Treatment Plan printable pdf download

Treatment Plan

MHRT CTO template updated May 2015

To be printed on the letterhead of the Community Mental Health Facility

TREATMENT PLAN

Client’s Name:

Date of Birth:

Client’s Address:

Mental Health Facility:

Mental Health Facility Address:

Director/Deputy Director of Community Treatment:

Treating Doctor/Psychiatrist:

Psychiatric Case Manager:

Date:

GOALS OF TREATMENT

(Set out specific goals relevant to the client including a brief description of

how the client will be supported to pursue their own recovery)

•

RESPONSIBILITIES OF THE (insert name of Mental Health Facility)

(Set out an outline of the proposed treatment, counselling, management,

rehabilitation or other services to be provided by the Mental Health Facility

to meet the needs and circumstances of the client)

•

(insert client’s name)’S OBLIGATIONS (include as required)

1. (insert client’s name) must take the medication as prescribed and/or varied by

(insert name of treating doctor) or delegate.

Current Medication:

Medication

Dose

Oral/Intramuscular Frequency

Treatment Plan