Chapter 44 *NEW*

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NOTE: Do NOT miss out on this weeks moving audiobook reading by kaelking12

*Trigger Warning: This chapter deals with themes of anxiety and depression.

CHAPTER 44 

Lacey

Mountain Ridge Psychiatric Rehabilitation Center Patient Exit Form

Name: Lacey J. Sanders

DOB: 3/14/1997

Mountain View Counsellor: Dr. Christine Davis

Note: Form to be filled out by patient and supervising physician. Completed forms are confidential (HIPPA) and to be sent to approved follow-up physicians and/or counselors only.

1. Please indicate the length of your visit at Mountain Ridge:

( ) 15 Days

(x) 30 Days

( ) 6 months or longer


2. Original date of admission: ______May 3rd____


3. Please select the reason(s) for your visit below:

(x) Psychological counseling

(x) Stress management

(x) Mental health evaluation

(x) Anxiety

(x) Depression (Bi-Polar Disorder, Manic, Clinical)

(x) Christian Counseling

(x) Grief Counseling

(x) Referral

- Referring doctor name & practice: Dr. Richard Jensen M.D.


4. Please indicate the symptoms for which you've received counseling and/or treatment throughout the duration of your stay at Mountain Ridge:

( ) Insomnia

( ) Mania

( ) Paranoia

(x) General or heightened anxiety

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