Importance of collecting data for intake and assessment forms

You Discuss The Importance Of Collecting Appropriate Data For Intake And Assessment Forms.

Scenario Three: Claire

Claire is 33 years old and lives with her younger sister and second cousin. Claire was fired from her last job at a 24-hour convenience store for behavioral issues and for not arriving on time for work.

Claire was diagnosed with bipolar disorder when she was 18 years old and has been on many different medications to stabilize her moods. Claire has been taking an antidepressant to treat her bipolar disorder and attending maintenance counseling off and on for the past 2 or 3 years.

Claire is enrolled in Medicaid, which pays for her medications, but she cannot find her Medicaid card, her birth certificate, or her state identification card. Claire also goes through cycles where she does not want to take her medication. Claire’s sister and cousin are threatening to kick Claire out for not taking her medication, not attending her counseling sessions, and not paying bills or rent for the last 4 months.

Claire would like to take the required test to obtain her high school equivalency diploma and be able to afford her own apartment.

Wildwood Case Management Unit

New Referral or Inquiry

CLIENT SEX DOB

ADDRESS

ZIP

HOME TELEPHONE WK TELEPHONE

PARENT OR SPOUSE

EMPLOYER

SCHOOL

REFERRED BY

CHIEF COMPLIANT &/OR DESCRIPTION OF PROBLEM

PREVIOUS EVALUATION, SERVICES, OR TREATMENT

TAKEN BY DATE

DISPOSITION FOR INTAKE

VERIFICATION SENT

From SUMMERS. Fundamentals of Case Management Practice, 4E. © 2012 Wadsworth, a part of Cengage Learning, Inc. Reproduced by permission. www.cengage.com/permissions

client:
address:
sex:
dob:
home_tel:
zip:
work_tel:
parent:
employer:
school:
referred:
complaint:
evaluation:
taken:
date:
disposition:
verification: