.| .| Client Evaluation of Motivational Interviewing| | Date Given: <.Date_Given.>| Clinician: <.Staff_Ordered_By.>| Location: <.Location.>| | Veteran: <.Patient_Name_Last_First.>| SSN:
<*Answer_7333*>| 15. Help you feel confident in your ability to change your behavior.| <*Answer_7334*>| 16. Help you recognize the need to change your behavior.| <*Answer_7335*>| | |
Information contained in this note is based on a self-report assessment and is not sufficient to use alone for diagnostic purposes. Assessment results should be verified for accuracy and used in
conjunction with other diagnostic activities and procedures.| $~
<.Patient_SSN.>| DOB: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)| Gender: <.Patient_Gender.>| | | | Technical Factor: <-Technical Factor->| Relationship
Factor: <-Relationship Factor->| | CEMI Total: <*Answer_7772*>| | | Scores range from6-64 with higher scores being more motivational Interviewing (MI)consistent| |
Questions and Answers| | 1. Focus on your weakness.| <*Answer_6405*>| 2. Help you to talk about changing your
behavior.| <*Answer_6406*>| 3. Act as a partner in your behavior change.| <*Answer_6407*>| 4. Help you to discuss your need to change your behavior.| <*Answer_6408*>| 5. Make you
feel distrustful of him/her.| <*Answer_6409*>| 6. Help you examine the pros and cons of changing your behavior.| <*Answer_6410*>| 7. Help you to feel hopeful about changing your
behavior.| <*Answer_6411*>| 8. Argue with you to change your behavior.| <*Answer_6412*>| 9. Change the topic when you become upset about changing your behavior.| <*Answer_6413*>|
10. Push you forward when you become unwilling to talk about an issue further.| <*Answer_6477*>| 11. Act as an authority on your life.| <*Answer_6478*>| 12. Tell you what to do.|
<*Answer_6479*>| 13. Argue with you about needing to be 100% ready to change your behavior.| <*Answer_7332*>| 14. Show you that she/he believes in your ability to change your behavior.|
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