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 Mental Health Treatment PlanArea of Need: Present Level: Measurable Long-Term Goal: Parents will be informed of progressQuarterly□TrimesterSemester□Other:_________How?Annotated Goals/Objectives□Other: ____________________Periodic Review Dates1. ________________2. ________________3. ________________4. ________________Progress Toward Goal1. ___________________________2. ___________________________3. ___________________________4. ___________________________Sufficient Progress to Meet Goal□ Yes □ No ___________________□ Yes □ No ___________________□ Yes □ No ___________________□ Yes □ No ___________________Benchmark/Short-Term Objective: Date:□ Achieved□ ReviewedPerson(s) Responsible: _Benchmark/Short-Term Objective: Date:□ Achieved□ ReviewedPerson(s) Responsible: _Area of Need: Present Level: Measurable Long-Term Goal: Parents will be informed of progressQuarterly□TrimesterSemester□Other:___________How?Annotated Goals/Objectives□Other: _____________________Periodic Review Dates1. ________________2. ________________3. ________________4. ________________Progress Toward Goal1. ___________________________2. ___________________________3. ___________________________4. ___________________________Sufficient Progress to Meet Goal□ Yes □ No ___________________□ Yes □ No ___________________□ Yes □ No ___________________□ Yes □ No ___________________Benchmark/Short-Term Objective: Date:□ Achieved□ ReviewedPerson(s) Responsible: _Benchmark/Short-Term Objective: Date:□ Achieved□ ReviewedPerson(s) Responsible: _______________________________________ ______________ ______________________________________ ______________Student SignatureDate Signature of ParentDate__________________________________________ ______________Signature of Mental Health Services RepresentativeDateDate: Student: Type of Service: Start Date: Duration: ................
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