Psychiatry Documentation Challenges
RxNote understands the unique documentation needs of psychiatry
Lengthy Session Notes
Psychiatric sessions often run 45-60 minutes, creating extensive documentation requirements that cut into patient time.
Complex Assessments
Mental status exams, risk assessments, and standardized screening tools require detailed documentation.
Multiple Note Formats
Psychiatrists need SOAP, DAP, BIRP, and progress notes depending on the encounter type.
Psychiatry AI Scribe Features
Specialized documentation tools for psychiatry encounters
Mental Status Exam Documentation
Automatically captures appearance, behavior, mood, affect, thought process, and cognition from your conversation.
DAP & BIRP Note Formats
Generate notes in DAP, BIRP, SOAP, or custom formats optimized for psychiatric documentation.
Risk Assessment Capture
Identifies and documents suicidal ideation, self-harm risk, and safety planning discussions.
Screening Tool Integration
Recognizes PHQ-9, GAD-7, and other standardized assessment scores mentioned during sessions.
Therapy Session Notes
Specialized templates for individual therapy, group therapy, and family therapy documentation.
Medication Management
Accurately captures medication changes, dosage adjustments, and side effect discussions.
How It Works
Get started in three simple steps
Start Your Session
Begin your psychiatric evaluation or therapy session and tap record.
AI Captures Details
RxNote identifies mental status observations, risk factors, and treatment discussions.
Generate Notes
Get structured DAP, BIRP, or SOAP notes with mental health-specific formatting.
Why Psychiatry Providers Choose RxNote
- Save 2+ hours daily on psychiatric documentation
- Never miss critical risk assessment details
- Reduce documentation burden after long therapy sessions
- Generate notes in DAP, BIRP, or SOAP format
- HIPAA-compliant with enterprise-grade security
- Capture PHQ-9, GAD-7, and other screening scores
Sample Psychiatry Note
See how RxNote generates structured documentation for psychiatry encounters
Subjective
Patient reports persistent low mood for 3 weeks, difficulty sleeping, decreased appetite. PHQ-9 score: 14 (moderately severe). Denies suicidal ideation.
Objective
Appearance: appropriate. Behavior: cooperative, psychomotor retardation noted. Mood: "depressed." Affect: constricted. Thought process: linear, goal-directed. No perceptual disturbances.
Assessment
Major Depressive Disorder, recurrent episode, moderate severity. PHQ-9 14, up from 9 at last visit.
Plan
1) Continue sertraline 100mg, increase to 150mg. 2) CBT techniques for sleep hygiene. 3) Follow-up in 2 weeks. 4) Safety plan reviewed.