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‍CONFIDENTIAL PSYCHIATRIC REPORT

• Name:
• Date of Birth:
• Address:
• Incident Date:
• Date of Examination:
• Venue of Examination:
• Examining Expert:
• Instructed by:
• Solicitors Ref:
• Ref:
• Our Ref:

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Qualifications and Experience.

Introduction.

What follows is my psychiatric report concerning this patient

RTA on…

History of Present Illness.

Family History.

Personal History.

Schooling.

Jobs.

Psycho-Sexual History.

Past Medical History.

Past Psychiatric History.

Pre-Morbid Personality.

Smoking.

Alcohol History.

Drug History.

Forensic History.

Social Circumstances.

Mental State Examination on the ….Date.

Appearance and Behaviour -

Speech  -

Mood -  

Affect –

Cognition -

Thought -  .

Insight -  

Investigations.

Summary.

Diagnosis.

Axis I -

Axis II - No diagnosis.

Axis III - History of Asthma.

Axis IV -

Axis V - Global Assessment of Functioning (GAF).

..during the past year.

..during the present year.

Opinion.

Treatment

Prognosis

Fitness to work

Level of Suffering and Inconvenience

Recommendations.

Declaration.

1. I understand my overriding duty is to the Court, both in preparing reports and giving oral evidence. I have complied with and will continue to comply with that duty.
2. I am aware of the requirements of Part 35 and practice direction 35, the protocol for instructing experts to give evidence in civil claims and the practice direction on pre-action conduct.
3. I have set out in my report what I understand from those instructing me to be the questions in respect of which my opinion as an expert is required.
4. I have done my best, in preparing this report, to be accurate and complete.  I have mentioned all matters that I regard as relevant to the opinions I have expressed.  All of the matters on which I have expressed an opinion lie within my field of expertise.
5. I have drawn attention to all matters, of which I am aware, that might adversely affect my opinion.
6. Wherever I have no personal knowledge, I have indicated the source of factual information.
7. I have not included or excluded anything which has been suggested to me by anyone, including those instructing me, without forming my own independent view of the matter.
8. I will notify those instructing me if, for any reason, I subsequently consider that the report requires correct or qualification.
9. I understand that this report will be the evidence that I give under oath, subject to any correction or qualification I may make before swearing to its veracity and I may be cross-examined on my report by a cross-examiner assisted by an expert.
10. I have not entered into any agreement where the amount of payment of my fee is in any way dependent on the outcome of the case.

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Statement of Truth.

I confirm that I have made clear which facts and matters referred to in this report are within my own knowledge and which are not.  Those that are within my own knowledge I confirm to be true. The opinions I have expressed represent my true and complete professional opinions on the matters to which they refer.  I understand that proceedings for contempt of court may be brought against anyone who makes, or causes to be made, a false statement in a document verified by a statement of truth without an honest belief in its truth.

Signature ………………………………………………  Date: …………………………...

Name & Qualifications

Date of Report:

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