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Family Behavioral Health CHILDHOOD/ADOLESCENT HISTORY FORM (ages 18 and under) www.FBHChicago.com 13246 S. Route 59 Suite 100 Plainfield, IL 60586 Tel: 8152547400 Fax: 8152547408 Childs Name Date

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How to fill out family behavioral health childhoodadolescent

How to fill out family behavioral health childhoodadolescent:

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Start by gathering all relevant information about the child's behavioral health, such as any previous diagnoses, behavioral issues, or treatment history.

02

Fill out the basic demographic information in the form, including the child's name, date of birth, gender, and contact information.

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Provide detailed information about the child's medical history, including any physical or mental health conditions they have been diagnosed with, medications they are taking, and any allergies or sensitivities they have.

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Describe the child's current behavioral health concerns or issues in detail. Include information about when the behaviors started, how often they occur, and their impact on the child's daily life and functioning.

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Include any relevant information about the child's family history of behavioral health issues, such as whether any family members have been diagnosed with similar conditions.

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Provide information about any previous treatments or interventions the child has received for their behavioral health concerns, including therapy, counseling, or medication.

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Discuss any additional supports or services the child is receiving, such as educational accommodations or involvement with community programs.

Who needs family behavioral health childhoodadolescent?

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Children and adolescents who are experiencing behavioral health concerns or issues.

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Parents or caregivers who are seeking assistance and support for their child's behavioral health.

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Healthcare professionals, therapists, or educators who are involved in the child's care and want to have a comprehensive understanding of the child's behavioral health.

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