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The Georgia Cold Case Project

Cold Case File Most Recent Child Psychological Assessment Review

Reviewer:

Date:

Cold Case File#:

Assessment Date:

Children are likely to have had a number of psychological evaluations if they have been in the system for any length of time. Begin by locating the earliest completed report in the file, whether that is a multi-page, stand-alone report completed by a community-based mental health practitioner or a one-page report completed by a mental health professional working in a residential setting. If you are unsure how to complete this form while reviewing the report, feel free to call Dr. Kevin Baldwin, Clinical Psychologist, at Applied Research Services (770) 286-8312.

DSM Diagnoses (all axes may not be present):

Numerical Code: Diagnostic Label:

Axis I:

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Axis II:

______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________

Axis III:

______________________________________________________________________ ______________________________________________________________________

Axis IV:

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Axis V: Assessment of Functioning: _______________________________________________

Intelligence/Aptitude Testing

Name of IQ test administered: Performance IQ: __________

___________________________________________________

Verbal IQ:

__________

Full Scale IQ:

__________

Other quotient 1 (specify name: Other quotient 2 (specify name: Other quotient 3 (specify name:

Standard Score _____________________________________) ___________ _____________________________________) ___________ _____________________________________) ___________

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