Adult ADHD Intake Workflow for Small PMHNP Practices

A good adult ADHD intake workflow for a small practice does three things in order. It collects screening and collateral information before the first visit. It uses the visit itself for a structured DSM-5 evaluation and rule-outs. And it holds the prescribing decision until the pre-prescribing safety checks and at least one standardized measure are in the chart. For a solo PMHNP, especially one working by telehealth, a fixed sequence saves time, cuts no-shows and incomplete workups, and produces the documentation payers and regulators expect.

Photo by Vitaly Gariev on Unsplash

Below is a practical sequence that you can adapt. It isn’t a clinical guideline, and it doesn’t replace your judgment, your state’s rules, or any collaborative agreement you work under. Where a step depends on law or payer policy, we cite the source and suggest you verify it. For the objective-measure step, objective ADHD testing with AxonCPT is one option; the workflow works with any validated measure. For the clinical-diagnostic detail behind stage 2 — DSM-5-TR criteria, structured interviews, and differential diagnosis — see our companion piece, adult ADHD evaluation: a step-by-step clinician workup.

The workflow at a glance

Stage	What happens	Who does it	Output in the chart
0. Eligibility	Confirm patient location, your license and Schedule II authority there, insurance	Front desk / you	Location and eligibility note
1. Pre-visit packet	Self-report scale, informant form, records request, history questionnaire	Patient, informant	Scored scales, records
2. Diagnostic visit	Structured interview, childhood history, rule-outs, safety history, PDMP	You	Diagnostic evaluation note
3. Objective measure	Standardized attention test	Patient (remote or in office)	Test report
4. Feedback and plan	Integrate sources, diagnose (or not), discuss options, consent	You	Integration note, treatment plan, agreement
5. Titration follow-up	Repeat measures at dose changes, vitals, misuse reassessment	You	Follow-up notes with trend

Stage 0: eligibility before anything else

Telehealth PMHNPs should check this first, because it can end the process. Confirm where the patient will be located during visits, and confirm that you hold an APRN license, Schedule II authority, and DEA registration covering that state. Rules vary a lot. Texas, for example, limits APRN Schedule II delegation to hospital facility-based practice and hospice [1]. Our framework for telehealth stimulant prescribing by state walks through the checks.

Also tell the patient up front that an evaluation doesn’t guarantee a diagnosis or a prescription. Setting that expectation early avoids conflict later.

Stage 1: the pre-visit packet

Send it when the appointment is booked, and make its completion a condition of the diagnostic visit:

• Adult self-report screen. The WHO Adult ADHD Self-Report Scale (ASRS v1.1) screener has six items and was validated in a general population sample [2]. It screens but doesn’t diagnose.
• Informant form. A partner, parent, or close friend who knows the patient’s current functioning and, ideally, their childhood.
• Records request. School report cards, prior evaluations, prior prescriber notes, especially for patients transferring on a stimulant.
• History questionnaire. Psychiatric, substance use, medical, cardiac (including family history of sudden death), sleep, and medication history.

A complete packet makes the diagnostic visit shorter and more focused.

Stage 2: the diagnostic visit

Structure the interview around DSM-5 criteria. For adults (17+), that means at least five symptoms in one or both domains, several symptoms before age 12, several symptoms in two or more settings, clear impairment, and no better explanation [3]. A semi-structured interview such as DIVA-5, which systematically reviews the 18 DSM-5 symptom criteria in childhood and adulthood, keeps this consistent from patient to patient [4].

Cover these in the same visit:

• Differential diagnosis: depression, anxiety, bipolar spectrum, trauma, sleep disorders, substance use, and medical causes. Note your reasoning for each rule-out.
• Pre-prescribing safety history: stimulant labeling tells prescribers to assess risk of abuse, misuse, and addiction before prescribing, to assess for cardiac disease (history, family history of sudden death or ventricular arrhythmia, and exam), and to screen for risk factors for mania [5][6].
• Vitals: blood pressure and pulse, which labeling says to monitor at appropriate intervals [6]. By telehealth, document how you obtained them.
• PDMP check: per your state’s rules [7], with the date and result recorded.

Rating scales are easy to overinterpret and easy to exaggerate on. Our comparison of ADHD rating scales vs. objective testing covers how the two complement each other.

