Client Needs Assessment/Student Observer Worksheet

This worksheet is for students who have assisted with a forensic medical exam. Please fill out the form below to assist with our data collection endeavors and help us learn more about our clients and their needs. NB: the medical and social resources needs assessment at the bottom of this form should be completed before or after the forensic exam takes place. A downloadable form of this worksheet can be found here.

Student Name *
Student Name
This code should have been emailed to you by the case scheduler prior to your examination date.
Clinician Name *
Clinician Name
Date of Exam *
Date of Exam
Client Demographics
Languages spoken
Migration History
This information can be obtained from client records and/or from your observations during the interview.
Exam Workflow
What was your role as a student?
Medical and Social Resources Needs Assessment: These questions are specific to the client's access to medical and social resources in the US rather than in their country of origin. *Please fill this section out before or after the forensic exam takes place.
What is the address of your attorney's office?
What is the address of your attorney's office?
Have you applied for asylum?
Please check the following resources for which the client needs information: