Intake Worker Local Community

Name of Client __ Young-Hwa ______________________________________________ Date_____________________ Appearance __Well groomed __Neat __Casual __Unkempt __Unclean __Inappropriate __Bizarre __Unusual General Presentation __Cooperative __Guarded __Distractible __Agitated Speech __Clear __Tone (loud/soft) __Rhythmic __Poverty of Speech __Rapid __Slow __Stutter __Pressured __Slurred Affect __Appropriate __Blunted __Melancholy __Restricted __Labile __Inappropriate __Flat Mood __Even __Depressed/sad __Anxious __Irritable __Angry __Elevated __Euphoric/elated __Expansive __Passive __Pessimistic __Blunted Orientation __Time __Place __Person Intelligence Level __High __Average __Low __Retarded Judgement __Rational __Impaired __Immature __Impulsive Insight __Emotional __Intellectual __Denial __Blames Others __Blames Self __Slight Awareness __ Acknowledges problem Thought Content __Logical/Reality Based __Delusions __Obsessions __Tangential __Illogical __Loose Associations __Hallucinations __Ideas of reference/influence __Compulsions __Flight of Ideas __Circumstantial __Inhibited __Concrete __Abstract Comments __________________________________________________________________________________________________ ______The client frequently suffers from depression and a feeling of hopelessness which tends to make him feel alienated __Hew suffers from long bouts of self sympathy and this tends to make him agitated and depressed.____________________________________________________________________________________________________________________________________________________________________________________________ RISK STATUS CHECK Violence/Abuse (Domestic and Workplace, Child and Sexual) Present Risk ____None ____Low ____Moderate ____High Current _none__________________________________________________________________________________________________ ____________________________________________________________________________________________________________ Past _none______________________________________________________________________________________________________ ____________________________________________________________________________________________________________ Suicide/Homicide (Past attempts, Prior inpatient admissions, Ideation, Intent, Attempt, Plan, Compromised ADLs) Present Risk ____None ____Low ____Moderate ____High Current ___none ________________________________________________________________________________________________ __________________________________________________________________________________________ Past ___none___________________________________________________________________________________________________ ____________________________________________________________________________________________________________ Other risks (eating disorder, history of multiple diagnoses, non-compliance with