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.

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.
Please check the following resources for which the client needs information: