INTAKE summary supplemental data Instructions for Therapists: ESTIMATED TIME TO COMPLETE: 10 minutes Please complete each item below within 24 hours of an initial session. Do not overwork or overthink, and keep paragraphs similar in length to the examples provided. Be as concise as is possible while also being thorough. Reference the MMLHI often, and cut and paste relevant items whenever possible. Contact the Clinical Director if you have questions!Provider Name(Required)Stacy Blassingame, LPCCortney Dollens, LPCMacaela Gilson, LCSWMarybeth Gras, LCSWDr. Travis Munnerlyn, PsyDNicole Neace, LPCEmily Horning, LCSWProvider Email(Required) Please use your Change, Inc. Gmail Address! (Example: emily.changeinc@gmail.com)Provider NPI Number(Required)1386134138Provider NPI Number(Required)1740653161Provider NPI Number(Required)1821708769Provider NPI Number(Required)1215915582Provider NPI Number(Required)1144690231Provider NPI Number(Required)1780270983Provider NPI Number(Required)1336798354Client Name:(Required) First Last Client DOB(Required) MM slash DD slash YYYY See MMLHIDate of Intake Session:(Required) MM slash DD slash YYYY Today's Date(Required) MM slash DD slash YYYY NOTE: Should be within 24 hours or less of Intake Session DateExact Session Start Time:(Required) Hours : Minutes AM PM AM/PM Exact Session End Time:(Required) Hours : Minutes AM PM AM/PM Session Location(Required)3460 Hampton Avenue, Suite 204, St. Louis, MO 63139Telehealth, client provided consent to telehealth, service performed on HIPAA compliant softwareICD-10 Diagnosis(Required)ICD-10-CM Disorder, condition, or problemZ55.9 Academic or educational problemZ60.3 Acculturation difficultyF43.0 Acute stress disorderAdjustment disorderF43.20 Adjustment disorder, UnspecifiedF43.22 Adjustment disorder, With anxietyF43.21 Adjustment disorder, With depressed moodF43.24 Adjustment disorder, With disturbance of conductF43.23 Adjustment disorder, With mixed anxiety and depressed moodF43.25 Adjustment disorder, With mixed disturbance of emotions and conductZ72.811 Adult antisocial behaviorAdult physical abuse by nonspouse or nonpartner, ConfirmedT74.11XA Adult physical abuse by nonspouse or nonpartner, Confirmed, Initial encounterT74.11XD Adult physical abuse by nonspouse or nonpartner, Confirmed, Subsequent encounterAdult physical abuse by nonspouse or nonpartner, SuspectedT76.11XA Adult physical abuse by nonspouse or nonpartner, Suspected, Initial encounterT76.11XD Adult physical abuse by nonspouse or nonpartner, Suspected, Subsequent encounterAdult psychological abuse by nonspouse or nonpartner, ConfirmedT74.31XA Adult psychological abuse by nonspouse or nonpartner, Confirmed, Initial encounterT74.31XD Adult psychological abuse by nonspouse or nonpartner, Confirmed, Subsequent encounterAdult psychological abuse by nonspouse or nonpartner, SuspectedT76.31XA Adult psychological abuse by nonspouse or nonpartner, Suspected, Initial encounterT76.31XD Adult psychological abuse by nonspouse or nonpartner, Suspected, Subsequent encounterAdult sexual abuse by nonspouse or nonpartner, ConfirmedT74.21XA Adult sexual abuse by nonspouse or nonpartner, Confirmed, Initial encounterT74.21XD Adult sexual abuse by nonspouse or nonpartner, Confirmed, Subsequent encounterAdult sexual abuse by nonspouse or nonpartner, SuspectedT76.21XA Adult sexual abuse by nonspouse or nonpartner, Suspected, Initial encounterT76.21XD Adult sexual abuse by nonspouse or nonpartner, Suspected, Subsequent encounterF98.5 Adult-onset fluency disorderF40.00 AgoraphobiaAlcohol intoxicationAlcohol intoxication deliriumF10.121 Alcohol intoxication delirium, With mild use disorderF10.221 Alcohol intoxication delirium, With moderate or severe use disorderF10.921 Alcohol intoxication delirium, Without use disorderF10.129 Alcohol intoxication, With mild use disorderF10.229 Alcohol intoxication, With moderate or severe use disorderF10.929 Alcohol intoxication, Without use disorderAlcohol use disorderF10.10 Alcohol use disorder, MildF10.20 Alcohol use disorder, ModerateF10.20 Alcohol use disorder, SevereAlcohol withdrawalF10.231 Alcohol withdrawal deliriumF10.232 Alcohol withdrawal, With perceptual disturbancesF10.239 Alcohol withdrawal, Without perceptual disturbancesAlcohol-induced anxiety disorderF10.180 Alcohol-induced anxiety disorder, With mild use disorderF10.280 Alcohol-induced anxiety disorder, With moderate or severe use disorderF10.980 Alcohol-induced anxiety disorder, Without use disorderAlcohol-induced bipolar and related disorderF10.14 Alcohol-induced bipolar and related disorder, With mild use disorderF10.24 Alcohol-induced bipolar and related disorder, With moderate or severe use disorderF10.94 Alcohol-induced bipolar and related disorder, Without use disorderAlcohol-induced depressive disorderF10.14 Alcohol-induced depressive disorder, With mild use disorderF10.24 Alcohol-induced depressive disorder, With moderate or severe use disorderF10.94 Alcohol-induced depressive disorder, Without use disorderAlcohol-induced major neurocognitive disorder, Amnestic confabulatory typeF10.26 Alcohol-induced major neurocognitive disorder, Amnestic confabulatory type, With moderate or severe use disorderF10.96 Alcohol-induced major neurocognitive disorder, Amnestic confabulatory type, Without use disorderAlcohol-induced major neurocognitive disorder, Nonamnestic confabulatory typeF10.27 Alcohol-induced major neurocognitive disorder, Nonamnestic confabulatory type, With moderate or severe use disorderF10.97 Alcohol-induced major neurocognitive disorder, Nonamnestic confabulatory type, Without use disorderAlcohol-induced mild neurocognitive disorderF10.288 Alcohol-induced mild neurocognitive disorder, With moderate or severe use disorderF10.988 Alcohol-induced mild neurocognitive disorder, Without use disorderAlcohol-induced psychotic disorderF10.159 Alcohol-induced psychotic disorder, With mild use disorderF10.259 Alcohol-induced psychotic disorder, With moderate or severe use disorderF10.959 Alcohol-induced psychotic disorder, Without use disorderAlcohol-induced sexual dysfunctionF10.181 Alcohol-induced sexual dysfunction, With mild use disorderF10.281 Alcohol-induced sexual dysfunction, With moderate or severe use disorderF10.981 Alcohol-induced sexual dysfunction, Without use disorderAlcohol-induced sleep disorderF10.182 Alcohol-induced sleep disorder, With mild use disorderF10.282 Alcohol-induced sleep disorder, With moderate or severe use disorderF10.982 Alcohol-induced sleep disorder, Without use disorderAmphetamine (or other stimulant) intoxication deliriumF15.121 Amphetamine (or other stimulant) intoxication delirium, With mild use disorderF15.221 Amphetamine (or other stimulant) intoxication delirium, With moderate or severe use disorderF15.921 Amphetamine (or other stimulant) intoxication delirium, Without use disorderAmphetamine (or other stimulant)-induced anxiety disorderF15.180 Amphetamine (or other stimulant)-induced anxiety disorder, With mild use disorderF15.280 Amphetamine (or other stimulant)-induced anxiety disorder, With moderate or severe use disorderF15.980 Amphetamine (or other stimulant)-induced anxiety disorder, Without use disorderAmphetamine (or other stimulant)-induced bipolar and related disorderF15.14 Amphetamine (or other stimulant)-induced bipolar and related disorder, With mild use disorderF15.24 Amphetamine (or other stimulant)-induced bipolar and related disorder, With moderate or severe use disorderF15.94 Amphetamine (or other stimulant)-induced bipolar and related disorder, Without use disorderF15.921 Amphetamine (or other stimulant)-induced deliriumAmphetamine (or other stimulant)-induced depressive disorderF15.14 Amphetamine (or other stimulant)-induced depressive disorder, With mild use disorderF15.24 Amphetamine (or other stimulant)-induced depressive disorder, With moderate or severe use disorderF15.94 Amphetamine (or other stimulant)-induced depressive disorder, Without use disorderAmphetamine (or other stimulant)-induced