MASTER TREATMENT PLAN

HUMBOLDT COUNTY HHS MENTAL HEALTH BRANCH / SEMPERVIRENS

PATIENT NAME John   Doe

ADMIT DATE December 17, 2002

DATE / TIME OF PLAN December 20, 2002 10:00 hrs

DIAGNOSIS from psychiatric evaluation: AXIS I Bipolar I Disorder M R E Manic

AXIS II Antisocial Personality Traits

AXIS III Asthma

AXIS IV Letter codes: a, c, e

AXIS V 30 / 55

STRENGTHS Intelligence [MD]

Youth [RN]

Supportive family [SW]

IDENTIFIABLE DISABILITIES Poor communication [RN]

Poor social skills [SW]

ELOS 5 - 7 days

PROGNOSIS Guarded

 

Problem / Reason for Hospitalization

1.   Potential for Harm to Others  AMB Threatening to kill girlfriend  R/T Manic episode

2.   Altered Mood: Manic  AMB Affective lability, pressured speech, grandiosity  R/T Non med compliance

                  

                  

                  

                  

3.   Medical Concerns:   a. Asthma                        

Long Term Goals [Discharge Objectives]

1. Will state two positive alternatives to acting out when angry 24 hrs before d/c

2. Affect will stable, speech normal, will not make grandiose statements 24 hrs before d/c

     

     

     

     

 

Short Term Goals

Target Date

Date Met

1. Will not act out toward self or others 48 hrs

12.22.02

 

 

2. Will take meds to stabilize mood 48 hrs

12.22.02

     

 

     

 

     

 

     

 

 

Client signature:                                                                                                                                                  Date:

 

MASTER TREATMENT PLAN

PATIENT John   Doe                                                                                                   Admit Date: December 17, 2002

 

[Name and Title]

 

Special procedures for health and safety:

 

GOALS

Monitor q 15 min to ensure safety, 1:1 to assess mood and encourage med compliance

Amy Larum RN

    

    

           

    

    

           

 

Medications:

Use this space to note any non-standard orders:

Jonathan Sommers MD

Amy Larum RN

 

Lithium Carbonate 300 mg PO BID

                       

                       

                       

                       

                       

                       

                       

                       

                       

                       

                       

                       

                       

                       

 

 

 

Diet:

Regular

 

 

 

MASTER TREATMENT PLAN

PATIENT John   Doe                                                                                                   Admit Date: December 17, 2002

 

[Name and Title]

 

Discharge and aftercare plans:

Sharon Crockett LCSW

LTG 1

Enter first intervention

 

    

    

 

    

    

 

    

    

 

    

    

 

    

    

 

 

 

 

 

Plans for Continuing Care:

Sharon Crockett LCSW

LTG 1

Enter first intervention

 

    

    

 

    

    

 

    

    

 

    

    

 

    

    

 

    

Activities:

Robert Shoop AT

LTG 1

Enter first intervention

 

    

    

 

    

    

 

    

    

 

 

 

 

MD Signature:                                                                 Date:

Jonathan Sommers MD

Social Worker Signature:                                      Date:

Sharon Crockett LCSW

Nursing Signature:                                                          Date:

Amy Larum RN

Activity Worker Signature:                                   Date:

Robert Shoop AT

 

TREATMENT PLAN REVIEW: