Form36 - [FORM 36-Use the top of this page for your...

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[ FORM 36 —Use the top of this page for your letterhead.] Chemical User’s Case Formulation Based on the data collected during this evaluation process, here are my conclusions. (The best descriptors are checked.) A. Identification Name: Date: Case #: B. Observations Client was intoxicated at interview q Not at all q Possibly q Mildly q Clearly q Hung over Consumption history was q Acknowledged q Minimized q Denied, q but confirmed Legal consequences were q Acknowledged q Minimized q Denied, q but confirmed Financial consequences were q Acknowledged q Minimized q Denied, q but confirmed Health consequences were q Acknowledged q Minimized q Denied, q but confirmed Spiritual consequences were q Acknowledged q Minimized q Denied, q but confirmed Vocational consequences were q Acknowledged q Minimized q Denied, q but confirmed Familial consequences were q Acknowledged q Minimized q Denied, q but confirmed What brought the patient in now? The patient’s goals (and their realism, comprehensiveness, resources needed): C. Degree of identification/denial as having alcoholism/addiction q Denies any intemperate use; denies need for treatment
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This note was uploaded on 07/01/2010 for the course COUN 6682 A and taught by Professor All during the Spring '10 term at Walden University.

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Form36 - [FORM 36-Use the top of this page for your...

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