tag:blogger.com,1999:blog-4380461556942622162.post8207650085513461581..comments2015-12-30T00:15:47.792-05:00Comments on Ben and Sarah See the World: Doctor, Doctor, Give me the News!Anonymoushttp://www.blogger.com/profile/01221184478891167982noreply@blogger.comBlogger1125tag:blogger.com,1999:blog-4380461556942622162.post-25103647305661571692012-03-02T06:08:22.909-05:002012-03-02T06:08:22.909-05:00In 2008 I went to counseling for a few weeks at my...In 2008 I went to counseling for a few weeks at my university and Peace Corps wanted more information about it. They requested a personal statement about this, and they also sent a long form for my counselor to fill out. <br /><br />I'm retyping the Mental Health Treatment Summary for anyone interested. Also, summaries of a bunch of similar forms can be found here http://www.gpo.gov/fdsys/pkg/FR-2012-01-20/html/2012-1040.htm<br /><br /><br /><br /><br />MENTAL HEALTH TREATMENT SUMMARY<br /><br />1. Dates and FREQUENCY OF THERAPY SESSIONS<br /><br />Dates of all sessions (first, last, etc.)<br /><br />Was termination of sessions satisfactory/mutual?<br /><br />Did you meet with this applicant to complete this form? <br /><br /><br />2. Please provide the following information based on your treatment and clinical assement of this applicant. Please be as detailed as possible.<br /><br />DIAGNOSES (DSM 1V CODES)<br />Working Diagnoses & Date given<br /><br />Axis I:<br />Axis II:<br />Axis III:<br />Axis IV:<br />Axis V:<br /><br />Current Diagnosis<br /><br />Axis I:<br />Axis II:<br />Axis III:<br />Axis IV:<br />Axis V:<br /><br /><br />*For a description of this system, look here: http://www.psyweb.com/DSM_IV/jsp/dsm_iv.jsp *<br /><br /><br />Were there any other DSM Diagnses given during the course of treatment? If yes, please describe.<br /><br /><br />3. PRESENTING PROBLEM & PRECIPITATING FACTORS:<br /><br />4. SYMPTOMS: Please be as specific and as comprehensive as possible.<br /><br />Symptom, Onset, Severity, Duration, Date remitted<br /><br />5. RELEVANT FAMILY HISTORY:<br /><br />6. COURSE OF TREATMENT:<br /><br />7. PSYCHOTROPIC MEDICATIONS: Current and Previous<br /><br />Medication and Dosage<br />Start Date, End date<br />Response to medication<br /><br />8. HISTORY OF PREVIOUS COUNSELING: (includes dates and DSM diagnoses where known. <br /><br />9. HISTORY OF PSYCHIATRIC HOSPITALIZATIONS: (If applicable, please have the applicant provide discharge summary).<br /><br />10. HISTORY OF SUICIDE ATTEMPTS, GESTURES, IDEATION, or self-harm behavior: Please describe fully including dates and risk of recurrence under stress. <br /><br />11. LEVEL OF FUNCTIONING:<br />History of functioning:<br /> Work:<br /> Interpersonal:<br /><br />Assessment of current functioning:<br /> Work:<br /> Interpersonal:<br /><br />12. PROGNOSIS<br /><br />13. RISK OF EXACERBATION OR RECURRENCE: Please consider issues of isolation, lack of structure and lack of social support in an overseas, austere environment.<br /><br />14. RECOMMENDATION FOR FOLLOW-UP:<br /><br />Additional Comments.<br /><br /><br />And that's it!Benhttps://www.blogger.com/profile/00718365563907236277noreply@blogger.com