PHILIP PEZESHKI, MPA, MS A Calm Connection d/b/a 34 Patchen Road, #APFC, South Burlington, VT 05403 Licensed Clinical Mental Health Counselor Licensed Drug and Alcohol Counselor (802) 658-4208, x114 (vm), acalmconnection@gmail.com MENTAL HEALTH, MEDICAL, and ADDICTION HISTORIES Please list your experiences and treatment of mental health, medical, and addiction challenges: Mental health challenges symptoms/diagnosis dates (first, last) reason/circumstance treatment/outcomes Mental health and medical medications name of medication dosage outcomes dates (first, last) Medication Assisted Treatment (“maintenance”) medications name of medication dosage dates (first, last) prescribing facility/doctor outcomes Psychiatric challenges/crisis episodes symptoms/diagnosis dates (first, last) reason/circumstance treatment/outcomes Major medical history (diabetes, hypertension, head traumas, heart problems, asthma, cancer, etc.) medical hospitalizations/operations (w/approx. current health problems past health problems
PHILIP PEZESHKI, MPA, MS d/b/a A Calm Connection Licensed Clinical Mental Health Counselor 34 Patchen Road, #APFC, South Burlington, VT 05403 Licensed Drug and Alcohol Counselor (802) 658-4208, x114 (vm), acalmconnection@gmail.com MENTAL HEALTH, MEDICAL, and ADDICTION HISTORIES Please list your experiences and treatment of mental health, medical, and addiction challenges: Mental health challenges symptoms/diagnosis dates (first, last) reason/circumstance treatment/outcomes Mental health and medical medications name of medication dosage dates (first, last) outcomes Medication Assisted Treatment (“maintenance”) medications name of medication dosage dates (first, last) prescribing facility/doctor outcomes Psychiatric challenges/crisis episodes symptoms/diagnosis dates (first, last) reason/circumstance treatment/outcomes Major medical history (diabetes, hypertension, head traumas, heart problems, asthma, cancer, etc.) current health problems past health problems medical hospitalizations/operations (w/approx.