obsessive-compulsive and related disorderF15.188 Amphetamine (or other stimulant)-induced obsessive-compulsive and related disorder, With mild use disorderF15.288 Amphetamine (or other stimulant)-induced obsessive-compulsive and related disorder, With moderate or severe use disorderF15.988 Amphetamine (or other stimulant)-induced obsessive-compulsive and related disorder, Without use disorderAmphetamine (or other stimulant)-induced psychotic disorderF15.159 Amphetamine (or other stimulant)-induced psychotic disorder, With mild use disorderF15.259 Amphetamine (or other stimulant)-induced psychotic disorder, With moderate or severe use disorderF15.959 Amphetamine (or other stimulant)-induced psychotic disorder, Without use disorderAmphetamine (or other stimulant)-induced sexual dysfunctionF15.181 Amphetamine (or other stimulant)-induced sexual dysfunction, With mild use disorderF15.281 Amphetamine (or other stimulant)-induced sexual dysfunction, With moderate or severe use disorderF15.981 Amphetamine (or other stimulant)-induced sexual dysfunction, Without use disorderAmphetamine (or other stimulant)-induced sleep disorderF15.182 Amphetamine (or other stimulant)-induced sleep disorder, With mild use disorderF15.282 Amphetamine (or other stimulant)-induced sleep disorder, With moderate or severe use disorderF15.982 Amphetamine (or other stimulant)-induced sleep disorder, Without use disorderAmphetamine or other stimulant intoxicationAmphetamine or other stimulant intoxication, With perceptual disturbancesF15.122 Amphetamine or other stimulant intoxication, With perceptual disturbances, With mild use disorderF15.222 Amphetamine or other stimulant intoxication, With perceptual disturbances, With moderate or severe use disorderF15.922 Amphetamine or other stimulant intoxication, With perceptual disturbances, Without use disorderAmphetamine or other stimulant intoxication, Without perceptual disturbancesF15.129 Amphetamine or other stimulant intoxication, Without perceptual disturbances, With mild use disorderF15.229 Amphetamine or other stimulant intoxication, Without perceptual disturbances, With moderate or severe use disorderF15.929 Amphetamine or other stimulant intoxication, Without perceptual disturbances, Without use disorderF15.23 Amphetamine or other stimulant withdrawalAmphetamine-type substance use disorderF15.10 Amphetamine-type substance use disorder, MildF15.20 Amphetamine-type substance use disorder, ModerateF15.20 Amphetamine-type substance use disorder, SevereAnorexia nervosaF50.02 Anorexia nervosa, Binge-eating/purging typeF50.01 Anorexia nervosa, Restricting typeAntidepressant discontinuation syndromeT43.205A Antidepressant discontinuation syndrome, Initial encounterT43.205S Antidepressant discontinuation syndrome, SequelaeT43.205D Antidepressant discontinuation syndrome, Subsequent encounterF60.2 Antisocial personality disorderF06.4 Anxiety disorder due to another medical conditionAttention-deficit/hyperactivity disorderF90.2 Attention-deficit/hyperactivity disorder, Combined presentationF90.1 Attention-deficit/hyperactivity disorder, Predominantly hyperactive/impulsive presentationF90.0 Attention-deficit/hyperactivity disorder, Predominantly inattentive presentationF84.0 Autism spectrum disorderG47.419 Autosomal dominant cerebellar ataxia, deafness, and narcolepsyG47.419 Autosomal dominant narcolepsy, obesity, and type 2 diabetesF60.6 Avoidant personality disorderF50.8 Avoidant/restrictive food intake disorderF50.8 Binge-eating disorderBipolar and related disorder due to another medical conditionF06.33 Bipolar and related disorder due to another medical condition, With manic featuresF06.33 Bipolar and related disorder due to another medical condition, With manic- or hypomanic-like episodesF06.34 Bipolar and related disorder due to another medical condition, With mixed featuresBipolar I disorder, Current or most recent episode depressedF31.76 Bipolar I disorder, Current or most recent episode depressed, In full remissionF31.75 Bipolar I disorder, Current or most recent episode depressed, In partial remissionF31.31 Bipolar I disorder, Current or most recent episode depressed, MildF31.32 Bipolar I disorder, Current or most recent episode depressed, ModerateF31.4 Bipolar I disorder, Current or most recent episode depressed, SevereF31.9 Bipolar I disorder, Current or most recent episode depressed, UnspecifiedF31.5 Bipolar I disorder, Current or most recent episode depressed, With psychotic featuresF31.0 Bipolar I disorder, Current or most recent episode hypomanicF31.74 Bipolar I disorder, Current or most recent episode hypomanic, In full remissionF31.73 Bipolar I disorder, Current or most recent episode hypomanic, In partial remissionF31.9 Bipolar I disorder, Current or most recent episode hypomanic, UnspecifiedBipolar I disorder, Current or most recent episode manicF31.74 Bipolar I disorder, Current or most recent episode manic, In full remissionF31.73 Bipolar I disorder, Current or most recent episode manic, In partial remissionF31.11 Bipolar I disorder, Current or most recent episode manic, MildF31.12 Bipolar I disorder, Current or most recent episode manic, ModerateF31.13 Bipolar I disorder, Current or most recent episode manic, SevereF31.9 Bipolar I disorder, Current or most recent episode manic, UnspecifiedF31.2 Bipolar I disorder, Current or most recent episode manic, With psychotic featuresF31.9 Bipolar I disorder, Current or most recent episode unspecifiedF31.81 Bipolar II disorderF45.22 Body dysmorphic disorderR41.83 Borderline intellectual functioningF60.3 Borderline personality disorderF23 Brief psychotic disorderF50.2 Bulimia nervosaF15.929 Caffeine intoxicationF15.93 Caffeine withdrawalCaffeine-induced anxiety disorderF15.180 Caffeine-induced anxiety disorder, With mild use disorderF15.280 Caffeine-induced anxiety disorder, With moderate or severe use disorderF15.980 Caffeine-induced anxiety disorder, Without use disorderCaffeine-induced sleep disorderF15.182 Caffeine-induced sleep disorder, With mild use disorderF15.282 Caffeine-induced sleep disorder, With moderate or severe use disorderF15.982 Caffeine-induced sleep disorder, Without use disorderCannabis intoxicationCannabis intoxication deliriumF12.121 Cannabis intoxication delirium, With mild use disorderF12.221 Cannabis intoxication delirium, With moderate or severe use disorderF12.921 Cannabis intoxication delirium, Without use disorderCannabis intoxication, With perceptual disturbancesF12.122 Cannabis intoxication, With perceptual disturbances, With mild use disorderF12.222 Cannabis intoxication, With perceptual disturbances, With moderate or severe use disorderF12.922 Cannabis intoxication, With perceptual disturbances, Without use disorderCannabis intoxication, Without perceptual disturbancesF12.129 Cannabis intoxication, Without perceptual disturbances, With mild use disorderF12.229 Cannabis intoxication, Without perceptual disturbances, With moderate or severe use disorderF12.929 Cannabis intoxication, Without perceptual disturbances, Without use disorderCannabis use disorderF12.10 Cannabis use disorder, MildF12.20 Cannabis use disorder, ModerateF12.20 Cannabis use disorder, SevereF12.288 Cannabis withdrawalCannabis-induced anxiety disorderF12.180 Cannabis-induced anxiety disorder, With mild use disorderF12.280 Cannabis-induced anxiety disorder, With moderate or severe use disorderF12.980 Cannabis-induced anxiety disorder, Without use disorderCannabis-induced psychotic disorderF12.159 Cannabis-induced psychotic disorder, With mild use disorderF12.259 Cannabis-induced psychotic disorder, With moderate or severe use disorderF12.959 Cannabis-induced psychotic disorder, Without use disorderCannabis-induced sleep disorderF12.188 Cannabis-induced sleep disorder, With mild use disorderF12.288 Cannabis-induced sleep disorder, With moderate or severe use disorderF12.988 Cannabis-induced sleep disorder, Without use disorderF06.1 Catatonia associated with another mental disorder (catatonia specifier)F06.1 Catatonic