PRELIMINARY 1TREATMENT PLAN Internet		HUMBOLDT COUNTY HHS MENTAL HEALTH BRANCH / SEMPERVIRENS
PATIENT NAME Donna Larsen	ADMIT DATE 1/25/08			DATE / TIME OF PLAN 1/25/08 00:30 hrs
PRELIMINARY DIAGNOSIS Borderline personality d/o, PTSD
STRENGTHS ____________________ [MD]		Access to services [RN]			____________________ [SW]
IDENTIFIABLE DISABILITIES Poor coping skills [RN]						____________________ [SW]
ELOS ____________________			PROGNOSIS ____________________

Problem / Reason for Hospitalization (prioritized) 1. Self harm behavior AMB Pt. threatening to escalate, harm self. Has long hx of self-mutilation and suicidal ideation and suicide attempts R/T MI and ineffective coping with strong negative emotions
2. Medical Concerns: a. IDDM b. Hyperlipidemia
Long Term Goals [Discharge Objectives]
1. Pt. willl not harm self, express hope and optimism for her future 24 hrs before dc 2. Pt's medical concerns will remain stable during her hospitalization and pt. will agree to F/U as needed with pci 24 hrs before dc
Short Term Goals	Target Date	Date Met
1. Pt. will contract no self harm behavior qday and prn when feeling self harm impulses. Will comply with medications offered to diminish thoughts of self harm Within 48 hrs	1/27/08
2. Pt. will comply with all assessments, treatments and medications prescribed for medical concerns Within 48 hrs	1/27/08

Client signature: Date:

PRELIMINARY TREATMENT PLAN

PATIENT Donna Larsen Admit Date: 1/25/08

						[Name and Title]
	Special procedures for health and safety. Nursing staff will:
LTG #1	Offer 1:1 to build / reinforce trust and rapport and establish alliance. Encourage pt. to verbalize intent to not self harm Q shift when awake. Examine coping skills that have worked in the past / draw on pt. strengths. Explore pt.'s strengths and applications to selecting a positively reinforcing lifestyle and future plans Offer med education with each medication pass and encourage attendance at medication education group					S. Ferrogiaro RN
LTG #2	Assess pt.'s understanding of medical concerns and commitment to med compliance / healthy lifestyle. Educate as indicated and reinforce commitment -- encourage pt. to take an active role in preventative measures r/t her medical concerns					S. Ferrogiaro RN
MEDICATIONS: MD will prescribe and nursing will administer medications. Both disciplines will monitor and assess for efficacy and adverse side effects						M. Chaudhry MD S. Ferrogiaro RN
Medication		Dose	Route	Frequency	Reason for medication
Lipitor		20mg	BY MOUTH	BED TIME	High cholesterol level in blood
Revia		50mg	BY MOUTH	EVERY MORNING
Thorazine		200mg	BY MOUTH	4PM AND BED TIME	Agitation
Cymbalta		60mg	BY MOUTH	EVERY MORNING	Depression
Seroquel		200mg	BY MOUTH	AM, NOON, BEDTIME	Psychosis
Use this space to note any non-standard orders: Humulin Insulin 70/30, 65 units under the skin, every Blood sugar level (glucose) before insulin administration for safety
Diet: 1800 cal American Dietary Association diet, no concentrated sugar, low fat, low cholesterol

PRELIMINARY TREATMENT PLAN

PATIENT Donna Larsen Admit Date: 1/25/08

			[Name and Title]
	Discharge and aftercare plans. Staff SW will:		Name LCSW
GOALS	Obtain releases of information for PMD, family, significant other, to gather information and make discharge and aftercare treatment plans
	Plans for Continuing Care. Staff SW will:		Name LCSW
GOALS	Enter first intervention
	Activities:		Name AT
GOALS	Enter first intervention
MD Signature: Date: M. Chaudhry MD		Social Worker Signature: Date: Name LCSW
Nursing Signature: Date: S. Ferrogiaro RN		Activity Worker Signature: Date: Name AT
		TREATMENT PLAN REVIEW: