Provider intake packet

PsychNET Adaptive Screening — Provider Note

Generated Jun 28, 2026, 8:50 PM · Pseudonym Family 042 · Journey a3f8e2d1…

PsychNET Adaptive Screening — Provider Note

Generated Jun 28, 2026, 8:50 PM · Pseudonym Family 042 · Journey a3f8e2d1-7c45-4b91-8f3e-9d2a6c1b0e47

Identifying information · ID

Age: 14
Sex: female
State: California
Insurance: Blue Shield of California

Reason for referral · CC

“My daughter has been crying almost every day for the past six weeks. She used to be on the honor roll but her grades have dropped to Bs and Cs. She stopped hanging out with her two best friends — says she doesn't feel like it. She's sleeping 10–11 hours but still says she's exhausted. Last Tuesday she said 'I don't see the point anymore' and I don't know if that means something serious.”

History of present illness · HPI

Caregiver-reported concern at intake (paraphrased verbatim): "My daughter has been crying almost every day for the past six weeks. She used to be on the honor roll but her grades have dropped to Bs and Cs. She stopped hanging out with her two best friends — says she doesn't feel like it. She's sleeping 10–11 hours but still says she's exhausted. Last Tuesday she said 'I don't see the point anymore' and I don't know if that means something serious." Symptom duration is approximately 6 weeks. The adolescent (female, age 14) was administered an adaptive screening battery selected by PsychNET's child-psychiatry agent. Screening identified elevated findings on: PHQ-9 (Moderately severe depression, 17); GAD-7 (Moderate anxiety, 12).

Past psychiatric history · PPHx

No prior psychiatric diagnoses. No prior psychiatric hospitalization or residential treatment. No current or prior psychotropic medications. Mother reports patient had notable separation anxiety in kindergarten and first grade that resolved without formal treatment by age 7. No prior individual or family therapy.

Past medical history · PMHx

Asthma (mild persistent; well-controlled on albuterol PRN, last used approximately 4 months ago). Seasonal allergic rhinitis (loratadine 10 mg daily as needed, spring/fall). No other chronic conditions. Last well-child visit 8 months ago (age 13); hearing and vision screening normal. Menarche at age 12; menstrual cycles irregular. No known drug, food, or environmental allergies beyond seasonal pollen. No current supplements.

Family psychiatric history · FHx

Maternal aunt (age 41): major depressive disorder, single episode in her 20s, responded to sertraline; no recurrence. Maternal grandfather (deceased, age 68, cardiac): history of alcohol use disorder, untreated. Paternal family history limited — father estranged from his family of origin; no known psychiatric history reported. No known family history of bipolar disorder, psychotic illness, ADHD, or completed suicide.

Social history · SH

Lives with both biological parents (married, no reported conflict) and one younger sibling (brother, age 11). Attends 9th grade at a large suburban public high school; prior academic record strong (honor roll through 8th grade). Reports 2–3 close friends; social engagement has decreased significantly over the past 6 weeks — now mainly communicating by text. Screen time has increased to approximately 6–7 hours per day (primarily social media and streaming). Sleep: bedtime ~10 PM, difficulty falling asleep (~45–60 min sleep latency), early-morning awakening at 5 AM with inability to return to sleep. Appetite decreased; has lost approximately 4 lbs over the past 4 weeks. Denies alcohol, tobacco, or illicit substance use. No recent losses, moves, or acute stressors. No known history of physical, emotional, or sexual abuse. No current IEP or 504 plan.

Substance use

CRAFFT not administered (not indicated by intake or age range).

Safety screen

Suicidal ideation screen administered via PHQ-9 item 9. Additional safety items pulled from any flagged instruments are listed below.

⚠ Safety flags

PHQ-9 item 9 endorsed at "Several days" (value 1). Active suicidal ideation must be assessed and documented at first contact; consider C-SSRS.
PHQ-9: Endorsed suicidal ideation (PHQ-9 item 9) — clinician review required.

Screening results

PHQ-9Depression

Moderately severe depression17 · 9/9 items

Patient Health Questionnaire-9 (Modified for Adolescents)

Endorsed suicidal ideation (PHQ-9 item 9) — clinician review required.

Why this matters: Sum-scored 0–27. Bands: 0–4 minimal, 5–9 mild, 10–14 moderate, 15–19 moderately severe, 20–27 severe. A score ≥10 has 88% sensitivity and 88% specificity for major depression. Item 9 (suicidal ideation) is a discrete safety prompt — any non-zero endorsement requires direct clinician follow-up regardless of total score, per AAP/NIMH guidance for adolescent depression screening.

Sources

Item	Response	Score
Little interest or pleasure in doing things	More than half the days	2
Feeling down, depressed, irritable, or hopeless	Nearly every day	3
Trouble falling asleep, staying asleep, or sleeping too much	Nearly every day	3
Feeling tired or having little energy	More than half the days	2
Poor appetite, weight loss, or overeating	Several days	1
Feeling bad about yourself — or that you are a failure, or have let yourself or your family down	More than half the days	2
Trouble concentrating on things like school work, reading, or watching TV	More than half the days	2
Moving or speaking so slowly that other people could have noticed — or being so fidgety or restless that you were moving a lot more than usual	Several days	1
Thoughts that you would be better off dead, or of hurting yourself in some way	Several days	1

GAD-7Anxiety

Moderate anxiety12 · 7/7 items

Generalized Anxiety Disorder-7

Why this matters: Sum-scored 0–21. Bands: 0–4 minimal, 5–9 mild, 10–14 moderate, 15–21 severe. A score ≥10 yields 89% sensitivity and 82% specificity for generalized anxiety disorder, with similar performance for panic disorder and social anxiety in primary care. The GAD-7 was originally validated in adults but has been studied in adolescents 11–17 with comparable cutoffs.