disorder due to another medical conditionCentral sleep apneaG47.37 Central sleep apnea comorbid with opioid useR06.3 Cheyne-Stokes breathingZ62.898 Child affected by parental relationship distressChild neglect, ConfirmedT74.02XA Child neglect, Confirmed, Initial encounterT74.02XD Child neglect, Confirmed, Subsequent encounterChild neglect, SuspectedT76.02XA Child neglect, Suspected, Initial encounterT76.02XD Child neglect, Suspected, Subsequent encounterZ72.810 Child or adolescent antisocial behaviorChild physical abuse, ConfirmedT74.12XA Child physical abuse, Confirmed, Initial encounterT74.12XD Child physical abuse, Confirmed, Subsequent encounterChild physical abuse, SuspectedT76.12XA Child physical abuse, Suspected, Initial encounterT76.12XD Child physical abuse, Suspected, Subsequent encounterChild psychological abuse, ConfirmedT74.32XA Child psychological abuse, Confirmed, Initial encounterT74.32XD Child psychological abuse, Confirmed, Subsequent encounterChild psychological abuse, SuspectedT76.32XA Child psychological abuse, Suspected, Initial encounterT76.32XD Child psychological abuse, Suspected, Subsequent encounterChild sexual abuse, ConfirmedT74.22XA Child sexual abuse, Confirmed, Initial encounterT74.22XD Child sexual abuse, Confirmed, Subsequent encounterChild sexual abuse, SuspectedT76.22XA Child sexual abuse, Suspected, Initial encounterT76.22XD Child sexual abuse, Suspected, Subsequent encounterF80.81 Childhood-onset fluency disorder (stuttering)Circadian rhythm sleep-wake disordersG47.22 Circadian rhythm sleep-wake disorders, Advanced sleep phase typeG47.21 Circadian rhythm sleep-wake disorders, Delayed sleep phase typeG47.23 Circadian rhythm sleep-wake disorders, Irregular sleep-wake typeG47.24 Circadian rhythm sleep-wake disorders, Non-24-hour sleep-wake typeG47.26 Circadian rhythm sleep-wake disorders, Shift work typeG47.20 Circadian rhythm sleep-wake disorders, Unspecified typeCocaine intoxicationCocaine intoxication deliriumF14.121 Cocaine intoxication delirium, With mild use disorderF14.221 Cocaine intoxication delirium, With moderate or severe use disorderF14.921 Cocaine intoxication delirium, Without use disorderCocaine intoxication, With perceptual disturbancesF14.122 Cocaine intoxication, With perceptual disturbances, With mild use disorderF14.222 Cocaine intoxication, With perceptual disturbances, With moderate or severe use disorderF14.922 Cocaine intoxication, With perceptual disturbances, Without use disorderCocaine intoxication, Without perceptual disturbancesF14.129 Cocaine intoxication, Without perceptual disturbances, With mild use disorderF14.229 Cocaine intoxication, Without perceptual disturbances, With moderate or severe use disorderF14.929 Cocaine intoxication, Without perceptual disturbances, Without use disorderCocaine use disorderF14.10 Cocaine use disorder, MildF14.20 Cocaine use disorder, ModerateF14.20 Cocaine use disorder, SevereF14.23 Cocaine withdrawalCocaine-induced anxiety disorderF14.180 Cocaine-induced anxiety disorder, With mild use disorderF14.280 Cocaine-induced anxiety disorder, With moderate or severe use disorderF14.980 Cocaine-induced anxiety disorder, Without use disorderCocaine-induced bipolar and related disorderF14.14 Cocaine-induced bipolar and related disorder, With mild use disorderF14.24 Cocaine-induced bipolar and related disorder, With moderate or severe use disorderF14.94 Cocaine-induced bipolar and related disorder, Without use disorderCocaine-induced depressive disorderF14.14 Cocaine-induced depressive disorder, With mild use disorderF14.24 Cocaine-induced depressive disorder, With moderate or severe use disorderF14.94 Cocaine-induced depressive disorder, Without use disorderCocaine-induced obsessive-compulsive and related disorderF14.188 Cocaine-induced obsessive-compulsive and related disorder, With mild use disorderF14.288 Cocaine-induced obsessive-compulsive and related disorder, With moderate or severe use disorderF14.988 Cocaine-induced obsessive-compulsive and related disorder, Without use disorderCocaine-induced psychotic disorderF14.159 Cocaine-induced psychotic disorder, With mild use disorderF14.259 Cocaine-induced psychotic disorder, With moderate or severe use disorderF14.959 Cocaine-induced psychotic disorder, Without use disorderCocaine-induced sexual dysfunctionF14.181 Cocaine-induced sexual dysfunction, With mild use disorderF14.281 Cocaine-induced sexual dysfunction, With moderate or severe use disorderF14.981 Cocaine-induced sexual dysfunction, Without use disorderCocaine-induced sleep disorderF14.182 Cocaine-induced sleep disorder, With mild use disorderF14.282 Cocaine-induced sleep disorder, With moderate or severe use disorderF14.982 Cocaine-induced sleep disorder, Without use disorderG47.36 Comorbid sleep-related hypoventilationConduct disorderF91.2 Conduct disorder, Adolescent-onset typeF91.1 Conduct disorder, Childhood-onset typeF91.9 Conduct disorder, Unspecified onsetG47.35 Congenital central alveolar hypoventilationConversion disorder (functional neurological symptom disorder)F44.4 Conversion disorder (functional neurological symptom disorder), With abnormal movementF44.6 Conversion disorder (functional neurological symptom disorder), With anesthesia or sensory lossF44.5 Conversion disorder (functional neurological symptom disorder), With attacks or seizuresF44.7 Conversion disorder (functional neurological symptom disorder), With mixed symptomsF44.6 Conversion disorder (functional neurological symptom disorder), With special sensory symptomsF44.4 Conversion disorder (functional neurological symptom disorder), With speech symptomsF44.4 Conversion disorder (functional neurological symptom disorder), With swallowing symptomsF44.4 Conversion disorder (functional neurological symptom disorder), With weakness/paralysisZ65.0 Conviction in civil or criminal proceedings without imprisonmentF34.0 Cyclothymic disorderF52.32 Delayed ejaculationDeliriumF05 Delirium due to another medical conditionF05 Delirium due to multiple etiologiesF22 Delusional disorderF60.7 Dependent personality disorderF48.1 Depersonalization/derealization disorderDepressive disorder due to another medical conditionF06.31 Depressive disorder due to another medical condition, With depressive featuresF06.32 Depressive disorder due to another medical condition, With major depressive-like episodeF06.34 Depressive disorder due to another medical condition, With mixed featuresF82 Developmental coordination disorderZ59.2 Discord with neighbor, lodger, or landlordZ64.4 Discord with social service provider, including probation officer, case manager, or social services workerF94.2 Disinhibited social engagement disorderZ63.5 Disruption of family by separation or divorceF34.8 Disruptive mood dysregulation disorderF44.0 Dissociative amnesiaF44.1 Dissociative amnesia, with dissociative fugueF44.81 Dissociative identity disorderF98.1 EncopresisF98.0 EnuresisF52.21 Erectile disorderL98.1 Excoriation (skin-picking) disorderF65.2 Exhibitionistic disorderZ65.5 Exposure to disaster, war, or other hostilitiesZ59.5 Extreme povertyF68.10 Factitious disorderF52.31 Female orgasmic disorderF52.22 Female sexual interest/arousal disorderF65.0 Fetishistic disorderF65.81 Frotteuristic disorderF63.0 Gambling disorderF64.1 Gender dysphoria in adolescents and adultsF64.2 Gender dysphoria in childrenF41.1 Generalized anxiety disorderF52.6 Genito-pelvic pain/penetration disorderF88 Global developmental delayF16.983 Hallucinogen persisting perception disorderZ63.8 High expressed emotion level within familyF60.4 Histrionic personality disorderF42 Hoarding disorderZ59.0 HomelessnessG47.10 Hypersomnolence disorderG47.31 Idiopathic central sleep apneaG47.34 Idiopathic hypoventilationF45.21 Illness anxiety disorderZ65.1 Imprisonment or other incarcerationZ59.1 Inadequate housingInhalant intoxicationInhalant intoxication deliriumF18.121 Inhalant intoxication delirium, With mild use disorderF18.221 Inhalant intoxication delirium, With moderate or severe use