Organizing DB 2


Primary Task Response: Within the Discussion Board area, write 400-600 words that respond to the following questions with your thoughts, ideas, and comments. This will be the foundation for future discussions by your classmates. Be substantive and clear, and use examples to reinforce your ideas.
The financial results of an organization are a very important part of how it measures success. Managers and finance professionals use various methods of quantitative analysis and financial analysis to report the company’s results. Please review the following articles on quantitative and financial analysis:

Quantitative Analysis
Types of Financial Analysis

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Then, with your fellow classmates, reflect on what you have learned in your program and the information from the articles, and discuss the following:

What are the different types of quantitative analysis?
What are the different types of financial analysis?
What is your recommended strategy for measuring a companys financial success?

How to Evaluate the Impact
of Corporate Purpose
Christian Busch and Lisa Hehenberger

Companies must develop the capacity to accurately assess whether they

are making progress toward social and environmental goals.

Brian Stauffer/

Confronted by employees seeking meaningful work,
customers demanding sustainable and traceable products,
and investors who want companies to do both well and good
while inequality is rising and climate change is an
increasingly dire threat business leaders are redefining
the purpose of their organizations. These days, one is hard-
pressed to find a major company that has not incorporated
the greater good into a statement that lays out the
organizations reason for existing.

But if corporate purpose is to be more than window dressing
and deliver on the promise of an engaged, motivated
workforce and more loyal customers, companies must
develop a capacity that is still lagging for most: They must
be able to accurately assess the results of executing their
purpose-driven strategy, particularly when that strategy

extends to making a positive social and environmental
impact. If companies measure this at all, they often
outsource it to consultants, silo it in a corporate social
responsibility function, or even delegate it to an intern. This
attitude has led to suboptimal approaches that fail to look
holistically at the core business, are not taken seriously by
key stakeholders, or produce poor data that is not actionable.

Even companies that are making a sincere effort to
implement purpose often focus largely on aligning
employees with the organizations raison dtre.
Consequently, their efforts to track the impact of purpose
may lean toward measuring employees understanding of
purpose and its effect on engagement and retention. But
for an organizations stated purpose to be sustainable,
companies must begin to engage in the hard work of
assessing how it is made manifest (or not) in all business
activities in terms of specific objectives, outputs, and
outcomes. At truly purpose-driven companies, managing
purpose is inseparable from managing the business. 1 They

evolve into what we call impact organizations that
strategically define, measure, and manage their financial,
social, and environmental objectives.

Start by Understanding

Current Impact

As companies define specific, purpose-driven objectives and
the ways in which they will manifest their purpose, it is


Copyright Massachusetts Institute of Technology, 2022. All rights reserved. Reprint #64106

tempting to focus attention on new initiatives and to track
the impact of only those activities. However, it is important
to consider the whole organization and uncover potentially
negative effects of current operations.

For example, a company that provides a platform for food
delivery services and defines its purpose as feeding all
communities might launch a program in which delivery
personnel collect food that restaurants would otherwise
throw away and deliver it to people in need. It would be
disingenuous to measure the positive impact of that project
and not consider the potential food insecurity of delivery
workers earning minimum wage or the job insecurity of gig

Identify Performance

Indicators That Track

Outcomes, Not Just Inputs

Many organizations are accustomed to quantifying their
positive contributions to society in terms of the amount of
money they invest in good works. Shifting from merely
measuring inputs (resources invested) to outputs or
outcomes is necessary but not easy to accomplish. The
smaller and more focused the scope of an activity, the easier
it tends to be to measure outputs and outcomes. Starting
with outputs (such as the number of people fed) can be
helpful, because they are often directly related to an
organizations efforts, and data is more readily available. 2

Measuring outcomes, in turn, often requires outside
information. For example, improving food security could
be measured by polling community members.

Furthermore, an organization needs to identify to what
extent its own efforts contributed to these results. 3

Especially for longer-term outcomes, it can often be difficult
to disentangle the causal relationship between an
organizations activity and the long-term effect.
Understanding whether outcome changes were caused by
the organizations actions or someone/something else often
requires a look at the counterfactual what would have
occurred had the organization not made that particular
effort. Businesses can gain this insight by capturing the

activities of other actors in the area, as well as those of
partners who contributed to the organizations efforts
measuring impact at the level of a system, such as a
community. 4

One indicator should be chosen that assesses scale and
another that measures depth per outcome area. If an
organization develops an educational program to prepare
youths for jobs in its sector, for example, program leaders
will likely want to understand both how many students
completed the program (scale) and how the program helped
them get jobs (depth).

