Alliance Psychiatric Evaluation Database

Go down

Alliance Psychiatric Evaluation Database

Post by Snowy on Sat Apr 23, 2016 3:25 pm

Tidied up the list, they will appear in spolier-boxes


Psych Eval Format:

SYSTEMS ALLIANCE
Psychiatric Evaluation
_______________





- IDENTIFICATION OF PATIENT-

- Name of Individual; ______________
- Date of Birth; ___ /____ /___ 
- Gender; M ___ F___
- Race - Please Specify; ___________
- Medical Record; #_________________________
- Psychological/Medical Problems Known; _________________________


- PSYCHOLOGICAL ISSUES / CHEMICAL RESTRAINT -

- Indications for Possible Restraint (Tick all that apply)


  • Confusion []
  • Violent/Disruptive []
  • Demented []
  • Non-Verbal []
  • Suicidal []
  • Agitation []
  • Alcohol/Substance Abuse []
  • Other; ___________



- Currently taking medication? []
            - If TICKED, What medication, dose, and number of doses are used;


  • Name of Medication;       
  • Dose;



Overall Psychiatric Diagnosis;


  • Depressed []
  • Suicidal []
  • Manic []
  • Psychosis []
  • Homicidal []
  • Other; ___________



If individual poses any of these tendencies, immediately inform staff and personnel. If individual poses series-two threats, contact onboard-authorities for removal and relocation to a registered facility for futher diagnosis. - If the individual causes acts of aggression, suicidal tendencies or direct harm to on-board staff, physical restraint is heavily advised.

___________________

JOINT-TASK FORCE PERSONNEL PSYCHIATRIC EVALUATIONS - CLASSIFIED #X12B  


Subject; VIKIAN, JULE:
SYSTEMS ALLIANCE
Psychiatric Evaluation
_______________



-- Examiner; Dr. L. D'Kallos
   -- Date Issued; 10th / January / 2187


- IDENTIFICATION OF PATIENT-

- Name of Individual; VIKIA, JULE
- Date of Birth; CHECK WITH ADMINISTRATION
- Gender; M _X F___
- Race - Please Specify; TURIAN
- Medical Record; SAMR.JTF--#3T81093
- Psychological/Medical Problems Known; Difficulty with social interactions, repetitive disruptive behaviour, engaged in a physical altercation with on-board staff/crew.


- PSYCHOLOGICAL ISSUES / CHEMICAL RESTRAINT -

- Indications for Possible Restraint (Tick all that apply)


Confusion [X]
Violent/Disruptive [X]
Demented []
Non-Verbal []
Suicidal []
Agitation [X]
Alcohol/Substance Abuse []
Other; ___________



- Currently taking medication? []
           - If TICKED, What medication, dose, and number of doses are used;


Name of Medication; n/a        
Dose; n/a



Overall Psychiatric Diagnosis;


Depressed []
Suicidal []
Manic [X]
Psychosis []
Homicidal []
Other; ___________


Examiner's Notes; N/A
_________________

--- Examiner of psychiatric examination and evaluation; Dr. L. D'Kallos
--- Signiture; Layna D'Kallos.
 


((((( This is for both uh, IC reasons and OOC in a sense so we know how damaged half of us are xD If you have had a character prior that was discharged, or currently is in somewhat a threat to the characters on here that you feel should have a actual pysch eval report IC'ly post your name down below and I'll fill out it. IC'ly medical staff and high ranks would have this data and means that if something happens and you have a report bleeping on a high ranks omnitool, then you could get a bite on the butt for whatever it is. Its for fun too, so.

Jot your names down if you feel you should have one, and I'll fill out the form for you. Put in the type of pysch problems the char has, if they are on meds and a short reason why they are like this! ^^ ))))))


Last edited by Snowy on Wed Apr 27, 2016 10:10 am; edited 3 times in total
avatar
Snowy

Posts : 63
Join date : 2016-04-11
Location : My Winter Fortress

View user profile

Back to top Go down

Re: Alliance Psychiatric Evaluation Database

Post by Snowy on Tue Apr 26, 2016 4:20 pm

THREE forms have been filled out for individuals. IC'ly the necessary officers of the crew have the information.
avatar
Snowy

Posts : 63
Join date : 2016-04-11
Location : My Winter Fortress

View user profile

Back to top Go down

Re: Alliance Psychiatric Evaluation Database

Post by Sail on Tue Apr 26, 2016 5:07 pm

Add Jule
avatar
Sail

Posts : 41
Join date : 2016-04-16
Location : Palevan

View user profile Http://drtraumaty.weebly.com

Back to top Go down

Re: Alliance Psychiatric Evaluation Database

Post by Snowy on Wed Apr 27, 2016 10:10 am

Updated! Added Jule
avatar
Snowy

Posts : 63
Join date : 2016-04-11
Location : My Winter Fortress

View user profile

Back to top Go down

Re: Alliance Psychiatric Evaluation Database

Post by Quads on Thu Apr 28, 2016 1:52 pm

Pip is needed.
avatar
Quads

Posts : 71
Join date : 2016-03-21

View user profile

Back to top Go down

Re: Alliance Psychiatric Evaluation Database

Post by Sponsored content


Sponsored content


Back to top Go down

Back to top


 
Permissions in this forum:
You cannot reply to topics in this forum