Clinical Supervision Case Presentation Format
Clinical Supervision Case Presentation Format
CLIENT NAME: _____________________________________________
ID# ______________________________
DATE:
I.
II.
AODA Tx History / Longest Clean Time / Reason for Tx:( Referred BY)
AODA (Stage of Change with supporting evidence):
III.
Diagnosis: (AODA & Mental Health):
IV.
Psychiatric History: (Treatment & Medications):
V.
VI.
Treatment plan goals (addressed in Individual sessions): Any Assignments
Medical History (Previous & Current) Any Medications taken
VII.
Progress / Issues in Tx:
VIII.
Violations/Interventions
IX.
Discharge Planning
................
................
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