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COSIG CONFERENCE BROCHURE.pdf - Drexel University College ...

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16<br />

Therapist Data Summary Sheet<br />

Date:________________________<br />

Patient: ______________________<br />

Summary of Session 1<br />

Drug of Choice:<br />

Drugs most frequently used:<br />

1. _______________________________<br />

2. _______________________________<br />

People you use with:<br />

1. ________________________________________<br />

2. ________________________________________<br />

3. ________________________________________<br />

Psychosocial Problems:<br />

1. Employment: ___________________________________________________<br />

2. Family Relationships:__________________________________________________<br />

3. Relationships with peers:______________________________________________<br />

4. Living arrangements:___________________________________________________<br />

5. Medical problems:_____________________________________________________<br />

6. Legal difficulties ___________________________________________________<br />

Summary statement of difficulties (use wording from GAG/CGI)<br />

Summary of Session 2

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