MASTER 1TREATMENT PLAN |
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ADMIT DATE 3/17/06 |
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DIAGNOSIS (psychiatric evaluation) AXIS I Enter Axis I Diagnosis |
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STRENGTHS From Psychiatric Evaluation [MD] |
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IDENTIFIABLE DISABILITIES From Admitting Nursing Assessment [RN] |
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PROGNOSIS From psychiatric evaluation |
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1. Suicidal AMB Enter signs and symptoms or supporting data R/T Enter etiology 2. Show treatment of an approved DSM IV Diagnosis AMB Enter signs and symptoms or supporting data R/T Enter etiology 3. Frequently occurring problems AMB Enter signs and symptoms or supporting data R/T Enter etiology |
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1. State goal in objective terms 24 hrs before dc 2. State goal in objective terms 24 hrs before dc 3. State goal in objective terms 24 hrs before dc |
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Target Date |
Date Met |
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1. State goal in objective terms Within 48 hrs |
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Special procedures for health and safety. Nursing staff will: |
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Name RN |
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MEDICATIONS: MD will prescribe and nursing will
administer medications. Both disciplines will monitor and assess for efficacy
and adverse side effects |
Name MD Name RN |
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Use this space to note any non-standard
orders: |
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Diet: Diet |
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Discharge and aftercare plans. Staff SW will: |
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GOALS |
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Plans for Continuing Care. Staff SW will: |
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GOALS |
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Activities: |
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GOALS |
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MD Signature: Date: |
Social Worker Signature: Date: |
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Nursing Signature: Date: |
Activity Worker Signature: Date: |
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TREATMENT PLAN REVIEW: |
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