Assessment Report

Assessment Report

for

Personality Assessment

 

Date:

To:

From:

Re:

 

 

History and Description of Primary Complaint and Current Related Symptoms

 

Who Referred

 

For

 

Etiology

 

Symptom Duration

 

Activity Scale

 

 

Assessment Instruments (examples)

Clinical Interview Minn. Multiphasic Pers. Inventory (MMPI-2)

Beck Depression Inventory (BDI) Zung Depression Inventory (ZDI)

Brief Battery for Health Improvement-2 (BBHI2) Multidimensional Pain Inventory (MPI)

Battery for Health Improvement-2 (BHI2) Beery VMI

Mini-Mental Status Exam (MMSE) Repeatable Battery for Neuropsychological Functioning (RBANS)

Seven Minute Screen for Dementia Substance Abuse Subtle Screen. Inv. (SASSI-3)

Millon Clin. Multiaxial Inven. (MCMI-III) Validity Indicator Profile (VPI)

Dementia Rating Scale-2 (DSR2) Halstead-Raitan Neuropsychological Battery (HRB)

Luria-Nebraska (LNB) Millon Behavioral Medicine Diagnostic (MBMD)

Multidimensional Health Locus Wechsler Adult Intelligence Scale

Of Control Wechsler Intelligence Scale for Children

 

Presentation

 

Orientation?

 

Affect?

 

Appearance? Dress _____ Hygiene _____

 

Speech

 

Memory/cognitive deficit

 

Psychosis:______Thought disorder_________Uncontrolled mood disorder.

 

 

Previous Medical Treatment for Complaint

 

Physicians

 

Procedures

 

Medications

 

Life Disruption From Present Symptoms

 

Work

 

Family

 

Avocational

 

Sleep

 

Appetitie

 

Commonly Used Coping Mechanisms

 

Physical pain and discomfort

 

Affective discomfort and suffering

 

Any Possible Secondary Gain Issues?

 

Litigation

 

Workman’s Compensation

 

Disability

 

Addiction Potential

 

Does this patient drink – How much/frequently? Any legal (DUI) or social (fights with family) about drinking? Does the client use illicit drugs? How much/frequently? What prescription meds? Ever felt “out of control” on the meds? Ever run out of controlled meds early? Has a doctor ever decided not to refill meds

 

General Medical History

 

Conditions –

 

Medication –

 

Allergies –

 

Family Medical and Pain History

 

 

Current Living Environment

Who does the client life with? What is the circumstance of the home environment.

 

Life History

Childhood

Reared where?

 

Parents

 

Siblings

 

Discpline

 

Abuse

 

Education

 

Adult

Leaving Home

 

Marriage(s)

 

Domestic Abuse

 

Parental Discipline

 

Friends

 

 

Work History –

Where and for how long? What does the client do at this job?

 

Avocational Activities –

Hobbies?

 

Previous Psychological Testing and Treatment —

 

Expectation for Treatment Outcome

 

Diagnosis –

 

Summary and Recommendation

 

Summary of evaluative instruments

 

Recommendation —