As taken by Zac Riddler

LOWER LOUISIANA JUVENILE CENTER
PRELIMINARY PATIENT QUESTIONNAIRE/INTAKE FORM

Please answer all questions and complete all fields

Character Name (First, Middle, Last)
Mitzi Kuhn

Avatar Name (if different than above) mitzi Cao

Age: 14

Grade & School: Freshman, 9th grade, - homeschooled
University of PA - summer program

Race/Ethnic Background:
"I'm lots a stuff I got Spanish an Indian from mah Ma an Creole Black an more Indian from pops. I'm like a mix ya know" ( quoted from Mitzi )

Please list name and relationship of child's guardian(s).:

Hali Hinkles - Mother
Jake Kuhn - Father

Please note the infraction which resulted in the child's current detention:
**Signed in as incoragable by her father as the official reason**
Was arrested for resisting arrest after kicking an officer in the knee splitting his stitches open and running in an attempt to help Rabid avoid
getting arrested with her drug stash on him. Since she has no other run in with the laws the arangement was made to keep it off the perminant record

Please detail below the child's criminal history.
Extensive drug use which ended up escalating from pills pot and booze to cocain which is what lead to this incarceration.
Has been in fights but always self defence except for the attacking the officer while high on cocain
has robbed TT's wasn't caught but a description was given to the cops;

Please detail any previous psychiatric/counseling sessions the child may have been involved with prior to arrival at LLJC.
Appointment had been made for Self injury when she was discovered cutting but she never attended
Rehab type appointments have been schedualed for after her release for her drug use.

Please detail medical history (physical or psychological) of which the LLJC staff should be aware. (ie. diabeties, schizophrenia, Tourette's Syndrome, etc.)
She's got scars in various stages of healing up and down her arms from cutting
She just got over a case of the normal flu but is no longer contagious
Has a scar across her face and gets ocasional headaches from an ax to the head
Was treated for a drug OD
otherwise is healthy and her only hospitalizations have been related from street attacks and one explosion

Please detail any medications and the corresponding doses the child has been prescribed.

none