Log in

I forgot my password

Word Counter



Who is online?
In total there is 1 user online :: 0 Registered, 0 Hidden and 1 Guest

None

[ View the whole list ]


Most users ever online was 16 on Thu Jun 06, 2013 9:22 am
Statistics
We have 54 registered users
The newest registered user is kaylmarn

Our users have posted a total of 1892 messages in 473 subjects
AFFILIATES



Listed At:
RPGCollection RPG-Directory Seductive Supernatural Shadowplay redcarpet&&rebellion. Blank Pages The GLITTER Web Directory
Affiliates:
Shelpey Alley Bittersweet Forever Nuages du Monde GATHERING SOULS HL2 The Hammel Institute Souls on Fire Mystical Realms Role Playing Chat * Action * Fantasy * Historical Fiction * Horror * Sci Fi * Steampunk * Western Bonsoir

Jared Melhorn

View previous topic View next topic Go down

Jared Melhorn

Post by Guest on Thu Jul 28, 2011 3:34 pm


_____________________________________________________________
-Patient Admission Form-

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: Melhorn, Jared

Age: 28
DOB: 09/22/1982
Gender: Male
Address: 1435 Palamino Dr.
City: New York
State: New York
Ethnicity: Caucasian
Height: 6’2”
Weight: 176 lbs.
Eye Color: Brown
Hair Color: Hazel-Green
Distinguishing Marks: I got a tattoo of a lion on my right bicep, I tribal band on my left, and the Chinese symbol for peace on my upper left back. I also got both ears pierced.

_____________________________________________________________

Medical History:

Please list any and all allergies and age of onset below:
I don’t think I have any.

Are you aware of any ongoing medical issues?:
Nope.

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:
I used to drink every week with my buddies, not that I don’t drink anymore. I’m not a big drinker though. As for other that other stuff, I was never interested though I did try mushrooms. Had a bad trip the first time, never went back.

_____________________________________________________________


Psychiatric History:

Have you been diagnosed with any psychiatric issues? If so, please list diagnoses and age of diagnoses below:
I got diagnosed with mysophobia when I was 26 or so. And then when I was 27, the shrink said I might be OCD too.

If you answered yes to the above, please list any and all prescriptions, including dosage and frequency of dosage, and other treatment plans below:
They tried flooding once, but I ended up having a major panic attack so they had to get me out before I hurt myself or something. I refused any treatment of that kind after that experience. Now, they’re just telling me to take 20 mgs of Valium per day.

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:
This really started when I was a kid, but back then, all it took was some Germ X to calm me down. As I go older though, the anxiety just got worse, I never told anyone though, I mean, wasn’t everyone a little afraid of germs? What really set it off though, was when I was 26. I was out at the park with a couple of friends. By then, I always kept a big bottle of Germ X with me. They just thought of it as a quirk. Anyways, some kid must have gotten sick there and threw up, because there was this puddle of puke there. We were all having a laugh, daring each other to get close to the puke. I stayed far away though. Seeing this, they started teasing me a bit, accusing me of being chicken, the usual. So I decided to just get bit closer, prove that I’m not a coward. Then, my best friend pushed, not really hard, but I still managed to trip and fall. The rest, I don’t really remember. But I can remember that I just… freaked out. I thought I was going crazy or something like that. I couldn’t breathe, everything was dizzy... and yeah, I passed out. My friends said they called 911 and I was hospitalized for a little while. My parents found out, made me go to a shrink… and there you go.

It only got worse after that, as I started panicking over just about everything. A fly lands on my food; it all goes in the trash. Some dirt’s on the stereo, time to bring out the bleach. Germ X for just about everything and anything I touched had to be squeaky clean. They tried a few treatments though they weren't too effective. Finally, they decided to just dope me up on anti anxiety medication which helped a bit… a bit. The stuff at least keeps me from panicking over specks of dirt and stuff like that, so I make sure to take it every day.

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:
As said, 26, panic attack, hospitalization for a day or two. I think I got sent to the Bellevue Hospital, not too sure. Afterwards, I went to a few shrinks if that counts. I’ve never been put in a nuthouse though.

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:
My parents were really big neat freaks, which is probably why I’m like this since from a young age, I was always told to be scared of germs and all that. I don’t think they were crazy though, just worried.

_____________________________________________________________


Environmental History:

Are you aware of any complications during your birth? If yes, please explain below:
Nope.

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

Are you aware of any long term separation from your mother during your infancy? If yes, please explain below:
Nah, she was a stay at home mom.

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 grew up in Dallas, TX. My family and I lived in an old apartment there. They always warned me about the danger of germs. Most kids had a monster in their closet, I had bacteria and viruses. I don’t really blame them though; they were just trying to protect me. We didn’t live in the best area of town, and it truly was filthy in both the literal and figurative sense. There were tons of gangs as well, though I am a bit thankful for that. Otherwise, I would never have discovered my calling in life.

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 never a bad student though I was never the best either. I pretty much always did my homework and my grades were usually in the B to C range. School was just school for me, a place too see my friends and get yelled at by the teachers for doodling in class. I had quite a few friends though I was never in the popular crowd since I was a bit geeky, not overly so though. The thing I enjoyed most about school though was art class. Most teachers and my parents could see that I loved to draw, and as expected, I went to an art school for college.

