Process - Physician - Fraser Health Authority

METABOLIC MONITORING FORMMENTAL HEALTH AND SUBSTANCE USE (MHSU)Client name: _______________________________Page: 3 of 3Additional laboratory investigations as per risk level and BC Mental Health and Addictions recommendationsRisk factor Risk level BaselineTest date (dd/mm/yy) DateDateDateDateDateInitialsInitialsInitialsInitialsInitialsInitialsTx At risk Tx At risk Tx At risk Tx At risk Tx At risk Tx At riskTx At risk Tx At risk Tx At risk Tx At risk Tx At risk Tx At riskTx At risk Tx At risk Tx At risk Tx At risk Tx At risk Tx At riskTx At risk Tx At risk Tx At risk Tx At risk Tx At risk Tx At riskDateLifestyle factors (health lifestyle actionplan, nutrition, physical activity/ FITT, smoking)DateEducation provided (monitoring, heart disease, DKA/diabetes, BP, cholesterol, smoking cessation, lifestyle)DateReferrals made (send this form with allreferrals, transfers and discharges)DateNotesHigh risk = Any of the following conditions are present: 1)On psychotropic medications AND presence of any riskfactors or on treatment for any risk factors; OR 2) New starton psychotropic medications with high or moderate risk ofweight gain (see Tables 7 and 8 in guidelines, e.g.,atypicals/second-generation antipsychotics)Moderate risk = Any of the following conditions arepresent: 1) New start on all other psychotropic medications(those with low risk of weight gain – see Tables 7 and 8 inguidelines); OR 2) On psychotropic medications but nochanges in past 3 months; OR 3) Greater than or equal to5% increase in weight seenLow risk = No metabolicrisk factors present; ANDnot on psychotropicmedications