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<br /> Psychological History Report
<br /> Anger,Problems (555-66-7779) 29-Nov-01
<br /> A forcible sex act or rape:
<br /> Has never committed or been arrested for it. (G18,e,100%,100%)(0)
<br /> Sexually abusing or molesting a child:
<br /> Has never committed or been arrested for it. (G19,e,100%,100%)(0)
<br /> Causing harm to others(such as assault, resisting arrest, or battery):
<br /> Has never committed or been arrested for it. (G20,e,92%,100%)(0)
<br /> Theft of property(such as burglary,stealing,or breaking and entering):
<br /> Has never committed or been arrested for it. (G21,e,86%,100%)(0)
<br /> Vandalism or malicious mischief:
<br /> Has never committed or been arrested for it. (G22,e,91%,100%)(0)
<br /> A sexual crime, other than rape or child molesting (such as self-exposure, obscene phone calls, or peeping tom):
<br /> Has never committed or been arrested for it. (G23,e,99%,100%)(0)
<br /> Driving under the influence of alcohol:
<br /> Has never committed or been arrested for it. (G24,e,73%,100%)(0)
<br /> Causing injury or death while driving under the influence of alcohol:
<br /> Has never committed or been arrested for it. (G25,e,100%,100%)(0)
<br /> Reckless driving causing injury or death to another person:
<br /> Has never committed or been arrested for it. (G26,e,100%,100%)(0)
<br /> Vehicular manslaughter(criminal homicide while driving):
<br /> Has never committed or been arrested for it. (G27,e,99%,100%)(0)
<br /> Substance Use
<br /> => Has less than 1 drink of alcohol a week. (H1,b,45%,83%)(0)
<br /> During period of life when he drank the most, had 1-2 alcoholic drinks a week. (H2,c,17%,71%)(0)
<br /> Has been intoxicated. (H3,b,78%,78%)(0)
<br /> => Has 6 or more alcoholic drinks in a single afternoon or evening about once a year, or less.
<br /> (H4,b,23%,51%)(0)
<br /> • Feels the effects of alcohol after 3-5 drinks. (H5,c,36%,39%)(1)
<br /> => Becomes intoxicated after 3-5 drinks. (H6,c,46%,73%)(0)
<br /> After consuming alcohol, has not
<br /> had marital or family difficulties (H8,a,98%,100%)(0)
<br /> missed work (H9,a,97%,100%)(0)
<br /> been involved in fighting (H10,a,95%,100%)(0)
<br /> been intoxicated in public (H11,a,67%,100%)(0)
<br /> After consuming alcohol, has
<br /> • had blackouts (H7,b,12%,12%)(2)
<br /> Never drinks on the job in violation of employer rules. (H12,a,99%,100%)(0)
<br /> Never drives after having 4 or more drinks. (H13,a,86%,100%)(0)
<br /> Never drives while drinking. (H14,a,97%,100%)(0)
<br /> Has never been warned by an employer about his drinking habits. (H15,a,100%,100%)(0)
<br /> => Has never been in any kind of trouble after drinking. (H16,a,90%,100%)(0)
<br /> => Quit smoking less than 3 years ago. (H17,c,9%,21%)(0)
<br /> _> Has used marijuana. (H18,b,49%,49%)(0)
<br /> Has used marijuana 1-2 times. (H19,a,20%,49%)(0)
<br /> Has not used marijuana during the last 12 months. (H20,a,99%,100%)(0)
<br /> • Last used marijuana 3 or more years ago. (H21,f,46%,49%)(2)
<br /> Has never used cocaine. (H22,a,94%,100%)(0)
<br /> Has never used crack. (H27,a,100%,100%)(0)
<br /> =>Verify with applicant . Serious admission ..Conditional DO admission •, Unconditional DQ admission ??Unanswered
<br /> 7/31/$SYLEPS PLLC PsyQ_190520 41
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