Hazel Rodriguez

Please use blue or black ink when filling out this admission form. Additional information from all but the patient must be initialled 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: RODRIGUEZ, HAZEL

Age: 14
DOB: 02/28/1997
Gender: Female
Address: 3rd Apt. 88 Kingstown Rd.
City: Union
State: N.J.
Ethnicity: Hispanic/African American
Height: 5’3”
Weight: 115 lbs.
Eye Color:Brown
Hair Color: Black
Distinguishing Marks: N/A


Medical History:
Extra information filed by Psychiatrist Judy Lloyd.

Please list any and all allergies and age of onset below:
Bee Stings: When I was 4 a bee stung me on the finger and my whole arm swelled up.

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:
No way that stuff is disgusting and would make me even more revolting.



Psychiatric History:

Have you been diagnosed with any psychiatric issues? If so, please list diagnoses and age of diagnoses below:
I know I have issues. The doctors say I have Avoidant Personality Disorder. I guess I was diagnosed when I was twelve and since then I have been dealing with people telling me that I’m nice, pretty, smart and can make lots of friends if I try, but I don’t believe them. Sometimes I wish people would just leave me alone. There are times when I really really want to be someone’s friend or girlfriend, but if they started to hate me, it would hurt too much. I would feel like I was dying, so I think it’s better to be alone.

If you answered yes to the above, please list any and all prescriptions, including dosage and frequency of dosage, and other treatment plans below:
So far the doctors have just tried therapy. Once I was even hospitalized for socialization therapy, but my symptoms keep getting worse so they want to try something different.

If you answered yes to the above, please describe noted feelings, symptoms, triggers and incidents associated with the diagnoses, and ages of incidents below:
I feel it and see it all the time, rejection. When my mom says “hold on a minute I need to make some coffee” and then she doesn’t come back to finish our conversation. When people say hi and then just walk away. It hurts and I’m stupid enough to believe that they could care about me or be my friend. Sometimes I can’t even say hi to a person, I only stare at the floor, because I can feel that they will hate me. Everything is easier if I just stay in my room and watch TV or read a book.

We have found that Hazel has strong avoidance triggers when she knows she will meet new people. Her family says she just “freezes up” and becomes a shy introvert. At the beginning of the school year, she refused to go to school because she would be in a new class with a new teacher. After a negative social interaction, Hazel also has isolation triggers, where she berates herself and then spends long amounts of time alone. This entails long hours spent on her computer creating fantasy stories. At the time she was hospitalized her symptoms became severe to the point that she locked herself in her room and refused to eat or do other daily routines as it would require social interaction where she might "make a fool of herself." Although this did not last very long, her family is concerned that this extreme might situation might happen again. (J.L.)

Have you ever been hospitalized for these diagnoses? If yes, please provide facility name(s) and age of admissions and discharges:
Garnet Youth Psychiatric Help Center: Age 13 for 3 months (to try socialization therapy)

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:
I don’t think so.

Notes taken from family members state that there might be symptoms of anxiety and depression that run in the family. However, these disorders have never been diagnosed and have only been treated with home remedies such as alcohol and adapting to the symptoms. (J.L.)



Environmental History:

Are you aware of any complications during your birth? If yes, please explain below:
No

Are you aware of any difficulties in development during your infancy, such as learning disabilities, speech impediments, etc? If yes, please explain below:
My mom did say I was born a little early so I had balance problems. I used to fall down all the time. My mom also said that I used to sit all crooked just so I wouldn’t fall over.

Are you aware of any long term separation from your mother during your infancy? If yes, please explain below:
My mom would often be busy. My mom was usually unemployed, but she still wasn’t around much and didn’t take care of me. My dad was always working too. My aunts told me my mom would leave me with them, or they would come over and use me as a “practice baby” because she just wouldn’t care if I was crying.

