PRELIMINARY TREATMENT PLAN Master 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 01:31 hrs
PRELIMINARY DIAGNOSIS from admission orders: Enter Provisional Axis I Diagnosis
STRENGTHS ____________________ [MD]		From Admitting Nursing Assessment [RN]			____________________ [SW]
IDENTIFIABLE DISABILITIES From Admitting Nursing Assessment [RN]						____________________ [SW]
ELOS ____________________			PROGNOSIS ____________________

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:

PRELIMINARY 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

PRELIMINARY 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: