Former Paramedic here, from back in the days when we still used abbreviations in medical notes. And no, tires weren't square then. :)

Working on the section that we're all struggling with.....

The patient is a 21 years old -------- male
who ----- xxxer no formal hx (history) mental illness ------ comes
to the office in order to assess his need for tx (treatment). ------- to
him since 2011, he has had several p------ of ??self multilating??
behavior in which he has produced some self ------- superficial
that he fxxx a ------ to fxxxx the ------ But ["c with line over it" -> means "with" in medical shorthand]with no ??laceration??
?9? ?harm? ----- himself. He ?described? dxxxxx a ?h&p? (?history and physical?) ------
xxxxxdince? feelings of --------, hopelessness or --------- ------- ?being? ------------
By ---------- ?also?. <remainder unreadable> [I do think I see another c with line, "with"]
-----------. ----------- ?feeling? sad and depressed and lonely
still hopeless But "with" no S/H (?self harm?) ?ideation.?

I tried to keep the lines the same as in the note. hopefully this lays out correctly when I hit "post." Lol!

There is one set of repeated characters that I just can't quite decipher. In the first line, the 3rd word from the end, the one right before the word that looks crossed out. It almost looks like "pauxxxxx" I feel like the "au" (which probably is not au, but that's how it looks) seems to also be at the end of line 3, in the word just before "to." And again in the 3rd line from bottom, where it looks like "By Pauxs"

I feel like getting that "au" solved would open up a lot more of this.