TIME TO FILL OUT THAT PAPERWORK change!

TIME TO FILL OUT THAT PAPERWORK
Hey!
NPS get’s it. This is a ton of paperwork to fill out. Many times you fill all this out and you
wonder, does any of this get used? At NPS, nothing gets wasted…promise!. This will save you several
sessions and you’ll love this…..tons of money. At NPS, as your team clinicians, we understand that our
intake is a lengthy, pain in the rumpster, comprehensive history of you or child’s life. This will take 1 to
1 ½ hours to complete. (I know,……. already half of you are gouging your left eye out and hating us
before we can even help you.) Also, this time line will be yours to keep in your NPS binder for future
appointment with other professionals. Trust us. You’ll be glad you have it. Make copies….again, it will
save you money in the future.
***IMPORTANT-if you have already been diagnosed with ADHD and take medication for it, fill out the
rating scales for when you are NOT taking meds. We need to know what you are experiencing in your
life in all areas while off of your meds.
Now, grab a cup of coffee, start writing and know that your life is about to
change!
We look forward to meeting you,
Dr. Douglas Neal and the NPS team
MEDICATION/EVENT TIME LINE
Create a time line based on age or grade level for each medication prescribed or
medical/psychological event (ie: hospitalization, counseling sessions, special services, 504, IEP,
surgeries, family or pet death, job loss, divorce, location move, major illness, etc) .
Include all of the following information for each grade level or age: use as many pages as
needed for multiple meds or events.
Please signify age or grade level.
-medication name / check whether
brand or
generic______________
-name of person diagnosing:__________
-diagnosis given:__________________
-name of doctor prescribing medication:___________________
-dosage level(s): state each dosage level tried ___mg, ____mg, ____mg
-age started medication:______________
-age stopped medication?___________
-Reasons for stopping or changing medication; please check box(s)
Cost prohibitive?
Side effects
Tics,
Irritable
Sleep issues
Anger
Zombie
Appetite loss
Affect
Not Effective
Stomach
Other _______________________
Headaches
-Age & facility name of past hospitalizations:
Major event: _____________________________________________________________
______________________________________________________________________________
____________________________________________________________________________