Try it with your next patient. AxonCPT gives you 2 free tests every month — no card required. Send a link, your patient finishes in ~16 minutes from home, and you get a norm-referenced report instantly. Create your free account →

Stage 3: an objective measure

A continuous performance test (CPT) measures sustained attention and response inhibition under standardized conditions. It doesn’t diagnose ADHD on its own. What it gives you is a data point that doesn’t depend on self-report, and a baseline you can repeat during titration.

For a small practice, the practical questions are time, logistics, and remote validity. Doing the test remotely saves an office visit, but it introduces environmental variables, so give the patient clear instructions (quiet room, no phone, a consistent device, and timing relative to medication). Our post on remote CPT testing validity covers the evidence and the controls. If volume is low, see free objective ADHD test options for clinicians.

If you bill for testing, check payer rules first. PMHNP eligibility for testing codes varies by payer and state; see can nurse practitioners bill 96130?

Stage 4: feedback, diagnosis, and plan

Write one integration paragraph that pulls together the interview, informant report, records, rating scales, and objective results, and states the diagnosis and reasoning. If the sources disagree, say how you weighed them. Then document:

• Treatment options discussed, including non-stimulant and non-medication options
• The risk discussion: storage, not sharing, disposal, and misuse risk [5]
• A controlled-substance agreement if you use one
• How you will measure response, and when

That paragraph and plan are also most of what a stimulant prior authorization asks for.

Stage 5: titration follow-up

At each dose change, repeat the same measures: a rating scale, vitals, a misuse reassessment and PDMP check per state rules, and the objective test if you used one at baseline. Comparing like with like turns “feels better” into a documented trend.

How this looks in practice

Here is a telehealth version for a solo PMHNP:

1. Booking: eligibility check, then an automated pre-visit packet. The visit is confirmed when the packet is complete.
2. Visit 1 (video): structured interview, rule-outs, safety history, PDMP.
3. Between visits: send the AxonCPT link from your account. The patient completes the test on any device at home in about 16 minutes, with no app or login. The report is ready instantly, with five metrics compared against age- and sex-matched norms from a 20,000+ reference dataset and a Q1–Q4 vigilance breakdown. See what the report looks like.
4. Visit 2 (video): feedback, diagnosis, plan, consent.
5. Follow-ups: retest at dose changes and compare with baseline.

This two-visit structure keeps the diagnostic decision separate from the first conversation. That’s better practice, and it’s easier to defend.

Frequently asked questions

How long should an adult ADHD intake take? It varies with complexity. A two-visit structure with a pre-visit packet is common in small practices because it spreads the work and allows collateral to arrive. Complex differentials may need more time or a referral for full psychological testing.

Can I diagnose adult ADHD by telehealth? Clinically, many clinicians do. Prescribing stimulants by telehealth also depends on DEA rules (flexibilities currently run through December 31, 2026) and on state law [8]. Verify both before prescribing.

Should I test patients who are already on a stimulant? For transfers, document the current dose and timing. Testing on medication shows current functioning, not baseline, so record the conditions of any test and interpret it accordingly.

What if the patient won’t provide an informant? Document that you asked and why none was available, and give more weight to records and objective measures. Note the limitation in your integration paragraph.

Start testing your patients with AxonCPT

A reliable intake workflow depends on steps that happen the same way every time. AxonCPT makes the objective-measure step quick for PMHNPs: send a link, the patient tests at home, and a norm-referenced report is waiting for your feedback visit. You get 2 free tests every month, with no card required. Create your free AxonCPT account or learn more at axoncpt.com.

References

1. Texas Occupations Code §157.0511, Delegation of prescribing and ordering drugs and devices. Accessed September 27, 2026.
2. Kessler RC, Adler L, Ames M, et al. The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in the general population. Psychological Medicine. 2005;35(2):245–256.
3. Epstein JN, Loren REA. Changes in the definition of ADHD in DSM-5: subtle but important. Neuropsychiatry (London). 2013;3(5):455–458.
4. DIVA Foundation. What is DIVA-5? Accessed September 27, 2026.
5. U.S. Food and Drug Administration. FDA updating warnings to improve safe use of prescription stimulants used to treat ADHD and other conditions. May 11, 2023.
6. U.S. Food and Drug Administration. Adderall XR prescribing information. Revised October 2023.
7. PDMP Training and Technical Assistance Center. State profiles. Accessed September 27, 2026.
8. Drug Enforcement Administration & Department of Health and Human Services. Fourth Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications. Federal Register, December 31, 2025.