Do/did you have many friends growing up? Do/did you have a best friend? If yes, please explain below:
Yeah, as said, I had a few friends as a kid though my best friend and I drifted apart after we graduated from high school. I still keep in touch with a few of my high school and college buddies. And my current group is actually quite accepting of my phobia and everything that comes along with it. We’re a quirky bunch though, so I shouldn’t be so surprised. My best friend’s been especially supportive, I think it’s because he kind of blames himself for me being like this. It’s not his fault though, I think that the panic attack was bound to happen sooner or later.

Do/did you pursue any extra curricular activities or talents? If yes, please explain below:
I was in art club from middle school to high school. I’ve won a few art contests as well, and I got to the state level in the Reflections contest where I got 3rd place.

If sexually active, please list age of onset and sexual preference below. If not sexually active, are you aware of a sexual preference?:
Well… I’m straight. I started having sex at 16 or so. When I was 22, I had my first long term girl friend. They were mainly just flings though. I’ve dated a few girls seriously though I haven’t found the one yet, mainly because of my quirk. I stopped having a sex life soon after the panic attack. You know how sexual orifices aren’t exactly clean… Yeah, because of this stupid phobia, I can’t even get laid anymore.

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:
Well… as said, I grew up in the ghettos of Dallas. There were tons of gangs in that area, and there were tons of tattoos you know. Since I was a kid, I was fascinated with those, seeing them all the time. Other then that though, I was a pretty normal kid, never getting into too much trouble except when I got caught doodling. After a while though, I think they just realized I loved drawing. I wasn’t a social recluse though, I had friends and we’d just hang out. A few of them joined gangs and stuff, started drugs, you know, in high school. It sucked watching the people I knew since I was little get in trouble and stuff. I think I may be one of the few out of my old group of friends that actually went to college.

While I was at college, one of my buddies discovered my love of tattoos and took me to a tattoo partner. That’s where I got my tribal band. I think that’s when I realized what I wanted to do with my life. After college, I went to New York and got an apprenticeship in a tattoo parlor. I was pretty good at it too, got featured in the inked magazine once. With the meds, I was able to keep working for a while, tattoo parlors are really clean places. They have to be, I made sure of that too. During that time, I got my lion tattoo to symbolize courage, and the peace symbol as a hope that I could be calm. I’d have gotten more but the fear just kept getting worse. My art and performance was suffering though because I was always worrying about germs… so yeah. I left the job just a few months ago. I didn’t really do much after that. I kept drawing at home though… but yeah. That’s my life in a nutshell.

_____________________________________________________________


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:
Not really. I already had other issues, didn’t need more.

Have you ever been convicted of a crime? If yes, please list conviction, age of conviction and circumstances below:
Nope. As said, I was a pretty good kid.

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 stole my friend’s markers when I was 8 if that counts. Still have them I think.

_____________________________________________________________


Personal Interview:

Describe yourself to the best of your ability in only five words:
Troubled forgiving geeky tattoo artist.

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 don’t get why people always ask this question… but half full I suppose. I don’t know how to explain… I guess I just always hope for the best. I mean, how else am I supposed to keep living?

If you could change only one thing in your life, what would it be, and why?:
I’d make it so my parents didn’t focus on being clean so much. That way, the seeds of this phobia would never have been planted.

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?:
Looking back, I think I did pretty good. I lived a pretty good life, never got in to too much trouble or anything like that. I started down the road to my dream… Yeah, I think it’s been pretty good up to when the phobia manifested. That’s when things started getting shitty.

What are your goals in life, and how do you feel those would be best accomplished?:
My goal is to open my own tattoo shop, get known for my designs, and maybe get a girl, have some kids. I just want a normal life really. Really, the only way to accomplish this is to get rid of the phobia.

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 just want to get rid of this phobia that’s taken control of me. It’s completely fucked up my life. It’s made me give up my dream job, give up my chances of getting a girl. Hell! Even my friends are starting to lose hope in me. They say I’m getting more and more moody, they say I’m changing. I’m watching my world crumble, my dreams fade to dust. I just want to have my life back again… That’s all I want, my life back.

_____________________________________________________________


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:


    Jared Melhorn 07/28/2011






St. Christina Psychiatric Rehabilitation Center & St. Christina Medical Center are Subsidiaries of GR Biotech. All rights reserved ® 2011




Player Nickname: Jejune
Chatango Screename: JejuneNightshade
Character Play-By Karl Urban



Guest
Guest


Back to top Go down

Re: Jared Melhorn

Post by Admin Space on Sun Jul 31, 2011 3:59 pm


_____________________________________________________________
-Patient Admission Approved-

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: Main
Wing: Male
Ward: C
Room: 1
Bed: 1
Primary Therapist: Dr. Annette Fowler

_____________________________________________________________
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:

Your assigned membergroup is: Adult Patient

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.


_____________________________________________________________
FILE NOTE
-For St. Christina's Staff Use Only-

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

    _____________________________________________________________[/center]

    [b]Patient Name:[/b] Melhorn, Jared
    [b]Primary Study Group:[/b] Psychiatric Issues
    [b]Primary Therapist:[/b] Dr. Annette Fowler
    [b]Building:[/b] Main
    [b]Wing:[/b] Male
    [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.)

   

This app was reviewed by: Admin Space.

_____________________________________________


avatar
Admin Space
Admin

Posts : 137
Reward Points : 140

View user profile http://www.stcrpg.com

Back to top Go down

View previous topic View next topic Back to top


 
Permissions in this forum:
You cannot reply to topics in this forum