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Method of History Taking in Psychiatry Date __________ 1. Identifying data: I. Name: II. Age: III. Sex : M/F IV.

Education: V. Occupation: VI. Marital Status: VII. Religion: H/ M/Ch VIII. Present Address: IX. Permanent Address: X. Name of Father / Husband: XI. Information: 2. Chief Complaint: 3. History of Present Illness: 4. Past Psychiatric Illness: 5. Past Physical Illness: 6. Personal History: 7. Family History: 8. Mental Status Examination : I. General Appearance and Behaviour II. Mood and Affect III. Speech IV. Perceptual Disturbance V. Thought VI. Sensorium and cognition i. Alertness and consciousness ii. Orientation iii. Memory iv. Concentration v. Abstract thinking vi. Fund of information and intelligence vii. Impulse control viii. Judgement ix. Insight 9. Physical Examination 10. Laboratory test 11. Diagnosis 12. Prognosis 13. Psychodynamic Formulation 14. Treatment Suggested