disorderF18.921 Inhalant intoxication delirium, Without use disorderF18.129 Inhalant intoxication, With mild use disorderF18.229 Inhalant intoxication, With moderate or severe use disorderF18.929 Inhalant intoxication, Without use disorderInhalant use disorderF18.10 Inhalant use disorder, MildF18.20 Inhalant use disorder, ModerateF18.20 Inhalant use disorder, SevereInhalant-induced anxiety disorderF18.180 Inhalant-induced anxiety disorder, With mild use disorderF18.280 Inhalant-induced anxiety disorder, With moderate or severe use disorderF18.980 Inhalant-induced anxiety disorder, Without use disorderInhalant-induced depressive disorderF18.14 Inhalant-induced depressive disorder, With mild use disorderF18.24 Inhalant-induced depressive disorder, With moderate or severe use disorderF18.94 Inhalant-induced depressive disorder, Without use disorderInhalant-induced major neurocognitive disorderF18.17 Inhalant-induced major neurocognitive disorder, With mild use disorderF18.27 Inhalant-induced major neurocognitive disorder, With moderate or severe use disorderF18.97 Inhalant-induced major neurocognitive disorder, Without use disorderInhalant-induced mild neurocognitive disorderF18.188 Inhalant-induced mild neurocognitive disorder, With mild use disorderF18.288 Inhalant-induced mild neurocognitive disorder, With moderate or severe use disorderF18.988 Inhalant-induced mild neurocognitive disorder, Without use disorderInhalant-induced psychotic disorderF18.159 Inhalant-induced psychotic disorder, With mild use disorderF18.259 Inhalant-induced psychotic disorder, With moderate or severe use disorderF18.959 Inhalant-induced psychotic disorder, Without use disorderG47.00 Insomnia disorderZ59.7 Insufficient social insurance or welfare supportIntellectual disability (intellectual developmental disorder)F70 Intellectual disability (intellectual developmental disorder), MildF71 Intellectual disability (intellectual developmental disorder), ModerateF73 Intellectual disability (intellectual developmental disorder), ProfoundF72 Intellectual disability (intellectual developmental disorder), SevereF63.81 Intermittent explosive disorderF63.2 KleptomaniaZ59.4 Lack of adequate food or safe drinking waterF80.9 Language disorderZ59.6 Low incomeMajor depressive disorder, Recurrent episodeF33.42 Major depressive disorder, Recurrent episode, In full remissionF33.41 Major depressive disorder, Recurrent episode, In partial remissionF33.0 Major depressive disorder, Recurrent episode, MildF33.1 Major depressive disorder, Recurrent episode, ModerateF33.2 Major depressive disorder, Recurrent episode, SevereF33.9 Major depressive disorder, Recurrent episode, UnspecifiedF33.3 Major depressive disorder, Recurrent episode, With psychotic featuresMajor depressive disorder, Single episodeF32.5 Major depressive disorder, Single episode, In full remissionF32.4 Major depressive disorder, Single episode, In partial remissionF32.0 Major depressive disorder, Single episode, MildF32.1 Major depressive disorder, Single episode, ModerateF32.2 Major depressive disorder, Single episode, SevereF32.9 Major depressive disorder, Single episode, UnspecifiedF32.3 Major depressive disorder, Single episode, With psychotic featuresG31.9 Major frontotemporal neurocognitive disorder, Possible[Frontotemporal disease +] Major frontotemporal neurocognitive disorder, Probable[G31.09 +] F02.81 [Frontotemporal disease +] Major frontotemporal neurocognitive disorder, Probable, With behavioral disturbance[G31.09 +] F02.80 [Frontotemporal disease +] Major frontotemporal neurocognitive disorder, Probable, Without behavioral disturbance[G31.09 +] G31.9 Major neurocognitive disorder due to Alzheimer’s disease, Possible[Alzheimer’s disease +] Major neurocognitive disorder due to Alzheimer’s disease, Probable[G30.9 +] F02.81 [Alzheimer’s disease +] Major neurocognitive disorder due to Alzheimer’s disease, Probable, With behavioral disturbance[G30.9 +] F02.80 [Alzheimer’s disease +] Major neurocognitive disorder due to Alzheimer’s disease, Probable, Without behavioral disturbanceMajor neurocognitive disorder due to another medical conditionF02.81 Major neurocognitive disorder due to another medical condition, With behavioral disturbanceF02.80 Major neurocognitive disorder due to another medical condition, Without behavioral disturbance[HIV infection +] Major neurocognitive disorder due to HIV infection[B20 +] F02.81 [HIV infection +] Major neurocognitive disorder due to HIV infection, With behavioral disturbance[B20 +] F02.80 [HIV infection +] Major neurocognitive disorder due to HIV infection, Without behavioral disturbance[Huntington’s disease +] Major neurocognitive disorder due to Huntington’s disease[G10 +] F02.81 [Huntington’s disease +] Major neurocognitive disorder due to Huntington’s disease, With behavioral disturbance[G10 +] F02.80 [Huntington’s disease +] Major neurocognitive disorder due to Huntington’s disease, Without behavioral disturbanceMajor neurocognitive disorder due to multiple etiologiesF02.81 Major neurocognitive disorder due to multiple etiologies, With behavioral disturbanceF02.80 Major neurocognitive disorder due to multiple etiologies, Without behavioral disturbanceG31.9 Major neurocognitive disorder due to Parkinson’s disease, Possible[Parkinson’s disease +] Major neurocognitive disorder due to Parkinson’s disease, Probable[G20 +] F02.81 [Parkinson’s disease +] Major neurocognitive disorder due to Parkinson’s disease, Probable, With behavioral disturbance[G20 +] F02.80 [Parkinson’s disease +] Major neurocognitive disorder due to Parkinson’s disease, Probable, Without behavioral disturbance[Prion disease +] Major neurocognitive disorder due to prion disease[A81.9 +] F02.81 [Prion disease +] Major neurocognitive disorder due to prion disease, With behavioral disturbance[A81.9 +] F02.80 [Prion disease +] Major neurocognitive disorder due to prion disease, Without behavioral disturbance[Late effect of intracranial injury without skull fracture (ICD-9-CM) / Diffuse traumatic brain injury with loss of consciousness of unspecified duration, sequela (ICD-10-CM) +] Major neurocognitive disorder due to traumatic brain injury[S06.2X9S +] F02.81 [Late effect of intracranial injury without skull fracture (ICD-9-CM) / Diffuse traumatic brain injury with loss of consciousness of unspecified duration, sequela (ICD-10-CM) +] Major neurocognitive disorder due to traumatic brain injury, With behavioral disturbance[S06.2X9S +] F02.80 [Late effect of intracranial injury without skull fracture (ICD-9-CM) / Diffuse traumatic brain injury with loss of consciousness of unspecified duration, sequela (ICD-10-CM) +] Major neurocognitive disorder due to traumatic brain injury, Without behavioral disturbanceG31.9 Major neurocognitive disorder with Lewy bodies, Possible[Lewy body disease +] Major neurocognitive disorder with Lewy bodies, Probable[G31.83 +] F02.81 [Lewy body disease +] Major neurocognitive disorder with Lewy bodies, Probable, With behavioral disturbance[G31.83 +] F02.80 [Lewy body disease +] Major neurocognitive disorder with Lewy bodies, Probable, Without behavioral disturbanceG31.9 Major vascular neurocognitive disorder, PossibleMajor vascular neurocognitive disorder, ProbableF01.51 Major vascular neurocognitive disorder, Probable, With behavioral disturbanceF01.50 Major vascular neurocognitive disorder, Probable, Without behavioral disturbanceF52.0 Male hypoactive sexual desire disorderZ76.5 MalingeringG25.71 Medication-induced acute akathisiaG24.02 Medication-induced acute dystoniasee specific substances Medication-induced deliriumsee specific substances Medication-induced deliriumG25.1 Medication-induced postural tremorG31.84 Mild frontotemporal neurocognitive disorderG31.84 Mild neurocognitive disorder due to Alzheimer’s diseaseG31.84 Mild neurocognitive disorder due to another medical conditionG31.84 Mild neurocognitive disorder due to HIV infectionG31.84 Mild neurocognitive disorder due to Huntington’s diseaseG31.84 Mild neurocognitive