MASTER TREATMENT PLAN Preliminary Plan Internet			HUMBOLDT COUNTY HHS MENTAL HEALTH BRANCH / SEMPERVIRENS
PATIENT NAME Marie T. Goddi		ADMIT DATE February 8, 2003			DATE / TIME OF PLAN February 8, 2003 11:13 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. Altered Mood: Manic AMB Intelligent R/T Ma 2. One size does not fit all AMB Idiot R/T Blah
3. Medical Concerns: a. Enter Med Concern b. Med Concern c. Med Concern d. Med Concern e. Med Concern
Long Term Goals [Discharge Objectives]
1. State goal in objective terms Time Frame 2. State goal in objective terms Time Frame
Short Term Goals	Target Date	Date Met
1. State goal in objective terms Time Frame	Enter Date
2. State goal in objective terms Time Frame	Enter Date
3. State goal in objective terms Time Frame	Enter Date
4. State goal in objective terms Time Frame	Enter Date
5. State goal in objective terms Time Frame	Enter Date
6. State goal in objective terms Time Frame	Enter Date

Client signature: Date:

MASTER TREATMENT PLAN

PATIENT Marie T. Goddi Admit Date: February 8, 2003

			[Name and Title]
	Special procedures for health and safety:
LTG 1	Hit pt on head		Trish Goddi RN
			Trish Goddi RN
	Medications:	Use this space to note any non-standard orders:	Name MD Trish Goddi RN
	Medication dose ROUTE FREQUENCY
	Diet: Diet

MASTER TREATMENT PLAN

PATIENT Marie T. Goddi Admit Date: February 8, 2003

			[Name and Title]
	Discharge and aftercare plans:		Name LCSW
GOALS	Enter first intervention
	Plans for Continuing Care:		Name LCSW
GOALS	Enter first intervention
	Activities:		Name AT
GOALS	Enter first intervention
MD Signature: Date: Name MD		Social Worker Signature: Date: Name LCSW
Nursing Signature: Date: Trish Goddi RN		Activity Worker Signature: Date: Name AT
		TREATMENT PLAN REVIEW: