Katy Wilcox

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
in our guide brochure.

Patient Full Name: Wilcox, Katy

Age: 17
DOB: 01/28/1994
Gender: Female
Address: 786 Poplar Street
City: Helena
State: Montana
Ethnicity: Caucasian
Height: 5'6"
Weight: 125lbs
Eye Color: Greyish-Blue
Hair Color: Brown
Distinguishing Marks: A chestnut brown birthmark is under the arch of my left foot. I have a 3 cm long scar below my right knee from where a shard of glass was embedded in my leg. I fell off my bike when I was twelve, slid on the street, and sliced open my leg. The doctors gave me five stitches.


Medical History:

Please list any and all allergies and age of onset below:
I've allergic to peanuts and nuts and have been all my life.

Are you aware of any ongoing medical issues?:
No.

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:

No.



Psychiatric History:

My name is Dr. Catherine Wilkes, and I am Katy's doctor, and have been for the past year and a half since the incident. I will be assisting in the filing of the application to St. Christina Psychiatric Rehabilitation Center.

Have you been diagnosed with any psychiatric issues? If so, please list diagnoses and age of diagnoses below:

My doctor says I love Max Chatmon more than a girl my age should.

When Katy was 15, she went to the library to get some books for a report she was writing in school. On the way, Max Chatmon, then 39, approached her. He convinced her to follow him home, where he said he had the necessary books for her to complete her report, and offered her aid. Once there, he drugged her with Flunitrazepam, and drove her to his cabin in the Bitterroot Mountains. There, he brainwashed her into believing she loved in, convincing her to perform sexual acts. It was three months before they were found, and then it was only because Katy was spotted in Clancy Montana, picking up groceries.
Max Chatmon is serving 42 years in Montana State Prison on a host of charges including Kidnapping, Sexual Interference, and Indecent Acts.
Meanwhile, Katy is suffering from Stockholm Syndrome. She is in love with Chatmon, and writes him frequently. As far as I know, he has never returned nor replied to a single letter. Still, she remains fascinated with him. She is no longer interested in boys her own age, refusing to acknowledge them. She claims she will wait the 42 years until Chatmon is released, and their "love" can be reunited.
From her time with Max, she has become suspicious and untrusting of others. She worries that I am trying to trick her into falling out of love with him, and refuses to accept her diagnosis. She has become withdrawn from her friends and her grades have dropped. I worry she is becoming more and more paranoid, as well as more obsessive, every day.


If you answered yes to the above, please list any and all prescriptions, including dosage and frequency of dosage, and other treatment plans below:
In my experience, cases such as these are best treated by lengthy counseling sessions. However, it appears my attempts so far have been futile. I hope that she will find the help she needs at St. Christina's.

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:
Dr. Wilkes believes I have been tricked into loving Max. This is simply not true. Max is a kind soul, who had a terrible family life growing up. His wife left him and took the kids, and he was left all alone. Now he’s stuck in a prison because of me, and is alone once more. Max really just needs someone to love him, and I want to be that someone.

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:
Dr. Wilkes has always said it would be best if I was with my mother, for support. But now she wants to send me across the country to separate Max and I.

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:
No.



Environmental History:

Are you aware of any complications during your birth? If yes, please explain below:
No. My mom says it took six long hours, but then her little miracle was born!

Are you aware of any difficulties in development during your infancy, such as learning disabilities, speech impediments, etc? If yes, please explain below:
Mom says I was always a very bright little girl. My reading level has always been ahead of the grade!

Are you aware of any long term separation from your mother during your infancy? If yes, please explain below:
No, my Mom has always been there. My father, on the other hand, left my Mom and I and started another family.

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:
I was born and raised in Helena, Montana, the Queen City of the Rockies. We're right beside the mountains and we're close to Canada. We have under 75,000 people in Helena, making our capital city a little more like a big town than a big city.

I grew up with my Mother, my Aunt Becky, and a toy poodle named Zoot. My father left my Mom and I when I was six, because he fell in love with a woman named Donna. They were married when I was eight, and had three kids of their own - Tyler, Jordan, and Peter. My Dad didn’t really spend time with us, and I only know my stepbrothers through the town, we’re not very close.


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 always in the over-achievers portion of the class in school. When I was in Elementary, I would help the teacher by teaching kids in my class to read, or assisting them in the lessons. I graduated middle school top of my class, and chose to take IB courses when starting high school. Despite being what some would call a nerd, I’ve always had a bunch of friends. I’ve never worried about being the popular kid in school, but I’ve had plenty of friends to hang out with and parties to attend. I may not be homecoming queen, but I’ve never been sitting alone at a school dance. Ever since meeting Max though, I haven’t really been too keen on my courses. IB is great and all, but I don’t really think I need to go to University. So, why not drop all that extra work and focus on important things? Spending time writing letters to Max, taking Home Economics, or Choir, are much better uses of my time. Plus, learning to sew, cook, and sing will all be admirable qualities when it comes to being Max’s wife.