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 Union, NJ. I stayed in the same town, but my family moved a lot because of my parents. My dad works as a mechanic, so he doesn’t make a lot of money. My mom would usually get a part time job to help pay the bills. When my parents were both working I was home alone. Then again, my mom would constantly get fired or quite her job for random reasons. Even when my mom didn’t work she was busy. She would always go out shopping or be reading a book. In the end I was usually by myself and we moved a lot, because we couldn’t pay the rent. We stayed in the same town so we would always have family around to help us out. My aunt’s even paid for my therapy. Anyway, because we moved so much, I never really had friends and I would have lost contact with them anyway, because of all the moving.

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? Please answer below:
I mostly get A’s and B’s, with some C’s in middle school. I hate school, but I love learning. In school there are just so many mean people. Bullies come and push me and pull my hair. I hate it, but I guess I might deserve it. I mean why else would someone I don’t know physically hurt me. Plus on top of bullies, ever September you have to start ALL OVER AGAIN. I mean new class mates, new schedules, new cafeteria seats, and worst of all new teachers. I know I have to be alone and sit in the back of the classroom so everyone will just ignore me, but why do I have to start the ritual over every year. First the new teacher tries to get to know you and be your friend, but then if you do one thing wrong they can give you an F. Then there are the kids who have their cliques and just look at you as if your scum. I know I’m scum you don’t have to keep telling me. Then the cafeteria, you ask “may I sit here?” the kids reply “no” and then you have a whole table of people who hate you. If I make one stupid wrong decision I could have an enemy for life, or make someone really upset.

Do/did you have many friends growing up? Do/did you have a best friend? If yes, please explain below:
My computer. I can do anything I want in the stories on my computer and nothing bad ever happens to me. It never ignores me either.

Do/did you pursue any extra curricular activities or talents? If yes, please explain below:
No. It would just mean being picked last for the baseball team or no one who wants to play chess with you, it is better just to stay home.

If sexually active, please list age of onset and sexual preference below. If not sexually active, are you aware of a sexual preference?:
No I’m not and … well I like boys, but I could never have a boyfriend. It’s better not to get my hopes up.



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:
No way. Like smoking and stuff it is way too dangerous.

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:
N/A



Personal Interview:

Describe yourself to the best of your ability in only five words:
Shy, Alone, Nerd, Strange, Odd.

Is the glass half empty, or half full? Explain your answer below:
Half empty I think. Right now things are horrible, and they will probably just get worse. I mean one mistake and everything could go wrong. For example if you hit the glass and the glass breaks, then there is no water for anyone and everyone gets mad at you.

If you could change only one thing in your life, what would it be, and why?:
I want someone who will never hate me. I don’t think there is anyone like that. So I want to be really rich instead so I can buy anything I need and I wouldn’t have to depend on anyone.

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 bad in case I ever hurt anyone. I really didn’t mean too. I’m not sure what to do about life though.

What are your goals in life, and how do you feel those would be best accomplished?:
I don’t know. I don’t have any I guess.

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 was told that St. Christina’s might help me get better. I guess that is my goal right now.



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:

Judy Lloyd 05/15/2011

Hello I just have one question. I put in the hospital stuff because I thought Hazel needed to be a more severe to be accepted at Hadley. However, to be honest I thought of Hazel as being more observed and recently just needed extra ... care. So would she still be accepted if I took out the hospital stuff. (Aka what I did above.) I also corrected all the other things above. Thanks :-)

Edited and completely changed my character after some Wikipedia research. I hope this is much better. Thank You for all your help :-)

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: -
Ward: C
Room: C1
Bed: 3
Primary Therapist: Dr. __________

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: Antisocial Behaviors

Final Application Approval Steps for Players:


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• 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] Rodriguez, Hazel
[b]Primary Study Group:[/b] Antisocial Behaviors
[b]Primary Therapist:[/b] Dr. ___________
[b]Building:[/b] Bennett
[b]Wing:[/b] -
[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.)