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Bio-Psychosocial Assessment

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Bio-Psychosocial Assessment
Bio-Psychosocial Assessment, Intervention, and Evaluation Plan with Individuals and Families
Limestone College
Social Work Practicum 2011
Troy A. Bowers
Dr. Chuck Kuhn

BIO-PSYCHOSOCIAL ASSESSMENT

Consumer Identification
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Consumer Name Client Record #: GRIN122682
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Last: Grier First: Natalie Middle:
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Date of Birth: 12/26/1982 Age: 29 Medicaid ID #: 5555555 Not Medicaid Enrolled
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Applied for Medicaid (Date):

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Gender
------------------------------------------------- Female Male
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Ethnicity
------------------------------------------------- M (Hispanic Mexican American)
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C (Hispanic Cuban)
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P (Hispanic Puerto Rican)
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N (Not Hispanic)
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H (Hispanic Other)
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Race
------------------------------------------------- W (White)
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B (Black/African American)
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A (Asian)
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I (American Indian or Alaska Native)
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P (Native Hawaiian or other Pacific Islander)
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U (Unreported)
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