disorder due to multiple etiologiesG31.84 Mild neurocognitive disorder due to Parkinson’s diseaseG31.84 Mild neurocognitive disorder due to prion diseaseG31.84 Mild neurocognitive disorder due to traumatic brain injuryG31.84 Mild neurocognitive disorder with Lewy bodiesG31.84 Mild vascular neurocognitive disorderF60.81 Narcissistic personality disorderNarcolepsyG47.429 Narcolepsy secondary to another medical conditionG47.411 Narcolepsy with cataplexy but without hypocretin deficiencyG47.419 Narcolepsy without cataplexy but with hypocretin deficiencyG21.0 Neuroleptic malignant syndromeG21.11 Neuroleptic-induced parkinsonismF51.5 Nightmare disorderZ03.89 No Diagnosis or Condition on Axis I / No Diagnosis on Axis II [DSM-IV]Z91.19 Nonadherence to medical treatmentNon-rapid eye movement sleep arousal disordersF51.4 Non-rapid eye movement sleep arousal disorders, Sleep terror typeF51.3 Non-rapid eye movement sleep arousal disorders, Sleepwalking typeF06.8 Obsessive-compulsive and related disorder due to another medical conditionF42 Obsessive-compulsive disorderF60.5 Obsessive-compulsive personality disorderG47.33 Obstructive sleep apnea hypopneaOpioid intoxicationOpioid intoxication deliriumF11.121 Opioid intoxication delirium, With mild use disorderF11.221 Opioid intoxication delirium, With moderate or severe use disorderF11.921 Opioid intoxication delirium, Without use disorderOpioid intoxication, With perceptual disturbancesF11.122 Opioid intoxication, With perceptual disturbances, With mild use disorderF11.222 Opioid intoxication, With perceptual disturbances, With moderate or severe use disorderF11.922 Opioid intoxication, With perceptual disturbances, Without use disorderOpioid intoxication, Without perceptual disturbancesF11.129 Opioid intoxication, Without perceptual disturbances, With mild use disorderF11.229 Opioid intoxication, Without perceptual disturbances, With moderate or severe use disorderF11.929 Opioid intoxication, Without perceptual disturbances, Without use disorderOpioid use disorderF11.10 Opioid use disorder, MildF11.20 Opioid use disorder, ModerateF11.20 Opioid use disorder, SevereF11.23 Opioid withdrawalF11.23 Opioid withdrawal deliriumOpioid-induced anxiety disorderF11.188 Opioid-induced anxiety disorder, With mild use disorderF11.288 Opioid-induced anxiety disorder, With moderate or severe use disorderF11.988 Opioid-induced anxiety disorder, Without use disorderF11.921 Opioid-induced deliriumOpioid-induced depressive disorderF11.14 Opioid-induced depressive disorder, With mild use disorderF11.24 Opioid-induced depressive disorder, With moderate or severe use disorderF11.94 Opioid-induced depressive disorder, Without use disorderOpioid-induced sexual dysfunctionF11.181 Opioid-induced sexual dysfunction, With mild use disorderF11.281 Opioid-induced sexual dysfunction, With moderate or severe use disorderF11.981 Opioid-induced sexual dysfunction, Without use disorderOpioid-induced sleep disorderF11.182 Opioid-induced sleep disorder, With mild use disorderF11.282 Opioid-induced sleep disorder, With moderate or severe use disorderF11.982 Opioid-induced sleep disorder, Without use disorderF91.3 Oppositional defiant disorderOther (or unknown) substance intoxicationOther (or unknown) substance intoxication deliriumF19.121 Other (or unknown) substance intoxication delirium, With mild use disorderF19.221 Other (or unknown) substance intoxication delirium, With moderate or severe use disorderF19.921 Other (or unknown) substance intoxication delirium, Without use disorderF19.129 Other (or unknown) substance intoxication, With mild use disorderF19.229 Other (or unknown) substance intoxication, With moderate or severe use disorderF19.929 Other (or unknown) substance intoxication, Without use disorderOther (or unknown) substance use disorderF19.10 Other (or unknown) substance use disorder, MildF19.20 Other (or unknown) substance use disorder, ModerateF19.20 Other (or unknown) substance use disorder, SevereF19.239 Other (or unknown) substance withdrawalF19.231 Other (or unknown) substance withdrawal deliriumOther (or unknown) substance-induced anxiety disorderF19.180 Other (or unknown) substance-induced anxiety disorder, With mild use disorderF19.280 Other (or unknown) substance-induced anxiety disorder, With moderate or severe use disorderF19.980 Other (or unknown) substance-induced anxiety disorder, Without use disorderOther (or unknown) substance-induced bipolar and related disorderF19.14 Other (or unknown) substance-induced bipolar and related disorder, With mild use disorderF19.24 Other (or unknown) substance-induced bipolar and related disorder, With moderate or severe use disorderF19.94 Other (or unknown) substance-induced bipolar and related disorder, Without use disorderF19.921 Other (or unknown) substance-induced deliriumOther (or unknown) substance-induced depressive disorderF19.14 Other (or unknown) substance-induced depressive disorder, With mild use disorderF19.24 Other (or unknown) substance-induced depressive disorder, With moderate or severe use disorderF19.94 Other (or unknown) substance-induced depressive disorder, Without use disorderOther (or unknown) substance-induced major neurocognitive disorderF19.17 Other (or unknown) substance-induced major neurocognitive disorder, With mild use disorderF19.27 Other (or unknown) substance-induced major neurocognitive disorder, With moderate or severe use disorderF19.97 Other (or unknown) substance-induced major neurocognitive disorder, Without use disorderOther (or unknown) substance-induced mild neurocognitive disorderF19.188 Other (or unknown) substance-induced mild neurocognitive disorder, With mild use disorderF19.288 Other (or unknown) substance-induced mild neurocognitive disorder, With moderate or severe use disorderF19.988 Other (or unknown) substance-induced mild neurocognitive disorder, Without use disorderOther (or unknown) substance-induced obsessive-compulsive and related disorderF19.188 Other (or unknown) substance-induced obsessive-compulsive and related disorder, With mild use disorderF19.288 Other (or unknown) substance-induced obsessive-compulsive and related disorder, With moderate or severe use disorderF19.988 Other (or unknown) substance-induced obsessive-compulsive and related disorder, Without use disorderOther (or unknown) substance-induced psychotic disorderF19.159 Other (or unknown) substance-induced psychotic disorder, With mild use disorderF19.259 Other (or unknown) substance-induced psychotic disorder, With moderate or severe use disorderF19.959 Other (or unknown) substance-induced psychotic disorder, Without use disorderOther (or unknown) substance-induced sexual dysfunctionF19.181 Other (or unknown) substance-induced sexual dysfunction, With mild use disorderF19.281 Other (or unknown) substance-induced sexual dysfunction, With moderate or severe use disorderF19.981 Other (or unknown) substance-induced sexual dysfunction, Without use disorderOther (or unknown) substance-induced sleep disorderF19.182 Other (or unknown) substance-induced sleep disorder, With mild use disorderF19.282 Other (or unknown) substance-induced sleep disorder, With moderate or severe use disorderF19.982 Other (or unknown) substance-induced sleep disorder, Without use disorderOther adverse effect of medicationT50.905A Other adverse effect of medication, Initial encounterT50.905S Other adverse effect of medication, SequelaeT50.905D Other adverse effect of medication, Subsequent encounterOther circumstances related to adult abuse by nonspouse or nonpartnerZ69.82 Other circumstances related to adult abuse by nonspouse or nonpartner, Encounter for mental health services for perpetrator of nonspousal adult abuseZ69.81 Other circumstances related to adult abuse by nonspouse or nonpartner, Encounter for mental health services for victim of nonspousal adult abuseOther circumstances related to child neglectZ69.021 Other circumstances related to child neglect, Encounter for mental health services for perpetrator of