Output measures under an organizations direct control
should be tracked at least quarterly. Outcomes the
changes the organization aims to achieve might be
tracked less frequently, given that change requires time.

Qualitative data that connects outputs to the lived reality of
program participants adds depth and can inform the design
of future activities. For example, students who successfully
completed an apprenticeship program might report getting
a job, but also describe how the program awakened broader
interests and inspired them to begin a higher education

Systematize Data Collection

and Analysis

As companies become serious about measuring the impact
of purpose, they also need to develop formal systems for
collecting and tracking impact data and apply the same
standards of data quality that they do to their financial
information. Business leaders should integrate the data into
the companys reporting and governance systems such that it
is transparent and accessible, and they should communicate
results to key stakeholders. Senior leaders who are sincerely
committed to purpose will demand no less and data must
withstand scrutiny from stakeholders who seek to hold the
company accountable for living its purpose, such as activist
employees and customers, and impact investors.

Good data on outputs and outcomes doesnt just verify the
value created by the organization; when it is fed into
management analytics dashboards and decision support


Copyright Massachusetts Institute of Technology, 2022. All rights reserved. Reprint #64106

systems, it can reveal opportunities for iterating, learning,
and improving upon execution of a purpose-based strategy.
The right impact data will be relevant to daily activities.
For instance, the data a company collects on the energy
efficiency of its plants to track its progress toward
sustainability commitments is material to decisions on how
it manages its entire value chain.

Developing strategies and systems that track and report
impact data, hold the organization accountable, and provide
decision makers with actionable and timely operational data
is paramount for making a purpose statement a mission
rather than just a motto. In a fast-changing world, data can
also offer up serendipitous associations that might lead to
new solutions especially welcome as businesses take on
the more complex challenge of fulfilling a purpose that
embraces multiple stakeholder needs. 5 This can make

companies into impact organizations and turn rhetoric into

About the Authors

Christian Busch (@chrisserendip) directs the Global
Economy program at New York Universitys Center for
Global Affairs and is the author of The Serendipity Mindset:
The Art and Science of Creating Good Luck (Penguin
Random House, 2020). Lisa Hehenberger (@lhehenberger)
is an associate professor at Esade Business School and
director of the Esade Center for Social Impact.


1.1. V.K. Rangan, L. Chase, and S. Karim, The Truth About CSR, Harvard
Business Review 93, no. 1-2 (January-February 2015): 41-49.

2.2. L. Hehenberger, A. Harling, and P. Scholten, A Practical Guide to
Measuring and Managing Impact PDF file (Brussels: European Venture
Philanthropy Association, April 2013),; also see C. Busch
and H.G. Barkema, Align or Perish: Dynamic Social Enterprise Network
Orchestration in Sub-Saharan Africa, Journal of Business Venturing 37,
no. 2 (March 2022): 1-26.

3.3. M.K. Gugerty and D. Karlan, Ten Reasons Not to Measure Impact
and What to Do Instead, Stanford Social Innovation Review 16, no. 3
(summer 2018): 41-47.

4.4. J. Mair and C. Seelos, Organizations, Social Problems, and System
Change: Invigorating the Third Mandate of Organizational Research,
Organization Theory 2, no. 4 (October 2021): 1-22.

5.5. C. Busch, The Serendipity Mindset: The Art and Science of Creating
Good Luck (New York: Penguin Random House, 2020).


Copyright Massachusetts Institute of Technology, 2022. All rights reserved. Reprint #64106

