Course: NURS 223L
INTERPERSONAL PROCESS ANALYSIS TEMPLATE
NURS 223L - INTERPERSONAL PROCESS
ANALYSIS 1.
Student: NAME HERE Date: 05/01/20
Clinical Instructor:
Name (initials only): VR Unit: secure psych unit
Current Legal Status (Vol., 5150, 5250, 30-day, T-Con, LPS-Conservatorship): Family still care for patient. “Grandson and niece that is
her support system and Power of Attorney”
Multiaxial Diagnostic System: Axis I (Clinical Disorder): ANXIETY, DEMENTIA, DEPRESSION
Axis II (Personality Disorder / Mental Retardation): Alter mental statue
Axis III (General Medical Conditions): CHF, DVT, Stage IV ovarian cancer.
Axis IV (Psychosocial and Environmental Problems): Lack of education, only attended high school. Refused to attend group
activities.
, Course: NURS 223L
INTERPERSONAL PROCESS ANALYSIS TEMPLATE
Axis V (Global Assessment of Functioning Scale): Level 31. Pt possesses some danger of hurting self or others.
INTERPERSONAL PROCESS ANALYSIS TEMPLATE
NURS 223L - INTERPERSONAL PROCESS
ANALYSIS 1.
Student: NAME HERE Date: 05/01/20
Clinical Instructor:
Name (initials only): VR Unit: secure psych unit
Current Legal Status (Vol., 5150, 5250, 30-day, T-Con, LPS-Conservatorship): Family still care for patient. “Grandson and niece that is
her support system and Power of Attorney”
Multiaxial Diagnostic System: Axis I (Clinical Disorder): ANXIETY, DEMENTIA, DEPRESSION
Axis II (Personality Disorder / Mental Retardation): Alter mental statue
Axis III (General Medical Conditions): CHF, DVT, Stage IV ovarian cancer.
Axis IV (Psychosocial and Environmental Problems): Lack of education, only attended high school. Refused to attend group
activities.
, Course: NURS 223L
INTERPERSONAL PROCESS ANALYSIS TEMPLATE
Axis V (Global Assessment of Functioning Scale): Level 31. Pt possesses some danger of hurting self or others.
