Reference no: EM131706000

Assignment

o Develop an intake assessment form for your future clinical practice. The form should provide the necessary information for you to make a competent diagnosis.

o Your intake assessment form should be written as a three- to four-page questionnaire with questions to aid in gathering relevant information to do the following:

- Form diagnostic impressions
- Complete a differential diagnosis

o Your questionnaire should tap into key areas of developmental, social, emotional, medical, behavioral, psychological, and athletic performance functioning.

o Your intake assessment form should contain the following components:

- Identifying information
- Presenting problem
- Symptomatology
- Developmental history
- Educational history
- Family history
- Medical history
- Athletic/performance history

o Develop specific questions to obtain detailed information about these components. You are welcome to review intake assessment measures you have access to professionally, or you can conduct research to locate and view examples of intake assessment forms.

o The level of detail within these sections is up to your discretion as well as the inclusion of additional components (such as checklists or diagrams).