Reproduced with permission of copyright owner. Further reproduction





Katarina OREVI


Abstract: In the contemporary environment whose main feature implies

constant and unpredictable change in competition, companies have to

pay additional attention to the time and resources both financial and

human resources in order to be capable of measuring success

performances in their organization. Such a state of the contemporary

environment has led to the situation where, apart from the financial

aspects of doing business, an organization also has to monitor the other

key performance elements, where traditional financial indicators are

considered as insufficient for the current environment, which makes

performance measurement systems much more complex. The BSC

represents the model that came to light in 1990, when Kaplan and Norton

conducted a research study entitled: Performance Measurement in the

Organization of the Future. The main reason why Kaplan and Norton

conducted the research study was the belief that the financial

performance measures were inappropriate for the modern business

operations of organizations given the fact that the then organizations

were exclusively using financial measures to manage their business

operations based upon historical data. The BSC model proposed by

Kaplan and Norton is a management tool supportive of the successful

implementation of corporate strategies. This was discussed and broadly

considered in practice and research. Connecting operational and

nonfinancial corporate activities with the causal chains in the context of

a companys long-term strategy, the BSC supports the compliance and

management of all corporate activities in compliance with their strategic

relevance. The balanced scorecard enables taking into consideration the

nonmonetary strategic success factors, which exert a significant

influence on an organizations economic success. The BSC is therefore a

promising starting point which also includes ecological and social

aspects in the main management system of an organization.

Key words: balanced scorecard, BSC model, financial perspective,

internal processes, performances, buyer perspective



1. Introduction

The Balanced Scorecard (hereinafter referred to in the abbreviated form

BSC) originated from the sports world, namely from boxing. During a

boxing match, the referee uses a card called a scorecard to record a boxers

successful and correct hits. In case the match does not end in a knockout,

the referee makes a decision based upon the records in the already

mentioned scorecard.

In todays contemporary business and business operations, an

organization not only has a goal to survive, but also to win a market game.

Global technological, economic, political, legal, sociocultural and other

factors have had an influence on changes being made faster and on the

modeling of the management methodology and practice as well. There are

authors who refer to a new strategy management theory which would enable

development in the field of creative, proactive strategic contemplations. In

todays dynamic networked world, the fact that a whole is greater than the

sum of its parts, on the one hand, and that holistic contemplation and such

approached should be replaced by or at least amended with analytical ones,

on the other, are increasingly being accepted (Hamel, 1998). Todays

environment is becoming more and more dynamic and more and more

uncertain. The availability of an increasingly larger number of pieces of

information, a simple approach to information, as well as oversaturation

with information, have led to the world being reoriented from the industrial

economy to the knowledge economy (Drucker, 1998).

In the contemporary environment, the companies whose main feature

reflects in permanent and unpredictable change in competition have to pay

additional attention to the time and resources, both financial and human

resources, so as to be able to measure success performances in their

organization. Such a state of the contemporary environment has led to the

situation in which the organization also has to monitor the other key

performance elements apart from the financial aspects of doing business,

where the traditional financial indicators are considered as insufficient for

the current environment, which makes performance measurement systems

much more complex. The traditional financial indicators were good in the

industrial era, but they are obsolete in relation to the necessary

competencies and capacities which todays enterprises are doing their best

to develop. (Kaplan & Norton, 1992)

It is also due to the changes in the character of labor and doing business

that there have been changes from labor-intensive towards capital-intensive,

all the way to knowledge-colored-intensive labor and business operations

which we are in today, which has led to the key problem faced by



management namely the application of the formulated organizational

strategy (Papalexandris et al., 2005).

The key problem identified in the traditional performance measurement

and management models is a great tendency to manage business operations

only founded on financial performances reporting on past events. Such a

performance measurement and management model is insufficient for the

successful implementation of the organizational strategy (Niven, 2002;


The BSC is a model which came to light in 1990, when Kaplan and

Norton conducted their research study entitled Performance Measurement

in the Organization of the Future. That research study included ten

organizations in which new performance measurement methods were being

studied. The main reason why Kaplan and Norton conducted that research

study was the belief that the financial performance measures were

inappropriate for the modern business operations conducted by

organizations given the fact that the then organizations had exclusively been

using financial measures to manage their business operations based upon

historical data. Because of all the mentioned problems and challenges

encountered by contemporary organizations, a later research study carried

out with a very small number of the organizations included in the survey

assessed the existing approaches to performance measurement as either

efficient or very efficient (Kaplan & Norton, 2001).

The BSC model proposed by Kaplan and Norton represents a

management tool supportive of the successful implementation of corporate

strategies. This was discussed and broadly contemplated in practice and

research. Connecting operational and nonfinancial corporate activities with

causal chains in the context of a companys long-term strategy, the BSC

supports the reconciliation and management of all corporate activities in

compliance with their strategic relevance. The balanced indicator enables

taking into consideration the nonmonetary strategic success factors that exert

a significant influence on the economic success of the organization. The BSC

is therefore a promising starting point, which also includes ecological and

social aspects in the main management systems of an organization.

