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Name: Elizabeth “Betty” Borden
Address: 17641 60th Ave Lovers Lane, MI 58858
Telephone: 321-555-1212
Date of Birth: 12/25/1993
Reported Identified Problem:
Elizabeth Borden is a 21 year old woman who has been referred to our office for an evaluation for Attention Deficit Hyperactive Disorder and depression. Elizabeth likes to be called “Betty” so we will refer to her as Betty from now on. Betty’s mother reports that her daughter seems disorganized at home and in college. Betty’s mother also notices very poor attention span, that seems to be very sad, doesn’t want to spend time with her family or friends. Betty’s mother reports she spends her weekends at her childhood home sleeping a majority of the time.
Interview:
Hello Elizabeth, is it ok that I call you Elizabeth? Elizabeth: “I prefer Betty.” Ok, Betty my name is Carrie Todd, I am a social worker here at Central Michigan Community Mental Health and I will be assisting you through this process. So did you have any trouble finding our office? Betty: “No, I didn’t. I live about a mile away, Carrie this is my mother Marge Borden.” Hello Marge, how are you? Marge: “I am fine. I am just worried about my daughter Betty, I want to see her smile again.” Oh, I see I am sure Betty has a nice smile, this is the first step in her getting help she needs. Well, Betty let me tell you how this process is going to work. We will first complete the required forms, then you and we will discuss what you want to gain from these services. Betty we will discuss what your strengths are, we want to focus on the positive and build your treatment plan together. If we need to refer you to an outside source we will fill out the referral forms and before you leave you will have your set schedule for appointments. If any of the appointments do not fit your schedule or you need to reschedule here is my direct line so you can contact me. I am also giving you