Clinical Assessment Marking and Interpretation Form

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CLINICAL ASSESSMENT MARKING AND INTERPRETATION FORM

NAME OF CLIENT
AGE
BIRTHDAY

RAVEN STANDARD PROGRESSIVE MATRICES (RSPM)


RAW SCORE PERCENTILE GRADE LEVEL

BENDER GESTALT VISUALMOTOR TEST (BGVMT)


BENDER RAW SCORE STANDARD SCORE CLASSIFICATION
COPY
RECALL
*In scoring the Bender-Gestalt Visual Motor Test, you may use your own judgment on how similar the
drawing to the actual image. The rating will range from 0 to 4, wherein 4 is the highest (most similar) and
0 is the lowest (not similar).

*Refer to the manual for the standard score based on the age of the client and its corresponding
classification.

PSYCHOLOGICAL WELLBEING SCALE (PWBS)


RAW MEAN
SUBSCALES ITEMS VI
SCORE SCORE
Autonomy
1 10 13 21 24 35 41
Environmental
Mastery 3 12 15 23 26 36 42
Personal Growth
2 5 14 17 25 28 37
Positive Relations
with Others 4 7 16 18 27 30 38
Purpose in Life
6 9 20 29 32 33 39
Self-Acceptance
8 11 19 22 31 34 40
SCORING:
1. Write the answer (number) in the box at the top of the item number.
2. For highlighted items, write the reverse scoring (e.g., if the client answer 1, the reverse score will
be 7)
3. Add all the raw scores and write it on its designated column.
4. Divide the raw score to 7 (number of items) and write the mean score in its designated column.

VERBAL INTERPRETATION (VI):


 3.99 below – Low
 4.00 and up – High
CALIFORNIA TEST OF PERSONALITY (CTP)
DOMAINS RAW SCORE PERCENTILE REMARKS
Personal Adjustments
Social Adjustments
TOTAL

PERSONAL ADJUSTMENTS
SUB-SECTIONS RAW SCORE PERCENTILE REMARKS
Self-reliance
Sense of Personal Worth
Sense of Personal Freedom
Feeling of Belonging
Withdrawing Tendencies
Nervous Symptoms
SOCIAL ADJUSTMENTS
Social Standards
Social Skills
Antisocial Tendencies
Family Relations
Occupation Relations
Community Relations
SEVERITY [based on T-scores]
75 above Moderate to Severe
65 – 74 Minimal to Mild
64 below NMS (No Marked Severity)

CATEGORY
70 above Clinical
60 – 69 Subclinical
59 below Low

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