nonparental child neglectZ69.011 Other circumstances related to child neglect, Encounter for mental health services for perpetrator of parental child neglectZ69.010 Other circumstances related to child neglect, Encounter for mental health services for victim of child neglect by parentZ69.020 Other circumstances related to child neglect, Encounter for mental health services for victim of nonparental child neglectOther circumstances related to child physical abuseZ69.021 Other circumstances related to child physical abuse, Encounter for mental health services for perpetrator of nonparental child abuseZ69.011 Other circumstances related to child physical abuse, Encounter for mental health services for perpetrator of parental child abuseZ69.010 Other circumstances related to child physical abuse, Encounter for mental health services for victim of child abuse by parentZ69.020 Other circumstances related to child physical abuse, Encounter for mental health services for victim of nonparental child abuseOther circumstances related to child psychological abuseZ69.021 Other circumstances related to child psychological abuse, Encounter for mental health services for perpetrator of nonparental child psychological abuseZ69.011 Other circumstances related to child psychological abuse, Encounter for mental health services for perpetrator of parental child psychological abuseZ69.010 Other circumstances related to child psychological abuse, Encounter for mental health services for victim of child psychological abuse by parentZ69.020 Other circumstances related to child psychological abuse, Encounter for mental health services for victim of nonparental child psychological abuseOther circumstances related to child sexual abuseZ69.021 Other circumstances related to child sexual abuse, Encounter for mental health services for perpetrator of nonparental child sexual abuseZ69.011 Other circumstances related to child sexual abuse, Encounter for mental health services for perpetrator of parental child sexual abuseZ69.010 Other circumstances related to child sexual abuse, Encounter for mental health services for victim of child sexual abuse by parentZ69.020 Other circumstances related to child sexual abuse, Encounter for mental health services for victim of nonparental child sexual abuseOther circumstances related to spouse or partner abuse, PsychologicalZ69.12 Other circumstances related to spouse or partner abuse, Psychological, Encounter for mental health services for perpetrator of spouse or partner psychological abuseZ69.11 Other circumstances related to spouse or partner abuse, Psychological, Encounter for mental health services for victim of spouse or partner psychological abuseOther circumstances related to spouse or partner neglectZ69.12 Other circumstances related to spouse or partner neglect, Encounter for mental health services for perpetrator of spouse or partner neglectZ69.11 Other circumstances related to spouse or partner neglect, Encounter for mental health services for victim of spouse or partner neglectOther circumstances related to spouse or partner violence, PhysicalZ69.12 Other circumstances related to spouse or partner violence, Physical, Encounter for mental health services for perpetrator of spouse or partner violenceZ69.11 Other circumstances related to spouse or partner violence, Physical, Encounter for mental health services for victim of spouse or partner violenceOther circumstances related to spouse or partner violence, SexualZ69.12 Other circumstances related to spouse or partner violence, Sexual, Encounter for mental health services for perpetrator of spouse or partner violenceZ69.81 Other circumstances related to spouse or partner violence, Sexual, Encounter for mental health services for victim of spouse or partner violenceZ71.9 Other counseling or consultationOther hallucinogen intoxicationOther hallucinogen intoxication deliriumF16.121 Other hallucinogen intoxication delirium, With mild use disorderF16.221 Other hallucinogen intoxication delirium, With moderate or severe use disorderF16.921 Other hallucinogen intoxication delirium, Without use disorderF16.129 Other hallucinogen intoxication, With mild use disorderF16.229 Other hallucinogen intoxication, With moderate or severe use disorderF16.929 Other hallucinogen intoxication, Without use disorderOther hallucinogen use disorderF16.10 Other hallucinogen use disorder, MildF16.20 Other hallucinogen use disorder, ModerateF16.20 Other hallucinogen use disorder, SevereOther hallucinogen-induced anxiety disorderF16.180 Other hallucinogen-induced anxiety disorder, With mild use disorderF16.280 Other hallucinogen-induced anxiety disorder, With moderate or severe use disorderF16.980 Other hallucinogen-induced anxiety disorder, Without use disorderOther hallucinogen-induced bipolar and related disorderF16.14 Other hallucinogen-induced bipolar and related disorder, With mild use disorderF16.24 Other hallucinogen-induced bipolar and related disorder, With moderate or severe use disorderF16.94 Other hallucinogen-induced bipolar and related disorder, Without use disorderOther hallucinogen-induced depressive disorderF16.14 Other hallucinogen-induced depressive disorder, With mild use disorderF16.24 Other hallucinogen-induced depressive disorder, With moderate or severe use disorderF16.94 Other hallucinogen-induced depressive disorder, Without use disorderOther hallucinogen-induced psychotic disorderF16.159 Other hallucinogen-induced psychotic disorder, With mild use disorderF16.259 Other hallucinogen-induced psychotic disorder, With moderate or severe use disorderF16.959 Other hallucinogen-induced psychotic disorder, Without use disorderG25.79 Other medication-induced movement disorderG21.19 Other medication-induced parkinsonismOther or unspecified stimulant use disorderF15.10 Other or unspecified stimulant use disorder, MildF15.20 Other or unspecified stimulant use disorder, ModerateF15.20 Other or unspecified stimulant use disorder, SevereZ91.49 Other personal history of psychological traumaZ91.89 Other personal risk factorsZ56.9 Other problem related to employmentZ65.8 Other problem related to psychosocial circumstancesF41.8 Other specified anxiety disorderF90.8 Other specified attention-deficit/hyperactivity disorderF31.89 Other specified bipolar and related disorderR41.0 Other specified deliriumF32.8 Other specified depressive disorderF91.8 Other specified disruptive, impulse-control, and conduct disorderF44.89 Other specified dissociative disorderOther specified elimination disorderR15.9 Other specified elimination disorder, With fecal symptomsN39.498 Other specified elimination disorder, With urinary symptomsF50.8 Other specified feeding or eating disorderF64.8 Other specified gender dysphoriaG47.19 Other specified hypersomnolence disorderG47.09 Other specified insomnia disorderF99 Other specified mental disorderF06.8 Other specified mental disorder due to another medical conditionF88 Other specified neurodevelopmental disorderF42 Other specified obsessive-compulsive and related disorderF65.89 Other specified paraphilic disorderF60.89 Other specified personality disorderF28 Other specified schizophrenia spectrum and other psychotic disorderF52.8 Other specified sexual dysfunctionG47.8 Other specified sleep-wake disorderF45.8 Other specified somatic symptom and related disorderF95.8 Other specified tic disorderF43.8 Other specified trauma- and stressor-related disorderE66.9 Overweight or obesityPanic attack specifierF41.0 Panic disorderF60.0 Paranoid personality disorderZ62.820 Parent-child relational problemF65.4 Pedophilic disorderF95.1 Persistent (chronic) motor or vocal tic disorderF34.1 Persistent depressive disorder (dysthymia)Z62.812 Personal history (past history) of neglect in childhoodZ62.810 Personal history (past history) of physical abuse in childhoodZ62.811 Personal history (past history) of psychological abuse in childhoodZ62.810 Personal history (past history) of sexual abuse in childhoodZ91.412 Personal history (past