Personal Notes

While at McLean Hospital

IntroDuction
People come to McLean Hospital in all stages
of illness. You may already have one or more
psychiatric diagnoses or an idea of what is going
on with you. Conversely, you may not have had
any prior mental health care. Writing down your
thoughts, questions and concerns about your
diagnosis and medications can be helpful, as
can reviewing these with your psychiatrist
while you are in the hospital. Nurses
are also available at all times to
answer your questions about
your diagnosis.

This booklet is a resource for your private use. You do not need to share
what you record in here with anyone unless you choose to do so.

My diagnosis is: ______________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
My medications are: ________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________

Personal Notes

My Diagnosis

_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
Questions I have about my diagnosis: ____________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
Symptoms or feelings I need to tell my treatment team about: _______________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
Fears I have about my diagnosis: __________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
How my diagnosis may affect my future: _________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________

Personal Notes While at McLean Hospital 1

Personal Notes

Goals of My Hospitalization
Before my hospitalization, I was having difficulties with these activities: ___________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
I was worried about: ________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
I came to the hospital because: ____________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
I hope this hospitalization helps me to: __________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
I am most concerned about my:

Work/School
Family
Future
Friends
Health
Body
I am also concerned about: _________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________

Personal Notes While at McLean Hospital

It can be especially difficult to call family and friends after being in the hospital. To help you guide the
conversation, jot down your thoughts before making the call.
Before the conversation:
Today, I want to contact: ____________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________

Personal Notes

Family and Friends Contact Sheet

I want to talk to him/her about: ___________________________________________________________________________________________

_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
I am afraid of talking to this person about: _______________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
Im going to say: ______________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
After the conversation:
We talked about: _____________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
Now I feel: ____________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________

Personal Notes While at McLean Hospital 3

Personal Notes

Family and Friends Contact Sheet

It can be especially difficult to call family and friends after being in the hospital. To help you guide the
conversation, jot down your thoughts before making the call.
Before the conversation:
Today I want to contact: ____________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
I want to talk to him/her about: ___________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
I am afraid of talking to this person about: _______________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
Im going to say: ______________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
After the conversation:
We talked about: _____________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
Now I feel: ____________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________

Personal Notes While at McLean Hospital

Date: ___________________________________________________________________________________________________________________________
My goal for the day: _________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
The names of my nurses today: ___________________________________________________________________________________________
_________________________________________________________________________________________________________________________________

Personal Notes

Daily Reflections

Activities today: _____________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
My visitors today: ___________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
I talked to my doctors about: _______________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
I still have these question and concerns: _________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
I also feel: _____________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________

Personal Notes While at McLean Hospital 5

Personal Notes

Daily Reflections
Date: ___________________________________________________________________________________________________________________________
My goal for the day: _________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
The names of my nurses today: ___________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
Activities today: _____________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
My visitors today: ___________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
I talked to my doctors about: _______________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
I still have these question and concerns: _________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
I also feel: _____________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________

Personal Notes While at McLean Hospital

Date: ___________________________________________________________________________________________________________________________
My goal for the day: _________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
The names of my nurses today: ___________________________________________________________________________________________
_________________________________________________________________________________________________________________________________

Personal Notes

Daily Reflections

Activities today: _____________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
My visitors today: ___________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
I talked to my doctors about: _______________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
I still have these question and concerns: _________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
I also feel: _____________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________

Personal Notes While at McLean Hospital 7

Personal Notes

Building My Resilience/Maintaining My Wellness

I derive Hope from: __________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
My Strengths and Skills are: ________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
I find Healing in/from: _____________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
My plan for maintaining Wellness: ________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________

Personal Notes While at McLean Hospital

_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________

Personal Notes

_________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________

Personal Notes While at McLean Hospital 9

115 Mill Street :: Belmont, MA :: 02478 :: www.mcleanhospital.org :: 800.333.0338

2012 The McLean Hospital Corporation

0398 0812