90-Day Mental Health Treatment Plan
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290-DAY MENTAL HEALTH TREATMENT PLAN
NAME (Offender):
AGENCY:
DATE:
1. DSM IV DIAGNOSIS:
2. SHORT TERM GOALS/TIME FRAME:
3. LONG TERM GOALS/TIME FRAME:
4. MEASURABLE OBJECTIVES:
5. FREQUENCY OF SERVICES:
6. SPECIFIC CRITERIA FOR TREATMENT COMPLETION:
7. DOCUMENTATION FOR TREATMENT PLAN REVIEW (INCLUDING D/O INPUT):
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Revised: 6/20/12
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Parent category: Medical