Free tool · Documentation aid · Behavioral health
Mental Status Exam (MSE) Builder.
A structured way to assemble a clean mental status exam note. Work through the standard domains — appearance, behavior, speech, mood, affect, thought process and content, perception, cognition, insight, and judgment — choosing the descriptors that fit and adding your own words. The tool builds a copy-ready narrative. It organizes your assessment; it doesn’t make clinical judgments for you.
Build the note
Pick a descriptor or type your own in any field. Leave a field blank to omit it. Quotes around the stated mood are added automatically.
Fill in the fields to build the note.
The standard MSE domains [1]
A complete mental status exam typically documents: appearance, behavior/psychomotor activity, speech, mood (the patient’s stated feeling, often quoted), affect (your observation of expressed emotion), thought process (how thoughts connect), thought content (including suicidal/homicidal ideation, delusions), perception (hallucinations), cognition/sensorium (orientation, attention, memory), and insight and judgment. The MSE is a snapshot of the patient at the time of the interview.
References
- Mental status examination — standard domains and descriptors. See e.g. Voss RM, M Das J. Mental Status Examination. StatPearls. Treasure Island (FL): StatPearls Publishing. ncbi.nlm.nih.gov/books/NBK546682. (Components of the MSE.)
Domain structure transcribed from standard psychiatric references; documentation conventions follow your facility.
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