2010 Individual Plan Of Care (Ipoc) / Individual Treatment Plan Template Page 4
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5Individual Plan of Care (IPOC) / Individual Treatment Plan
Client Name (Last, First, MI):
ID #:
Medicaid #:
90-Day Review
Progress / Appropriateness for Treatment / Need for Continued Treatment / Recommendation(s)
Date of Service:
Clinician Signature, Title, and Date:
IPOC 10/10 HAND-FILLED
Page 4 of 5
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