Comprehensive Diagnostic Assessment at a glance
What it is: Comprehensive Diagnostic Assessment of Wright Step Counseling and Recovery, Idaho Falls, Idaho.
Who signs: Responsible party completing this form: Signature.
A filled-in Comprehensive Diagnostic Assessment example: a new counseling participant fills page 1
How to fill out Comprehensive Diagnostic Assessment, box by box
Name, DOB, Clinician and Date of Assessment
Enter Name, DOB, Clinician and Date of Assessment.
New or Active Counseling Participant
Mark New Counseling Participant when no Medicaid mental health counseling services have been received in the past 12 months, and Active Counseling Participant when Medicaid mental health counseling services have been received in the past 12 months.
Main reasons and recent stressful life events
Please indicate the main reasons for seeking consultation and/or treatment.
Please list recent stressful life events within the past 6 months.
Family of Origin
Under Family of Origin, enter the Place of birth. Were you in the same location or home while growing up?
Did your family move frequently? Were you adopted? Age at the time of adoption.
Enter the Circumstances.
More rules for Comprehensive Diagnostic Assessment
Under Family Psychiatric History, include any mental health and/or substance use problems with biological relatives. Consider diagnoses such as depression, anxiety, bipolar disorder, schizophrenia, ADHD, alcohol and/or drug abuse, or any suicides.
Have any of your family members had significant illness or medical treatment? If so, please explain.
Under Family History and Functioning, Current Status: Single Married Remarried Separated Divorced Widowed Living Together.
Please check all that apply to your current marriage: Good, satisfied Supportive Warm relationship Stable.
Are you receiving personal care services, Meals on Wheels, or any other basic living skills provided?
Common questions about Comprehensive Diagnostic Assessment
Who signs it?
Under Signatures, enter the Responsible party completing this form, the Relationship to Client, the Signature and the Date.
Sources
[1] Wright Step Counseling and Recovery Comprehensive Diagnostic Assessment (the served file; no issuer file found) (the Official source link on this page).