Patient presents with suicidal ideation, characterized by thoughts of self-harm and death.  Assessment includes evaluation of suicidal thoughts, plan, intent, and access to means.  Risk factors such as depression, anxiety, bipolar disorder, schizophrenia, PTSD, substance abuse, history of suicide attempts, family history of suicide, recent stressors, social isolation, and chronic pain were explored.  Patient denies current plan or intent but reports passive suicidal thoughts, stating "Life isn't worth living."  Mental status exam reveals depressed mood, constricted affect, and poor eye contact.  Patient reports difficulty sleeping and decreased appetite.  Judgment and insight appear impaired.  Diagnosis of Suicidal Ideation (ICD-10 R45.851) is made.  Patient was assessed for immediate safety and determined to be at moderate risk for suicide.  Safety plan implemented, including increased frequency of therapy sessions, engagement of family support, and referral to a psychiatrist for medication management.  Patient education provided on coping mechanisms, crisis resources, and suicide prevention hotline information.  Treatment plan includes psychotherapy focusing on cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) skills training to address suicidal thoughts and develop coping strategies.  Prognosis is guarded, with ongoing monitoring and reassessment of suicidal risk crucial.  Follow-up scheduled in one week.  Patient encouraged to contact the crisis hotline or present to the emergency room if suicidal ideation intensifies.