I.

PERSONAL DATA

Name: Sir X
Age:
Address: Sampaloc, Manila
Name of Parents:
Father: Age: Occupation:
Mother: Age: Occupation:
Name of Siblings: Age: Occupation:
Educational Background:
Birthday:
Place of Birth:
Sex: Male
Marital Status: Single
Religion: Catholic

II. CHIEF COMPLAINT

Sir X is a year old male, with a chief complaint, “I always fight with my neighbors. They
don’t want me around anymore.” He was already admitted to different rehabilitation
centers, and shares “I had to change my bad ways.”

III. HISTORY OF PRESENT ILLNESS

IV. PAST PSYCHIATRIC HISTORY

Sir X has been admitted to rehabilitation centers. He mentioned two rehabilitation
centers in Taft and Pasay.

V. MEDICAL HISTORY
VI. FAMILY HISTORY
However, he admits that his father is a smoker, and is a drug-user, as well as his
brothers. He also added that his father uses

VII. PERSONAL AND SOCIAL HISTORY

Sir X was born in _____, the 4th of 4 children with 2 older sisters, and 1 older brother.
His father is (job, I forgot), while his mother is (job) . He describes his relationship with
his parents as fine, and reports that he is particularly much closer to his ___ (we forgot
to ask). He is also in good terms with his siblings, but reports that they fight over small
things, too, like normal siblings do. Sir X denies any significant trauma or abuse from
his parents.

He is a friendly person, and talks much about his “barkada”.

He had difficulties in school especially when he was in high school. He says that his
teachers don’t treat him right. He attended high school for 5 years. He was able to get
into college, a marine school, but only studied for 2 years. The reasons behind this,
according to Sir X, are vices, and academic problems. He said that his intellect already
reached its limit. In addition, he joined fraternities, and rarely attended class
promptly. He also admitted cutting classes, and playing billiards during class hours.

Sir X is single, but admits that he had many girlfriends in the past, but all his
relationships only lasted for a brief period of time because he was busy with work.
According to him, his longest relationship is 5 months.
 Before admission, Sir X also shared that he worked as a room boy or housekeeper in
many hotel. His longest duration of service to a company is 3 years, while his shortest
is 2 years. He shared that sometimes, he would get blankets and towels from these
hotels. He saw his job as very exhausting. In addition, he also said that he worked in
cinemas as maintenance personnel. He cleans the cinema early before the mall opens,
and late, after the mall closes. He shared that he gets to watch movies free because
of his job.

VIII. GENERAL OBSERVATION (MENTAL STATUS EXAMINATION)

IX. PSYCHOLOGICAL TESTS ADMINISTERED

X. TEST RESULTS AND INTERPRETATION

XI. SUMMARY OF FINDINGS

XII. DIAGNOSIS

XIII. RECOMMENDATIONS