Treatment_Plan_Template

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					                            RIDE TO PRIDE PARTNERSHIP, INC.
                                   TREATMENT PLAN
                                     (Plan to be completed every 90 days)



Client Name:                                 DOB:                           Date:

Client Strengths:

Presenting Problem:


Significant events, safety issues, occurring in the last 90 days. Justification for update/change in
diagnosis if necessary:




Diagnosis:
Axis I:
Axis II:
Axis III:
Axis IV:
Axis V:

                                             **********
1. Goal:

Measurable Objective:


Intervention:


Target date for goal achievement:

Progress: _____No change _____Slight Improvement _____Moderate Improvement
_____Great Improvement _____Slight Regression           ______Moderate Regression
_____Extreme Regression
 _____Underlying issues being addressed to access root cause of symptomology/functional impairment.
Comment:_____________________________________________________________________________
______________________________________________________________________________________


                                             **********



Client name:                               SS#                                        1
2. Goal:

Measurable Objective:


Intervention:

Target date for goal achievement:

Progress:


                                          **********

3. New Goal:

Measurable Objective:

Intervention:

Target date for goal achievement:

                                        ***************

Estimated length of stay:

Barriers to Treatment: (check all that apply)
____None at this time        _____Attendance             _____Resistance to therapy
_____Schedule conflicts                     _____Lack of parent/guardian involvement
Illness: (specify)_____________________________________________________
Other:_____________________________________________________________

Discharge Criteria:

Aftercare Plan:




Submitted by:________________________________________________________________

Printed name of therapist_______________________________________________________



Client name:                             SS#                                           2

				
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posted:12/20/2011
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