Biopsychosocial Assessment Template Essay Assignment Paper
Biopsychosocial Assessment Template Essay Assignment Paper
CNL-605: Biopsychosocial Assessment Template
Client’s Name:
Date:
DOB:
Age:
Start Time:
End Time:
Identifying Information:
Presenting Problem/Chief Complaint:
Substance Use History:
Addictions (i.e., gambling, pornography, video gaming):
Medical History/Mental Health History/Hospitalizations:
Abuse/Trauma History:
Social History and Resources:
Legal History:
Educational History:
Family History:
Cultural Factors:
Resources, Strengths, and Weaknesses:
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Case Conceptualization (Conceptualize the case using your preferred theoretical orientation):
Clinical Justification:
Initial Diagnosis (DSM-5):
Principal Diagnosis:
ICD-10 Code:
DSM-5 Disorder:
Subtypes:
Specifiers:
Provisional Diagnosis:
ICD-10 Code:
DSM-5 Disorder:
Subtypes:
Specifiers:
Initial Treatment Goals Informed by Theoretical Orientation (SMART Goal Format):
Goal # 1:
Objectives:
Interventions:
Target Date:
1.
2.
Goal # 2:
Objectives:
Interventions:
Target Date:
1.
2.
Student Clinician’s Name:
Date:
CNL-605: Biopsychosocial Assessment Template
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