Not only is this approach a set of performance indicators, but it also

represents something much more than that it is a management structure

modelling an integral planning, management and control process. There is

also the need to emphasize the fact that certain segments and employees

goals are brought into harmony with the companys organizational strategy,

so that the BSC approach is considered as the central and organizational

framework for the whole management process.



In relation to the first time that it appeared, the BSC approach has

changed so some extent, those changes leading to the yet better integration

of the strategy into the organizational business operations. This new version

of the BSC approach is based upon the continuous improvement of the

approach and encompasses six stages (Kaplan & Norton, 2008):

1. The development of a strategy based upon the internal context, the

external context and the existing strategy.

2. Strategy planning by developing a Map Strategy.

3. Bringing to compliance all initiatives with the organizational strategy.

4. Planning operations the budget and the strategy need to be connected

with each other.

5. Testing and adaptation whether the strategy is being implemented is

checked and necessary modifications to the same are made.

To be even more precise, the BSC concept is implicative of a balanced

organizational performance measurement system which implies a balance

between short-term and long-term goals, financial and nonfinancial

indicators, the leading indicators, as well as both internal and external

perspectives of the organizations performances (Kloppenborg & Petrick,


2. The Four Fundamental Perspectives of the BSC Approach

2.1. The four perspectives of the BSC Approach

The starting basis of the BSC approach methodology implies that no

management is possible of what cannot be measured; in the same way, it is

also impossible to measure what cannot be described (Kaplan et al., 1996;

Anthony et al., 2007).

The BSC model presented by Kaplan and Norton in 1992 is a popular

performance measurement system categorizing the goals of the organization

into the four measurable and operational perspectives: learning and growth,

the financial perspective, the user perspective, and internal business

processes (Kaplan & Norton, 1992).

As has already been mentioned, the BSC approach consists of the

measures of financial successfulness, buyer relationships, internal business

processes, organizational learning and growth. Each business unit in the

organization should develop its own BSC measures so that they should

reflect the organizations goals and strategies. Some of those measures will

be common to all participants, i.e. to all units, whereas others will be unique

for each business unit (Gascho et al., 2000).



The four main perspectives of the BSC approach according to

(Hannabarger et al., 2011) are as follows:

1) the financial perspective it measures the success made by a company

in increasing value for its shareholders, i.e. whether the organizational

strategy does contribute to the improvement of the financial state of the

organization or not;

2) the buyer perspective it measures how the organizational strategies

and activities oriented towards buyers influence buyer loyalty and

greater profitability;

3) the internal business processes perspective it measures how the

processes inside the organization should be carried out so as to increase

the efficiency of the organization itself; and

4) the learning and development perspective it measures how

innovations, employee education and employee satisfaction contribute

to the achievement of strategic goals.

The foregoing four perspectives do not eliminate one another, but they

rather support the goals of different management techniques (such as

strategic planning, Total Quality Management), which were being used in

the years when the BSC appeared for the first time. Each mentioned

perspective contains and is observed through the following four parameters,


goals What is it that needs to be done in order to make a success?

measures Which parameters will be selected and monitored in order to

prove a business success?

target values Which quantitative values are going to be used to

determine the measurement success?

initiatives What is it that needs to be done so as to achieve such set


According to the BSC concept, all financial and nonfinancial measures

should be included and they should be a part of the information system at

all the organizational levels (Kaplan & Norton, 2006).

The BSC contributes to the improvement of organizational performances,

enabling the existence of the four main elements, which, in comparison with

the other frameworks, make a difference between strategic management and

learning (Kaplan & Norton, 2007):

1. the clarification of the vision and mission for all the employed inside

the organization;

2. the role of communication as a factor of the integration of all the efforts

made by individual business units intended to meet the organizational




3. be focused on the importance of the approach as the tool enabling a

revised strategy; and

4. be focused on strategic feedback by including professional types of

knowledge of changes in the competitive environment.

It would be desirable that the BSC approach should be implemented in

all organizations as a performance measuring and improvement system. In

that manner, based upon a set of different financial and nonfinancial

indicators, the organization would be knowledgeable of where it stands in

relation to its set and planned goals (Kaplan & Norton, 1996).

