Child A aged 9
CHIEF COMPLAINT: Blindness.
REVIEW OF SYSTEMS: Unavailable.
PAST MEDICAL/SURGICAL HISTORY: None.
FAMILY HISTORY: Noncontributory.
CLINICAL IMPRESSION: Fussy eater.
DISPOSITION: Discharged home.
Psychiatric Hospitalisations (include where, when, & for what reason):
Have you ever had psychotherapy?
Have you ever had ECT?
Age of first period:
Have you reached menopause? Y / N
At what age?
Do you have regular periods? Y / N
DO YOU EVER DREAM OF DESIRE?