Pre Hire Assessment

 Tandem Behavioral Health Clinical Documentation Tool — New Hire Prescreening This tool is designed to support structured clinical documentation for new hire prescreening at Tandem Behavioral Health. All fields must be completed using your own clinical observations and professional judgment. “I understand that this is a clinical documentation tool intended for professional use. I will complete all assessments and notes based solely on direct client interaction and my own clinical reasoning — not with the assistance of any artificial intelligence tool, language model, or automated text generation service.” I acknowledge the above statement and confirm I will not use AI tools to complete this documentation. I understand that AI-assisted documentation may violate clinical integrity standards and agency policy. Enter Documentation Tool  Tandem Behavioral Health Clinical Documentation — New Hire Prescreening Preview & Print Clear Form 0 of 0 required fields completed Biopsychosocial Assessment Comprehensive intake assessment — biological, psychological & social domains DAP Progress Note Session note — Data, Assessment, Plan format ⚠️ All documentation must reflect your own clinical observations. The use of AI-generated text in clinical records is prohibited. Complete each field independently using direct client information. MOCK CLIENT Practice Scenario — Jordan M., Age 34 Read this information, then complete the form below ▼ ⚠️ This is a fictional training scenario for new hire prescreening practice only. All names, details, and clinical information are entirely made up. Do not use real client information on this form. IDENTIFYING INFORMATION Name Jordan Mercer Date of Birth March 4, 1991 (Age 34) Gender / Pronouns Male / He, Him Race / Ethnicity Black / African American Primary Language English Referral Source Primary care physician (Dr. Lisa Okafor) Living Situation Lives alone — 1-bedroom apartment Marital Status Divorced (2022) Children One daughter, Amara, age 6 — lives with ex-wife; Jordan has every-other-weekend visitation PRESENTING PROBLEM In Jordan’s words: “I’ve just been feeling really down for the past several months — like I can’t get out of my own head. I’m not sleeping, I’m not eating right, and honestly I’ve been drinking more than I should. My doctor told me I need to talk to someone.” Jordan reports symptoms of depression worsening over approximately 8 months, coinciding with his divorce being finalized and a demotion at work. He describes persistent low mood most days, loss of interest in hobbies he previously enjoyed (basketball, cooking), and difficulty concentrating at work. He denies any prior mental health treatment. BIOLOGICAL DOMAIN Medical Hx Hypertension (diagnosed 2020), managed with lisinopril 10mg daily. No other chronic conditions. Appendectomy 2015. Current Meds Lisinopril 10mg (Dr. Okafor). No psychiatric medications. Allergies Penicillin (rash). No other known allergies. Substance Use Alcohol: currently drinking 4–6 beers nightly, increased from 1–2 over the past year. No blackouts reported. Marijuana: occasional weekend use, about once per week. Denies use of other substances. No prior substance use treatment. No history of withdrawal complications. Sleep Difficulty falling asleep; averages 4–5 hours/night. Frequently wakes at 3am with racing thoughts. Denies nightmares. Appetite Decreased; reports skipping meals, has lost ~12 lbs in past 3 months without intentional dieting. Exercise Previously played rec basketball 2x/week. Has not exercised in approximately 4 months. Family Medical Father: alcohol use disorder (deceased, age 58, cardiac event). Mother: Type 2 diabetes, alive. No known family psychiatric history reported. PSYCHOLOGICAL DOMAIN MH History No prior mental health diagnoses. No prior therapy or psychiatric treatment. One ED visit in 2023 for chest pain that was determined to be a panic attack (not followed up on). Trauma Hx Father was verbally and physically abusive toward Jordan and his mother throughout childhood. Parents divorced when Jordan was 11. Jordan describes “being pretty much on my own from age 14.” Reports witnessing a shooting in his neighborhood at age 16. Minimizes impact: “I dealt with it. That’s just how it was.” Current Mood Client reports: “Numb, mostly. Sometimes real sad.” Observed Affect Constricted; minimal facial expression; occasional brief smiles when discussing daughter. Voice flat and low in volume. Thought Process Linear and goal-directed. No loosening of associations. Thought Content Ruminative — reports frequently replaying the divorce and the demotion. States “I keep thinking about everything I’ve done wrong.” Suicidal Ideation Passive SI present — states “Sometimes I think everyone would be better off without me, but I’d never do anything.” Denies plan, intent, or means. Protective factor: daughter. Homicidal Ideation Denied. Orientation Alert and oriented x4. Memory Intact — recent and remote. Insight / Judgment Fair — acknowledges he needs help but expresses