Case Document Entered on FLSD Docket Page of Place Burman Critton Luttier Coleman Flagler Dr Ste West Palm Beach FL Manner Face-to-face Independent Medical/Psychiatric Examination Duration Anticipated hours Conditions Exam to take place with only evaluator and evaluee in the room with the evaluation being videotaped with appropriate audio and visual recordings Scope Full medical and psychiatric history including chief complaint history of present illness specific complaints of symptoms or injury medical history past psychiatric history family history abuse history birth history childhood history school history occupational history violence history legal history relationship history substance use history sexual history review of systems activities of daily Jiving mental status examination diagnoses using DSM-IV axes and discussion of case findings and opinions Psychological tests and questionnaires Zung Depression Scale Zung Anxiety Scale Mini Mental State Examination MCMI-I MMPI with forensic implications Life History Questionnaire and Forensic Questionnaire Case Document Entered on FLSD Docket Page of No opinion of mine has ever been disqualified in a legal proceeding I declare under penalty and perjury that the foregoing is true and correct Executed this day of J_Vv_ in Lake Mary Florida STATE OF FLORIDA COUNTY OF SEMINOLE 1J:f Nfo MD RY C.W HALL M.D BEFORE ME the undersigned authority personally appeared RYAN C.W HALL M.D who is dT personally known to me or who has produced as identification and who did take an oath deposes and says that the attached Affidavit is true and correct to the best of his knowledge and belief SWORN TO AND SUBSCRIBED before me on this fl day of Nota Printed Name My Commission Expires MARCIA CHAPMAN Comm i El Jllre Fbrlda NoOlly i
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