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Outpatient Services

2001 Claflin Rd.

Manhattan, KS 66502

September 18, 2001

Leonard Robinson

Jayhawk Plaza Suite 140

PO Box 8138

Topeka, KS 66608-0138

Dear Mr. Robinson:

R E C E I V E D

S E P 1 S 2 0 0 1

This is to confirm that I met with Claudine Dombrowski on A.ugust 23, 2001 forevaluation and have seen her for four subsequent psychotherapy sessions. The

major stressor with which Ms. Dombrowski is attempting to cope, is related to the

custody of her daughter Rikki. Ms. Dombrowski is distressed that Rikki is living

with her father, a man with a history of perpetrating domestic violence. Ms.

Dombrowski is therefore, verj concerned about her daughter's welfare.

I have no reason to believe that Ms. Dombrowski is not a loving and competent

parent, who wants what is best for her daughter. Ms. Dombrowski's anxiety and

depression appear to be situational, a normal response to a distressing situation.

Sincerely,

Bonnie Uffman, Ph.D.

Outpatient Therapist

Addendum: I am enclosing a copy of my intake evaluation of Claudine

Dombrowski.

BU/nm

DivisIOn Offices: 2001 Claflin Road

Manhattan, KS 66502

785-587-4300 FAX 785-587-4305

814 Caroline Avenue

Junction City, KS 66441

785-762-5250 FAX 785.762-2144

210 W. 21", Po. Box 585

Concordia, KS 66901

785-243-8900 FAX 785-243-8933

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DOtvIBROWSKI, Claudine

ill #:2001-0890

IDENTIFY1:-JG DATA:

ThITAKE EVALUATION

Bonnie Uffman, Ph.D.

August 23, 2001

A.rnt.Of Time: 60 minutes

Tne client is a thirty-six year old married Caucasian female. She shares a home in .'vlanhattan with

her husband. She is not currently employed.

REFERRL\.L SOURCE A .i'J1 ) REASO~- FOR REFERRAL:

Tne client is self-referred. She stares that she that she is a victim of domestic viole::lce and that her

child is in the custody of the abuser.

PRESE~l'[0;'G PROBLE.'v[:

Tne client reports that she is here for support as she faces custody issues of her six-year-old

daughter. hIe diem reports that sh"":ceDecember or last year her six-year-old daughter has been

in the custody of her daughter's fathe. The clie::ltreports tb.at this father has bee::labusive both to

the client and to the child. B'1e clie::lt repons that she is allowed only two one-hour supervised

visits per week with her daughter. She states that this is the result because she reported her rape

and battery to the police when she had been ordered by the authorities not to contact them for any

reason. The client is very concerned about the curre::ltsafety of her daughter. Tc1ecliem believes

that her ex-husband's only reason in maintaining custody of their child is because he wants topunish her, the client.

BACKGROl ~1)Il'JFOR.y[ATIOl'J:

Familv Configuration and Data/tarlv Development: The cliem reports having grown up in

western Kansas with her mother, step-father, two younger sisters, and one younger brother. She

states that her mother and stepfather married when the client was four years of age. Tne client did

nor meet her biological father until she was eighteen years of age. Tne client describes her familY'-' '-' ., - ."

life as having been "pretty much fun." She reports that the only exception to this was a one year

period when she was in foster place:nem.

Educational Historv: The client completed high school in 1983 in Topeka, Kansas. She states that

she has been in and out of the military for the past nine years and that during her years ~g the

military she completed a LP~ (License Practical Nurse) certification. "Y'

INTAKE EVALUATION

DONIBROWSKI, Claudine

August 23, 2001

Page 1



Employment History: The client reports a total of approximately thirteen years of employment as

a psychiatric LPN. She has worked at Lamed State Hospital, Topeka State Hospital, and the VA

Psychiatric Unit. She was employed at Lamed State Hospital until approximately one year ago.

Medical Historv: The client lists Dr. David Jones of St. Marys, Kansas as her primary care

physician. She states that she has known him for a number of years. The client reports having

had a head-on collision with a school bus on ice in January of 1999. She reports that her most

serious injury at that time was a crushed foot and she reports that she experiences residual

disability as a result of this. She is able to be on her foot for a ma.mum of one-and-a-half hours

per day at this time. The client's medications include Klonopin, one milligram up to four times

daily; Serzone, 20 0 mg BID; Prilosec: Ha1cion, .25 mg which she takes as needed for sleep. The

client lists her general health as being good; however, she describes her appetite, sleep. and energy

level as poor.

Alcohol and Drug Historv: The client reports that she uses wine approximately twice a week. She

denies any usage of illicit drugs. She denies any history of abuse of alcohol or other drugs.

L e Q ::J .I Historv: Denied.

Treatment Historv: The client repcr:s having seen a therapist in the mental he:llth center in Gre::l.t

Bend for sever:ll years. She stmes that she sought counseling in order to cope with issues of

domestic violence.

Dating/~rarital Historv: Tne client first married at age tV,ienty-four. Tnis marriage lasted for five

years. She states that it ended amicacly as a result of she anJ her husband having different goals.

Subsequent to this, the client met her second husband and they married when their daughter was

ten months of age. The client states that this was an abusive relationship from the time that shewas four months pregnant. She states that she married her daug.hter's fau~er only so that she

would be able to get her daughter back from the daughter's father. She states that she and her

husband did not live together for more than several days past their marriage date.

Historv of Aggression Toward Selli'Others: Denied.

j \; fE)[TAL STATUS StTMi 'vLARY:

Tne client was alert and oriented in all three spheres. Her affect was dysphoric, congruent with

her described mood. The client's intellectual functioning appears to be average to perhaps aboveaverage. She displays no impairment of either recent or r~mote memorj. Her thought, sensory

and perceptual processes are all within normallirnits. The client's judgment and insight appear to

be adequate. There is no evidence of a suicidal or homicidal ideation or plan.

INTAKE EVALUATION

DOMBROWSKI, Claudine

August 23,2001

Page 2



DIAGNOSTIC EvlPRESSION:

AXIS I:

A.'XIS II:AXIS III:

A.'XIS IV:

A.'XIS V:

309.18 Adjustment Disorder \Vith Mixed Anxiety and Depressed Mood

V7!.09 No DiagnosisResidual Disability from a c ar accident in 1999 according to client report.

Psychosocial Stressors: Client reports having sun'ived and left an abusive

relationship and is no\v distressed that her child is in the custody of the abuse:-.

This is of course a severe stressor.

Current GAF: 80

RECO~E'v1E:-;DATIONS:

Psychotherapy with the undersigned is recommended. A . psychiJtric enlUJtion to e';:J.!uatc the

client's psychotropic medications is Jiso recommended.

PROG:-;OSTS:

The prognosis depends gTeatly upcr. the outcome of the clie:1r"s cur-erlt legal baIlIes to regain

custody of her daughter.

'--'-~

S - - t = = r'L~Steven D. Eshelman. MD

:v1edic:J.lDirector

BC,slp

R: 08/23/200!

;1: 08/28/200!

C: 09/04,200!

INTAKE EVALUATION

DOMBROWSKI, Claudine

~";"/""I

\V1(H£~~/~-it)nnie Cffinan. Ph.D.

Outpatient T'ne:-apist

August 23,2001

Page 3