Date of commencement of medical investigation:
Date of completion of medical investigation:
SCREENING FOR MENTAL ILLNESS
Mental State Examination
General appearance and behaviour: Gait incoordination, abusiveness,
dressing pattern, smell of alcohol from the body or during conversation
Psychomotor activity: Increased or decreased
Speech: Coherence/relevance
Affect: Irritable, depressed thought:
Presence of any delusions, ideas of hopelessness, helplessness,
worthlessness, suicidal ideation and risk
Perception: Visual/auditory hallucinations
Orientation: Disorientation to time/place/person in alcohol withdrawal
delirium
Attention and concentration, memory, intelligence, abstraction Judgmentintact/impaired Insight Level of motivation.
SCREENING FOR HIV/TB if response to any of the below is yes, then
initiate HIV screening blood test after consent and for TB initiate
sptum for AFB and chest x-ray.
1.
2.
3.
4.
5.
6.
7.
8.
H/O Drug abuse
Injection marks
Involved in sexual violence as per record
Presence of tattoo
If underweight
Chronic cough/fever/night sweats >2 weeks
Any non-healing wound
H/O Blood transfusion
MEDICAL DIMENSION OF FREQUENTLY ENCOUNTERED CASES | 72
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No
Yes/No