history) of spouse or partner neglectZ91.411 Personal history (past history) of spouse or partner psychological abuseZ91.410 Personal history (past history) of spouse or partner violence, PhysicalZ91.410 Personal history (past history) of spouse or partner violence, SexualZ91.82 Personal history of military deploymentZ91.5 Personal history of self-harmF07.0 Personality change due to another medical conditionZ60.0 Phase of life problemPhencyclidine intoxicationPhencyclidine intoxication deliriumF16.121 Phencyclidine intoxication delirium, With mild use disorderF16.221 Phencyclidine intoxication delirium, With moderate or severe use disorderF16.921 Phencyclidine intoxication delirium, Without use disorderF16.129 Phencyclidine intoxication, With mild use disorderF16.229 Phencyclidine intoxication, With moderate or severe use disorderF16.929 Phencyclidine intoxication, Without use disorderPhencyclidine use disorderF16.10 Phencyclidine use disorder, MildF16.20 Phencyclidine use disorder, ModerateF16.20 Phencyclidine use disorder, SeverePhencyclidine-induced anxiety disorderF16.180 Phencyclidine-induced anxiety disorder, With mild use disorderF16.280 Phencyclidine-induced anxiety disorder, With moderate or severe use disorderF16.980 Phencyclidine-induced anxiety disorder, Without use disorderPhencyclidine-induced bipolar and related disorderF16.14 Phencyclidine-induced bipolar and related disorder, With mild use disorderF16.24 Phencyclidine-induced bipolar and related disorder, With moderate or severe use disorderF16.94 Phencyclidine-induced bipolar and related disorder, Without use disorderPhencyclidine-induced depressive disorderF16.14 Phencyclidine-induced depressive disorder, With mild use disorderF16.24 Phencyclidine-induced depressive disorder, With moderate or severe use disorderF16.94 Phencyclidine-induced depressive disorder, Without use disorderPhencyclidine-induced psychotic disorderF16.159 Phencyclidine-induced psychotic disorder, With mild use disorderF16.259 Phencyclidine-induced psychotic disorder, With moderate or severe use disorderF16.959 Phencyclidine-induced psychotic disorder, Without use disorderPicaF50.8 Pica, In adultsF98.3 Pica, In childrenF43.10 Posttraumatic stress disorderF52.4 Premature (early) ejaculationN94.3 Premenstrual dysphoric disorderZ56.82 Problem related to current military deployment statusZ72.9 Problem related to lifestyleZ60.2 Problem related to living aloneZ59.3 Problem related to living in a residential institutionZ64.1 Problems related to multiparityZ65.3 Problems related to other legal circumstancesZ65.2 Problems related to release from prisonZ64.0 Problems related to unwanted pregnancyF95.0 Provisional tic disorderF54 Psychological factors affecting other medical conditionsPsychotic disorder due to another medical conditionF06.2 Psychotic disorder due to another medical condition, With delusionsF06.0 Psychotic disorder due to another medical condition, With hallucinationsF63.1 PyromaniaG47.52 Rapid eye movement sleep behavior disorderF94.1 Reactive attachment disorderZ63.0 Relationship distress with spouse or intimate partnerZ65.8 Religious or spiritual problemG25.81 Restless legs syndromeF98.21 Rumination disorderSchizoaffective disorderF25.0 Schizoaffective disorder, Bipolar typeF25.1 Schizoaffective disorder, Depressive typeF60.1 Schizoid personality disorderF20.9 SchizophreniaF20.81 Schizophreniform disorderF21 Schizotypal personality disorderSedative, hypnotic, or anxiolytic intoxicationSedative, hypnotic, or anxiolytic intoxication deliriumF13.121 Sedative, hypnotic, or anxiolytic intoxication delirium, With mild use disorderF13.221 Sedative, hypnotic, or anxiolytic intoxication delirium, With moderate or severe use disorderF13.921 Sedative, hypnotic, or anxiolytic intoxication delirium, Without use disorderF13.129 Sedative, hypnotic, or anxiolytic intoxication, With mild use disorderF13.229 Sedative, hypnotic, or anxiolytic intoxication, With moderate or severe use disorderF13.929 Sedative, hypnotic, or anxiolytic intoxication, Without use disorderSedative, hypnotic, or anxiolytic use disorderF13.10 Sedative, hypnotic, or anxiolytic use disorder, MildF13.20 Sedative, hypnotic, or anxiolytic use disorder, ModerateF13.20 Sedative, hypnotic, or anxiolytic use disorder, SevereSedative, hypnotic, or anxiolytic withdrawalF13.231 Sedative, hypnotic, or anxiolytic withdrawal deliriumF13.232 Sedative, hypnotic, or anxiolytic withdrawal, With perceptual disturbancesF13.239 Sedative, hypnotic, or anxiolytic withdrawal, Without perceptual disturbancesSedative-, hypnotic-, or anxiolytic-induced anxiety disorderF13.180 Sedative-, hypnotic-, or anxiolytic-induced anxiety disorder, With mild use disorderF13.280 Sedative-, hypnotic-, or anxiolytic-induced anxiety disorder, With moderate or severe use disorderF13.980 Sedative-, hypnotic-, or anxiolytic-induced anxiety disorder, Without use disorderSedative-, hypnotic-, or anxiolytic-induced bipolar and related disorderF13.14 Sedative-, hypnotic-, or anxiolytic-induced bipolar and related disorder, With mild use disorderF13.24 Sedative-, hypnotic-, or anxiolytic-induced bipolar and related disorder, With moderate or severe use disorderF13.94 Sedative-, hypnotic-, or anxiolytic-induced bipolar and related disorder, Without use disorderF13.921 Sedative-, hypnotic-, or anxiolytic-induced deliriumSedative-, hypnotic-, or anxiolytic-induced depressive disorderF13.14 Sedative-, hypnotic-, or anxiolytic-induced depressive disorder, With mild use disorderF13.24 Sedative-, hypnotic-, or anxiolytic-induced depressive disorder, With moderate or severe use disorderF13.94 Sedative-, hypnotic-, or anxiolytic-induced depressive disorder, Without use disorderSedative-, hypnotic-, or anxiolytic-induced major neurocognitive disorderF13.27 Sedative-, hypnotic-, or anxiolytic-induced major neurocognitive disorder, With moderate or severe use disorderF13.97 Sedative-, hypnotic-, or anxiolytic-induced major neurocognitive disorder, Without use disorderSedative-, hypnotic-, or anxiolytic-induced mild neurocognitive disorderF13.288 Sedative-, hypnotic-, or anxiolytic-induced mild neurocognitive disorder, With moderate or severe use disorderF13.988 Sedative-, hypnotic-, or anxiolytic-induced mild neurocognitive disorder, Without use disorderSedative-, hypnotic-, or anxiolytic-induced psychotic disorderF13.159 Sedative-, hypnotic-, or anxiolytic-induced psychotic disorder, With mild use disorderF13.259 Sedative-, hypnotic-, or anxiolytic-induced psychotic disorder, With moderate or severe use disorderF13.959 Sedative-, hypnotic-, or anxiolytic-induced psychotic disorder, Without use disorderSedative-, hypnotic-, or anxiolytic-induced sexual dysfunctionF13.181 Sedative-, hypnotic-, or anxiolytic-induced sexual dysfunction, With mild use disorderF13.281 Sedative-, hypnotic-, or anxiolytic-induced sexual dysfunction, With moderate or severe use disorderF13.981 Sedative-, hypnotic-, or anxiolytic-induced sexual dysfunction, Without use disorderSedative-, hypnotic-, or anxiolytic-induced sleep disorderF13.182 Sedative-, hypnotic-, or anxiolytic-induced sleep disorder, With mild use disorderF13.282 Sedative-, hypnotic-, or anxiolytic-induced sleep disorder, With moderate or severe use disorderF13.982 Sedative-, hypnotic-, or anxiolytic-induced sleep disorder, Without use disorderF94.0 Selective mutismF93.0 Separation anxiety disorderZ70.9 Sex counselingF65.51 Sexual masochism disorderF65.52 Sexual sadism disorderZ62.891 Sibling relational problemSleep-related hypoventilationF80.89 Social (pragmatic) communication disorderF40.10 Social anxiety disorder (social phobia)Z60.4 Social exclusion or rejectionF45.1 Somatic symptom disorderSpecific learning disorderF81.2 Specific learning disorder, With impairment in mathematicsF81.0 Specific learning disorder, With impairment in readingF81.81 Specific learning disorder, With impairment in written expressionSpecific phobiaF40.218 Specific phobia, AnimalSpecific phobia, Blood-injection-injuryF40.230 