clinical evaluation

· Review this week’s Learning Resources and reflect on the insights they provide on family assessment. Be sure to review the resource on psychotherapy genograms.

· Download the Comprehensive Psychiatric Evaluation Note Template and review the requirements of the documentation. There is also an exemplar provided with detailed guidance and examples.

· View the  Mother and Daughter: A Cultural Tale video in the Learning Resources and consider how you might assess the family in the case study.

The Assignment

Document the following for the family in the video, using the Comprehensive Evaluation Note Template:

· Chief complaint

· History of present illness

· Past psychiatric history

· Substance use history

· Family psychiatric/substance use history

· Psychosocial history/Developmental history

· Medical history

· Review of systems (ROS)

· Physical assessment (if applicable)

· Mental status exam

· Differential diagnosis—Include a minimum of three differential diagnoses and include how you derived each diagnosis in accordance with  DSM-5-TR diagnostic criteria

· Case formulation and treatment plan