random chemical use testing / self help groups / chemical use / mood-altering chemicals / chemical dependency treatment / chemicals / car accident / online fill-in process / energy / /
MedicalCondition
miscarriages / mental health disorders / ADHD / Drug Dependency Eating Disorder Fetal Alcohol Syndrome / alcoholism/other drug addiction / severe illness / eating disorder / head injuries / Transmitted Disease / substance abuse disorder / withdrawal symptoms / hallucinations / depression / serious depression / Liver Disease High Cholesterol Chickenpox Immunization HIV/AIDS MMR Immunization Immune Deficiency/Lupus TB / alcoholism / Bi-polar Obsessive Compulsive Disorder Depression Panic Attacks Drug Dependency Schizophrenia Eating Disorder Sexual Disorders Fetal Alcohol Syndrome / /
MedicalTreatment
enemas / counseling / /
Person
Montana Resident / /
Position
therapist / social worker / PROBATION OFFICER / physician / Major / YES Counselor / valid driver / Counselor / YES CHILD AND FAMILY SERVICES SOCIAL WORKER / counselor for this problem / psychologist / therapist / psychiatrist / psychologist / /
Part B of the Universal Biopsychosocial (To be completed by the consumer) Thank you for completing this form. Please take your time and complete all questions/areas to the best of your ability. Incomplete, missing, u