Counseling-treatment-plan.docx

Counseling Treatment Plan Client Name: ________________________________________ Reopen Date: _______________

Case: ________________

Inactive: _____________

Symptom rating for level of functioning change (scale 1-5; 1-mild, 3-moderate, 5-severe) Decrease in energy Panic attacks Anxiety Poor concentration Legal problems Impulsivity Substance abuse Other:

Restlessness Cruelty Sleep disturbance Indecisive Irritability Worrying Ritualistic Behavior

Hopelessness Loss of pleasure Withdrawn Mood swings Helplessness Aggression/rage Low self-esteem

Excessive guilt Depressed mood Oppositional Violation of rules Eating disturbance Tearfulness Low motivation

Changes in Psychosocial/ Psychological level of distress: Greater: ____ Less: ___ None: _____ Changes in physical status: _____________________________________________________ Reports received/ Ancillary services documented: ___________________________________ Treatment Plan: Progress toward /modification of goals and objectives, with estimated completion dates: _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Changes in treatment criteria: yes _____ no _____ if yes, note changes:

_____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

Sessions per month: ____ Client concurred: yes ___ no ___ Dx Code (original): ________________________________________________________ Dx Code (current): ________________________________________________________ URC: _____________________________________

__________________________________

__________________________________

Psychologist

Social Worker

Date

Date

__________________________________

__________________________________

Psychiatrist

Therapist

Date

Date