Revised 2.24.21
Rahill Diagnostic Worksheet 2021
Student’s Name: ____________________________ “Client’s” Name: ____________________________
Categories/ conditions to rule out/consider
Circle 1
Explain
Is there a current or previous medical condition that could contribute to client’s observed/ documented or reported symptoms
Yes
No
Is there a known medication that the client is taking or has recently stopped taking that may contribute to client’s observed/ documented or reported symptoms?
Yes
No
Is there evidence of current or a history of substance abuse/misuse or withdrawal that may contribute to client’s observed/ documented or reported symptoms?
Yes
No
Are there cultural factors (as defined by the DSM-5 cultural formulation interview) that may contribute to client’s observed/ documented or reported symptoms?
Yes
No
Unsure
First Diagnosis (With Specifiers)
Differential Diagnoses for First Diagnosis
Main Reasons for Ruling out these diagnoses
Second Diagnosis (if applicable) (With Specifiers)
Differential Diagnoses for Second Diagnosis (If there is a second diagnosis)
Main Reasons for Ruling out these diagnoses
Known Details that led you to the First Diagnosis
DSM-5 Criteria
(Relate to “known details” – include letters, numbers, & key words, e.g.: A1. Inflated self-esteem)
Known Details that led you to the second Diagnosis (if there is a second diagnosis)
DSM-5 Criteria