PRELIMINARY 1TREATMENT PLAN |
|
|||||||
ADMIT DATE 8/3/06 |
||||||||
PRELIMINARY DIAGNOSIS (admission orders) Enter provisional Axis I diagnosis |
||||||||
STRENGTHS ____________________ [MD] |
____________________ [SW] |
|||||||
IDENTIFIABLE DISABILITIES From Admitting Nursing Assessment [RN] |
____________________ [SW] |
|||||||
ELOS ____________________ |
PROGNOSIS ____________________ |
|||||||
1. Show medical necessity: 5150 criteria 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 |
|||
1. State goal in objective terms 24 hrs before dc 2. State goal in objective terms 24 hrs before dc |
|
||
Target Date |
Date Met |
||
1. State goal in objective terms Within 48 hrs |
|
||
PRELIMINARY
TREATMENT PLAN |
|
Special procedures for health and safety. Nursing staff will: |
|
|||||||
Name RN |
|||||||||
|
|||||||||
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 |
||||||||
Use this space to note any non-standard
orders: |
|||||||||
Diet: Diet |
|||||||||
PRELIMINARY
TREATMENT PLAN |
|
Discharge and aftercare plans. Staff SW will: |
||
GOALS |
|
||
|
|
||
|
|
||
|
|
||
|
|
||
|
|
||
|
|
|
|
|
Plans for Continuing Care. Staff SW will: |
||
GOALS |
|
||
|
|
||
|
|
||
|
|
||
|
|
||
|
|
||
|
Activities: |
Name AT |
|
GOALS |
|
||
|
|
||
|
|
||
|
|
||
|
|
|
|
MD Signature: Date: |
Social Worker Signature: Date: |
||
Nursing Signature: Date: |
Activity Worker Signature: Date: |
||
|
TREATMENT PLAN REVIEW: |
||