PRELIMINARY TREATMENT PLAN		HUMBOLDT COUNTY HHS MENTAL HEALTH BRANCH / SEMPERVIRENS
PATIENT NAME John Doe	ADMIT DATE December 17, 2002			DATE / TIME OF PLAN December 17, 2002 10:15 hrs
PRELIMINARY DIAGNOSIS from admission orders: Bipolar Disorder MRE Manic
STRENGTHS ____________________ [MD]		Youth [RN]			____________________ [SW]
IDENTIFIABLE DISABILITIES Poor communication [RN]						____________________ [SW]
ELOS ____________________			PROGNOSIS ____________________

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:

PRELIMINARY 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

PRELIMINARY 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: