Alabama Mental Health Intake & Evaluation Patient Name: MaryMedical Record #: 202306Date of Birth: June 12 2000Current Age: 33Date Service Provided: 2/6/2023Primary Care Provider: Click here to enter text.Reason for Referral:Service(s) Provided: 90791 (psychological evaluation)Evaluation Procedures: ☒Interview with select an option☐Review of records☐Psychological testing: select an option Click here to enter text.Background InformationMedical History: ☐see medical chart for details☐addiction☐cardiac illness☐hypertension☐diabetes☒sleep disorder☐fertility issues☐per patient history is significant for chronic pain☐nutrition/obesity/eating disorder☐otherAdditional Comments: Current Medications per patient: NoneCurrent FunctioningOrientation: To PersonAppearance/Personal Hygiene: Attired in street clothesEye Contact: directPsychosis: select an option Hallucinations: ☒None ☐Auditory ☐visual ☐olfactory ☐gustatory Delusions: ☐Bizarre ☐Grandiose ☐Jealousy ☐Nihilistic ☐Persecutory ☐Reference ☐SomaticHomicidal Ideation/Intentions: No ☒Duty to Protect process completed Insight: present and adequate Intelligence: above averageMemory/Cognition: select an optionMood/Affect: ☐Angry☒Anxious☐Appropriate☐Bright ☐Distressed☐Fatigued☐Flat☐Expressing Guilt☐Hopeful☐Being Irritable☐Labile☒Expressing Loss of Pleasure☐Being Sad ☐Suspicious☐Tearful☐Having Trouble Concentrating☐Withdrawn☐Expressing Worthlessness☐Expressing Worry☐Difficult or Unable to AssessSuicidal Ideation/Intentions: no Frequency of occurrence: Click here to enter text. How long does it