DescriptionPCN 610 Psychosocial Assessment Template Psychosocial Assessment Template Assignment: Age: ________________________________ Start Time: ____________ End Time: ___________ Identifying Information: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Presenting Problem: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Life Stressors: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Substance Use/Abuse: Yes No ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Addictions (i.e., gambling, pornography, video gaming) ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Medical/Mental Health Hx/Hospitalizations: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Abuse/Trauma: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________…