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How to Approach the Consult
Before working through prep, take a few minutes to ground yourself in why this consult matters and how to hold it. The themes below shape every decision made across the next three stages.
First Touchpoint with the Practice
The consult is the patient's first real experience of Life Lab. Before this, they have filled out forms in isolation and waited. Now a person is in front of them.
This first impression sets the tone for everything that follows — whether the patient continues with treatment, how openly they engage with their assigned clinician, and whether they tell other people in their life that this is a place worth coming to. A consult that feels procedural or rushed undermines the work before it has begun.
The goal is for the patient to leave the consult feeling that they came to the right place. That does not require performing warmth. It requires presence, attentiveness, and the willingness to slow down when something matters to them, even if it means setting the agenda aside for a bit. The tool below will help with structure. The frame of being welcoming is the clinician's responsibility throughout.
Patient Vulnerability
For many patients, this is the most vulnerable they have been or will be during the course of treatment.
The consult is the first time many patients tell anyone about their trauma, their substance use, their suicidal thoughts, their relationship patterns. Some of them have rehearsed for weeks. Some have decided in the parking lot that they will only share the surface. Some will disclose things they have never said aloud and watch the clinician's face for what happens next.
The clinician's job is to make this experience one the patient can survive and use. That means actively listening rather than just collecting data, validating where validation is warranted, normalizing where normalization helps, and pacing the harder material based on what the patient can hold. It also means not asking every difficult question simply because it appears on a form. The information matters, but the patient leaving the room feeling heard and cared for matters more, and the two are not in conflict when the clinician is paying attention.
Holistic Conceptualization Without Premature Conclusions
The aim of the consult is to understand the patient as completely as the available information allows — and to hold that understanding loosely until all of it is in.
Prep work, the intake, the HHQ, and the PAI provide a structured picture before the consult begins. The consult itself adds the patient's voice, affect, presentation, and the parts of their story that do not fit on a form. A useful conceptualization integrates all of this rather than over-weighting any single source.
At the same time, it is a mistake to arrive at the consult with a diagnosis already in mind. Assessment scores, PAI elevations, and trauma history on paper can pull the clinician toward conclusions that the live encounter may complicate. Holding hypotheses rather than verdicts allows the patient to be more than their paperwork. Wait until after the consult, when all of the information is in front of you, to draw conclusions about diagnosis and treatment needs. The note assembly stage is the appropriate place to integrate; the consult itself is the place to listen.
Considering Whether the Case Merits Multiple Sessions
A single 75-to-90-minute consult cannot adequately capture every patient. Recognizing when more time is needed is part of the clinician's responsibility.
Some patients carry histories that cannot be responsibly covered in one session. Extensive trauma, ongoing or historical abuse, complex substance use, prior psychiatric hospitalizations, multiple prior treatment episodes, complicated medical involvement, dissociative experiences, and significant family system complexity are all signals that the consult may need to extend across two or more sessions.
Trying to cover everything in one sitting in these cases produces two problems. The clinician ends up with a surface-level understanding of areas that deserve depth, and the patient leaves the consult emotionally exposed in a way that a single closing conversation cannot adequately contain. Both compromise the quality of the eventual treatment recommendation.
Consider extending to multiple consult sessions when any of the following are true: the trauma history is extensive and the patient has not previously processed it in treatment; substance use is significant and complicated by mental health symptoms; there are multiple competing clinical demands that each warrant their own focused exploration; the patient is in acute crisis and risk assessment takes a substantial portion of the time; or the patient's pacing simply does not allow the depth needed within the standard frame. Discuss with the Clinical Director when uncertain.
Document Upload — Auto-Populate Fields
Upload the patient's intake, HHQ, and PAI PDFs. The tool extracts text in your browser only — no data leaves this device. For image-based PDFs (most EMR exports), OCR runs automatically on first upload (~10MB download, then cached). Auto-populated fields will be briefly highlighted. Review for accuracy before proceeding.
Intake
No file chosen
HHQ
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PAI
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Parsing is best-effort and pattern-based. Some fields may not extract cleanly. Always review populated fields against the source document before proceeding to the consult.
