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Chanchala Jai

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Chanchala Jai Empty Chanchala Jai

Post by Guest Wed May 18, 2011 11:43 am

Chanchala Jai Stchristinaslogobase
_____________________________________________________________
-Patient Admission Form-

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.

_____________________________________________________________

Chanchala Jai AyeshaKapoor1

Patient Full Name: JAI, CHANCHALA

Age: 15
DOB: 10/22/1996
Gender: Female
Address: 57 W 4th St
City: Patchogue
State: New York
Ethnicity: Indian
Height: 5' 4"
Weight: 115 lbs
Eye Color: brown
Hair Color: brown
Distinguishing Marks: Chanchala has her earlobes pierced, and a heartshaped mark on her right hip, just a few shades darker than her skin tone. Also, on the top half of her left arm, just under her shoulder, she has a series of raised scars across her arm. There are five of them, and it seems like she has cut herself there, in the same five spots repeatedly. This worries me a great deal. I was completely unaware she was doing this. Perhaps I did not watch her closely enough, and it is my fault.
_____________________________________________________________

Medical History:

Please list any and all allergies and age of onset below:
Lactose intolerant - we first noticed when she turned eight. The poor thing's belly swelled and she was nauseous and gassy for the rest of the night. We thought at first it might just be the amount of ice cream she had consumed, as it had been a plentiful amount. We didn't get ice cream much, back then. But a later, less severe experience with a little bit of milk she drank led us to believe milk would make her sick.

Are you aware of any ongoing medical issues?:
Other than the mental issues for which I'm sure you are mostly aware, since you contacted us, she is going through some withdrawal issues. Which seems odd to me, as what she was taking isn't physically addicting, or so I understand. Perhaps it is all in her head? You'd know better, I'm sure. But her doctor says what she was taking causes effects that he can't treat with medicine.

If yes, list age of diagnoses by medical professionals, or age of onset below:
I went to a hospital with her a month ago for a scheduled physical, which is when she confessed to her drug use. It was after a urine test, so the doctor already knew. It caused us a lot of trouble, because whose 15 year old daughter finds drugs like that without their parent's knowledge? We are good parents. But even the best have trouble keeping track of everything their child does. Though, admittedly, I probably should have known something was wrong. There was this girl I would see Chanchala with from time to time. A bit older than herself. I was so desperate to believe that my girl had found herself a friend, that she was opening herself up to human contact again, that I may have cast a blind eye to warning signs that would have otherwise been obvious.

Looking back now, she did appear to be a dark presence. Almost rough. Perhaps she was the one who started my daughter down the darker path she's been following since we came here. I'm not sure. I've since seen her lingering about the house this past month, but Chanchala comes inside and hides in her room, away from the girl. I just view this as further evidence to my theory.

Of course I made my daughter quit the drugs and avoid the older girl, but within a day she began to act odd. Shaking, sweating, staying up all night, muttering to herself. Like she was extremely anxious, or nervous. At first I thought it was because her old acquaintance kept lingering about, but the symptoms persisted even when the strange girl did not. We had to go back to the hospital and they said they were typical, if not a bit extreme, withdrawal symptoms. What makes me think she's faking it is that she only acts that way when alone, or when her father is not home. But the doctors said that if she were showing signs, they'd have to treat it as such. Again, I'm not really sure I completely understand. So, 15 would be her age of onset, though I am not certain how long she has been taking the drugs themselves.

If you are receiving treatment for an ongoing medical complaint, please list prescriptions, strength of dose, frequency of dose, and other treatment plans below:
She's not getting any medicines for it. The doctor says councelling is best, but it doesn't seem to be working. She's just getting more and more anxious. It's reached a point where I dread her coming home, because I just don't know what to do with her. I just can't find my precious daughter in her anymore. She is getting some medication for her depression, however, so, perhaps it is best for me to add that here. Her doctor prescribed Prozac and therapy for her depression about two years ago now. She takes 20mg each day.

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:
She was taking LSD or Acid. I'm not really sure, and I didn't really care what it was specifically. I just wanted her to stop, so we got rid of it all. She's not doing it anymore. I do not believe she has ever had alcohol. Her father locks it up away from us and only brings it out when he has friends over.

_____________________________________________________________


Psychiatric History:

Have you been diagnosed with any psychiatric issues? If so, please list diagnoses and age of diagnoses below:
Depression, diagnosed at age 14. I've also seen marks on her that I think are self inflicted. It pains me to think that she may hurt herself, but I don't think anyone has attacked her save for two years ago. I honestly don't think any of this came about because she dislikes her looks or anything like that. I think it's a combination of things.

