Serena Nightingale

Please use blue or black ink when filling out this admission form. Additional information from all but the patient must be initialed by the author. Please answer all questions to the best of your ability. For further information or guidance, please contact a member of St. Christina staff at the number provided
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Patient Full Name: Nightingale, Serena

Age: 14
DOB: 11/13/1996
Gender: Female
Address: 1900 Pennsylvania Avenue
City: Washington D.C
State: District of Columbia
Ethnicity: Caucasian (English/Irish)
Height: Not sure, through I am very tall.
Weight: 47 KGs
Eye Color: Blue Eyes
Hair Color: Brown
Distinguishing Marks: I have scars on my torso from been beaten by my kidnapper, Mr Saku. I also have a scarlet-gold Phoenix tattoo I got illegally.


Medical History:

Please list any and all allergies and age of onset below:
N/A

Are you aware of any ongoing medical issues?:
N/A

If yes, list age of diagnoses by medical professionals, or age of onset below:
N/A

If you are receiving treatment for an ongoing medical complaint, please list prescriptions, strength of dose, frequency of dose, and other treatment plans below:
N/A

Do you smoke tobacco, consume alcohol, or use street drugs? If yes, please list number of packs per day, number of drinks per day and/or names of consumed drugs below:
N/A



Psychiatric History:

Have you been diagnosed with any psychiatric issues? If so, please list diagnoses and age of diagnoses below:
Post-Traumatic Stress Disorder ~ Age 12 (caused through forced prostitution and human trafficking from the age 9 to 12)
Dependent Personality Disorder ~ Age 13

If you answered yes to the above, please list any and all prescriptions, including dosage and frequency of dosage, and other treatment plans below:
Trauma-focused cognitive-behavioral therapy ~ Twice a week, Dr. Temperance Jenkins (little effects, 17 months)
Zoloft ~ 12 MG's, weekly
Group Therapy ~ Daily, Dr. Jeff Robinson

If you answered yes to the above, please describe your feelings, symptoms, triggers and any incidents associated with the diagnoses, such as outbursts, suicide attempts or any other signs of non-typical behaviors, and approximate ages of incidents below:
Ever since the age of 12 and having being admitted to the Abraham Lincoln Children's Abuse Shelter (ALCAS), I have being diagnosed with Post-traumatic Stress Disorder. Often I am very anxious by being in a room with a boy, especially if it is a small bedroom or bathroom. If they try to get near me, I try to run away and start sobbing quite badly, sometimes to the point where I can't breathe.
I also am known to have nightmares, very vivid and realistic about my clients, the brothel I was forced to live in and my dreadful keeper, Mr. Saku. Normally I am found screaming and frigidly moving around in a hysterical manner.
I am found to be very obedient and submissive, not only by the staff in the hospital but also by my kidnappers, which they have had used to their advantage so I would not try to escape or fight back.
You can say that I am like Ella from Ella Enchanted, I am completely obedient without question and because of my nature that comes from having Dependent Personality Disorder, I find it to be a curse.

Have you ever been hospitalized for these diagnoses? If yes, please provide facility name(s) and age of admissions and discharges as well as what diagnoses you were you hospitalized for, or what incidents lead to hospitalization:

Oxford Childrens Hospital ~ Age 6, Dependent Personality Disorder, 13 months.
Abraham Lincoln Children's Abuse Shelter (ALCAS) ~ Age 12, Dependent Personality Disorder & Post-Traumatic Stress Disorder, present

Are you aware of a history of psychiatric complaints in your family? If yes, please list family member(s), diagnoses, and how this affected you personally:
N/A



Environmental History:

Are you aware of any complications during your birth? If yes, please explain below:
I find that my birth was completely normal.

Are you aware of any difficulties in development during your infancy, such as learning disabilities, speech impediments, etc? If yes, please explain below:
N/A

Are you aware of any long term separation from your mother during your infancy? If yes, please explain below:
No, my mother had loved me very much so I had my mother during most of my childhood.

Please describe the location and environment in which you grew up. Please list town and state, and what it was like and how this affected you:
In the beginning, I was a young girl who lived in the heart of London, England. My family was of upper class and I was very much loved and nurtured. My father was Physician and my mother a Seamstress, so you can say we had a wealthy income. I remember that my Mother and Father was very adoring of me, probably being a very pretty girl and a clever one too. My grandfather was alive and was rather affectionate of me, so I had a good childhood.

Please describe your educational history. How were you in school, both as a young child and in later grades? How were your grades? Did you enjoy school? What was school socialization like? What were your academic strengths and weaknesses? Please answer below:
I was a very clever girl, and I had rather liked school alot. Normally I had gotten B's or A's and my favorite subjects were English, Religion and Science. Because of the family wealth, I was sent to a private boarding school where I would spend the weekends and holidays at my parents. I was not very liking of Maths, French or History, but my Mother and Father insisted I do well in all my subjects so I did so.

