Student name Student ID Degree program Area of specialization

Title of the Internship Report

Background Information/ History For instance, Marital status, no of children (if any), work, health status, family mental health history, family and social relationships, drug and alcohol history, life difficulties, goals, and coping skills and weaknesses. ( any important information that could have affect on the presenting problem)

Description of the Presenting Problem you will describe the problem or symptoms that the client presented with. Describe any physical, emotional, or sensory symptoms reported by the client. Thoughts, feelings, and perceptions related to the symptoms should also be noted.

Diagnostic Assessments Any screening or diagnostic assessments that are used should be described in detail and all scores reported. ( any psychological diagnostic tests or/ check lists) Description of Global assessment of functioning (GAF)

Mental Status Examination Description of mental status examination

Diagnosis Provide your diagnosis and give the appropriate DSM-IV code. Explain how you reached your diagnosis, how the clients symptoms fit the diagnostic criteria for the disorder(s), or any possible difficulties in reaching a diagnosis.

Intervention and Recommendations Pharmacological Psychological/psychotherapy Social (Identify all the possible social, psychological and biological factors that can help in solving the problem (s) of your client and provide recommendations accordingly) Note: main emphasis should be on psychological/psychotherapy and social aspects.

Prognosis and Follow up Plan

Case Formulation A brief and comprehensive report of complete case.

Thank You