If you answered yes to the above, please list any and all prescriptions, including dosage and frequency of dosage, and other treatment plans below:
Prozac 20mg each day. Also she goes to therapy in an attempt to help. It doesn't seem to be working. She just comes back more agitated than she was when she left. It's come to the point where I just can't handle her anymore. Even the doctors are worried. They don't see much improvement in her either. In fact, the therapist who was seeing her for the past two years said it's as though she's only getting worse. He suggested we may need to find some other way of getting her special care.

If you answered yes to the above, please describe noted feelings, symptoms, triggers and incidents associated with the diagnoses, and ages of incidents below:
She becomes really quiet, and doesn't look up at anyone, unless they specifically tell her to. She just looks down at the ground, most of the time. Sometimes she'll lock herself away in her room. She hasn't been doing this recently due to some new rules in the house, but this is causing me a lot of trouble as well. She becomes very anxious around men, especially. Which isn't too strange, really. All of this started after something horrible happened in India, before we moved to America. Her father is extremely disappointed in her for it, but I can only worry. She was so young, only thirteen, and she was just in the wrong place at the wrong time. And that man was evil. I know it, so no one can say my daughter was in the wrong. But after he had his way with her, and my husband found her stumbling home in tatters, we simply had to leave. America seemed like a good place to escape to, but now I wonder, because it was here that she found those drugs. And now she's just anxious, sad and closed off all the time. She's not the same.

And, while I do not intend to say anything ill about my husband at all, because he is a good man, and has taken good care of us, and I am grateful to him, I am afraid he has always been harsh and heavy-handed around Chanchala. And it only increased after the rape. It's almost as though he blames her. She sees this and blames herself as well, which in turn makes her hate herself. I've heard her mumbling things like "worthless" and "soiled" before, and it worries me that she has lost all sense of self worth, in part because of her father's treatment.

Have you ever been hospitalised for these diagnoses? If yes, please provide facility name(s) and age of admissions and discharges:
We never took her to the hospital for her depression, or for the incident. Only regular check-ups and psychologists. And only after I spent weeks trying to coax my husband into allowing it.

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:
None. My family is very healthy.

_____________________________________________________________


Environmental History:

Are you aware of any complications during your birth? If yes, please explain below:
No complications. She was a strong baby, and for my first pregnancy, it seemed very easy, compaired to my mother's stories. Perhaps I was lucky. I've been pregnant two times after her, but both her brothers were still-born. Nothing could be done to save them, and they were very difficult pregnancies.

Are you aware of any difficulties in development during your infancy, such as learning disabilities, speech impediments, etc? If yes, please explain below:
Chanchala was always a smart, good girl. She never had any trouble. She grew at a very nice, average pace. She was always sweet, and always quiet. She rarely cried. I was a lucky mother. We were worried for a while, when she didn't speak when other children her age were. But we received a shock when the first thing out of her mouth was a full sentance. A small one, but a whole one, none-the-less. It was like she was taking her time and learning properly before trying it out.

Are you aware of any long term separation from your mother during your infancy? If yes, please explain below:
Never. She was always with me. And if I wasn't holding her, my mother was, right next to me.

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:
We raised her in India. In a close-knit community. Everyone knew each other and loved Chanchala. She had a huge family of everyone we lived around. She was happy, until that day. But that man, he was a stranger, someone from another town. No one knew him, and no one could name him. Most of the people wanted to be supportive, but it's difficult with a man as stubborn as my husband pushing people away out of shame.

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:
Like I said, she was always very smart. Such a good girl. She was proud to come home with compliments for us from her teachers. Things have been different over the past two years. I wouldn't say she's struggling, as that, to me, means she's putting in a lot of extra effort and getting nowhere with it. Truthfully, it's as though she completely stopped thinking about her schooling at all. She never gets the compliments she used to. Just last week her teacher spoke to me of her disintrest in class and her classmates.

Do/did you have many friends growing up? Do/did you have a best friend? If yes, please explain below:
She had many friends! All the children in our town played together and got along very well. There were a few exceptions, but Chanchala wasn't one of those. She was always surrounded with smiling faces. She didn't have one best friend. She did have three girls whose company she preferred over the rest, however. She was coming home from playing with them when she was attacked. She refused to even look at them, after that. Not like she blamed them. But as though she were ashamed to let them see her face.

Do/did you pursue any extra curricular activities or talents? If yes, please explain below:
Not that I'm aware. She always comes straight home from school to help me around the house.

