90-Day Mental Health Treatment Plan Page 2

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90-DAY MENTAL HEALTH TREATMENT PLAN
8. INFORMATION ON FAMILY/SIGNIFICANT OTHERS:
9. CONTINUED NEED FOR TREATMENT (CHECK ONE):
YES
NO
FORM SHOULD BE ATTACHED TO THE MONTHLY TREATMENT REPORT
(FORM 46) EVERY 90-DAYS
COMMENTS:
______________________________________________________________________________
______________________________________________
__________________________
Signature of Counselor
Date
Page 2 of 2
Revised: 6/20/12

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