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Child Dissociative Checklist (CDC), Version 3 Frank W. Putnam, MD Date: Age: Sex: M F Identification: Below is a list of behaviors that describe children. For each item that describes your child NOW
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How to fill out child dissociative checklist form
How to fill out the Child Dissociative Checklist (CDC):
01
Carefully read through the CDC form to familiarize yourself with the questions and instructions.
02
Begin by providing the personal details of the child in question, such as their name, age, and any relevant identification numbers.
03
Answer each question on the checklist honestly and to the best of your knowledge. Use additional space if needed to provide detailed explanations or examples.
04
If a question does not apply to the child or the situation, mark it as "N/A" or leave it blank.
05
If you are unsure about a specific question, seek guidance from a healthcare professional or fill out the checklist with the information you have available.
06
Once you have completed the entire checklist, review your answers to ensure accuracy and clarity.
07
If required, sign and date the checklist to indicate your completion and acceptance of the provided information.
Who needs the Child Dissociative Checklist (CDC):
01
Mental health professionals: The CDC is designed for mental health professionals, such as psychologists, psychiatrists, or therapists, who are working with children and suspect dissociative symptoms. It serves as a tool for assessing and documenting dissociative experiences.
02
Parents or guardians: If you suspect that your child may be experiencing dissociative symptoms, you may consider discussing this checklist with a mental health professional. It can help in providing relevant information about your child's experiences and aid in their evaluation and treatment.
Remember, the CDC is a screening tool and does not provide a definitive diagnosis. It serves as a starting point for further evaluation and conversations with a qualified mental health professional.
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What is child dissociative checklist cdc?
Child Dissociative Checklist-CDC is a tool used to assess and identify symptoms of dissociation in children.
Who is required to file child dissociative checklist cdc?
Child psychologists, therapists, or mental health professionals are required to file Child Dissociative Checklist-CDC for their patients.
How to fill out child dissociative checklist cdc?
Child Dissociative Checklist-CDC can be filled out by answering the questions provided in the checklist based on the observed symptoms.
What is the purpose of child dissociative checklist cdc?
The purpose of Child Dissociative Checklist-CDC is to help professionals assess and diagnose dissociation in children for proper treatment.
What information must be reported on child dissociative checklist cdc?
Child Dissociative Checklist-CDC requires information on the child's behavior, emotions, and experiences related to dissociation.
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