Comprehensive Bio-Psychosocial Assessment Instrument Name:

Comprehensive Bio-Psychosocial Assessment Instrument
____________________________
History of Present Illness: __________________________________________________________________________________________________________________________________________________________________________________________________________________
Past Psychiatric/Psychological History:
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Past Medical History: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Past Surgical History: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Allergies: _____________________________________________________________
Current Medication List
Medication
Dose
Frequency
Prescriber
Reason
Past Medication List
Medication
Dose
Frequency
Reason Started
Reason Stopped
Comments:
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Drug/Alcohol Assessment
Which substances are currently used
Method of use (oral, inhalation, intranasal, injection)
Amount of use
Frequency of use (times/ month)
Time period of use
Which substances have been used in the past
__ Alcohol
__ Alcohol
__ Caffeine
__ Caffeine
__ Nicotine
__ Nicotine
__ Heroin
__ Heroin
__ Opiates
__ Opiates
__ Marijuana
__ Marijuana
__ Cocaine/Crack
__ Cocaine/Crack
__ Methamphetamines
__ Methamphetamines
__ Inhalants
__ Inhalants
__ Stimulants
__ Stimulants
__ Hallucinogens
__ Hallucinogens
__ Other: ________________
__ Other: ________________
Suicidal/Homicidal Ideation
Is there a suicide risk? ___ No ___ Yes___ Previous attempt (When: _____________________________________________) ___ Current plan ___ Means to carry out plan ___ Intent ___ Lethality of planIs the patient dangerous to others? ___ Yes ____ NoDoes the patient have thoughts of harming others? ___ Yes ___ NoIf yes: Target: __________________________________________________________ Can the thoughts of harm be managed? ___ Yes ___ No___ Current plan ___Means to carry out plan ___ Intent ___ Lethality of planHigh risk behaviors___ None ___ Cutting ___ Anorexia/Bulimia ___ Head Banging___ Self injurious behaviors___ Other: _____________________________________________________________
Abuse Assessment
In the past year has the patient been hit, kicked, or physically hurt by another person? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Is the patient in a relationship with someone who threatens or physically harms them? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Has the patient been forced to have sexual contact that they were not comfortable with? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Has the patient ever been abused? ___ Yes ___ No. If yes, describe by whom, when and how. ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Family/Social History
Born/raised ________________________________________Siblings ___ # of brothers ___ # of sistersWhat was the birth order? ____of ____ childrenWho primarily raised the patient? ___________________________________________Describe marriages or significant relationships: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Number of children: _____________________________________________________Current living situation: __________________________________________________Military history/type of discharge: __________________________________________ Support/social network: __________________________________________________Significant life events: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Family History of Mental Illness (which relative and which mental illness): ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Employment
What is the current employment status? ___________________________________Does the patient like their job? _____________________________________________Will this job likely be done on a long-term basis? _______________________________Does the patient get along with co-workers? __________________________________Does the patient perform well at their job? ____________________________________Has the patient ever been fired? Yes No If yes, explain ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
How many jobs has the patient had in the last five years? ________________________
Education
Highest grade completed: ________________________________________________ Schools attended: _______________________________________________________ Discipline problems: _____________________________________________________
Current Legal Status
_____ No legal problems _____ Probation_____ Previous jail
Developmental History
_____ Parole_____ Charges pending _____ Has a guardian
Describe the childhood:Describe the childhood in relation to personality, school, friends, and hobbies): _____ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Describe any traumatic experiences in the childhood: (List the age when they occurred) ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ What is the patient’s sexual orientation? ___ Heterosexual ___ Homosexual___ Bisexual
Spiritual Assessment
Religious background: ___________________________________________________Does the patient currently attend any religious services? Yes No If yes, where. ______________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Cultural Assessment
List any important issues that have affected the ethnic/cultural background.
Financial Assessment
Describe the financial situation. ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
___ Traumatic ___ Painful ___ Uneventful
Coping Skills
Describe how the patient copes with stressful situations. ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Is the patient’s coping methods: ___ adaptive ___ maladaptive
Interests and Abilities
What hobbies does the patient have? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________What is the patient good at? ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
What gives the patient pleasure? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
MENTAL STATUS ASSESSMENT
(Describe any deviation from normal under each category.)
Arousal/Orientation
___ Alert ___ Sleepy ___ Attentive ___ Unresponsive ___ Oriented to person___ Oriented to place ___ Oriented to time ___ Confused___ Other: _____________________________________________________________
Appearance
___ Well groomed ___ Good eye contact ___ Poor eye contact ___ Disheveled ___ Bizarre ___ Poor hygiene ___ Inappropriate dress___ Other:____________________________________________________________
Behavior/Motor Activity
___ Normal ____ Restless ____ Agitated ___ Lethargic___ Abnormal facial expressions ___Tremors ___ Tics___ Other:____________________________________________________________
Mood/Affect
___ Normal ____ Depressed ___ Flat ____ Euphoric ___ Anxious ___ Irritable ___ Liable ___ Indifferent ___ Careless ___ Inability to sense emotions___ Lack of sympathy___ Other:_____________________________________________________________
Speech
___ Normal ___ Nonverbal ___Slurred ___ Soft ___ Loud ___ Pressured ___ Limited ___ Incoherent ___ Halting ___ Rapid
___ Other: ____________________________________________________________
Attitude
___ Cooperative ___ Uncooperative ___Guarded ___ Suspicious ___ Hostile___ Other: _____________________________________________________________
Thought Process
___ Intact ___ Flight of ideas ___ Tangential ___ Concrete thinking___ Loose associations ___ Unable to think abstractly ___ Circumstantial
___ Neologisms ___ Racing ___ Word Salad___ Other: _____________________________________________________________
Thought Content
___ Normal ___ Phobia ___ Hypochondriasis ___ Delusions ___ Obsessive___ Preoccupations___ Other: _____________________________________________________________
Delusions
___ None ___ Religious ___ Persecutory ___ Grandiose ___ Somatic___ Ideas of reference ___Thought broadcasting ___Thought insertion___ Other: ____________________________________________________________
Hallucinations
___ None ___ Auditory hallucinations ___ Visual hallucinations___ Command hallucinations___ Other: _____________________________________________________________ Describe: ______________________________________________________________ ______________________________________________________________________
Impulse Control
___ Normal ___ Partial ___ Limited ___ Poor ___ None___ Frequently participates in activities without planning or thinking about them
Judgment
(What would you do if there was a fire in a crowded movie theater?) ___ Normal ____ Poor
Cognition/Knowledge
Orientation
___ Person ___ Place ___ Time
Attention
Can the patient spell W-O-R-L-D backwards? ___ Yes ___ No
Memory
Immediate recall of 3 objects ___/3 Recall after 5 minutes ___/3
Naming
Point out three objects. How many can the patient name? ___/3
Visual-spatial
Can the patient copy intersecting pentagons? ___ Yes ___ No
Praxis
Can the patient follow a three step command? ___ Yes ___ No
Calculations
Serial 7’s (how many times can the patient correctly subtract 7 from 100): __________
Abstractions
___ Comprehends ___ Does not comprehend
Insight
___ Normal ___ PoorIs the patient able to meet their basic needs (e. g., food, shelter, medical):
___ Yes ___ NoIf no, Describe: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Functional Ability
Check the area of concern___ None ___ Activities of daily living ___Work ___ Family relationships___ Social relationships ___ Cognitive functioning ___ Physical health___ Housing ___ Impulse control ___ Social skills
___ Finances ___ School ___ Safety ___ Legal
IMMEDIATE TREATMENT PLAN:
DX to RO (Rule Out):
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Immediate Treatment Goals & Objectives:
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Signature: _______________________________ Date: _______________________

Calculate your paper price
Pages (550 words)
Approximate price: -

Why Choose Us

Quality Papers

We value our clients. For this reason, we ensure that each paper is written carefully as per the instructions provided by the client. Our editing team also checks all the papers to ensure that they have been completed as per the expectations.

Professional Academic Writers

Over the years, our Acme Homework has managed to secure the most qualified, reliable and experienced team of writers. The company has also ensured continued training and development of the team members to ensure that it keep up with the rising Academic Trends.

Affordable Prices

Our prices are fairly priced in such a way that ensures affordability. Additionally, you can get a free price quotation by clicking on the "Place Order" button.

On-Time delivery

We pay strict attention on deadlines. For this reason, we ensure that all papers are submitted earlier, even before the deadline indicated by the customer. For this reason, the client can go through the work and review everything.

100% Originality

At Graduate Assistants, all papers are plagiarism-free as they are written from scratch. We have taken strict measures to ensure that there is no similarity on all papers and that citations are included as per the standards set.

Customer Support 24/7

Our support team is readily available to provide any guidance/help on our platform at any time of the day/night. Feel free to contact us via the Chat window or support email: support@acmehomework.com.

Try it now!

Calculate the price of your order

We'll send you the first draft for approval by at
Total price:
$0.00

How it works?

Follow these simple steps to get your paper done

Place your order

Fill in the order form and provide all details of your assignment.

Proceed with the payment

Choose the payment system that suits you most.

Receive the final file

Once your paper is ready, we will email it to you.

Our Services

Graduate Assistants has stood as the world’s leading custom essay writing services providers. Once you enter all the details in the order form under the place order button, the rest is up to us.

Essays

Essay Writing Services

At Graduate Assistants, we prioritize on all aspects that bring about a good grade such as impeccable grammar, proper structure, zero-plagiarism and conformance to guidelines. Our experienced team of writers will help you completed your essays and other assignments.

Admissions

Admission and Business Papers

Be assured that you’ll definitely get accepted to the Master’s level program at any university once you enter all the details in the order form. We won’t leave you here; we will also help you secure a good position in your aspired workplace by creating an outstanding resume or portfolio once you place an order.

Editing

Editing and Proofreading

Our skilled editing and writing team will help you restructure you paper, paraphrase, correct grammar and replace plagiarized sections on your paper just on time. The service is geared toward eliminating any mistakes and rather enhancing better quality.

Coursework

Technical papers

We have writers in almost all fields including the most technical fields. You don’t have to worry about the complexity of your paper. Simply enter as much details as possible in the place order section.