For debugging: see what OCR/PDF.js produced. Last extraction only.
Ready to Begin
When you have reviewed the approach, move to Stage 1 to prepare for the consult.
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Document Upload — Auto-Populate Fields
Upload the patient's intake, HHQ, and PAI PDFs. The tool extracts text in your browser only — no data leaves this device. For image-based PDFs (most EMR exports), OCR runs automatically on first upload (~10MB download, then cached). Auto-populated fields will be briefly highlighted. Review for accuracy before proceeding.
Parsing is best-effort and pattern-based. Some fields may not extract cleanly. Always review populated fields against the source document before proceeding to the consult.
For debugging: see what OCR/PDF.js produced. Last extraction only.
Pre-Consult Checklist
Verify completion before proceeding. Items not yet completed should be addressed before the consult or flagged for the consult itself.
Sections hidden — not yet completed: PAI. Check the corresponding box above to reveal extraction fields. Domains not covered in completed documents will appear in the gap report and consult outline.
Patient Identifiers and Referral
Pulled from intake. Verify accuracy.
Intake Form — Key Data
Extract the following from the intake paperwork. Leave blank if not addressed.
Symptom Intensity (Patient-Rated)
From intake "current symptoms checklist." When parser detects endorsement, the symptom label highlights. Tap intensity directly.
Depressed mood
Anxiety / OCD / Panic
Suicidal thoughts
Self-harm
Hyperactivity / Impulsivity
Agitation / Irritability
Mood swings
Delusions / Hallucinations
Trauma / PTSD
Fatigue / Low energy
Eating disorder
Sleep disturbance
Goals and Engagement
Health History Questionnaire — Mental Health
Extract from HHQ items 4–16.
Past Psychiatric Treatment
Medication History
Suicide / Self-Harm History
HHQ — Trauma History
Extract from HHQ items 17–27. Note perpetrator, age range, frequency, and current contact where applicable.
HHQ — Substance Use
Extract from HHQ items 31–43.
HHQ — Medical
Extract from HHQ items 44–70.
HHQ — Family
Extract from HHQ items 71–82.
Family of Origin
HHQ — Developmental
Extract from HHQ items 83–104.
HHQ — Social / Educational / Occupational / Relational
Extract from HHQ items 105–128.
Education
Employment
Relationships
Sexual History
Legal / Spiritual
Strengths and Interests
Assessment Measures — Scores
Self-report measures embedded in the HHQ. DERS, ISI, MDQ count, MDQ same-time, ADHD, and EDQ totals auto-extract from the HHQ. BAI and TSC report endorsement counts (not true totals — column position is lost in OCR; verify totals against the PDF). BDI total and BDI item 9 require manual scoring from the source PDF. PHQ-9 and GAD-7 are manual if administered.
PAI — Personality Assessment Inventory
How this section works:
Upload your PAR PAI Score Report PDF in the upload section above. The 10 supplemental indices, critical items, and profile fits extract automatically from the PDF text. The 22 standard scale T-scores (ICN through WRM) come from OCR of the chart pages — OCR output appears in the box below so you can see exactly what was extracted and fix any wrong digit before applying. If OCR fails entirely, paste or type the row directly into the same box.
Standard Scales — 22 T-Scores
VALIDITYCLINICALTREATMENTINTERPERSONAL
Supplemental Indices (auto-extracts from PAR Score Report)
≥6 raw suggests defensiveness
≥148 suggests positive distortion
≥3 raw raises concern
Positive raises concern
≥13 raw elevated
≥9 raw elevated
≥6 raw suggests barriers
Compare to ALC; ≥10T higher suggests denial
Compare to DRG
Overall severity index
Critical Items Endorsed
Outside Records and Collateral
Optional. Document source, date, and key content.
Generate Prep Outputs
Generates the gap report and consult outline in-page. Review and edit before proceeding to the consult.
Navigate:
Auto-drafted from intake / HHQ / PAI.