The BSC approach offers a possibility for strategic goals to be

transparent and converted into the goals of all the organizational segments

and all employees as well. A strategy would have to be so defined as to

make it possible for each organizational whole, for each segment, for each

process owner, even for each single employee in it to be able and obliged to

recognize their role in such defined strategic goals, determining their own

goals and activities towards meeting them and improving the very indicators

of organizational performances in that manner.

The BSC approach has the role to contain in itself regular mixes of

measuring and process assessment and additional value for buyers, which may

lead to the financial results previously wanted and planned (Niven, 2010).

2.2. The financial perspective

Generally viewed, financial performance measures can be considered as

the most important component in the application of the companys strategy.

That is a consequence of the main role of support and organizational

improvement. The goal to be achieved b the main financial perspective

reflects in an increase in shareholder value, growth and profitability.

The construction of a strategy map itself as a rule starts with a financial

strategy. As has already been mentioned, this perspectives goal is to increase

value for shareholders, to increase income, and to increase organizational

growth. An increase in income can be achieved via penetrating new markets,

offering new products and services, or attracting new buyers, as well as

increasing the value of the existing buyers through strengthening the

relationships by broadening the offer. As a rule, there are two productivity

approaches: the first relates to the improvement of the cost structure by

decreasing direct and indirect costs; the second approach relates to a better

utilization of the existing assets through a decrease in labor and fixed capital.

The financial perspective represents the most important aspect of doing

business given the fact that profit achievement is the most important goal

aspired to by every single organization. The financial perspective of the



BSC approach consists of the goals and measures that represent the ultimate

measure of successfulness for the organization for the purpose of profit

maximization. The achievement of such goals in the learning and

development perspective, the internal business processes perspective and

the buyer perspective result in the financial perspective, which indicates the

importance of financial performance indicators, but not as the only indicator

of the achievement of organizational goals, for which reason long-term

financial growth may be achieved using the BSC approach to setting goals

which measure such financial performances in combination with a series of

the other activities that can be used to engage employees, improve the

financial processes, the internal processes and the buyer relationships.

If organizations want to achieve the optimal advantage using the BSC

approach, they should also consider the nonfinancial factors, too. If

organizations are only focused on achieving short-term financial outcomes,

that might lead to that organization only developing short-term goals and

ignoring long-term value and investments, simultaneously also neglecting

the significance of intellectual and intangible assets, whose main role

reflects in organizational development (Kaplan et al., 1996). It is indicative

that some among the applicable financial measures are as follows: gross

marge percentage, cost reduction in key areas, investment return and

invested capital return (Kaplan et al., 1996; Collis et al., 2012).

2.3. The buyer perspective

In the last few years, the majority of organizations have developed their

own vision based on the own buyer, given the fact that the buyer focus and

satisfaction are considered to be important for any sector. The basic

organizational goal based upon the buyer perspective is offering excellent

services, an excellent quality and the provision of buyer satisfaction so that

business operations would be able to maintain a good reputation amongst

them (Amaratunga et al., 2000).

The main leading indicator of this perspective is meeting key user, i.e.

key buyer needs and expectations. Yet another factor of importance which all

business entities have to consider is ensuring that all the products and services

are delivered in time and that market circumstances are so classified to enable

the measuring of a share in particular sectors (Kaplan et al., 1996).

The buyer perspective is focused on the buyers opinion about the

organization and about how the organization wants to be seen by buyers

(Norreklit, 2000). Buyer satisfaction is a priority for many organizations,

especially today, when the business environment is even more competitive and

can act as a very important, even key, performance indicator, which testifies to



the efforts made by the organization to be yet more successful (Anderson &

Sullivan, 1993). When defining a strategy, it is very important that the market

segment and the buyer segment, as well as their wishes with respect to prices,

the quality, functionality, etc. should be defined through market research. The

organizations that opt for performance excellence have to be very careful about

the competitions prices, product and service quality, and the quick realization

of the orders made and delivery within the deadline. A personal approach to

the buyer (user) requires a quality relationship with the buyer through an

exceptional service level and product offer. If the product and service

leadership has already been selected, the strategy must be redirected towards

such product and service functionality, features and total performance.

