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    Formulir Multiaksial

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    Muflih Federick Jackson
    This document is a multiaxial evaluation report form used in DSM-IV diagnosis. It includes sections for recording clinical disorders and other issues of clinical attention (Axis I), personality disorders and intellectual disabilities (Axis II), general medical conditions (Axis III), psychosocial and environmental problems (Axis IV), and a global assessment of functioning score and timeframe (Axis V).

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    Formulir Multiaksial

    Uploaded by

    Muflih Federick Jackson
    9 views1 page
    This document is a multiaxial evaluation report form used in DSM-IV diagnosis. It includes sections for recording clinical disorders and other issues of clinical attention (Axis I), personality disorders and intellectual disabilities (Axis II), general medical conditions (Axis III), psychosocial and environmental problems (Axis IV), and a global assessment of functioning score and timeframe (Axis V).

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    Formulir muktiaksial

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    Formulir multiaksial

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    This document is a multiaxial evaluation report form used in DSM-IV diagnosis. It includes sections for recording clinical disorders and other issues of clinical attention (Axis I), personality disorders and intellectual disabilities (Axis II), general medical conditions (Axis III), psychosocial and environmental problems (Axis IV), and a global assessment of functioning score and timeframe (Axis V).

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    9 views1 page

    Formulir Multiaksial

    Uploaded by

    Muflih Federick Jackson
    This document is a multiaxial evaluation report form used in DSM-IV diagnosis. It includes sections for recording clinical disorders and other issues of clinical attention (Axis I), personality disorders and intellectual disabilities (Axis II), general medical conditions (Axis III), psychosocial and environmental problems (Axis IV), and a global assessment of functioning score and timeframe (Axis V).

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    Multiaxial Evaluation Report Form

    (From DSM-IV-TR, p.36)

    AXIS I: Clinical Disorders


    Other Conditions That May Be a Focus of Clinical Attention
    Diagnostic code DSM-IV name
    __ __ __.__ __
    __ __ __.__ __
    __ __ __.__ __

    AXIS II: Personality Disorders


    Mental Retardation
    Diagnostic code DSM-IV name
    __ __ __.__ __
    __ __ __.__ __

    AXIS III: General Medical Conditions


    ICD-9-CM code ICD-9-CM name
    __ __ __.__ __
    __ __ __.__ __
    __ __ __.__ __

    AXIS IV: Psychosocial and Environmental Problems


    … Problems with primary support group Specify:
    … Problems related to the social environment Specify:
    … Educational problems Specify:
    … Occupational problems Specify:
    … Housing problems Specify:
    … Economic problems Specify:
    … Problems with access to health care Specify:
    … Problems related to interaction with the legal system Specify:
    … Other psychosocial and environmental problems Specify:

    AXIS V: Global Assessment of Functioning Scale


    Score: __ __ __
    Time frame: ________

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