The Forensic DOCUMENTATION SOURCEBOOK The Complete Paperwork Resource for Forensic Mental Health Practice SECOND EDITION Theodore H. Blau Fred L. Alberts, Jr. John Wiley & Sons, Inc. The Forensic DOCUMENTATION SOURCEBOOK The Forensic DOCUMENTATION SOURCEBOOK The Complete Paperwork Resource for Forensic Mental Health Practice SECOND EDITION Theodore H. Blau Fred L. Alberts, Jr. John Wiley & Sons, Inc. This book is printed on acid-free paper. Copyright © 2004 by John Wiley & Sons, Inc. All rights reserved. Published by John Wiley & Sons, Inc., Hoboken, New Jersey. Published simultaneously in Canada. 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Note about Photocopy Rights The publisher grants purchasers permission to reproduce handouts from this book for professional use with their clients. ISBN 0-471-68288-8 Printed in the United States of America. 10 9 8 7 6 5 4 3 2 1 To Dr. Theodore H. Blau (1928–2003) whose intellect, generosity, and gracious presence is greatly missed. Contents CD Contents xv Acknowledgments xix Introduction xxi Chapter 1 Initiating Forms 1.1 Form 1 Forensic Intake Sample Form 1.6 Example of Completed Form 1.7 Form 2 Charge Sheet Sample Form 1.8 Example of Completed Form 1.9 Form 3 Terms of Agreement Letter Sample Form 1.10 Form 4 Terms of Engagement Contract Sample Form 1.11 Form 5 Case Chronology Sample Form 1.13 Example of Completed Form 1.14 Form 6 Case Material Received Sample Form 1.15 Example of Completed Form 1.16 Form 7 Case Materials Sent Sample Form 1.17 Example of Completed Form 1.18 Form 8 Forensic Intake Sheet (Pre-Examination) Sample Form 1.19 Example of Completed Form 1.20 Form 9 Preselection Interview Form Sample Form 1.21 vii Contents Chapter 2 Initiating the Assessment Process 2.1 Form 10 Background Summary—From Record Review Sample Form 2.4 Example of Completed Form 2.5 Chapter 3 Initiating a Forensic Evaluation 3.1 Form 11 Apprisal of Rights Sample Form 3.5 Example of Completed Form 3.6 Sample of Spanish Language Form (Aviso de Derechos) 3.7 Form 12 Authorization for Release of Psychological Information Sample Form 3.8 Example of Completed Form 3.9 Form 13 Authorization for Release or Receipt of Information Sample Form 3.10 Form 14 Psychological Evaluation Informed Consent Sample Form 3.11 Chapter 4 Process Forms 4.1 Form 15 Informed Consent—Child Custody/Visitation Evaluation Sample Form 4.22 Example of Completed Form 4.23 Form 16 Informed Consent—Custody and Visitation Evaluation Sample Form 4.24 Example of Completed Form 4.25 Form 17 Informed Consent—Release of Records Sample Form 4.26 Form 18 Informed Consent Sample Form 4.27 Form 19 Authorization for Release of Psychological Information Sample Form 4.28 Form 20 HIPAA Compliant Protected Health Information Disclosure Authorization Sample Form 4.29 Form 21 Permission to Release Confidential Records Sample Form 4.30 Form 22 Family History—Child Sample Form 4.31 Example of Completed Form 4.34 Form 23 Adult History Sample Form 4.37 Example of Completed Form 4.39 viii [...]... charges as well as civil lawsuits The devil is in the details The Forensic Documentation Sourcebook, 2nd ed provides the structures likely to improve quality of forensic psychological practice, enhance the reputation and credibility of the forensic psychologist, and prevent improper or unfortunate occurrences Almost all of the forensic psychologist’s work is within the framework of adversary judicial... credibility The forensic psychologist should view this reality as a challenge and an opportunity to demonstrate professional competence The forms and procedural outlines herein were designed to help accomplish this goal xxi Chapter 1 Initiating Forms Initiating Forms FORM 1 Forensic Intake The Forensic Intake Form is the tool for initiating a forensic consultation Usually filled out by the forensic psychologist,... matter Abbreviations Dr The hourly fee for the forensic psychologist Ret The retainer (against which fees will be charged) Res—Library or research work by assistants Tr—Test room charges (using a psychometrist) FORM 2 Charge Sheet The charge sheet should be started as soon as the retaining attorney agrees to the forensic psychologist’s terms of engagement This usually occurs during the Forensic Intake interview... time spent on the case by the psychologist or staff A copy of the charge sheet should be enclosed with the monthly invoice for services sent to the retaining attorney Form 2a is a completed form 1.3 Chapter 1 FORM 3 Terms of Agreement Letter FORM 4 Terms of Engagement Contract This letter (Form 3), prepared on the forensic psychologist’s letterhead with the terms of engagement entered in the appropriate... (Pre-Examination) The Forensic Intake sheet provides basic data concerning the plaintiff or defendant who is to be interviewed and/or examined by the psychologist who has been retained to be an expert witness This sheet should be completed prior to the first meeting except for appointments that are scheduled later in the evaluation process Some of the information can be obtained from the office of the retaining... representation of the other client In turn, you agree that you will be reasonable in evaluating such circumstances and you will give your consent if we can confirm to you in good faith that the following criteria are met: 1 There is no substantial relationship between any matter in which I am serving you and the matter for the other client 2 My delivery of professional services to the other client will... you 3 My work for you and the discharge of my professional responsibilities to you will not be prejudiced by the other client for the other client has also consented in writing based on full disclosure of the relevant facts, circumstances, and implications of my undertaking the two representations By making this agreement, we are establishing the criteria that will govern the exercise of your right... materials were received, when testing or interviews took place, or other events easily forgotten in a complex case The purpose may be to confuse the witness or to suggest that the psychologist’s memory is faulty All this can be short-circuited by having the Case Chronology Form annotated as the case proceeds and making the form a part of the case file, readily available when needed Form 5a is a completed... Psychological Autopsy Interview 4.81 49 Final Form for Psychological Autopsy 4.82 50 Visitation Questionnaire 4.84 51 The Best Interests of the Child—Parent Evaluation Worksheet 4.86 52 The Best Interests of the Child—Workup Sheet 4.88 53 The Best Interests of the Child 4.90 54 Meeting the Best Interests of the Children: Parental Summary 4.92 55 Visitation Plan Outline 4.94 56 Standard Paragraphs for Custody or... on behalf of the client or the client’s project During the course of my service, it may be appropriate or necessary to hire third parties to provide services on behalf of the project These services may include such things as consultation with other experts, psychological assistants, or research assistants If my statements are not paid within 30 days after they are rendered, I reserve the right to discontinue . Inc. The Forensic DOCUMENTATION SOURCEBOOK The Forensic DOCUMENTATION SOURCEBOOK The Complete Paperwork Resource for Forensic Mental. The Forensic DOCUMENTATION SOURCEBOOK The Complete Paperwork Resource for Forensic Mental Health Practice SECOND EDITION Theodore H.