Narrative fields below have been pre-filled from your prep data. These are drafts — verify with the patient during the consult and edit as needed. Auto-drafted fields are tinted yellow with a yellow left border until you touch them.
Consult Timing
Opening Frame and Informed Consent
Standard opening to deliver before history-taking. Check items as completed during the consult.
Gap Report (from Prep)
Generated from Stage 1 data. Use this as a live reference during the consult.
Click "Refresh from Prep Data" to display the gap report here.
Consult — Live Notes & Domain Coverage
The chip selectors below are at the top because they're fastest to record during a moving consult. Click chips for each category as the patient speaks. Then use the Live Consult Notes textarea for everything else, and click "Distribute" to route content into the per-section fields below for the final note.
PPS — Clinical Context and Symptoms▾
Click chips to select. These render as the "CLINICAL CONTEXT:" and "SYMPTOMS:" prose paragraphs at the end of the assembled note.
CLINICAL CONTEXT
Current stressors
Patient goals
Patient strengths
SYMPTOMS
Depression
Mania
Anxiety
OCD symptoms
Trauma symptoms
Psychosis
Personality features
Disordered eating
Sleep issues
Pain level
Suicide assessment
Homicide assessment
Substance abuse assessment
Complete Neurobehavioral Mental Status Exam — PPS▾
Click chips for each category. Renders at the end of the assembled note in the format: "CATEGORY: chip1, chip2, chip3".
PSYCHIATRIC
General appearance
Behavior
Attitude
Mood
Affect
Thought process
Content/perception
Judgement
Insight
NEUROLOGICAL
Orientation
Memory
Fund of knowledge
Speech/language
Gait and stance
Motor
Cognitive functions
Attention/concentration
Live Consult Notes
Type freely. To route content into specific note sections, start a line with a marker: [HPI], [MH], [SUBS], [MED], [FAM], [DEV], [SOC], [REL], [TRAUMA], [RISK], [ENG]. Content on the same line as the marker AND every line below (until the next marker) routes to that section. Anything before the first marker goes to HPI. Use the "Insert Section Marker" button to add at your cursor. Clicking Distribute writes the content to the section fields below and clears this textarea. Anything already in those fields is preserved — new content is appended.
Section Fields (auto-populated by Distribute, or edit directly)
These per-section fields feed the final assembled note. The Live Consult Notes above route here when you click Distribute, and these can also be edited directly.
Presenting Concern (HPI Expansion)
Write as prose narrative (not bullets) — multiple paragraphs are fine. Cover: onset, course, severity, triggers, impact on functioning, prior episodes, what makes it better/worse, what brings them in now. Include in-session observations where clinically relevant: how the patient responded to scaffolding being withdrawn, what activated their defenses, what role silence played, how affect was held or routed. This is the primary prose vehicle for clinical conceptualization in the new template — write it in the same voice you would use to brief a colleague who is about to start the work.
Mental Health History — Verification and Expansion
Verify HHQ entries. Past treatment: what helped, what didn't, why it ended. Med trials and reasons for discontinuation. Prior diagnoses and patient's understanding of them.
Substance Use — Verification and Expansion
Past or current use even if HHQ is negative. Specifically ask about alcohol, cannabis, prescription misuse, others. Family history of substance use. Where relevant, note the function of the substance — what affect it manages, contains, or substitutes for — not just the volume. Chronic low-volume use in a patient with limited affect-regulation strategies can be clinically significant even when behavioral consequences are absent.
Medical — Verification
Current treatment, medications, pain, sleep, hormonal/menstrual where relevant, recent labs or physical.
Family History — Expansion
Family of origin: parents, siblings, household structure. Family psychiatric history. Quality of relationships over time. Cultural and intergenerational context. Where clinically relevant, note who in the family system carried which affective function — who held emotion, who managed it downward, whose anger or disappointment shaped the patient's defensive style. Note dependency lines that may have routed from caregivers to current partners. This field renders into the merged FAMILY AND DEVELOPMENTAL HISTORY prose section of the final note.
Developmental History — Verification
Pregnancy and birth, milestones, infancy/toddler temperament, attachment, early difficulties. Note discrepancies between caregiver report (if known) and patient self-report.
