LANG Initial Contact Note
The BHO for this contact is
*
MAJ Angela Huval, LCSW
Harvey Norris, LCSW (CIV)
The Date of this contact is:
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Month
-
Day
Year
Date
Time of Contact
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
SM Last Name and last 4 are
*
Enter Parish?
Yes
No
SM Currently lives in the Parish of :
East Baton Rouge
Jefferson
Orleans
Caddo
St. Tammany
Lafayettee
Calcasieu
Ouachita
Rapides
Livingston
Tangipahoa
Bossier
Ascension
Terrebonne
LaFourche
St. Landry
Iberia
Acadia
Vermillion
Vernon
St. Mary
St. Martin
St. Charles
Lincoln
Washington
St. John Baptist
Avoyelles
St. Bernard
Webster
Natchitoches
BEAUREGARD
Evangeline
Iberville
Jefferson Davis
Morehouse
DeSoto
Allen
Sabine
West Baton Rouge
Plaquemines
Assumption
Point Coupe
Union
Grant
St. James
Richland
Franklin
Concordia
East Feliciana
Clairborne
Jackson
West Feliciana
Winn
LaSalle
Bienville
Madison
West Carroll
St. Helena
Catahoula
Caldwell
Red River
East Carrolll
Cameron
Tensas
Contact was made via
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Phone
F2F
Email
Other
The initial Clinical Activity was
*
Clinical Case Contact (SM)
Clinical Event
Crisis Intervention
Postvention
The Crisis Intervention Type was
Abuse/Neglect Perp (child, elder, partner)
Abuse/Neglect Victim (child,elder, partner)
Alcohol or Substance Abuse
Homicide-Ideation
Homicide-Plans/Means/Intent
Other Crisis
Suicide-Ideation
Suicide-Plans/Means/Intent
Referrals were made to the following
*
Casualty Assistance/Survivor Outreach
Employment/Benefits Support (ESGR, Job Coach, MOS, Insurance)
Family/Marital/Parent Support Services
Financial
Housing
Legal
Local Hospital/Clinicl
Military Family Life Consultant
Military Treatment Facility
Private Practice/Community Provider
Sexual Assault Prevention Response
Social/Recreational Services
Spiritual/Grief Support (Chaplains)
VA Medical Center/Clinic/Specialty Treatment Program
Vet Center
Website, Hotline or Other Resource
Type of Assessment completed was Assessments
Command Directed Evaluations
Fit for Duty Evaluations
Periodic Health Assessments (PHA) -BH Screen
Post-Deployment Health Readiness Assessments (PDHRA)
Self-Directed Evaluations
Service Separation Evaluations
Other activities were
Briefing
Non-Clinical Case Contact
Non-Clinical Consultations
Non-Clinical Event/Meeting
Training
BHO discussed with SM the following
Submit
Should be Empty: