Multiple Choice
1. When conducting a client intake by phone, which of the following is not deemed an appropriate reason for speaking
with an individual other than the client him- or herself?
a.
The client is in the midst of a mental-health-related crisis.
b.
The referred client is 14 years old.
c.
The client is mute and needs a helper to facilitate the call.
d.
The referral is court mandated.
2. A client intake is taking place. The individual has recently completed high school and is scheduled to begin studies at
Wake Forest University in two short months. The line on the form pertaining to “school” should read:
a.
Wake Forest University
b.
Sunderland High School
c.
“Vacation/Break”
d.
N/A
d
Steps for Filling Out the New Referral or Inquiry Form
3. The information included in Step 1, at the top of the form, is:
a.
Person’s name, DOB, your name
b.
Person’s name, sex, DOB, address, your name
c.
Person’s name, sex, DOB, address
d.
Person’s name, DOB, sex, address, type of referral, your name
c
Steps for Filling Out the New Referral or Inquiry Form
4. If the person undergoing intake is employed, input the following information to the form:
a.
Name of employer
b.
Name, address, and telephone number of employer
c.
Name and telephone of employer, length of employment
d.
Name and telephone number of employer
a
Steps for Filling Out the New Referral or Inquiry Form
5. Pertaining to the intake item of “chief complaint,” it is essential to record:
a.
Why the client called but only in general terms
b.
The specific catalyst for the call
c.
How the client obtained the contact details for the agency (if self-referred) plus the complaint itself
d.
Why the client decided to call now
d
Steps for Filling Out the New Referral or Inquiry Form
6. When recording the “chief complaint,” the person conducting the intake should:
a.
Strive to be concise yet accurate
d
Introduction
b.
Go into as much detail as possible; the details of the complaint can be “whittled down” later
c.
Describe the reasons in generalities
d.
Include all relevant background information
7. Which of the following is an appropriate description of the mood of a client undergoing intake?
a.
Mark expressed feelings of hopelessness; however after speaking with me, he seemed as if an initial weight
had been lifted from his shoulders.
b.
Mark initially cried inconsolably, stating he believed he was the only person in the world with such a problem.
c.
Mark reports that he has been episodically depressed since his mother passed away last year.
d.
Mark, a court-referred client, expressed hostility and anger.
c
Evaluating the Client’s Motivation and Mood
8. While assessing the mood of the person undergoing a phone intake, it is essential to concurrently, if applicable, assess
and record information regarding:
a.
Risks of harm to self and/or others
b.
Intonation of voice
c.
Intonation of voice
d.
Motivation
d
Evaluating the Client’s Motivation and Mood
9. Margaret is conducting the intake. The first place in which her name appears on the intake form is:
a.
Step 1
b.
Step 3
c.
Step 9
d.
At the bottom of the final page along with the date
c
Steps for Filling Out the New Referral or Inquiry Form
10. As pertains to the Verification of Appointment Form, the signature of the person conducting the intake must appear in
proper alignment. The landmarks of the signature placement are:
a.
“Respectfully” and “Intake conducted by”
b.
“Sincerely” and “Case Manager”
c.
“Disposition” and “Date”
d.
“Date,” “Name,” and “I swear these facts to be correct and accurate to the best of my knowledge”
b
Steps for Preparing the Verification of Appointment Form
Subjective Short Answer
11. Name 2 of the 4 guidelines for filling out forms.
Answers will vary
PAGE 278
a
Steps for Filling Out the New Referral or Inquiry Form
12. On a verification form, what date should a case manager put on the date line?