ambivalence: “I don’t really think talking helps but I’m willing to try.” Strengths Strong love for daughter; employed; sought help voluntarily; articulate; some awareness of drinking pattern as a problem. Coping Current: alcohol use, isolation, watching TV for hours. Prior adaptive: basketball, cooking for his daughter. SOCIAL DOMAIN Family of Origin Grew up in Charlotte, NC. Father absent / abusive; mother worked two jobs. One younger brother, Marcus (age 30), lives in Atlanta — limited contact. Describes childhood as “chaotic and stressful.” Support System Reports limited support. One close friend, Darnell, who “checks in sometimes.” Mother is supportive but Jordan does not want to “worry her.” Describes himself as “pretty isolated right now.” Education Associate’s degree in Business Administration (Forsyth Tech, 2012). Employment Full-time warehouse logistics supervisor at a distribution company. Demoted from manager role 9 months ago following a conflict with a new supervisor. Reports job feels “pointless now” but maintains attendance. Cultural / Spiritual Grew up in Baptist church; no longer attends regularly. States faith “used to matter more.” Open to exploring spiritual support if suggested. Legal History One arrest for disorderly conduct at age 19 — charges dropped. No pending legal issues. Housing / Finances Stable housing. Reports some financial stress following divorce and demotion but meeting basic needs. 01 Identifying Information ▼ CLIENT LAST NAME * CLIENT FIRST NAME * DATE OF BIRTH * ASSESSMENT DATE * CLINICIAN NAME * REFERRAL SOURCE GENDER IDENTITY PRONOUNS RACE / ETHNICITY PRIMARY LANGUAGE LIVING SITUATION — Select — Lives alone Lives with spouse/partner Lives with family Lives with roommate(s) Shelter / Transitional housing Homeless / Unhoused Inpatient / Residential facility Other MARITAL / RELATIONSHIP STATUS — Select — Single In a relationship Married / Domestic partnership Separated Divorced Widowed Other 02 Presenting Problem & Reason for Referral ▼ CHIEF COMPLAINT (CLIENT’S OWN WORDS) * HISTORY OF PRESENTING PROBLEM * CLINICIAN’S SUMMARY OF PRESENTING CONCERNS 03 Biological Domain ▼ MEDICAL HISTORY CURRENT MEDICAL CONDITIONS CURRENT MEDICATIONS ALLERGIES / ADVERSE REACTIONS PAST HOSPITALIZATIONS / SURGERIES FAMILY MEDICAL HISTORY SUBSTANCE USE SUBSTANCE USE HISTORY PRIOR TREATMENT FOR SUBSTANCE USE WITHDRAWAL HISTORY / DTS PHYSICAL FUNCTIONING SLEEP PATTERNS APPETITE / EATING EXERCISE / PHYSICAL ACTIVITY 04 Psychological Domain ▼ MENTAL HEALTH HISTORY PREVIOUS MENTAL HEALTH DIAGNOSES PREVIOUS MENTAL HEALTH TREATMENT PREVIOUS PSYCHIATRIC MEDICATIONS TRAUMA HISTORY TRAUMA / ADVERSE EXPERIENCES CURRENT MENTAL STATUS MOOD (CLIENT-REPORTED) AFFECT (CLINICIAN-OBSERVED) THOUGHT PROCESS — Select — Linear / Goal-directed Tangential Circumstantial Disorganized / Loose associations Flights of ideas Perseverative Other THOUGHT CONTENT SUICIDAL IDEATION — Select — None reported / denied Passive ideation — no plan Active ideation — no plan Active ideation with plan Active ideation with intent and plan HOMICIDAL IDEATION — Select — None reported / denied Passive ideation Active ideation — no plan Active ideation with identified target ORIENTATION MEMORY — Select — Intact — recent and remote Impaired — recent only Impaired — remote only Significantly impaired INSIGHT / JUDGMENT — Select — Good Fair Poor Absent CURRENT SYMPTOMS DEPRESSION ANXIETY PANIC ATTACKS PTSD / TRAUMA OCD MANIA / HYPOMANIA PSYCHOSIS DISSOCIATION SELF-HARM EATING CONCERNS GRIEF / LOSS ANGER / RAGE SLEEP DISTURBANCE CONCENTRATION DIFFICULTY Check all that apply as reported by client and/or observed STRENGTHS & COPING CLIENT-IDENTIFIED STRENGTHS CURRENT COPING STRATEGIES 05 Social Domain ▼ FAMILY & RELATIONSHIPS FAMILY OF ORIGIN CURRENT SUPPORT SYSTEM ROMANTIC / INTIMATE RELATIONSHIPS CHILDREN / DEPENDENTS EDUCATION & EMPLOYMENT HIGHEST EDUCATION COMPLETED — Select — Less than high school GED / High school diploma Some college Associate’s degree Bachelor’s degree Graduate degree Vocational / Trade certification EMPLOYMENT STATUS — Select — Employed full-time Employed part-time Self-employed Unemployed — seeking work Unemployed — not seeking Disability / Unable to work Retired Student Other OCCUPATION CULTURAL, SPIRITUAL & LEGAL CULTURAL / RELIGIOUS / SPIRITUAL BACKGROUND LEGAL HISTORY / PENDING LEGAL ISSUES TRAUMA / VIOLENCE / ABUSE HISTORY (SOCIAL CONTEXT) 06 Clinical Assessment & Impressions ▼ CLINICAL IMPRESSIONS * RISK FACTORS IDENTIFIED PROTECTIVE FACTORS IDENTIFIED PROVISIONAL / WORKING DIAGNOSIS DIFFERENTIAL DIAGNOSES CONSIDERED 07 Treatment Recommendations ▼ LEVEL OF CARE RECOMMENDED OUTPATIENT IOP PHP RESIDENTIAL INPATIENT CRISIS STABILIZATION RECOMMENDED TREATMENT MODALITIES TREATMENT GOALS (PRELIMINARY) REFERRALS MADE SAFETY PLAN INITIATED? — Select — Not indicated at this time Yes — completed with client Yes — partially completed, follow-up needed Client declined CLINICIAN SIGNATURE / CREDENTIALS Complete required fields to submit Clear Form Preview & Print 📤 Submit to Tandem