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GP MENTAL HEALTH TREATMENT PLAN
PATIENT ASSESSMENT
Patient’s Name
Date of Birth
Address
Phone
Carer details and/or
emergency contact(s)
GP Name / Practice
Other care plan YES
Eg GPMP / TCA NO
AHP or nurse
currently involved in
patient care
Medical
Records No.
PRESENTING ISSUE(S)
What are the patient’s
current mental health
issues
PATIENT HISTORY
Record relevant biological
psychological and social
history including any family
history of mental disorders
and any relevant
substance abuse or
physical health problems
MEDICATIONS
(attach information if
required)
ALLERGIES
ANY OTHER RELEVANT
INFORMATION
RESULTS OF MENTAL
STATE EXAMINATION
Record after patient has
been examined
RISKS AND
CO-MORBIDITIES
Note any associated risks
and co-morbidities
including risks of self harm
&/or harm to others
OUTCOME TOOL USED RESULTS
DIAGNOSIS