MASTER TREATMENT PLAN

Preliminary Plan

Internet

HUMBOLDT COUNTY HHS MENTAL HEALTH BRANCH / SEMPERVIRENS

PATIENT NAME Anil   Mitra

ADMIT DATE August 19, 2003

DATE / TIME OF PLAN August 19, 2003 01:40 hrs

DIAGNOSIS from psychiatric evaluation: AXIS I Enter Axis I Diagnosis

AXIS II Enter Diagnosis

AXIS III Medical condition

AXIS IV Letter codes: / describe stressors

AXIS V Current GAF / Highest GAF - Past Year

STRENGTHS From Psychiatric Evaluation [MD]

From Admitting Nursing Assessment [RN]

From Social Service Evaluation, Item 3h [SW]

IDENTIFIABLE DISABILITIES From Admitting Nursing Assessment [RN]

From Social Service Evaluation, Item 3h [SW]

ELOS Expected length of stay from psychiatric evaluation

PROGNOSIS From psychiatric evaluation

 

Problem / Reason for Hospitalization

1.   Potential for Self-Harm  AMB OD on 90 Klonopin 1mg  R/T MI: Depression

2.   Altered Mood: Depressed  AMB Preoccupation with suicide, poor sleep and difficulty eating  R/T Poor med compliance

                  

                  

                  

                  

3.   Medical Concerns:   a. Asthma                        

Long Term Goals [Discharge Objectives]

1. Will be free of suicidal thoughts 24hours before d/c

2. Will agree to take meds as prescribed after d/c 24hours before d/c

     

     

     

     

 

Short Term Goals

Target Date

Date Met

1. Will not harm self on unit 48 hours

8.21.03

 

 

2. Will comply with meds 48 hours

8.21.03`

     

 

     

 

     

 

     

 

 

Client signature:                                                                                                                                                  Date:

 

MASTER TREATMENT PLAN

PATIENT Anil   Mitra                                                                                                              Admit Date: August 19, 2003

 

[Name and Title]

 

Special procedures for health and safety:

 

GOALS

Intervention

Amy Larum RN

    

    

Amy Larum RN

    

    

Amy Larum RN

 

Medications:

Use this space to note any non-standard orders:

J. Sommers MD

Amy Larum RN

 

Effexor 37.5mg PO QAM AND HS

                       

                       

                       

                       

                       

                       

                       

                       

                       

                       

                       

                       

                       

                       

 

 

 

Diet:

Regular diet

 

 

 

MASTER TREATMENT PLAN

PATIENT Anil   Mitra                                                                                                              Admit Date: August 19, 2003

 

[Name and Title]

 

Discharge and aftercare plans:

Sharon Crockett LCSW

GOALS

Enter first intervention

 

    

    

 

    

    

 

    

    

 

    

    

 

    

    

 

 

 

 

 

Plans for Continuing Care:

Sharon Crockett LCSW

GOALS

Enter first intervention

 

    

    

 

    

    

 

    

    

 

    

    

 

    

    

 

    

Activities:

Jean Shoop AT

GOALS

Enter first intervention

 

    

    

 

    

    

 

    

    

 

 

 

 

MD Signature:                                                                   Date:

J. Sommers MD

Social Worker Signature:                                          Date:

Sharon Crockett LCSW

Nursing Signature:                                                            Date:

Amy Larum RN

Activity Worker Signature:                                       Date:

Jean Shoop AT

 

TREATMENT PLAN REVIEW: