CAMS Suicide Status Form

Section A (Patient):
 Please list your reasons for wanting to live and your reasons for wanting to die. Then rank in order of importance 1 to 5. Rate and fill out each item according to how you feel right now. Then rank in order of importance 1 to 5
Rank (1 = most important to 5 = least important)
Please list your reasons for wanting to live and your reasons for wanting to die. Then rank in order of importance 1 to 5.
RANK
REASONS FOR LIVING
RANK
REASONS FOR DYING
TREATMENT PLAN
Problem #
Problem Description
Goals & Objectives
Interventions
Duration
1
Self-harm potential
Safety and Stability
Stabilitation plan completed ☐
 
2
 
 
 
 
3
 
 
 
 
CAMS STABILIZATION
Attending treatment as scheduled:
Potential Barriers
Solutions I will try