Example Of A Psychosocial Assessment (Page 8 of 8) in pdf

Example Of A Psychosocial Assessment Page 8

Cognition/Knowledge

Orientation

___ Person ___ Place ___ Time

Attention

Can the patient spell W-O-R-L-D backwards? ___ Yes ___ No

Memory

Immediate recall of 3 objects ___/3 Recall after 5 minutes ___/3

Naming

Point out three objects. How many can the patient name? ___/3

Visual-spatial

Can the patient copy intersecting pentagons? ___ Yes ___ No

Praxis

Can the patient follow a three step command? ___ Yes ___ No

Calculations

Serial 7’s (how many times can the patient correctly subtract 7 from 100): __________

Abstractions

___ Comprehends ___ Does not comprehend

Insight

___ Normal ___ Poor

Is the patient able to meet their basic needs (e. g., food, shelter, medical):

___ Yes ___ No

If no, Describe:

________________________________________________________________________________

________________________________________

Functional Ability

Check the area of concern

___ None ___ Activities of daily living ___Work ___ Finances

___ School

___ Family relationships___ Social relationships

___ Safety ___ Legal

___ Cognitive functioning ___ Physical health

___ Housing ___ Impulse control ___ Social skills

Example Of A Psychosocial Assessment Page 8