History and Description of Primary Complaint and Current Related Symptoms
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
Appearance? Dress _____ Hygiene _____
Psychosis:______Thought disorder_________Uncontrolled mood disorder.
Previous Medical Treatment for Complaint
Life Disruption From Present Symptoms
Commonly Used Coping Mechanisms
Physical pain and discomfort
Affective discomfort and suffering
Any Possible Secondary Gain Issues?
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
Family Medical and Pain History
Current Living Environment
Who does the client life with? What is the circumstance of the home environment.
Work History –
Where and for how long? What does the client do at this job?
Avocational Activities –
Previous Psychological Testing and Treatment —
Expectation for Treatment Outcome
Summary and Recommendation
Summary of evaluative instruments