Do/did you have many friends growing up? Do/did you have a best friend? If yes, please explain below:
I had a close group of girls I was close to, also being in the companionship of a few boys. Gracie I remember was the quiet and reserved one of the group who wanted to be romance novelist when she grew up, Amelia was the most sporty and fiery and hoped to become a acrobat in a circus, Lucinda was the smartest and logical and dreamed of becoming a mathematician like her father and Frances being the most confident and the leader was wishing to become a world class explorer. I was considered the gentlest and sweetest of the girls and like my friends had my dreams of my future: A nurse like Florence Nightingale. I remember having a crush on a boy named Peter, but had never tried to flirt with. I was too scared to and instead watched from afar.

Do/did you pursue any extra curricular activities or talents? If yes, please explain below:
I had quite liked horseriding, being a natural at it and loved Ballet and Piano, I love feeling so graceful and perfect while I am dancing and it feels wonderful.

If sexually active, please list age of onset and sexual preference below. If not sexually active, are you aware of a sexual preference?:
My sexual experiences with men was rather violent and frightening, being against my own will. I have had romantic for boys, so I consider myself straight.

Please explain a little about your overall life below. What circumstances do you feel have brought you to where you are now? How do you feel about those? Do you have any thing else to note about your life that you feel has had some bearing on your current situation? Please explain below:
When I was little, I thought I would have grown up to marry someone and become a nurse. Yet one day, while I was playing out in the busy market courtyards of London with my friends Gracie, Amelia and Frances; I was snatched by a group of young men. That was the last time I had lived a normal life.
I forced to be shipped over to America and become a prostitute at the age of 9, having to live in a brothel and serve men that would probably be my fathers or my grandfathers age. The brothel had no windows, so we were constantly in darkness with only a single candle for light and it was cold and damp most of the time.
We could hear the screams of other girl's upstairs as they were raped and abused and I was constantly scared and frightened.
Most of the men I served were rough and aggressive, far from gentle and kind and payed little attention to our sobs or screaming as they would pin us down to the bed.
The boss of the brothel Mr. Saku had came to the attention that I had DPD and used to his advantage, saying that I was to obey him by fulfilling the sexual desires of my clients and not try to run away, otherwise I would be punished. And because of my submissive and extremely obedient nature, I obeyed.I was afraid that if I tried to escape, I would not survive in america without my parents and was dependent on Mr Saku.
When I was 12, the brothel was taken and Mr Saku was arrested. While the girls' from the brothel had recovered from their traumatic experience, I am still fearful and cautious, having nightmares about it and sometimes flashbacks.


Legal History:

Do/did you ever abuse controlled substances, including but not limited to prescription medications, street drugs or alcohol? If yes, please explain below:
I have never taken any illegal substances at all.

Have you ever been convicted of a crime? If yes, please list conviction, age of conviction and circumstances below:
N/A

If you answered yes to the above, please list sentences connected to these convictions below:
N/A

Have you ever knowingly committed a crime for which you were not convicted or sentenced? If yes, please explain below:
I had gotten a phoenix tattoo at the age of 13, in a unregistered tattoo parlor.



Personal Interview:

Describe yourself to the best of your ability in only five words:
Submissive, Gentle, Thoughtful, Obedient, Clever

You come across a glass of water. The total volume of water in the glass constitutes half of its total capacity. Is the glass half empty, or half full? Explain your answer below:
Half full, since water is supposed to be drank. On the other hand, It may be bad, since it could have being someone else's drink so I better fill it up just in case,

If you could change only one thing in your life, what would it be, and why?:
Having being kidnapped. I loved my parents so much, I have never seen since the age of 9, because of the kidnapping. If I was never kidnapped, I would have lived a normal life and probably been in court with Peter.

How do you feel about your life and the things you have done in it, looking back? If you have committed crimes, how do you feel about those now?:
I feel pretty sad, since most of my life has being wasted to the kidnapping but I feel that I had a good childhood, and I still lovingly remember my parents in a good light.

What are your goals in life, and how do you feel those would be best accomplished?:
Once my Post-Traumatic Stress Disorder is treated, I hope to go back to London and find my parents again. I also hope to become a married woman once I grow up, have a daughter named Catriona and a son named Edmund and become a nurse.

Lastly, why have you chosen admission at St. Christina Psychiatric Rehabilitation Center, and how do you think this will help you toward your life goals?:
I feel that by transferring here, I will be of better mind and health and my conditions will be solved quicker then at the facility I am in.



Patient/Guardian Signature:

By agreeing to admission to our facilities, you hereby agree to abide by all rules and terms of service outlined in patient or resident handbooks, rules and codes of conduct. You hereby agree to waive your right to voluntary dismissal from our facilities until such a time as facility administrators sign paperwork for your release. You hereby agree to comply with facility staff recommendations, demands, or outlines for treatment. You hereby waive your right to informed medical consent before medication changes or medical procedures. You hereby agree to waive your right to hold GR Biotech and its Subsidiaries responsible for any personal harm or distress incurred during treatment. GR Biotech and its Subsidiaries reserve the right to add or amend these terms of service at any time.

Please sign and date below:

Serena Nightingale 18/06/2011