Biopsychosocial Assessment Evaluation
I. Client Information
Client's Name | Birth Date | Age |
|---|
| | |
II. Assessment Sections
A. Biological Factors
Medical History
Substance Use History
Alcohol use:
Drug use:
Tobacco use:
Family Medical History
Conditions:
Genetic predispositions:
B. Psychological Factors
Mental Health History
Previous diagnoses:
Treatment history:
Current symptoms:
Cognitive Functioning
Memory:
Attention span:
Decision-making ability:
Emotional Health
Stress level:
Coping mechanisms:
Mood fluctuations:
C. Social Factors
Family and Support Systems
Work and Financial Situation
Employment status:
Financial stability: S
Cultural and Community Influences
Cultural background:
Community involvement:
III. Assessment Table
Criteria | Observations | Recommendations |
|---|
Medical History | | |
Substance Use | | |
Mental Health | | |
Cognitive Functioning | | |
Emotional Health | | |
Family/Support System | | |
Work/Financial Situation | | |
Cultural/Community Factors | | |
V. Summary of Findings
Based on the assessment, Golda Larson exhibits the following strengths and challenges:
Recommendations:
Physician's Signature
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