If sexually active, please list age of onset and sexual preference below. If not sexually active, are you aware of a sexual preference?:
A child her age? I don't think she would have, if she had had the choice. My daughter is not like that. Besides, she's so scared of men, I can't imagine finding someone to want her will be easy. She has a much easier time around females, but the thought of her wanting one of her own gender is forbidden. Not allowed.

_____________________________________________________________


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:
Yes. She was taking LSD for some time, I'm not sure how long, or where she found it. But it just made everything worse.

Have you ever been convicted of a crime? If yes, please list conviction, age of conviction and circumstances below:
Chanchala is a good girl. She does not break laws often. And save for the drugs, I cannot think of anything serious she's ever done. She wasn't even convicted for the drugs. They just decided to put her on the path to recovery. Her father and I are dealing with the conscequences, which is one of the reasons we are even considering sending her away. Perhaps she will be safe from all this trouble away from us.

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

Have you ever knowingly committed a crime for which you were not convicted or sentenced? If yes, please explain below:
Just the illegal drug usage.

_____________________________________________________________


Personal Interview:

Describe yourself to the best of your ability in only five words:
My mother says I need to fill this part out in blue so you can tell what I've written and what she has. I'm sorry if I do it wrong.


  • ruined
  • useless
  • trapped
  • quiet
  • cold


Is the glass half empty, or half full? Explain your answer below:
What glass? I do not understand this question.

If you could change only one thing in your life, what would it be, and why?:
Me. Everything I touch spoils. It would be better if I weren't me.

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 a bad person. I hurt my mother, and my father hates me. And it's my fault. I didn't help things when I did break a law, I just made things worse. But it made me hurt less, so I couldn't help it. If I had just come straight home from school that day, none of this would have happened, and I could still be a good girl for my mother, and make her smile. But I ruined it.

What are your goals in life, and how do you feel those would be best accomplished?:
To either be a good daughter, and make my mother smile again, or just disappear so she doesn't need to be burdened with me any further.

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?:
My mother asked father. Father thought about it. I told him at least I would be somewhere else where I couldn't make things worse for them anymore. That made him angry for some reason and he screamed that my mother should just send me, then. So mother has been filling out the papers. It would be nice if you could make me better, though perhaps disappearing there might be easier? That would be good, too.

After reading over what my daughter has written to you, I am beginning to believe even more that this may be a good decision. She is obviously very hurt, and feels very alone. And I am failing her as a mother by being incapable of protecting her and helping her. Perhaps you are the only chance I have of getting my baby back. Please, help her in the way I cannot. I cannot stand the idea that she will feel this pain forever. Help her to see that she is still a good girl, and can still make me smile. I need 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:


    Amrita Jai 05/18/2011
    Chanchala Jai 05/18/2011






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

.


Last edited by Chanchala Jai on Wed May 18, 2011 11:10 pm; edited 1 time in total

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Chanchala Jai Empty Re: Chanchala Jai

Post by Admin Space Wed May 18, 2011 10:42 pm

-Pending-
_____________________________________________________________

This application is currently pending. Below, you'll find the reasons for this pending notice. If you wish to continue the application process, please follow the points laid out below by a member of STC's staff.
_____________________________________________________________

  • I think you have a great character here, there's just one little thing we need you to expand on before we can get Chanchala approved.

  • Where is she getting her drugs from? There's no mention of any shady friends or anything that could explain it, we'd just like to know where it's coming from. Once we know that, we'll be happy to approve her.

_____________________________________________________________

Please reply to this thread once you have edited your application, to let us know, and a member of STC's staff will review your application again at our next possible convenience..
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Chanchala Jai Empty Re: Chanchala Jai

Post by Guest Wed May 18, 2011 11:11 pm

Perhaps that is what you are looking for. Edit in "If yes, list age of diagnoses by medical professionals, or age of onset below:" section.

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Chanchala Jai Empty Re: Chanchala Jai

Post by Admin Space Wed May 18, 2011 11:19 pm

Chanchala Jai Stchristinaslogobase
_____________________________________________________________
-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: Bennett
Ward: B
Room: 1
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:Drug Abuse
      Psychiatric Issues
      Depression/Suicide Risk


_____________________________________________________________

Final Application Approval Steps for Players:

Your assigned membergroup is: Adolescent 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] Jai, Chanchala
[b]Primary Study Group:[/b] Drug Abuse
[b]Primary Therapist:[/b] Dr. ___________
[b]Building:[/b] Bennett
[b]Ward:[/b] B

[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.)

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