This was signed by rubber stamp:
They was using this information to put records back:
They didn't give me this for my records. I was called by someone claiming to be Social Security claiming that they lost what the Doctor had sent and need me to go to them and get another copy and bring it to them hand delivery.But I got it and kept it. Because they would not have called me to go get it.
George L.(Woods)Miller,III,Psy.D.
Clinical Psychologist
408 E. Bolton Street
Savannah, Ga 31401
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Telephone: (912)447-5530
PSYCHOLOGICAL EVALUATION CONFIDENTIAL
Name: Jamal Faatih
Social Security Number: 256-84-5579
Date Of Birth: 01/12/1953
Adjudicator: Tonya Mounkes
Type of Examination: Three-Hour Disability
Examiner: George L.(Woods)Miller, Psy.D.
Date of Evaluation: March 16, 2005
Reason for Referral
Jamal Faatih was referred for a Psychological Evauation and consultation by The Georgia Department of Human Resources. Specifically, the Disability Adjudication Services has requested the evaluation for the propose of medical documentation for a Federal Disability Claim. Accordingly, Jamal was evaluated in order to ascertain his cognitive, social, and emotional functioning.
Background Information
Jamal is 52- year- old African American male who lives alone in Savannah Georgia.
According to the claimant,he has had a history of heart problems, which has affected his ability to work. According to Jamal, he has no history of mental illness. He was released from prison in 2004 for habitual violator conviction. Jamal reports going to high school to the ninth grade and then dropping out. He also reports he has limited contact with his children and no family support. In school,though he sometimes struggled to stay on task and to comprehend what he was being taught he reportedly was in all regular classes.
Jamal stated that he has a difficult time finding and holding onto job since his incarceration and diagnosis of heart problems. Currently, he spens much of his day at home and mostly watches T.V. and does chores around the house. He indicated that he feels OK and sometimes depressed for most of the time, as evidenced by feeling of hopelessness, helplessness, fatigue,and feelings of low self-esteem. He indicated that he wants to work but that everytime he tries,he fails.
Mental Status and Behavioral Observations
Jamal is a 52-year-old African American male who arrived on time by riding his bike to the office. The date for testing is a rescheduled date due to Jamal's inability to locate the office. He was neatly and appropriately dresed for evaluation. His affect was slightly blunted and his mood was mildly anxious. However,he engaged readily with the examiner and was mostly cooperative throughout testing. He maintained fair eye contact.His psychomotor activity was,for the most part, appropriate,though he did exhibit signs of distress and mild depression.His anxiety might have had a mildly negative impact on test results. His speech was at times slurred and occasionally difficult to understand,though he had to repeat many items asked for clarification. He was oriented to person,place,time and situation.He thoughts were linear, and his associations were logical.His concentration was fair,but he exhibited some impairment with memory. There was no evidence of auditory or visual hallucinations. While he exhibited some signs of dysthymia,he displayed no risk of being dangerous to himself or to others. He denied having suicidal or homicidal thoughts. He also denied drug or alcohol use.
Test Administered
Structured Clinical interviews with claimant
Psychosocial History
Wechsler Adult Intelligence Scale,third edition(WAIS-III)
Reports Reviewed
Disability Report-Adult Form SSA-3368
Intellectual Test Results
WAIS-III
The Wechsler Adult Intelligence Scale-III(WAIS-III) is battery of tests that evaluates intellectual and cognitive abilities.Jamal's scores were as follows.
Composite Scales Score Classification
Verbal IQ 78 Borderline
Performance IQ 89 Low Average
Full Scale IQ 81 Low Average
Vebal Scaled(Raw) Performance Scaled(Raw)
Subtests Scores Subtests Scores
Vocabulary 5 (24) Picture Completion 6 (15)
Similarities 6 (13) Digit Symbol-Coding 9 (15)
Arithmetic 6 (09) Block Design 7 (25)
Digit Span 6 (11) Matrix Reasoning 7 (08)
Information 8 (13) Picture Arrangement 13 (17)
Jamal's subtest scores resulted in a Verbal Scale IQ of 78, a Performance Scale IQ of 89,and a Full Scale IQ of 81. The Full scale IQ of 81 is within the Low Average range of intelligence.Because this score is subject to a small degree of error,the probability is 95% out of 100 that his true IQ is between 72 and 85.The claimant's WAIS-III results would seem to be an accurate reflection of his intellectual abilities.
The Verbal IQ of 78 falls within the Borderline range. The probability is 95% out of 100 that his Verbal Scale IQ is between 74 and 84.The Verbal Scale measures language expression comprehension, listen, and the ability to apply these skills to solving problems. Jamal consistently demonstrates below average abilities in language expression,conceptual thinking, and knowledge.
The Performance Scale IQ of 89 also falls within the Low Average range.The probability is 95% out of 100 that his true Preformance Scale IQ is 83 and 96.The Preformance Scale assesses nonverbal problem solving, perceptual organization,speed,and visual-motor proficiency.Jamal demonstrated that he has below average perceptual skills,does not attend as well to detail as peers his own age and, has a below average ability in differentiating between essential and nonessential details.
Summary and Diagnostic Impressions
Jamal is a 52-year-old African American male who lives alone in Savannah, Georgia.In January 2004 he was release from prison in which he served a 5-year sentence for a habitual violator conviction. He has a history of heart problems he reportedly takes no medications.
On The WAIS III, Jamal achieved a Full Scale IQ of 81, A Verbal Scale IQ of 78, and a Performance Scale IQ of 89,which places him the Low Average range of intelligence.He was cooperative during the test session and showed no signs of delusional thinking or bizarre behavior. He exerted appropriate effort in responding to test questions.however,he experience difficulty in both understanding and expressing concepts and ideas. He did exhibit some memory impairment,which was also probably influenced by his anxiety.The clamant has difficulty processing some information, has a difficult time asking for what he needs,but he does not need continuing assistance with any of his daily living needs. He can bathe and dress himself, can cook and do chores. He has a limited support system and has had no medical follow up since his release from prison.Given observations and test results,the following diagnostic impressions are suggested:
Axis I:
Axis II:
Axis III:
Axis IV: Psychosocial Stressors: Financial Strain
Axis V: GAF Current
Highest Past Year
Despite the lack of any evidential support obtained from this evaluation, Jamal did exhibit some symptoms of a clinical depression,though it does not appear that he meets the criteria for a depressive disorder. Currently, the claimant does not seem to be functioning particularly well and seems to have some substantial limitations. If it should be determined that the claimant requires funds for dis ability, it is the opinion of this Psychologist that someone assit the claimant in managing his funds.
Thank you for this referral.
(Rubber Stamped) George L.Miller III
George L.(Woods)Miller,III,Psy,D.
Georgia Licence# 2167