There are usually the main four concerns on the users part related to a

product or service offered by an organization, those concerns being the time,

the quality, the performances and the service, and the costs. For the reason of

that fact, the organization has to bring to compliance its goals according to

these four elements, and then to have these goals transformed into special


2.4. The internal processes perspective

Internal process can be used to categorize buyers and the

organizations goals. This is achieved by measuring the companys

processes with the aim to achieve the best performance outcome.

Conducting the internal process perspective, customer satisfaction and

financial strategic goals can be achieved (Kaplan et al., 1996).

Organizational process can also be observed through the use of the BSC

approach, and they can ensure that results will be sufficient, i.e. satisfactory.

There are two main differences between the traditional approach and the

BSC style when performance measurement is concerned. The main two

differences are as follows according to (Amaratunga et al., 2000):

– the main method used in the traditional approaches pertained to

observing and developing the existing processes, whereas the BSC

approach generates new processes, which enable the organization to

overcome meeting financial goals and clients goals;

– in order to introduce new products and services, the BSC approach

integrates innovative processes so as to increase the outcome of the

introduction of novel products and services.

The goals of this perspective are usually set after the financial

perspective and the buyer perspective, since this element de facto identifies

the processes critical for the achievement of buyers and the owners goals,

thus also creating value for the organization itself.



The connectedness of the processes and buyers is very important, since

there are two big transitions signalized here, namely the transition from the

internal (the employees, the atmosphere, the processes) towards the external

(clients), and from the intangible (know-how) towards the tangible

(outcomes with buyers and financial rewards). Outcomes with buyers

signalize what? and the internal processes give the answer to the question

how? to have it strategically conducted (Niven, 2010).

Financial gains founded on improved business processes may appear in

several stages. Stage one is a cost reduction which appears due to the

improvement of business processes. It is in this stage that short-term gains

for the organization a


wk 101

NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Template

Week (enter week #): (Enter assignment title)

Student Name
College of Nursing-PMHNP, Walden University
NRNP 6635: Psychopathology and Diagnostic Reasoning
Faculty Name
Assignment Due Date


CC (chief complaint):


Past Psychiatric History:

General Statement:

Caregivers (if applicable):


Medication trials:

Psychotherapy or
Previous Psychiatric Diagnosis:

Substance Current Use and History:

Family Psychiatric/Substance Use History:

Psychosocial History:

Medical History:

Current Medications:


Reproductive Hx:




Physical exam: if applicable

Diagnostic results:


Mental Status Examination:
Differential Diagnoses:


2021 Walden University Page 1 of 3 NRNP/PRAC 6635 Comprehensive Psychiatric Evaluation Exemplar

If you are struggling with the format or remembering what to include, follow the
Comprehensive Psychiatric Evaluation Template

the Rubric
as your guide. It is also helpful to review the rubric in detail in order not to lose points unnecessarily because you missed something required. Below highlights by category are taken directly from the grading rubric for the assignment in Weeks 410. After reviewing the full details of the rubric, you can use it as a guide.

In the
Subjective section, provide:

Chief complaint
History of present illness (HPI)
Past psychiatric history
Medication trials and current medications
Psychotherapy or previous psychiatric diagnosis
Pertinent substance use, family psychiatric/substance use, social, and medical history

Read rating descriptions to see the grading standards!

In the
Objective section, provide:

Physical exam documentation of systems pertinent to the chief complaint, HPI, and history
Diagnostic results, including any labs, imaging, or other assessments needed to develop the differential diagnoses.

Read rating descriptions to see the grading standards!

In the
Assessment section, provide:

Results of the mental status examination,

presented in paragraph form.

At least three differentials with supporting evidence. List them from top priority to least priority. Compare the
DSM-5-TR diagnostic criteria for each differential diagnosis and explain what
DSM-5-TR criteria rules out the differential diagnosis to find an accurate diagnosis.

Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case


Read rating descriptions to see the grading standards!

Reflect on this case. Include: Discuss what you learned and what you might do differently. Also include in your reflection a discussion related to legal/ethical considerations (

demonstrate critical thinking beyond confidentiality and consent for treatment

!), social determinates of health, health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

(The comprehensive evaluation is typically the
initial new patient evaluation. You will practice writing this type of note in this course. You will be ruling out other mental illnesses so often you will write up what symptoms are present and what symptoms are not present from illnesses to demonstrate you have indeed assessed for all illnesses which could be impacting your patient. For example, anxiety symptoms, depressive symptoms, bipolar symptoms, psychosis symptoms, substance use, etc.)