Sources

Item	Response	Score
Feeling nervous, anxious, or on edge	More than half the days	2
Not being able to stop or control worrying	More than half the days	2
Worrying too much about different things	More than half the days	2
Trouble relaxing	More than half the days	2
Being so restless that it's hard to sit still	Several days	1
Becoming easily annoyed or irritable	More than half the days	2
Feeling afraid as if something awful might happen	Several days	1

Assessment · A

Diagnostic considerations:

Major depressive episode — moderate to severe — Moderately severe depression (PHQ-9 = 17, 6-week duration, functional impairment in school and social domains) (supported by PHQ-9)
Generalized anxiety disorder features — Moderate anxiety (GAD-7 = 12, pervasive worry across multiple domains, difficulty relaxing) (supported by GAD-7)

Urgency: Expedited — match within 7 days

PHQ-9 item 9 endorsed (passive suicidal ideation); PHQ-9 total 17 (moderately severe band); 6-week duration with functional impairment across school and social domains. Expedited referral (within 7 days) indicated per AAP adolescent depression guidelines. If ideation escalates or becomes active before appointment, direct to nearest ED or call/text 988.

⚠ Triage flags

PHQ-9 item 9 endorsed at 'Several days' — passive suicidal ideation. Clinician review required at first contact. Administer C-SSRS at intake appointment to characterize ideation (passive vs. active, with/without plan or intent).

Recommendations / plan · P

Provider type: Child & adolescent psychiatrist — medication evaluation + therapy referral

Dr. Natalie Okonkwo, MD

Sequoia Adolescent Psychiatry, Palo Alto, CA

Medication managementPsychoeducationCBT coordination

Estimated wait: 5 days

Treatment plan:

Modality: Child & adolescent psychiatry — medication evaluation (SSRI consideration) + individual CBT referral
Cadence: Psychiatric intake within 5 days; CBT initiation within 2–3 weeks; combined therapy + medication management biweekly × 12 weeks, then monthly
Pharmacology: Fluoxetine 10 mg QAM to be considered after full psychiatric evaluation; titrate to 20 mg at week 2 if tolerated. Baseline weight, vital signs documented. Black-box counseling (suicidality monitoring weeks 1–4) per FDA labeling. SSRI initiation decision to be made by treating psychiatrist at intake appointment.
Next review: 8 weeks post-intake (full PHQ-9 + GAD-7 re-administration; safety check; medication adjustment if indicated)

Goals:

PHQ-9 score ≤9 (response) within 8 weeks; ≤4 (remission) within 16 weeks
Return to baseline academic performance (honor roll) within one semester
Resumption of at least 2 social activities per week within 6 weeks
Safety: C-SSRS administered at every visit; safety plan completed at first appointment
Sleep hygiene protocol: target 8–9 hours with consistent wake time; restrict screens 1 hour before bed
Family psychoeducation on adolescent depression — caregiver session within first 4 weeks

Agent decision log

Every routing, form-selection, question-pick, and triage decision the agent made for this case, in order. Claude entries used the LLM; rules entries used the deterministic fallback.

routerulesApr 10, 2025, 12:00 AM
orchestrator
Intake language contains multiple internalizing markers (persistent low mood, anhedonia, academic decline, passive suicidal ideation phrase) with no organic indicators. Age 14 falls within child & adolescent psychiatry scope. Confidence 0.97 — near-certain routing.
select_formsrulesApr 10, 2025, 12:01 AM
child_psychiatry
Primary presentation maps to MDD screening domain — PHQ-9 is USPSTF Grade B for ages 12–18. Anxiety comorbidity prevalence ~50% with adolescent MDE; GAD-7 added as secondary screen. CRAFFT excluded (no substance cues). SCARED excluded (presentation is diffuse, not phobia/separation-focused). VADRS-P excluded (no ADHD cues). SDQ excluded (not needed when PHQ-9/GAD-7 are primary). Two-instrument battery keeps burden low.
triagerulesApr 10, 2025, 12:40 AM
child_psychiatry
PHQ-9 = 17 → moderately severe band. Item 9 = 1 (passive SI) → safety flag; triggers C-SSRS recommendation regardless of total score. GAD-7 = 12 → moderate anxiety; comorbidity confirmed. Duration 6 weeks with impairment in ≥2 domains (academic + social) satisfies MDE criteria A and B. Urgency escalated from routine to expedited per AAP guideline: any PHQ-9 ≥10 with item 9 endorsement warrants referral within 7 days.
matchrulesApr 10, 2025, 12:43 AM
child_psychiatry
Searched provider directory filtered to: CA license, Blue Shield in-network, adolescent-only or adolescent-primary caseload, psychiatrist credential (MD/DO — medication evaluation indicated). Top match: Sequoia Adolescent Psychiatry (Dr. Okonkwo) scores 0.96 — adolescent-only practice, in-network, depression + anxiety specialization, 5-day average wait which satisfies expedited urgency band. Second match (Dr. Flores, 12-day wait) does not satisfy expedited threshold.
triagerulesJul 3, 2025, 12:00 AM
child_psychiatry
PHQ-9 = 4 at week 12 crosses remission threshold (<5). GAD-7 = 5 (mild residual). Item 9 = 0 at all follow-up points — safety concern resolved. Combined therapy (CBT) + pharmacotherapy (fluoxetine 20 mg) produced full depressive remission within 12 weeks. Journey closed as improved. Learning system notified: PHQ-9 + GAD-7 combination confirmed diagnostic accuracy for this archetype.