|
Psychological History Report
<br /> Anger,Problems (555-66-7779) 29-Nov-01
<br /> Neither he nor his spouse nor any other custodian of his children has been referred to Child Protective
<br /> Services. (L7,a,98%,100%)(0)
<br /> Psychological Treatment and Evaluation History
<br /> • Has voluntarily consulted with one therapist/counselor. (M1,b,16%,23%)(1)
<br /> • Has consulted a therapist/counselor within the last 12 months. (M2,b,4%,7%)(2)
<br /> Contacted a mental health professional because of
<br /> • depression. (M3,e,3%,3%)(2)
<br /> • anxiety. (M3,f,2%,2%)(2)
<br /> Has never been hospitalized for psychiatric or psychological reasons. (M4,a,99%,100%)(0)
<br /> Has never been required to be evaluated/treated by a mental health professional because of behavior, or
<br /> alleged behavior. (M5,a,99%,100%)(0)
<br /> Has never filed claims or lawsuits for compensation where psychological or emotional well being was an
<br /> issue. (M6,a,99%,100%)(0)
<br /> => Has never had any professional contact with a mental health provider. (M7,a,82%,100%)(0)
<br /> Has had emotional or psychological problems that resulted in
<br /> • receiving a prescription for anti-depressants or mood elevators (such as Prozac,amitriptyline),
<br /> or mood stabilizers(such as lithium,tegretol, etc) (M10,e,4%,4%)(3)
<br /> • receiving a prescription for tranqualizers or anti-anxiety drugs (such as barbiturates,valium,
<br /> librium,stelazine) (M10,f,1%,1%)(3)
<br /> Has had no emotional or psychological problems that resulted in
<br /> limitation of a major life activity at the time of the problems (M10,a,96%,100%)(0)
<br /> impairment of work function at the time of the problems (M10,b,99%,100%)(0)
<br /> current limitation of a major life activity because of emotional or psychological problems
<br /> (M10,c,100%,100%)(0)
<br /> current impairment of work function because of emotional or psychological problems
<br /> (M10,d,100%,100%)(0)
<br /> Has never seriously considered committing suicide. (M11,a,98%,100%)(0)
<br /> => Has never attempted suicide. (M13,a,99%,100%)(0)
<br /> Job Relevant Sexual History
<br /> Has never used the services of a prostitute. (N1,a,97%,100%)(0)
<br /> Has never provided sexual services for money or goods. (N2,a,100%,100%)(0)
<br /> Has never had sexual contact with someone 14 years old or younger. (N3,a,97%,100%)(0)
<br /> Has never had sexual intercourse with someone between the age of 16 and 18,when he was 3 or more years
<br /> older than they were. (N4,a,96%,100%)(0)
<br /> Has never engaged in voyeurism. (N5,a,99%,100%)(0)
<br /> Has never made sexual phone calls to strangers. (N6,a,100%,100%)(0)
<br /> Has never engaged in flashing (sexual self-exposure to strangers). (N7,a,100%,100%)(0)
<br /> Has never engaged in forced sexual contact(unwanted fondling, date rape, rape). (N8,a,100%,100%)(0)
<br /> Has never been accused of forced sexual contact(unwanted fondling, date rape, rape).
<br /> (N9,a,100%,100%)(0)
<br /> _>Verify with applicant . Serious admission •.Conditional DQ admission ,, Unconditional DQ admission ??Unanswered
<br /> 7/31/PS 'LEPS PLLC PsyQ_190520 45
<br />
|