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It gathers information about father, mother, other children and household members, marital history, and any additional treating clinicians. The form records referred-by details, therapists and primary care providers, lists all current medications and supplements, and asks about the child’s reasons for seeking care, onset, prior treatments, and family, school, and peer impacts. 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It also asks about parents’ marital status and relationships within the home.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"How does the form document treatments and medical history?",{"text":113,"@type":109},"It records current medications, vitamins, supplements, and any prior interventions such as medications, other therapists, or non-traditional treatments. It also requests past and present medical history, including hospitalizations and serious illnesses, with timing and reasons.",{"name":115,"@type":106,"acceptedAnswer":116},"What questions are asked about the child’s current problems and their impact?",{"text":117,"@type":109},"It asks what brings the family in at this time, how long the problems have been present, and whether any stresses or precipitating events occurred. 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Marriage   Separation   Divorce   Prior: Mother married to   Date Separated   Date divorced   Father married to   Date Separated   Date divorced    \n****************************************************************************************************************  \nOTHER TREATING CLINICIANS  \nREFERRED BY   Name Phone Number  \n____________________________________________________________________________________  \nAddress  \nTHERAPIST  \n____________________________________________________________________________________  \nName Phone Number  \nAddress  \nPRIMARY CARE    \nName Phone Number  \nAddress  \nOTHER  \n____________________________________________________________________________________  \nName Phone Number  \nAddress  \n****************************************************************************************************************  \nLIST ALL CURRENT MEDICATIONS, VITAMINS, ADDITIVES AND HERBAL  \nSUPPLEMENTS  \n\n| NAME | DOSE | REASON OR PURPOSE | RESULT/EFFECT |\n| --- | --- | --- | --- |\n|  |  |  |  |\n|  |  |  |  |\n|  |  |  |  |\n|  |  |  |  |\n|  |  |  |  |\n|  |  |  |  |\n|  |  |  |  |\n|  |  |  |  |\n\n****************************************************************************************************************  \nREASON FOR BEING HERE AT THIS TIME  \nCURRENT PROBLEMS: What brings you here? Please briefly describe your child’s current problems starting with the most serious.  \n**************************************************************************************************************** ONSET: How long ago did the problems begin? How old was your child? Was there a precipitant? Were there any major stresses happening in the family at the time the problems began?  \n**************************************************************************************************************** TREATMENT: What kinds of interventions have been tried? Have you tried medications, seen other therapists, used any“non-traditional” treatments?  \n**************************************************************************************************************** FAMILY RELATIONSHIPS: Describe what effects the problems have had on family relationships and famil","cbCaivy8AfF3kvVF","https://ap.wps.com/l/cbCaivy8AfF3kvVF","pdf",535763,"English","# Child and Adolescent Intake Questionnaire\n## Parent Form Sections\n## Family Information\n## Treating Clinicians and Referral\n## Current Medications and Supplements\n## Reasons, Onset, and Treatment History\n## Family Relationships, School, and Peer Relationships\n## Past Psychological or Psychiatric Problems\n## Additional Mental Health Notes\n## Child’s Medical History","[{\"question\":\"What information does the form collect about the child and family?\",\"answer\":\"It collects the child’s name, birthdate, address, phone numbers, current school details, and caregiver information including father, mother, and other household members. It also asks about parents’ marital status and relationships within the home.\"},{\"question\":\"How does the form document treatments and medical history?\",\"answer\":\"It records current medications, vitamins, supplements, and any prior interventions such as medications, other therapists, or non-traditional treatments. It also requests past and present medical history, including hospitalizations and serious illnesses, with timing and reasons.\"},{\"question\":\"What questions are asked about the child’s current problems and their impact?\",\"answer\":\"It asks what brings the family in at this time, how long the problems have been present, and whether any stresses or precipitating events occurred. It also covers how the issues affect family relationships, school functioning, and peer relationships.\"}]","CAP Intake Form - 3 | PDF",1789852819,6]