CC (chief complaint): A
brief statement identifying why the patient is here. This statement is verbatim of the patients own words about why presenting for assessment. For a patient with dementia or other cognitive deficits, this statement can be obtained from a family member.

HPI: Begin this section with patients initials, age, race, gender, purpose of evaluation, current medication and referral reason. For example:

N.M. is a 34-year-old Asian male presents for psychiatric evaluation for anxiety. He is currently prescribed sertraline which he finds ineffective. His PCP referred him for evaluation and treatment.
P.H., a 16-year-old Hispanic female, presents for psychiatric evaluation for concentration difficulty. She is not currently prescribed psychotropic medications. She is referred by her therapist for medication evaluation and treatment.
Then, this section continues with the symptom analysis for your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis.
Paint a picture of what is wrong with the patient. First what is bringing the patient to your evaluation. Then, include a PSYCHIATRIC REVIEW OF SYMPTOMS. The symptoms onset, duration, frequency, severity, and impact. Your description here will guide your differential diagnoses. You are seeking symptoms that may align with many DSM-5-TR diagnoses, narrowing to what aligns with diagnostic criteria for mental health and substance use disorders.

Past Psychiatric History: This section documents the patients past treatments. Use the mnemonic

General Statement: Typically, this is a statement of the patients first treatment experience. For example: The patient entered treatment at the age of 10 with counseling for depression during her parents divorce. OR The patient entered treatment for detox at age 26 after abusing alcohol since age 13.

Caregivers are listed if applicable.

Hospitalizations: How many hospitalizations? When and where was last hospitalization? How many detox? How many residential treatments? When and where was last detox/residential treatment? Any history of suicidal or homicidal behaviors? Any history of self-harm behaviors?

Medication trials: What are the previous psychotropic medications the patient has tried and what was their reaction? Effective, Not Effective, Adverse Reaction? Some examples: Haloperidol (dystonic reaction), risperidone (hyperprolactinemia), olanzapine (effective, insurance wouldnt pay for it)

Psychotherapy or
Previous Psychiatric Diagnosis: This section can be completed one of two ways depending on what you want to capture to support the evaluation. First, does the patient know what type? Did they find psychotherapy helpful or not? Why? Second, what are the previous diagnosis for the client noted from previous treatments and other providers. Thirdly, you could document both.

Substance Use History: This section contains any history or current use of caffeine, nicotine, illicit substance (including marijuana), and alcohol. Include the daily amount of use and last known use. Include type of use such as inhales, snorts, IV, etc. Include any histories of withdrawal complications from tremors, Delirium Tremens, or seizures.

Family Psychiatric/Substance Use History: This section contains any family history of psychiatric illness, substance use illnesses, and family suicides. You may choose to use a genogram to depict this information. Be sure to include a readers key to your genogram or write up in narrative form.

Social History: This section may be lengthy if completing an evaluation for psychotherapy or shorter if completing an evaluation for psychopharmacology. However, at a minimum, please include:

Where patient was born, who raised the patient
Number of brothers/sisters (what order is the patient within siblings)
Who the patient currently lives with in a home? Are they single, married, divorced, widowed? How many children?
Educational Level
Work History: currently working/profession, disabled, unemployed, retired?
Legal history: past hx, any current issues?
Trauma history: Any childhood or adult history of trauma?
Violence Hx:
Concern or issues about safety (personal, home, community, sexual (current & historical)

Medical History: This section contains any illnesses, surgeries, include any hx of seizures, head injuries.

Current Medications: Include dosage, frequency, length of time used, and reason for use. Also include OTC or homeopathic products.

Include medication, food, and environmental allergies separately. Provide a description of what the allergy is (e.g., angioedema, anaphylaxis). This will help determine a true reaction vs. intolerance.

Reproductive Hx:
Menstrual history (date of LMP), Pregnant (yes or no), Nursing/lactating (yes or no), contraceptive use (method used), types of intercourse: oral, anal, vaginal, other, any sexual concerns

ROS: Cover all body systems that may help you include or rule out a differential diagnosis. Please note: THIS IS DIFFERENT from a physical examination!

You should list each system as follows:
EENT: etc. You should list these in bullet format and document the systems in order from head to toe.