Do/did you have many friends growing up? Do/did you have a best friend? If yes, please explain below:
I used to have two best friends. Melinda Thomas and Stephanie Rosenburg were my best friends since kindergarten. We met on the playground at school, one of those “I like Barbies, you like Barbies, let’s be friends!” moments. Then we were inseparable. We had sleepovers almost every other week, made friendship bracelets, managed to get through puberty... We once spent the night camped outside of the local Ticketmaster in order to be first in line to get Jonas Brother tickets. We would do everything together - sit together on the bus, go shopping, write notes in class... But, they're more like frenemies now... they just don't understand how immature they are. Constantly focusing on the boys in school - they're just boys. They should be focusing on the real men, and less on history assignments. I spent a history lesson writing a letter to Max instead of focusing on our former Presidents, and my so-called friends ratted me out to the teacher! Can you believe that? So much for BFF. I unfriended them on Facebook after that.

Do/did you pursue any extra curricular activities or talents? If yes, please explain below:

I'm in Choir class. I like to sing and Dr. Wilkes thought it would be good for me.

If sexually active, please list age of onset and sexual preference below. If not sexually active, are you aware of a sexual preference?:
I'm no longer sexually active, but I did give myself to Max when I was 15. It was very romantic, out there in the mountains... But I haven't even given another thought to a man since Max was taken away. Hopefully, when I'm 18, I can go visit him and we'll share more times together.

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:
I don't know what brought Max into my life, but I'm immensely grateful for him. He's my everything now. I feel blessed, happy, and in love.



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:
Max once gave me some pot to smoke. He said it would help loosen me up. But I haven't smoked it in over a year.

Have you ever been convicted of a crime? If yes, please list conviction, age of conviction and circumstances below:
No, and I wouldn't trust the justice system at all. They lock up people who are guilty of nothing but loving others.

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:
No.



Personal Interview:

Describe yourself to the best of your ability in only five words:
Loving. Talented. Sweet. Friendly. Loyal.

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:
I'm not really sure... I guess it would be half empty. But can't you just fill it?

If you could change only one thing in your life, what would it be, and why?:
I would be reunited with Max!

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 am sorry that I went down for groceries without wearing a hat. I just wanted to feel the wind in my hair, and my lover suffered for my mistakes.

What are your goals in life, and how do you feel those would be best accomplished?:
To lead a happy, loving life as a content wife with my beloved.

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?:
Dr. Wilkes told me it's for the best. Also, I think living in a center will allow me to better understand what Max is going through.

I can only hope that by sending her to the professionals over at St. Christina, where she is forced to interact with other teens and talk over her problems, will improve Katy's mental state. Katy is a bright young woman who is throwing away her future because of her problems, and I hope that you will be able to help her.




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:

Katy Wilcox 02/07/2011

Catherine Wilkes 02/07/2011

---

Player Nickname: Brittney
Chatango Screename: CGBritt
Character Play-By Daniella Monet

Okee dokee, how does this look now?

She's hopefully less delusional, Max has aged by 20 years, and she's got a bit more of a past.

Also, Allison Brie has become Daniella Monet.

Does it need any more tweaking?

Alright Kelsey, how's this look?

Tattoo has been nixed, Chatango created...

Welcome to St. Christina's Psychiatric Rehabilitation Center. Your ward and room assignments can be found below, along with the name of your primary therapist. Please familiarise yourself with all patient handbooks and codes of conduct.

Building: Bennett
Wing: N/A
Ward: C
Room: 5
Bed: 1
Primary Therapist: Dr. Matthias Savage

OOC Information: All information below this line is not known by the patient, but is available on the patient's file, viewable only by staff.

Study Group(s):

Primary:Psychiatric Issues

Final Application Approval Steps for Players:


Before you can begin play on STC, you must complete these final steps:

• Sign up your playby on the faceclaim.
  
• Sign up for the who plays who list.
  
• Sign up for your assigned membergroup (shown above) HERE (Pay close attention to pick the correct usergroup listed on this approval stamp! Characters that are not signed up for their correct membergroups after approval will be subject to deletion during the next activity check.)
  
• Familiarise Yourself with you Patient Hanbook, located in St. Christina's Rosters and Information forum, on the main board.

Code:

[center][font=garamond][size=22][color=#555555][b] -File Note- [/b][/color][/size][/font]

    _____________________________________________________________[/center]

    [b]Patient Name:[/b] Wilcox, Katy
    [b]Primary Study Group:[/b] Psychiatric Issues
    [b]Primary Therapist:[/b] Dr. Matthias Savage
    [b]Building:[/b] Bennett
    [b]Wing:[/b] N/A
    [b]Ward:[/b] C

    [center]_____________________________________________________________[/center]

    [b]Note Subject:[/b] (Therapy Report, Medication Change, Dormitory Reassignment, Medical Report, Behavioural Report, Progress Report, Procedure Report, Disciplinary Report, etc.)

    [b]Note Contents:[/b] (Explain behaviour observations, patient actions, procedures, medication changes, disciplinary actions, medical reports, etc. here)

    [b]Note Author:[/b] (Your character name here.)

    [b]Other:[/b] (Optional extra notes here.)