Poor Concentration

Symptoms

Complaining of Difficulty remembering things Trouble sitting still for extended periods Difficulty thinking clearly Trouble making decisions Frequently losing things Difficulty remembering where things are Trouble performing complicated tasks Lack of focus Lack of energy to concentrate

Has No Difficulty remembering things No Trouble sitting still for extended periods No Difficulty thinking clearly No Trouble making decisions Not Frequently lost things No Difficulty remembering where things are No Trouble performing complicated tasks No Lack of focus No Lack of energy to concentrate

Report negative symptoms?

Previous Next

Symptoms

Reports Often making careless mistakes Difficulty concentrating at certain times of day Others commenting that they appear distracted Missing appointments/meetings due to a lack of focus Trouble falling asleep Trouble staying asleep Feeling tired during the day Taking naps during the day Consuming caffeine to stay awake Using stimulants to stay awake

Reports Not often making careless mistakes No difficulty concentrating at any times of day No one commenting that they appear distracted Not missing appointments/meetings due to a lack of focus No trouble falling asleep No trouble staying asleep Not feeling tired during the day Not taking naps during the day Not consuming caffeine to stay awake Not using stimulants to stay awake

Report negative symptoms?

Previous Next

Symptoms

Reports Frequent feelings of worry/fear Trouble relaxing Racing heart Sweaty palms Sense of dread/panic in certain situations Following a restrictive diet Frequently skipping meals Low appetite Dizziness Lightheadedness

Reports No frequent feelings of worry/fear No trouble relaxing No racing heart No sweaty palms No sense of dread/panic in certain situations Not following a restrictive diet Not frequently skipping meals Normal appetite No dizziness No lightheadedness

Report negative symptoms?

Previous Next

Symptoms

Reports Drowsiness Symptoms started after starting new medication Working or studying in a noisy or cluttered environment Difficulty concentrating in brightly lit areas Frequently experiencing interruptions while working or studying Spending long periods of time sitting or standing still Feeling tired or sluggish throughout the day Experiencing muscle weakness or stiffness Frequently losing interest in tasks started Finding it difficult to focus on tasks

Reports No drowsiness Symptoms did not start after starting new medication Not working or studying in a noisy or cluttered environment No difficulty concentrating in brightly lit areas Not frequently experiencing interruptions while working or studying Not spending long periods of time sitting or standing still Not feeling tired or sluggish throughout the day Not experiencing muscle weakness or stiffness Not frequently losing interest in tasks started Able to focus on tasks

Report negative symptoms?

Previous Next

Drug History

Is using Benzodiazepines Opioids Antidepressants Anticonvulsants Histamine H2 receptor antagonists Corticosteroids Nonsteroidal anti-inflammatory agents (NSAIDs) Cardiac drugs

Is not using Benzodiazepines Opioids Antidepressants Anticonvulsants Histamine H2 receptor antagonists Corticosteroids Nonsteroidal anti-inflammatory agents (NSAIDs) Cardiac drugs

Report negative symptoms?

Previous Next

Symptoms

Has a history of Alcohol use disorder Attention deficit hyperactivity disorder (ADHD) Chronic fatigue syndrome Concussion Cushing syndrome Dementia Depression or anxiety

Has no history of Alcohol use disorder Attention deficit hyperactivity disorder (ADHD) Chronic fatigue syndrome Concussion Cushing syndrome Dementia Depression or anxiety

Report negative symptoms?

Previous Next

Symptoms

Has a history of Epilepsy Insomnia Major depressive disorder Schizophrenia Bipolar disorder Multiple sclerosis (MS)

Has no history of Epilepsy Insomnia Major depressive disorder Schizophrenia Bipolar disorder Multiple sclerosis (MS)

Report negative symptoms?

Previous Next

Any other relevant details



Previous Create Clerk Sheet Email Clerk Sheet Copy Clerk Sheet