Social / Educational / Occupational
Education trajectory, employment history, current functioning. Social network. Hobbies, sources of meaning. Legal. Religion/spirituality where relevant to presenting concern.
Relational and Sexual History — Expansion
Current relationship quality. Pattern across prior relationships. Sexual history where clinically relevant. Children: relationship and functioning.
Trauma — Verification and Expansion
Verify HHQ entries with care. Ask about disclosure history, current symptoms (intrusion, avoidance, hyperarousal, mood/cognition shifts, dissociation), what feels manageable to discuss vs. what doesn't.
Risk Assessment — Live
Current SI/HI: ideation, plan, intent, behaviors, access to means. Prior attempts (timeframe, method, lethality, outcome). NSSI. Violence. Protective factors. Patient's stated ability to remain safe.
Risk Assessment — Structured
Top-line Risk Indicators
Suicidal Ideation (check one)
Plan / Intent / Behavior (check all that apply)
Access to Means (check all that apply)
Risk Factors (check all that apply)
Protective Factors (check all that apply)
Safety Planning (check all that apply)
Disposition (check all that apply)
Mental Status Exam — Free-text notes
Optional free-text MSE notes that supplement the chip selectors at the top of the consult. Both render into the final note (chips render the structured "Complete Neurobehavioral Mental Status Exam — PPS" section; free-text appears under MENTAL STATUS EXAM).
Engagement, Stage of Change, Treatment Interfering Factors
Patient's understanding of their difficulties, openness to treatment, prior treatment relationship patterns, anticipated obstacles.
Wrap-Up
Final items to address before ending the consult.
Treatment Goals (3 collaborative goals)
Proceed to Note Assembly
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Auto-drafted from prep + consult data.
BPS, medical necessity, interactive complexity, and diagnostic criteria fields below have been pre-filled with synthesized content. These are drafts — read carefully, verify, and edit before finalizing. Auto-drafted fields are tinted yellow with a yellow left border until you touch them.
Final Clinical Sections
Sections that require clinician judgment. The note assembler will pull these along with prep and consult data.
Diagnoses (DSM-5-TR / ICD-10)
Biopsychosocial Formulation
Clinician-authored. Use the buttons below to generate either (a) an organizational outline of relevant data placed under each BPS heading, or (b) a sample BPS draft modeled on the clinician's example structure and voice.
Provider and Supervision
Assemble Final Note
Assembles the PPS consult note from prep + consult + clinical sections above. Output is in-page; copy to clipboard, then paste into the PPS template.
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Session Note Writer
Paste your raw session notes below. The tool reformats them into the house structure: 5-bullet Subjective Patient Report, optional Diagnostic Assessment (only emitted if DSM-5-TR review is detected in your notes), and Interventions Used drawn from the trained intervention library. All processing is local; nothing leaves the browser.
Inputs
No JSON loaded.
Generate the formatted note
Click Generate. The tool reformats your raw notes into SUBJECTIVE PATIENT REPORT, optional DIAGNOSTIC ASSESSMENT, and INTERVENTIONS USED. Review and edit the output as needed, then Copy to clipboard for AthenaNet.
Format reference
SUBJECTIVE PATIENT REPORT: up to 5 items without diary JSON, up to 8 with · each item is its own paragraph (no bullet marks) · factual, no interpretation · patient name never used in this section · "Patient" / "Reported" voice
DIAGNOSTIC ASSESSMENT: only if DSM-5-TR review occurred · opens with "Reviewed DSM-5-TR criteria for [Disorder] ([Code])" · prose paragraphs · closes with criteria conclusion
INTERVENTIONS USED: 2-4 only · ~80% shorter than full descriptions · no patient name · drawn from library
Separator between sections: --- · no em dashes anywhere · no DSM disclaimers
Navigate:
Saved
PAI parsed — 12 fields populated
OCR can be imperfect on checkboxes and tables. Review highlighted fields for accuracy.
Reading Document
PDF text not embedded. Running OCR — this is slower than text extraction.