Two Peas in a Pod Questionable

822-4 Pre-Admissions Note

Patient Name: Patient ID #:

Frankie Dominguez

Date of Service:

06/27/13

Duration of Service: Type of Service: IA-1

12:00pm to 1:15p

Brief (15 min)

Normative (30 min)

Extended (75 min) *

Results of the Service, including data evaluated, any determination to recommended level of care and planned next steps; including any recommendations or determinations for initial, continued or revised treatment for the patient: Patient is a 23 years old Hispanic (Cuban) male. Patients meets the DSM-IV Criteria for Phencyclidine Dependence (PCP) (304.30) and Nicotine Dependence (305.10). Patient reported he has no history in Domestic Violence. Patient screened negative in the child abuse assessment. Patient does not have any gambling addiction reports. Patient has history in Mental Health concerns in the year of 2000. Patient goes to Metropolitan Hospital for his Psychiatrist once a month for his medications. Patient medications are: Trazodone 15mg and Respredon 15mg. Patient stated that he have not taking his medications since 2012. Patient reported he stop going to his Psychiatrist since 2012. Patient reports he does not like to take anti-depression medications. Patient is on Probation. Patient will attended Relapse Prevention Groups as a part his Legal case. This writer recommends that some of the following life areas be addressed in the initial treatment plan: Substance Use and Legal Issues. Patient is scheduled for IA-2 on 07/02/13 at 11:00am. Signature of Staff Member Providing Service: Date of Service: Duration of Service: Type of Service: Brief (15 min) Normative (30 min) Extended (75 min) * Date:

Results of the Service, including data evaluated, any determination to recommended level of care and planned next steps; including any recommendations or determinations for initial, continued or revised treatment for the patient:

Signature of Staff Member Providing Service: Date of Service: Duration of Service: Type of...