BEHAVIORAL SCIENCES II (COURSE 632-A)

WORKGROUP VIGNETTE CLINICAL EVALUATION

WORKGROUP __________ DATE ______________

PERTINENT POSITIVE SYMPTOMS PERTINENT NEGATIVE SYMPTOMS

1. 1.

2. 2.

3. 3.

4. 4.

5. 5.

MULTIAXIAL DIAGNOSIS

AXIS I

AXIS II

AXIS III

AXIS IV

AXIS V GAF = (current level)

DIFFERENTIAL DIAGNOSIS OF PRIMARY AXIS I CONDITION

1.

2.

3.

4.

5.

1
DIFF EVIDENCE IN FAVOR EVIDENCE AGAINST
DX # a a

1 b b

c c

a a

2 b b

c c

a a

3 b b

c c

a a

4 b b

c c

a a
5
b b

c c

PROPOSED PSYCHOTHERAPY SPECIFIC GOALS

PROPOSED BIOLOGICAL THERAPY Reason/Benefit Over Other Choices

(bonus)

1.

2.

3.

2
PROBLEM LIST