Example of Complete ROS:

GENERAL: No weight loss, fever, chills, weakness, or fatigue.
HEENT: Eyes: No visual loss, blurred vision, double vision, or yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose, or sore throat.
SKIN: No rash or itching.
CARDIOVASCULAR: No chest pain, chest pressure, or chest discomfort. No palpitations or edema.
RESPIRATORY: No shortness of breath, cough, or sputum.
GASTROINTESTINAL: No anorexia, nausea, vomiting, or diarrhea. No abdominal pain or blood.
GENITOURINARY: Burning on urination, urgency, hesitancy, odor, odd color
NEUROLOGICAL: No headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control.
MUSCULOSKELETAL: No muscle, back pain, joint pain, or stiffness.
HEMATOLOGIC: No anemia, bleeding, or bruising.
LYMPHATICS: No enlarged nodes. No history of splenectomy.
ENDOCRINOLOGIC: No reports of sweating, cold, or heat intolerance. No polyuria or polydipsia.

Physical exam (If applicable and if you have opportunity to performdocument if exam is completed by PCP): From head to toe, include what you see, hear, and feel when doing your physical exam. You only need to examine the systems that are pertinent to the CC, HPI, and History.
Do not use WNL or normal. You must describe what you see. Always document in head-to-toe format i.e., General: Head: EENT: etc.

Diagnostic results: Include any labs, X-rays, or other diagnostics that are needed to develop the differential diagnoses (support with evidenced and guidelines).



Mental Status Examination: For the purposes of your courses, this section must be presented in paragraph form and not use of a checklist! This section you will describe the patients appearance, attitude, behavior, mood and affect, speech, thought processes, thought content, perceptions (hallucinations, pseudohallucinations, illusions, etc.)., cognition, insight, judgment, and SI/HI. See an example below. You will modify to include the specifics for your patient on the above elementsDO NOT just copy the example. You may use a preceptors way of organizing the information if the MSE is in paragraph form.

He is an 8-year-old African Americanmale who looks his stated age. He is cooperative with examiner. He is neatly groomed and clean, dressed appropriately. There is no evidence of any abnormal motor activity. His speech is clear, coherent, normal in volume and tone. His thought process is goal directed and logical. There is no evidence of looseness of association or flight of ideas. His mood is euthymic, and his affect appropriate to his mood. He was smiling at times in an appropriate manner. He denies any auditory or visual hallucinations. There is no evidence of any delusional thinking. He denies any current suicidal or homicidal ideation.Cognitively, he is alert and oriented. His recent and remote memory is intact. His concentration is good. His insight is good.

Differential Diagnoses:
You must have at least three differentials with supporting evidence. Explain what rules each differential in or out and justify your primary diagnostic impression selection. You will use supporting evidence from the literature to support your rationale. Include pertinent positives and pertinent negatives for the specific patient case.

Also included in this section is the reflection. Reflect on this case and discuss whether or not you agree with your preceptors assessment and diagnostic impression of the patient and why or why not. What did you learn from this case? What would you do differently?

Also include in your reflection a discussion related to legal/ethical considerations (
demonstrating critical thinking beyond confidentiality and consent for treatment!), social determinates of health, health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).

References (move to begin on next page)

You are required to include at least three evidence-based, peer-reviewed journal articles or evidenced-based guidelines which relate to this case to support your diagnostics and differentials diagnoses. Be sure to use correct APA 7th edition formatting.

2021 Walden University Page 1 of 3
Training Title 24
Name: Ms. Jess Davies
Gender: female
Age: 30 years old
T- 98.6 P- 86 R 20 120/70 Ht 52 Wt 126lbs
Background: Jess is brought for evaluation by her 2 roommates who are concerned with
behaviors. She had some issues with depression after aunt died but worsened in the 12 days after
she witnessed her brother killed via GSW in a gas station burglary. She is estranged from her
parents and her brother were her only sibling. She is only sleeping 2 hours/24hrs; she will only eat
canned foods. She smokes cannabis daily since she was 17 and goes out on weekdays couple
times with her roommates and has couple drinks of beer. She was prescribed alprazolam 1mg
twice daily as needed by her PCP for 15 days. She works in a bakery. Allergies: medical tape
Symptom Media. (Producer). (2016). Training title 24 [Video].


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