COUN 6360 Week 3 Assignment; Client Intake Assessment Form; Part 1
- $15.00
Patient Name: xxxxxx
Medical Record #: 21x8
Date of Birth:
Current Age: 8 years old
Date Service Provided: December 22, XXXX
Primary Care Provider: Medicaid
Reason for Referral:
Mikayla was referred to the agency by her school counselor and her classroom teacher as well. However, Mikayla has been showing behavioral issues at school frequently. Besides, Mikayla appears to struggle to follow directions, stay on task, remain seated, and has low grades. Mikayla was retained in second grade, and her recent teacher consulted with her previous teachers (kindergarten and first grade). They have expressed that they do not think that Mikayla has communication issues or special learning disorder because she performed her academic skills above the grade-level expectations in small and one-on-one attention. Now is in a large classroom where Mikayla is in constant motion, yelling when she should be talking quietly and easily distracted. Mikayla was alluded to the school counselor today in the classroom because she braked the fish tank during the silent reading activity. Mikayla stated, “I was just trying to feed Flipper.”
Service(s) provided:
Evaluation Procedures:
☒Interview with
☒Review of records
☒Psychological testing: Environmental Assessment................ continue
