Medicaid Mental Status Exam
None

 

 
Appearance
 Age Appropriate
 
 Younger Than Age
 
 Older Than Age
 
Eye Contact
 Good
 
 Fair
 
 Poor
 
Grooming
 Good
 
 Fair
 
 Poor
 
Attentiveness
 Attentive
 
 Distracted
 
 Resistant
 
 Preoccupied
 
 Disinterested
 
Alertness
 Alert
 
 Drowsy
 
 Stupor
 
Motor
 Normal
 
 Slowed
 
 Agitated
 
 Abnormal (tics,tremors,grimaces)
 
Speech
 Normal
 
 Slowed
 
 Pressured
 
 Loud
 
 Quiet
 
 Inarticulate
 
Affect
 Stable/appropriate
 
 Labile
 
 Constricted
 
 Flat
 
 Blunted
 
 Inapp. to Content and Circumstance
 
 Other
 
Mood
 Neutral
 
 Pleasant
 
 Happy
 
 Sad
 
 Euphoric
 
 Irritable
 
 Anxious
 
 Fearful
 
 Angry
 
 Apathetic
 
 Other
 
Thought Content
 Normal
 
 Worthless/Hopeless
 
 Self-Deprecating
 
 Threatening
 
 Obsessions
 
 Ruminating
 
 Phobias
 
 Ideas of Reference
 
 Paranoia
 
 Magical Ideation
 
 Delusions
 
 Grandiose
 
 Others
 
Thought Process
 Normal
 
 Associations
 
 Illogical
 
 Incoherent
 
 Tangential
 
 Flight of Ideas
 
 Word Salad
 
 Other
 
Perceptions
 Normal
 
 Auditory Hallucinations
 
 Visual Hallucinations
 
 Tactile Hallucinations
 
 Depersonalization
 
 Derealization
 
 Other
 
Intelligence
 Average
 
 Below Average
 
 Above Average
 
Insight (for age)
 Good
 
 Fair
 
 Poor
 
Judgement
 Good
 
 Fair
 
 Poor
 
Describe any status exam concerns
 

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