RECEIVED

Outpatient Services
2001 Claflin Rd.
SEP 1 S 2001
Manhattan, KS 66502

September 18, 2001

Leonard Robinson
Jayhawk Plaza Suite 140
PO Box 8138
Topeka, KS 66608-0138

Dear Mr. Robinson:

This is to confirm that I met with Claudine Dombrowski on A.ugust 23, 2001 for
evaluation 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 814 Caroline Avenue 210 W. 21", Po. Box 585
Manhattan, KS 66502 Junction City, KS 66441 Concordia, KS 66901
785-587-4300 FAX 785-587-4305 785-762-5250 FAX 785.762-2144 785-243-8900 FAX 785-243-8933

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ThITAKE EVALUATION

DOtvIBROWSKI, Claudine Bonnie Uffman, Ph.D.

ill #:2001-0890 August 23, 2001
A.rnt.Of Time: 60 minutes

IDENTIFY1:-JG DATA:

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::lceand 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 to
punish 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 August 23, 2001

DONIBROWSKI, Claudine 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, 200 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.

LeQ::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 she
was 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 above
average. 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 August 23,2001

DOMBROWSKI, Claudine Page 2
 DIAGNOSTIC EvlPRESSION:

AXIS I: 309.18 Adjustment Disorder \Vith Mixed Anxiety and Depressed Mood
A.'XIS II: V7!.09 No Diagnosis
AXIS III: Residual Disability from a car accident in 1999 according to client report.
A.'XIS IV: 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.
A.'XIS V: 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~ ~";"/""I

\ V1(H£~~/~-
Steven D. Eshelman. MD it)nnie Cffinan. Ph.D.
:v1edic:J.lDirector Outpatient T'ne:-apist

BC,slp
R: 08/23/200!
;1: 08/28/200!
C: 09/04,200!

INTAKE EVALUATION August 23,2001

DOMBROWSKI, Claudine Page 3