Specific phobia, Fear of bloodF40.231 Specific phobia, Fear of injections and transfusionsF40.233 Specific phobia, Fear of injuryF40.232 Specific phobia, Fear of other medical careF40.228 Specific phobia, Natural environmentF40.298 Specific phobia, OtherF40.248 Specific phobia, SituationalF80.0 Speech sound disorderSpouse or partner abuse, Psychological, ConfirmedT74.31XA Spouse or partner abuse, Psychological, Confirmed, Initial encounterT74.31XD Spouse or partner abuse, Psychological, Confirmed, Subsequent encounterSpouse or partner abuse, Psychological, SuspectedT76.31XA Spouse or partner abuse, Psychological, Suspected, Initial encounterT76.31XD Spouse or partner abuse, Psychological, Suspected, Subsequent encounterSpouse or partner neglect, ConfirmedT74.01XA Spouse or partner neglect, Confirmed, Initial encounterT74.01XD Spouse or partner neglect, Confirmed, Subsequent encounterSpouse or partner neglect, SuspectedT76.01XA Spouse or partner neglect, Suspected, Initial encounterT76.01XD Spouse or partner neglect, Suspected, Subsequent encounterSpouse or partner violence, Physical, ConfirmedT74.11XA Spouse or partner violence, Physical, Confirmed, Initial encounterT74.11XD Spouse or partner violence, Physical, Confirmed, Subsequent encounterSpouse or partner Violence, Physical, SuspectedT76.11XA Spouse or partner Violence, Physical, Suspected, Initial encounterT76.11XD Spouse or partner Violence, Physical, Suspected, Subsequent encounterSpouse or partner Violence, Sexual, ConfirmedT74.21XA Spouse or partner Violence, Sexual, Confirmed, Initial encounterT74.21XD Spouse or partner Violence, Sexual, Confirmed, Subsequent encounterSpouse or partner Violence, Sexual, SuspectedT76.21XA Spouse or partner Violence, Sexual, Suspected, Initial encounterT76.21XD Spouse or partner Violence, Sexual, Suspected, Subsequent encounterF98.4 Stereotypic movement disordersee specific substances Stimulant intoxicationsee specific substances Stimulant use disordersee specific substances Stimulant withdrawalsee specific substances Substance intoxication deliriumsee specific substances Substance intoxication deliriumsee specific substances Substance withdrawal deliriumsee specific substances Substance withdrawal deliriumsee specific substances Substance/medication-induced anxiety disordersee specific substances Substance/medication-induced bipolar and related disordersee specific substances Substance/medication-induced depressive disordersee specific substances Substance/medication-induced major or mild neurocognitive disordersee specific substances Substance/medication-induced obsessive-compulsive and related disordersee specific substances Substance/medication-induced psychotic disordersee specific substances Substance/medication-induced sexual dysfunctionsee specific substances Substance/medication-induced sleep disorderG25.71 Tardive akathisiaG24.01 Tardive dyskinesiaG24.09 Tardive dystoniaZ60.5 Target of (perceived) adverse discrimination or persecutionTobacco use disorderZ72.0 Tobacco use disorder, MildF17.200 Tobacco use disorder, ModerateF17.200 Tobacco use disorder, SevereF17.203 Tobacco withdrawalTobacco-induced sleep disorderF17.208 Tobacco-induced sleep disorder, With moderate or severe use disorderF95.2 Tourette’s disorderF65.1 Transvestic disorderF63.3 Trichotillomania (hair-pulling disorder)Z75.3 Unavailability or inaccessibility of health care facilitiesZ75.4 Unavailability or inaccessibility of other helping agenciesZ63.4 Uncomplicated bereavementF10.99 Unspecified alcohol-related disorderF15.99 Unspecified amphetamine or other stimulant-related disorderF41.9 Unspecified anxiety disorderF90.9 Unspecified attention-deficit/hyperactivity disorderF31.9 Unspecified bipolar and related disorderF15.99 Unspecified caffeine-related disorderF12.99 Unspecified cannabis-related disorder[R29.818 +] F06.1 [Other symptoms involving nervous and musculoskeletal systems +] Unspecified catatoniaF14.99 Unspecified cocaine-related disorderF80.9 Unspecified communication disorderR41.0 Unspecified deliriumF32.9 Unspecified depressive disorderF91.9 Unspecified disruptive, impulse-control, and conduct disorderF44.9 Unspecified dissociative disorderUnspecified elimination disorderR15.9 Unspecified elimination disorder, With fecal symptomsR32 Unspecified elimination disorder, With urinary symptomsF50.9 Unspecified feeding or eating disorderF64.9 Unspecified gender dysphoriaF16.99 Unspecified hallucinogen-related disorderZ59.9 Unspecified housing or economic problemG47.10 Unspecified hypersomnolence disorderF18.99 Unspecified inhalant-related disorderG47.00 Unspecified insomnia disorderF79 Unspecified intellectual disability (intellectual developmental disorder)F99 Unspecified mental disorderF09 Unspecified mental disorder due to another medical conditionR41.9 Unspecified neurocognitive disorderF89 Unspecified neurodevelopmental disorderF42 Unspecified obsessive-compulsive and related disorderF11.99 Unspecified opioid-related disorderF19.99 Unspecified other (or unknown) substance-related disorderF65.9 Unspecified paraphilic disorderF60.9 Unspecified personality disorderF16.99 Unspecified phencyclidine-related disorderZ60.9 Unspecified problem related to social environmentZ65.9 Unspecified problem related to unspecified psychosocial circumstancesF29 Unspecified schizophrenia spectrum and other psychotic disorderF13.99 Unspecified sedative-, hypnotic-, or anxiolytic-related disorderF52.9 Unspecified sexual dysfunctionG47.9 Unspecified sleep-wake disorderF45.9 Unspecified somatic symptom and related disorderUnspecified stimulant-related disorderF95.9 Unspecified tic disorderF17.209 Unspecified tobacco-related disorderF43.9 Unspecified trauma- and stressor-related disorderZ62.29 Upbringing away from parentsZ65.4 Victim of crimeZ65.4 Victim of terrorism or tortureF65.3 Voyeuristic disorderZ91.83 Wandering associated with a mental disorderList is alphabetical.Do you need to add additional data/specifiers?(Required)YesNoAdditional Data/Specifiers(Required) For example, for a diagnosis of F34.1 – Persistent Depressive Disorder, specifiers could be: Moderate, with melancholic features, with moderate-severe anxious distress, with intermittent major depressive episodes, with current episodeChief Complaint:(Required)100 Words or Less // Example (57 Words): Katie presents to initial session with report of worsening depression over the last month. Informs therapist she was previously diagnosed in 2019, has been to therapy in the past and finds it helpful. Says she was doing well until she lost her job 3 months ago. Once she found a new job her boyfriend ended their relationship.Therapist Assessment & Plan:Assessment:(Required)100 Words or Less // Example (93 Words): Katie presents with symptoms consistent with mood disorder, she describes her overall mood as “i have nothing to look forward to,” “i feel bad for existing,” and “i randomly feel like i have a lump in my throat.” Described mood consistent with DSM-5 criteria for Major depressive disorder of worthlessness, feelings of guilt, she endorses sleep disturbance of difficulty falling asleep, low energy/fatigue and difficulty concentrating. Therapist helped Katie process her feelings, provided in depth psychoeducation on depression overall, and relevant symptoms that she is experiencing such as guilt and low energy.Plan:(Required)100 Words or Less // Example (42 Words): Therapist will utilize both motivational interviewing and CBT-Depression to help Katie learn coping skills to manage depression symptoms specifically feelings of guilt. Therapist recommends weekly sessions, Katie is in agreement with this. Next session, therapist and Katie will complete the treatment plan.Electronically signed by(Required)Stacy Blassingame, LPCCortney Dollens, LPCMacaela Gilson, LCSWMarybeth Gras, LCSWDr. Travis Munnerlyn, PsyDNicole Neace, LPCEmily Horning, LCSWOn Today's Date(Required) MM slash DD slash YYYY NOTE: Should be within 24 hours or less of Intake Session DateCAPTCHA Δ
