERAN KNOW THE AMOUNTS OF MONTHLY BILLS? No
    DOES THE VETERAN PRUDENTLY HANDLE PAYMENTS? No
    DOES THE VETERAN PERSONALLY HANDLE MONEY AND PAYS BILLS? No

    IS THE VETERAN CAPABLE OF MANAGING FINANCIAL AFFAIRS? No

    IS A SOCIAL WORK ASSESSMENT NECESSARY TO RENDER AN OPINION? No

  MENTAL DISORDER: EMPLOYMENT HISTORY
  --------------------------------
    USUAL OCCUPATION:
      farmer
    IS THE VETERAN CURRENTLY EMPLOYED? No
    IS VETERAN RETIRED? No
    IS VETERAN UNEMPLOYED BUT NOT RETIRED? Unsure
    AXIS I: ptsd
    AXIS II: none
    AXIS III: hypertension
    AXIS IV: unemployed
    AXIS V: GLOBAL ASSESSMENT OF FUNCTIONING
    ----------------------------------------
      SCORE: 86 TIME FRAME:
    OTHER COMMENTS:
    this is only a test

    DOES EACH DIAGNOSIS OF MENTAL DISORDER MEET THE DSM-IV DIAGNOSTIC CRITERIA?
    Yes

    RESOLUTION OF DIAGNOSIS:
      A new clinical condition

PSYCH SUMMARY
=============

  EFFECTS OF MENTAL DISORDER ON OCCUPATIONAL AND SOCIAL FUNCTIONING
  -----------------------------------------------------------------
    IS THERE TOTAL OCCUPATIONAL AND SOCIAL IMPAIRMENT DUE TO MENTAL DISORDER
    SIGNS AND SYMPTOMS? Yes
      EXAMPLES AND PERTINENT SYMPTOMS, INCLUDING THOSE ALREADY REPORTED:
        this is only a test

  WAS A MEDICAL OPINION REQUESTED?
  No
  
  
  

 
/es/ DAVID M. DOUGLAS MD
CHIEF HEALTH INFORMATICS OFFICER/ATTENDING PSYCHIATRIST
Signed: 03/06/2014 14:27
</text>
                  <approvedBy>
                    <id>2926</id>
                    <name>DOUGLAS,DAVID M</name>
                    <signature>DAVID M. DOUGLAS MD CHIEF HEALTH INFORMATICS OFFICER/ATTENDING PSYCHIATRIST</signature>
                  </approvedBy>
                  <status>completed</status>
                  <type>PN</type>
                  <procTimestamp>3140306.142739</procTimestamp>
                </noteTO>