LOWER LOUISIANA JUVENILE CENTER
PRELIMINARY PATIENT QUESTIONNAIRE/INTAKE FORM
Please answer all questions and complete all fields
Character Name (First, Middle, Last)
Esperanza Hernadoz-Harper
Avatar Name (if different than above)
Esperanza hernandoz
Age:
17
Grade & School:
senior at st. marys private school
Race/Ethnic Background:
puerto rican (born there)
Please list name and relationship of child's guardian(s).:
Legal guardians: jacinda harper and Noble Spykers
Please note the infraction which resulted in the child's current detention:
assualt of an officer, evasion, possesion, vandalism,
Please detail below the child's criminal history.
whats above plus
assault with a deadly weapon (3 counts at least)
(check criminal recordss for actual charges))
Please detail any previous psychiatric/counseling sessions the child may have been involved with prior to arrival at LLJC.
one session with juvi counselor
one seesion with Kendra Coakes while in Juvie
Please detail medical history (physical or psychological) of which the LLJC staff should be aware. (ie. diabeties, schizophrenia, Tourette's Syndrome, etc.)
Diagnosed in juvie with IED with a possible development of BPD
Please detail any medications and the corresponding doses the child has been prescribed.
none
Child has been assigned sadie