Edit Training Case History

Use this form for practice only. Do not enter any real client names or identifying details.

Training only · Mock / demo cases

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Student & Batch

Your Name (Student) *

Mandatory field.

Batch Code

You can keep it as Dec25 for this internship batch.

Socio-demographic details

Client Name

Age

Gender

Education

Occupation

Marital Status

Residence

Religion

Socioeconomic Status (SES)

Handedness

Identification marks

Disability / Medical conditions

Referral & Presenting Complaints

Source of referral

Relationship with informant

Chief complaints

Presenting concerns (therapist summary)

Verbatim (client's own words)

History of Present Illness (HOPI – A B C D)

Affect (A)

Behaviour (B)

Cognition (C)

Daily functioning (D)

Onset & Course of Illness

Onset details

Course of illness

5 Ps – Case Formulation

Predisposing factors

Precipitating factors

Perpetuating factors

Protective factors

Present maintaining factors

Extended Case History

Family history

Personal history

Educational history

Vocational / occupational history

Sexual and marital history

Forensic history

Suicidal / deliberate self-harm & substance use history

Living conditions

Premorbid personality

SMART Goal Plan

Use this area to convert the case into a structured SMART plan: Specific, Measurable, Achievable, Relevant, Time-bound.

Free summary / extra notes (optional)

Short Case Title / Summary

Extra notes (optional)

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